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Med. J. Cairo Univ., Vol. 81, No.

2, March: 179-188, 2013


www.medicaljournalofcairouniversity.com

Effect of Educational Program for Nurses about Pregnancy Induced


Hypertension on their Knowledge in Port Said Hospitals
MOHAMED A. EL-BAHY, M.D.; HAYAT I. MOHAMED, D.N.Sc.; NAGAT S. SALAM, D.N.Sc. and
ELSAYDA H. NASR, D.N.Sc.
The Departments of Obstetrics & Gynecology, Faculty of Medicine, Suez Canal University, Maternal & Newborn Health Nursing,
Faculty of Nursing, Cairo University and Maternity Obstetric & Gynecological Nursing, Faculty of Nursing, Port Said University

Abstract Although many pregnant women with high


Objectives: The aim of this study was to examine the blood pressure have healthy babies without serious
impact of pregnancy induced hypertension nursing educational problems, high blood pressure can be dangerous
program for maternity nurses on their knowledge. for both the mother and the fetus. Women with
Subjects and Methods: The study was carried out in the pre-existing, or chronic, high blood pressure are
Obstetric and Gynecological Departments in Port Said Hos- more likely to have certain complications during
pitals using a quasi-experimental (pre & post test) design. pregnancy than those with normal blood pressure.
The subjects of the study were 30 nurses working in the However, some women develop high blood pressure
Obstetric and Gynecological Departments in Port Said Hos-
pitals. Data were collected using one tools devised specifically while they are pregnant (often called gestational
for the study. hypertension). The effects of high blood pressure
Results: The results revealed that there was a significant
range from mild to severe. High blood pressure
improvement in the nurses' knowledge score about pregnancy can harm the mother's kidneys and other organs,
induced hypertension especially definition, types, incidence, and it can cause low birth weight and early delivery.
signs and symptom, complications of the mothers and fetus, In the most serious cases, the mother develops
high risk group and diagnosis and nursing management mean- preeclampsia or "toxemia of pregnancy" which
while, the scores in the follow-up (after 3 months) tend to
decline. can threaten the lives of both the mother and the
fetus [3].
Conclusion: Educational program has a significant and
improvement impact on the nurse's knowledge regarding Pregnancy induced hypertension continues to
pregnancy induced hypertension that tends to decline with
the progress of time. be important in the united States in recent studies,
these conditions were to be the second leading
Key Words: Pregnancy induced hypertension Preeclampsia
and eclampsia Nursing role.
causes of maternal death it is estimated that hyper-
tensive complications approximately 10% of all
Introduction pregnancies. The prevalence is increase as many
as 20 to 40% of pregnancies in women with chronic
PREGNANCY induced hypertension, is common hypertension [4,5]. In Egypt pregnancy induced
throughout the world but more frequent in devel- hypertension is considered a major cause of mater-
oping countries. It defined as high blood pressure
and excess protein in the urine usually after the nal death, associated with 27% of direct obstetric
fifth month of pregnancy, the condition is more death and 22% of all maternal deaths [6].
often seen among women in the lower socio- Medical researchers are yet to determine the
economic group and women over 35 years, spe- cause of pre-eclampsia. However, it has been found
cially if they are primigravida. Women with a to be common among those with a history of pre-
family history of pregnancy induced hypertension vious pre-eclampsia, gestational diabetes, obesity
(PIH) are at higher risk for it [1,2].
and renal/kidney problems, hyperthyroidism. It is
Correspondence to: Dr. Mohamed A. El-Bahy, The Department generally seen in the first pregnancy and the 5th
of Obstetrics & Gynecology, Faculty of Medicine, and subsequent pregnancies and is less common
Suez Canal University in the 2nd, 3rd and 4th pregnancies [1,7].

179
180 Effect of Educational Program for Nurses about Pregnancy

When Pre-eclampsia is diagnosed in its early Nursing, while the rest were diploma nurses. This
stages, bed rest is usually advised for the mother study was carried out in the inpatient (obstetric
and her BP should be monitored closely. However and gynecological department) at three hospitals
if the disease progresses, the doctor would be left located in Port Said city as. 1- Port said general
without a choice but to induce labor or deliver by hospital is the largest public hospital affiliated by
Caesarean, regardless of whether the baby has ministry of the wide range of maternity services;
matured to full term or not. The blood pressure it has tree rooms and ten beds. Also, contain fifty
would then return to normal within 2-3 days [1,8]. six physicians, eleven nurses and three workers.
Pre-eclampsia can affect the arteries carrying blood 2- Port Fouad Hospital at private and inpatient
to the placenta. When this happens the fetus re- (Obstetric and Gynecological Department) has four
ceives less oxygen and nutrition, resulting in slow rooms each room has 4 beds, privet ward consist
growth, low birth weight, pre-maturity or stillbirth. of four rooms. The services are running by fifteen
Pre-eclampsia also increases the risk of the placenta physicians, ten nurses and two work aids. And 3-
separating from the inner wall of the uterus before El-Tadamon Hospital at private and inpatient (ob-
delivery (abruption). This can cause =controllable stetric and gynecological department) it has ten
bleeding and be life-threatening for both mother rooms at thirty three beds. The services are rurming
and baby. Another complication is Eclampsia (Pre- by four physicians, nine nurses and three work
eclampsia plus seizures) that happens when Pre- aids.
eclampsia is uncontrolled. This is associated with
maternal mortality [91. One tool was developed and used by the re-
searcher for data collection.
Although preeclampsia is not preventable, many Tool I: Pregnancy induced hypertension Knowl-
deaths from the disorder can be prevented. Women edge Assessment Questionnaire
who do not receive prenatal care are seven times
more likely to die from complications related to This questionnaire was developed by the re-
preeclampsia-eclampsia than women who receive searcher after reviewing of literature, this tool was
some level of prenatal care Rol. To decrease preec- divided into two main parts.
lampsia-related mortality, appropriate prenatal care
must be available to all women. Early detection, Part (1): Nurses' socio-demographic data such
careful monitoring, and treatment of preeclampsia as age, sex, education, experience years, attended
are crucial in preventing mortality related to this in training program before, expectations from
disorder [iii. So this study was carried out to assist training program and best educational tool for
the nurses to gain knowledge and skills on preg- nurses.
nancy-induced hypertension and hypertension con- Part (2): This part included questions to assess
trol. Knowledge that comes from this study may nurses' lmowledge about pregnancy induced hyper-
be used to enhance the body of knowledge for tension such as definition-types-incidence-signs
nursing profession, in nursing education, in training and symptoms-complications of the mothers and
schools, nursing practice and MCH area. fetus, high risk group and diagnosis and nursing
management of PIH.
Aim of study:
The aim of this study is to examine the impact Content validity:
of pregnancy induced hypertension nursing educa- The researcher designed an opirmiormaire sheet
tional program for maternity nurses on their lmowl- to test the content validity of the assessment ques-
edge. tionnaire sheet for nurses and mothers by a jury
including 10 Experts in the field of Obstetric and
Subjects and Methods Gynecology from Medical and Nursing Faculty
A quasi-experimental (pre & post) design was staff. It involved two parts:
used to determine the impact of pregnancy induced A- The opinions of the experts for each item were
hypertension nursing educational program for recorded on a two point scale: Relevant, not
maternity nurses on their knowledge. The subjects relevant and clear, not clear.
of the study were all nurses working in the Obstetric B- General or overall opinion about the form, they
and Gynecological Departments in Port Said Hos- were requested to express their opinions and
pitals at El-Amery Hospital, Port Fouad Hospital comments on the tool and provide any sugges-
and El-Tadamon Hospital (The total sample size tions for any additional or omissions of items.
was 30 nurses). Two of them were graduates of Then necessary modifications were done. This
Technical Institute of Nursing and two Faculty of phase was carried out in a period of two months.
Mohamed A. El-Bahy, et al. 181

A pilot study, which was carried out on 10% ments were statistically significant in the all items.
from nurses. The main purpose of the pilot study The most prominent improvements were related
were to test the clarity, feasibility of the tools and to defmition. This reached 100.0% in the immediate
whether it was understandable, and to determine post-test and remained at the level at follow-up
the time needed to fill the tool. The tool was handed test. Meanwhile, the score generally slightly decline
to participants to fill it and collected by researcher. at 3-month follow-up, compared to the post-test.
The time for the completion of the questionnaire Nonetheless, the levels were still significantly
sheet was ranged from 1-1.30 hour. Then reliability higher than the pre-program levels.
of the tool was done which lead to omission of
two items (how to predict the woman suffering Table (3) displays the distribution of the nurses
from PIH, classification). Following this pilot lmowledge about clinical picture and investigations
study, the process of data collection and implemen- of pregnancy induced hypertension assessed at
tation of educational program consumed 12 months different timings of the study. It indicates improve-
from June 2010 to March 2011. ment of nurses' lmowledge in the all items. These
improvements were statistically significant in the
Resufts all items. The most prominent improvements were
related to investigations needed for the infants and
Table (1) shows the distribution of nurses ac- complications of hypertension for the pregnant
cording to their socio-demographic and job char- women, which reached 100.0% in the immediate
acteristics. As regard age, half of the studied sub- post-test and remained at the level at the follow-
jects (50%) were in the age group ranging between up test. Meanwhile, the score slightly decline at
20 to less than 30 years, while those aged 50 or 3-month follow-up, compared to the immediate
more constituted 6.7% of the subjects. Concerning post-test. Nonetheless, the levels were still signif-
their educational level the majority of the nurses icantly higher than the pre-program levels.
(86.7%) had nursing diploma and did not have
certificate of specialization (93.3%). The mean Table (4) shows the frequency of nurses' lmowl-
years of experience in nursing of the nurses were edge regarding medications for hypertensive preg-
around 10.89.3. nant women assessed at different timings of the
study. It indicates an improvement of nurses' lmowl-
Table (1): Nurses' socio-demographic and job characteristics edge about medications in the all items, and in
data (n=30).
their score post program implementation. These
Socio-demographic characteristics No. % improvements were statistically significant
Age (years): 3 10.0 (p<0.0001). The most prominent improvement was
Less than 20 15 50.0 in the score of knowledge about solutions needed
20 5 16.7 to treat PIH, dose of magnesium sulfate and nurse's
30 5 16.7 role before and during administration of magnesium
40 2 6.7
More than 50 sulfate, which reached 100.0% and 96.7% in the
Range 18-55 post-test and follow-up test, respectively. Mean-
MeanSD 30.610.3 while, the score generally slightly decline at 3-
Educational level: month follow-up, compared to the immediate post-
Nursing diploma 26 86.7 test. Nonetheless, the levels were still significantly
Technical of nursing 2 6.7 higher than the pre-program levels.
Faculty of nursing 2 6.7
Certificate of specialization: The results of nurses' satisfactory knowledge
Yes 28 93.3 about personal care for hypertensive pregnant
No 2 6.7 women throughout the study phases are displayed
Duration of experience: in Table (5). It indicates an improvement of nurses'
Less than 10 17 56.7 knowledge in the all items, and in their score post
10 5 16.7
20 6 20.0 program implementation. These improvements
More than 30 2 6.7 were statistically significant (p<0.0001). The most
Range 1-31 prominent improvement was in the scores of lmowl-
MeanSD 10.89.3 edge about nutrition for hypertensive pregnant
women, especially in the amount of proteins needed
Table (2) displays the distribution of the nurses daily and types of food that should be avoided.
knowledge about general concepts of pregnancy which reached 100.0% in the immediate post-test
induced hypertension that was assessed at different remained at this level at follow-up test. Meanwhile,
timings of the study. It indicates improvement of the score generally slightly decline at 3-month
nurses' lmowledge in the all items. These improve- follow-up, compared to the immediate post-test.
182 Effect of Educational Program for Nurses about Pregnancy

Nonetheless, the levels were still significantly immediate post-test. Nonetheless, the levels were
higher than the pre-program levels. still significantly higher than the pre-program
levels.
The knowledge about nursing care for pre ec-
lampsia & eclampsia patients throughout the study Table (7) describes the relation between nurses'
phases are displayed in Table (6). It indicates an lmowledge score about PIH to their age at different
improvement of nurses' knowledge in the all items, timings of the study. It shows that a statistical
and in their total score post program implementa- significant association were revealed between
tion. These improvements were statistically signif- nurses' knowledge about PIH at the follow-up
icant (p<0.0001). The most prominent improvement phase and their age.
was in the scores of knowledge about environmental
precautions around the patient, which reached Table (8) shows relationship between nurses'
100.0% and 96.7% in the immediate post-test and knowledge score about PIH and duration of their
follow-up test, respectively. Generally, the total experience at different timings of the study. The
score of the items about nursing care for pre ec- findings revealed statistical significant between
lampsia & eclampsia patients has shown improve- nurses' knowledge about PIH before the program
ment. Meanwhile, the score generally slightly and attended training courses in studied nurses to
decline at 3-month follow-up, compared to the duration of their experience.
Table (2): Nurse's knowledge about general concepts of pregnancy induced hypertension throughout the study phases.
Time
Pre Post FU X2 Test X2 Test X2 Test
Knowledge variables (n=30) (n=30) (n=30) (p-value) (p-value) (p-value)
Pre-post Pre-FU Post-FU
No. % No. % No. %
General Knowledge about PIH:
Definition 13 43.3 30 100.0 30 100.0 X2=23.72 (0.0001)* X2=23.72 (0.0001)* FEp=1.0*
Types 4 13.3 30 100.0 27 90.0 X2=38.57 (0.0001)* X2=45.88 (0.0001)* FEp=0.492*
Incidence 3 10.0 29 96.7 28 93.3 X2=45.27 (0.0001)* X2=41.71 (0.0001)* FEp=1.0*
High risk groups 2 6.7 29 96.7 29 96.7 X2=48.65 (0.0001)* X2=48.65 (0.0001)* FEp=1.0*

Table (3): Nurse's knowledge about clinical picture and investigations of pregnancy induced hypertension throughout the study
phases.
Time
X2 Test X2 Test X2 Test
Pre Post FU
Knowledge variables (p-value) (p-value) (p-value)
(n=30) (n=30) (n=30)
Pre-post Pre-FU Post-FU
No. % No. % No. %
Clinical Picture and Investigation
of PIH:
Clinical picture of mild 9 30.0 29 96.7 27 90.0 X2=31.52 X2=28.71 FEp=i .0*
hypertension (0.0001)* (0.0001)*
Clinical picture of severe 3 10.0 29 96.7 28 93.3 X2=48.12 X2=49.09 FEp=i .0*
hypertension (0.0001)* (0.0001)*
Clinical picture of eclampsia 3 10.0 28 93.3 25 83.3 X2=41.71 X2=32.41 p=0.424*
(0.0001)* (0.0001)*
Occurrence of convulsions 10 33.3 30 100.0 28 93.3 X2=30.0 X2=30.0 FEp=i .0*
(0.0001)* (0.0001)*
Stages of convulsions 7 23.3 29 96.7 30 100.0 X2=33.61 X2=37.29 FEp=i .0*
(0.0001)* (0.0001)*
Dangerous stages of convulsions 1 3.3 20 66.7 14 46.7 X2=26.45 X2=15.02 X2=2.44
(0.0001)* (0.0001)* (0.118)*
Investigations needed for women 16 53.3 30 100.0 26 86.7 X2=18.26 X2=7.94 FEp=0.112*
suffering from PIH (0.0001* (0.005)*
Investigations needed for the fetus 22 73.3 30 100.0 30 100.0 FEp=0.005* FEp=0.005* FEp=i .0*
Complications of hypertension 11 36.7 30 100.0 30 100.0 X2=27.81 X2=27.81 FEp=i .0*
for the pregnant female (0.0001)* (0.0001)*
Complications of hypertension 9 30.0 30 100.0 25 83.3 X2=32.31 X2=32.31 p=0.314*
for the fetus (0.0001)* (0.0001)*
pl,p2,p3: Chi-Square test X2 (p). FEP: Fisher's Excat test. *Significant atpD105. NA: Not applicable.
Mohamed A. El-Bahy, et al. 183

Table (4): Nurses' knowledge regarding medications for hypertensive pregnant women throughout the study phases.

Time
X2 Test X2 Test X2 Test
Pre Post FU
Knowledge about medications (p-value) (p-value) (p-value)
(n=30) (n=30) (n=30)
Pre-post Pre-FU Post-FU
No. % No. % No. %
Medications needed to prevent PIH 0 0.0 29 96.7 28 93.3 X2=56.13 X2=52.5 FEp=1.0
(0.0001)* (0.0001)*
Medications needed to treat 7 23.3 27 90.0 25 83.3 X2=27.15 X2=21.69 FEp=o3o6
(0.0001)* (0.0001)*
Solutions needed to treat PIH 26 86.7 30 100.0 30 100.0 FEp=0.353 FEp=0.112 FEp=1. 0

Magnesium Sulfate:
Causes for use of magnesium 9 30.0 29 96.7 27 90.0 X2=28.71 X2=32.31 FEp=1. 0
sulfate (0.0001)* (0.0001)*
Dose of magnesium sulfate 2 6.7 30 100.0 29 96.7 X2=52.5 X2=52.5 FEp=1. 0
(0.0001)* (0.0001)*
Nurse's role before and during 1 3.3 30 100.0 29 96.7 X2=56.13 X2=52.27 F Ep, = 1 . 0
administer magnesium sulfate (0.0001)* (0.0001)*
Signs of toxicity with magnesium 0 0.0 29 96.7 28 93.3 X2=59.0 X2=60.0 FEp=1. 0
sulfate (0.0001)* (0.0001)*
Nurse's role in management of 0 0.0 29 96.7 25 83.3 X2=59.0 X2=60.0 FEp=0.605
magnesium sulfate (0.0001)* (0.0001)*

Table (5): Nurses' knowledge regarding personal care for hypertensive pregnant women throughout the study phases.

Time
X2 Test X2 Test X2 Test
Pre Post FU
Knowledge about personal (p-value) (p-value) (p-value)
(n=30) (n=30) (n=30)
care of females Pre-post Pre-FU Post-FU
No. % No. % No. %
Comfort and Sleep:
Importance of comfort 3 10.0 24 80.0 24 80.0 X2=29.69 X2=29.69 FEp=i .0
(0.0001)* (0.0001)*
Proper position during sleep 10 40.0 30 100.0 29 96.7 X2=20.0 X2=16.71 FEp=i .0
(0.0001)* (0.0001)*
Personal cleaning of mother 4 13.3 28 93.3 27 90.0 X2=38.57 X2=35.31 FEp=i .0
(0.0001)* (0.0001)*
Nutrition:
Food needed for PIH 9 30.0 28 93.3 28 93.3 X2=25.45 X2=25.45 FEp=i .0
(0.0001)* (0.0001)*
Amount of proteins needed daily 4 13.3 30 100.0 30 100.0 X2=45.88 X2=45.88 -NA-
(0.0001)* (0.0001)*
Amount of fluids needed daily 1 3.3 30 100.0 29 96.7 X2=56.13 X2=52.27 FEp=i .0
(0.0001)* (0.0001)*
Amount of salt needed daily 0 0.0 29 96.7 29 96.7 FEp<0.0001* X2=56.13 FEp=i .0
(0.0001)*
Types of food that should be 6 20.0 30 100.0 30 100.0 X2=40.0 X2=40.0 -NA-
avoided (0.0001)* (0.0001)*

FEp: Fisher's Excat test. *Significant at pD105. - NA : Not applicable.


-
184 Effect of Educational Program for Nurses about Pregnancy

Table (6): Nurses' knowledge regarding nursing care for pre-eclampsia & eclampsia patients throughout the study phases.
Time
Pre Post FU X2 Test X2 Test X2 Test
Knowledge about nursing care for (p-value) (p-value) (p-value)
(n=30) (n=30) (n=30) Pre-FU
preeclampsia and eclampsia Pre-post Post-FU
No. % No. % No. %
Nursing care for mild cases of pre- 1 3.3 30 100.0 27 90.0 X2=56.13 X2=56.13 FEp= 1 0*.

eclampsia (0.0001)* (0.0001)*


Nursing care for severe cases of 1 3.3 30 100.0 27 90.0 X2=56.13 X2=56.13 FEp= 1 0*.

pre-eclampsia (0.0001)* (0.0001)*


Environmental precautions around 16 53.3 30 100.0 29 96.7 X2=18.26 X2=18.26 FEp= 1 0*.

the patient (0.0001)* (0.0001)*


Nursing care for cases of eclampsia 0 0.0 30 100.0 28 93.3 X2=60.0 X2=60.0 FEp= 1 0*.

before convulsions (0.0001)* (0.0001)*


Nursing care for cases of eclampsia 6 20.0 30 100.0 27 90.0 X2=40.0 X2=36.27 FEp= 1 0*.

during convulsions (0.0001)* (0.0001)*


Nursing care for cases of eclampsia 1 3.3 28 93.3 19 63.3 X2=48.65 X2=24.3 X2=7.95
after convulsions (0.0001)* (0.0001)* (0.005)*
FEp: Fisher's Excat test. *Significant at pD:).05. -NA-: Not applicable.

Table (7): Relation between nurses' knowledge score about PIH to their age at different timings of the study.
Time & Age
PRE (n=30) POST (n=30) FU (n=30)
Items
Less than 25 yrs or Less than 25 yrs or Less than 25 yrs or
25 yrs more 25 yrs more 25 yrs more
(n=11) (n=19) (n=11) (n=19) (n=11) (n=19)
Total satisfactory knowledge score (%) 23.7% 27.1% 92.7% 91.9% 87.8% 79.4%
Mann Whitney test (p) 0.322 0.73 0.025*

Table (8): Relation between nurses' knowledge score and duration of their experience.
Time & Age
PRE (n=30) POST (n=30) FU (n=30)
Items
Less than 10 yrs or Less than 10 yrs or Less than 10 yrs or
10 yrs more 10 yrs more 10 yrs more
(n=17) (n=13) (n=17) (n=13) (n=17) (n=13)
Total satisfactory knowledge score (%) 23.6% 28.7% 93.1% 91.1% 84.6% 79.7%
Mann Whitney test (p) 0.044* 0.425 0.201

Discussion these disorders to minimize the adverse effects in


both mother & infant through attending the ante-
Pregnancy induced hypertension is common natal clinic periodically during pregnancy. Further-
throughout the world but more frequent in devel- more, collaborative efforts from all members of
oping countries [ii, it is unpredictable, multi-organs the health team as well as appropriate self care
disorder and unique to human pregnancy. It is practices of women with PIH is required. The nurse
associated with significant maternal and fetal mor- should be knowledgeable and highly skillful in
bidity and mortality worldwide. It is a leading providing nursing care according to women's needs
cause of death in 10% of all pregnancies [12]. and problems to save their lives [13]. Therefore,
this study was undertaken to provide nurses, as
Nurses have an important and effective role in healthcare providers, with the knowledge, and
the prevention of complication of PIH, assistance skills necessary to provide care to the women with
in early detection and appropriate management of PIH.
Mohamed A. El-Bahy, et aL 185

Regarding the nurses knowledge about defini- Churchill & Beevers [18], mentioned that; epi-
tion and types of PIH before the training program, demiological research has identified several risk
it was found that more than half of them did not factors for the development of pre-eclampsia. Some
know the correct answer. This lack of knowledge have stronger associations than others, but all have
may be related to their level of education [14], a role to play in identifying women at risk of the
stated that; the terminology used to describe hy- disorder. These factors were: Multiparity, a previous
pertension in pregnancy is confusing and several history of pre-eclampsia, a high body mass index,
overlapping terms are commonly applied. This is physical work during pregnancy, a family history
supported by Gobbe et al. [15], who stated that of pre-eclampsia, and an African-American ethnic
terminology used to classify the hypertension background. Another study in (1994) done by Stone
disorder of pregnancy has been confusing and et al. [20], Also, identified three of these factors'
making comparison of studies difficult and often as significant: Sever obesity, a previous history of
impossible. preeclampsia and multiple pregnancies. Others
known but often neglected risk factors include:
Simpson and Greenhan [16], mentioned that Low socio-economic status, diabetes, hydramnios,
terminology used to describe the pregnancy induced and trophoplastic disease. Pregnancies complicated
hypertension is causing confusion for health care by other medical disease such as diabetes become
providers. The Lenfant et al. [17], outlines current highly complicated when preeclampsia occur in
accepted terminology of hypertension disorder conjunction with these other conditions.
with pregnancy (HDP). Clinically, there are two
basic types of hypertension during pregnancy. Regarding nurses' knowledge about signs and
Chronic hypertension and PIH, with the distinction symptoms of mild and sever preeclampsia, it was
based on the onset of hypertension in relation to found that there is a lack of knowledge related to
the pregnancy. about signs and symptoms of PIH before the train-
It was obvious from the finding of this study ing program. This may be due to the nurses did
that, there is lack of lmowledge about the incidence not attend seminars, workshops and refreshing
of PIH. Before the training program, nurses didn't courses related to PIH. This finding supported by
lmow the severity of the disease to take the specific the result of Tawfek [21] who reported that the
precautions or measures. This is supported by maternity nurses mentioned some signs and symp-
Churchill & Beevers [18], who stated that prevention toms while others did not mention.
of a disease or disease process first require an According to Roberts [22], emphasized that; the
intimate understanding of the path physiology and proposition of primary preventive care as well as
incidence of the disease or disease process, and an the management of prenatal care requires that the
effective modality of treatment. nurse midwife be knowledgeable and competent
Gorrie et al. [14], emphasized that the value of to recognize the initial signs and symptoms of PIH
screening procedures is based on two assumptions, and depending on their severity, initiate the appro-
prevention is better than cure, early diagnosis priate additional assessment & precautions involv-
allows early treatment. While the pathologic process ing patient education and reevaluations.
is still reversible. Moreover, because the etiology
of PIH is unknown, it's mandatory to identify Churchill & Beevers [18], stated that diagnosis
women who are at risk for future development of of hypertensive disorders in early pregnancy and
pre eclampsia. Lim and Tweed [19], stressed that, preeclampsia in late pregnancy need through in-
nurses dealing with pregnant women should know vestigations. These investigations will differ slightly
how to identify high-risk groups in relation to PIH depending upon the diagnostic priorities. In early
to detect early and treat properly any deviation pregnancy identifying any underling causes of
from normal and to prevent bad consequences for hypertension is important, whereas after 20 weeks
mothers and their babies. of gestation the investigations will be tailored to
making the diagnosis and determining the severity
In the present study, it was found that there is of pre-eclampsia. There will, however, be a great
a lack of knowledge about the identification of deal or overlap between the two situations and
high risk group. This may be due to the fact that, their investigations will be considered in tandem.
nurses did not receive adequate information or Gorrie [14], reported that the nurses are responsible
may be need for refreshment in-services training, for explaining screening and diagnostic procedures
regarding high risk factors during pregnancy that and for clarifying options, so that women can make
may lead to or predispose to PIH. informed decisions about care.
186 Effect of Educational Program for Nurses about Pregnancy

Regarding nurse's knowledge about maternal related to doses, signs of MgSo4 toxicity, treatment
and fetal investigations, it was found that, before of MgSo4 toxicity and nursing role during admin-
implementation of the training program, more than istration of MgSo4. While after the training program
half of nurses gave true answers, while, after the majority of nurses showed satisfactory knowledge
training program, the all of them gave complete related to the previous items. These results are the
answers. Moodley & Naicker [23], mentioned that same line with Gorrie et al. [14], who reported that
fetal investigations include the following; assess- nurses should be aware of actions, indications,
ment of fetal growth by recording maternal weight doses and route of administration, sides effects
twice weekly and measurement of fundus height and nursing implications of MgSo4 treatment. This
weekly, fetal kick count and weekly ante partum comes in agreement with Sibai [24], who stated
cardiotocography and ultrasonography. that; Magnesium sulfate; satisfied all the above
criteria to make it the ideal anticonvulsant in
This result agrees with Tawfek [21] who reported preeclampsia & eclampsia. Its use has been stan-
that lack of nurses knowledge regarding fetal dardized, which has made it easy and simple to
investigations. Before the training program one administer, as well as to monitor its effects and
third of nurses gave wrong answers, while after side effects. All nurses and physicians working in
the training program, more than three-quarters of obstetric units in this country are familiar with at
them gave complete answers. least one regimen of drug administration doses and
clinical monitoring of potential side effects.
Regarding nurse's knowledge about maternal
and fetal complications, it was found that, before Studd [25], stressed that; the aim of treating the
implementation of the training program, one third hypertensive women are very clear: To prevent
of nurses gave true answers, while, after the training maternal complications and if safe, to prolong the
program, the all of them gave complete answers pregnancy either to allow time for steroids to be
about maternal and fetal complications. This finding administered or allow maturation of the fetus to
supported by result of Tawfek [21] who reported take place, thus preventing or attenuating the prob-
that lack of nurses knowledge regarding maternal lem of respiratory distress syndrome in the neonate.
and fetal complications before applying of the Whenever there is more than one way of treating
training program. Churchill & Beevers [18], stressed a specific condition, it is important for the doctor
that the most common complication is eclampsia, to be clear regarding the aims of treatment. Clearly
if treated appropriately and promptly the mother the aims of treating severe hypertension in cases
will make a full and =complicated recovery. Other of fulminating pre-eclampsia are to prevent mor-
complications that may occur are: Cerebrovascular bidity and mortality of mother and fetus.
accident, myocardial infarction, renal failure, dis-
seminated intravascular coagulation, retinal detach- Regarding knowledge of nurses' about the IV
ment, HELLP and adult respiratory distress syn- infusions used to treat PIH, before the program
drome. Fetal complications that may occur is Intra training, high percentage of nurses gave complete
Uterine Growth Retardation (IUGR), Intrauterine answers, while after the program all nurses gave
deaths, prematurity and perinatal asphyxia. complete and correct answers. Most of nurses were
familiar with all IV infusions given, but they did
The present study indicated that, the most of not know the reasons for giving these infusions.
nurses gave wrong answers related to drugs given This results supported by Yakout [26], who stated
in case of PIH before implementation of the training that, nurses gave complete answers. Most of them
program, while, after the training program, the were quite familiar with glucose 5%. Also, nurses
most of them gave complete answers about the did not have knowledge about reasons for giving
drugs needed to treat PIH. This may be due to these infusion.
inadequate basic information and unavailability of
pre-service training program. This results in contrast Many authors Potter & Perry [27] and Cole [28],
with Tawfek [21] who reported that some of nurses stated that; the administration of medication places
gave correct answers related to medications given great responsibility on the nurse. Knowledge of
in case of PIH before the program. This may be specific drug classification and guideline is impor-
due to the fact that nurses have their knowledge tant. The nurse must learn legal guidelines in order
during their work experiences. to meet expected standards of law when adminis-
tering medication. The nurse should have knowl-
Concerning nurses' knowledge related to mag- edge in the following areas before administering
nesium sulfate (MgSo4),it was found that, the medication to patient: Basic math for calculation
nurses didn't have knowledge before the program of correct dosages of medications; guidelines for
Mohamed A. El-Bahy, et aL 187

administering medication, abbreviations and sym- perineal care are also important components of
bols and legal aspects to meet the standards of health care for women during pregnancy and should
accountability & responsibility; drug preparations not be neglected.
& appropriate administration techniques; and prin-
ciples of administering medication including the Regarding knowledge of nurses' about the nu-
five rights. trition for women with PIH, the diet as an essential
items of personal care. The present study showed
The finding of the present study showed that, that most of nurses did not gave correct answers
the majority of nurses did not have knowledge about types of food, amount of protein and fluid
about personal care for hypertensive pregnant needed daily before the training program. While
women (important of comfort or taking enough after the program the majority of them were gave
period of rest and sleep), before the training pro- complete and correct answers about the previously
gram, this is may be due to lack of in service mentioned items. This may be attributed to the fact
training program and standardized protocols for that most of the nurses lacked the basic knowledge
the management and personal or self care items of regarding the essential nutritional elements. These
PIH. This result supported by Tawfek [21] who results are the same line with Tawfek [21] who
stated that the most of nurses did not instruct reported that the most of nurses did not teach
women with HDP about the impotence of taking women with HDP about the kinds of food and
enough period of rest & sleep. Cole [28], stated amount of protein daily before the training program.
that; the nurses' responsibilities include assessing Conclusion:
the patients need for rest and sleep, diagnosing
any potential or actual sleep problems, implement- Based on study findings, it can be concluded
ing measures to promote rest & sleep and evaluating that:
the patients response to the effectiveness of intra- Educational program has a significant and im-
venous infusions. It was reported that promoting provement impact on the nurse's knowledge re-
health and nursing recovery from illness. garding pregnancy induced hypertension that tend
Lowdermilk et al. [29], stated that advising to decline with the progress of time.
women to take enough rest with laying on left side Recommendations:
position was especially emphasized, as it was Frequent and schedule In-services training
considered a key element in the therapy. Another program should be applied for nurses at the hospital.
study done by Dickason et al. [30], revealed that A manual containing the basic needed information
bed rest during pregnancy has both risks and ben- about PIH, as well as how to counsel and teach
efits. Periods of modified bed rest in lateral position woman should be available at the department.
are often recommended in mild hypertension. Com- Establish library with recent scientific books and
plete bed rest is currently questioned because of magazines in an Arabic language and budget should
its potential side effects. be allowed every year for the educational activities
Gilbert & Hartman [13], added that; resting in of nurses. Encourage nurses to attend continuing
bed in the lateral recumbent position should be education in the form of workshops, conferences,
maintained until the pressure of gravid uterus training programs and review update nursing care
decreases from inferior vena cava. This facilitates related to PIH. Standardized protocols for treatment
of emergency obstetric including PIH, should be
venous return, increasing the circulatory volume, developed for legal protection of nurses during
decreases of angeotension II which increase renal their clinical practices. Future research should also
blood flow and promotes dieresis. take patients' contributions into consideration and
Regarding daily hygiene, it was found that, the focus on patient outcomes. Study the psychological
majority of nurses before the training program did aspects of women with PIH. Study factors affecting
not gave correct answers about daily hygienic care women with PIH self care practices.
for women with PIH, while after the program their References
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