Effect of applying standards for labor and delivery nursing care on performance of nurses

Background Childbirth is one of the most important events in the life of a woman however, the care provided and practices for childbirth are not standardized. The aim of this study was to evaluate the Effect of applying standards for labor and delivery nursing care on performance of nurses. A quasiexperimental design was adopted. The study was carried out at labor and delivery units in Minia hospitals (Obstetric University Hospital, General hospital and Health Insurance at Labor unit) . Convenience sample for all (50 nurses) who were working in different labor and delivery units during the study in the previous settings. Tools, An interviewing questionnaire for nurses was developed by the researcher and the second was performance standards for maternal and neonatal health Normal Labor and Delivery (NLD) . Results The significant difference were found concerning, immediately and after 3 months and total scores of nurses' performance were highly statistical significant difference was illustrated (p <0.001) , while the mean scores of nurses' performance (163.5±8.2) immediate post test was the higher than 3 months later after application of standards (138.9±11.5), and pretest (107.1±3.1), Conclusion: there was improvement in achievements of performance standards for maternal and neonatal health: Normal Labor and Delivery (NLD) after application of this study immediately better than three months later follow up . Recommendation: Develop evidence-based maternity & neonatal care manual in all hospital based on established evidence-based practice with national standards. Nursing performance appraisal to ensure that nursing care level in maternal &neonatal units follow standardized care manuals. Key wards: applying Standards, labor and delivery, nursing care, performance of nurses Introduction: Every year, more than 200 million women become pregnant. Most pregnancies end with The birth of a live baby to a healthy mother. childbirth is not the joyous event; it is a time of pain, fear, suffering and even death. Because of difficulties associated with human birth, women often require assistance during delivery. Childbirth may be surrounded by traditions, many of which are beneficial, but others may be harmful (1). Childbirth is a risky event for babies too. The complications that cause the deaths and disabilities for mothers also damage the infants they are carrying. These perinatal and neonatal deaths are largely the result of the same factors that cause the deaths and disabilities for mothers (2). Childbirth is a normal physiological process and as such should not be life threatening to the women who experience it. However, in developing countries where pregnancy is complicated by the harsh realities of malnutrition, poverty and the disease associated with them, giving birth dire consequences for mother and child. As a result of child birth, half a million women worldwide die annually (3). Standardized care is required in health facilities, to address the problems of maternal and neonatal health in developing countries, to define the level of performance, improve the quality of services provided and ultimately reduce maternal and neonatal deaths. Only a few reports exist on hospital adherence to these standards. Such information is useful because it identifies critical functions that are not performed and could inform quality improvement efforts (4, 5). Healthy mother and a healthy baby and family integrity must be the focus of high quality maternity services. High quality care should be safe, effective, woman-centered, timely and equitable. It should also be evidence-based and delivered as close as possible to the communities where women live or work. It should continue to be free and accessible to everyone at the point of need (6, 7). All women need nursing care at every stage of labor. The nurse or midwife helps women make decisions based on their clinical need, values and preferences, on the research evidence and on the context of care (8). Aim of the Study The current study was carried out to evaluate the Effect of applying standards for labor and delivery nursing care on performance of nurses. Research Hypothesis There will be a positive effect of Applying Standards for nursing care on nursing performance at the labor unit. Subjects and Methods Research design: The Quasiexperimental design (pre and post test) was adopted in the current study to reach the stated aim. Study setting: The present study was conducted in Minia hospitals ( Obstetric University Hospital , General hospital and Health Insurance at the Labor unit). Obstetric university hospital divided into three floors: first floor containing 2 rooms (gynecology and antenatal care clinics). Second floor containing (15) rooms for gynecological diseases and postoperative care and third floor containing (15) rooms of (obstetric ward) and section contains delivery room, and operating room. Minia Scientific Nursing Journal (Print) (ISSN 2537-012X) Vol. (3) No. (1) July 2018 P a g e | 25 Naglaa F. , et al El-Minia general hospital divided into three floors; first floor containing 2 rooms gynecology and family planning clinics and one operating room, Second floor containing ( infection control unit) ,and Third floor containing one room for delivery and one room for postoperative care. Health Insurance at Labor unit divided into seven floors: third floor containing 3 rooms (antenatal care and post natal ) and two delivery room Sample Convenience sample of 50 nurses who were working in different labor and delivery units during the study in the previous settings Inclusion criteria Each nurse works in labor and delivery unit (which includes settings for normal delivery and provide immediate care of the newborn. Exclusion criteria. Any nurse works in OB-GYN department at Maternity unit but not participating neither in delivery unit work nor providing immediate care of the Newborn was excluded. Tools of data collection To achieve the purpose of current study, data has been collected by using the following two tools: (Tool one): Interviewing questionnaire sheet: This questionnaire was developed, translated and utilized by the researcher to collect the necessary data to be filled by nurses who were involved in the provision of direct care in labor unit, such as (Age, level of education, years of experience in labor unit, and previous attended nursing training about care during labor. knowledge related to first, second, third and fourth stage of labor. (Tool two): The performance standards for maternal and neonatal Health. This tool was prepared by Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO, 2011), to assess the actual performance of health care providers caring for women in labor and delivery units it included 9 performance standards. Normal Labor and Delivery (NLD) NLD-01 standard, which is related to “The provider properly in charge prepare equipments , supplies and the environment to conduct clean and safe deliveries this included 6 criteria , NLD-03 standard, which is related to “The provider treatment the pregnant woman in labor in a cordial manner” this contains 9 criteria, NLD-06 standard, which is related to “The provider properly conducts the obstetric examination between contractions if time allows” it included 9 criteria , NLD-7 standard , which is related to “The provider properly conducts a vaginal examination” including 11 criteria , NLD-11 standard, which is related to “The healthcare provider informs or reinforces information about infant feeding-emphasizing Breastfeeding” including 6 criteria, NLD-13 standard, which is related to “The provider uses the partograph to monitor labor and makes adjustments to care when necessary” including 16 criteria, NLD14 standard ,which is related to provider prepares to assist the delivery/ birth, it included 9 criteria, NLD-17 standard, which is related to “The provider properly monitors the newborn and provides essential initial newborn care and subsequent care” including 10 criteria and NLD-18 standard, which is related to “The provider properly disposes of the used instruments and medical waste after assisting the birth including 7 criteria. Ethical considerations: Each participant nurse in the study was informed that her rights would be secured, informed about the nature, process, and expected outcomes of the study, reassured that the study procedures would be harmless, reassured that all data would be confidential and would be used only for the research purposes, and informed about her rights to withdraw at any time throughout the study. Statistical Design: The collected data were organized, tabulated and analyzed using statistical package of social science (SPSS) 19.0 programs Results Table (1) Distribution of the study sample according to their age, Marital status and level of education (n= 50)