A study to assess the knowledge of III year GNM students regarding management of Pregnancy Induced Hypertension in selected college of Belgaum Karnataka
Mrs. Shweta Dandagi1*, Mr. Shivarajkumar Dandagi2
1Senior Tutor, Department of OBG (N), KLEU’S Institute of Nursing Sciences, Belgavi.
2Lecturer, Department of Community Health Nursing, KLEU’S Institute of nursing Sciences, Belgavi.
*Corresponding Author’s Email: angadi.shweta@yahoo.com
ABSTRACT:
Hypertension is a universal problem and it complicates at least 10% of all the pregnancies. Preeclampsia is defined as the triad of hypertension, proteinuria and edema occurring after 20 weeks gestation in previously normotensive women. It is specific to human pregnancy. It is transient but potentially dangerous complication of pregnancy. Preeclampsia is still one of the leading causes of maternal and foetal morbidity and mortality. It is well known fact that electrolytes play an important role in aetiopathogenesis of hypertension. So need to improve the knowledge of sample regarding the management of Pregnancy Induced Hypertension, since they are only health care personnel who work with pregnant mother at grass root level.
Objectives of study were: 1.To assess the knowledge of III year GNM students regarding management of Pregnancy Induced Hypertension. 2. To determine the association between knowledge scores and selected socio demographic variables. Materials and methods: The study was conducted using non experimental descriptive study design. The demographic variables were Age, Religion, Source of information etc. The study was conducted on 30 samples of III year GNM class of KLEU’s Institute of Nursing Science, Belgaum, Karnataka. The instrument used for data collection was structured knowledge questionnaire. The data obtained was tabulated and analysed in terms of objectives of study, using descriptive and inferential statistics. Result: The major finding of the study were:-The data on sample characteristics revealed that, 0% (0) were belonged to age group of 19-20 years, 66.66% (20) students were belonged to age group of 20-21 years, 33.33% (10) were belonged to age group 22-23 years,0% (0) were belonged to age group 24-25 years. Among all 86.66% (26) were Hindus, 6.66% (2) were Muslim, 6.66% (2) were Christian and no student belonging to the other religions.
About source of information, 73.33% (22)had got information through books, 3.33% (1) had got information from hospitals, 13.33% (4) had got information from teachers, 10% (3) had got information from other means.
The findings on assessment of knowledge regarding management of Pregnancy Induced Hypertension showed that 3.33% (1) student had good knowledge, 76.67% (23) students had average knowledge and 20% (6) students had poor knowledge about management of Pregnancy Induced Hypertension.
Statistical analysis using Chi-square test to find out association between knowledge of III year GNM students and selected socio demographic variables, revealed that the knowledge score and demographic variables are independent of each other at 0.05 level of significance.
KEYWORDS: Knowledge, Pregnancy Induced Hypertension, III year GNM Students.
INTRODUCTION:
Pregnancy is being most precious period in every woman’s life. It needs continuous care for safe confinement, early detection of difficulties and prompt treatment in an appropriate period. Women in general and also during pregnancy stage are vulnerable statement of population. In India, 23million birth’s takes place every year. There would be about 24million pregnancies in a year, among them 7-15% of all pregnancies are complicated by hypertension. Changes such as increased sensitivity to vasopressin, reduce plasma volume, alter proximal tubular function and activation of co-agulation system suggest that hypertension may not be central to the pathogenesis of pre-eclampsia1.
Pregnancy induced hypertension occurs more frequently in young primigravidae. It is more common in mothers over 35years of age and multiple pregnancies and obese mother. It is equally common in women, from low socioeconomic group who are not likely to have received adequate antenatal care. PIH is characterized by hypertension and proteinuria accompanied by oedema. It develops only during pregnancy. Both mother and fetus are adversely affected by maternal hypertension. PIH is recognized as the death in which requires the united efforts of all members of the health care team in close collaboration with other than medical personnel2.
Preclampsia, eclampsia still account for 20% maternal deaths worldwide. The current annual worldwide mortality can be estimated to be 1,50,000 women. Substandard care also add to the maternal mortality. Farook recorded 20-24% maternal mortality due to eclampsia while Hashmi reported eclampsia mortality to be 9% over a fine year period. Bashir Et al reported a prevalence of eclampsia of 1.2% and maternal mortality from eclampsia to be 8.35-10.3% during 1991-93 in Faisalabad city3.
The incidence of preeclampsia is commonly cited to be about 5%, although remarkable variations are reported. The incidence is influenced by parity. It is related to racial, and thus, to genetic predisposition and environmental factors may also have a role. Incidence of eclampsia is approximately one in 1500 pregnancies. Of this about 50% occurs in the antenatal period, 30% occurs during the intrapartum period and 20% takes place within the first few hours after delivery. Deaths due to eclampsia occur because of cerebral haemorrhage and adult respiratory distress syndrome. Maternal mortality due to eclampsia varies between 2-30% and is much higher in rural areas4.
NEED FOR STUDY:
Hypertensive disorders of pregnancy are leading cause of maternal and infant mortality and morbidity. Worldwide it has been estimated that approximately 50,000 women die every year from eclampsia. Hypertensive disorder of pregnancy affect 5-10% of all pregnancies, worldwide, and cause substantial and perinatal mortality and morbidity. Women with pre-eclampsia are 2-3 times more likely to have caesserian delivery compared to normotensive women and have longer hospital stay.
Accurate pre-eclampsia statistics are difficult to obtain because the condition ranges from extremely mild to severe, and mild cases are sometime not included in the official figure. Furthermore, mild cases may have no effect on pregnancy, which is why the figures for pre-eclampsia as a whole are higher than for those that actually complicate pregnancies: around 10% of pregnant women develops pregnancy induced hypertension or pre-eclampsia5.
Worldwide >4 million women per year develops pre-eclampsia6 and over 63000 maternal deaths due to pre-eclampsia and eclampsia7.
In India maternal mortality rate is around 254 per lakh live birth. As per WHO in developing countries like India there is 40% increase in the incidence of PIH in recent years8.In Maharashtra this rate is approximately 130 per lakh.
The combined prevalence of various hypertensive disorder in pregnancy, is said to be of 6-8%, which are the leading causes of maternal and perinatal mortality and morbidity Interventions during pregnancy, may improve maternal outcomes. In this regard, the interventions include primary preventions, detection of increased risk and early detection of any stage of PIH by antenatal adequate care9.
Secondary prevention of progression is by treatment at primary level or referral for expert care. Caring of a primigravida with eclampsia is a challenge to any midwife. The midwife’s keen observation, prompt decision making ability to use lifesaving procedures and referral to the right place, at the right time, can save the mother and the baby. The mother requires intensive care with continuous monitoring and recording the baby also needs close observation and care, for the first 24-48hrs, in the neonatal intensive care unit9
STATEMENT OF THE PROBLEM
“A study to assess the knowledge of third year GNM students regarding management of pregnancy induced hypertension in selected college of Belgaum, Karnataka.”
THE OBJECTIVES OF THE STUDY WERE:
1. To assess the knowledge of the third year GNM students regarding management of pregnancy induced hypertension.
2. To determine the association between knowledge scores and selected socio demographic variables
OPERATIONAL DEFINITION:
1. Knowledge: In this study it refers to the fact what respondent know about PIH through structured questionnaire knowledge.
2. Management: In this study management refers to treatment modules related to PIH.
3. Pregnancy induced hypertension: In this study it refers to hypertension that develops as direct result of the gravid state.
4. Third year GNM students: III year GNM students studying in KLEU’S INS, Belgaum.
5. Selected college: Refers to KLEU’S Institute of Nursing Sciences, Belgaum Karnataka.
Inclusion criteria:
1. III year GNM students who are willing to participate in the study.
2. III year GNM students who were present during the time of data collection
Exclusion criteria:
1. III year GNM students who are not willing to participate in the study.
2. III year GNM students who were not available at the time of data collection.
Assumption:
The study assumed that,
1. Third year GNM students have some knowledge regarding management of pregnancy induced hypertension
Delimitation:
The study was delimited to third year GNM students, KLEU’ Institute of Nursing Sciences, Belgaum Karnataka.
REVIEW OF LITERATURE:
A perspective study was conducted on electrolyte status in pre-eclampsia by Ph. D Student, Dept of Biochemistry, MIMER Medical College, Talegaon (D), Pune- 410507, Maharashtra-India with the objective to evaluate role of serum calcium, magnesium, sodium and potassium in preeclampsia and to compare them with those in normal pregnancy. The method used to study comprised of three groups aged between 18-35 years. Group I- Preeclamptic women, Group II- Normal pregnant women, Group-III, Normal healthy controls. The result showed that serum calcium, magnesium, potassium were significantly decreased (P<0.01) and serum sodium significantly increased (P<0.01) in preeclamptics as compared to normal pregnant women as well as healthy controls. The result for this study concluded that the reduced levels of serum calcium, magnesium, potassium and increased level of sodium in patients of pre-eclampsia as compared to the normal pregnant women6.
A retrospective study on Incidence of Pregnancy Induced Hypertension and the effects on mother and foetus was conducted during 1989-1998 in the Department of Obstetrics and Gynaecology, Shanghai Sixth People's Hospital, Shanghai 200233, China, to investigate the incidence of Pregnancy Induced Hypertension (PIH). The data were analyzed retrospectively from three municipal general hospitals and five special hospitals obstetrics and gynaecology. The results showed that there were 158,790 deliveries in ten years. The total numbers of PIH were 8,852 cases. The incidence of PIH was 5.57%. The rate of mild, moderate and severe PIH was 55.83%, 29.39%, and 14.78% respectively. There were 114 cases (1.29%) complicated with eclampsia. The rate of caesarean section was 66.97% in PIH patients. The complications of PIH were as following: abruptio of Placenta 0.52%, heart failure 0.34%, renal failure 0.20%, DIC 0.07% haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome 0.03%, maternal death one case. There were 9, 197 birth of 8,852 cases of PIH (twin 343 cases, triplets one cases). The perinatal death 66 occurred in cases in which foetal death 48 cases, stillbirth 12 and neonatal death 6. The result for this study concluded that the incidence of PIH and the rate of perinatal infant death can be reduced by strengthen antenatal monitoring, prevention, early diagnosis and treatment of PIH8.
An evaluative study was conducted on clinical risk factors for gestational hypertensive disorders in pregnant women at high risk for developing pre-eclampsia in October 2013 by Tsz. Y. Wong, Henk Groen, Marijke M. Faas, Maria G. Van Pampus. The objective of study was to evaluate clinical risk factors for the development of gestational hypertension disorders in a group of pregnant women at high risk for developing pre-eclampsia. The study design was a prospective analysis of data obtained from a short study was performed. In this study the pregnant women were included who had at least one of the following risk factors. For the pre-eclampsia: previous history of pre-eclampsia, HELLP Syndrome, Chronic hypertension, obesity, DM, multiple pregnancy, etc. Univariate and multivariate logistic regression analysis were used to evaluate the role of clinical characteristics and risk factors in the development of hypertensive disorders. The main outcome measure was department of gestational hypertensive disorder. The result for this study was 35% (36/103) develop a hypertensive disorders. The univariate and multivariate both analysis identified pre-ecalmpsia in a previous pregnancy as significant risk factor 51.4% for gestational hypertensive disorders compared to the incidence rates of other risk factors. The result for the study concluded that a previous history of pre-eclampsia proves to be a strong independent clinical risk factor for gestational hypertensive disorders10.
RESEARCH METHODOLOGY:
Research approach and research design
Research approach used in this study was descriptive approach and non-experimental descriptive survey design was used to find out the knowledge of third year GNM student regarding management of Pregnancy Induced Hypertension.
Setting
The study was conducted in KLEU’S Institute of Nursing Sciences, Belgaum Karnataka.
Population
Population for the present study was III year GNM students studying in KLEU’S Institute of Nursing Sciences, Belgaum, Karnataka.
Variables
Independent variables: In this study independent variables includes selected socio-demographic variables like age, religion and source of information.
Dependent variable: In this study dependent variable in knowledge of third year GNM student regarding management of Pregnancy Induced Hypertension.
Sample and sample technique
In this study, samples were III year GNM students studying in KLEU’S Institute of Nursing Sciences, Belgaum, Karnataka and convenient (non-probability sampling) technique was used to select the samples.
Sample size
The study was conducted among 30 students of III year GNM class of KLEU’s Institute of Nursing Science, Belgaum, Karnataka.
Description of tool
The tool was organized into following two sections, they are
1. Socio-demographic variables
2. Knowledge on management of Pregnancy Induced Hypertension.
Section A-
Socio-demographic variables
This section elicited the socio-demographic information of the III year GNM students are age, religion and source of information.
Section B-
This section deals with knowledge aspects of III year GNM students through structured knowledge questionnaire regarding management of Pregnancy Induced Hypertension.
Data Collection Procedure
Data collection is the gathering of information needed to address a research problem.
1. A formal permission was obtained from-
Principal, KLE University Institute of Nursing Sciences, Belgaum and class co-ordinator of GNM III year KLEU’S Institute of Nursing Sciences, Belgaum, Karnataka.
2. Prior to data collection informed consent was taken from the sample and they were assured their identity was not revealed in any case.
3. Structured questionnaire was distributed among III year GNM students of KLEU’S Institute of Nursing Sciences, Belgaum, Karnataka.
4. 45 min time was allotted to answer the question to III year GNM student of KLEU’S Institute of Nursing Sciences, Belgaum, Karnataka.
Schematic representation of research process
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Target Population |
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III year GNM Students |
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Sampling Technique |
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Non Probability Convenient Sampling |
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Instruments |
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Structured knowledge questionnaire |
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Analysis |
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Frequency And Percentage distribution |
ANALYSIS AND INTERPRETATION OF DATA
SECTION 1
Distribution of sample according to selected socio demographic variable of the study.
Demographic characteristics of study were Age, Religion, Source of information.
TABLE NO 1 n=30
|
SR. NO |
DEMOGRAPHIC VARIABLES |
FREQUENCY |
% |
|
1 |
AGE ( In Year) 19- 20 20-21 22-23 24-25 |
0 20 10 0 |
0% 66.66% 33.33% 0% |
|
2 |
RELIGION Hindu Muslim Christian others |
26 2 2 0 |
86.66% 6.66% 6.66% 0% |
|
3 |
SOURCE OF INFORMATION Through Books From Hospital From Teachers Any Others Means |
22 1 4 3 |
73.33% 3.33% 13.33% 10% |
Demographic characteristics of samples:
The demographic characteristic of the study were Age, Religion, Source of information.
In this study, 0% were belonged to the age group 19-20 years, 66.66% were belonged to the age group 20-21, 33.33%were as the age group 22-23, and none of them belonged to the age group 24-25.
Among all 86.66% were Hindus, 6.66% were Muslim, 6.66% Christians. and students belong to other religion were not founded.
Among source of information, 73.33% sample had got information through Books, 3.33% samples had got information from Hospitals, 13.33% sample had got information from Teachers, 10% samples had got information from other means.
Graph 1: conical graph showing percentage distribution of Age of third year GNM Student
Graph2: conical graph showing percentage distribution of religion of third year GNM Student
Graph3: conical graph showing percentage distribution of source of information of third year GNM students
Table No: 2 Frequency and percentage distribution of knowledge scores of third year GNM students
|
Sr. No. |
Level of Knowledge |
Score Range |
Frequency |
Percentage |
|
1. |
Good |
20-25 |
1 |
3.33% |
|
2. |
Average |
7-19 |
23 |
76.67% |
|
3. |
Poor |
0-6 |
6 |
20.00% |