“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING SELECTED OBSTETRIC

EMERGENCIES AND THEIR MANAGEMENT AMONG JUNIOR
HEALTH ASSISTANT FEMALE STUDENTS IN
SELECTED JUNIOR HEALTH ASSISTANT
FEMALE TRAINING CENTRE OF
RAICHUR, KARNATAKA.”

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

SNEHA MATHEW

NAVODAYA COLLEGE OF NURSING

RAICHUR, NOVEMBER - 2008
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate : Mrs. Sneha Mathew

M.Sc. Nursing, 1st Year
Navodaya College of Nursing
Navodaya Nagar
Manthralayam Road, Raichur

2. Name of the Institute : Navodaya College of Nursing

3. Course of Study and Subject : M.Sc. Nursing, 1st Year

Obstetrics and Gynaecological Nursing

4. Date of Admission : 13-06-2008

5. Title of the Topic :

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING SELECTED OBSTETRIC
EMERGENCIES AND THEIR MANAGEMENT AMONG JUNIOR
HEALTH ASSISTANT FEMALE STUDENTS IN
SELECTED JUNIOR HEALTH ASSISTANT
FEMALE TRAINING CENTRE OF
RAICHUR, KARNATAKA.”
6. BRIEF RESUME OF THE INTENDED WORK

6.1. NEED FOR THE STUDY

“A mother’s joy begins when a new life is stirring

inside…. When a tiny heart beat is heard from
the very first time and a playful kick reminds
her that she is never alone”

Pregnancy is a unique, exciting and often joyous time in a woman’s

life, as it highlights the woman’s amazing creative and nurturing powers
while providing a bridge to the future. Pregnancy comes with some cost,
however, a pregnant woman also needs to be a responsible woman so as to
best support the health of her future child.¹

Pregnancy begins when an egg is fertilized by a sperm, and it

continues for a period of nine months and ends when a baby is born. From
the beginning of the pregnancy to the next 36 weeks the mother will be on a
truly exciting journey as she actively take part in the miracle of creating a
new life.

Pregnancy can be the best of times and pregnancy can be the worst of
times. Being a joyous time pregnancy can also be a time of uncertainty and
worry.² The pit fall of pregnancies can be malpresentation, haemorrhages,
emergency situations like cord prolapse, cord presentation, uterine rupture,
shoulder dystocia, amniotic fluid embolism etc. These pitfalls of pregnancies
can threaten the well being of both mother and child.
Obstetrical emergencies are life threatening conditions that occur in
pregnancy during labour and after delivery. It is common that approximately
15% of all pregnant women develop serious complication from conception
to delivery. Among all the emergency situations which may arise across the
field of obstetrics, there are small numbers which call urgent practical steps
to be taken in order to safeguard the life of the mother or the baby or both.³

Most life threatening obstetric complications require hospital

treatment to avert maternal mortality. Some assume that in developing
countries, hospital services for the poor must be in government hospitals and
health centers and a large proportion of deliveries need to be in these
hospitals to provide timely access to emergency care. This presents a major
problem in countries like India where almost all deliveries occur at home,
government hospitals and health centers, generally where care lacks in
emergency situations.

‘Complications related to pregnancy and child birth are among one of

the leading causes of mortality and morbidity of women of reproductive age.
Most of these deaths, health problems and injuries are preventable through
improved access to adequate health care services including emergency
obstetric care.’
-United nations 4th world conference of women

The present study includes the obstetric emergencies like cord

prolapse, uterine rupture and amniotic fluid embolism.
 Umbilical cord prolapse occurs when the baby’s umbilical cord falls
into the birth canal. A prolapsed cord is a serious emergency situation and it
can be very harmful to the baby.³

Statistical information shows that the incidences of cord prolapse in

India is 3/10,000 deliveries and fetal mortality is high i.e. 82% in such
conditions. Therefore it is should and must that effective assessment of the
knowledge of the health care professionals’ regarding obstetric emergencies
has to be done and they should be aware regarding how to tackle such
emergency situation in obstetrics.

Advances in the knowledge of the forthcoming health assistants and

staff nurses regarding the management of umbilical cord prolapse, hold
promise for reducing maternal and fetal morbidity and mortality.⁶
The most dangerous and untreatable emergency situation in obstetrics
is amniotic fluid embolism. It is a rare condition and occurs when the uterus
contracts strongly. When the uterus is contracting strongly, there will be an
opening between the amniotic sac and the uterine vein, a bolus of the
amniotic fluid is pumped into the circulatory system of mother.

Statistical evidences show that the incidence of clinically detectable

amniotic fluid embolism is low and is estimated to be 1 in 20,000 to 80,000
live births. Maternal mortality rate is high as 86% and neonatal survival is
reported as 70%. In India from the year 1970 – 2000 amniotic fluid
embolism contributed to 8.2% of maternal mortality.
 Even though amniotic fluid embolism is a disastrous and untreatable
condition, sometimes it is managed with success.

A severe case of amniotic fluid embolism has managed successfully in

Alexandra General Hospital, Athens in the year 2006. A healthy 29 year old
primigravida mother developed amniotic fluid embolism during labour. The
patient underwent an urgent caesarian section and a total hysterectomy was
performed to save the life of the patient.

The patient in the reported case was under normal labour process and
she developed sudden dysponea and production of frothy sputum. The
symptoms was first noticed by the nurse midwife and reported immediately.
The outlines of management for amniotic fluid embolism by the nurse
practitioner saved the life of the mother.

Training the health assistants and the staff nurses in the management
of obstetric emergency like amniotic fluid embolism will enhance the
reduction of maternal and fetal mortality.

Uterine rupture is uncommon but potentially fatal to both mother and

baby. Uterine rupture results when there is a weak spot in the uterus such as
scar or when the uterine wall is thinned by multiple pregnancy.³

The incidence of uterine rupture is 0.05% of all pregnancies,

occurring between 1 in 140 to 1 in 300 of women with pre existing scar. It is
a common obstetric event and care and management by nursing personnel is
important because it continuous to be associated with maternal mortality
rate, maternal morbidity and peripartum hysterectomy. It is associated with
high incidence of perinatal mortality that is ten times that of maternal
mortality.⁹

Statistical information shows that there was reduction in occurrence of

uterine rupture in Central India. The incidence of uterine rupture between
1983 and 1988 was 1.45 per 1000 births and 1989 to 2000 it was .62 per
1000 births.¹º

To reduce the incidence of uterine rupture still more, the health

assistants, the nurses, general practitioners and paramedics should gain
adequate knowledge and training in the management of uterine rupture.⁹

The management of emergencies is usually the responsibility of

hospital obstetricians. As more maternity care is now given in the
community, however, health assistants, general practitioners and paramedics
may be involved and must know the outlines of management of obstetric
emergencies and the possible side effects.

When obstetric emergencies occur, effective and efficient care by the

health care professionals is essential for good outcome and safety. As a care
giver the junior health assistant females play an important role in managing
obstetric emergencies. So to give effective and efficient care the knowledge
of the junior health assistant females regarding obstetric emergencies should
be improved. Employing teaching programme regarding obstetric
emergencies can facilitate the knowledge of the junior health assistant
females. The teaching strategy helps the junior health assistant females to
develop decision making and working skills when dealing with an obstetric
emergency.¹¹

Hence the researcher felt the need to assess the effectiveness of

structured teaching programme on knowledge regarding selected obstetric
emergencies and their management among junior health assistant female
students in selected junior health assistant female training centre of Raichur.

6.2 REVIEW OF LITERATURE

A review of literature on the research topic makes the researcher

familiar with the existing studies and provides information which helps to
focus on a particular problem, lays a foundation upon which to base new
knowledge. It creates accurate picture of the information found on the
subjects.¹²

A study was conducted to assess the knowledge of health care

practitioners regarding village based care in obstetric emergencies in West
Java. The study consists of 100 samples and data were collected by using
check list. The findings showed that only 48% 0f health care practitioners
had adequate knowledge regarding community based care in managing
obstetric emergencies. The study concluded that health care practitioners
should receive appropriate support for the management of obstetric
emergencies.¹³

A study was conducted to assess the effectiveness of obstetric

emergency training programme on knowledge regarding obstetric
emergencies among medical graduates in Bristol Medical Simulation Centre,
England. One hundred and forty samples have selected by non-random
method for the study. Data were collected by using questionnaire. The result
of the study showed significant difference between pre-test and post-test.
Post-test score was (23.1) more while comparing to pre-test score (18.1) and
P < 0.001.¹

A study to evaluate the risk factors, management, maternal and

perinatal outcome of uterine rupture was conducted in Department of
Obstetrics and Gynaecology, JIPMER, Pondycherry between January 1995
and December 2004. A Two fifty three case of uterine rupture was managed
between the 10 years. The result showed that 128 cases (50.8%) of uterine
rupture occurred in a scared uterus and 125 (49.40%) occurred in unscarred
uterus. The predisposing factors include cephalo pelvic disproportion in 69
cases (27.25%), malpresentation in 20 (7.90%), labour induction in 14 cases
(11.64%) and multiparity in 20 cases (7.90%). Repair of uterus was done in
147 cases (58.33%) and hysterectomy in 105 cases (41.51%). The study
concluded that there were 7 maternal deaths (2.76%) and perinatal mortality
was 94.07%.¹

A study was conducted to assess the effectiveness of simulation based

training programme among midwives and obstetric doctors in Israeli Center
for Medical Simulation, United Kingdom. One hundred and sixty five
samples have selected by random method. Among the samples 77 were
obstetric doctors and 88 were midwives. Questionnaire responses showed
that post-test score (79.4 ± 4.3) were more than pre-test score (70 ± 5.3).
The study concluded that employing high fidelity simulations of obstetric
emergencies has great teaching and learning potential and simulation can
provide a learning experience that facilitates knowledge application to

midwifery practise.¹⁶

A systematic review of training in obstetric emergencies to describe

models used for the training of labour ward personnel in obstetric
emergencies was conducted in John Rad Cliffe Hospital, Oxford, United
Kingdom. The sample consists of 100 labour ward personnel who were
selected randomly. A data collection form was used to extract relevant
information. The result showed that out of 32 relevant papers, 22 were
editorials, 6 were descriptions of training programme and 4 papers involved
an evaluation of such programme. The study concluded that only few
training programme had been described to train the nurses in obstetric
emergencies and few more training method need to be developed.¹

A population based study to assess the pregnancy outcomes associated

with amniotic fluid embolism was conducted in California between January
2001 to December 2002. The study covered all singleton deliveries occurred
in 328 hospitals in California and the data were obtained from a
computerized data base. The result showed that among 1,094,248 deliveries,
53 singleton gestations had the diagnosis of amniotic fluid embolism and
maternal mortality rate is 26.4%. The study concluded that the maternal
mortality rate is less than the previous reports.¹
STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme

on knowledge regarding selected obstetric emergencies and their

management among junior health assistant female students in selected
junior health assistant female training centre of Raichur, Karnataka.”

6.3 OBJECTIVES OF THE STUDY

To assess the existing level of knowledge of junior health assistant female
students regarding selected obstetric emergencies and their management.

To implement structured teaching programme on selected obstetric

emergencies and their management.

To analyse the effectiveness of structured teaching programme on selected

obstetric emergencies and their management.

To identify the relationship between the knowledge of junior health

assistant female students regarding selected obstetric emergencies and their
management with selected variables.

6.4 OPERATIONAL DEFINITIONS

a. Effectiveness :
It refers to the extent to which the structured teaching programme
improves the knowledge of junior health assistant female students
regarding selected obstetric emergencies and its management.
b. Structured teaching programme :
 It refers to the type of teaching programme on selected obstetric
emergencies and their management prepared by the Investigator to
enhance the awareness of junior health assistant female students.

c. Knowledge :
Refers to the level of understanding of the junior health assistant
female students with regard to selected obstetric emergencies and their
management as measured by their correct response to knowledge items of
the questionnaire.

d. Obstetric emergencies :
Refers to severe life threatening condition that related to pregnancy or
delivery which requires urgent medical intervention.¹¹
In present study the obstetric emergencies included are
cord prolapse, uterine rupture and amniotic fluid embolism.

e. Management :
Refers to health care activities which will be practised by the junior
health assistant female students in treating the emergency situations in
obstetrics.
f. Junior health assistant female :
Refers to the students who are studying in junior health assistant
female training centre, Lalbahaddur Shastri Nagar, Raichur.
6.5 HYPOTHESES

On the basis of the objectives of the study the following hypotheses

have been formulated.

H : There will be significant difference between the pre-test and post-test

knowledge scores of junior health assistant female students with regard
to obstetric emergencies and their management.

H₂ : There will be significant relationship between the knowledge scores of

junior health assistant female students on selected obstetric emergencies
and their management with selected variables.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

Design :
One group pre-test and post-test pre-experimental design is adopted
for the present study.
O1 X O2

Setting of the study :

The present study will be conducted in a junior health assistant female
training centre. The junior health assistant female training centre of Raichur
has been selected purposively for the present study, which is functioning
under Government of Karnataka
 The junior health assistant female training centre of Raichur was
established in 1963. It is situated in Raichur Institute of Medical Sciences
compound, Lalbahaddur Shastri Nagar of Raichur. The present batch
consists of 30 students and each batch is circulated for every 18 months.

Population :
The population included in this study are the students who are
studying in junior health assistant female training centre of Raichur.

Sample :
Sample for the study consists of 30 junior health assistant female
students who are studying in junior health assistant female training centre of
Raichur.

Sampling Technique :
Non- random purposive sampling technique will be used to select
junior health assistant female training centre and complete enumeration
method will be used to select the sample.

Inclusion Criteria :
The study includes junior health assistant female students who are
 studying in junior health assistant female training centre, Raichur
 willing to participate in the study
 available at the time of data collection

Exclusion Criteria :
 The study excludes junior health assistant female students
who are not
 studying in junior health assistant female training centre, Raichur
 willing to participate in the study
 available at the time of data collection

Selected Variables :
Variables includes in the present study are

 Dependant Variable :
Knowledge of junior health assistant female students regarding
selected obstetric emergencies and their management.

 Independent Variable :
Structured teaching programme regarding selected obstetric
emergencies and their management.

 Extraneous Variables :
(a) Age :
Refers to the chronological age of the junior health assistant students.
For the present study age was categorized as
15 – 19 years
20 – 24 years
25 – 29 years
Above 30 years
(b) Basic Educational Qualification :
It refers to the previous education of the junior health assistant female
students. It categorized as:
S.S.L.C
P.U.C

(c) Religion :
Refers to the system of faith of worship, the junior health assistant
female students follows. For the present study the religion is categorized as :
Hindu
Muslim
Christian

(d) Exposure during clinical postings :

Refers to whether the student had any opportunity to witness or to
assist any case of obstetric emergencies during their clinical postings.
Yes
No

(e) Sources of Information :

Refers to the information which can shed light on the knowledge of
junior health assistant female students.
Journals
Television
News paper
Relatives
Friends
7.2 METHODS OF DATA COLLECTION

Data Collection Instrument :

Data collection will be done through structured self-administered
questionnaire. It consists of two parts :

Part 1 – Deals with sample characteristics

Part2– Represents knowledge related items regarding selected obstetric
emergencies and their management.

Data Collection Method :

After obtaining prior permission from concerned authorities and

consent from the samples, the Investigator will assess the knowledge of
junior health assistant female students regarding selected obstetric
emergencies and their management by using structured self-administered
questionnaire.

Data collection will be carried out in 3 phases :

First phase : Pre-test will be given to assess the initial knowledge of junior
health assistant female students regarding selected obstetric emergencies and
their management.
Second phase : A structured teaching programme on selected obstetric
emergencies and their management will be conducted to junior health
assistant female students
Third phase : Post-test will be conducted for the junior health assistant
female students after a week after structured teaching programme.
Plan for Data Analysis :

Data analysis is the systematic organization and synthesis of research

data, the testing of the research hypotheses by using the obtained data. The
following methods are planned to analyse the data.
 Descriptive statistics like percentages and frequencies will be used to
describe sample characteristics.
 Mean, standard deviation and paired ‘t’ test will be used to assess the
effectiveness of structured teaching programme.
 Chi-square test will be used to find out the relationship between the
knowledge and selected variables.

7.3 PROJECTED OUTCOME

The result of the present study gives an insight for the future
researchers to inculcate different methods or types of teaching programme in
order to improve the knowledge of junior health assistant female students
regarding obstetric emergencies and their management.

7.4 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR
OTHER HUMAN OR ANIMALS? IF SO, PLEASE DESCRIBE
BRIEFLY.
Yes, the study requires intervention like enactment of structured
teaching programme and active involvement of junior health assistant female
students during session.
7.5 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.4 ?
 Permission will be obtained from Institutional Ethical Committee,
Navodaya College of Nursing, Raichur.
 Permission will be obtained from the Principal of the junior health
assistant female training centre, Lalbahaddur Shastri Nagar, Raichur.
 Consent will be obtained from all participants.
8. LIST OF REFERENCES

1. Pregnancy. WIKIPEDIA, the free Encyclopedia.

2. Week by Week Pregnancy Guide. www.indiaparenting.com

3. Nadel E, Talbotstern J. Obstetric and Gynaecologic Emergencies. Emerg

Med Clin North America ; 1997.

4. Prem Kumar R, Arole S. Efficient and effective emergency obstetric care

in rural India. International Journal of Obstetrics and Gynaecology; 2001.

5. Katz Z, Zalel. Management of labour with Umblical Cord Prolapse,

Obstetric and Gynaecology ; 2001.

6. Griese M E, Prickett S. Nursing Management of Umblical Cord Prolapse.

Journal of Obstetric and Gynaecology and Neonatal Nursing ; 1998.

7. Perozzi K J, Englert N C. Amniotic Fluid Embolism – An Obstetric

Emergency. Crit Care Nurse : 2004.

8. Peitsidou A, Samanta E. Amniotic Fluid Embolism managed with success

during labour : A report of severe clinial case and review of literature.
Arch. Gynecol Obstet ; 2008.

9. Dare F O, Oboro V O, A 15 year analysis of uterine rupture. Int J

Gynaecol Obstet ; 2002.

10.Chhabra S, Bhagwat N, Chakravorthy A. Reduction in the occurance of

uterine rupture in Central India. J Obstet Gynaecol ; 2002.
11.Baskett T. Essential management of Obstetric Emergencies, Wiley and
Sons United Kingdom ; 1991.

12.Denise F Polit, Nursing Research Priniciples and Methods, Philadelphia,

Lippincott, 7th edition ; 2004.

13.Neil A M, Study to assess the knowledge of health care practitioners

regarding village based care in Obstetric Emergencies, Journal of
Obstetric and Gynaecology ; 1999.

14.Crofts J F, Ellis D, Draycott T J, Changing knowledge of midwives

following Obstetric Emergency Training, British Journal of Obstetric and
Gynaecology ; 2007.

15.Sahu Latika, A 10 year analysis of uterine rupture at a teaching

Institution. Med Ind. nic ; 2005.

16.Sharon Maslovit, Gad Barkai, Recurrent Obstetric Management-

Mistakes identified by simulation. Obstetric and Gynaecology Green
Journal ; 2007.

17.Black R S, Brocklehurst P, A systematic review of training in acute

Obstetric Emergencies, British Journal of Obstetric and Gynaecology ;
2004.

18.Gilbert W M, Danielsen B, amniotic fluid embolism : decerased mortality

in a population based study, Obstet Gynaecol ; 2004
9. Signature of the candidate :

10. Remarks of the Guide :

11. Name and Designation of :

11.1 Guide : Mrs. Sreelekha C

M.Sc. (N)
Associate Professor
Department of Obstetrics
and Gynaecological Nursing
11.2 Signature :

11.3 Co-Guide :

11.4 Signature :

11.5 Head of the Department : Mrs. Sreelekha C

M.Sc. (N)
Associate Professor
Department of Obstetrics
and Gynaecological Nursing

11.6 Signature :

12. Remarks of Chairman and Principal :

12.1 Signature :