Effect of structured teaching programme on knowledge regarding self assessment of daily fetal movement count, among normal and high risk primigravida mothers at Red Cross Hospital, Bhopal, M.P.

 

Ms. Surabhi Bhargava¹*, Mrs. Sushila Singh², Dr. Mrs. Abhilekha Biswal³

¹Final Year Student, M.Sc Nursing, (Obs & Gynae), P.G. College of Nursing, Bhilai (C.G.)

²Head of Department, (Obs & Gynae), P.G. College of Nursing, Bhilai (C.G.)

³Principal, P.G. College of Nursing, Bhilai (C.G.)

 

ABSTRACT:

In this study, to assess the effectiveness of structured teaching programme (STP) on knowledge regarding self assessment of Daily Fetal Movement Counts, 60 patients were selected by using non-probability purposive sampling technique. The pre test was conducted using a structured interview schedule. STP was conducted and a DFMC chart and a pamphlet were given to each patient following the STP. Seven days later post test was conducted using the same structured interview schedule. Most of the normal primigravida mothers had poor knowledge (53.33%) in the pre test and after STP 83.33% had good knowledge and 16.67% had average knowledge. Most of the high risk primigravida mothers had average knowledge (53.33%) in the pre test and after STP 90% had good knowledge and 10% had average knowledge. Paired and unpaired t test was applied to compare pre and post test mean and standard deviation of normal and high risk primigravida mothers. Knowledge level of pre and post test of normal and high risk primigravida mothers regarding self assessment of Daily Fetal Movement Count was statistically significant (p<0.05). Knowledge level of pre test of normal and high risk primigravida mothers and post test of normal and high risk primigravida mothers regarding self assessment of Daily Fetal Movement Count was statistically not significant (p>0.05). There was a significant association between pre test knowledge of normal primigravida mothers and selected socio-demographic variables such as education received (p<0.05) and no association between pre test knowledge of high risk primigravida mothers and selected socio-demographic variables. This study demonstrated that STP on knowledge regarding self assessment of Daily Fetal Movement Count is effective in increasing the knowledge level of normal and high risk primigravida mothers.

 

INTRODUCTION:

‘Quickening’ is the first point at which the woman experiences fetal movements in early pregnancy. In primigravida, it may be felt from 18-22 weeks and in multigravida, from 16-20 weeks. A fetal movement chart records the frequency of fetal movements and thereby assesses the condition of the fetus.

 

Decreased fetal movements are present in 5% to 15% of pregnancies and are associated with intrauterine fetal death and intrauterine growth restriction. The investigator found that most of the women do not have adequate knowledge regarding fetal movement count during pregnancy.  Assessments of fetal movements are used as a marker of fetal viability and well being.   It reduces the risk of still birth, Fetal Growth Restriction and fetal distress, causing reduction in perinatal mortality.  

 

AIMS/ OBJECTIVES:

Objectives of the study are:

1.      To assess the pre and post test knowledge regarding self assessment of Daily Fetal Movement Count, among normal primigravida mothers.

2.      To assess the pre and post test knowledge regarding self assessment of Daily Fetal Movement Count, among high risk primigravida mothers.

3.      To evaluate the effectiveness of structured teaching programme on knowledge regarding self assessment of Daily Fetal Movement Count, among normal and high risk primigravida mothers.

4.      To compare the pre and post test knowledge regarding self assessment of Daily Fetal Movement Count, among normal and high risk primigravida mothers.

5.      To determine the association between pre test knowledge regarding self assessment of Daily Fetal Movement Count, among normal and high risk primigravida mothers with selected socio-demographic variables.

6.      To develop a pamphlet on knowledge regarding self assessment of Daily Fetal Movement Count, among normal and high risk primigravida mothers.

 

BACKGROUND AND NEED OF THE STUDY:

According SRS reports (2007-2009), the maternal mortality rate worldwide is 210 deaths per 100,000 live births, in India is 212 deaths per 100,000 live births and that of Madhya Pradesh is found to be 269 deaths per 100,000 live births. According to NFHS Survey (2007-2008), the infant mortality rate worldwide is 35/1000 live births, in India is 50/1000 live births and that of Madhya Pradesh is 69/1000 live births which is highest among all the states.

 

Still birth is a high global burden and according to SRS estimates (2009), the still birth rate worldwide is 18.9/1000 deliveries, of India is 22/1000 and that of Madhya Pradesh is 25/1000 deliveries, which is highest among all other states.

 

The health of the women represents the health status of any country.  Women‘s health assumes importance during pregnancy because her health status directly effects the health of the fetus. Since biblical times, fetal movements have been viewed as a reassuring sign of a healthy pregnancy. A high risk mother is one in whom; some condition put the mother, the developing fetus, or both at high risk for complication during or after the pregnancy and birth.  The complications that arise from high risk pregnancies are intrauterine death, stillbirth, preterm labour or delivery, miscarriage, pre-eclampsia, eclampsia, maternal death, birth defect. Thus in order to reduce the perinatal mortality formal counting of the fetal movements by pregnant women could identify a fetus at risk.

 

Considering all above mentioned factors, the investigator felt the need to assess the knowledge of normal and high risk primigravida mothers regarding self assessment of DFMC.    

Assumptions were that the primigravida mothers will have some knowledge regarding self assessment of daily fetal movement count, be able to monitor daily fetal movement count chart and the pregnancy outcome will be good for mothers who comply with the daily fetal movement count chart. Hypothesis were that there is a significant difference in gain of post test knowledge as compared to pre test knowledge regarding self assessment of Daily Fetal Movement Count, among normal and high risk primigravida mothers at 0.05 level of significance and that there is a significant association between pre test knowledge regarding self assessment of Daily Fetal Movement Count, among normal and high risk primigravida mothers and selected socio-demographic variables at 0.05 level of significance.         

 

The conceptual framework of the study was based on Modified Nola J Pender’s Health Promotion Model.

 

REVIEW OF LITERATURE:

Lt Col Singh G, Maj Sidhu K (2008) conducted a prospective study in Military hospital, Amritsar among 500 booked cases after introducing daily fetal movement count chart (DFMC) in ninth month of pregnancy. No fetus was lost in the 250 cases that were given DFMC chart and delivered with nil prenatal mortality.  This was compared with 250 booked cases that were not given DFMC chart. Five intrauterine deaths occurred in the ninth month in control group (2% prenatal mortality). The result of intrauterine deaths were statically analyzed using Chi – Square test and the difference was found to be significant at the value of p<0.025.  The findings of the study showed that fetal death reduced from 20.4 per 1000 live births to nil in the study group. DFMC chart helps in identifying at risk fetus in low risk pregnancies in the absence of any other adverse factors necessitating early delivery.

 

Mangesi Lindeka, G Justus Hofmeyr, Valerie Smith (2007) in his study compared the effects of fetal movement counting selectively or routinely with no fetal movement counting on perinatal outcome. The largest trial to date (Grant 1989) compared routine fetal movement counting with ’normal care’, which included fetal movement counting at the discretion of the caregiver (8.9% in a subset of ’control’ participants received a formal fetal movement counting chart). The potential effectiveness of routine over discretionary fetal movement counting is also suggested by the fact that, when fetal movements were formally counted, there were more babies with subsequent unexplained late fetal deaths who were alive when first admitted to hospital (11/59 versus 6/58).

 

Heazell A E, Froen J F (2006) conducted a study on methods of fetal movement counting and the detection of fetal compromise, it stated that the maternal perception of fetal movements is widely used as a marker of fetal viability and well-being. A reduction in fetal movements has been proposed as a screening tool for FGR or fetal compromise. Assessment of fetal movements using formal fetal movement counting has shown that there was a decrease in perinatal mortality and also suggests a beneficial role for raising maternal awareness of fetal movements.

 

Ethiop (2007) did a study on maternal complications in a Hospital. The aim of study was to describe frequency of maternal complication and associated maternal mortality .The sample size was 7249. The result was 56.2% had antenatal care .complication identified were preterm labour 72%, PROM 6%, pre eclampsia 5.2% and 32 maternal death. In conclusion frequency of severe maternal morbidity is high and is associated with high case fatality ratio. This indicates need of improvement in quality of obstetrics care to prevent maternal complication.

 

MATERIAL AND METHOD:

Pre-experimental one group pre-test post-test research design was used for this study. The main study was carried out among 60 primigravida mothers, 30 normal and 30 high risk attending out-patient department in Red Cross Hospital, Bhopal, M.P. Non probability purposive sampling was used.

 

In this study, the independent variable is structured teaching programme regarding self assessment of Daily Fetal Movement Count and the dependent variable is normal and high risk primigravida mothers.

 

Inclusion criteria includes primigravida mothers who are: attending the antenatal O.P.D. of selected hospital of Bhopal, M.P. normal and high risk, willing to participate in the study, available during the data collection period, between age 18-34 years. Exclusion criteria includes primigravida mothers who are: not present at the time of the study, not willing to participate in the study, experiencing premature contractions, less than 28 weeks of gestation & all multi-gravida mothers, admitted in the hospital.

 

The tools used for the data collection consisted of 2 tables. Table 1 (fetal movement monitoring in relation to peri-natal outcome) consisting of 2 sections: Section A of socio demographic data and Section B of self structured interview schedule. Table 2 (chart to monitor fetal movements) consisting of Daily Fetal Movement Count (DFMC) chart.

 

The tool was found to be reliable (by Karl Pearson correlation coefficient formula r=0.77), validated and tested. A computer assisted structured teaching programme was given to the normal and high risk primigravida mothers and an educational pamphlet was also developed and distributed regarding 5 easy steps to monitor daily fetal movement count.

 

RESULTS:

Data collected was analyzed using descriptive and inferential statistics. The results of the study indicate that during area wise analysis of normal primigravida mothers, in the pre-test, the area of maximum knowledge was effect of external factors on fetal movements (51.75%) while in the post-test, the area of maximum knowledge was effect of external factors on fetal movements (80.0%). During overall analysis of normal primigravida mothers in the pre-test, maximum 16 (53.33%) had poor knowledge while in the post-test, maximum 25 (83.33%) had good knowledge.

 

 

 

During area wise analysis of high risk primigravida mothers in pre test, the area of maximum knowledge was effect of external factors on fetal movements (50.0%) while in the post test, the area of maximum knowledge was effect of external factors on fetal movements (81.75%). During over all analysis of high risk primigravida mothers in the pre test, maximum 16 (53.33%) had average knowledge while in the post test, maximum 27 (90%) had good knowledge.

 

 

 

The ‘t’ value obtained from the pre and post test knowledge of the normal primigravida mothers was 16.88 at df 29 and it was highly significant (p<0.05).

 

GROUP	N	MEAN	MEAN %	SD	CV	PAIRED t TEST	CRITICAL t	df	SIGNIFICANCE
Normal primigravida Pre-test	30	8.87	34.11	2.45	27.62	16.88	2.05	29	P<0.05 Highly Significant
Normal primigravida Post-test	30	19	73.08	2.21	11.63

 

The ‘t’ value obtained from the pre and post test knowledge of the high risk primigravida mothers was 18.78 at df 29 and it was highly significant (p<0.05).

GROUP	N	MEAN	MEAN %	SD	CV	PAIRED t TEST	CRITICAL t	df	SIGNIFICANCE
High risk primigravida Pre-test	30	9.07	34.87	2.48	27.34	18.78	2.05	29	P<0.05 Highly Significant
High risk primigravida Post-test	30	19.4	74.62	1.70	8.76

 

This represents that the structured teaching programme was effective in increasing the knowledge of normal and high risk primigravida mothers. Hence, hypothesis that there is a significant difference in gain of post test knowledge as compared to pre test knowledge regarding self assessment of Daily Fetal Movement Count, among normal and high risk primigravida mothers at 0.05 level of significance is accepted.

 

The ‘t’ value obtained from the pre test knowledge of the normal and high risk primigravida mothers was 0.31 at df 58 and it was not significant (p>0.05) which represents that both groups had almost same level of knowledge. The ‘t’ value obtained from the post test knowledge score of the normal and high risk primigravida mothers was 0.78 at df 58 and it was not significant (p>0.05) which represents that both groups were receptive to the structured teaching programme almost equally.

 

There was found significant association between the level of pre-test knowledge of normal primigravida with education received as the calculated value is 6.45 which is greater than the table value 5.99 at 0.05 level of significance, while there was no significant association with age, educational status, occupational status and the number of ANC visits while no significant association between the level of pre-test knowledge of high-risk primigravida with age, educational status, occupational status, the number of ANC visits and education received was found.

 

Hence, hypothesis that there is a significant association between pre test knowledge regarding self assessment of Daily Fetal Movement Count, among normal and high risk primigravida mothers and selected socio-demographic variables at 0.05 level of significance is rejected.

 

NURSING IMPLICATIONS:

Nursing Practice

1.      Nurses can educate the illiterate normal and high risk primi and multigravida about alternative, simple effective method of counting daily fetal movement count besides using the  DFMC chart regarding monitoring of fetal movements.

2.      As primary care giver community nurses can take a specialist role as ‘antenatal health educator’ for increasing awareness among normal and high risk primi and multigravidas with early identification of complication and providing prompt treatment.

 

 

Nursing Education

1.      The present study emphasis the need for increasing the knowledge of normal and high risk primi and multigravidas regarding self assessment of Daily Fetal Movement Count by conducting role play, health education, poster display, puppet show.

2.      Training programme and continuing education to health workers to be enhanced by nurse educator for impacting their knowledge regarding Daily Fetal Movement Count.

 

Nursing Administration

1.      Nursing administrators can organize in-service education for staff and students to create awareness on self assessment of Daily Fetal Movement Count as it is a prevailing topic and knowledge can be impacted to general public.

2.      The nurse administrator should conduct survey of the community areas and need to be aware of the problems faced by the normal and high risk primi and multigravida in monitoring of the Daily Fetal Movement Count chart.

 

Nursing Research

1.      The finding of the study can be used as further reference material for the students and provide baseline data for conducting other research studies.

2.      More research study needs to be conducted with large sample size in different settings like community area, rural area.

 

RECOMMENDATIONS:

v  The present study can be replicated, with a pre test post test control group design.

v  A comparative study can be conducted among normal and high risk primigravida and normal and high risk multigravida.

v  A similar study can also be done to assess the practice and attitude of the primigravida regarding Daily Fetal Movement Count.

v  A comparative study can be conducted regarding self assessment between Daily Fetal Movement Count chart and Kick Count chart.

 

CONCLUSION:

The findings of the study suggests that the structured teaching programme was effective in increasing the knowledge regarding self assessment of Daily Fetal Movement Counts, among normal and high risk primigravida mothers.

 

REFERENCES:

1.       Anne M.L. Berndl, MD, FRCSC, Colleen M. O’Connell, PhD, N. Lynne Mc Leod, MD, FRCSC. Fetal Movement Monitoring: J Obstet Gynaecol Can 2013; 35(1):22–28.

2.       Current Scientific research conferences-about decreased fetal movement. Available from: http://www.infoplease.com/images/03/atlas. Accessed  August 11, 2008.

3.       Estimated global resources needed to attain universal coverage of maternal and Newborn Health services. Benjamine Johns. Kristjane. Helga Fogstard. Jelka Zupan Mttews Mathai Bulletin of the WHO Issues.2008; 86(3) March 161-240.

4.       Heazell et al. Midwives’ and obstetricians’ knowledge and management of women presenting with decreased fetal movements. Obstetrical and Gynaecological survey.2006 Aug; 63(8):484-86.

5.       Ministry Of Health and Family Welfare Government of India. National Family Health Survey (NFHS-3) 2007-2008. Available from: http://www.measuredhs.com.

 

 

Received on 06.09.2014           Modified on 14.09.2014

Accepted on 05.10.2014           © A&V Publication all right reserved