الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Uterotonics are the drugs of varying chemical nature that have the power to excite contractions of the uterine muscles. Among a large number of drugs belonging to this group, oxytocin is an important one and is widely used in clinical practice. The maternity nurses should have thorough knowledge of the indications, action, and side effects of these drugs as well as the nursing considerations related to each of them in order to plan and implement effective nursing process. Inappropriate administration may result in hyper-stimulation of the uterus, which can lead to uterine rupture, fetal asphyxia, and/or fetal demise. Therefore, provision of comprehensive nursing care before and after uterotonic drugs administration by skilled nurse is consider one of the most important ways of reducing maternal, fetal and neonatal complications. The aim of the study was to: - Evaluate the effect of instructional guidelines regarding uterotonic drugs administration on nurses’ performance and labor outcome. To fulfill the study aim:- Setting:- This study was conducted at labor units of obstetric department at three settings in Tanta city: Tanta University Hospital. El-Menshawy General Hospital Affiliated to the Ministry of Health and Population. El-Mabara Hospital Affiliated to the Health Insurance. Subjects:- The sample of this study consisted of: 1. All available nurses (40 nurses) who were working in the previously mentioned study settings and provided care to women before, during and after uterotonic drugs administration. - Nurses who are working at Tanta University Hospital (20 nurses). - Nurses who are working at El-Menshawy Hospital (10 nurses). - Nurses who are working at El-Mabra Hospital (10 nurses). 2. Purposive sample of 120 parturient women were selected from the previously mentioned study settings with the following inclusion criteria: - Age ranged from 20 -35years old. - Free from any medical or obstetric diseases. - Pregnant with singleton fetus, also with cephalic presentation - Willing to participate in the study. Tools of data collection: To achieve the aim of this study the following three tools were used by the researcher based on review of recent related literatures. Tool I: A structured interview schedule: A specially designed structured interview schedule was developed and used by the researcher based on the recent review of relevant literatures to collect the basic data about the study subjects. It included the following three parts. Part (1): Nurses socio-demographic characteristics: This part was used to collect data about nurses’ general characteristics such as; age, marital status, level of education, occupation, years of experience in labor unit as well as previous training courses regarding care of women during uterotonic drugs administration. Part (2): Assessment of nurses′ knowledge regarding uterotonic drugs: This part was developed by the researcher after reviewing of recent related literature (15-16) to assess nurses′ knowledge regarding uterotonic drugs administration. Part (3): A structured interview schedule for parturient women: This part was developed by the researcher after reviewing of recent related literature (17-18 and 27) and was used to collect basic data about parturient women: (a): Socio-demographic characteristics of parturient women included data such as: age, marital status, education, occupation and also their residence. (b): Reproductive history of parturient women, this part was used to collect data about obstetric characteristics of parturient women such as: gravidity, parity, spacing period, number of abortion, mode and place of past deliveries as well as previous use of uterotonic drugs and previous maternal or fetal complications with uterotonics administration during previous labor and deliveries. Tool II: Observational checklist for nurses′ practice regarding uterotonic drugs administration: This tool was developed by the researcher after reviewing of recent related literature (17-19, 21). It was used and comprised of 53 items to assess nurses′ practice for caring women who receive uterotonic drugs; it included the following parts: Part (1): Pre-Preparation for uterotonic drugs administration Part (2): Administration of uterotonics Part (3): Emergency measures during uterotonics administration Part (4): Documentation Tool (III): Labor outcome assessment tool: This tool was developed by the researcher, after reviewing of recent related literature (27-29) and was used to assess maternal and fetal/ neonatal outcome of parturient women before and after implementation of the instructional guidelines. The main findings of the current study were as follow:- 1. Socio- demographic characteristics of the studied nurses. It is observed that nurses’ age ranged from 28-57 years, with Mean age ± SD of 41.65±8.25. As regards their marital status, the majority (90.0%) of nurses were married while the minority (10.0%) of them were widow. Regarding the educational level of nurses’ almost two third (67.5%) of them had completed diplome of nursing and (25% and 7.5% respectively) had completed nursing technical institute and bachelor of nursing. In relation to their occupation, the vast majority (92.5%) of nurses were bed side nurse, while the minority (7.5%) of them were nursing supervisor. Moreover, the table also reveals that (62.5%) of nurses had 20 years of experience or more as well as one quarter (25%) of them had 10 to less than 20 years of experience and only (12.5%) of them had 5 to less than10 years. It is also noticed that the vast majority (85%) of nurses didn’t take any previous training courses regarding uterotonic drugs administration and only (15%) of them who had previous training regarding uterotonic drugs administration. Finally, the table also reveals that the entire sample (100%) of nurses reported that they did not have any teaching aids (booklet - poster - brochure) regarding uterotonic drugs administration. 2. The studied nurses’ total score level of knowledge regarding uterotonic drugs administration pre, immediately and three months post guidelines implementation. It was observed that (12.5%) of nurses had high level of knowledge regarding uterotonic drugs administration pre guidelines implementation, which increased to (92.5%) immediately after guidelines implementation, then the percentage decreased to (85%) three months post guidelines implementation with highly statistical significant difference (P<0.001**). 3. The studied nurses’ total score level of practice regarding uterotonic drugs administration pre, immediately and three months post guidelines implementation. It is noticed that (27.5%) of nurses had satisfactory practice regarding uterotonic drugs administration pre guidelines implementation, increased to (90%) immediately after guidelines implementation, while the percentage decreased to (85%) three months post guidelines implementation. 4. Maternal outcome assessment after uterotonic drugs administration pre, immediately and three months post guidelines implementation. In relation to ineffective cervical dilatation, it is observed that (37.5%, 2.5% and 7.5% respectively) had ineffective cervical dilatation or failed induction during labor pre, immediately and three months post guidelines implementation. As regard the duration of second stage of labor, it is found that (30%, 100%, and 97.5% respectively) had normal duration of second stage of labor pre, immediately and three months post guidelines implementation. It is also demonstrated that (20%, 0%, and 2.5% respectively) had complications of uterine hyper-stimulation (hypertonic uterine contractions) pre, immediately and three months post guidelines implementation. Moreover, it is also noticed that only (2.5%, 0%, and 0% respectively) had incidence of precipitous labor as well as uterine rupture pre, immediately and three months post guidelines implementation. In relation to occurrence of intrapartum hemorrhage among parturient women, it is also evident that only (5%, 0%, and 0% respectively) had intrapartum hemorrhage pre, immediately and three months post guidelines implementation. As regard type of delivery, it is observed that (62.5%, 97.5%, and 92.5% respectively) of parturient women delivered normal vaginal delivery pre, immediately and three months post guidelines implementation. Also about (17.5%, 2.5%, and 5% respectively) had experienced third or fourth degree perineal tear pre, immediately and three months post guidelines implementation. Finally regarding occurrence of postpartum hemorrhage and maternal intensive care admission, it is observed that only (5%, 0%, and 0% respectively) as well as (7.5%, 0% and 0% respectively) experienced postpartum hemorrhage and admitted to the maternal intensive care unit pre, immediately and three months post guidelines implementation. 5. Fetal/ neonatal outcome assessment after uterotonic drugs administration pre, immediately and three months post guidelines implementation. In relation to occurrence of fetal heart rate abnormality, it is observed that only (12.5%, 0% and 0%) had fetal heart rate abnormality during labor pre, immediately and three months post guidelines implementation respectively. As regard incidence of fetal hypoxia, it is found that (7.5%, 0% and 2.5%) who experienced fetal hypoxia during labor pre, immediately and three months post guidelines implementation respectively. Concerning incidence of intrapartum fetal death, it is noticed that only (7.5%, 0% and 2.5% respectively) who had incidence of still birth pre, immediately and three months post guidelines implementation as well as only (12.5%, 0%, and 2.5% respectively) had abnormal Apgar score at one and five mints pre, immediately and three months post guidelines implementation. In relation to occurrence of meconium aspiration and incidence of respiratory distress, it is also evident that only (7.5%, 0%, and 2.5% respectively) who experienced meconium aspiration and respiratory distress pre, immediately and three months post guidelines implementation. As regard neonatal intensive care admission, it is also observed that only (12.5%, 0%, and 2.5% respectively) of delivered newborn admitted to the neonatal intensive care unit pre, immediately and three months post guidelines implementation. Based on the findings of this study, it can be concluded that: The implementation of the instructional guidelines resulted in a significant positive improvement of nurses’ performance regarding uterotonic drugs administration compared to pre instructional guidelines implementation consequently the maternal and neonatal outcome were positively improved. Based on the findings of the present study, the following recommendations are derived and suggested:- I) Recommendations for nurses: - Planning in-service training programs for all nurses regarding uterotonic drugs administration must be conducted in order to improve, update and refresh their knowledge and qualify their practices dependent on recent evidence based guidelines during labor. - Reactivating the role of the head nurse in supervising, guiding and evaluating the provided nursing care for the parturient women in order to identify weak points and manage them to achieve and maintain the best nursing care during uterotonic drugs administration. - Empowering nurses in labor and delivery units with provision of an instructional booklet about nursing interventions for parturient women during labor induction and augmentation as well as encourage them to read recent textbooks and attend scientific meetings and conferences regarding standard, policies and guidelines of uterotonic drugs administration. - Recommendations for nursing administration: - Holding annual seminars, courses, workshops and conferences under the supervision of the hospital administration and the Ministry of Health and Population regarding care of parturient women during uterotonic drugs administration for enhancement of nurses’ knowledge and practices in this area. - Written policies, protocol of care and guidelines should be developed for improving the quality of nursing care rendered to parturient women during uterotonic drugs administration. III) Recommendations for further research studies: - Develop and implement evidence based guidelines regarding nursing care of parturient women during uterotonic drugs administration. - Investigate barriers against nurses’ compliance with uterotonic drugs administration guidelines.