الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
Postpartum period is a critical phase in the life of mother and new born babies. Major changes occurring in this period which determine the wellbeing of the mother and newborn. The majority of maternal and newborn deaths occur around the time of birth, typically within the first 24 hours after childbirth. Most of these deaths are preventable. The immediate postpartum period is a crucial period because many life- threatening complications can accompany this period.
Postpartum hemorrhage is one of the most alarming and serious emergencies which nurse may face first so, nurses and midwifes play a pivotal role in prevention and management of PPH especially in the third stage of labor and early postpartum period.
The study aimed to:
Assess nurses’ compliance with guidelines for the reduction of postpartum hemorrhage during third stage of labor and early postpartum period.
To fulfill the study aim:
The study was conducted at labor and postpartum units in three governmental maternity hospitals in Alexandria. Subjects: the study was included 80 nurses were working at the settings and providing direct care for laboring and postpartum women.
Tools used in this study:
Three tools were designed, validated and utilized by the researcher to collect the necessary data. Tool one: it entailed three parts; part 1 included nurse’s socio-demographic data. Part 2 included nature of work such as working shift. Part 3 included postpartum hemorrhage training programs. Tool two: nurses ’ knowledge and role about third stage of labor and postpartum hemorrhage. General knowledge about third stage of labor, postpartum period, postpartum hemorrhage, nurses’ role in third stage of labor and early postpartum period.
Tool three: nurses’ compliance to guidelines for reduction of postpartum hemorrhage observational checklist. Nurse’s role during third stage of labor and early postpartum period.
The tools were tested for content validity by 5 juries who were expert in the field.
A pilot study was carried out on 8 nurses who were excluded from the study sample to test the relevance, validity, and clarity of tool as well as the time needed to complete it.
The main findings of the present study were:
The basic data:
Less than half (45.0%) of nurses were in their twenties and less than one-third (28.7%) in their forties or more. The mean age of nurses was 34.9 ± 11.01 years. More than half (55.0%) of nurses were less than 15 years of experience. Most of studied nurses (82.5%) did not participate in any training programs related to postpartum hemorrhage.
Nurses’ knowledge about third stage of labor, postpartum period and postpartum hemorrhage
• Less than half (45%) of nurses gave correct & complete answers about onset of third stage of labor and three-quarters of them (75%) gave correct & complete answers about signs of placental separation.
• Less than three-quarters (73.7%) of nurses gave correct but incomplete answers about normal duration of third stage of labor and three-fifths (60%) of them gave correct but incomplete answers about nursing measures for third stage of labor.
• Slightly more than two-thirds (67.5%) of them gave incorrect or didn’t know about timing of umbilical cord cutting after delivery.
• Less than three-quarters (72%) gave correct but incomplete answers about level of uterine fundus, three-fifths (60%) gave correct but incomplete ones regarding advantage of early urination.
• More than half (57.5%) gave incorrect or didn’t know about duration of early period of puerperium, monitoring of vital signs in early postpartum and maternal heart rate and most of them (80%) gave incorrect or didn’t know about timing of maternal urination.
• Half (50%) of nurses gave correct & complete answers about the main cause of postpartum uterine atony, more than four-fifths (82.5%) of them gave correct & complete ones about appropriate nursing intervention for postpartum uterine atony.
• More than half (53.8%) of nurses gave correct but incomplete answers about factors increasing incidence of postpartum hemorrhage in Egypt and more than half (55% & 57.5% ) gave incorrect or didn’t know about timing of incidence of postpartum hemorrhage and the second most common cause of postpartum hemorrhage respectively.
Nurses’ knowledge about role of nurse during third stage of labor and early postpartum period
• More than half (55%) of nurses gave correct & complete answers About nursing intervention during delivery of placenta and umbilical cord and less than three-quarters (70% &73.8%)of them gave correct & complete ones about route and timing of administration of drug of choice to prevent PPH respectively.
• The majority of nurses (90% &96.4%) gave correct but incomplete answers about vaginal, perineal examination and placental examination respectively and more than half (51.2%) of them gave correct but incomplete ones about fundal examination immediately after placental delivery.
• More than half (55%) gave incorrect or didn’t know about timing of umbilical cord cutting and monitoring of maternal vital signs during third stage of labor.
• Around half (51.3%) of nurses gave correct & complete answers about monitoring of vital signs during early postpartum period, slightly more than two-fifths (56.3%) of them gave correct & complete ones about definition of early postpartum period, more than three-fifths (61.2%) of them gave correct & complete answers about bladder evacuation, the majority of nurses (85%) gave correct & complete ones about signs of postpartum complications.
• More than half (56.2%) of nurses gave correct but incomplete ones about uterine examination, less than three-quarters (72.5%) of them gave correct but incomplete ones about early postpartum hemorrhage and less than two-thirds (62.5%) of them gave correct but incomplete ones about postpartum perineal examination.
Nurses’ compliance with guidelines during third stage of labor and early postpartum period
• Comparing name of Oxytocic’s with woman’s sheet to ensure correct name, giving Oxytocics according to physician’s order after delivery of fetus, examination of utero-vaginal canal and perineum for trauma and prompt repair if present were completely done by the all nurses.
• Late cord clamping was not done by less than three-quarters (71.7%) of them.
• Controlled cord traction with support of the uterus for delivery of placenta and examination of placenta and membranes for completeness were incompletely done by less than three-quarters (73.9%) of them and avoidance of fundal pressure to assist the delivery of the placenta was incompletely done by more than three-fifths (63%) of them.
• Administration of prophylactic antibiotic prescribed by physician and observations notified to the physician were completely done by the all nurses included in the study.
• Record pulse and blood pressure every 15 minutes was incompletely done by 74.1% of nurses, assessment of fundal level, consistency, position and shape every 15 minute after delivery was incompletely done by the all nurses included in the study, examine lochia for amount and consistency was incompletely done by 77.8% of them and intake and output chart was incompletely done by more than half (55.6%) of them.
• Putting mother in a comfortable position after delivery with avoidance of supine position was not done by less than three-quarters (70.4%) of them, encourage mother to evacuate urinary bladder regularly was not done by less than half (48.1%) of them, check temperature every 4 hours was not done by 59.3% of them, relieve anxiety by explaining her condition and management was not done by majority of them (88.9%) and encourage mother for early ambulation was not done by the all nurses included in the study.
• Slight uterine massage in case of uterine atony was not applicable by the remaining (77.8%) of them.
Recommendations
Based on the findings of the present study, the following recommendations are suggested:
• Ministry of health should provide doctors and nurses with hand out guidelines to decrease incidence of PPH and improve maternal outcome.
• The nursing curriculum should be revised and updated to include guidelines about caring of postpartum hemorrhage.
• Collaborate with the operating department nursing authorities to find effective method of staff mix and assignment in order to overcome the shortage of staff and long shift.
• Providing nurses with an instructional booklet regarding PPH to enhance their knowledge and practices.
• Periodic participation of nurses in training programs about PPH to improve their knowledge, skills and ensuring from their compliance with guidelines for reduction of PPH.
• Nurses should follow written guidelines to close observation for the mother in the early postpartum period to detect PPH.