A Study to Evaluate the effectiveness of Self-Instructional Module on Knowledge and Practice regarding infection control strategies among Staff Nurses working in Labour room at selected Hospitals, Chamarajanagar

 

Vinay Kumar G¹, Prasanna Kumar², Madhu M P³, Sandyashree B⁴

¹Principal, JSS School of Nursing, Chamarajanagar, Karnataka.

²Asst. Professor, Bapuji College of Nursing, Davangere, Karnataka.

³Nursing Tutor, JSS School of Nursing, Chamarajanagar, Karnataka.

⁴Nursing Tutor, JSS School of Nursing, Chamarajanagar, Karnataka.

 

ABSTRACT:

Introduction: Infection prevention and control is an integral component of nursing care delivery in any setting to reduce risks for morbidity and mortality in patients and care givers at all levels. Basic principles of infection prevention are simple and include personal hygiene and hand washing. Nurses are on the front line to answer questions from patients and families when the media report outbreaks of exotic infectious diseases and the development of new super pathogens associated with health care. The most common infections acquired in the hospital setting and focus on the nurse’s role in prevention. Hence the focus of this study was to evaluate the effectiveness of Self-Instructional Module on infection control strategies among staff nurses at selected Hospitals, Chamarajanagar. Objectives: 1. To assess the knowledge and Practice of infection control strategies among Staff Nurses Working in Labour Room, in terms of pre-test knowledge scores. 2. To assess the effectiveness of Self-Instructional Module on knowledge and Practice of Infection control strategies among Staff Nurses by comparing the pre and post-test Knowledge score. 3. To find the association between post-test knowledge scores with their selected demographic Variables of Staff Nurses. Methods: A pre-experimental design and evaluative approach was used in the study. The data was collected from 50 subjects; through purposive sampling technique. Data was collected using structured questionnaire. Major Findings of The Study: The overall analysis of level of Knowledge of staff nurses regarding infection control strategies showed that mean Knowledge scores of the subjects at pre-test were 14.7 (49%) with standard deviation 2.823 found to be moderate Knowledge regarding infection control strategies. After administration of Self-Instructional Module mean Knowledge scores of the subjects was 22.84 (76.13%) with standard deviation 2.787 found to be improvement in the level of Knowledge among staff nurses. Among the participants 60% of the staff nurses had inadequate Knowledge and 40% had moderate Knowledge in the pre-test. After administration of the Self-Instructional Module 62% of the subjects had adequate Knowledge, 38% had moderate Knowledge regarding infection control strategies in the post test. The analysis of practice reveals that 48% of the staff nurses had poor Practice and 52% had moderately good Practice in the pre-test. After administration of the Self-Instructional Module 62% of the subjects had Good Practice and remaining 38% had moderately good practice regarding infection control strategies in the post test. The Overall mean practice scores of the respondents was found to be 7.06 (47.06) with the standard deviation of 2.014 which indicates the poor practice of infection control strategies in pre-test. After administration of self-instructional module the overall practice scores of respondents were found to be 11.08 (73.86%) with standard deviation 1.967 shows improvement in the practice of staff nurses regarding the infection control strategies. Interpretation and Conclusion: Findings of the study show that there was a significant difference in pre-test and post-test level of Knowledge and Practice of staff nurses. From this it is concluded that the Self-Instructional Module is effective in improving the level of Knowledge and Practice of staff nurses. And there was a significant association between level of Knowledge and Practice of staff nurses and selected demographic variables such as Age, gender, religion, professional qualification, area of working, experience, source of information and attendance of in-service education programme.

 

 

 

INTRODUCTION:

Infection prevention and control is an integral component of nursing care delivery in any setting to reduce risks for morbidity and mortality in patients and care givers at all levels. Basic principles of infection prevention are simple and include personal hygiene and hand washing. More comprehensive infection risk reduction strategies are needed for the management of indwelling devices such as central venous catheters and equipment for assisted ventilation and for surgical procedures that involve permanently implanted foreign bodies such as total joints. Nurses share responsibility with other health care personnel for infection risk reduction in patients across entire continuum of care and play vital role in reducing risks for infection through a variety of direct care activities.¹

 

The health care market place is rapidly changing with far reaching effects on how we as nurses practice our craft. These changes include integrating infection control into daily nursing care both in hospitals and in the growing field of professional nursing in the home.²

 

Dr. Marguerite Jackson gives us a comprehensive view in her study in 2000, on today’s market place followed by its overall effect on the specific practice of infection control. She makes a strong case for keeping the specialty of infection control and using Infection Control Professionals in closely bound partnerships with colleagues delivering patient care. We hope that this issue of the Nursing Clinics of India reflects a successful partnership between a clinically practicing nurse and an infection control professional. We see these partnerships as a better way to cross train.¹

 

Nurses are on the front line to answer questions from patients and families when the media report outbreaks of exotic infectious diseases and the development of new super pathogens associated with health care. The most common infections acquired in the hospital setting and focuses on the nurse’s role in prevention.  There are practice recommendations for nurses that are prominent in delivering safe health care in the modern era.¹

 

Prevention and control of nosocomial infection are essential parts of nursing care. Many of Florence Nightingale’s innovations in health care were concerned with eradicating environmental factors that influenced the development of infection. Environmental factors form one aspect in the chain of infection that must be broken by good nursing care.³

 

It must be appreciated that although the virus may be transmitted to the conceptus, viremia usually precedes maternal clinical symptoms such as fever or rash, and that many maternal viral infections may be subclinical. Almost all human viral diseases have been reported during pregnancy and adverse effects on the foetus, such as spontaneous abortion and developmental anomalies, have been attributed to a number of them.⁴  

    

Nevertheless, a clear-cut and consistent etiological relationship between maternal virus infection and developmental anomalies has been established for a few viruses, the best known being cytomegalovirus and rubella virus. The gestational age at which maternal infection occurs, the virus itself and its “infectivity”, as well as the severity of maternal infection are some of the factors that may influence the outcome of virus infection in pregnancy.⁴

 

Indirect effects on the foetus of a viral infection in the mother spontaneous abortion, stillbirth and perinatal mortality, which may result from various viral diseases in pregnancy, are probably not, in most cases, due to a viral invasion of the foetus. There seems to be a correlation between the severity of maternal infection and the likelihood of an adverse effect on the conceptus.⁴

 

Staff education is an important component of the hospital infection control programme. The efficiency of infection control measures is highly dependent on the compliance of the hospital staff. To secure their compliance, education is needed to inform the staff and to convince them that these measures are really worthwhile. Without an effective in-service education programme, the work of infection control is rendered ineffective.⁴

 

The separation of the source has to be interpreted in a broad sense. It includes not only the isolation of infected patients but also all “aseptic techniques” – the measures that are intended to act as a barrier between infected or potentially contaminated tissue and the environment.⁴

 

 

NEED FOR THE STUDY:

Pregnancy is a time of joy and excitement. Labour, the culmination of pregnancy, is the start of an incredible journey with great psychological, social and emotional meaning for the mother and her family. During this incredible journey of childbirth, a woman’s genital tract, a bare surface prone to infections which are introduced by certain invasive procedures routinely done in labour unit such as vaginal examination, urinary catheterization, and artificial rupture of membrane, instrumental deliveries and also by the sub-standard level of infection control practice.⁵

 

The burden of this disease resulting from infection has led to a revival of general interest in infection control. Infection prevention and control is integral to safe, effective and ethical nursing practice. Ensuring the use of infection control standards is an important component of nursing. It aims to avoid infection (i.e. primary prevention) by enhancing practices of hand hygiene, surgical asepsis, environmental hygiene, clean equipment’s and training of health care. Therefore, collecting national data on maternal morbidity and mortality, reforming infection control guidelines and enrolling it hospital policies, providing holistic and flexible maternal health care, and initiating in-service educational programs in hospitals are recommended. Further research is needed on issues related to infection control practice in labour unit.⁵

 

An international survey of prevalence of hospital acquired infections was conducted in 14 countries in different regions of the world between 2003 and 2004. The results of this survey, which covered 47 hospitals of size ranging from 227 to 1502 beds showed a wide range of nosocomial infections, with prevalence varying from 3% to 12% (mean 6.4%) in individual hospitals.⁶

 

A study conducted on “Labour and Delivery”. There is a particular need for compliance with universal precaution although it must be recognized that some midwives may feel uncomfortable in using these precautions at such a sensitive time. The findings of the research suggesting that retention of skills and knowledge quickly deteriorates if not used or updated regularly. Therefore, this research supports the importance of infection control strategies (universal precaution) refresher courses on a regular basis.⁷

 

A study conducted on   assessment of the knowledge and practice of the staff nurses working in the labour room with relation to universal precautions. Studies have suggested that assessing the knowledge and practice of the nurse working in the labour room with relation to universal precautions need to be evaluated and refined in order to improve practice.⁸

 

Infection control strategies help to decrease the infection control rate, maternal and neonatal mortality and morbidity rate. The rate of maternal deaths in the world is 1 death every 5 minutes. Department of Health and Family Welfare, Gujarat state has reported that the maternal mortality in the India in year 2007 is 453/100,000 live births whereas in the Gujarat state it is 389/100,000 live births.  The major causes of these deaths have been identified as haemorrhage (25%), Eclampsia (12%), Indirect Causes (20%), obstructed labour (8%), sepsis (15%) and unsafe abortion (13%) and other direct causes (7%). Many studies have been conducted for the effectiveness of infection control strategies for a hospital but till date concrete work has been done as seen from research appraisal about competences of infection control strategies of the activities performed by the staff nurses in labour room.⁸

 

The incidence, prevalence, explaining disease prevention behaviour, and expands to encompass behaviour for enhancing health. Health promotion model describe the multidimensional nature of person as they interact with in their environment to pursue health⁹.

Saving mother’s life is a global aim as the health of mothers has long been considered as cornerstone of public health and attention. Safe motherhood encompasses a series of initiatives, practices, protocols and service delivery guidelines designed to ensure that women receive high-quality gynaecological, family planning, prenatal, delivery and postpartum care in order to achieve optimal health for the mother, fetus and infant during pregnancy, childbirth and postpartum. The ways to achieve safe motherhood include skilled attendance at all births, access to quality emergency obstetrical care, access to quality reproductive health care including family planning and safe post-abortion care¹⁰.

 

Hence, investigator found need for research work to appraise competences of infection control strategies activities performed by staff nurses in labour room.

 

OBJECTIVES:

1.     To assess the knowledge and Practice of infection control strategies among Staff Nurses Working in Labour Room, in terms of pre-test knowledge scores.

2.     To assess the effectiveness of Self-Instructional Module on knowledge and Practice of Infection control strategies among Staff Nurses by comparing the pre and post-test Knowledge score.

3.     To find the association between post-test knowledge scores with their selected demographic Variables of Staff Nurses.

 

HYPOTHESES:

H₁: There is a significant difference in the pre-test and post-test Knowledge and Practice scores of Staff nurses regarding infection control strategies.

H₂: There is a significant association between the pre-test Knowledge and Practice of Staff nurses regarding infection control strategies and selected demographic variables.

 

ASSUMPTIONS:

·       Staff nurses may have some basic Knowledge and Practice regarding infection control strategies

·       Self-Instructional Module may increase the Knowledge and Practice of staff nurses regarding infection control strategies.

 

MATERIALS AND METHODS:

Study Design:

An evaluative research approach was used.

 

Research Design:

In the present study the pre-experimental (one group pre-test and post-test) design was adapted

 

Variables:

Variables of the present study were the following

 

Dependent variables:

In this study Knowledge and Practice of staff nurses regarding the infection control strategies.

 

Independent variable:

In this study Self Instructional Module regarding infection control strategies.

 

Socio Demographic variables:

Age, gender, religion, professional qualification, area of working, experience, source of information and attendance of in-service education programme are the socio demographic variables.

 

Population:

Target population:

In this study, target population consists of all staff nurses of selected Hospitals, Chamarajanagar.

 

Sample:

In this study the sample consisted of staff nurses of selected Hospitals, Chamarajanagar.

 

Sampling Technique:

In this study, Purposive sampling technique was adopted.

 

Sample Size:

The total sample size of this study is 50 staff nurses.

 

Sampling criteria:

Inclusion Criteria:

The study includes the Staff nurses,

·       Who are working in Labour room?

·       Who are willing to participate?

·       Who are available at the time of data collection?

 

Exclusion Criteria:

The study excludes the Staff nurses,

·       Who are working at managerial level?

·       Who are long leave?

 

Data Collection Instrument:

·       A structured Knowledge and Practice questionnaire was used for data collection.

·       A structured Knowledge and Practice questionnaire is a method of gathering self-reported information from respondents through self-administration of the questionnaire in a paper and pencil format.

 

SECTION A:

It consists of socio demographic profile like Age, gender, religion, professional qualification, area of working, experience, source of information and attendance of in-service education programme are the socio demographic variables.

 

SECTION B:

It consists of structured Knowledge questionnaire regarding General information and clean birthing environment.

 

SECTION C:

It consists of structured Practice Checklist regarding General information and clean birthing environment.

 

RESULTS:

The Findings of data has been finalized and organized in accordance with the plan for data analysis. These are presented under the following sections.

 

Section–I: Demographic characteristics of staff nurses.

Section–II: Knowledge and Practice level of staff nurses regarding infection control strategies through pre and post-test.

Section–III: Comparison of pre-test and post-test Knowledge and Practice regarding infection control strategies.

Section–IV: Association of the pre-test Knowledge and Practice scores with the demographic variables of staff nurses.

 

SECTION – I: DEMOGRAPHIC    CHARACTERISTICS OF STAFF NURSES:

 

Table 1: Distribution of subjects by their personal Variables N= 50

 

SECTION II: KNOWLEDGE AND PRACTICE LEVEL OF STAFF NURSES REGARDING THE INFECTION CONTROL STRATEGIES:

 

Table 2: pre-test and post-test Knowledge level of the staff nurses. N = 50

 

Table 2 depicts that majority 60% of the staff nurses had inadequate Knowledge and 40% had moderate Knowledge in the pre-test. After administration of the Self-Instructional Module 62% of the subjects had adequate Knowledge and 38% had moderate Knowledge regarding infection control strategies in the post test.

 

Table 3: pre-test and post-test Practice level of the staff nurses. N = 50

 

Table 3 depicts that 48% of the staff nurses had poor Practice and 52% had moderately good Practice in the pre-test. After administration of the Self-Instructional Module 62% of the subjects had Good Practice and remaining 38% had moderately good practice regarding infection control strategies in the post test.

 

Table 5 depicts that the maximum mean percentage obtained by the subjects in post-test is in the aspect of General information (82.66%), followed by Clean birthing environment (82%) and least mean Knowledge score (67%) found in the aspect of Storage of sterile equipment’s and waste disposal. The overall Knowledge scores of respondents were found to be 22.84 (76.13%) with standard deviation 2.787 shows improvement in the Knowledge of staff nurses regarding the infection control strategies.

 

Table – 4: Overall and area wise analysis of pre-test Knowledge and Practice scores of staff nurses N = 50

 

Table 6 depicts that the maximum mean percentage obtained by the subjects in pre-test is in the aspect of General information (62.66%), followed by Clean birthing environment (54.33%) and least mean Knowledge score (36.83%) found in the aspect of Storage of sterile equipment’s and waste disposal. The overall mean Knowledge scores of respondents were found to be 7.06 (47.06%) with standard deviation 2.823 indicates that staff nurses had inadequate Knowledge regarding infection control strategies in the pre-test. The Overall mean practice scores of the respondents was found to be 7.06 (47.06) with the standard deviation of 2.014 which indicates the poor practice of infection control strategies in pre-test.

 

Table – 5: Overall and area wise analysis of post-test Knowledge and Practice scores of staff nurses N = 50

 

SECTION III: COMPARISON OF THE KNOWLEDGE AND PRACTICE LEVEL OF STAFF NURSES:

Table 6: Overall and area-wise comparison of Knowledge and Practice scores of staff nurses N = 50

 

The overall practice scores of respondents were found to be 11.08 (73.86%) with standard deviation 1.967 shows improvement in the practice of staff nurses regarding the infection control strategies. From the table 13 it is evident that the mean enhancement of the Knowledge and Practice score was 8.140 and 4.020 respectively with the “t” value 16.587 and 11.585 which is greater than the table value both at 0.01 level of significance. Therefore, "t" value is found to be significant. Hence it is inferred that there is significant difference between the pre-test and post-test Knowledge and Practice level of staff nurses regarding the infection control strategies. Hence the hypothesis H_1: There is a significant difference in the pre-test and post-test Knowledge and Practice scores of Staff nurses regarding infection control strategies is accepted.

 

SECTION IV: ASSOCIATION BETWEEN PRETEST KNOWLEDGE AND PRACTICE OF STAFF NURSES AND THE SELECTED DEMOGRAPHIC VARIABLES

 

Table 7: Association between pre-test Knowledge scores of staff nurses and the selected demographic variables N = 50

 

Table 7 shows X² value computed between the Knowledge level of staff nurses and selected demographic variables. Variables such as Age, religion, professional qualification, area of working and source of information were significant at 0.05 level of significance. Thus it is inferred that there is significant association between the Knowledge scores of staff nurses regarding infection control strategies and selected demographic variables. Hence the hypothesis H_2: There is a significant association between the pre-test Knowledge of Staff nurses regarding infection control strategies and selected demographic variables is accepted.

 

Table 8: Association between pre-test practice scores of staff nurses and the selected demographic variables     N = 50

Variables	Below Median	Median and above	Chi square	Df	P value (0.05)	Inference
Age in years
20-30 years	6	9	0.555	2	0.758	NS
31-40 years	15	14
41-50 years	3	3
Gender
Male	6	6	0.025	1	0.874	NS
Female	18	20
Religion
Hindu	11	20	5.141	2	0.076	NS
Muslim	7	3
Christian	6	3
Professional qualification
Diploma in General Nursing	15	20	7.647	2	0.022	S
PC B.Sc. Nursing	3	6
B.Sc. Nursing	6	0
Area of working
Emergency Labour OT	3	3	1.438	2	0.487	NS
Labour OT	12	9
Labour room	9	14
Experience
Less than 5 years	6	6	3.392	3	0.335	NS
5-10 years	7	6
11-15 years	4	10
More than 15 years	7	4
Source of information
Journal/Magazine	9	17	5.152	3	0.161	NS
Conference/Workshop	5	2
Colleagues	9	5
Others	1	2
Attendance of in-service education
Yes	4	3	0.273	1	0.602	NS
No	20	23
Age in years

 

Table 8 shows X² value computed between the Practice scores of staff nurses and selected demographic variables. Variables such as Age, gender religion, area of working, source of information and attendance of in-service education were not significant at 0.05 level of significance. Thus it is inferred that there is no significant association between the practice scores of staff nurses regarding infection control strategies and selected demographic variables. Hence the hypothesis H_2: There is a significant association between the pre-test practice of Staff nurses regarding infection control strategies and selected demographic variables is rejected.

 

IMPLICATIONS OF THE STUDY:

The findings of the study can be used in the following areas of nursing profession.

 

1.     Nursing Practice:

Nurses should have adequate Knowledge regarding infection control strategies. Special emphasis needs to be given to the prevention and management role of the nurse. The hospital can provide timely information and training to the nurses to update their knowledge and encourage them to develop the skills in providing comprehensive care to mother through the use of proper infection control strategies.

In the present study, on assessment of the Knowledge and Practice of participants on various aspects of infection control strategies, it reveals that they have moderate Knowledge regarding infection control strategies. Hence the studies recommend that the nurses in the clinical area should be trained about the use infection control strategies and encourage them to adopt this Knowledge into their practices.

 

Nursing Education:

Nursing education emphasizes that health care system should pay more attention to train the nursing students on infection control strategies and thereby enhance the quality assurance in paediatric care.

 

As a nurse educator, there is an abundant-opportunities for nursing professionals to educate the staff nurses on infection control strategies. The study emphasizes need of short-term in-service education for nurses on infection control strategies. Student nurses should be informed about infection control strategies.

 

Nursing Administration:

Institutions providing maternal care services should review their policies and practices regarding infection control strategies in maternal hospitals. Nursing administrator should take initiative and involved with the implementation of infection control strategies and formulating policies and protocols in hospitals, for organizing the short-term in-service education programs on infection control strategies.

 

Nursing Research:

The findings of the study serve as a basis for the professional and the student nurses to conduct further studies on infection control strategies. The study helps the nurse researchers to develop appropriate training programs on infection control strategies. The nurses should take initiation to conduct the further research on infection control strategies. The study will motivate the initial researchers to conduct the same study on large scale and the study will be a reference for the research scholars.

 

LIMITATIONS OF THE STUDY:

·       Only Knowledge and Practice was considered in the present study.

·       The study was conducted in one area, which restricts the generalization.

 

RECOMMENDATIONS:

On the basis of the findings of the study following recommendations have been made:

·       A similar study can be replicated on large sample to generalize the findings.

·       A similar study can be conducted in different setting.

·       A true experimental study can be conducted to assess the effectiveness of in-service educational programmes

 

REFERENCE:

1.      Jacquelyn H. Flaskerad & Janet M. Serers, The Nursing Clinics of North America, June 2002.

2.      Aggrawal J.C., Educational Research. Arya Book Depot; New Delhi: 1975

3.      Lucile M. Arking & Barbara J. Mcarthur, The Nursing Clinics of Infection Control, December 2005.

4.      Grkiz, Prenatal and perinatal infections, World Health Organization: December 1985.

5.      Benita D. Effectiveness of infection control standards on practice among health care personnel working in labour unit at selected hospitals, Nagercoil. Dissertation submitted to The Tamil Nadu Dr.M.G.R. Medical University Chennai. 2014.

6.      Lary Anderson BN, et al. Tidssk Sykepl Hospital hygiene – number of hospital infection reduced, 1998, Jan 27 86 (2).

7.      Adele Pilitteri, Maternal and child Health Nursing. 1^st edition, J. B. Lippincott Company publications; Hangerstown, London: 1992.

8.      Bennett V.R. and Brown L. K., Myle’s textbook for Midwives. 13th edition, London: Churhill Livingstone, 1999.

9.      Gagan Sharma, Manisha Kammar. Assess the knowledge and Attitude regarding primary prevention of Coronary-Heart-Disease among bank employees of selected banks of Pune city with a view to develop a self-instructional module. Asian J. Nursing Education and Research. 2018; 9(3):365-369.

10.   V. Indra. Effectiveness of Self-Instructional Module (SIM) on Knowledge Regarding Selected Aspects of Safe Motherhood among Primigravida Women in Selected Hospitals, Puducherry. Int. J. Adv. Nur. Management. 2016; 4(3): 253-270.

 

Received on 02.05.2022         Modified on 08.06.2022

Accepted on 01.07.2022       ©A&V Publications All right reserved