Abstract
Aim:The present study aimed to investigate nurses’ knowledge about the care provided to pre-eclamptic patients in a tertiary care centre in Romania.
Study design:A cross sectional study.
Setting:This study was conducted in Polizu Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania, from early January 2019 to the end of February 2019.
Subjects:Sixty five nurses working at the Obstetrics and Gynecology Department.
Data analysis:Data were collected using a self-administered structured questionnaire and they were analysed using IBM SPSS Statistics 20 and Microsoft Office Excel/Word 2013.
Tools:Two tools were used for data collection. Tool I: Assessment sheet to collect data regarding nurses’ general characteristics; and Tool II: A questionnaire to evaluate nurses’ knowledge and practices regarding the management of pre-eclampsia/eclampsia.
Results:About 73.8% of nurses confirmed that they participated in educational programs in the obstetrics field; 10.8% of them confirmed that they participated in training programs for pre-eclampsia/eclampsia, 47.7% gave the right answer when they were asked to correctly identify the definition of eclampsia, 78.5% answered correctly to the proper identification of proteinuria in pregnancy definition, only 9.2% gave the right answer when asked to properly identify chronic hypertension, 40% chose the right answer when asked to correctly identify gestation ages for antenatal use of corticosteroids to improve neonatal result, and 70.8% answered correctly to the proper identification of the best anticonvulsant for severe pre-eclampsia/ eclampsia.
Conclusion:Continuous professional development is critical in nurses’ work in both theory and clinical practice. Unfortunately, this study identified wide gaps in the knowledge of nurses about pre-eclampsia/ eclampsia, including their assessment, diagnosis and management. This is a major concern as globally, severe pre-eclampsia and eclampsia result in 70 000 maternal deaths annually.
Recommendations:Improving nurse’s awareness regarding nursing knowledge and practices through educational programs aimed to encourage them to use best evidence-based practices in their daily practice and reducing maternal and child mortality by pre-eclampsia/eclampsia in Romania.
Keywords:nursing knowledge and practice, pre-eclampsia, eclampsia, Romania.
INTRODUCTION
“Education is the most powerful weapon which you can use to change the world.” (Nelson Mandela)
ccording to the information provided by the World Health Organization in 2011, most deaths due to pre-eclampsia and eclampsia could be avoided by timely and effective treatment of women, particularly in the prenatal phase (1-3). In Romania, health care facilities of the formal health care system are decisive points for successful management of all complications in pregnancy, including pre-eclampsia and eclampsia. Pre-eclampsia is a complex disease, in which several service providers on various care levels must cooperate across disciplines in a coordinated manner to ensure appropriate and effective treatment (4-7). Eclampsia is a potentially fatal disorder of pregnant women that has been prevalent since the time of Hippocrates; it remains an important cause for a serious complication of hypertensive disorders in pregnancy, accounting for about 50 000 maternal deaths a year worldwide (8). Suboptimal care or quality care levels at any time of the care continuum may lead to negative and even fatal results. Therefore, it is important to know how pre-eclamptic and eclamptic patients are treated across all levels. These findings enable health care employees and their upper management to develop possible strategies for solving problems. To date, there is little international research around the world on nurses’ knowledge and regular practices regarding pre-eclampsia and eclampsia. Romania had none at all before. The literature available in Romania showed no studies exploring nurses´ knowledge of pre-eclampsia and eclampsia in a tertiary care centre in Romania.
Aim
The present study aimed to investigate nurses’ knowledge about pre-eclamptic patient care in a tertiary care centre in Romania in an attempt to improve their knowledge and practice in the management of pre-eclampsia/eclampsia, so as to reduce the majority of maternal and fetal deaths due to pre-eclampsia/eclampsia can be avoidable through the provision of timely and effective care to the women presenting with this complication.
MATERIAL AND METHODS
Study design: A cross sectional study design was used, the research was applied on 65 nurses working in a tertiary care centre in Bucharest, Romania.
Setting: This study was conducted from early January 2019 to the end of February 2019.
Subjects: 65 nurses working in Polizu Clinical Hospital of Obstetrics and Gynecology in Bucharest, Romania.
Method: A structured questionnaire developed by the researcher was used to collect data. Questions were based on the related up-to-date literature. After obtaining subjects’ written informed consent, the researcher personally distributed the questionnaires in individual envelopes to each participant and collected all completed questionnaires in sealed envelopes; questionnaire completion did not exceed 30 min.
Questionnaires were divided into two tools: Tool I – assessment sheet to collect data regarding general characteristics of nurses, which included variables such age, gender, education level, total years of experience; and Tool II – well-defined questions about the knowledge regarding management of pre-eclampsia/eclampsia, structured in a questionnaire with 31 questions divided into seven topics; each topic was subdivided into further sub-topics for assessing nursing knowledge and practices regarding management of pre-eclampsia/eclampsia.
Grading: The content of knowledge was determined by 31 questions. A score of (1) was assigned for a right answer, and (0) for a wrong one. An answer with (yes) led to (1) and (no) led to (0).
The total score of 31 for knowledge has been converted to 100%.
Data analysis: Statistical analysis was performed using IBM SPSS Statistics 20 and Microsoft Office Excel/Word 2013.
RESULTS
Data presented in Table 1 show the demographic values of the investigated nurses. All subjects were females with an average age of 15.2 ± 10.028 years. Most of them had a post-secondary non-tertiary education level (83.1%). Participants’ average number of years of experience was 43.82 ± 8.276.
Data from Table 2 and Figure 1 show the distribution of the investigated nurses according to their participation in educational programs in the obstetrics field. About 73.8% of all nurses confirmed that they participated in educational programs.
Data from Table 3 and Figure 2 show the distribution of the investigated nurses according to their participation in training programs for pre-eclampsia/eclampsia. Only 10.8% of all nurses confirmed that they have been participating in training programs for pre-eclampsia/eclampsia.
Data from Table 4 and Figure 3 show distribution of the investigated nurses according to the correct identification of eclampsia definition. Only 47.7% of all nurses answered correctly.
Data from Table 5 and Figure 4 show the distribution of the investigated nurses according to the correct identification of proteinuria in pregnancy definition. Most of the subjects (78.5%) answered correctly.
Data from Table 6 and Figure 5 show the distribution of the investigated nurses according to the correct identification of chronic hypertension in case of DBP of 90 mm HG or more before 20 weeks of pregnancy without proteinuria. Only 9.2% of all nurses answered correctly.
Data from Table 7 and Figure 6 show the distribution of the investigated nurses according to the correct identification of gestation ages for antenatal use of corticosteroids to improve neonatal results. Only 40% of all nurses answered correctly.
Data from Table 8 and Figure 7 show the distribution of the investigated nurses according to the correct identification of the best anticonvulsant for severe pre-eclampsia/eclampsia. 70.8% of all nurses gave the right answer.
DISCUSSION
In this study, participants’ average number of years of experience was 15.2±10.028. About 73.8% of all nurses confirmed that they participated in educational programs in the obstetrics field; 10.8% confirmed that they participated in training programs for pre-eclampsia/eclampsia, 47.7% gave the right answer when asked to correctly identify eclampsia definition, most of the nurses (78.5%) answered correctly to the proper identification of proteinuria in pregnancy definition, only 9.2% chose the right answer to the correct identification of chronic hypertension, 40% answered correctly to the proper identification of gestation ages for antenatal use of corticosteroids to improve neonatal result, and 70.8% gave the right answer to the correct identification of the best anticonvulsant for severe pre-eclampsia/ eclampsia. Unfortunately, this study identified wide gaps in the knowledge of nurses about pre-eclampsia/eclampsia, including their assessment, diagnosis and management. This is a major concern as globally, severe pre-eclampsia and eclampsia result in 70 000 maternal deaths annually (9). It is problematic if nurses from a tertiary referral center in Bucharest, the capital and largest city of Romania, are not able to distinguish between the various categories of hypertensive disorders of pregnancy, diagnose, assess or manage patients with pre-eclampsia/eclampsia. It is thus crucial that nurses working in such an important referral center should have the required knowledge and skills to function independently without a doctor’s support. Nurses play a critical role in promoting public health and it is imperative that they involve assimilation of a problem-solving approach within the background of caring, considering best evidence from studies, patient care data, clinical knowledge and expertise, and patients’ preferences and values with its application in current practice for the benefit of community (10). To highlight and advance clinical effectiveness and evidence- based practice agendas, the Institute of Medicine set the following goal: by 2020, 90% of clinical decisions should be supported by accurate, timely and up-to-date clinical information, in order to reflect the best available evidence to achieve the best patient outcomes (11).
For example, in obstetrics care, it sometimes dramatically reduced morbidity and mortality due to a decreased risk of premature infant death by 20% by using the seminal meta-analysis as Heater (12). It cannot be emphasized enough that optimal care given by nurses is crucial for the safety of both mothers and their babies. Nurses should not only be updated in theoretical knowledge, but their clinical skills should also be updated to ensure competence. In addition, nurses should be able to manage unforeseen obstetrical complications and the high-risk new-born. Having trained preservice nurses, it remains a challenge whether they will be allowed to use their knowledge in the management of pre-eclampsia/eclampsia. Providing evidence of attendance at workshops, conferences and refresher courses in obstetrics and nurses should be compulsory. The maternal and infant mortality rates in Romania will continue to increase if urgent measures are not implemented to ensure that nurses are qualified in advanced optimal care of obstetric emergencies, including continuous refresher courses, to ensure competence in both theory and practice for all practicing nurses.
CONCLUSIONS
“Death caused by preeclampsia is avoided with early detection and effective treatment of women with pre-eclampsia.” (WHO 2011)
A gap in the nurses’ knowledge about pre-eclampsia/eclampsia was identified. This is not acceptable, according to the pre-eclampsia knowledge standards in a tertiary care centre level in Bucharest, the capital and largest city of Romania. In this study, the majority of health professionals were shown to have no sufficient knowledge regarding pre-eclampsia. It is thus extremely important to improve qualification and optimal patient care, which is likely to improve the quality of care for each patient and reduce maternal and perinatal mortality in Romania, in connection with pre-eclampsia. The findings of this study point to some of the most important points such as none of all questioned nurses reached an excellent level of performance (score 100% - level of knowledge). We stress the necessity to conduct further studies on the topic of the current review with methodological rigor, seeking to provide subsidies for nursing care.
Recommendations
ZERO maternal mortality in Romania by pre-eclampsia!
Health education programs for health professionals require more attention. Regular training programs (obstetrics emergency drills) should be introduced for health care professionals to improve the quality of care for women with obstetric emergencies such as pre-eclampsia/eclampsia. Health care facilities should learn about developments in the methods of education and invest in suitable methods that refer to the results within their organization, or change work practices to improve work in the facilities. Guidelines should be disseminated to all maternities and maternal and child health services and integrated to undergraduate nursing curriculum in order to be further applied into practice after graduation. Improving nurses’ awareness regarding evidence-based practices should be done by involving them in educational programs and thus encouraging them to use their knowledge into patient daily care. Further studies are needed to investigate whether the findings of the present study could be replicated in other obstetric emergencies’ settings and on larger sample sizes.
Conflict of interests: none declared
Financial support: none declared.
Acknowledgements: I express my gratitude and thanks towards all who have directly or indirectly helped me to complete this study and their support in each major step of the study.
Ethical standards: This study was conducted after getting approval from the Institutional Ethics Committee and after obtaining written consents from all subjects.
TABLE 1.
Demographic values of the investigated nurses
TABLE 2.
Distribution of the investigated nurses according to their participation in educational programs in the obstetrics field
FIGURE 1.
Distribution of the investigated nurses according to their participation in educational programs in the obstetrics field
TABLE 3.
Distribution of the investigated nurses according to
FIGURE 2.
Distribution of the investigated nurses according to their participation in training programs for pre-eclampsia/eclampsia
TABLE 4.
Distribution of the investigated nurses according to the correct identification of eclampsia definition
FIGURE 3.
Distribution of the investigated nurses according to the correct identification of eclampsia definition
TABLE 5.
Distribution of the investigated nurses according to the correct identification of proteinuria in pregnancy definition
FIGURE 4.
Distribution of the investigated nurses according to the correct identification of proteinuria in pregnancy definition
TABLE 6.
Distribution of the investigated nurses according to the correct identification of chronic hypertension in case of DBP of 90 mm HG or more before 20 weeks of pregnancy without proteinuria
FIGURE 5.
Distribution of the investigated nurses according to the correct identification of chronic hypertension in case of DBP of 90 mm HG or more before 20 weeks of pregnancy without proteinuria
TABLE 7.
Distribution of the investigated nurses according to the correct identification of gestation ages for antenatal use of corticosteroids to improve neonatal results
FIGURE 6.
Distribution of the investigated nurses according to the correct identification of gestation ages for antenatal use of corticosteroids to improve neonatal results
TABLE 8.
Distribution of the investigated nurses according to the correct identification of the best anticonvulsant for severe pre-eclampsia/eclampsia
FIGURE 7.
Distribution of the investigated nurses according to the correct identification of the best anticonvulsant for severe pre-eclampsia/eclampsia
Contributor Information
Carmen Liliana SOGGIU-DUTA, ”Carol Davila” University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, ”Alessandrescu Rusescu” Institute for Mother and Child Care, Bucharest, Romania.
Diana POPOVICI, ”Grigore T. Popa” University of Medicine and Pharmacy, “Elena Doamna” Clinical Hospital of Obstetrics and Gynaecology, Iasi, Romania.
Eduard CRAUCIUC, ”Grigore T. Popa” University of Medicine and Pharmacy, “Elena Doamna” Clinical Hospital of Obstetrics and Gynaecology, Iasi, Romania.
Dragos CRAUCIUC, ”Grigore T. Popa” University of Medicine and Pharmacy, “Elena Doamna” Clinical Hospital of Obstetrics and Gynaecology, Iasi, Romania.
Nicolae SUCIU, ”Carol Davila” University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, ”Alessandrescu Rusescu” Institute for Mother and Child Care, Bucharest, Romania.
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