A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING
NON INVASIVE DIAGNOSTIC PROCEDURES USED TO ASSESS THE FETAL BEING AMONG STAFF
NURSES AT ASHWIN HOSPITAL, COIMBATORE
BY
REG.NO
:301721103
A DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN
PARTIAL FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF
SCIENCE IN NURSING
OCTOBER - 2019
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING
NON INVASIVE DIAGNOSTIC PROCEDURES USED TO ASSESS THE FETAL BEING AMONG STAFF
NURSES AT ASHWIN HOSPITAL, COIMBATORE
BY
REG.NO
:301721103
EXTERNAL INTERNAL
A DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN
PARTIAL FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF
SCIENCE IN NURSING
OCTOBER - 2019
CERTIFIED THAT THIS IS THE BONAFIDE WORK OF Reg. No: 301721103
PPG College of Nursing Coimbatore
SIGNATURE: COLLEGE SEAL
Dr. P. MUTHULAKSHMI, M.Sc.(N)., M.Phil., Ph.D., Principal,
PPG College of Nursing, Coimbatore – 35.
A DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN
PARTIAL FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF
SCIENCE IN NURSING
OCTOBER – 2019
A STUDY TO ASSESS EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING
NON INVASIVE DIAGNOSTIC PROCEDURES USED TO ASSESS THE FETAL BEING AMONG STAFF NURSES AT ASHWIN HOSPITAL, COIMBATORE
APPROVED BYTHE DISSERTATION COMMITTEE ON OCTOBER 2018
PRINCIPAL : ______________________
Dr. P. MUTHULAKSHMI, M.Sc (N).,M.Phil, Ph.D., Principal
PPG College of Nursing Coimbatore – 35.
SUBJECT GUIDE : __________________________
Prof. Kalaivani, M.Sc (N).,M.Phil.,Ph.d., HOD department of Obstetrics and gynaecology PPG College of Nursing,
Coimbatore– 35.
MEDICAL GUIDE : __________________________
Dr. T.Ashwin MS., Department of medicine, Ashwin Hospital, Coimbatore.
A DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN
PARTIAL FULFILLMENT OF REQUIREMENT
FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER - 2019
PLAGIARISM CERTIFICATE
This is to certify that this disseratation work titled A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE REGARDING NON INVASIVE DIAGNOSTIC
PROCEDURES USED TO ASSESS THE FETAL BEING AMONG STAFF NURSES AT ASHWIN HOSPITAL, COIMBATORE of the candidate Mumthaj Begum .A with registration number 301721103 for the award of M.S.c.
Nursing in the Branch of Obstetrics and Gynaecology. I personally verified the PLAGARISIM CHECKER X.COM website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion pages and results shows 13% of plagiarism in the dissertation.
SUBJECT GUIDE SIGNATURE PRINCIPAL SIGNATURE
ACKNOWLEDGEMENT
ACKNOWLEDGEMENT
Whole heartedly convey the gratitude to Lord Almighty for his abiding grace, love, compassionate and immense showers and blessings on me, which gave me the strength and courage to overcome all the difficulties and whose salutary benison enabled me to achieve this target.
I express my deep sense of gratitude to Dr. L. P. Thangavelu, MS., F.R.C.S., Chairman and Mrs. Shanthi Thangavelu, M.A., Correspondent, PPG group of institutions and our trustees for encouragement and providing the source of the success of the study.
It is my long felt desire to express my profound gratitude and exclusive thanks to Dr. P. Muthulakshmi, M.Sc (N)., M.Phil., Ph.D., Principal and our research guide with professional competence. It is obvious that without her esteemed suggestion, highly scholarly touch and perching insight at every stage of the study, this work could not have been presented in the manner it has been made. I also express my gratitude for her valuable guidance and help in the statistical analysis of data which is the core of the study.
The present study has been completed under the expert guidance and support of Prof. Kalaivani, M.Sc. (N).,M.Phil.,Ph.D., (Head of Obsterics Gynecology Department) If not the present study would have missed much of its presence and substance. Her keen support, guidance, encouragement, sustained patience, valuable suggestions and constrictive evaluation have enabled me to shape up this research as a worthy contribution to the field.
My work will not have attained perfection without the constant persuation and guidance rendered by Mrs. Hatlinsugi, Msc (N)., Assistant professor, and Mrs.Priya, Msc. (N)., Associate professor Department of obstetrics and gynaecology in my every minutes move.
My sincere thanks to Prof. Andria, M.Sc. (N)., and other faculty members of other department in PPG college of nursing for their valuable suggestion in research.
I express my sincere gratitude to Prof .Venugopal, statistician for the expert guidance and suggestion in the statistical analysis of data.
I extend my grateful thanks to the teaching and non teaching staffs for their co-operation and help for completing my work successfully.
I take this opportunity to thank the Experts who have done the content validity and valuable suggestions in modification of tool.
I express my thanks to the Dissertation Committee Members for their healthy criticism, supportive suggestions which moulded the research.
I extend thanks to Librarian and Assistant Librarian PPG institute of health science for leading their help for my literature review.
I express my heartiest thanks to the samples who have supported and co- operated with me throughout the study.
Last but not the least, my sincere thanks to my Colleagues for their kind cooperation and effort in making my study great success.
Above all, words fail to express my deep indebtedness and gratefulness to my loving Husband, parents, brother and my friends for being motivational force behind my every step of move and their love, support and prayers to help me complete my work.
ABSTRACT
ABSTRACT
Statement of the problem: a study to assess the effectiveness of structured teaching programme on knowledge regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses at Ashwin Hospital, Coimbatore. Objectives : a) To assess the level knowledge regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses.
b) To administer structured teaching programme regarding non invasive diagnostic procedures used to assess the fetal well being among the staff nurses. c) To evaluate the effectiveness of structured teaching programme on knowledge regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses.
d) To find out the association between level of knowledge with selected demographic variables Methodology: The research design selected for the study , experimental approach a subtype of quantitative design was used for present study, experiments involve the manipulation of an independent variables that is implementing an intervention. An evaluation approach will be used to evaluate the effectiveness of structure teaching programme among staff nurses attending Ashwin Hospital, Coimbatore. Pre test was conducted. The structured teaching programme was conducted after pre test on the same day. Post test was conducted on the seventh day after pre test using the same questionnaire to evaluate the effectiveness of structured teaching programme sample size for the study was 60, sample technique used for the study was non probability randomized and demographic variables were used to collect date. Result: Inferential and descriptive statistics were used analyze the values. The obtained “t value” (25.97) in knowledge was higher than table value (significant at (0.05) level). Interpretation and Conclusion: This study shows an improvement in knowledge after educational intervention.
LIST OF CONTENTS
CHAPTER CONTENTS PAGE No
I INTRODUCTION 1
Need for the Study 6
Statement of the Problem 9
Objectives 9
Operational Definitions 9
Hypothesis 9
Assumptions 10
II REVIEW OF LITERATURE 11
Conceptual Framework 25
III METHODOLOGY 26
Research Approach 26
Research Design 26
Setting of the Study 27
Population 28
Sample Size 29
Sampling Technique 29
Criteria for Selection of Samples 29
Description of the Tool 29
Testing of the Tool 30
Pilot Study 31
Data Collection Procedure 31
Plan for Data Analysis 32
IV DATA ANALYSIS AND INTERPRETATION 33
V DISCUSSION 49
VI SUMMARY, CONCLUSION 51
REFERENCES APPENDICES
LIST OF ABBREVATIONS
LIST OF TABLES
S.NO CONTENT PAGE No
1. Grading of knowledge level 30
2. Frequency percentage distribution of demographic variables of the staff nurses in respect to age, educational qualification, tears of experience.
34
3. Frequency and percentage distribution of pre test knowledge level among staff nurses regarding non invasive diagnostic procedures used to assess the fetal well being
40
4. Frequency and percentage distribution of post test knowledge level among staff nurses regarding non invasive diagnostic procedures used to assess the fetal well being.
42
5. Distribution of Pretest and post test scores of knowledge among staff nurses about non invasive diagnostic procedures used to assess the fetal well being.
44
6. Comparison of pretest and post test knowledge regarding non invasive diagnostic procedures used to asses the fetal well being.
46
7
Mean value of pre test and post test knowledge level among staff nurses regarding non invasive diagnostic procedures used to assess the fetal well being.
48
LIST OF FIGURES
S.NO CONTENTS PAGE NO
1. Conceptual Framework Based On Ernestine Weidenbach (1967).
25
2. The schematic representation of the research design. 27 3. The schematic representation of the demographic
variables.
28 4. Frequency and percentage distribution of staff nurses
according to the age.
36 5. Frequency and percentage distribution of staff nurses
according to the educational qualification.
37 6. Frequency and percentage distribution of staff nurses
according to the years of experience.
38 7. Frequency and percentage distribution of staff nurses
according to the in service education demographic variables according to the in service education of the staff nurses.
39
8. Frequency and percentage distribution of pre test knowledge level among staff nurses regarding non invasive diagnostic procedures used to assess the fetal well being.
41
9. Frequency and percentage distribution of post test knowledge level among staff nurses regarding non invasive diagnostic procedures used to assess the fetal well being.
43
10. Comparison of pre test and post test scores of knowledge level among staff nurses regarding non invasive diagnostic procedures used to assess the fetal well being.
45
11. Mean of pre test and post test knowledge level among staff nurses regarding non invasive diagnostic procedures used to assess the fetal well being.
47
LIST OF APPENDIX
APPENDIX TITLE
A. Letter seeking Requisition for conducting the study
B. Letter seeking permission form experts for content validity of the tool C. Format for the content validity
D. Certificate for English Editing E. List of experts for content validity F. Certificate for plagiarism
G. Questionnaire H. English I. Slides J. Photos
LIST OF ABBREVITIONS
PPGCON P.Perichi Gounder College of Nursing
et al. And others
Fig Figure
H1 Research Hypothesis 1
H2 Research Hypothesis 2
HOD Head of the Department
STP Structure Teaching Program
LOS Level Of Significance
M.Sc.,(N) Master of Science (Nursing)
n Total number of samples
No. Number
p Probability
r Reliability
Prof. Professor
S.D Standard Deviation
Sig Significant
WHO World Health Organization
X2 Chi-Square Test
% Percentage
INTRODUCTION
1
CHAPTER – I
INTRODUCTION
“As a general rule, the most successful man in life is the man who has the best information”
K. Park
The primary goal of antenatal evaluation is to identify fetuses at risk for intrauterine injury and death so that intervention and timely delivery can prevent progression to stillbirth. Ideally, antenatal tests would decrease fetal death without putting large numbers of healthy fetuses at risk for premature delivery and the associated morbidity and mortality. Despite widespread use of many tests, limited evidence exists to demonstrate effectiveness at improving perinatal outcomes with application of these tests. (John thorp 2016)
Certainly, there is a definite need to find a reliable test of fetal well-being. The National Center for Health Statistics defines perinatal mortality rate (PMR) as the number of late fetal deaths (28-wk gestation or more) plus early neonatal deaths (infants 0 to 6 d of age) per 1000 live births plus fetal deaths. In the United States, stillbirths account for more than 55% of the perinatal mortality1 and could potentially be prevented with an effective form of fetal testing.
Unfortunately, many barriers need to be overcome in the development of a reliable assessment of fetal well being. First, the basis of fetal testing rests on the hypothesis that a compromised fetus undergoes a series of detectable physiological changes such as the redistribution of blood flow or decreasing unnecessary movements. However, in the third trimester, normal fetuses spend 25% of their time in a quiet sleep state. During the normal sleep state the fetal heart rate variability is reduced, and there may be infrequent breathing movements.2 Tests performed while a fetus is in a resting state may be incorrectly classified as an abnormal test.
2
Therefore, when using tests to evaluate fetal condition, clinicians need to appreciate whether a fetus is simply in a temporary quiet sleep state or neurologically compromised. (Erica Neill 2016)
A 10-fold difference in perinatal mortality between high-risk and low-risk groups (70/1000 vs. 7/1000). Yet the overall prevalence of these high-risk conditions is low and 30% to 50% of perinatal deaths actually occur in low-risk patients. Therefore if a sensitive and specific test existed, all women would benefit from some form of fetal testing. Targeting only high-risk women would still be inadequate.
Third, the prevalence of an abnormal condition has the greatest impact on the predictive capability of an antepartum test. Although stillbirths are devastating, they are unlikely even among high-risk women and very rare among low-risk women. In many cases an abnormal test may be more likely to indicate a false positive (healthy fetus), instead of a true positive (compromised fetus).2 Even in the case of high-risk pregnancies with a prevalence of 70/1000, a test that is 99% sensitive and specific only has a positive predictive value of 88%.( MJ Sankar 2016)
Finally, to be successful at preventing death, an antepartum test needs to identify a compromised fetus in enough advanced time for an intervention to be successful. No known method of assessment can predict sudden events, such as a cord accident or placental abruption, which are frequent causes of fetal death. It is important for the clinician to keep these limitations in mind when evaluating the merits of an antenatal test of fetal well-being.
Fetal movement counting is an evaluation method which pregnant women quantify the fetal movements they feel. In theory, decreased movement alerts the mother of a deteriorating fetal condition. She can then bring this to the attention of health care providers who can evaluate further and intervene as needed to prevent fetal death. Because it can be performed each day, or multiple times daily, it has advantages over other fetal tests that cannot practically be performed this frequently.
(AA Usynina 2017)
3
Women who report decreased fetal movement have an incidence of stillbirth that is 60 times higher than women without this complaint. Although decreased fetal movement commonly precedes fetal death, it does not necessarily indicate fetal death is imminent. Many factors other than worsening fetal condition can influence the perception of movement, including maternal activity, position, obesity, medications, gestational age, placental location, and amniotic fluid volume. Fetal movement also varies normally over the course of the day, peaking between 9pm and 1 am when maternal glucose.
The cardiotocograph (CTG) is a continuous record of the fetal heart rate obtained by an ultrasound transducer placed on the mother's abdomen, with a second transducer placed over the uterine fundus to record uterine activity simultaneously.
Components of the fetal heart rate that are assessed include baseline rate, variability, accelerations, and decelerations as well as the relationship between fetal heart rate and the timing of uterine contractions.8 CTG may be used in isolation, referred to as the “non stress test,” or with the stimulation of uterine contractions to see how the fetal heart responds, known as the “contraction stress test.” The contraction stress test is time consuming to perform and requires an intravenous infusion of oxytocin in many cases. Contraindications limit use of the contraction stress test in many high- risk situations such as antepartum bleeding, placenta previa, preterm premature rupture of membranes, or a history of preterm labor. The contraction stress test suffers from many disadvantages, has shown minimal demonstrated benefits over other methods of fetal evaluation, and should not be used routinely. (Devane D.2015)
The non stress test is used widely in current obstetrics practice. The false- negative rate for the non stress test is low ranging from 0.19% to 1%, and when assessing the inter observer variation the proportions of agreement for normal tests were high.10 In contrast, the false-positive rate of a nonreactive non stress test is as high as 55%,11 and the proportions of agreement among experts for equivocal/ominous tests were poor.10 Given that with an abnormal test result a fetus is more likely to be healthy than compromised, results must be used cautiously by clinicians, particularly at early gestational ages when delivery could result in significant morbidity. Fetal Doppler evaluation uses ultrasound to measure blood
4
flow velocities in the fetal vessels, most commonly the umbilical artery. Flow is most often quantified either by pulsatility index or resistant index. These indices reflect the downstream vascular resistance by quantifying the differences between the peak systolic and the end-diastolic velocity within blood vessels of interest in each cardiac cycle.15 Ratios are created to allow the sonographer to not have to measure the angle of insonation, which is notoriously inaccurate. Normally growing fetuses have high- velocity diastolic flow. Growth-restricted fetuses often have diminished, absent, or even in severe cases reversed umbilical artery diastolic flow (John thorp 2016)
The odds ratio for perinatal mortality in growth-restricted pregnancies complicated by absent diastolic flow is 4.0. With reversed diastolic flow, the odds ratio for mortality is increased to 10.6. This increase in mortality with abnormal Doppler testing persists even after adjustment for gestational age.16 An absence of umbilical artery diastolic flow has been shown to be an accurate clinical test with a sensitivity of 78% for detecting hypoxia and a sensitivity of 90% for detecting acidosis on fetal blood gas at delivery. The positive predictive value of absent end- diastolic flow ranges from 53% to 88% and negative predictive value is high at 98%
to 100%.
Of all the antenatal assessment methods, Doppler-based tests have been evaluated most rigorously in randomized trials. A meta-analysis combined 4 randomized trials and demonstrated that routine umbilical artery Doppler screening of all low-risk pregnancies does not reduce the risk of perinatal death.15 On the basis of a single study with 2016 low-risk women, no significant difference was identified in serious neonatal morbidity, Apgar scores <7 at 5 minutes, cesarean section, operative vaginal births, induction of labor, or neonatal resuscitation.
Doppler ultrasound may be effective in identifying at-risk fetuses specifically in high-risk pregnancies. In a meta-analysis of 18 randomized trials enrolling just over 10,000 high-risk women, the use of Doppler ultrasound to evaluate the fetal umbilical artery was associated with a significant reduction in perinatal deaths.18 The group that had Doppler results provided to the clinician had a perinatal death rate of 1.2% versus 1.7% in the group that clinicians did not have access to Doppler results. The number of infants needed to be assessed with Doppler to prevent a perinatal death was 203. In most of those studies Doppler ultrasound
5
was used in addition to other fetal monitoring, such as NST or the BPP. However, 4 studies compared Doppler ultrasound alone with non stress test alone in women whose pregnancies were considered at increased risk of problems. This analysis included 2813 women and had much less power for assessing the main clinical outcome. The perinatal mortality was not significantly different. (Dr. Matt. A 2017)
Doppler studies can also be performed on other fetal vessels. Recently, considerable interest has been generated by observations that ductus venosus flow may be a good predictor of perinatal outcome. However, the effectiveness of this assessment has yet to be tested in large clinical trials.
Doppler studies of the umbilical artery should be included in the protocols for fetal monitoring in high-risk pregnancies thought to be at risk of placental insufficiency. The clear definition of suspected placental insufficiency, frequency of Doppler studies, and timing of delivery in the presence of abnormal Doppler studies have not been determined. (Erica Neill 2016)
The American Congress of Obstetricians and Gynecologists practice bulletin on antepartum fetal surveillance suggests that antepartum testing may be appropriate for any pregnancy in which there is an increased risk of fetal demise. However, as antepartum fetal surveillance has not been shown to definitively improve perinatal outcome in controlled trials, all indications for antepartum testing must be considered tentative.19 Experts currently recommend antenatal testing regimens for many maternal and fetal conditions, such as maternal diabetes, hypertension, and fetal growth restriction. Although observational studies have examined the use of non stress test and BPP in the management of specific maternal conditions, such as the diabetic pregnancy, no method has been assessed in well-designed clinical trials and it is not clear whether any method is effective and which method, if any, is superior
During the last couple of decades, the fetus in utero has been considered assecond patient, the mother being the first. Pregnancies can be described as high risk for any of several undesirable outcomes. The fetus usually faces much greater risks of serious morbidity and mortality – than does the mother. The leading causes of death in the neonatal period are congenital anomalies, disorders relating to short gestation, low birth weight, respiratory distress syndrome and the effect of maternal
6
complications.Certain events occurring during prenatal period can have an adverse effect on the infant in later l life.
Although, a number of perinatal problems have benefited from improved treatment, congenital anomalies continue to be the leading cause of infant mortality.
Increased rates of survival during the neonatal period have resulted largely from the improvement in perinatal services including the technology of neonatal intensive care units, high quality prenatal care and the use of obstetric technology. The primary purpose of the various antepartum surveillance techniques is to detect fetal distress so as to prevent fetal death. There has been several advances in the aspect of perinatal care in the last 25 years which have resulted in the dramatic decline of perinatal mortality. These advances have led to, in the vast realm of revolutionary modern day medicine, the forecast of fetal health.
The fetus today has achieved a status almost equivalent to that of the mother and this importance is gaining more ground as we progress with the ever evolving science of medicine and its synergy with fast developing technology. So Early identification of an abnormality through advanced antepartum investigation of fetal well-being is of great benefit in antenatal care to bring down the maternal and neonatal morbidity and mortality. (Johnthrop (2017).
NEED FOR THE STUDY
Modern child bearing has brought with it new and expanding reproductive testing options that provide women with previously unavailable information about their pregnancies. Of the 3 to 4% of babies born with recognizable birth defects most are born in families without identified risk factors. Because women are concerned about the health and well being of the fetus, prenatal screening and or diagnosis is offered to all women early in pregnancy .Early booking and early detection of any abnormality during pregnancy through specialized investigation leads to appropriate treatment of the mother and beneficial effect for the fetus. Nurse may participate in fetal assessment in various ways. They may be involved in planning, implementing, administering or evaluating screening and testing programme or they may educate, assist and support the pregnant women to undergo regular or specialized antenatal investigation. (Baby Susan K.2015)
7
A prospective evaluative study was conducted to determine the agreement between nurse and physician interpretation of biophysical profile score. The study was conducted on twenty-three women with high-risk pregnancies who were regularly scheduled for a biophysical profile, in a fetal assessment centre of a large tertiary care centre. The proportion of agreement between the physicians and nurses and the physician expert was calculated for each biophysical profile criteria. Results showed that, when compared with the expert, physicians showed 60% moderate or substantial agreement and the nurse showed 80% moderate or substantial agreement.
That means nurse’s interpretation of biophysical profiles were at least as reliable as physicians when compared with an expert reviewer.
Nurses employed in prenatal care settings need to have accurate information they can provide to women so, they understand the benefits and limitations of screening. Timely presentation of information and identification of available resources will help nurses minimize confusion and provide support for women as they proceed with pregnancy screening. The importance of genetics in nursing practice and the desire for information about evolving genetic screening and technology makes accurate information necessary for nurses in many practice settings. (CLGegor 2015)
Nurses who understand the screening process can help women make informed decisions about participating in screening. They can provide appropriate information and support throughout the testing process and help to interpret results.
Unless she has thorough knowledge regarding antepartum assessment of fetal well being, she may not educate the client and family members to undergo regular and specialized antepartum assessment of fetal well being. Hence the researcher feels that there is a need to assess the knowledge of staff nurse on assessment of fetal well- being with a view to prepare an information booklet on antepartum assessment of fetal well being. The scientific paper being reviewed for this write-up is a prospective observational study conducted at Queen Mary’s Hospital, Lucknow in 1964 to determine the incidence of perinatal mortality and identify possibly responsible medical, biological and socio-economic causes. During the study duration (5.5 months), the outcomes of 1000 consecutive viable births and 114 perinatal deaths were studied. Maternal details, test results in the case of still born data, and autopsy
8
findings were analyzed. The Aberdeen classification system, developed by Sir Dugald Baid in 1954, was used for determining etiology of stillbirths.
The study findings were compared with available data from other hospitals.
Perinatal mortality rate .ranged from 61.5 (Hyderabad) to 161 (Bombay) in India, and 13.8 (London) to 38.6 (Aberdeen) in the United Kingdom. The causes were similar in the Indian studies, however differed from the developed countries. When this data was compared with statistics from the same hospital ten years ago (1954), it was observed that PMR decreased from 131.2 to 114 per thousand births, primarily due to reduction in early neonatal deaths. The authors concluded that most of the causes of perinatal mortality were preventable and that this could be decreased by improving diagnostic studies in hospitals and improving early neonatal care.
In 2010, that it is possible to deduce the entire genomic sequence of a fetus through Non Invasive Perinatal Test, implying that Non Invasive Perinatal Test could identify a much wider range of genetic disorders in the future. These major developments in the field of prenatal testing are generating a great amount of debate regarding the potential impact, benefits and drawbacks of Non Invasive Perinatal Test. for example, provides a summary of the ethical questions that have been raised with regard to the implications of Non Invasive Perinatal Test on the current prenatal screening setting and even on society as a whole. Where many women now decline prenatal screening due to the miscarriage risk of follow-up diagnostic testing,it is likely that more women will consider NIPT as it does not jeopardise the health of their fetus, Ethicists however, worry that the safety and ease of the test might lead to normalisation of testing and to a decrease in informed choice, as parents might not be aware or fully comprehend what they are consenting to. Other concerns that are being raised include whether earlier testing might lead to trivialisation of selective abortions or that the future prospective of broadening the scope of prenatal testing might lead to identifying and possibly aborting fetuses affected with minor abnormalities or non-medical traits (Sharmila.B.2014)
9 Statement of the problem
A study to assess the effectiveness of structure teaching programme on knowledge regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses at Ashwin Hospital, Coimbatore.
Objective
1. To assess the level of knowledge regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses.
2. To administer structure teaching programme regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses.
3. To evaluate the effectiveness of structure teaching programme on Knowledge recording non invasive diagnostic procedures used to assess the fetal well being among staff nurses.
4. To find out the association between level of knowledge with selected demographic variables.
Hypothesis
H 1 : There will be a significant difference between pretest and post test knowledge scores.
H 2 : There will be significant association between knowledge scores with selected demographic variables.
Operational definitions Assess
It refers to the level of knowledge on regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses by using structured questionnaire prepared by the researcher.
10 Effectiveness:
It refers to the desire change, which can be brought about by structured teaching programme and is measured in terms of significant difference in level of knowledge regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses after structured teaching programme.
Structured Teaching Programme
It refers to systemically planned information regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses through power point presentation.
Knowledge:
Information acquired by the staff nurses through the structured teaching programme regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses.
Non invasive procedure:
A medical procedure is defined as Non invasive when non break in the skin is create and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. Such as partograph, CST, NST, Nipple Stimulation Test, Doppler, USG.
Staff nurses:
The nurses who are registered and qualified with diploma or graduate in nursing and working in the Ashwin Hospital.
Assumptions
Nurses working in hospital may have inadequate knowledge on non invasive diagnostic procedures used to assess the fetal well being.
Nurses may not use some non invasive diagnostic procedures used to assess the fetal wellbeing.
REVIEW OF
LITERATURE
11
CHAPTER II
REVIEW OF LITERATURE
A research literature review is a systemic, explicit and reproducible method for identifying, evaluating and synthesizing the existing body of completed and recorded work produced by researchers, scholars and practioners (Arlene fink, 2010) Review of Literature is considered as the most important pre – requisite to actual planning and conduct of the study .it helps in selecting appropriate methodology, developing tools, analysing data and relating the findings of one study to another. Literature view involves systematic identification ,location, scrutiny and summarization of the written materials that contain information regarding research problem.
In this study, the investigator has create certain relevant aspects of literature, which explored the details of about fetal well being assessment. The related literature has been discussed on the basis of their priority. Studies related to knowledge to antepartal assessment of fetal well being .studied related to antenatal assessment of fetal well being. Studies related to antenatal assessment of fetal well being .Studies related to antepartal assessment of fetal well being Current prenatal screening practices provide a more effective risk assessment. They provide an important adjunctive tool for the identification of the high risk pregnancy and adverse neonatal outcome. Non invasive procedure is an excellent means of fetal surveillance. It helps for screening major abnormalities of pregnancy.
Literature related to knowledge of staff nurses on assessment of fetal well being There are numerous factors that influence the specific risk of fetal aberration or chromosomal abnormalities of the actual fetus. Individually tailored risk assessment needs to be established during pre- procedure genetic counselling.
Psychological factors and recent scientific development should also be discussed in order to give most information to the parents before they decide about taking any invasive procedure. Nurses should have an adequate knowledge about the various methods used for the assessment of fetal well being. They have a vital role to
12
alleviate fear and anxiety by counsel the mothers. In this chapter the investigator has presented and discussed the review of literature. The literature review has helped the investigator to gain an insight about the magnitude of the problem.
Lewis and Rowe (2014) conducted a qualitative study to assess the importance of assessing Fetal Heart Rate and thus fetal well being. The study was conducted with midwives practicing in Qucens Land. They insisted that the ideal method of monitoring the fetal heart rate in low-risk labour is intermittent auscultation. This analysis highlights the range methods and the rationale contexts and factors motivating and the influencing midwifes practice choices. This shows that, in the current complex care environment, midwives facc a range of challenges to practice that facilitates the provision of consistent woman centered care for that nurses should have adequate knowledge
Huggerty and Nuttall (2015) conducted a quasi-experimental study to assess experienced obstetrics nurses' decision making in fetal risk situations. The study was conducted on Boston college of Nursing USA, to determine which clinical factors, experienced obstetric nurses consider most important in determining fetal risk during the intra partum period. Maternal parity, amniotic fluid colour and long term variability of fetal heart rate. Result showed that, fetal scalp PH, important predictors of nurses fetal risk assessment. This indicates that, participants were realistic about the fetal well -being assessment.
Aida abd el- rasek (2017) A quasi-experimental study design was used in carrying out the study to impact knowledge and awareness assessment of methods of fetal wellbeing among staff nurses. The study was conducted at obstetric and gynecological department working at setting in Jarsh Governorate Hospitals and Prince Hussein Bin Abdullah Hospitals. Represents comparison of knowledge about fetal well being assessment among staff nurses on post test than on pre test. A highly statistical significance differences was found at 5 % and 1 % level of statistical significance, where p-value 0.001.
13
Aziza Ibrahim Mohamed (2018) A quasi experimental design was utilized to fulfil the aim of the study. A convenient sample of a total 64 maternity nurses were included in the present study. The present study was conducted at fetal wellbeing assessment unit at obstetrics and gynaecological department affiliated in Benha university hospital. Results of the study indicated that mean score of knowledge and practice of the studied maternity nurses were highly improved at post intervention A highly positive association was illustrated between studied nurses educational qualification and their knowledge and practice mean score (p 0.001*). The present study concluded that educational intervention had a positive effect improving knowledge and practice of maternity nurses regarding fetal wellbeing measures.
Hanan El-Sayed Mohamed El-Sayed, (2018) The quasi experimental study to evaluate the effect of education session about cardiotocograph on nurses knowledge and skill at labor and high risk unit. A purposive sampling was used. The study was conducted at labor and high risk unit in Mansoura university hospital.
structure interviewing questionnaire which include socio demographic characteristics of nurses and questions about nurses' knowledge about cardiotocograph . the present study result showed that there was statistically significant improvement were found among pre test immediate post test and after 3 month post test related to knowledge and skills of nurses recording cardiotocograph P-(0.001) The study research concluded that implementing and educational session about cardiotocograph significantly improved nurses' knowledge and skills and labour unit, High Risk Unit.
Ashibang U, Agan TU, (2014) conducted a cross-sectional descriptive study among 130 purposely selected non-physician obstetric caregivers in the General Hospital, Calabar, Nigeria. This study aimed to evaluate the non-physician obstetric caregivers. Knowledge of partograph use. The majority of the respondents (70.8%) had good general knowledge of the partograph but lacked detailed and in depth knowledge of the component parts of the partograph. Knowledge of partograph and partograph availability had a significant relationship with its utilization. Previous training was significantly related to knowledge of partograph. Factors affecting utilization were: little or no knowledge of the partograph (85.4%), nonavailability (70 %), shortage of staff (61.5 %), and the fact that it is time- consuming to use.
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Haymanot Mezmur Agumasie Semahegn, (2017) conducted a cross- sectional quantitative study was carried out among health professionals who were working in public health institutions. Multistage sampling with proportional to size allocation was used to recruit a total of 441 study participants. Self-administered questionnaire was used to collect data in this study. Eight midwives were recruited and trained to facilitate the data collection activities. Health professionals who had in- service training about the partograph .10, 95% and who had positive attitude about the partograph, 95 % were significantly associated with utilization of the partograph.
Desalegne Amare Zelellw et al, (2016) cross-sectional study was conducted to assess knowledge and attitude of obstetric caregivers about partograph and associated factors. Study was conducted on 273 study participants. Results About 153 (56.04% ) and 150 (54.95%) of the obstetric caregivers had good knowledge and favorable attitude about partograph, respectively, Knowledge of partograph was significantly higher among obstetric caregivers that learnt about partograph during their College and who had received partograph on job training Favorable attitude towards partograph was significantly higher among obstetrical caregivers who had training and learnt about partograph during their college correspondingly Conclusion.
above half of obstetric caregivers had good knowledge and a favorable attitude partograph. The provision of on pre service and job training is necessary to improve caregivers' knowledge and attitude.
Susan K. Baby (2015) conducted a study to assess the knowledge of staff nurses on selected aspects of antepartal assessment of fetal well being working in selected hospitals of Bangalore South, Karnataka. The knowledge score obtained by the participants were arranged in ascending order, grouped and the median (46) of the total knowledge score was found. To test the association between the knowledge and selected demographic variables, the following hypothesis was formulated. There is a significant association between knowledge level on antepartal assessment of fetal well-being in staff nurses with selected demographic.
Nurs J India.(2016) conducted a study was therefore undertaken to assess the existing knowledge of staff nurses regarding fetal well being measures, evaluate the effectiveness of self-instructional module and find the association, if any, between post-test knowledge score and selected variables. The sample consisted of 40 staff
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nurses of Vanivilas Women & Children Hospital, Bangalore. Using non-probability purposive sampling, the views of staff nurses were elicited 40 knowledge items. All the respondents were female, had GNM qualification; majority of them were married and in age range 30-39 years; over half of them had not undergone in-service education in obstetrics/ pediatrics. It is concluded that screening and monitoring in pregnancy are important strategies to monitor the well being of the fetus and reducing the incidence of perinatal mortality and morbidity.
K.Varalakshmi (2017) conducted a Quasi experimental study one group pre test and post test design was used to assess Effectiveness of Structured Teaching Programme on assessment of fetal well-being among staff nurses. The study findings in the pre-test revealed that the majority 58.3 % (35) had inadequate knowledge where as 16.7 % (10) had moderate knowledge and least 25 % (15) had adequate knowledge on assessment of fetal well being. In post test knowledge scores on assessment of fetal well being among staff nurses. It reveals the majority 68.3% (41) had fair knowledge where as least6. 7% (4) had average knowledge on assessment of fetal well being.
Babu Lal Meena (2018) conducted a Where non experimental quantitative research design study to assess the Knowledge of Staff Nurses regarding antenatal assessment of Fetal Well Being Working in Mahila Chikitsalaya Sanganeri Gate Jaipur Rajasthan, India. Where non experimental quantitative research design was used and 60 staff nurses were selected using convenient and purposive sampling. The association between experience of staff nurse and knowledge score was statistically significant (x2= 4.53) as established by chi -square test the knowledge score were in the range of 9-36. Study findings concluded that overall knowledge score is 59.75.
The analysis showing that they don't have adequate knowledge about antenatal assessment of fetal well being. There is a need to determine what form of assistance would best to improve the knowledge of staff nurses regarding antenatal assessment Review of literature related to non invasive diagnostic procedures
Tabur, Zdravkpvic and Perslev (2015) conducted a prospective cohort study to assess the fetal well being by using of ultrasonography for analysing congenital malformations. The study was carried out at a Danish University Hospital in Denmark. The infants were followed up to the age of at least one year to measure the
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detection rate of fetal abnormalities. Result showed that, significant malformations were detected in 100 fetuses or infants corresponding to an incidence of 1.3%
Drysdale et al (2002) conducted n prospective study to evaluate the feasibility acceptability of routine early ultrasound (12 14 weeks) as a screening tool for fetal well being and congenital anomalies. The study involved 991 women who presented clinically showed that, 984 (99%) women accepted the pregnant before 12 weeks gestation. Result offer of an early ultrasound scan at 12-24 weeks gestation. Thirty pregnancies (3%) were diagnosed as abnormal or having high risk of abnormality at the early scan. This result showed that early pregnancy ultrasound at 12 - 14 weeks gestation is an effective method of identifying and screening for major abnormalities of pregnancy.
Tongsong, Piyamongkol and Ananta Chote (2016) conducted a prospective study on the rapid non invasive procedure for assessment of fetal well being. The objective of the study was to determine the efficacy of CTG, Doppler ultra sound the combination of amniotic fluid index (AFI) and detected by ultrasound in predicting the intra - partum fetal distress in high risk pregnancies compared with the non -stress test (NST), Results showed that the non invasive methods was a reliable predictor of intra partum fetal distress with high sensitivity and specificity
Nagcotte, Towers, Asrat and Freeman (2017) conducted a comparative study to evaluate the perinatal outcomes in high risk pregnancies monitored with a non stress test. Those having an abnormal fetal heart rate had received either a contraction stress test. The overall incidence of an adverse perinatal outcome (Apgar less than 7), perinatal death or nursery death, caesarean delivery for fetal distress was 7%. This shows that non invasive methods is an excellent means of fetal surveillance and identifies a group of patients at increased risk for adverse perinatal outcome and small for gestational age infants.
Kamel, Makhlouf and Youssef (2015) conducted a comparative study to assess whether simplified non invasive procedure is an effective antepartum fetal screening test. The study was conducted by faculty of medicine in Assiret University, Egypt. The test was compared with the ultra sound and non - stress test for predicting abnormal outcome. The sensitivities of the ultrasound, non stress test and the
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proposed test were 100 %, 98.4 % and 100 % respectively. This showed that ultrasound is a good negative preliminary screening test.
Petrovic, Skunca and Matejcie (2014) conducted a prospective study at department of obstetrics and genecology, university of Rijekn, Croatin to modify the classic fetal non invasive methods with the aim of obtaining rapid and accurate information about fetal condition in non - compromised fetus with a subsequent favourable outcome and to be suitable for a out clinic patient Result showed that of the examined fetus, 326 fetuses in the control group were monitored by the non invasive methods and there are 316 (96.9 % ) favourable outcomes and 10 (3.1%) adverse perinatal outcome. In the study group of 168 fetuses there were 165 (98.2 %) favourable outcomes and 3 (1.8%) adverse perinatal outcome.
Steen Neldan (2013) conducted a study to assess the importance of fetal movement as an indicator of fetal well being. The value of maternal monitoring of fetal movement was assessed in 2250 pregnant women. Half of the women were taught to count fetal movement, methodically and contact the hospital if they felt less than three movements per hour. These results demonstrated the maternal monitoring of fetal movement can aid the opportune delivery of infants who are at increased risk of intrauterine death.
Muggli and Halliday (2014) conducted a longitudinal study in Royal Children's Hospital, Victoria to describe patterns of uptake of prenatal diagnostic testing and prenatal detection rates for Down Syndrome with regard to maternal age .Results showed that, utilization of prenatal diagnosis in women less than 37 years increased significantly, where as in olden women it has fallen from 65.1 % to 42.7 %.
This shows that, current prenatal screening practices provide a more effective risk assessment for Down syndrome and indication for prenatal diagnosis than advanced maternal age.
Yaron et al (2017) conducted a study to determine whether second trimester non invasive diagnostic procedure predict the pregnancy outcome. A total of 60,040 patients underwent non invasive diagnostic measurements. The incidence of various pregnancy outcomes were evaluated according non invasive methods by using clinically applied cut of points. Results showed that, were found to be significantly associated with intrauterine growth retardation, intrauterine fetal death,
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oligohydramnios and abruptio placentae. Increased beta human chorionic gonatrophin level were significantly associated with miscarriage, preterm delivery and intrauterine fetal death. Non invasive procedure can be used not only for the detection of fetal anomalies and aneuploidy but also for detection of high-risk pregnancies.
Milunsky A (2016) conducted a prospective study of non invasive procedure screening to assess the overall predictive value, sensitivity, specificity, and relative risk for congenital defects and complications of pregnancy. Among 13, 486 women with the single tone pregnancies interviewed at the time of screening (15 to 20 weeks of gestation) 3.9 % had high and 3.4% had low values. This result showed that non invasive procedure screening provides an important adjunctive tool for the identification of high risk pregnancy and adverse neonatal outcome.
LR Evertson, RJ Gauthier, et.al (2015), conducted a comparative study on new antepartum fetal heart rate protocol that was put into clinical use. In this study contraction stress test and a new concept of non stress test are included. The non stress test was based on fetal heart rate response associated with fetal movements and was categorized as reactive (normal) or nonreactive (abnormal). The nonreactive fetus was then evaluated with a contraction stress test if not contraindicated. A reactive non stress test was as predictive of good outcome .Also, some non reactive fetuses became reactive with oxytocin and showed good outcome. These observations were utilized in the development of a newer, shorter non stress test which allows for fetal stimulation in an attempt to further define fetal well-being.
Maryam Zangeneh, (2017) conducted a longitudinal study to a non-stress test. It is the first step to determine fetal well being. This study was conducted on 323 pregnant patients, referred to Motazedi Hospital, Kermanshah, Iran to justify the non- stress test's strength. 33.1 % were stricken by a fetal distress and 9.9% by meconium passing, around 5 % by an Apgar below even, 5.3 %were hospitalized at the NICU, and 86.4% were delivered by the cesarean section
Dr Ajit B Deshpande, (2015) conducted comparative study on antepartum fetal surveillance were invented which have contributed significantly to the striking reduction in perinatal mortality and morbidity. Non stress test is one such biophysical technique which is widely used in management of high-risk pregnancies. With this view the efficacy of non stress test in high-risk pregnancy in Indian Population was
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analysed. In the present study, 100 patients with high-risk pregnancy were studied using electronic fetal monitor; Non stress test was used primarily as an indicator for antepartum fetal surveillance. 51 % of the patients included in the study were prime gravida. Out of four patients with bad obstetric history, two patients were fifth gravid and two were sixth gravida: We are able to save the babies in cases of non- reactive non-stress tests by prompt termination of pregnancy when the baby was salvageable.
Chii-Wann Lin, (2016) A comparative study of fetal Monitoring the evaluate the fetal well being of the fetus during pregnancy and in labor. Computerized analyses can mitigate the intra-observer and inter-observer variability of visual CTG recording explanation, decrease the examination time, and the need of additional tests for fetal health. The signal processing methods utilized in this study are median filter and peak/valley detection method. The accuracy of FHR baseline, baseline variability, early deceleration, UC frequency and NST all reach 100 %. The accuracy of acceleration frequency reaches 90%. The accuracy of late and variable decelerations reaches 95%.
Trupti J. Dhakare1* and Kiran P. Patole, (2014) conducted a prospective study of cardiotocography during labor to assess the fetal well being and perinatal outcome in high risk pregnancy. Prospective observational study was conducted on 105 high risk pregnant fulfilling the eligibility criteria and written informed consent..
CTG monitoring was done during labor. The results of CTG were, Perinatal outcome were studied by Apgar score, NICU admission. CTG appears to be a simple non- invasive test that can serve as a screening tool in assessing fetuses of high risk obstetric patients in hospitals/centers with a heavy work load and limited resources.
Spoorthy, K. Arunakumari, (2018) conducted a prospective randomized study on fetal well being to pregnant women in labour who were admitted to labour room. The mean age group of the patient is 23 years and mean gestational age is 37.77 weeks. In this study, 125 (62.5%) belong to high risk group and 75(37.5%) belong to low risk group. In the present study normal CTG was seen in 59.5 %, suspicious CTG in 11% and pathological CTG in 29.5% in low risk group and in high risk group normal CTG was seen in 51.2 %, suspicious CTG in 9.6% and pathological CTG in 39.2%. Incidence of MSL was more in women with abnormal CTG finding in both low and high risk women.3 NICU admissions were 55.9% in patient with
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abnormal CTG as compare to 1.7% in normal CTG patterns.4 The sensitivity, specificity, PPV and NPV of CTG in Prediction of low APGAR score at 5 minutes was 93.75%, 80.13% , 50.84 % and 98.31 % respectively.
Joseph de Graft-Johnson, (2014) conducted a cross-sectional study of partograph allow for early identification of Fetal condition, abnormal labour and referral for advanced care to Emergency Obstetric Care (EMOC) facilities. A systematic assessment of the quality of partograph utilization in clinical-decision making will contribute to understanding the use of the tool by health workers...
Interviews with health workers revealed poor interpretation of referral indications from the partographs. Limited accessibility to the nearest EMOC facility, inadequate time for referral, and noncompliance to referral by clients were identified by the interviewed health workers as the key barriers for referral decision making
Deepti D. Sharma*, Kavita C. Chandnan, (2016) conducted a retrospective study to assess the clinical findings in IUGR with colour Doppler and perinatal outcome, to study prognostic efficacy of Doppler parameters in early detection of fetal compromise The sensitivity and this specificity of (78%, 93 % ) as an indicator for extent of fetal compromise in IUGR was highest. Non reactive non stress test was shown to have positive predictive value of only 24% with false positive rate of 75 %.
Colour Doppler study is a simple, quick, non invasive procedure and multiple vessel study has high accuracy among the other tests for ante partum foetal surveillance.
Mojgan Barati, Nahid Shahbazian, (2014) conducted a cross-sectional study. To assess the fetal well being through Doppler study. Three hundred and seventy-nine women with singleton pregnancy, between the age of 18 and 40 years at 32 to 36 weeks of gestation for pregnancy complications such as pre-eclampsia, small fetus for gestational age, intrauterine fetal death, preterm delivery, and other adverse outcomes.. There were 17 cases (4.5 %) of abnormal uterine artery Doppler results and 15 of them (88.2 %) developed pre- eclampsia and four cases (23.5%) had neonates small for gestational age.
David J Taylor, (2017) The conducted a longitutinol study to quantify and compare longitudinal uterine artery blood volume flow changes in appropriate for gestational age (AGA) pregnancies and those complicated by intrauterine growth restriction (IUGR). The diameter of the proximal uterine artery just after it crosses the
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external iliac artery was smaller in the IUGR group from as early as 20 weeks of gestation but this difference only became statistically significant from 24 weeks of gestation and widened as pregnancy advanced.
Rachel Nall RN, (2015) conducted a prospective study to assess the effectiveness of fetal heart rate by using of nipple stimulation. By doing of nipple stimulation, uterine contraction is increased simultaneously the fetal heart rate also increased. For this study result shows the mother felt fetal heart rate through nipple stimulation.
Dr.P. Olofsson A. (2015) conducted a prospective study to assess the fetal heart rate by using oxytocin challenge test. One woman was excluded because of a positive OCT with reactive fetal heart pattern. We carried out simultaneous electronic fetal monitoring and Doppler velocimetry of uterine and umbilical artery flow during the OCT. The uterine artery flow resistance increased significantly during contraction in both OCT positive (n- 5) and OCT- negative (n 15). The study showed that fetal heart decelerations during the OCT are associated with rapid and exaggerated increased of vascular resistance in both uterine and umbilical arteries
V. Gomathi (2016) conduct a comparative study was to evaluate and compare the usefulness of colour Doppler velocimetry NST in predicting the perinatal outcome in severe preeclampsia and fetal growth restriction. The study population comprised of 90 singleton pregnancies beyond 30 weeks of gestation complicated by severe preeclampsia, fetal growth restriction or both were prospectively examined with serial colour Doppler of NST. The results of last Doppler and NST within one week of delivery were correlated with perinatal outcome. The data were analyzed using Chi square test after Yate's correction colour Doppler is useful in recognizing fetal compromise earlier than NST, giving a lead time which is important in the management of preterm high risk pregnancies such as severe preeclampsia and fetal growth restriction.
Nirmala Shivalingaiah (2018) conducted a comparative, non-randomized study done over a period of 18 months on 150 pregnant women between gestational ages of 34-42 weeks. Ultrasonography was done for all women was calculated by four quadrant technique. Umbilical artery Doppler velocimetry was done. There was increased incidence of intrauterine growth restriction (IUGR), fetal distress and NICU
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admission in cases with AFL, abnormal umbilical artery Doppler velocimetry had higher incidence of IUGR, LSCS for fetal distress and NICU admissions compared with normal umbilical artery Doppler. Umbilical artery Doppler velocimetry in cases with oligohydramnios would help in identifying high risk cases for poor perinatal outcome. Hence, all patients with oligohydramnios, umbilical artery Doppler should be done to recognize the compromised fetus and thus reducing the perinatal morbidity and mortality.
Conceptual Frame Work
Conceptual frame work is representing a less formal and less well developed mechanism for organizing phenomena than theories. It deals with abstractions that are assembled by virtue of their relevance to a common theme. A model is used to denote symbolic representation of concepts.
The present study is intended to evaluate the effectiveness of structured teaching programme in terms of improving the knowledge of staff nurses regarding non invasive diagnostic procedures used to assess the fetal well being at Ashwin Hospital.
The framework of the present study is based on Widenbach’s Clinical Nursing Practice-A helping Art, modified by the investigator.
The 3 components of Widenbach’s theory are
Identification of a Need For Help
Ministering the Needed Help
Validating that need for help was met.
Identifying of a Need ForHelp
Determining need for help based on the existence of a need. In thispresent study identifying and determining the staff nurses need for help based on the existence of knowledge. It consists of following components to identify the needs.
They are central purpose prescription and realities.
23 General information
This comprises the demographic variables
Central purpose
Central purpose is to improve the knowledge Prescription
It refers to develop a plan. In this study the investigator plans todevelop a structured knowledge questionnaire to assess the knowledge level of the staff nurses on non invasive diagnostic procedures and develops a structured teaching programme on non invasive diagnostic procedures used to assess the fetal well being in Ashwin Hospital.
STEP 2: Ministration the Help Needed
Refers to provision of a needed help. In this study the investigator prepares a plan in helping to meet the needs of staff nurses with non invasive diagnostic procedures based on available resources. Investigator administers a structured teaching programme regarding non invasive diagnostic procedures to staff nurses that helps them to improve their knowledge status and prevent further complications.
Agent:
In this study investigator is the agent who administers the structured teaching programme regarding non invasive diagnostic procedures used to assess the fetal well being to enhance staff nursesknowledge.
Recipient:
In this study staff nurses are the recipients.
Goal:
It is the nurse’s desired outcome. In this study the investigator’s goal is to identify the effectiveness of structured teaching programme regarding non invasive diagnostic procedures used to assess the fetal well being among staff nurses.
24 Means:
Are the activities and devices used by the nurse to achieve the goal. In thisstudy it is the pre-test and the post test conducted after the administration of structured teaching programme to assess its effectiveness.
Framework:
It refers to facilities in which nursing is practiced. In this study it is Ashwin Hospital, Coimbatore where the study has been done.
STEP 3: Validating need for help was met
It refers to collection of evidence thatshows the client’s need have been met and that his functional ability has been restored as a direct result of the nurse’s action.
In this study the investigator perceives that a need for help was met when staff nurses provides convincing evidence that their knowledge is improved with the help of structured questionnaire (post-test) on non invasive diagnostic procedures used to assess the fetal well being. This shows that STP is effective. If it is not effective the nurse reassesses and prescribes the intervention based on patient’s need.