الفهرس 
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Abstract
Early Postpartum hemorrhage (PPH) is an important obstetric emergency. It is an unpredictable and rapid cause of maternal death worldwide, with two-thirds of women with PPH having no identifiable risk factors. (American Association of Women’s Health, Obstetric and Neonatal Nurses. (2017). Early Postpartum hemorrhage was redefined in 2017 by the American College of Obstetrics and Gynecology as cumulative blood loss greater than 1000 mL with signs and symptoms hypovolemia within 24 hours of the birth process, regardless of the route of delivery (Yildirim, et al., 2018).
Furthermore; early postpartum hemorrhage (PPH) is the nursing concern because she plays a multidisciplinary role as a care giver for early detection, screening and referring patients with early postpartum hemorrhage to minimize maternal and fetal morbidity and mortality. No previous studies implemented guideline for early postpartum hemorrhage at Damanhur teaching hospital.
The Aim of the study: To investigate the effect of guideline on improving nurses’ practices among patients with early postpartum hemorrhage. Research hypothesis: Nurses who received guideline sessions related to early postpartum hemorrhage has shown better knowledge and practices more than those who did not participated these sessions. A Quasi- experimental (an intervention pre and posttest study) was conducted at obstetric departments in Damanhur teaching hospital at Beheira Governorate.
Purposive sample was included all nurses (40nurses) who were working at obstetric departments and accepted to participate in study, at previously mentioned study setting.
Tools were used for data collection;
1) A Structured interviewing questionnaire schedule which included two parts: The first part: assessed nurse’s general characteristics. The second part: assessed nurses’ knowledge regarding early postpartum hemorrhage.
2) Observational checklist: it consisted of all nursing procedures which were done by nurses at obstetric departments in Damanhur teaching hospital.
3) Nurse Satisfaction tool which included two parts: The first part: assessed nurses’ satisfaction regarding an instructional supportive guideline. The second part: assessed barriers that prevent nurses to comply with care for patients with early post-partum hemorrhage.
An instructional supportive guideline: was designed by researcher according to nurses’ learning needs pre intervention based upon advanced related literature. The pilot study was conducted for 10 %( 4 nurses) among total sample at selective all nurses who were worked at previously mentioned study setting.
Main results of the present study were as follows:
There was highly statistically significant (P= < 0.01) between pre, immediate and eight weeks post intervention related to nurses’ Knowledge about early postpartum hemorrhage.
There was highly statistically significant between pre, immediate and eight weeks post intervention related to total score of nurse’s Knowledge about early postpartum hemorrhage.
There was highly statistically significant(P= < 0.01) between pre, immediate and eight weeks post intervention related to general and local examination post implementation of an instructional supportive guideline related to care of mothers with early postpartum hemorrhage.
There was highly statistically significant(P= < 0.01) between pre, immediate and eight weeks post intervention related to health education post implementation of an instructional supportive guideline related to care of mothers with early postpartum hemorrhage.
There was highly statistically significant(P= < 0.01) between pre, immediate and eight weeks post intervention related to total score of nurse’s practices about early postpartum hemorrhage.
There was (82.5%) of studied sample satisfied with any recent information after the implementation of guidelines.
There was (80%) of the barriers were absent of nurses that prevent nurses to comply with the implemented guideline immediate and eight weeks post intervention
There was a highly significant positive correlation between total knowledge and total practice among the studied sample regarding early post-partum hemorrhage at pre, immediate and eight weeks post guideline.
There was a positive correlation between total practices among the studied sample regarding early post-partum hemorrhage, satisfactions and barriers at eight weeks post implementation guideline.
Conclusion & Recommendations:
There were a highly significant improvement in nurses’ knowledge and practices immediately and eight weeks post intervention compared to pre intervention. So the present study hypothesis was significantly approved with the aim of the present study.
Based on the results of the present study the following recommendations are suggested:
• Hospital administrator must directed their attention toward relieving nurses from administrative work and to devote their time for nurses’ activities only.
• Design and implement monitoring system to evaluate nurses’ practices at obstetric department continuously.
• Designing nursing standards, protocols and guideline for all nurses at obstetric department.
• The present study, implemented guideline was recommended to replicate at another setting and on larger sample.
• Establishing session’s education units to support patients through education and counseling to correct their misconception and unhealthy behaviors.