Assessment of Maternity Nurses' Knowledge and Practice Regarding Management of Eclamptic Women

Introduction

Eclampsia is commonly defined as a new onset of grand mal seizure activity and/or unexplained coma during pregnancy or postpartum in a woman with signs and symptoms of preeclampsia, it typically occurs during or after the 20^th week of gestation or in the postpartum period. ⁽¹⁾  Eclamptic seizure seems to be self-limiting, typically lasting no more than 3-4 minutes followed by a post-ictal period of confusion and agitation, and even coma. ⁽²⁾ Most cases of eclampsia present in the third trimester of pregnancy, with about 80% of eclamptic seizures occurring intrapartum or within the first 48 hours following delivery. ⁽³⁾

The nurse role and consistent nursing care is very important in Eclamptic cases and must be competent in knowledge and practices as should be aware how to deal accurately before, during and monitoring after fits. ⁽⁴⁾ Moreover, nurse should provide emotional support for the mothers & their families, and inform them how to cope with eclampsia during pregnancy, encourage elevation of edematous arms and legs to increase venous blood return and compliance with bed rest in lateral recumbent position to avoid uterine pressure on the vena cava and supine hypotension syndrome. ⁽⁵⁾

In addition,  maternity nurses provided pharmacological agents according to physician's orders, and promoting women health through utilizing safety measures regarding to drugs administration as intravenous magnesium sulphate as a first-line agent. The nurses must be aware of action related drugs (muscle relaxant, prevents seizures), as well as the five rights during drugs administration and how to deal with drug toxicity. ⁽⁶⁾ 

Many studies showed a woman in a developing Counties are seven times more likely to develop pre –eclampsia, three times more likely for it to progress to eclampsia, and 14 times more likely to die with eclampsia than a pregnant woman in a Developed Countries . ⁽⁷⁾

The nurse at three Indian hospitals stated that they had neither the knowledge nor the skills to manage eclampsia patients at the same time; they accepted that there was some hesitancy to manage such complicated cases. ⁽⁸⁾ The authors go on to report that; they feared being blamed for any negative outcomes that could result, even when those outcomes were a natural consequence of the condition.

A study done in Port Said hospitals revealed that nurse-midwives had knowledge and practice gaps in areas of managing eclampsia. Provider‘s practices were not at appropriate level or in line with guidelines. Few Nurse-midwives reported to have attended in-service training on managing eclampsia. Resuscitation equipment and essential drugs for managing eclampsia are not enough and not regularily available. ⁽⁹⁾            

The aim of the Study:

To assess Nurses' Knowledge and Practice regarding management of Eclamptic women at obstetric, gynecological and child minia university hospital and general minia hospitals.

Significance of the study:

The incidence of eclampsia has been relatively stable at 1.6 to 10 cases per 10,000 deliveries in developed countries. In developing countries, however, the incidence varies widely: from 6 to 157 cases per 10,000 deliveries.Incidence of 76 patients out of a total 5562 deliveries presented with eclampsia in Canada (excluding Quebec) 5.9/10,000 cases between 2009-2010 Thus, despite rate of eclampsia declining in the developed world, Eclampsia remains a worldwide problem so important to assess nurses knowledge and practices^{. (10)} The number of deliveries with a complication of eclampsia at Minia University Hospital and Minia General Hospital (2017) was 177 out of 5696 deliveries (3.1%).

Research questions

•  What are levels of knowledge and practice of maternity nurses regarding management of eclamptic women?

• Is there a difference between the nurses' knowledge and practice who working in Obstetric, Gynecological and Child Minia University Hospital and Minia general Hospital?

Subjects and methods:

Study Design:

A descriptive research design was utilized to fulfill the aim of this study.

Research Setting

The study was conducted in inpatient units at Obstetrics & Gynecological and Child Minia University and Minia General Hospitals. the study was conducted within 9 Months, during the period from the beginning of September 2016 and finished at May 2017

Sample

A total of 78 female nurses recruited at convenience which classified as (60) female nurses who worked at Minia University Hospital and (18) female nurses worked at Minia General Hopital which dealing with Eclamptic women.

Inclusion criteria:-

• Nurses worked at Minia university hospital and Minia General Hospital in antenatal, labor, post natal ward and intensive care units.

Exclusion criteria:-

•  Nurses who are attending training program from 6 months ago regarding management of eclamptic women.
• Nurses who refuse to participate in the study

Tools of the study:

Tool for data collection was developed by the researchers after extensive review of literature to fully meet the demands of this research study and it was structured from Jhpiego (2011) in collaboration with the Ministry of Health. After that the developed tool were revised by panel of Obstetrical and Gynecological experts in nursing field as A structure interview questionnaire (Appendix,1) and it was consisted of the following three parts:

• Part 1: It consisted of five questions regarded to Socio demographic data as age, the current nursing role. qualifications, years of experience and place of work.
• Part 2:  Included 28 questions to assess level of nurse's knowledge regarded to eclamptic women and its management such as (Definition, main physical findings, organ affected, risk factors, recommended IV line, drugs and dose, toxicity and its prevention, etc….)
• Part 3: Observational Checklist Questionnaire to assess nurse's performance during care provide to women with eclampsia, it consisted of (55) skills/tasks related to nurses practice and each correct or complete performance was marked as two and incorrect or incomplete performance was marked as one and other skills as not done or not applicable (N/A)

Scoring system for total level of knowledge/ practice

Validity and reliability:

To establish validity, the questionnaire was be piloted on panel of 3 experts of Obstetrics and Gynecological staff, and Nursing professors who reviewed the tool for clarity, relevance, comprehensiveness, understanding, applicability and easiness.

Also, the tool was tested for internal reliability (reliability referred to the consistency of measurement and was frequently assessed using the test-retest reliability methods) to achieve reliability of knowledge and practice questionnaire by using Cronback's Alpha test were 0.72 and 0.75 respectively.

 Pilot study:

Conducted on 10% of female nurses (8 nurses) from Minia University Hospital and General Minia Hospital, to test feasibility of tool and time required to be applied.  Modifications were done of some points of the questionnaire that did not consistent with the aim of this study.

Ethical Consideration:

• Research  proposal was  approved from ethics committee in faculty of nursing
• Oral consent was  obtained from nurses that are willing to participate in the study, after explaining the nature and purpose of the study
• Study subject have the right to refuse to participate and /or withdraw from the study without any rational at any time
• No health hazards were present. 
• Participants were assured that all obtained data are highly confidential, anonymity was also assured through assigned  number for each nurse instead of names to protect their privacy.

Study Procedure

An official permission was obtained from the research ethics committee of faculty of nursing and director of the two hospitals before the conduction of the pilot study as well as the actual study.

The researcher attended units where providing care for Eclamptic women (in patient and intensive care units) three days per week,  at the beginning of interview the researcher greet each nurse, utilized proper channel of communication  and explained the purpose of the study and took their oral consent. Questionnaire was filed by researcher through 1/2 to 1 hour for each nurse. This was done to determine the actual knowledge of study sample which used in managing eclampsia.

The observation checklist was used in observing nurses while managing Eclamptic women and performing their daily nursing activities each nurse was observed for 2-3 hours or more to avoid observing each nurse more than once write the code number for each nurse on questionnaire.

Limitation of study

1-       Interruption during interview was occurred between nurses so researcher made effort and useless time to complete questionnaire.

2-       The current study had few numbers of nurses; therefore findings may not be representative of the general population.

3-       Some nurses were reluctant to be interviewed for fear that the information could be used against them.

4-       Because decrease the number of eclamptic cases the researcher take longer time until complete observational checklist from sample size.

 Statistical analysis

The collected data was tabulated, computerized, analyzed and summarized by using descriptive statistical tests to test research questions by using SPSS version (20). The level of significance was accepted at P- value <0.05

Results

Table 1: Distribution of studied sample regarding to their socio-demographic data. (n= 77).

          Table 1: Shows nurses' age, near half of the study sample (49.3%) their age ranged from 25-30 years, while near one quarter of them (24.7%) were more than 30 years with mean age was 28.1 ±5.9 years. Moreover, around half of the study sample (49.3%) was staff nurse while more than one third of the study sample (37.7%) were practice nurse and minority (13.0%) was supervisor nurses. Regarding nurses' education it was found that more than half of the study sample (66.2%) were diploma nurse, while, (10.4%) were bachelor degree. According to years of experiences it was observed that (40.2%) had  years of experiences more than 10 years and near quarter of study sample  (27.3%) had >  5 years with mean of( 9.4 ± 6.1 years) . Regarding place of work more than one third of study sample (33.8%) were work in labor ward and (19.4%) in ante natal unit and (20.0%) in post natal unit while more quarter of study sample (26.0%) were work in ICU.

Table 2:  Distribution of the study sample related to total level of knowledge (n = 77)

Table 2: presents that more than half of study sample (53.2%) had good knowledge and (41.6%) had very good while the minority (5.2 %) had average knowledge regarding management of Eclamptic women.

Table 3: Distribution of the study sample related to their level of practices (n = 77)

Table 3:: shows that near to two- third of studied sample  (64.9%) had poor level in practice and more than quarter of them (29.9%) had  average level, while, the minority had moderate and higher levels in practice  (3.9% , 1.3%) respectively.

Table 4: Relations between level of nurse’s knowledge and demographic data (n=77)

NS = not statistically significance              * Statistical significantly differences

Table 4: shows that there were statistically significance differences between Nurses Educational qualifications and place of work with total knowledge level in which P- value > ₌ (.002  & .012 respectively).

Table 5: Relation between level of nurse’s practice and demographic data(n=77)

NS = not statistically significance              * Statistical significantly differences

Table 5: Findings of this study found that there was statistically significance difference related to place of work and total nurses practices score in which ( P – value .001*) .

Table 6: Relations between level of nurse’s knowledge & practices and hospital type (n=77)

NS = not statistically significance             

Table 6:  Findings of this study revealed that there were statistically significance differences between total knowledge level related nurses working in Obstetric, Gynecological and Child Minia University Hospital and Minia general Hospital score in which P value .05* while there were not statistically significance differences related to total practice level between two hospital.