IMPACT OF A STRUCTURED EDUCATIONAL PROGRAM ON NURSES' KNOWLEDGE AND PRACTICE IN THIRD AND FOURTH STAGE LABOR MANAGEMENT

Abstract

The third and fourth stages of labor are critical periods in maternal care, during which timely and evidence-based nursing interventions are essential for preventing postpartum hemorrhage (PPH) and other maternal complications. The nurses are key stakeholders in the implementation of Active Management of the Third Stage of Labor (AMTSL) and in the immediate postpartum period monitoring mothers. But lack of knowledge and clinical practices can affect the quality of maternal health care. It has been known that structured education programs are effective methods to improve nurses' competency and encourage compliance with evidence-based practice.

To evaluate the impact of a structured educational program on nurses’ knowledge and practices regarding the management of the third and fourth stages of labor at a tertiary care hospital.

The study employed a quasi-experimental pretest-posttest design in which 65 registered nurses in labor room and postnatal wards of Lahore General hospital Lahore, The participants were selected by non-probabilistic purposive sampling technique. Structured questionnaire and observation checklist were used to gather the data, which were modified and validated from previous instruments. 20 multiple-choice questions were used to assess nurse knowledge and 15 practice items were used to assess the clinical practices on the questionnaire. After baseline assessment, a structured educational program was provided using interactive lectures, demonstrations, media and educational handouts. Post Testing was carried out using the same tools. SPSS version 26.0 was used for data analysis. Participant descriptors were summarized with descriptive statistics, and Chi-square tests and paired sample t tests were used to evaluate intervention efficacy and associations between variables. P-values < 0.05 were deemed to be statistically significant.

Results of the 65 respondents, 70.8% were female, 40.0% qualified with a BS Nursing and 41.5% had 1-5 years experience in obstetrics. Before the intervention, only 9.2% of nurses had good knowledge and none had a good practice level. After the educational program, the number of nurses who had good knowledge and good practice scores were 56.9% and 64.6% respectively. The mean knowledge score increased significantly from 11.49 ± 2.06 to 16.78 ± 1.74 (t = 32.93, p < 0.001). Similarly, the mean practice score improved significantly from 8.35 ± 1.87 to 13.14 ± 1.17 (t = 30.12, p < 0.001). There were no statistically significant relationships between the demographic characteristics and the posttest knowledge or practice outcomes (p > 0.05).

The structured educational program proved to be quite successful in boosting the knowledge and practices of nurses in the management of third and fourth stage of labor. There was an improvement in theoretical knowledge and clinical skills after the intervention. Continuing nursing education should include competency-based educational programs that are regularly offered to reinforce evidence-based maternity care and maternal health care outcomes, along with refresher training.