PILOT STUDY PRESENTATION

TITLE OF THE STUDY

EFFECT OF COMPUTER ASSISTED INSTRUCTION ON KNOWLEDGE AND PRACTICE OF CARDIOTOCOGRAPHY AMONG STAFF NURSES WORKING IN THE MATERNITY DEPARTMENT

INTRODUCTION
Pregnancy is a period of happiness and expectations for a mother, and we the nurses are the people to take care of them In this modern world by the introduction of many instruments, assessment of mother and the fetus became easy. But lack of knowledge among nurses increased the importance of educating them with technologies which will help in easy and early identification of complications.

BACKGROUND OF THE STUDY

Electronic fetal monitoring is performed late in pregnancy or continuously during the labour to ensure normal delivery of a healthy baby

Perinatal mortality includes both still birth and early neonatal deaths within the first seven days of life. Still birth refers to a fetal death beyond the gestation of viability
(contd.)

Nearly 27 million babies are born in India each year; this accounts for 20% of global births. The current perinatal mortality and still birth rates in India according to NFHS-3 are 48.5 and 19.2 per 1000 pregnancies respectively. .

Purpose of the study

Researcher is aiming at improving knowledge of nurses regarding Cardiotocography which will in turn bring quality practice resulting in better fetal and neonatal outcome

STATEMENT OF THE PROBLEM

A pre experimental study to assess the effect of computer assisted instruction on knowledge and practice of Cardiotocography among staff nurses working in the maternity department in selected hospitals, Thrissur

OBJECTIVES
Objectives of the study are to
1. Compare pre and post interventional level of knowledge and practice of Cardiotocography among staff nurses working in the maternity department 2. Associate pre interventional level of knowledge and practice of Cardiotocography with selected demographic variable of staff nurses working in the maternity department. (contd.)

OPERATIONAL DEFINITIONS

Effect It refers to outcome of computer assisted instruction on knowledge and practice of Cardiotocography among staff nurses working in the maternity department.
(contd.)

Computer Assisted Instruction

It refers to systematically planned instructions designed to provide information regarding Cardiotocography and its interpretation, by the use of a computer which includes definition, indications, timing and frequency, procedure, interpretation, advantages and disadvantages of Cardiotocography.
Contd..

Cardiotocography :
In this study it refers to a procedure that is used for assessing the fetal wellbeing, in which the fetal heart rate is continuously monitored for 20 minutes or more by using device called Cardiotocograph

Contd..

Knowledge:

It refers to existing and gained information regarding Cardiotocography by the nurses working in the maternity department and which include procedure, fetal heart rate pattern, interpretation and is assessed by a structured questionnaire
Contd..

Practice
It refers to skill of performing and interpreting Cardiotocography by the staff nurses working in the maternity department which is assessed by observational checklist

Contd..

Staff nurses
It refers to the nurses who are completed GNM or BSc nursing, having license from Kerala Nurses and Midwives Council to practice and working in the maternity department of selected hospitals

ASSUMPTIONS

Nurses working in the Maternity Department are expected to assess the fetal condition when electronic devices are available Early identification of intrauterine fetal distress is an indication for termination of pregnancy

HYPOTHESES H1: Post interventional level of knowledge score is higher than that of pre interventional level of knowledge score among staff nurses working in the maternity department H2: Post interventional level of practice score will be higher than that of pre interventional level of practice score among staff nurses working in the maternity department
(contd.)

H3 : There is significant association between pre interventional level of knowledge and practice of Cardiotocography with selected demographic variables of nurse working in the maternity department at 0.05 level of significance

RESEARCH METHODOLOGY:

RESEARCH APPROACH:
Quantitative Approach.

RESEARCH DESIGN:
The design is Pre-experimental, one group pretest

and post test design

O1 X O2

O1 -Pre interventional level of knowledge and

practice of Cardiotocography

X -Computer assisted Instruction

O2-post interventional level knowledge and practice of Cardiotocography

VARIABLES
a. Independent variable

Computer assisted instruction

b. Dependant variable

Knowledge and practice

DAY-1

DAY -2

DAY -5

Population Staff Nurses working in the maternity department of selected hospitals Sample

Sample size- 40
Sampling techniquesimple random sampling

Collection of demographic data and assessment of level of knowledge by questionnair e and practice by observation al checklist

Intervention -. Computer assisted instruction on CTG is given to each sample for a duration of 30 minutes. After 5 days posttest is done.

Assessment of post interventional level of knowledge by questionnaire and practice by observational check list

Fig 1 SCHEMATIC REPRESENTATION OF THE STUDY

SETTING
Mother hospital, Thrissur Aswini hospital, Thrissur Elite hospital, Thrissur

POPULATION:

Population for the study are staff nurses working in the maternity department of selected hospitals

SAMPLING

SAMPLE

Staff nurses working in the Maternity

Department who fulfils the criteria for

sample selection .

SAMPLE SELECTION CRITERIA

Inclusion criteria
Staff nurses working in the Maternity

Department who are willing to participate

in the study

Exclusion criteria Nurses working in the maternity department who are not available at the time of conduction of study

SAMPLE SIZE:
40 staff nurses who are working in the Maternity Department

SAMPLING TECHNIQUE:
Simple random sampling

DESCRIPTION OF TOOL:
Tool consist of part I and II, III, IV I:Structured Questionnaire to

collect the demographic data II:Structured questionnaire to

assess the knowledge on Cardiotocography

III:- Observational check list to assess the observed practice of cardiotocography IV:InterventionComputer assisted

instruction on Cardiotocography

Scoring key for questionnaire

Total items -25 Right response -1 mark Wrong response -0

Knowledge score<13 (<50%) --- Inadequate knowledge

Knowledge score 13-18 (50% -75% )-- moderately adequate

knowledge

Knowledge score 19-25(7 5%-100%)--- Adequate knowledge

Scoring key for check list

Total items -20 Right response -1 mark Wrong response -0

Practice score 10(<50%) --- unskilled

Practice score 11 -15 (50% -75% )-- moderately

skilled Practice score 16 -20(7 5%-100%)- highly skilled

RELIABILITY OF THE TOOL

Reliability of the tool was checked by using Pearson product moment correlation and reliability coefficient obtained was r=.83

indicate that tool is reliable for the study

CONTENT VALIDITY
Validation of the tool was done by 5 experts in the field of Obstetrics and gynecologic Nursing and modifications were done

based on their suggestions

PILOT STUDY
STUDY PERIOD Pilot study was conducted from 19th November 2012 to 24th November 2012. STUDY SETTING Labour room, antenatal, postnatal wards of Westfort hospital, Thrissur SAMPLE SIZE 4 staff nurses in the maternity ward were taken for the study

ETHICAL CONSIDERATION
Obtained approval from Principal of College of Nursing, Institution Review Board, Ethical Committee West fort college of nursing The researcher obtained formal permission from Westfort hospital Thrissur and conducted pilot study by selecting the samples according to the inclusion criteria

Contd

Obtained written informed consent from the subjects. Confidentiality and privacy will be maintained

DATA COLLECTION PROCEDURE:

After getting permission to conduct the study ,samples were selected using simple random method Informed consent obtained from the participant Demographic data was collected by using questionnaire

. (contd.)

Questionnaire was administered to assess knowledge regarding cardiotocography to the staff nurses and pre interventional level of practice was assessed by observational checklist .
(

contd.)

Computer assisted instruction on Cardiotocography had given to each subject for a time duration of 30 minutes at a time convenient to them . On the 5th day, post test level of knowledge is assessed by using questionnaire and post test level of practice is assessed by observational check list

ORGANIZATION AND PRESENTATION OF DATA

Data obtained is discussed here under 3 main sections Section I Analysis of demographic variables Section II :- description of level of knowledge and practice of nurses before and after computer assisted instruction regarding cardiotocography
Contd..

Section IIIanalysis of significance of difference of knowledge of nurses regarding cardiotocography before and after computer Assisted instruction on cardiotocography Section IV- association of pretest level of knowledge and practice with selected demographic variables

Section I Analysis of demographic variables

Demographic variable Frequency Percentage

1. Age
a. 20-25 years a. 26 -30 years 2.Educational qualification a. General Nursing

75%

25%

100%

Contd..

Demographic variable 5.Area of work a. Labour room . b. Ward

Frequency Percentage

2 2

50% 50%

6.Previous

exposure

to

information/training regarding cardiotocography Nil 0

Section II :- Description of level of knowledge and practice of nurse before and after computer assisted instruction regarding cardiotocography

PERCENTAGE DISTRIBUTION OF PRE TEST AND POST TEST KNOWLEDGE SCORE 80% 70% 60% 50% 40% 30% 20% 10% 0% <13 inadequate 13 -18 moderatly adequate 19 -25 1dequate Fig 2

PRE TEST KNOWLEDGE SCORE POST TEST KNOWLEDGE SCORE

Fig 2 shows that 75% of samples had inadequate knowledge and 25 %had moderately adequate knowledge in the pre test. 25 % of samples had inadequate knowledge and 75% had moderately adequate knowledge in the post test

MEAN SCORE DISTRIBUTION PRE TEST AND POST TEST PRACTICE SCORE
16 15.5 15 14.5 14 13.5 MEAN SCORE

13
12.5 PRE TET SCORE POST TEST SCORE Fig 3

Fig 3 shows that mean pre test practice score of cardiotocography was 13. 5 and mean post test practice score was 15.5 after computer assisted instruction

Section III Analysis of significance of difference of knowledge and practice of nurses regarding cardiotocography before and after computer Assisted instruction on cardiotocography

Analysis of significance of difference in knowledge score

Test Pre test
Post test

Mean 10.5
13.5

Standard Deviation 3.41

2.08

t value 3.93

Level of significance 0.05

With regard to the pre test and post test ,the calculated t value is 3.93 which showed high statistical significance at p<0.005 level.

Analysis of significance of difference in practice score

Test Pre test Post test Mean 13.5 15.5 Standard Deviation 3. 69 2. 38 t value 3.47 Level of significance 0.05

With regard to the pre test and post test ,the calculated t value is 3.47 which showed a statistical significance at p<0.005 level.

Section IV Association of pretest level of knowledge and practice of cardiotocography with selected demographic variables

In pilot study as sample size is small it is difficult to do the association Association of pretest level of knowledge and practice with demographic variables such as age, education, experience, experience in maternity ward and area of work can be done chi square in the main study

PROBLEMS FACED IN THE STUDY

There is a difficulty in assessing the practice score of staff nurses in maternity ward

INFERENCE
There is a statistically significant difference in pre and post interventional level of knowledge and practice among staff nurses working in the maternity department The study is found to be feasible

THANK YOU

REFERENCES
1. Bobak.M.F. Maternity nursing, 4th edition, Missouri,
Mosby Publication;2007 2 Electronic fetal monitoring, http://medicaldictionary.the free dictionary.com/electronic+fetal+monitoring 3 Cardazo L.D,Kean L.Obstetric and gynaecology, first edition,.London:Arnold publication;2004

Essentials

of

fetal

monitoring,

http://www/espring
id=32634(oct-2006

erpub/com/prod.aspx?prod

5.Newborn

health

in

India.

http://www.newbornwhocc.org//teaching aids/2010/Newborn-health-in-India

6. Cardazo L.D,Kean L.Obstetric and gynaecology,

first edition,.London:Arnold publication;2004

7. Essentials of fetal monitoring, http://www/espring erpub/com/prod.aspx?prod id=32634(oct-2006 8.Newborn health in India.

http://www.newbornwhocc.org/pdf/teaching aids/2010/Newborn-health-in-India.

GHANT CHART GAANT CHART

Research work 2012 JA FEB N MA AP MA JN JL AU SE OC NO DE 2013 JA FE MA AP MA JUN Selection of problem Proposal presentation Tool presentation Submission of chapter I Submission of chapter II Submission of chapter III Submission of tool for validation Collection of tool after validation Pilot study and presentation Data collection Submission of chapter IV Submission of chapter V Submission of spiral binding I Submission of spiral binding II to Principal Final binding Submission of thesis to University

Educational qualification All the samples were belonging to general nursing and midwifery

SECTION I SAMPLE CHARECTERISTICS BASED ON THE DEMOGRAPHIC VARIABLES

Age
25%
21-25 years 26 -30years

75%
Fig 1 From fig 1 it is evident that 75% of staff nurses belong to21 -26 years and 25 % belong to 26 -30 years age group

Experience

PERCENTAGE

60% 40% 20% 0% 1- 2 years years 2-3 3-4 years Fig 2 - EXPERIENCE

1- 2 years 2-3 years 3-4 years

Fig 2 shows that 2 samples have 1-2 years of experience and 50% have 3 -4 years of experience

50% PERCENTAGE

40%
30%

20%
10% 0%

0 - 1 year 1 - 2 years

1 - 2 years Fig 3- Experience in maternity ward

0 - 1 year

Fig 3 shows that50% sample belong to 0-1 year experience category and 50% belongs t0 1-2 years category

Area of work

labour room

50%

50%

ward

Fig 4
Form the fig 4 the conclusion can be drawn that 50% samples belong to labour room category and 50% belongs to ward category

AUTHOR YEAR Gabrielle .N.Bankst on

2004

STUDY A descriptive study was conducted on obstetrical nurses regarding knowledge and attitude towards fetal monitoring in Florida

RESULT 80% nurses felt that fetal surveillance would be achieved by monitoring electronic fetal wellbeing

PURPOSE OF THE STUDY

Studies which are aiming in enhancing the knowledge of nurse will help the nurses to empower themselves. This study will help the nurses to acquire knowledge and skill regarding fetal monitoring

CONCEPTUAL FRAME WORK

Conceptual frame work adopted for the study is general system model Ludwig Von Bertalanffy(1968).

INPUT

THROUGHPUT

OUTPUT

Demograp hic variables Age, Education, Experienc e, experienc e in maternity ward

Pre test Assessme nt of existing level of knowledge and practice of cardiotoco graphy

A process of change in knowledge and understandin g about various aspects of CTG, which include definition, indication, procedure, Fetal Heart Rate Patterns and its interpretation FEEDBACK

Education program on CTG which include procedure, Fetal Heart Rate patterns and interpretatio n

Post test 1. Adequate knowledge 2.Moderate knowledge 3.Inadequate knowledge

REVIEW OF LITERATURE
A stydy conducted by Lu Yao- feng in the year 2007 to assess the clinical value of fetal monitoring in pregnancy. Study results showed that it can be used as a method to make timely decision of terminating pregnancies, and can decrease perinatal mortality.

A study conducted by Beckley S, Stenhouse E, Greene K in the year 2007 evaluate the effect of computer training programme on cardiotocography among 107 midwifery personnel and found that training programme was effective and mean score improved from 50% to 70% after the teaching programme

A study conducted by Herbert groeller in the year 2008m to examine the knowledge and practice on electronic fetal monitoring among midwives in Northern Ireland. The result showed that 50% of nurses had

poor skills on interpretation of data