“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING INFECTION CONTROL MEASURES IN LABOUR ROOM AMONG FOURTH YEAR BSC NURSING STUDENTS IN SELECTED NURSING COLLEGES OF TUMKUR.”
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
M. PRIYA OBSTERICS AND GYNAECOLOGICAL NURSING
ARUNA COLLEGE OF NURSING RING ROAD, MARALUR, TUMKUR
1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1. Name of the Candidate : MISS. M.PRIYA And Address MSc Nursing Ist Year Aruna College of Nursing Ring Road, Maralur Tumkur.
2. Name of the Institution : Aruna College of Nursing
3. Course of Study And : MSc Nursing Ist Year Subject Obstetrics & Gynaecological Nursing
4. Date of Admission : 10.06.2009
5. Title of the Topic : “A Study to assess the effectiveness of structured teaching programme on knowledge and practice regarding infection control measures in labour room among fourth year BSc Nursing students
2 in selected nursing colleges of Tumkur
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“We are always looking for better ways to serve birthing women.”
Raymond derives “Advanced education creates a more powerful workforce.”
Pregnancy and child birth are the most important events of a women’s life. Pregnancy, delivery is a normal physiological process. Most of the time the women achieves normal pregnancy outcome without any complication. But too many mothers and children in the world are dying and suffering from the effects ill health, poor nutrition and inadequate health care. Many of the deaths could be prevented using existing knowledge and affordable tools.1
WHO reported that every minute a mother dies from complication in pregnancy and child birth that means 1400 mothers die every day more than half a million mother die every year. The birth of baby is a momentous occasion in the life of a couple. The aim of modern management of labour should be to ensure optimum condition for the mother and the fetus during and after delivery as well as emotional satisfaction of all involved. The place of delivery plays an important role in child survival and safe motherhood. The child born in unhygienic condition is more to get infection. A properly assisted delivery with skilled personnel and following aseptic precaution is highly advantageous to both mother and fetus during delivery.2
3 Health can be neither be demanded nor given, It can be neither be bought, nor sold; but the circumstances and services that are prerequisite to health can certainly be demanded and received as a right. A protective environment in the hospital unit is very essential as a prerequisite particularly, when considering the services provided in the labour room provision for a safe and protective environment is a priority need.3 Puerperal infection is defined as a bacterial infection originating in the reproductive tract during labour or the puerperium. Mode of transmission of puerperal infection are carelessness regarding hand washing, numerous Vaginal infections, breaks in aseptic techniques, improper perineal care, prolonged labour, especially with ruptured membranes. The common micro organisms of puerperal infections are bacteria that are present in the hands of attending health care personnel or in the labour room. i.e E.coli, Proteus, Mycoplasma, N.gonorrhea4.
6.1 NEED FOR THE STUDY
“Right practice is the safest investment towards hazard-free care.”
Today’s student nurses are tomorrow staff nurses who can contribute themselves more in the field of treatment. But today this nursing curriculum does not give much importance to infection control measures, so naturally student have less exposure to that field make them vulnerable in knowledge and practice. “Educating these students and creating awareness in helping them to learn more about infection control measures in labour room, and they will be able to control the infection in the labour room.
WHO, UNICEF, UNFPA reported that in 2008, there are 5,29,000/year maternal death in 13 countries. The causes for maternal deaths are hemorrhage, PIH, puerperal sepsis are direct causes for maternal death5.
Puerperal sepsis is the 2nd leading cause for maternal mortality i.e. 19.2% of maternal death due to puerperal sepsis. Worldwide the puerperal sepsis rate is 15%. In our India the puerperal sepsis rate is 11%. In our India maternal mortality rate is 5.29 lakhs 1.36 lakhs due to puerperal sepsis. In December 2008 in our India 16% peoples
4 were died by maternal complications. The main cause for this is PIH, hemorrhage, sepsis, anemia, abortion in this 50 to 71% peoples were died in the post partum period. In 2008 UNICEF stated that there are 880 HIV cases are positive by mother to child transmission. Especially in 17% of case of HIV was transmitted during labour because lack of aseptic techniques6. In 2010 MMR was reduced to less than 100. The suggestion were 3 antenatal checkup, 3 postnatal check up, clean safe delivery, given by National health and family welfare department. Services to make motherhood safe include care by skilled health personnel, aseptic delivery, before, during, after, child birth, health education for women their families and decision makers. Most maternal deaths and pregnancy complication can be prevented, if efficient care is given during perinatal care7.
Nursing personnel working in the labour room unit should be knowledgeable and skilful in prevention of maternal infection. The Nursing personnel fail to adopt the infection control techniques then it will leads to septicemia and maternal death. In order to reduce the maternal mortality rate the midwifery students (at the base level) should be knowledgeable and skillful in providing infection free nursing care. So the nurses concerned with care and prevention of infection occurring through all sources, they hold a responsible position of involvement., So they have an important role in the prevention of infection in labour room. So the student midwifes has to be knowledgeable and as good practice activities, regarding Infection control measures in labour room to prevent the puerperal infection8.
The investigator was observed that many times midwife students fail to practice aseptic techniques in labour room. Practice of hand washing which is the single most important measures in prevention and spread of infection from one person to other is not being done often. Another important area of concern is where midwifery students should be careful in doing vaginal examination, conducting delivery, aseptic precaution is very important to prevent introduction of infection for the mother. The recognition of ignorance is the beginning of wisdom’s. To understand the degree of knowledge and related practices to help in future improvement thus the investigator felt that need to take
5 up the study i.e to assess the knowledge and practice among midwifery students in selected nursing colleges.
6.2 REVIEW OF LITERATURE
“Perfect tools are essential to validates perfect performance.”
Review of literature is the reading and organizing of previously written materials relevant to the specific problem to be investigated; frame work and methods appropriate to perform the study (Polit D.F.and B.P.Hunglur)9.
A study was conducted on knowledge application and confidence with standard and additional precaution in infection control in Taiwan university of midwife students(2009), A specific tool, the infection control evaluation was developed and distributed. A cross-sectional survey was conducted. The results were based on an 88% response rate and indicated that level of knowledge concerning standard and additional precaution was low among Taiwan midwifery students. Their ability in applying these precautions in clinical practice also appeared to be inadequate. Such findings indicate that Taiwanese preservice nursing students required comprehensive foundation course in infection control precaution before they enter the clinical environment. This will help to ensure their protection and that of their patients. As the findings highlights the importance of providing such information for students before they undertake any clinical work, the information provided here can help nursing educators to develop specific program10.
A study was conducted on knowledge and source of information among midwifery students regarding prevention of Nosocomial Infection and standard precautions.
6 (2008). The objective of the study is evaluate the knowledge of midwife students after four curricula on infection control and to identify sources of information to measure students knowledge of infection control and their resources of information, 6 multiple choice questions were asked about 3 specific areas. Standard precautions, hand hygiene, and Nosocomial infection. 350 midwifery students were included in the study. Midwifery students had mean overall score 23.2, the mean score for the component section of questionnaire were 3.5 for standard precaution, 7.4 for hand hygiene, 5.7 for Nosocomial infection. The overall score for infection control indicated that instruction was effective, ward training for daily infection control practice would be improved for health care students11.
A study was conducted on knowledge practice among ironies nurse, midwifes students regarding standard isolation procedures in labour room at Iran (2007). The goal was to assess the knowledge and practice regarding infection control measures and standard precaution among a group of nursing and midwifery students in Iran. A survey questionnaire was completed by 273 midwife students and nurses at shiraz university of medical sciences during the period from May to Nov 2002. 231 (90.9% ) of the participants reported that they need additional infection control education especially on standard isolation precaution. There was a linear positive correlation between knowledge and practice for the group of Nursing, midwifery students. Our study shows that there is an urgent need for evaluating education on infection control practices and standard precautions in general as well as for structured teaching programme regarding infection control programme among midwifery students12.
A study was conducted on accidental exposure to blood in midwifery students in Tehran university(2007). Health care workers and midwifery students are at risk of exposure to blood borne viruses such as HCV, HIV, HBV. Here the results of the survey are of the frequency and cutaneous blood exposure students among midwifery students. A definite exposure was defined as injury by a sharp object causing obvious bleeding, where as possible exposure was defined as subtle or superficial injury due to contact with a contaminated instrument or needle but without bleeding or contamination of an existing
7 wound with blood or other body fluids. 92% (184) subject were responded to questionnaire. We recorded 121 definite exposure and 259 possible exposure over a mean time interval of 14 months13.
A study was conducted on mentors hand hygiene practices influence midwife students hand hygiene in America (2006). A quasi experimental study conducted among 60 students enrolled in a certified Nursing program were selected to participate in the study. The mentor’s practice of hand hygiene was the strongest predictor of the student’s rate of hand hygiene for both observational periods P<(0.01). Students prior without medical experience had a significant increased hand hygiene rates when comparing observational period 1 to observational period-2. Students reported strongly positive attitude toward hand hygiene is very low14
A cross sectional study was conducted on the prevalence of needle stick injuries in midwifery students, nursing, medical at the university of teaching hospitals of shiraz University at Iran (2006). The students were evaluated Needle stick injuries and practices regarding protective strategies against blood born products in midwifery students at shiraz university. The questionnaire was completed by 688 (53%) students. 71.1% of the students had Needle stick injuries that most commonly occurred in patient room, non-reporting of Needle stick injuries were highly prevalent in these students. Education about the transmission of blood-borne infections, standard precautions and increasing availability of protection strategies must be provided15.
A Study was conducted on knowledge practice towards standard isolation precaution in Iranians midwifery university students (2004). A questionnaire was filled out by 465 midwifery students in their study. Their mean knowledge, practice in level of standard isolation precaution were 6.1, 2.3, statistically significant positive correlations were observed between knowledge and practice ninety percents of midwifery students in shiraz had received no education of students regarding isolation precaution and 75% of respondents wanted more education on standard isolation precaution. Education on
8 infection control issues should not only be focused on health care workers but should also to the midwifery students16.
A study was conducted on accidental exposure to blood by midwifery student in 2003. 241 hospital took part in national survey of blood borne injuries. The data were processed by the co-ordination center for the fight against Nosocominal infection. 6973 blood borne events reported during 2003 were signed by midwife students. The 1st 3 most frequent accidents reported were ocular protection during child birth, pricks when repairing episiotomy pricks or cuts when soiled instruments. Improving knowledge of risk as well as promotion of protection measures well adapted to this profession should be helpful in optimizing future attitudes17.
A study was conducted on knowledge perception and practice with regards to occupational risk of HIV among midwifery students at babcock university in Nigeria (2002). Midwifery students constitute a sub group of health care providers exposed to occupational risk of HIV infection because of direct contact with blood and body fluids during clinical practice. The study utilized both quantitative and qualitative method to gather information from midwifery students. The results showed a poor knowledge of WHO recommended universal precaution for preventing HIV transmission among students in all colleges18.
A study was conducted on knowledge and performance of the universal precaution by midwife students on 2001 in Korea St Mary Hospital. 714 midwife students were participated for the period between Nov 2, 1998 to April 30, 2001. The average knowledge level of universal precaution was 267.8 the correlation between knowledge and performance of the universal precautions showed a weak and positive correlation (r=0.319). The study demonstrated that the knowledge level of nursing midwifes about universal precaution was low. The group that receives education about universal precaution has a higher level of knowledge and prefer of the universal precaution than that group that receives no such education19.
9 A study was conducted on midwife students knowledge of universal precaution on 1993 in Washington. The 151 4th year students of the class at the Washington were given a questionnaire. The questionnaire were completed by 139 (81%) of the students. The mean % of correct answers by the responding students was 67% for 5 of 10 procedures from 104 to 123 of the students reported the proper level of protection. The result of the study was worrisome, because many students before they graduated lacked adequate knowledge of universal precaution during study period. So infection control education is needed20.
A study was conducted on perinatal continuing education program its effect on knowledge and practice of health care professionals on 1995. Test data were derived from health care providers 24 hospitals. Teaching programs of perinatal continuing education pretest and post test scores at the P<0.001 level for each group of providers studied. A continuing education program delivered. To a multi disciplinary group of health care providers can increased knowledge and improve perinatal care to newborns21.
6.3 STATEMENT OF THE PROBLEM
A study to assess the effectiveness of structured teaching programme on knowledge and practice regarding infection control measures in labour room among IVth year BSc(N) students in selected Nursing colleges of Tumkur.
6.4 OBJECTIVES
To assess the knowledge of IV the year BSc Nursing students regarding infection control measures in labour room.
To identify the practice of IVth year BSc(N) students regarding infection control measures in labour room.
10 To educate the students with structured teaching programme regarding infection control measures among IVth year BSC(N) students.
To evaluate the effectiveness of structured teaching programme on knowledge & practice regarding infection control measures among IVth year BSc(N) students.
To associate the demographic variables with knowledge and practice regarding infection control measures. 6.5 OPERATIONAL DEFINITION
Assess: It is the organized, systematic and continuous process of collecting data from the IVth year BSc(N) regarding infection control measures.
Effectiveness: It refers to the extent to which the structured teaching programme on infection control measures in labour room has achieved. The desired effect in improving the knowledge and changing the practice of IVth year BSC(N) as evident from gain in knowledge score and change in the practice score.
Structured Teaching Programme: It refers to systematically developed instruction designed to provide information regarding infection control measures to IVth year students
Knowledge: The sum of what is known regarding infection control measures.
Practice: It refers to actual activities done by the midwifery students to control the infection.
Infection Control: The utilization of procedures and techniques to reduce the spread of infection. Particularly hospital acquired infection.
Labour Room:.It refers to where the labour (delivery) process was going to take Place.
IVth year BSc Nursing students It refers to those who are studying final year
11 BSc Nursing in selected nursing colleges.
6.6 HYPOTHESIS
H1 There will be significant relationship between knowledge and practice regarding infection control measures in labour room among midwifery students.
H2 There will be significant relationship between structured teaching programme and the changes in knowledge and practice of infection control measures among midwifery students.
H3 There will be significant association between the knowledge and practice with selected demographic variables of the BSc(N) students such as age, sex, religion, family, income, etc.,
7.0 MATERIALS AND METHODS
The purpose of this study is to determine the effectiveness of structured teaching programme on knowledge and practice regarding infection control measures among IVth Year BSc(N) students in selected Nursing Colleges of Tumkur.”
7.1 SOURCES OF DATA
Research approach : The Pre experimental approach is used for the study
Research Design : One group pretest and post test pre experimental design is used
Setting of the study : Selected Nursing Colleges of Tumkur
12 Sample Size : 60 students
Sampling Technique : Simple random sampling
Selected Variables
Independent variable : Structured Teaching Programme
Dependent Variable : Knowledge and Practice of Infection
control measures.
Demographic variable : Age, Sex, Family income, Religion
Sampling criteria
Inclusion criteria Student who are studying IVth year BSc(N) Students who are willing to participate
Exclusion Criteria Students who are not willing to participate Students who are not available at the time of study.
7.2 METHODS OF DATA COLLECTION
13 7.2.1 Tools for data collection : Structured questionnaire
Tool 1 Part A : Proforma for collecting demographic Data
Part B : Structured questionnaire to assess the knowledge and practice on infection control measures in labour room
Tool 2 : Structured teaching programme
7.2.2 METHODS OF DATA ANALYSIS AND INTERPRETATION
Data will be analyzed according to the objectives of the study using descriptive and inferential statistics and will be presented in the form of tables, graphs and diagrams.
7.2.3 Duration of the study : 6 weeks
7.3 Does the study requires any investigation or intervention to be conducted on the patient or other human being or animals. If so please describe briefly
NO
7.4 Has ethical clearance been obtained from your institution in case of the above?
Yes Ethical clearance has been obtained from the institutions ethical committee.
14 8.0 LIST OF REFERENCES 1. Wong and Perry, Maternal and child Nursing care library of congredd.Cataloging in publication data:2006.
2. Child survival safe Motherhood 1992. Care at the time of delivery. Ministery of Health and family welfare.page No 29.110.
3. Maherbin Singh. Care of Newborn.6th edition. Sagar publication ; 2004. 56-57.225
4. Katharine, Amay.etal.Maternal and Neonatal Nursing.3rd edition ; page no. 270
5. K.Park.Textbooks of preventive and social medicine.Banarsidas publication.19th edition ; Page no.450-453
6. http://nvonews.com./national-seminar-gynaec women-medicon 2008.
7. http://india.gov.in/sectors/health-family/maternl-health.PhP.
8. Bready MT.Health care associated infections in labour Room.Journal of infection control 2005 June ; 33(5).265-75
9. Polit Denise and Hungler.Nursing Research Principles and method.J.B.lippincott company 1991 ; page no 40.
10. WU CJ, Garden GE, changAMetal. Knowledge application and confidence with standard and additional precautions in injection control Journal clinical nurse 2009 April ; 18(8): 1105-12
11. Tavolacci MP.Ladner J. etal \. Prevention of nosocomial infection and standard precautions knowledge and source of information among midwifery students . Infection control.Hospital epidemiology 2008.July ; 29(7) : 642-7
15 12. Menishza, Khan A A, Knowledge.Practice among Iranian midwife students regarding standard isolation precautions. Infection control Hospital epidemiology 2007.Feb : 28 (2) : 241-4
13. Sheriati B, oveyST T, etal. Accidental exposure to blood of Tehran university of Medical sciences among midwife students. Journal of occupationalhealth.2007. July ; 49(4). 317-21
14. Snow M. white GL Jr et.al. Mentor’s hand hygiene practices influence student’s hand hygiene rates. American Journal of infection control.2006.Feb;34(1): 18- 24.
15. Askarian M. Malakmakan L.The Prevalence of Needle stick injuries in midwifery students. Indian Journal of medical sciences.2006.Jan 60 (6). 227-32.
16. Honarvar B, Tabatabace HR. Knowledge. Practice towards standard isolation precaution in Iranian midwife students. Journal hospital infection.2004 Dec ; 58 (4) 292-6.
17. Vincent A. Cohe n. etal. Accidental exposure to blood by midwife students. Journal gynaecology obstetrics biological reproduction 2003 May ; 35(3) : 247-56
18. Atulomah.No. oladopoo.knowledge, Perception and practice with regards to occupational risk of HIV among midwifery students. African Journal medical science.2002 Sep ; 31(3) : 223-7
19. Kim KM. chung ys et al. department of hospital infection control.st.mary hospital.American Journal infection control.2001 oct ; 29(5) : 295-300.
20. Bauer, B.,&Kenney,J.Adverse exposure and use of universal precautions among Perinatal Nurses. Journal of obstetrics,gynaecologic and Neonatal nursing, 1993 ;22 ; 429-435
16 21. Haris JK,Yates B.etal. A Perinatal continuing education program : its effect on the knowledge and practice of midwifes students. Journal of obstetrics gynaecology. Neonatal nurses. 1995.Nov-Dec ; 24(9) : 829-35
17 9. Signature of Candidate :
10. Remarks of the Guide :
11. Name & Designattion :
11.1 Guide :
11.2 Signature :
11.3 Co-Guide (if any) :
11.4 Signature :
11.5 Head of Department :
11.6 Signature :
12. 12.1 Remarks of the Principal :
12.2 Signature :
18 19