Effectiveness of Self-Instructional Module on Knowledge and AttitudeRegarding Legal and Ethical Aspects in OBG Nursing among Staff Nurses

INTRODUCTION

The legal and ethical aspects in obstetrics and gynecological Nursing (OBG) are negligence, malpractice, unsafe abortions, consent, confidentiality and screening. Midwife’s negligence is ignoring warning signs in an effort to provide a natural birth; negligence is failure to assess the baby’s condition after birth, at significant risk to the baby. Midwife fails to follow adequate policies and procedures regarding emergency delivery of babies.¹ Malpractice is carelessness by a professional person. The common causes for lawsuits against nurses like involved in the administration of oxytocin for the augmentation of labor. Nurses have legal responsibilities regarding fetal monitoring during labor.²

The Maternal Mortality Rate (MMR) of India in 2012 was 212 per one lakh live births, whereas the country’s target is 109 per one lakh live births by 2015. India needs to focus on Assam, Bihar, Madhya Pradesh, Uttar Pradesh and Rajasthan, where the MMR is still high. MMR in Karnataka is 213 for every one-lakh live births in 2011 due to unsafe abortions.³ Worldwide, approximately 10- 20 million abortions are performed illegally. Illegal abortions are also called as unsafe abortions. According to World Health Organization, the causes for maternal mortality during postpartum period are postpartum hemorrhage, eclampsia, obstructed labor and 13% complications after unsafe abortion. Proper decision made by the nurses helps to overcome maternal death from emergency situations in labour ward during obstructed labour.^[4

The legal and ethical issues of adolescents on informed consent are the right to consent to various types of healthcare varies widely from state to state. Nurses have a responsibility to be aware of the issues surrounding adolescent consent and to know what state statutes guide the healthcare provider. Adolescents consents including contraception, abortion, prenatal care, sexually transmitted disease testing and treatment, confidentiality.⁵ 

A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that the information will be held in confidence. Confidentiality is a fundamental part of professional practice that protects human rights. Disclosure means the giving of information. Disclosure is only lawful and ethical if the individual has given consent to the information being passed on. Such consent must be freely and fully given. One aspect of privacy is that individuals have the right to control access to their own personal health information. It is not acceptable for nurses and midwives to discuss matters related to the people in their care outside the clinical setting by discussing a case with colleagues in public where they may be overheard and leave records unattended where they may be read by unauthorized persons.⁶

Mandatory Human Immunodeficiency Virus (HIV) Screening involves ethical issues related to privacy invasion and reproductive risks to the pregnant woman. Incidence of perinatal transmission from an HIV positive mother to her fetus ranges from 25% to 35%. Midwives have an obligation to make sure the pregnant woman is well informed about HIV symptoms and testing. ⁷

OBJECTIVES

1. To assess the existing level of knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses.

2. To assess the post test level of knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses.

3. To find the effectiveness of SIM onknowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses.

4. To find correlationbetweenpost-test level of knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses.

5. Tofind association between the pre-test level of knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses with their selected demographic variables.

METHODOLOGY

This study was conducted using a pre experimental one group pretest post- test design. A total of 60 staff nurses were selected by simple random sampling technique through lottery method in Jayanagar general hospital. The period of data collection was one month. Tool for data collection was a structured questionnaire and alikert scale which consisted of two sections. Section A related to demographic variables of staff nurses, Section B consisted of items on knowledge and Likert scale had items on attitude regarding specific legal and ethical aspects in OBG Nursing. The tools were pretested. Split haft technique with Spearman Brown’s prophecy formula was used to determine the reliability of the tool which yielded a result of 0.91 for knowledge, 0.92 for attitude scale respectively .Pilot study was conducted and study was found to be feasible. Prior to data collection ethical clearance and hospital permission was obtained. Informed consent was taken from the staff nurses. Structured Knowledge questionnaire and attitude scale was given. Then Self Instructional Module was administered on the same day. The post test was done after 7 days of administration of Self Instructional Module to the same subjects by using the same questionnaire and attitude scale.

RESULTS

I. Demographic characteristics of Staff Nurse

The majority of staff nurses (40%) belonged to age group of 41-50 years, most (88.3%) of them belonged to Hindu religion. Majority (86.7%) were married, half of the staff nurses had 16 years of experience (51.7%) and a little more than half (55.0%) no previous information on regarding legal and ethical aspects in OBG Nursing 

II. Pre and post-test level of knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses.

The findings of the study showed that 68.3% of the staff nurses had inadequate knowledge and 31.7% had moderate knowledge. With regard to the attitude of staff nurses 68.33% had moderately favourable attitude and 15% had unfavorable attitude regarding legal and ethical aspects in OBG Nursing. Whereas post-test revealed, majority of staff nurses (50%) had adequate knowledge and 41.7% had moderate knowledge. Majority of staff nurses (58.3%) had favorable attitude and 41.7% had moderately favourable attitude regarding legal and ethical aspects in OBG Nursing. (Table 1& 2)

III. Effectiveness of SIM on knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses.

There was a significant difference between the mean pretest (12.37±2.91) and posttest (21.17±3.59) knowledge score of nurses. The gain in mean score percentage for overall knowledge was 29.3 with paired‘t’ value of 25.99 which was highly significant at p < 0.05 for all the knowledge variables.

With regard to attitude there was a significant difference between the mean pretest (12.37±2.91) and posttest (21.17±3.59) attitude score. The gain in mean score percentage for overall attitude was 9.8 with paired ‘t’ value of 8.18 which was highly significant at p < 0.05 for all the attitude variables. This indicated that the SIM was effective in terms of improving the knowledge and attitude of nurses regarding legal and ethical aspects in OBG Nursing (Table 3)

IV. Correlation of posttest level of knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses.

The analysis revealed that the coefficient of correlation obtained between post-test knowledge and post-test attitude was 0.826. This shows a significant correlation between knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses. 

V. Association between the pre-test level of knowledge and attitude regarding legal and ethical aspects in OBG Nursing among staff nurses with their selected demographic variables.

The association of demographic variables with pretest level of knowledge and attitude revealed that there was statistically significant association with the demographic variables like experience and previous source of knowledge regarding legal and ethical aspects in OBG Nursing at p<0.05.

DISCUSSION

Present study findings showed that 68.3% of the staff nurses had inadequate knowledge and 31.7% had moderate knowledge regarding legal and ethical issues in OBG nursing. With regard to the attitude of staff nurses 68.33% had moderately favourable attitude and 15% had unfavorable attitude regarding legal and ethical aspects in OBG Nursing. This finding was in congruence with a descriptive study conducted to assess the professional misconduct in relation to pregnancy or delivery among 70 claimed cases of health professionals using non-probability convenience sampling technique. There were 2 maternal deaths, 38 peri-natal deaths and 17 cases of cerebral damage due to false interpretation of fetal signs of distress (clinical signs or cardiotocography) and the caesarean section was delayed too long. The finding revealed that the claimed cases were midwives in 11 cases, obstetricians in 39 cases, and the hospital for lack of routines in 18 cases. The study concluded that midwives should focus on quality and standards in obstetrics and improve national statistics.⁸

SIM on ethical issues in OBG nursing was effective in improving the knowledge and attitude of nurses. There was a significant difference between the mean pretest (12.37±2.91) and posttest (21.17±3.59) knowledge score of nurses. Paired‘t’ value of 25.99 which was highly significant at p < 0.05 for all the knowledge variables.With regard to attitude there was a significant difference between the mean pretest (12.37±2.91) and posttest (21.17±3.59) attitude score. Paired‘t’ value of 8.18 was highly significant at p < 0.05 for all the attitude variables. The investigator had personally observed the loss of mothers and newborns life due to lack of knowledge and attitude of staff nurses in labour wards regarding legal and ethical aspects in obstetrical practice. Hence it is important to provide clinical information guidelines to nurses adopt simple methods such as SIM for providing clinical updates on various issues in OBG to nurses.

CONCLUSION

The study found that the knowledge and attitude of the staff nurses regarding legal and ethical aspects in OBG Nursing was inadequate. A selfinstructional module on legal and ethical aspects in OBG Nursing was developed by the researcher and administered to the staff nurses.The use of SIM was found to be effective than more conventional instructional methods for improving concepts essential for guiding clinical practice among OBG nurses.