Thesis submitted to National Ribat University for Fulfillment of the requirement for the Award of Master Degree of Sciences in Midwifery

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1 The National Ribat University Faculty of Graduate studies & Scientific Research Thesis submitted to National Ribat University for Fulfillment of the requirement for the Award of Master Degree of Sciences in Midwifery Assessment of Nurse Midwives Knowledge and Practices Regarding Nursing Care During First Stage of Labour In Ribat University Hospital and New Omdurman Saudi and Sheikh Mohammed Ali Fadul Obstetric & Gynaecological Hospital, 2014 Khartoum State - Sudan Prepared by: Fatima Elbatoul Abdalmagid Awad Elgeed Supervised by: Associated Prof. Dr. Bothyna Bassyonie Elssyed Etewa Obstterics & Gynaecological Nursing, Algezira University I

2 ع ع ا ت ف أ ج اء ا ال و خ اض إ ل ج ذ ال خ ل ت ق ال ج ا ل خ ه ج ق ب ل ذ ا ك ج س ا ه س ا * ف اد ا ا ه ي ح ح خ ا أ ل ح ح ز ق ذ ج ع ل ر ب ك ح ح خ ك س ز ا ز إ ل ك ب ج ذ ال خ ل ت حس اق ظ ع ل ك رط با ج ا } صذق هللا العظ ن هز ن س رة ا اث II

3 To my father mercy on him, my dear mother God extend her life, my family-my husband, my Sons and daughters for their support pushing me to achieve my goal I

4 ACKNOWLEDGEMENTS I would like to express my sincere gratitude to the academic staff in The National Ribat University for their efforts in Postgraduates board. My deep appreciation provided to Dr. Bothyna Bassyony Elssyed Etewa for her valuable guidance, encouraging and inspiring notes, offering hours of her time and patience during preparing the thesis. Special thanks go to the members of staff working in Ribat University Hospital and New Om Dorman & Saudi hospital for their continued.. support. I wish to thank my colleagues and mates who were more than generous with their expertise and precious time. I would like to thank the administrators in our college that assisted me with this study. Their excitement and willingness to provide feedback made the completion of this research an enjoyable experience. Finally, gratitude to all nurses midwives who are caring for mothers during labour. II

5 Nurses midwives knowledge and practices regarding nursing care of women during first stage of labour in Ribat University Hospital and new Omdurman Saudi and Sheikh Mohamed Ali Fadul Obstetric & Gynaecological Hospital. Khartoum State Sudan Prepared by: Fatima Elbatoul Abdelmagid Awad Elgeed Abstract Labour process is stressful and so difficult so that woman exposure to high risk of death. The world health organization estimate that approximately 1,000 women globally die every day due to complications from pregnancy or delivery. Nurse midwives are in a key position to disseminate knowledge and provide proper nursing care during first stage of labour resulting in decreasing maternal mortality and morbidity. A descriptive hospital-based study was conducted aimed assessing nurse midwives knowledge and practices regarding care of women in the first stage of labor at AL-Ribat University Hospital and Elshieck Moh d Ali Fudal Saudi Obstetric and Gynaecological Hospital, Khartoum - Sudan. The sample size consisted of 80 nurse midwives during the period from (June/2013-december/013). Data collected by using a questionnaire designed for the study and observation check list for monitoring nurse midwives performance in caring of women in the first stage of labour. Data analysis was carried out by using statistical package for social sciences (SPSS). The results showed that, mean of nurse midwives knowledge regarding all was good with an average (85%), while their practice was poor (26.6%), all participants (100%) gave correct answers regarding definition of normal labour, 88% of them responded correctly regarding the onset of rhythmic uterine contractions, 62.5% of the study sample gave correct answers regarding physiological changes during first stage of labour and 36.3% of the study sample responded correctly regarding factors affecting initiation of normal labour and only 22.5% and 20% of them collect history of current pregnancy and wash their hands correctly respectively. All (100%) participants didn t assess women s pulse and respiration on admission and also didn t check lower extremities for pitting oedema.the study concluded that, nurse midwives knowledge towards first stage of labour found very good, while there is obvious deficit in practice. The study recommended that periodic training program for nurse midwives about care of women in first stage of labour is essential and supervision for nurse midwives performance for quality assurance. III

6 هعزفت هوارساث الووزضاث القابالث حجا الع ا الخوز ض للس ذ اث اء الوزحل ا ل ل لل لد بوسخشف الزباط الجاهع هسخشف الش خ هحوذ عل فضل السع د لهزاض ال ساء الخ ل ذ. ل ت الخزط م - الس داى اعذاد : الطالبت /فاطوت البخ ل عبذ الواجذ هلخص الذراست لموالدة كثير من المخاطر التي تعرض السيدة لخطر الموت بنسبة عالية. ىنالك 0111 حالة موت وسط األميات يوميا نتيجة مضاعفات الحمل أو الوالده كما جاء فى إحصائيات منظمة الصحو العالمية. الممرضات القابالت فى وضع يسمح لين بتعزيز صحة األم فى ىذه المرحمة ومنع المضاعفات لضمان مرور الوالده بسالم وخفض نسبة وفيات األميات. أجريت ىذه الد ارسة المقطعية الوصفية بمستشفى الرباط الوطني ومستشفى الشيخ محمد عمي فضل السعودي وىدفت إلى تقييم وممارسة الممرضات القابالت تجاه العناية التمريضية بالسيدة أثناء المرحمة األولى لموالدة. تكونت عينة الد ارسة من 01 ممرضة قابمة وتمثل العينو المتاحو في الفترة مابين يونيو 3102 م ديسمبر 3102 م. تم جمع البيانات باستخدام استمارة استبيان تم تصميميا لمد ارسة وقائمة المالحظة لرصد أداء الممرضات القابالت أثناء العناية بالسيدة في المرحمة األولى من الوالدة. تم تحميل البيانات باستخدام برنامح الحزمة اإلحصائية لمد ارسات االجتماعية. أظيرت الد ارسة أن كل القابالت )011(% كانت اجابتين صحيح عن تعريف الوالدة الطبيعية وبنسبة )%00( كانت إجابتين صحيحة عن بداية التقمصات المنتظمة المؤلمة. بينما %53.6 كانت أجابتين صحيحة عن التغي ارت الوظيفية أثناء لمرحمة األولى من الوالدة و %53.6 كانت إجابتين صحيحة عن مجئ الطفل بال أرس عند الوالدة و %25.2 من مجموعة الد ارسة قدمن إجابة صحيحة فيما يخص العوامل التي تؤثر عمى بدء عممية الوالدة الطبيعية وفقط %33.6 و %31 منين أخذن تاريخ الحمل الحالي وغسمن إيديين عمى التوالي. كل الممرضات الفابالت في الد ارسة لم يقمن بم ارقبة العالمات الحيوية )النبض والتنفس( عند دخول السيدة كما لم يقمن بفحص األط ارف السفمى بحثا عن وذمة. خمصت الد ارسة إلى أن معمومات الممرضات القابالت عن العناية بالسيدات أثناء المرحمة األولى من الوالدة الطبيعية كانت جيدة بينما ممارستين فى العنايو التمريضيو كانت غير كافية. وأوصت الد ارسة بضرورة عمل دو ارت تدريبية دورية لمممرضات القابالت عن العنايو بالسيده اثناء االلمرحمة األولى من الوالدة واإلش ارف عمى أدائين لضمان الجودة. IV

7 Table of Contents ا ل ت Dedication Acknowledgement Abstract English Abstract Arabic List of content List of tables List of figures List of abbreviations Introduction Justification Objectives Literature Review Material and Methods Results Discussion Conclusion Recommendation References Appendices Chapter One Chapter Tow Chapter Three Chapter Four Chapter Five I I II III IV V VI VIII IX V

8 No. Table 1 Table 2 Table 3 Table 4 Table 5 Table 6 Table 7 Table 8 Table 9 Table 10 Table 11 Table 12 Table 13 Table 14 Table 15 List of Tables Title Distribution of the study sample according to their age and years of experience, (n = 80) regarding definition of normal labour, (n = 80) regarding the benefits of breathing during and in between contractions, (n = 80) regarding characteristics of normal labour, (n = 80) regarding factor affecting initiating of normal labour, (n = 80) regarding signs and symptoms of labour, (n = 80) distribution of the study sample according to their knowledge regarding true and false labour contraction, (n = 80) regarding premature rupture of membrane, (n = 80) regarding stages of labour divided to 4 stage, (n = 80) regarding definition of first stage of labour, (n = 80) regarding phases of the first stage of labour, (n = 80) regarding normal FHR, (n = 80) regarding the important factors in successful labour, (n = 80) regarding the importance of bladder evacuation, (n = 80) regarding types of diet during labour, (n = 80) Page No VI

9 Table 16 Table 17 Table 18 Table 19 Table 20 Table 21 Table 22 Table 23 Table 24 Table 25 Table 26 Table 27 Table 28 Table 29 Table 29 regarding the presence of frank bleeding, (n = 80) regarding the care during first stage of labour regarding care during second stage labour, (n = 80) regarding care during 3rd stage of labour, (n = 80) regarding care during 4th stage of labour, (n = 80) regarding signs of placental separation, (n = 80) regarding examination of the placenta regarding characteristic of the uterus immediately after delivery, (n = 80) regarding monitoring of vital signs, (n = 80) Distribution of the nurse midwives according to their performance regarding nursing care on admissions Distribution of the nurse midwives according to their performance regarding local examination Distribution of the nurse midwives according to their practices regarding monitoring of labour progress Table No (28) Distribution of the nurse midwives according to their performance regarding health education and advice during first stage of labour Table (29) Distribution of the nurse midwives according to their practice regarding preparation for labour Distribution of the nurse midwives according to their performance regarding general examination VII

10 List of Figures No. of Figure Title Page No Figure (1) Check List care by the midwives on admission 72 Figure (2) Distribution of the nurse midwives according to their performance 73 Figure (3) Monitoring progress of labour 74 Figure (4) Health education and advice during first stage of labour 78 Figure (5) Preparations for labour 80 VIII

11 List of Abbreviations WHO PV ROP LOP SROM OA LMP EDD CNM UTI NST PMROM FHR CTG HIV PIH World Health Organization Examination Per Vagina Right Occipto Posterior Left Occipto Posterior Spontaneous Rupture Of Membranes Occipto Anterior Last Menstrual Cycle Expected Date Of Delivery Certified Nurse Midwife Urinary Tract Infection Non Stress Test Premature Rupture Of Membranes Fetal Heart R ate Cardio TcoGraphy Human Immuno virus Pregnancy Induced Hypertesion IX