http://doi.org/10.33698/NRF0270-Harshpinderpal Kaur, Parvesh Saini

ABSTRCT:

Introduction: Labor is a process of giving birth to a child. It is the most wonderful moment in women’s life and comes after the anticipated period of uncertainty, anxiety and fear. Hence the continuous monitoring is very important. Partograph is graphic method of monitoring the progress of labor and it is very important for doctors and nurses to ll, understand and interpret partograph. Objective: To assess the knowledge and practice regarding partograph among staff nurses working in labor room. Methodology: This descriptive study was conducted among 60 staff nurses working in the labor room selected by using purposive sampling from SGRD Hospital Vallah and Civil Hospital, Amritsar, Punjab. The data was collected by using knowledge questionnaire and expressed practices on partograph. The obtained data was analyzed by using descriptive and inferential statistics. Results : The ndings revealed that 75 % staff nurses had average knowledge and 25% had good  knowledge regarding the partograph where as in practice of partograph, half of staff nurses (51%) had average practice and 15% staff nurses have good practice. There was week positive correlation between the knowledge and practice. Conclusion : The study concluded that staff nurses were decit in both knowledge as well as in practice regarding partograph. Hence, there is need to plan in-service education for enhancement of the knowledge and practice regarding partograph.

Key Words: Knowledge, Practice, Partograph, Staff Nurses.

Correspondence at:

Dr. (Mrs.) Parvesh Saini Professor and Principal

Sri Guru Ram Das College of Nursing, Vallah, Amritsar

Introduction:

Labor is although a natural process but complications can arise at any time during its course.1 In this process a series of events take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world. A parturient is a patient in labor and parturition is the process of giving birth. Delivery is the expulsion or extraction of a viable fetus out of the womb. It is not synonymous with labor; delivery can take place without labor as in elective cesarean section. Delivery may be vaginal, either spontaneous or aided or it may be abdominal.2

Complications during childbirth usually arise without warning and cannot be predicted or prevented. Thus, all women should have access to skilled birth attendant and timely emergency care. Prolonged labor and obstructed labor are major causes of maternal and newborn morbidity and mortality; they can lead to ruptured uterus, postpartum hemorrhage, infection, obstetric stula, and fetal injury or death. However, information about prolonged and obstructed labor is incomplete. The reported incidence of these conditions varies widely, ranging from as low as 1% in some populations to as high as 20% in others; in 2000, about 42,000 deaths, or 8% of maternal deaths, were attributed to prolonged and obstructed labor because vital registration information is often lacking in settings where prolonged labor, obstructed labor, and maternal deaths are common, the incidence of these conditions may be signicantly under reported.3 Apart f rom mortality there i s signicant morbidity due to complications of labor like obstructed labor, sepsis, postpartum hemorrhage ruptured uterus and urinary stula. Obstructed labor is a major precedent of prenatal death. A partograph can help the health care professionals in timely identication of obstructed labor. Hence can protect the mother and child from morbidities due to obstructed labor. Every year, out of an estimated 120 million pregnancies that occurs Worldwide, about half a million women die from the complications of pregnancy and childbirth. India ranks very high on the list of countries with high maternal mortality at 155 per 100,000 live births in 2012.4

The partograph provides information about deviations from the normal progress of labor and about abnormalities of maternal or fetal condition during labor. It alerts care providers when a woman may need an intervention (e.g., referral to a higher-level facility, labor augmentation, and cesarean section) and facilitates ongoing evaluation of the effects of those interventions. While several versions of the partograph have been developed, they share common elements and purposes. Since 1991, the World Health Organization has designated management of labor with the partograph as one of the essential elements of obstetric care at the rst referral level.5

In many countries, midwives and obstetricians enthusiastically embrace and use the partograph. The provider must use critical thinking skills to interpret this information and then make appropriate clinical decisions based on evidence and established protocols. It should be introduced at hospital and health centers where staff with appropriate skills and training are available. Partograph is a record of all the observation made on a woman in labor, the central feature of which is the graphic recording of the dilatation of the cervix assessed by vaginal examination. There are three main components of partograph Fetal condition Progress of labor Maternal condition, Fetal heart rate is recorded 1 hourly during rst stage and every 30 minutes in 2nd stage of labour with the range of 100-180/min ,State of membranes and color of liquor, cervical dilatation, descent of the head , Uterine contractions , Drugs and uids , Blood pressure at every 2 hours and pulse at every 30 minutes, Oxytocin – contraction in upper box and dose in lower box , urine analysis , temperature record.6 Geetha C, Saranya. et al ( 2013 ) Conducted a descriptive study to assess the knowledge and practice of 30 Staff nurses selected by random Sampling Method. A structured questionnaire on knowledge, and checklist for practice was administered . The major ndings of the study related to knowledge on Partograph, were 9 (30.0%) of respondents belongs to good, 17 (56.7%) of respondents belongs to poor, and 4 (13.3%) of respondents belongs to very poor level of knowledge on Partogram.7

Fawole et al ( 2012) conducted a cross sectional study to assess the knowledge and utilization of the partograph for 719 health care workers from primary, secondary and tertiary levels of care over a period of one year in South Western Nigeria and the results revealed that only 32.3% used the partograph to monitor women in labor and partograph use was reported signicantly more frequently by health care workers in tertiary level compared with health care workers from primary or secondary levels and concluded that the knowledge about partograph is poor among the health workers and partograph is commonly not used to monitor the women in labour8 Since the use of partograph is very important in timely identication of problems during labor the need was felt to conduct a study to assess the knowledge and practice regarding partograph among staff nurses working in labour room of selected hospitals, Amritsar, Punjab.

Objective:

To assess the knowledge and practices regarding partograph among staff nurses working in labor room of selected hospitals,

Amritsar, Punjab.

Methodology:

A Descriptive study was conducted at SGRD Hospital and Civil hospital, Amritsar, Punjab. .Total 60 staff nurses working in the labor room of selected hospitals was taken by purposive sampling technique. Ethical Clearance was taken from the research and ethical committee of SGRD hospital, Amritsar and permission to conduct study was taken from Head of department (HOD) of obstetric and gynecology. Tool was prepared after an extensive review of literature and after consulting the subject experts. The tool consists of 3 parts:- Part A : personal prole s t aff nurses, Part B: Knowledge questionnaire including 30 questions related to knowledge regarding Partograph. For correct answer 1 mark is given and for wrong answer 0 mark is given.Total 30 items and total score is 30. The score of 0-10 score was categorized as poor knowledge, 11-20 score was categorized as average knowledge and 21 – 30 score was categorized as Good knowledge. Part C : Practice checklist comprising of 9 items. For correct answer 1 mark is given and for wrong answer 0 mark is given. Total 9 items and total score is 9. The score 0-3 was categorized as Poor practice, 4-6 score was categorized as Average practice and 7-9 score was categorized as Good practice.

Data was collected from 4/02/18 to 4/03/18. Self-introduction and purpose of collecting information was explained to the staff nurses. Good rapport was established with the subjects and they were assured that their responses would be kept condential and written consent was obtained. The data c o l l e c t e d b y a d m i n i s t e r i n g t h e questionnaire in the labor room and 30 minutes were given to each participant to answer the questionnaire. Portograms lled by them were assessed by using checklist. Data was computed and analyzed using descriptive and inferential statistics.

Results:

Table 1 describes the personal prole of staff nurses i.e. age, qualication , Pursuing study through in service education, Experience in labor room. Distribution of the subjects according to age reveals 57 % staff nurses were in the age group of 26-30 Years 17 % staff nurses were in the age group of 31-35 Years followed by 15% staff nurses age 35 Years and above and 12% were below 25 Years of age.

Table 1: Personal profile of staff nurses

N =60

Personal profile n(%)
Age(in year)
≥ 25 7(12)
26-30 34(57)
31-35 10(17)
> 35 9(15)
Qualification
G.N.M.Nursing 16(27)
B.Sc. Nursing 28(46)
M.Sc. Nursing 16(27)
Pursued in service education

Yes

 

21(35)

39(65)
No
Experience in labour room
15(25)
<1 year
1-2 year 22(37)
>2 year 23(38)

As per qualication 27 % of staff nurses completed Diploma in General Nursing and Midwifery (GNM), 46% completed B.Sc Nursing and 27 % did M.Sc Nursing. Among them 65 % staff nurses attended some in service education and 35% did not.

As per Experience in labor room 25 % staff nurses had less than 1 year experience in labor room and 37 % had experience 1-2 years in labor room, 38 % were experience above the 2 Years in labor room.

Table 2 describes the knowledge of staff nurses regarding partograph. Most of staff nurses (more than 80%) knew that partograph is graphical presentation (93.3%), it is invented by Friedman (85%), Partograph is important for proper monitoring of labour, and prevent further complication (80%), normal labor has 4 stages(96.6%), in primigravida duration of 1st stage of labour is < 10-12 hours (80%), normal color of amniotic uid is pale straw (81.6%), the starting dose of oxytocin infusion in 500 RL is 2 units (96.6%).

Table 3 shows that most staff nurses (75%) had average knowledge regarding partograph and 25% of the staff nurses had good knowledge regarding the partograph and no one had poor knowledge.

Table 4 depicts the practicing regarding plotting partograph among staff nurses. All the nurses plotted fetal heart rate and descent correctly on the partograph. Most of them correctly plotted cervix dilatation 4 hourly (96.6%), membrane status(88.3%) and  uterine  contractions ( 83 . 3 %). The different aspects of partograph which very few nurses marked correctly were maternal pulse monitoring every 30 minutes (18.3%), maternal BP monitoring 2 hourly (21.6%).

Table 2: Knowledge of staff nurses regarding partograph

N =60

s.no. Knowledge statements correct responses
f(%)
1 Partograph is graphical presentation 56(93.3)
2 Partograph was invented by Friedman 51(85.0)
3 Components of partograph are maternal condition, foetal condition and progress of labour 46(76.6)
4 Partograph is important for proper monitoring of labour, and prevent further complication. 48(80.0)
5 Partograph monitoring start from onset of labour 37(61.6)
6 The normal labour has 4 stages 58(96.6)
7 In primigravida duration of 1st stage of labour is < 10-12 hours 48(80.0)
8 In primigravida duration of 2nd stage of labour is < 2 hour 13(21.6)
9 In primigravida duration of 3rd stage of labour is< 30 mins 11(18.3)
10 In multigravida duration of 1st stage of labour is 6 hour 23(38.3)
11 In multigravida, 2nd stage of labour is <1 hour 17(28.3)
12 In latent phase cervical dilatation is 4 cm 36(60.0)
13 In Active phase cervical dilatation occurs from 4-10 cm 46(76.6)
14 Time interval of uterine contraction recording is 5 minutes 33(55.0)
15 For measuring the dilatation of cervix, one width of nger is equal to 1.5 cm 47(78.3)
16 In primi gravida effacement takes place after dilation of cervix 26(43.3)
17 The interval of P.V. examination in active phase of labour is 4 hours 28(46.6)
18 Dilatation of cervix and decent of fetal head are plotted both in opposite direction. 40(66.6)
19 Station of head -1in partograph means head will be at place of 1 cm above of ischial spine 42(70.0)
20 Contraction are said to be mild when persist for < 20 seconds. 22(36.6)
21 Contraction are said to be moderate when persist for > 20 to <40 seconds. 25(41.6)
22 Contraction are said to be strong when persist for > 40 seconds. 19(31.6)
23 If late deceleration in the fetal assessment is monitored, the rst action will be to

administer oxygen.

44(73.3)
24 Normal colour of amniotic uid is pale straw. 49(81.6)
25 Right time of rupture of membrane is during labour 49(81.6)
26 During active phase, FHS should be measured after every 5 minutes. 26(43.3)
27 Methods of administration of Oxytocin is controlled intravenous infusion. 35(58.3)
28 Dangers of oxytocin is fetal distress, rupture of uterus and hypotension. 45(75.0)
29 1 ampoule of oxytocin contains (units) is 5 units. 44(73.3)
30 The starting dose of oxytocin infusion in 500 RL is 2 units IV. 58(96.6)

Minimum score=11, Maximum score=58

Table 3 : Frequency and percentage distribution of knowledge score of staff nurses.

N =60

Knowledge level (Score Range) Frequency n(%)
Poor (0-10)
Average (11-20) 45(75.0)
Good (21-30) 15(25.0)

Table 4: Practices of staff nurses regarding plotting partograph among staff nurses

N =60

Item No  

Item

Correct

responses

f(%)
1 Fetal heart rate plotted correctly 60(100)
2 Cervix dilatation plotted 4 hourly correctly 58(96.6)
3 Descent plotted correctly 60(100)
4 Membrane status and color recoded correctly 53(88.3)
5 Uterine contraction plotted correctly 50(83.3)
6 Drugs given and IV uids 36(60.0)
7 Maternal B/P monitored 2hourly 13(21.6)
8 Maternal pulse monitored at least every 30 minutes 11(18.3)
9 Urine amount, acetone and protein are tested 14(23.3)

 

Table 5 shows that most staff nurses (85%) had average practice score regarding partograph plotting and 15% of the staff nurses had good knowledge regarding the partograph and no one had poor knowledge.

Table 6 and g 1 depicts that the mean of knowledge is 18.70 at the SD is 2.438 and mean of practice is 5.9 at the SD is 0.796 with the r value 0.133 shows weak positive correlation  between knowledge and practice regarding partograph among staff nurses.

The data reveals the association between knowledge score with socio demographic variables. There was no signicant association between level of knowledge scores and practice score with age, in service education and experience in the labor room. (p>0.05 as per chi square test).

 

Table 5 : Frequency and percentage of practice score of staff nurses

 

Practice level

(Score Range)

f(%)
Poor (0-3)
Average (4-6) 51(85.0)
Good (7-9) 9(15.0)

Table 6 : Correlation between knowledge and practice of staff nurses

 

Knowledge Practice r value p value
Mean SD Mean SD 0.133 0.312 NS
18.70 2.438 5.9 0.796

Level of Significance-0.05                                     NS-Non Significant

N =60

Fig 1: Correlation between knowledge and practice regarding partograph among staff nurses

Discussion:

A partograph is a graphical record of the observations made of a woman in labor. Once the woman has true signs of labor, the midwife initiates the use of the partograph to record her ndings and relevant measurements which includes cervical dilation, fetal heart rate, duration of labor and vital signs. This study intended to assess knowledge and practice on partograph among staff nurses working in labor room of selected hospitals of Amritsar. The study result shown that 75 % of staff nurses had average knowledge and 25% of staff nurses had good knowledge regarding the partograph. Related to practice the result shows that majority of staff nurses, 51% had average practice and 15% staff nurses had good practice regarding the partograph. Harpreet et al (2016) conducted a descriptive study to assess the knowledge, attitude and practice regarding partograph among 60 staff nurses selected by convenience sampling technique at selected hospital Ludhiana. A questionnaire for knowledge, Likert scale for attitude and checklist for practice regarding partograph staff nurses 55 % had good knowledge, majority 90% had positive attitude where as 18% had practiced partograph.9

The correlation between the level of knowledge and practice among staff nurses regarding partograph shows that the mean knowledge score is 18.70 and SD is 2.438 and mean practice score is 5.9 and SD is 0.796 with the r value 0.133 indicates weak positive correlation between knowledge and practice regarding partograph among staff nurses. Kumar Varnish et al (2014) conducted the quasi experimental study the results of study show that mean knowledge score is 18.2 and SD is 1.32 and mean of the practice is 12.83 and SD is 0.94 and the level of signicance 0.05. There was a positive correlation between knowledge and practice of nurse.6

The results of association between knowledge and practice with selected socio demographic variables reveals that all the demographic variables show non- signicant association with level of knowledge and practice score. C. Geetha. et.al. (2015) conducted the descriptive study which shows that there was no signicant association between knowledge and demographic variables like age, marital status, educational Qualication, Duration of experience, in service education, and previous experience in labor room.7

Conclusion:

The result of the study concludes that majority (75%) of respondents had average knowledge, (51%) had average practice regarding the partograph. Hence the ndings of the study suggests that there is need to educate nurses working in the labor room to adopt the partograph in daily practice during the normal vaginal delivery to prevent mothers in labor to become a  prey of untoward complications.

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