Effectiveness of Postnatal Care by Using Comprehensive Postnatal Nursing Stratergy (Cpns) Module

Introduction

The happiest moment in every mother’s life is childbirth and the mother enjoys the presence of a healthy newborn. Puerperium is the period during which the body tissues especially the pelvic organs revert back to an approximately prepregnant state, both anatomically and physiologically and this spans six weeks (Dutta. 2016). In this study, investigators adopted the World Health Organization guidelines (2013) and modified it into a teaching module. The comprehensive postnatal nursing strategies (CPNS) under expert guidance were considered as training and reinforcement tools to educate nurses on the following strategies of CPNS and to assess the effect of CPNS on postnatal nursing problems. The Ministry of health and family welfare, Government of India (2013) have published and reported strategic approaches on reproductive maternal newborn and adolescent health in India.

Globally, 2,87,000 maternal deaths have occurred in the year 2010, and the maternal mortality ratio (MMR) was 210 per 100,000 live births. Sub-Saharan Africa (56%) and Southern Asia (29%) accounted for 85% of maternal deaths in 2010, and India accounted for 19% (56000) of all global maternal deaths. Recommendations given by WHO on postnatal care are followed in every health care setting involved in postnatal care. Since then, the last sample registration report (2010) by the RegistrarGeneral of India on MMR reported decline in deaths from Kerala (66), Tamilnadu (90), Maharashtra (87), Andhra Pradesh (110) and Karnataka (144). In South India, Karnataka needs more attention when compared to other states. There is a need for further research to screen the implementation of nursing care at all levels and evaluate patient satisfaction with nursing care. Therefore, this study investigated the level of satisfaction of mothers with nursing care when administered CPNS when compared to mothers who received routine nursing care. The study also examined the association between demographic variables and level of patient satisfaction.

Methods

This study was conducted in 870 (test group=430, control group=440) mothers in their postnatal period and inpatients at 24 maternity hospitals associated with Bruhat Bangalore Mahanagar Palike (BBMP) in Bangalore. In this study a quasi-experimental, nonequivalent control group post-test only design was adopted. Data on age, education, family type, monthly income, designation, and professional experience, medical history were recorded.

A non-probability convenient sampling method as per inclusive criteria was adopted. As per staff inspection committee norms, a ratio of 1:5, that is a sample of one nurse: five postnatal mothers were selected. Therefore, for 174 nurses, 430 mothers were included in the test group. For 88 nurses, 440 postnatal mothers were recruited in the control group.

Nurses working in the postnatal ward in BBMP hospitals, more than two-years’ experience in midwifery, and willing to participate in the study were included. Postnatal mothers with normal pregnancy and mothers with comorbid conditions such as gestational diabetes, pregnancy-induced hypertension and anemia but underwent a normal delivery and can read and write in Kannada, and English were recruited.

Mothers with medical illnesses such as cardiac thoracic diseases, and bronchial asthma, psychiatric illness and mothers who underwent a caesarean section were excluded.

Assessments

Part I: Background variables of postnatal mother including age, education, gravida, caretaker details, comorbid conditions, were recorded. A verbal response was recorded from the mothers who participated in the study.

Part II: Background variables of nurse including age, family type, course, monthly income, designation, and professional experience in the postnatal ward were recorded. A verbal response was obtained from the nurses who participated in the study.

Part III: Interviews were scheduled to assess the satisfaction of CPNS in postnatal mothers. The total items in this tool were 14. Interview schedule to assess the satisfaction of CPNS in postnatal mothers measured satisfaction. The maximum score was 70, minimum score was 14.

Data collection process

Ethical clearance was obtained from the Institutional Ethics Committee. Permission was obtained from the Head of the Department, Obstetrics and Gynecology, Directorate of BBMP hospitals to collect the data from nurses and conduct the training and reinforcement sessions and to conduct the study in postnatal mothers at BBMP hospitals.

1. Data obtained from nurses: A list of available nurses working in BBMP hospitals was obtained from the register. Nurses in the morning, afternoon and evening shifts were identified and per day 3 nurses were met in each hospital. Nurses who fulfilled the inclusive criteria and gave informed consent after adequate explanation about the risk and benefits of the study were recruited. Data collection focused on collecting the demographic data by interview.
2. Data obtained from mother: The purpose of the study and their right to participate or withdraw from the study was explained to the postnatal mothers to obtain written informed consent. Postnatal mothers who fulfilled the inclusion criteria were enrolled to the study. Strict privacy was maintained during data collection. Data on demographic variables were collected on the first postnatal day and the interview was about 15 minutes, On the fifth postnatal day endpoint testing was conducted, for about 15-30 minutes.

Data Analysis and Interpritation

I. Demographic variables of postnatal mothers in the study and control group

In the test group, 215 of postnatal mothers were in the age group between 18 and 23 years, 149 (34.7%) completed PUC study group and 244 (56.7%) of them were primi, 175 (40.7%) of them had care takers and the source of information were parents. No illness was reported in 250 (58.1%) of them and comorbid conditions were observed with 79 (18.4%) diagnosed with anemia, 68 (15.8%) with pregnancy-induced hypertension and 38 (7.7%) had gestational diabetes.

In the control group, 220 (60%) were aged between 18 and 23 years, 54 (12.3%) completed primary school education, 250 (56.8%) were primigravida, 172 (39.5%) of them had parents as care takers, source of information was media 140 (31.8%), 266 (60.5%) reported no medical illness. Comorbid conditions were reported including 30 (6.8%) diagnosed with gestational diabetes, 70 (15.9%) pregnancy-induced hypertension and 74 (16.8%) were anemic. The difference between groups was insignificant (p>0.05).

The findings demonstrate that the sample of postnatal mothers observed in the test and control group were homogeneous in their demographic characteristics as per the requisite of baseline characteristics of study and control group (Table 1 & 2).

II. Findings on description of demographic characteristics of nurses in test and control groups (Table 2, Figure 1).

In the test group, majority of nurses, 25 (29%) were aged between 26 and 30 yrs, 36 (41.8%) were with a Bachelor of Nursing degree, 51 (59.3%) belonged to a nuclear family, 37 (43.0%) earned 10000-15000 rupees, 47 (54.7%) held the designation of a senior nurse, 47 (54.7%) had 2 to 5yrs experience in the postnatal ward.

In the control group, majority of nurses 26 (29.5%) were aged between 36 and 40 years, 40 (45.45%) had a Bachelor of Nursing degree, 53 (60.2%) belonged to a nuclear family, 37 (42.0%) earned between 10000 and 15000 rupees, 44 (50%) held a designation of senior nurse, 44 (50.3%) had 2 to 5 yrs experience in the postnatal ward. Chi-square results were not significant (p>0.05).

Findings demonstrate that the sample of nurses observed in the test and control group were homogeneous in their demographic characteristics and as per the requisite of baseline characteristics of a test and control group.

III. Findings on the comparison of satisfaction levels between test and control groups

In the test group, majority of postnatal mothers 304 (70.7%) had high level satisfaction of CPNS implementation, 126 (29.3%) had moderate level of satisfaction and none of them had poor satisfaction.

In the control group, majority of postnatal mothers, 233 (53%) had poor level of satisfaction with routine care, 207 (47%) had moderate level of satisfaction with routine car and none of them had high level of satisfaction with routine care.

Further, it was observed that a majority of postnatal mothers were highly satisfied with postnata nursing care in the test group and majority were poorly satisfied with postnatal nursing care in the control group. Findings of this study was supported by Varghese, (2012), conducted to evaluate the level of satisfaction as perceived by postnatal mothers following nursing care in postnatal wards.

IV. Findings on association between satisfaction levels with selected demographic variables of postnatal mothers in study group

Findings reveal that the association of age group with moderate level and high level of satisfaction was significant (chi-square=8.047, df=3, p<0.05). Association of education with moderate level and high level of satisfaction found to be non-significant (chisquare=1.889, df=1, p>0.05). Association of gravida with a moderate level and high level of satisfaction was found to be non-significant (chi-square=7.127, df=2, p>0.05). Association of caretakers with moderate level and high level of satisfaction was significant (chisquare=8.170, df=3, p<0.05). Association of source of information with moderate level and high level of satisfaction was significant (chi-square=13.245, df=3, p<0.05). Association of medical illness in pregnancy with moderate level and high level of satisfaction was non-significant (chi-square value=1.131, df=3, p>0.05) (Table 3 & 4).

V Findings on association between satisfaction levels with selected demographic variables of postnatal mothers in control group

Association of age group with poor level and moderate level of satisfaction was non-significant (chisquare=1.174, df=3, p>0.05). Association of education with moderate level and high level of satisfaction was non-significant (chi-square=1.006, df=2, p>0.05).

Association of gravida with poor level and moderate level of satisfaction was non-significant (chi-square=0.536, df=2, p>0.05). Association of caretakers with poor level and moderate level of satisfaction was significant (chisquare=0.559, df=3, p>0.05). Association of source of information with poor level and moderate level of satisfaction was non-significant (chi-square=2.014, df=3, p>0.05). Association of medical illness in pregnancy with poor level and moderate level of satisfaction was non-significant (chi-square=0.98, df=3, p>0.05).

Conclusions

The study concluded that CPNS implementation by nurses was associated with greater satisfaction levels among postnatal mothers. Findings of this study conclude that reinforcement of existing standard nursing practices with regular evaluation of nursing care is essential to prevent potential complications. Further strict adherence to systematic nursing practices is an important measure towards reducing maternal mortality rate.

Conflict of Interest

None.