Posted on 22nd Sep 2024 07:47:03 PM Medicine
1.1 General Introduction
The postnatal period is an important and extremely vulnerable time for new mothers and their infants. Research has outlined the considerable extent of maternal physiological and psychological morbidity following childbirth. The underreporting and undiagnosed aspect of this morbidity has also been highlighted. Newborn infants are totally dependent on their needs being met and are also at risk of newborn conditions particularly if they are undiagnosed, for example neonatal jaundice. There is however, mounting evidence regarding the lack of postnatal support from health professionals, with women continuing to report their dissatisfaction with postnatal care. Research into postnatal care is pre-dominantly quantitative and clinically focused. Few empirical studies have examined the meaning women give to their postnatal care experiences.
This research aims to generate a deeper understanding of the meanings, and lived experiences of postnatal care. In addition, it aims to reveal future possibilities to enhance nurse’s postnatal care experiences.
The study was carried out with a view to assess the knowledge of senior staff nurses regarding postnatal care following a quantitative research model using an explorative and descriptive design. It was conducted at Rajshahi Medical College Hospital (RMCH), a 500-bed tertiary level teaching hospital, which is located in Rajshahi Metropolitan city of Bangladesh, in thirty one wards under thirteen selected wards. Data were collected from the respected Senior Staff Nurses (SSN) on demographic features as age, gender, marital status, religion, academic qualification, professional qualification, length of service .
1.2 Specific Introduction
1.2.1. Postpartum Period
Postpartum care remains a vital process and service of the childbearing period. Yelland et al. (1998) states that this period is an opportunity for women to rest and recuperate following delivery, to receive guidance, support, and information on baby care. The postpartum period is a time of reflection, of relieving the birth experiences, a time of adjustment to the new roles and accommodation of the family to the new member. This period also involves the involution of the uterus back to non-pregnant state. It is a very special phase in the life of a woman and her newborn.
Nunnerley (1990) describes postpartum care as a vital part of the childbearing process that the midwife has to provide for the mother and the baby immediately following birth to the end of puerperium. Postpartum examination is very important in that it confirms the mother’s recovery from effects of pregnancy, labour and delivery, or if there are problems, interventions can be done.
Health workers who provide care to families during this transitional and disruptive period may have unique skills and expertise to offer. Information and support families receive during this period is important in augmenting the coping strategies they have used in previous times of change.
In Botswana, postpartum care includes general care and assistance given to the woman after delivery, visit by the health worker within first week following discharge, and the routine postpartum examination which is done at the end of puerperium 6-8 weeks after delivery (Safe Motherhood Task Force, 1992).
Postpartum assessment is the last examination, which marks the end of puerperium, probably because of the assumption that mothers would have recovered from effects of pregnancy and childbirth. It aims at achieving physical, psychological and emotional wellbeing of the mother, the baby and the family as a whole Bick and MacArthur (1995, 1997).
Available data shows that utilization of maternal health services has been steadily increasing and at present stands at 77%. Studies also show that in the recent maternal mortality survey, lack of adequate services and poor community communication system in certain areas in Botswana contributed to maternal and infant mortality (Safe Motherhood Task Force, 1992; Makokha et al., 1994).
This notion suggests that most women know and make use of available postpartum services. However, a few studies done in Botswana on maternal and child health services have noted the dissatisfaction among women regarding the delivery of maternity health services in general. Indigenous people all over the world are historically subjugated and discriminated against, which is explicitly and implicitly affecting their health status.
Studies reveal that indigenous/ethnic population experience more health related problems and inequalities than mainstream population (Ahmed, 2001; Fiscella, 2004; Harris et al, 2006; Hansen et al, 2008). In particular, indigenous people or ethnic minorities are adversely affected by reproductive health problems where maternal mortality and infant mortality rates are significantly higher.
For instance, only a small percentage (4%) of all maternal deaths occurred in Latin America and the Caribbean, but these deaths disproportionately occurred among indigenous peoples (UNFPA, 2005). In USA, black women have four times higher pregnancy related mortality rates (Berg et al., 2003; Fiscella, 2004) and 70 per cent higher hospitalization rates for pregnancy-related complications than white women.
The study also demonstrates that infant mortality rates among indigenous peoples are higher than non-Indigenous peoples in Canada, New Zealand, Australia, Brazil, India, Uganda and Peru, and these differences are significantly greater in the latter four less developed countries. Although indigenous people generally have a poorer health situation than the population at large, very few studies also show that health of indigenous people is better than non-indigenous people.
For instance, reproductive health status of Garo indigenous people in Bangladesh is better than the Bengali population at large (Islam et al., 2009). In Bangladesh, indigenous people also experience discrimination in health status as compared to their Bengali neighbours (Ahmed, 2001; Ahmed et al., 2003; Karim et al., 2005).
The indigenous people of Chittagong Hill Tracts (CHT), particularly in the Bandarban area, are marginalized in terms of ‘ultra-poor’ households, literacy, livelihood, childhood immunization, contraception, pregnancy and professional delivery care, and access to static (institutionalized) government health facilities as compared to plain land areas (Rafi and Chowdhury, 2001; Ahmed et al., 2003).
Since British rule up till today, most of the literature available on indigenous communities has focused on the socio-economic, cultural and political issues of these communities (Kamal, 1998). Most importantly very few accessible studies have been done regarding reproductive health issues of indigenous people. Moreover, these works do not cover all areas of reproductive health.
1.2.2. Postpartum Care
This pertains to care given to the mother and the baby immediately after the birth of the baby until six to eight weeks post delivery. It is as important to the mother as prenatal care. For the purpose of this study, postpartum care is defined as care given to the mother and infant just after delivery until six to eight weeks in order to assess, identify, give support and counselling on infant breastfeeding, nutrition, immunization, safer sex and family planning. Traditional birth attendants provide care to those who deliver at home due to shortage of transport and the long distance between levels of health facilities especially in the rural areas where roads are poor, shortage of transport and insufficient qualified health personnel Safe Motherhood Task Force,(1992).
Professional/ Modern Care Provision of Postpartum Care in Developed and Developing countries-
Developed Countries 90%
Developing Countries 30%
Very Poor Regions 5%
Source: WHO (1999) http://www Safe Motherhood. Org/facts and figures/maternal health/UNIEF (1999)
The fundamental aspects of care take place at the health facility before the mother is discharged home. The delivered mother’s vital signs should be checked, various observations done for early detection of risk factors, and treatment given where necessary to the mother or the baby. Counseling should also be done on family planning, personal hygiene, breastfeeding, and nutrition and care of the baby. The mother should be advised to come back with the baby for examination at six weeks to ascertain the return of the reproductive organs to pre-pregnancy state and give advice to the woman regarding her future reproductive activities. The baby should be given initial immunizations before discharge.
Due to limited hospital beds and overcrowding in most health facilities in developing countries, some mothers may be discharged before they are adequately informed about the importance of and attendance of the 6-8 weeks examination. This may suggest why most women do not get quality postpartum care and may not adequately get postpartum services at home during the first week of deliver. Nurses are expected to do home visits within the first week following discharge from maternity to observe lochia, and uterine involution, breast-feeding habits and conduct physical examination of the mother and the baby to exclude complications.
1.2.3 Postnatal visit
The optimum number and timing of PNC visits, especially in limited resource settings, is a subject of debate. Although no large-scale systematic reviews have been carried out to determine this protocol, three or four postnatal visits have been suggested. Early visits are crucial because the majority of maternal and newborn deaths occur in the first week, especially on the first day, and this period is also the key time to promote healthy behaviours. Each country should make decisions based on the local context and existing care provisions, including who can deliver the PNC package and where it can be delivered. The following are offered as a guide:
• First contact:
If the mother is in a facility, she and her baby should be assessed within one hour of birth and again before discharge
Encouraging women to stay for 24 hours, especially after a complicated birth, should be considered If birth occurs at home, the first visit should target the crucial first 24 hours after birth
• Follow up contacts: are recommended at least at 2-3 days, 6-7 days, and at 6 weeks
• Extra contacts: for babies needing extra care (LBW or those whose mothers have HIV) should have two or three visits in addition to the routine visits.
1.2.4 Benefit of postnatal care
- To assess the health status of the mother and institute effective therapy to the defect, if any. Medical disorder like Diabetes Mellitus, Hypertension should be reassessed.
- To detect and treat at the earliest gynaecological condition arising out of obstetric legacy.
- To note the progress of the baby including the immunization schedule for the infant.
- To impart family planning guidance.
1.2.5 Postnatal advice
- Diet: High nutritious diet containing vitamins, minerals including iron, folic acid, vitamin-c, calcium etc.
- Should not be bear heavy weight for at least 3 months.
- Contraception.
1. Progesterone only pill.
2. Barrier method for next 2 years
- Coitus:
1. Abstinence in first 45 days
2. with caution next 45 days
- Birth spacing: for at least 2 years
- Breast feeding advice
- Immunization advice
1.2.6 Physiological change during postnatal period
• The cardiovascular system reverts to normal during the first 2 weeks. The extra load on the heart from extra volume of blood disappears by the second week.
• The vaginal wall is initially swollen, bluish and pouting but rapidly regains its tone, although remaining fragile for 1-2 weeks. Perineal oedema may persist for some days.
• After delivery of the placenta, the uterus is at the size of 20-week pregnancy, but reduces in size on abdominal examination by 1 finger-breadth each day, such that on the 12th day it cannot be palpated. By end of puerperium it is only slightly larger than pre-pregnancy.
• For the first 3-4 days, lochia comprises mainly blood and remnants of trophoblastic tissue. During days 3-12 the colour is reddish-brown but then changes to yellow. Occasionally, lochia may become red again for a few days due to thrombi at end of vessels breaking.
1.2.7 Postnatal complications
- Postpartum haemorrhage
- Puerperal sepsis
- Postpartum psychosis
- Sub involution
- Breast complications
- Urinary complication
- Postnatal anaemia
- Thromboembolism
1.3. Justification of the study
As the postnatal period is a vital period for a woman so in this time the proper care is essential and as this care is provided by the nurses so it is must be needed to know that whether the nurses are knowledgeable or not about this care. This study will be helpful to assess the nurses knowledge about postnatal care.
1.4. Research question
What is the level of knowledge of senior staff nurses regarding postnatal care.
1.5 Objectives
1.5.1 General Objective
The study will be carried out with a view to assess the knowledge of senior staff nurses regarding the postnatal care.
1.5.2 Specific Objective
• To assess the knowledge of nurses regarding postnatal care.
• To find out the socio-demographic characteristics of the respondents.
• To find out the relationship between the knowledge about postnatal care and the socio-demographic characteristics of the respondents.
• To assess the quality of medical and facility records.
• To determine patient and hospital delays in postnatal emergency.
• To describe benefit about postnatal care.
CONTENTS
Abstract
CHAPTER – 1 Introduction
1.1 General Introduction
1.2 Specific Introduction
1.3 Justification of the study
1.4 Research question
1.5 Objective
CHAPTER – 2 Review of Literature
2.0 Introduction
2.1 Literature Review and Conceptual Framework
2.2 Regional and Global Maternal Health Status
2.3 Maternal Mortality
2.4 Maternal Morbidity
2.5 Barriers to utilization of maternal health services
2.6 Problems encountered during postpartum period
2.7 Quality of Care
2.8 Relevance and importance of quality postpartum care
CHAPTER – 3 Materials and Methods
3.1 Research Methodology
3.2 Design of the Study
3.3 Study Place
3.4 Setting, population and sample of the Study
3.5 Instrumentation
3.6 Translation of the instrument
3.7 Data collection procedure
3.8 Statistical analysis
CHAPTER – 4 Results
4.1 Demographic information of the Nurses
4.2 Knowledge about postnatal care of the Nurses
CHAPTER – 5
5.0 Discussion
CHAPTER – 6
6.0 Conclusion
CHAPTER – 7
7.0 References
CHAPTER – 8
8.0 Appendix
8.1 Appendix I (Informed Consent Form)
8.2 Appendix II (Instruments)
8.3 Appendix III (Questionnaire)
List of Tables
Table 1 Demographic information of the participated nurses
Table 2 Information of the participated nurses regarding postnatal care
Table 3 Information regarding knowledge of the participated nurses about postnatal care
Thesis, Assessment, Nurses, Knowledge, Regarding, Postnatal, Care, Rajshahi, Medical, Nursing, College, Hospital, Maternal, Mortality, Morbidity, Regional, Global, Maternal, Health, Instrumentation
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