INTRODUCTION:

“Birth and death are not two different states, But they are different aspects of the same state there is a little reason to deplore the one there is to be pleased over the other.”

Mahatma Gandhi

In every country mothers and children are constitute a major segment of the total population. Therefore a service to women during pregnancy and delivery is tremendously significant in health care delivery system (Rao K.S 2004).

Pregnancy is the major exciting period of expectation and fulfillment in a women’s life and its unique natural gift to women. The birth of a normal infant is the expectation of parent when pregnancy is considered, however there is threat to the fulfillment of the prospective parents dreams, resulting from the very dangerous disorders that contribute to unhealthy babies (Kildea.S, 2006).

Obstetric emergencies are life threatening medical conditions that occur in pregnancy or during or after delivery or labour and is the leading cause of maternal and perinatal mortality and morbidity. It comprises 46% of maternal mortality in worldwide (Park J.E, 2007). There are a number of illness and disorders of pregnancy that can threaten the well-being of both mother and child. Obstetric emergencies may occur during active labor, and after delivery. The obstetrics emergencies in pregnancies include ectopic pregnancy, placenta previa, placenta abruption, pre-eclampsia, eclampsia and premature rupture of membrane. Obstetrics emergencies during labour include amniotic fluid embolism, acute inversion of uterus, and rupture of uterus, placenta accerta, prolapsed umbilical cord and shoulder dystocia. And obstetric emergencies after delivery is post partum hemorrhage and shock (Dutta D.C 2004).

Many experts have produced encourage truth regarding causes, prevention and treatment of obstetrics emergencies. But in spite of their immense work, it shows that the unexperience nurses need more skill and knowledge to handle obstetric emergencies promptly. Maternal mortality and morbidity is also common due to mostly poor management of adverse condition. It is essential that advance practice nurses to be knowledgeable and skilled in the case of women, ensuring care and enhancing the quality of women lives. Along with assessment, diagnosis and treatment various women’s health conditions, advanced practice nurse can manage or co-manage treatment and follow up care (Dobson.K, 2002).

OBJECTIVES:

1. To assess the knowledge of staff nurses regarding obstetric emergencies.

2. To compare the knowledge of staff nurses regarding obstetrical emergencies with their selected demographic variables

METHODOLOGY:

A Descriptive design with cross sectional survey approach was selected to conduct study. The study was conducted in Vinayaka Mission’s Kirupanada Variyar Medical College Hospital, Salem. All the staff nurses working in Vinayaka Mission’s Kirupananda Variyar Medical College Hospital, Salem were the population for the study. 48 staff nurses were selected by convenient sampling technique.

Inclusion criteria:

The study was limited to the staff nurse who were -

· Completed either diploma or degree in nursing

· Working in a selected hospital, Salem.

· Present during the period of data collection.

· Willing to participate in the study.

Description of the tools

After an exhaustive review, author developed the tool, based on objectives

The tool has 2 section i.e, section-“A” and section-“B”

Section-A: consists of demographic data of the staff nurses such as age, education, professional qualification, experience, department where working, previous exposure, attended in service program in obstetric emergencies.

Section -B: It consists of multiple choice questions; each question has 4 options with One most appropriate answer. In each item the correct response carries the score “one” and wrong response carries “zero” score. The maximum score attainable is 64.

Scoring Procedure

The score was grouped in to item like very poor, poor, average, good and very good based on knowledge scores.

Level of knowledge	Percentage
Very poor	below 21%
Poor	21-40%
Average	41-60%
Good	61-80%
Excellent	above 80%

Validity and Reliability

The content validity of the tool was established in consultation with the research guide and experts from various fields such as Obstetrics and Gynecology, Social and preventive medicine, statistics, nursing and language experts.

Test -retest method where co-efficient correlation was tested to find out the reliability of the closed ended questionnaire (r=.88) and it was found reliable.

Data Collection Procedure:

(i) Ethical Consideration

Permission was obtained from medical director of Vinayaka mission’s Kirupanada Variyar Medical College Hospital. Prior to establish questionnaire, consent was obtained from respondent and self introduction was given to the staff nurse.

Planned for Data Analyses: Descriptive and inferential statistics was used for analysis.

Findings

Fig -1: percent wise distribution of staff nurses according to their education qualification.

Fig -2: percent wise distribution of staff nurses according to their age.

Fig-3: percent wise distribution of staff nurses according to their years of experience

Description of demographic variable

From Figure no 1, 2 and 3, it reveals that highest percentage (71%) of the staff nurses were in the age group of <25 years, Almost all (98%) were diploma holders, Most (86%) of them had below 5 years of experience, Around 50% had 1-2 years of experience in labour ward.

Table -1: overall and Area wise and assessment of knowledge of staff nurses regarding obstetric emergency

Area	Max score	Knowledge Score
Area	Max score	Mean	SD	Mean%
Introduction	2	1.39	0.63	50.5
Ectopic pregnancy	8	5.29	1.25	42.12
Pre-eclampsia and eclampsia	13	7.58	1.85	40.33
Antepartum hemorrhage	4	2.62	0.87	43.5
Placenta praevia	7	4.41	1.16	43
Abruptio placenta	4	2.47	2.14	40.97
Cord prolapsed	5	3.12	0.99	40.5
Premature rupture of membrane	4	2.6	0.85	45.1
Rupture of uterus	4	2.62	0.9	39.3
Inversion of uterus	6	3.5	1.11	58.33
Shoulder dystocia	3	1.85	0.84	40.6
Post partum hemorrhage	4	2.60	0.72	40.2
Overall	48	40.1	7.3	42.66

Table -1 : Depicts that Area wise distribution of mean, SD, and mean percentage of knowledge scores shows that highest mean score (3.12 ± 0.99) was for the area ‘inversion of uterus’ which is 58.33% of the maximum score. Whereas the lowest score was (2.62± 0.9) was for the area “rupture of uterus”. The overall mean, SD and mean percentage of knowledge scores of staff nurses regarding obstetric emergencies shows that the mean score (40.1 ± 7.3) which is 42.66% of maximum score revealing average knowledge of staff nurses regarding obstetric emergencies.

Comparison of knowledge score with demographic variable

Table:2: comparison knowledge score of staff nurses with their selected demographic variable

Age in years	Number of staff members	Knowledge scores
Age in years	Number of staff members	Mean	SD	Mean %
<25 years	34	40.35	7.07	43.05
25-30 years	9	37.22	7.87	48.15
31-35 years	1	46	0	41.87
>35 years	4	41.75	8.18	35.23
Working experience	Number of staff nurses	Knowledge score
Working experience	Number of staff nurses	mean	SD	Mean %
< 5 yrs	41	39.95	6.99	42.42%
5-10 yrs	2	37	1.2	47.81%
11-15yrs	1	45	0	40.31%
>15 yrs	4	41.75	8.18	35.23%
Education qualification	Number of nurses	Knowledge score
Education qualification	Number of nurses	Mean	SD	Mean %
GNM	47	40	7.37	42.5
B.SC (n)	1	40.1	2.1	52
Working experience	Number of staff nurses	Knowledge score
Working experience	Number of staff nurses	mean	SD	Mean %
< 5 yrs	41	39.95	6.99	42.42%
5-10 yrs	2	37	12	57.81%
11-15yrs	1	45	0	40.31%
>15 yrs	4	41.75	8.18	55.23%
Experience in Labour ward	Number of staff nurses	Knowledge score
Experience in Labour ward	Number of staff nurses	Mean	SD	Mean %
No experience	21	37	7.2	37.81
1-2 years experience	23	46.5	9.89	37.65
3-5 years	2	38.8	10.27	40.6
> 5 years	2	41	7.44	44.06
Over all	48	40.1	7.3	42.66

Table no -2 shows that highest mean score (37.2±7.87) which is 48.15% of the maximum score was obtained by staff nurses in the age group of 25-30 years revealing average knowledge. However mean, SD and mean percentage of knowledge score of staff nurses in relation to their qualification reveals that highest mean score (40.1±2.1) which is 52% of the total score was obtained by the staff nurses who had completed B.Sc nursing and Highest mean score (37±0) which is 70.31% of total score was obtained by staff nurses who had 11-15 years of experience and the mean score (37 ±1.2) which is about 47.81% of the total score was obtained by staff nurses who had 5-10 years of working experience . Highest mean score (41±7.44) which is 44.06% of the total score was obtained by staff nurses who had more than 5 years of experience in labor ward. Hence, it can be interpreted that there was no definite level of knowledge when compared to their selected demographic variable.

Testing the hypotheses

Table: 3- Association between knowledge score of the staff nurses with their selected demographic variables

SL/ NO	Demographic variables	Df	c² values	Level of significance
1.	Age	1	0.24	Not significant
2.	Educational qualification	1	0.61	Not significant
3.	Years of experience	1	0.01	Not significant
4.	Field of experience	1	0.01	Not significant

(P < 0.05 – Significant) (Table value = 3.84)

Table no -3 reveals that No significant association was found between knowledge scores when compared to age, educational qualification, years of experience, labour ward experience of staff nurses. It can be interpreted that the difference in mean score related to these demographic variables were only by chance and not the true difference. Thus the research hypothesis is rejected. Hence it seems that none of the demographic variable of the staff nurses affects the level of knowledge of the staff nurses.

IMPLICATION:

Nursing Service

· The findings of the study will help the nursing professional working in the hospitals to gain the knowledge of staff nurses and help in which they lack knowledge can be conducted for teaching.

· It can be utilized for assess the knowledge of the periphery level nurses on obstetric emergencies.

Nursing Education:-

· The nurse educator can use the tool to teach the student about obstetric emergencies.

· A module can be prepared based on present findings for improve the knowledge of the staff nurses on obstetric emergencies.

· The findings will help the nursing student to understand about the importance of management of obstetric emergencies and improve their knowledge obstetric emergencies.

Nursing Research

The findings of the study can be utilized for conducting research using large sample.

RECOMMENDATIONS:

Based on the findings of the study the following recommended have been made for further study.

· Similar study can be undertaken among large samples so that results can be generalized.

· A study can be done to evaluate the effectiveness of planned teaching program on obstetric emergencies.

· An experimental study can be carried out by preparing CD on obstetric emergencies.

CONCLUSION:

The study finding suggests that the staff nurses knowledge on management of obstetric emergency is essential to safeguard the patient in emergency condition.

REFERENCES

1) Rao K.S; An introduction to community Health Nursing”, 4^th edition, 2007.B.I publisher; Chennai.

2) Park K. Text book of Preventive and Social Medicine.19^th Edition,2007, Banarsidas Bhanot Publishers: Jabalpur

3) Kildea S, Kruske S, Bowell L. Maternity Emergency Care: Short course in maternity Emergencies for remote area health staff with no midwifery qualification. Aust. J. Rural Health. 2006 Jun; 14(3): 111-5..

4) DC Dutta, Textbook of obstetrics 6^th_EdCalcutta (India): new central book agency (P) Ltd; 2004: p-599.

5) Saizonou J, Godin I, Quendo EM, Zerbo R, Dujardin B. “Emergency obstetrical care in Benin referral hospitals: “Near-Miss” Patient’s views”. 2006May; 11(5): 672-82.

6) Johanson RB, Menon V, Burns E, Kargaramanya E, Osipov V, Israelyan M, Sargsan, K. Dobson S, Jones P. Managing Obstetrical Emergencies and Trauma (MOET) structured skill training in Armenia, Utilizing models and reality based scenarios. BMC Med Educ. 2002 May 20;2:5.

Received on 19.08.2014 Modified on 24.09.2014

Int. J. Nur. Edu. and Research 3(1): Jan.-March, 2015; Page 09-12

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