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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 356-359

Effect of live demonstration on practices of auxiliary nurse midwives identification and management of high-risk mothers for secondary postpartum hemorrhage during the postnatal period


Department of Community, Bharati Vidyapeeth College of Nursing, Pune, Maharashtra, India

Date of Submission15-Sep-2018
Date of Decision22-Oct-2019
Date of Acceptance10-Nov-2019
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Jasneet Kaur
Plot No A 206, Sunwind Society, Near Toyota Showroom, Bavdhan, Pune - 411 021, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_115_19

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  Abstract 


Background: An estimated 289,000 women die each year from complications in pregnancy or childbirth with over half of these deaths occurring in sub-Saharan Africa. Millennium Development Goal 5, to improve maternal health, includes a target to reduce the maternal mortality ratio by three quarters by 2017. The identification and initial management of high-risk mother during the postnatal period totally depend on the knowledge and practices of these ground-level workers; otherwise, they will remain unnotified and unreported. Objective: The main objective of the study was to determine the effect of demonstration on practices of auxiliary nurse midwives (ANMs) identification and management of high-risk mothers for secondary postpartum hemorrhage (PPH) during the postnatal period. Materials and Methods: Quasi-experimental design was adopted to implement live demonstration on 40 ANMs. The sample was selected by convenience sampling technique. Checklist was used to assess the practices of ANM identification and management of high-risk mothers for secondary PPH during the postnatal period. Results: Average practices score in pretest was 73 which increased to 138.8 in posttest. T-value for this test was 36.7 with 13° of freedom. Corresponding P value was small (<0.05), null hypothesis is rejected. It is evident that the live demonstration is significantly effective in improving the practices of ANMs regarding the identification and management of high-risk mothers during the postnatal period for PPH in the experimental group. Conclusion: It is evident that the live demonstration is significantly effective in improving the practices of ANMs regarding the identification and management of high-risk mothers during the postnatal period for PPH in the experimental group.

Keywords: High-risk mothers, live demonstration, postnatal period, secondary postpartum hemorrhage


How to cite this article:
Kaur J, Ray S. Effect of live demonstration on practices of auxiliary nurse midwives identification and management of high-risk mothers for secondary postpartum hemorrhage during the postnatal period. J Datta Meghe Inst Med Sci Univ 2019;14:356-9

How to cite this URL:
Kaur J, Ray S. Effect of live demonstration on practices of auxiliary nurse midwives identification and management of high-risk mothers for secondary postpartum hemorrhage during the postnatal period. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Aug 13];14:356-9. Available from: http://www.journaldmims.com/text.asp?2019/14/4/356/289886




  Introduction Top


An estimated 289,000 women die each year from complications in pregnancy or childbirth with over half of these deaths occurring in sub-Saharan Africa. Millennium Development Goal 5, to improve maternal health, includes a target to reduce the maternal mortality ratio (MMR) by three quarters by 2017.[1]

MMR of nation has decreased from 167 to 130 that showed there is overall 22% reduction. There are lot of measures and strategies adopted by the government to reduce maternal mortality rate. Web tracking system, compulsory antenatal visits, name-based tracking of pregnant women, and children have been initiated by the Government of India as a policy decision to track every pregnant woman, infant, by name for provision of timely antenatal care, institutional delivery are available and made compulsory.[2] The active measures are definitely supporting the reduction in maternal mortality rate but no special measures are available for the postnatal period except the postnatal visits by nursing health task force.

The identification and initial management of high-risk mother during the postnatal period totally depend on the knowledge and practices of these ground-level workers; otherwise, they will remain unnotified and unreported.

Purpose of the study

India has recorded a decline in maternal mortality rates between 1990 and 2013; but, along with Nigeria, it accounted for one-third of the global maternal deaths.[3] Maternal mortality is a huge public health issue where the causes range from excessive blood loss (postpartum hemorrhage [PPH]) to infections.

Nearly five women die every hour in India, and nearly 45,000 mothers die due to causes related to postpartum and postnatal period every year in India which accounts for 17% of such deaths globally.[4]

Maharashtra is the third state with 61 MMR after Kerala and Tamil Nadu. The reason is as follows:

  • Ninety-six percent deliveries were institutional. Good track of antenatal and intranatal services but less strategic system during the postnatal period
  • According to National Family Health Survey (NFHS)-3, nearly 50% (48%) of women aged 15–49 years are anemic and had postnatal complications[5]
  • NFHS-4 (2016–16) reported a small (9%) reduction in anemia among pregnant women but a rare reduction in postnatal complications[5]
  • According to District Level Household and Facility Survey-3 International Institute for Population Sciences: 2014, the top ten districts with highest percentage of pregnancy and postnatal complications were Akola, Buldhana, Dhule, Bhandara, Jalgoan, Ahmadngar, Washim, Nashik, Aurangabad, and Nagpur. Delivery complications were most prevalent in the districts of Ahmadnagar, Buldhana, Pune, Washim, Solapur, Nanded, Amarawati, Jalna, Parbhani, and Bhandara[5]
  • In Pune, almost 50% of maternal deaths go unreported; as much as 61% of maternal death is due to PPH[5]
  • District health department has projected the need for the same to test the strategy of inculcation of practices among these health taskforce to hit the target area of maternal mortality rate
  • Being a Community Health Nurse, it is aimed to enhance the service practice of nursing professional by inculcating a new component of practices base training to these ground-level workers.


Objectives

  • To assess the pretest practices of auxiliary nurse midwives (ANMs) on identification and management of high-risk mothers during the postnatal period for PPH in both experimental and control group before live demonstration
  • To assess the posttest practices of ANMs on identification and management of high-risk mothers during the postnatal period for PPH in both experimental and control group
  • To determine the effectiveness of live demonstration on practices of ANMs on identification and management of high-risk mothers during the postnatal period for PPH in the experimental group
  • To determine the association between practices of ANMs with selected demographic variable.



  Materials and Methods Top


Design

The research design selected for the study was quasi-experimental - nonequivalent control group design.

Setting

Setting of the research study was selected areas of Pune district.

Target population

Target population for the present research is ANM working in rural area under Zila Parishad, Pune.

Tool

A checklist was developed to observe practices of ANMs on identification and management of high-risk mothers during the postnatal period for PPH.

Procedure for data collection

  • Approval from Ethics Committee was obtained
  • Organizational permission from district health office Pune District was accorded
  • The administration approval was taken to club the ANM, at one center for feasibility of the training
  • Informed consent was taken from participants
  • The data were collected in the form of checklist developed to assess the practices
  • There were two groups: experimental and control group. The live demonstration was given to the experimental group
  • The posttest will be taken after the gap of 2 weeks.


Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of Bharati Vidyapeeth College of Nursing, Pune, on 12th Mar 2019. With ethical clearance no BV/EC/2019-20/111.


  Results Top


  1. Section I: Demographic characteristics calculated by percentage where maximum ANM were in the age group of more than 41 years


  2. Maximum of them (85.7%) were working in subcenters and were residential nurses. Maximum (71.4%) were having experience more than 10 years

  3. Section II: Analysis of data related to the pretest practices of ANMs on identification and management of high-risk mothers during the postnatal period for PPH in both experimental and control group [Figure 1]
  4. Figure 1: Pretest practices of auxiliary nurse midwives on the identification and management of high-risk mothers during the postnatal period for postpartum hemorrhage in both experimental and control group

    Click here to view


    In pretest, in the experimental group, 85.7% of the ANMs had poor practices (score 38–76) and 14.3% of them had average practices (score 77–115) regarding identification and management of high-risk mothers during the postnatal period. In control group, 71.4% of the ANMs had poor practices (score 38–76) and 28.6% of them had average practices (score 77–115) regarding identification and management of high-risk mothers during the postnatal period

  5. Section III: Posttest practices of ANMs on identification and management of high-risk mothers during the postnatal period for PPH in both experimental and control group[Figure 2]
  6. Figure 2: Posttest Practices of auxiliary nurse midwives on the identification and management of high-risk mothers during the postnatal period for postpartum hemorrhage in both experimental and control group

    Click here to view


    In posttest, in experimental group, all of the ANMs had good practices (score 116–152) regarding the identification and management of high-risk mothers during postnatal period. In control group, 42.9% of the ANMs force had poor practices (score 38–76) and 57.1% of them had average practices (score 77–115) regarding identification and management of high-risk mothers during the postnatal period

  7. Section IV: Effectiveness of live demonstration on practices of ANMs on identification and management of high-risk mothers during the postnatal period for PPH in the experimental group[Table 1]
  8. Table 1: Effectiveness of live demonstration on practices of auxiliary nurse midwives

    Click here to view


    Average practices score in pretest was 73 which increased to 138.8 in posttest. T-value for this test was 36.7 with 13° of freedom. Corresponding P value was small (<0.05); null hypothesis is rejected. It is evident that the live demonstration is significantly effective in improving the practices of ANMs regarding the identification and management of high-risk mothers during the postnatal period for PPH in the experimental group

  9. Section V: Association of practices of ANMs with selected demographic variable


None of the demographic variables was found to have a significant association with the practices of ANMs regarding the identification and management of high-risk mothers during the postnatal period for PPH.


  Discussion Top


PPH is one of the leading causes of maternal morbidity and mortality. The majority of these deaths occur within hours of delivery due to complications during the third stage of labor. The main aim of the study of the study was to determine the effect of demonstration on practices of auxiliary nurse midwives (ANMs) identification and management The present work emphasized on the live demonstration on identification and management of high-risk mothers during the postnatal period for PPH. Specifically, it has been examined whether this technique really effective in improving the practices or not. Concerning effect of live demonstration on skills of ANMs, the present study findings illustrated that there was significantly improvement of nurses' practices post intervention compared to pre intervention. The findings indicated that live demonstration is having a positive effect in improving the practices regarding the identification and management of high-risk mothers during the postnatal period for PPH. These finding was in same line with Sandeep etal, where they reported that the level of nurses' performance regarding their role in active management of maternal period was unsatisfactory before attending training. While post training there was a significant improvement. Similarily Ameh C etal confirms that simulation-based training consider as an effective educational strategy that to manage obstetric emergencies on live patients in working environment which can further help in improvement of knowledge, skills as well as increase itself-confidence also to recognize and avoid pitfalls in managing such emergencies in real life scenario.


  Conclusion Top


Based on the findings of the current study; the study concluded that findings supported that live demonstration strategy had a highly significant effect on improvement performance and practices of ANMs regarding management of secondary postpartum hemorrhage. Also, it is confirmed that demographic variables have no association with the practices.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. World Health Statistics. WHO, Geneva, Switzerland: 2014. Retrieved on 10th April 2015 Available from: http://www.who.int/gho/publications/world_health_statistics/2014/en/. [Last accessed on 2019 Aug 28].  Back to cited text no. 1
    
2.
World Health Organization. Maternal death surveillance and Response: Technical guidance. Information for Action to Prevent Maternal Death. Geneva, Switzerland: WHO; 2013b. Available from: http://www.who.int/maternal_child_adolescent/documents/maternal_deathsurveillance/en/. [Last accessed on 2019 Aug 28].  Back to cited text no. 2
    
3.
Registrar General of India. Sample registration system. SRS Bull 2000;33:1-8.  Back to cited text no. 3
    
4.
Ministry of Health and Family Welfare- Government of India. National Rural Health Mission (2005–12): Mission Document. New Delhi: Ministry of Health and Family Welfare- Government of India; 2005.  Back to cited text no. 4
    
5.
Aguayo VM, Bhattacharjee S, Bhawani L, Badgaiyan N. India's vitamin A supplementation programme is reaching the most vulnerable districts but not all vulnerable children. New evidence from the seven states with the highest burden of mortality among under-5s. Public Health Nutr 2015;18:42-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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Abstract
Introduction
Materials and Me...
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