NURSING INTERVENTION ON THE MIDWIVES’ SKILLS IN THE MANAGEMENT OF POSTPARTUM HAEMORRHAGE IN SELECTED SECONDARY HEALTH FACILITIES IN ONDO STATE, NIGERIA

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TABLE OF CONTENTS

Content                                                                                               Page

Title page                                                                                            i

Certification                                                                                       ii

Dedication                                                                              iii

Acknowledgements                                                                            iv

Abstract                                                                      v

Table of Contents                                                                   vi

List of Tables                                                                                     xi

List of Figures                                                                                                 x

Appendices                                                                             xi

Abbreviations                                                                                      xii

CHAPTER ONE: INTRODUCTION                                                       

1.1    Background to the Study                                                                      1

1.2    Statement of the Problem                                                                      3

1.3    Significance of the Study                                                                                  4

1.4    Scope of the Study                                                                                            4

1.5    Objective of the Study                                                                                      4

1.6    Research Questions                                                                                            5

1.7    Hypotheses                                                                                                        5

1.8    Operational Definition of Terms                                                            6

CHAPTER TWO: REVIEW OF LITERATURE

2.0    Introduction                                                                                                       7

2.1    Concept of Postpartum Haemorrhage                                       7

2.2    Relationship between Postpartum Haemorrhage and Maternal Mortality         7

2.3    Classification of Postpartum Haemorrhage                                      8

2.3.1 Blood loss Quantification                                                                                  8

2.3.1.1 Blood loss during and after Delivery                                8

2.3.1.2 Hematocrit Changes                                                                          9

2.3.1.3 Blood Loss Rate                                                                                             9

2.3.1.4 Blood volume insufficiency                                                           9

2.4    Etiology of Postpartum Haemorrhage                                                   10

2.4.1 Atonic uterus                                                                                        10

2.5    Pathophysiology of Postpartum Haemorrhage                                      12

2.6    Evidence based Measures for immediate Management of Postpartum

Haemorrhage   12

2.7    Non-Pneumatic Anti-shock Garment, strategy against Postpartum

 Haemorrhage  13

2.8    History of Non-Pneumatic Anti-shock Garment                                   13

2.9    Mechanism of action of NASG                         14

2.10  Application of NASG                14

2.10.1 Procedure of Application                                14

2.10.2 Procedure for   NASG Removal15

2.10.3  Contra-indications to NASG                          15

2.11  Benefits of the NASG                                                                                       15

2.12  Empirical Studies                                               16

2.13  Evidence based  report of NASG for Postpartum Haemorrhage in

University College Hospital, Ibadan, Nigeria                                                  17

2.14  Misoprostol                                18

2.15  Concept of Active Management of third Stage of Labour                   19

2.16  Trends of Uterotonic drugs used in the Prevention of PPH           19

2.17  Reasons why Misoprostol is Preferred  20

2.18  Misoprostol and its Mode of Action     20

2.19  Benefits of Misoprostol over other conventional Uterotonic drugs in management   of postpartum haemorrhage                                                       21

2.20  Empirical Studies on Misoprostol          21

2.21  Expanding Midwives Skills       22

2.22  Theoretical Model          23

2.22.1 Bloom’s Model                                                                                   23

2.22.2The Cognitive Domain                                                                     24

2.22.3  The Psychomotor Domain                                                     25

2.23  Application of Model to the Study                               25

2.24  Application of the Psychomotor Domain in the Application of NASG            26

2.25   Conceptual Model; source; adapted from bloom taxonomy (1956)27

CHAPTER THREE: METHODOLOGY

3.0    Introduction                                                        28

3.1    Research Design            28

3.2    Population          28

3.3    Sample size and sampling Technique                                                                 29

3.4    Instrument          30

3.5    Validity and Reliability of Instrument                                      30

3.6    Method of Data Collection                                                                    30

3.7    Method of Data Analysis          31

3.8    Ethical Consideration    32

CHAPTER FOUR: DATA ANALYSIS, RESULTS AND

DISCUSSIONOF FINDINGS

4.0    Introduction                                                                                  33

4.1    Data Analysis and Result Presentation                                                    33

4.2    Discussion of Findings                                                                          43

CHAPTER FIVE: SUMMARY, CONCLUSION AND

RECOMMENDATIONS

5.1    Summary                                                                                                            52

5.2    Conclusion                                                                                             53

5.3    Recommendations                                                                54

5.4    Limitation of the study                                                               54

5.5    Suggestion for Further Studies                                                              54

REFERENCES                                                                                              56

APPENDICES                                                                                               62

LIST OF TABLES

Table                                                                                      Page

2.1    Showing Standardized Classification of PPH as described by Benedetti        10

4.1    Showing Frequency and Percentage on participant’s Socio Demographic data 33

4.2    Showing Pre and Post Intervention Knowledge level of Midwives on

Misoprostol usein the Management of PPH in Control and Experimental

groups 35

4.3 ShowingPre and post Intervention Knowledge level of Midwives in the use of NASG in the Management of PPH in the Control and Experimental Groups           36

4.4Showing Application of NASG by the Midwives in the Management of PPH Pre    and Post Intervention in the Control and Experimental group.                                     37

4.5ShowingRemoval   of   NASG by the Midwives in the Management of PPH Pre and post intervention in the Control and Experimental group.                                  38

4.6Showing Inferential Statistics comparing mean scores of Post Intervention BKnowledge of Misoprostol and NASG in the Control and Experimental group         40

4.7Showing Inferential Statistics comparing mean scores of Post Intervention Knowledge of   Misoprostol and NASG in the Control and Experimental group        41

4.8Showing Inferential Statistics comparingKnowledge mean scores of Misoprostol   use in Experimental group Pre and Post intervention                                                      42

4.9Showing Inferential Statistics comparingPre and Post Skills in the Application of NASG                                                                            43

LIST OF FIGURES

Figure                                                                                                              Page

1        Conceptual Model                                                                                            27

2.       Research Design                                                                                               28

APPENDICES

Appendix                                                                                                        Page 

Informed Consent Form                                                                             62

Questionnaire                                                              63

Pathfinder Teaching Package                         68

Pictures from the field work                                                                           73

ABBREVIATIONS

PPH                             Postpartum Haemorrhage

NASG                         Non Pneumatic Antishock Garment

BUHREC                   Health Research Ethics Committee

OSHREC                    Ondo State Health Research Ethics Committee

SPB                             Systolic Blood Pressure

UNFPA                       The United Nationsfund for population activities

POPPHI                      Prevention of postpartum haemorrhage initiative

AMTSL                       Active Management of Third Stage of Labour

CCT                            Control Cord Traction

ANC                           Antenatal Clinic

CHWs                         Community Health Workers

FMOH                 &nbs