PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING MANAGEMENT OF SHOULDER DYSTOCIA AMONG THIRD YEAR GNM STUDENTS IN SELECTED NURSING SCHOOLS AT TUMKUR.”

SUBMITTED BY:

MS. SEENIYA GEORGE

1ST YEAR M.SC NURSING

OBSTETRIC AND GYNAECOLOGY NURSING

SRI RAMANA MAHARSHI COLLEGE OF NURSING

TUMKUR

(2011-2013)

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA ANNEXURE-II

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

MS. SEENIYA GEORGE

1S YEAR M.sc NURSING SRI RAMANA MAHARSHI COLLEGE OF NURSING TUMKUR-06

2 NAME OF THE INSTITUTION SRI RAMANA MAHARSHI COLLEGE OF NURSING

3 COURSE STUDY AND SUBJECT 1ST YEAR M.sc NURSING.

OBSTETRIC AND GYNAECOLOGY NURSING

4 DATE OF ADMISSION TO COURSE 15/07/2011

5 TITLE OF STUDY “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGADING MANAGEMENT OF SHOULDER DYSTOCIA AMONG THIRD YEAR GNM STUDENTS IN SELECTED NURSING SCHOOLS AT TUMKUR”

2

INTRODUCTION

“Who takes the child by the hands,

takes the mother by the hearts’’

Midwifery is as old as the history of human species. Archeological evidence of a woman

squatting in child birth supported by another woman from behind demonstrates the existence

of midwifery in 5000BC1. Moreover it mainly deals with child birth or parturition or labour.

Birth”, as the word suggests, means the bestowing of some form of life by the nature, to this

world. Being born is the purest virtues that can be held by a living being as after that one is

exposed to life, where one can breathe, feel, have emotions.2 Where as labour may be defined

as the process by which the fetus, placenta and membranes are expelled through the birth

canal. On the other hand it is the rhythmic contraction and relaxation of the uterine muscles

with progressive effacement (thinning) and dilatation (opening) of the cervix, leading to

expulsion of the products of conception.1

Child birth is one of the most natural and ancient things to occur, and the fact in 95% of

babies are delivered in the hospital, a huge percent are c- sections or causing complications,

is rather telling to our detachment from the process is this because of obstetrical emergencies.

An obstetrical emergency is a condition, under which the normal operations of the

facilities are threatened, and the health of mother and neonate are in jeopardy. In these

emergencies midwives and other obstetrical care providers consider one of the most

frightening complications they encounter to be shoulder dystocia. Dystocia is a term used to

describe the difficult delivery of a baby, where as shoulder dystocia is a common birth injury

that occurs when a baby’s shoulder become trapped in the birth canal and it has been

recognized and discussed for at least two centuries. Because of its infrequent occurrence and

unpredictability, however, health care professionals have had little opportunity to become

familiar with all aspects of this obstetric emergency. Potentially devastating maternal and

neonatal complications can occur without rapid resolution of the dystocia.3

“To witness the birth of a child is our best opportunity to experience the meaning of

word miracle” says by Paul Carvel so well trained obstetricians and health care professionals

have the knowledge and skills needed to anticipate, prevent and mitigate the possibility of

this type of birth trauma.

3

Shoulder dystocia is an obstetrical complication that occurs in approximately 30,000

deliveries in the US every year. In this medical emergency, the child's head is able to clear

the cervix, but the shoulders become impacted behind the mother's pelvis. This impaction

may prevent a vaginal delivery4. In such cases, the baby's face will exhibit what is known as

turtle sign, which involves the appearance and retraction of the fetal head (analogous to a

turtle withdrawing into its shell), and the erythematous (red), puffy face indicative of facial

flushing. This occurs when the baby's shoulder is obstructed by the maternal pelvis.5

Shoulder dystocia can be one of the most frightening emergencies in the delivery

room. Although many factors have been associated with shoulder dystocia, most cases occur

with no warning. Calm and effective management of this emergency is possible with

recognition of the impaction and institution of specified maneuvers, such as the McRoberts

maneuver, suprapubic pressure, internal rotation, or removal of the posterior arm, to relieve

the impacted shoulder and allow for spontaneous delivery of the infant. The “HELPERR”

mnemonic from the Advanced Life Support in Obstetrics course can be a useful tool for

addressing this emergency. Although no ideal manipulation or treatment exists, all maneuvers

in the HELPERR mnemonic aid physicians in completing one of three actions: enlarging the

maternal pelvis through cephalic rotation of the symphysis and flattening of the sacrum;

collapsing the foetal shoulder width; or altering the orientation of the longitudinal axis of the

foetus to the plane of the obstruction. In rare cases in which these interventions are

unsuccessful, additional management options, such as intentional clavicle fracture,

symphysiotomy, and the Zavanelli maneuver, are described.6

Shoulder dystocia is an obstetrical complication that occurs in thousands of deliveries

in the US each year. It has the potential for causing significant, lifelong injury to the

newborns involved in such deliveries.7

 Difficulty in delivering the shoulders is a relatively frequent obstetrical issue that can

present a significant challenge to delivery staff. A thorough understanding of the labour

process and techniques employed when this scenario arises can help us best protect both

fetus and mother. Ongoing efforts to recognize, avoid, and ameliorate significant injury are

a daily challenge to providers of intrapartum obstetric care, especially in the face of

challenging deliveries.8

4

NEED FOR STUDY

“Constant attention by a good nurse may be just as important as a major operation

by a surgeon” – Dag Hammarskjold.2

As per Gloria Lemay- “Attending births is like growing roses. You have to marvel at the

ones that just open up and bloom at the first kiss of the sun but you would not dream of

pulling open the petals of, the tightly closed buds and forcing them to blossom to your time

line”.9 Unfortunately In most of the developing world, child birth is a dance with death for

both mother and baby, even though 70% of those deaths could be prevented. The secret is

really knowledge, says by Anne Tinker.10 This reveals the necessity of proper knowledge and

awareness regarding shoulder dystocia in the order of preference, identification of risk

factors, prevention, management and prevention of further complication.

Shoulder dystocia is an obstetric emergency requiring skillful intervention from all delivery

personnel. The good news is there are several techniques clinicians can utilize when this

condition arises—and even ways to spot it prior to delivery. A thorough knowledge of these

approaches, coupled with expert support from a staff of skillful, proficient assistants, can help

reduce the frequency and severity of this challenging disorder.

The incidence of shoulder dystocia has reportedly increased over the past few

decades; the reasons for this being linked to fetal weight, occurring in 0.6% to 1.4% of births

where the infant weighed between 2500 g to 4000 g. In infants with a birth weight of 4000 g

to 4500 g the rate of shoulder dystocia increases to 5% to 9%. Shoulder dystocia occurs with

equal frequency in primigravid and multigravid women, although it is more common in

infants born to women with diabetes. The single most common risk factor for shoulder

dystocia is the use of a vaccum extractor or forceps during delivery. A prior birth

complicated by shoulder dystocia has been identified as a risk factor in some2 studies. For

instance, reported recurrent shoulder dystocia in five out of 42 women (12%) who had

previously had births complicated by shoulder dystocia.6

Below graph shows the incident rate of shoulder dystocia regarding foetal weight.

5

Risks of Shoulder Dystocia Studied, A 10-year case record review was done of all

instances of shoulder dystocia in the department of obstetrics and gynaecology of Dalhousie

University, Halifax, Nova Scotia. There were 254 cases of shoulder dystocia in 40,518

vaginal cephalic deliveries, a rate of 0.6 percent. In these cases, brachial plexus palsy

occurred 33 times (13 percent), and there were 13 fractures (5.1 percent). There were no

perinatal deaths attributable to shoulder dystocia. The risk was increased with prolonged

pregnancy (threefold), prolonged second stage of labour (threefold), mid-forceps delivery

(tenfold) and increasing birth weight. Of the maneuvers used to deal with shoulder dystocia,

strong downward traction on the head was significantly correlated with brachial plexus palsy

compared with other individual methods of delivering the shoulders. The use of hands and

knees position was not assessed. -Obstetrics and Gynaecology, July 199511

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Complications of shoulder dystocia

The above bar- diagram which describes that

Shoulder dystocia is associated with a high risk of physical and psychological complications

for the mother and neonate. Common maternal complications include uterine rupture,

postpartum haemorrhage (11%) and soft tissue damage to the cervix and vagina (3.8%).

Psychologically, mothers may experience postnatal depression, post-traumatic stress

syndrome. In addition, recto vaginal fistula, symphyseal separation of diathesis, with or

without transient femoral neuropathy and uterine rupture are the main complications.

Furthermore the most common foetal complications are brachial plexus palsies,

occurring in 4 to 15 percent of infants. These rates remain constant, independent of operator

experience. Nearly all palsies resolve within six to 12 months, with fewer than 10 percent

resulting in permanent injury.

Although attempts to correctly predict cases of shoulder dystocia have had limited

success, several risk factors are associated with an increased rate of its occurrence. Higher

birth weight is the common denominator connecting most current reports on maternal and

foetal risk factors for shoulder dystocia. The related maternal risk factors include diabetes,

obesity and multiparity. Keller 1991 identified shoulder dystocia in 7% of pregnancies

7

complicated by gestational diabetes. It is important to note that diabetic women diagnosed

with a macrosomic infant are more prone to get shoulder dystocia.

New research by multiple investigators has confirmed a linkage between maternal

size, foetal weight and shoulder dystocia. Based on this association, Dr. Hamilton in

Montreal, has developed a shoulder dystocia risk prediction tool (the CALM Shoulder

ScreenTM, patent pending) that is able to predict more than half of those women who will

encounter this complication. This methodology promises to change the current consensus of

obstetrical opinion about the predictability of shoulder dystocia and to change the way

obstetricians seek to prevent its occurrence and the complications that arise from it.7

Recognizing a shoulder dystocia and implementing proper interventions and timely

delivery are the goals of the medical team in emergencies such as shoulder dystocia.

Communication among the birth attendant, the nursing team and the parents is of utmost

importance. Accurate knowledge of the skills and interventions that can be used in resolving

shoulder dystocia along with skilful hands-on techniques is essential in obtaining the best

outcome for both mother and infant.11

Moreover, from these discussed aspects, it showed there was a need to clearly

define shoulder dystocia along with its degrees of severity and associated

interventions. Further more, it revealed "In the majority of cases shoulder dystocia can be

anticipated. Risk factors include maternal obesity, diabetes, preeclampsia, prolonged

gestation, and foetal macrosomia. A male infant is at a greater risk for macrosomia and

dystocia. The conceptual frameworks guiding this inquiry are biophysics of normal birth and

the pathophysiology of shoulder dystocia. This inquiry will develop an evidence-based

clinical practice guideline for diagnosis and treatment of shoulder dystocia.

To put it in a nut shell, it explicit the relevance of study to develop strategies for

managing women at increased risk of shoulder dystocia.

Moreover, owing to the investigator’s past experiences regarding shoulder dystocia

management, felt the need to disseminate the knowledge regarding shoulder dystocia

management to Third year GNM students as it will help them to manage various obstetrical

8

emergencies cases in general hospital setting. This will in the better professional outcome in

the quality of care given to the obstetrical patients in general hospital by the nurses.

9

6.2 REVIEW OF LITERATURE:

The purpose of review of literature is to obtain comprehensive knowledge base and in depth

of information from previous studies.

Review of literature is a key step in research process. Review of literature refers to an

extensive, exhaustive and systematic examination of publications relevant to the research

product.

The review of literature is defined as a broad comprehensive in depth; systematic and

critical view scholarly publications, unpublished scholarly print materials, audio visual

materials and personal communications.

The major goal of the review of literature is to develop a strong knowledge base to

carryout research.12

The related literatures are present in the following sub heading:

1. Studies related to shoulder dystocia.

2. Studies related to assessment of knowledge regarding risk factors, prevention and

management of shoulder dystocia.

3. Studies related to structured teaching program.

STUDIES RELATED TO SHOULDER DYSTOCIA

Shoulder dystocia is a serious obstetrical emergency and it requires early recognition

and prompt involvement of appropriately trained personnel to deliver the baby safely

and without delay. Therefore identifying the incidence and risk factors is very

important. This was supported by a study conducted by Rahman J and Bhattee G in a

teaching hospital. The objective of this study was to determine incidence and

maternal, obstetric, and fetal risk factors. Finally, in this study revealed that among

32,312singleton vaginal deliveries, 104 cases of shoulder dystocia were recorded.

Several reported high-risk factors related to increased incidence of shoulder dystocia

reported were confirmed by the study, although 26% of the neonates with shoulder

dystocia weighed < 4,000 g, neonatal brachial plexus injury occurred in 20%, clavicle

and humerus fracture in 10.6% and neonate asphyxiation in 8.6%.13

10

The risk of a woman having a repeat shoulder dystocia once having had one, as

reported from various authors, is: Ginsburg (2001) 11%, Smith (1994) 12% and

Gherman (2002) 11.9%. This was supported by a study conducted by Bingham J,

Chauhan SP. The objective of this study was to assess the incidence of recurrent

shoulder dystocia and the incidence of brachial plexus injury. A search of PubMed

was conducted between 1980 and March 2009. Odds ratios (OR) and 95% confidence

intervals (CI) were calculated. This study reveals the fact that the rate of shoulder

dystocia in the prior pregnancies and recurrent shoulder dystocia was 1.64%

(31,311/1,911,014) and 12% (OR, 8.25; 95% CI, 7.77, 8.76) respectively. In

addition, brachial plexus injury also occurred significantly more often during

recurrent shoulder dystocia than during the first shoulder dystocia (4% vs. 1%; OR,

3.59; 95% CI, 2.44, 5.29; or 45/1000 vs.13/1000 births).14

Accurate knowledge of the skills and interventions that can be used in resolving

shoulder dystocia along with skillful hands-on techniques is essential in obtaining the

best outcome for both mother and infant. So it is necessary to identify the risk factors

and preventive measures. This was supported by a study conducted by Aust N Z J

Obstet Gynaecol. The samples were women delivered vaginally at Jordan University

Hospital. This study concluded that multiparous, obese patient, over 42 weeks'

gestation in a pregnancy complicated by preeclampsia or diabetes with an infant

weighing 4,500 g or more. Neonatal complications were noted to be high.15

Most of the obstetrical literature still indicates that, in the majority of cases shoulder

dystocia can be anticipated by identifying risk factors include maternal obesity,

diabetes, preeclampsia, prolonged gestation, and fetal macrosomia. A male infant is at

a greater risk for macrosomia and dystocia." This was supported by a clinical study of

56 cases conducted by al-Najashi S, al-Suleiman SA in OBG department of King

Faisal University, Dammam. A retrospective analysis of 17,127 singleton vaginal

deliveries revealed an incidence of 0.3%. Although an increasing incidence of

shoulder dystocia was noted as the infant birth-weight increased, 41% of shoulder

dystocia occurred in infants of average birth-weight (2,500-3,999g). In the present

series shoulder dystocia occurred in 2.7% of all infants weighing 4,000 g or more.

Diabetic women experienced shoulder dystocia more often than non-diabetics. In the

diabetics 15.7% of neonates of birth-weight 4,000 g and above sustained shoulder

11

dystocia compared to 1.6% in the non diabetic patients. Immediate neonatal injury

was apparent in 43% of infants with shoulder dystocia. The perinatal mortality rate in

the series was 54/1,000 deliveries16

Shoulder dystocia is one of the most dreadful complications of vaginal deliveries.

This fact supported by a ten-year descriptive study in a level-III maternity unit,

hospital Nord which reveals the risk factors and complications of shoulder dystocia

has conducted by Gynecol Obstet Fertil. Sixty-six cases of shoulder dystocia

occurring between January 1998 and August 2008 in our university hospital were

identified. Finally, this study summarize that the incidence of shoulder dystocia was

0.3%. Multiparity, weight gain greater than 12 kg, and post-term delivery were more

present in our study group. McRoberts' maneuver and symphyseal pressure were first

realized. Brachial plexus injuries affected 9% of neonates with skeletal fractures in

7.5% of cases. Maternal morbidity was evaluated at about 8%. Twenty per cent had a

recurrent shoulder dystocia. From these results, it reveals that Shoulder dystocia is an

obstetric emergency which requires a prompt management of trained personnel.17

STUDIES RELATED TO ASSESSMENT OF KNOWLEDGE REGARDING RISK

FACTORS, PREVENTION AND MANAGEMENT OF SHOULDER DYSTOCIA.

Shoulder dystocia represents an obstetric emergency. So prompt knowledge regarding

recognition and skill full intervention of shoulder dystocia is necessary. This was

supported by a study conducted by Gherman RB, Chauhan S in Prince George’s

Hospital Centre, USA. The main objective of this study was to evaluate and impart

knowledge regarding shoulder dystocia. Moreover, this study sought to answer the

following questions: (1) is shoulder dystocia predictable? (2) Can shoulder dystocia

be prevented? (3) When shoulder dystocia does occur, what manoeuvers should be

performed? (4) What are the sequelae of shoulder dystocia? Electronic databases,

including PUBMED and the Cochrane Database, were searched using the key word

"shoulder dystocia." This shows that there are a significantly increased risk factors,

12

complications and incidence rate. Finally, this study depicts the understanding of the

detailed aspects of shoulder dystocia prevention and management.18

Proper knowledge regarding obstetrical emergencies will help the health care

professionals to manage the emergency situation safely and without delay. This was

supported by a study conducted by Neill AM, Sriemevan A in which, a questionnaire

was completed by 166 midwives and obstetric junior doctors to assess their

knowledge of the management of shoulder dystocia and to establish whether

mandatory teaching and updating is required. Ninety-six participants (58%) claimed

they were confident in the management of shoulder dystocia. However, only six (4%)

respondents gained full marks on the scoring system devised to assess their

knowledge. Furthermore 36 (22%) of those surveyed suggested rotation of the

shoulders to the anterior-posterior position to alleviate the dystocia and 32 (19%)

proposed pulling the head hard. Although there are limitations in assessing

competence by the use of a questionnaire, the results of this survey suggest that there

is considerable room for improvement19

Prevention of shoulder dystocia is a dilemma for health care professionals. So proper

knowledge regarding risk factors will help them to manage properly. This was

supported by a study conducted by Koregol MC, Bellad MB in Dr BR Ambedkar

Medical College, at Bangalore, Karnataka State in India. The sample was a 30-year-

old Indian woman of Asian origin, sixth gravid. There were no ultrasound

examinations as well as she had not received regular antenatal care also. The study

found out that the head of her baby was already outside the vulva but the remaining

parts of the baby were not yet delivered. Further examination was carried out and a

diagnosis of shoulder dystocia was confirmed. A stillborn baby boy of 3.5 kg was

delivered using McRoberts' maneuver. This study revealed that prenatal diagnosis by

ultrasound examination might help in detecting obstetrical emergency and preventing

complications associated with this condition.20

13

STUDY RELATED TO STRUCTURED TEACHING PROGRAM

* Teaching programmes are very useful to the health workers to recognize and manage the

obstetrical emergencies effectively. This was supported by a study conducted by Crofts JF,

Bartlett C in which they conducted a 40-minute workshop on shoulder dystocia management

for midwives and health care professional. A total of 122 participants were recruited. One

hundred eighteen were evaluated 3 weeks post training, for whom follow-up was available

for 95 (81%) at 6 months and 82 (70%) at 12 months. Before training, 60 of 122 (49%)

achieved delivery, 97 of 118 (82%) were able to deliver after initial training, 80 of 95 (84%)

were able to deliver at 6 months, and 75 of 82 (85%) were able to deliver at 12 months.

Twenty-one (18%) who could not deliver 3 weeks after training were offered additional

training; of these, 11 of 14 (79%) achieved delivery at 12 months. Those who were proficient

before initial training performed best at follow-up, but skill retention was also good in those

who learned to deliver during initial training. Eighteen percent could not deliver after initial

training and required additional individualized tuition; the large majority retained their newly

acquired skills at 6 and 12 months. Overall, training resulted in a sustained improvement in

performance.21

* Obstetrics is a high risk speciality, in which emergencies are to some extent, inevitable.

Training staff to manage these emergencies by various teaching method is very effective.

This was supported by a study conducted by Birch L, Jones N A at District General Hospital,

UK. The main objective was to determine the most effective method of delivering training to

staff on the management of an obstetric emergency. Thirty-six staff, comprising of junior and

senior medical and midwifery staff were included as research subjects. Each of the staff

members were put into one of six multi-professional teams. Effectively, this gave six teams,

each comprising of six members. Each team of staff were randomly allocated to undertake a

full day of training in the management of obstetrical emergencies utilising one of these three

teaching methods. Team knowledge and performance were assessed pre-training, post

training and at three months later. In addition to this assessment of knowledge and

performance, qualitative semi-structured interviews were carried out with 50% of the original

cohort one year after the training, to explore anxiety, confidence, communication, knowledge

14

retention, enjoyment and transferable skills. After analysing the results, all team shows a

marked improvement in their performance and knowledge.22

STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of structured teaching program on knowledge

regarding management of shoulder dystocia among Third year GNM students in selected

nursing schools at Tumkur.

6.3 OBJECTIVES OF THE STUDY

1. To assess the existing knowledge of third year GNM students regarding the knowledge

of shoulder dystocia.

2. To develop and implement structured teaching programme on shoulder dystocia among

Third year GNM students.

3. To compare the significant differences between pre test & post test knowledge score.

4. To determine the association between the post test knowledge score and demographic

variables

6.4 OPERATIONAL DEFINITIONS:

EVALUATE: It refers to determine the knowledge gained regarding management of

shoulder dystocia after the structured teaching program.

EFFECTIVENESS: It refers to the extent to which the structured teaching program

on the shoulder dystocia achieves desired effect in improving the knowledge of third

year GNM students as evident from the gain in knowledge scores.

STRUCTURED TEACHING PROGRAMME: It refers to the systematically

developed instructional method & teaching aids designed for the third year GNM

students to provide information of shoulder dystocia.

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KNOWLEDGE: It refers to the correct response of the students to the knowledge

items on shoulder dystocia as achieved by the knowledge scores.

Shoulder dystocia: “It is the arrest of normal labour after delivery of the head

because of the difficulty of anterior shoulder of the infant to pass below the symphysis

pubis”.

GNM students: Those students who are studying general and midwife course in

particular recognized institutions.

6.5 RESEARCH HYPOTHESES:

H1: There will be a significant increase in the mean post test knowledge score on

prevention, risk factors and management aspect of shoulder dystocia after the

administration of structured teaching program than the level of pre test knowledge.

H2: There is a significant association between the selected demographic variables and

the post test knowledge score.

6.6 ASSUMPTIONS:

The tool which is prepared by the researcher will be adequate to measure the level of

knowledge of the Third year GNM students and the effectiveness of structured teaching

program about shoulder dystocia.

The Third year GNM students may not have adequate knowledge regarding

management of shoulder dystocia.

Structured teaching program for Third year GNM students is an effective means to

reduce the complication of shoulder dystocia.

6.7 DELIMITATIONS OF THE STUDY:

The study is delimited to the Third year GNM students in selected nursing schools at

Tumkur.

Assessment of the knowledge of the Third year GNM students will be done through

written responses as elicited by structured questionnaire; hence the knowledge

displayed might not be comprehensive.

6.8. PILOT STUDY:

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The pilot study will be conducted on 10 students.

The purpose of conducting the pilot study is to-

Find out feasibility of conducting the final study.

Determine the method of data analysis.

Assess the practicability of carrying out main study.

6.9. VARIABLES:

Variables are an attribute of a person or objects that varies, that take on different

values.

Independent variable - Structured teaching program regarding shoulder dystocia.

Dependant variable - Knowledge regarding shoulder dystocia.

Demographic variable - Age, sex, occupation, dietary pattern and personal habits.

7 MATERIALS AND METHODS

7.1 SOURCE OF DATA COLLECTION:

The data will be collected from Third year GNM students in selected nursing schools at

Tumkur.

7.1.1 RESEARCH DESIGN:

One group pre test post test design will be adopted to assess the knowledge regarding

shoulder dystocia.

7.1.3 RESEARCH APPROACH :

Evaluative approach will be designed to assess the effectiveness of Structured

Teaching Program among Third year GNM internship students in order to accomplish

the objectives of the study.

7.1.2 RESEARCH SETTINGS:

Study will be conducted in Third year GNM students of selected nursing schools at Tumkur.

7.1.4 POPULATION

The target population of the present study includes Third year GNM students.

17

The accessible population of the present study includes Third year GNM students in selected

nursing schools in Tumkur.

7.2. METHOD OF DATA COLLECTION:

The data collection procedure will be carried out for a period of one month. The study will

be initiated only after obtaining permission from concerned authorities.

The data will be collected from Third year GNM students on the first day by using structured

questionnaire to assess the pre existing knowledge regarding shoulder dystocia. On the same

day, the researcher will provide structured teaching programme to the students using AV

aids. On the seventh day post test is conducted to assess the knowledge regarding shoulder

dystocia by using same structured questionnaire to assess the improvement in the knowledge.

7.2.1. SAMPLING TECHNIQUE

In this study non-probability convenient sampling technique will be used to select the

samples.

7.2.2. SAMPLE SIZE:

Sample size for the study will be 100 Third year GNM students in selected schools of

nursing at Tumkur.

SAMPLING CRIETERIA

7.2.3 INCLUSION CRITERIA:

Third year GNM students in selected schools of nursing.

Students who are willing to participate in the study.

Students who are available at the time of data collection.

7.2.4 EXCLUSION CRIETERIA:

Study is excluded for BSc nursing students.

Students who are not available and sick during the time of data collection.

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7.2.5. TOOLS FOR DATA COLLECTION:

The structured questionnaire is used to collect the data from the students. Content

validity will be established by requesting the experts to go through the developed tool and

give their valuable suggestions

The questionnaire format contains questions of the following section.

SECTION-A: questions that are included to collect demographic data.

SECTION-B: questionnaire that is formulated to assess the knowledge related to shoulder

dystocia.

7.2.6. DATA ANALYSIS METHOD:

The data obtained will be analyzed in terms of the objectives of the study by using

descriptive and inferential statistics.

DECRIPTIVE STATISTICS :

Mean percentage and standard deviation will be used for assessing the level of

knowledge regarding shoulder dystocia.

INFERENTIAL STATISTICS:

“Paired t-test” will be used to compare the pre-test and post-test knowledge of the

students regarding shoulder dystocia.

“Chi-square test” will be used to find out the association between the pre-test

knowledge and the selected demographic variables.

7.2.7. TIME AND DURATION:

The time and duration of the study will be limited to 6 weeks or as per guidelines

of university.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON STUDENTS OR OTHER

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HUMAN OR ANIMALS?IF SO PLEASE DESCRIBE BRIEFLY.

Yes. Structured teaching program will be conducted as an intervention to the

students.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM INSTITUTION?

The pilot study and the main study will be conducted after the approval of the

research committee. Permission will be obtained from the concerned head of the

institution. The purpose and details of the study will be explained to the study

subjects and an informed consent will be obtained from them. Assurance will be

given to the study subjects regarding the confidentiality and anonymity of the

data collected from them.

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LIST OF REFERANCES

1. Annamma Jacob, a comprehensive text book of midwifery, 2nd edition, Jaypee brothers’

medical publishers (P) Ltd, 2003.

2. Quotations on childbirth, Available from URL:http://www.best quotes.poems.com.

3. Myles, text book for midwives, 15th edition, Churchil Livingstone Elsevier, 2009.

4. Tara Pingle, shoulder dystocia. Available from URL: http:Ezine Articles.com.

5. Available from URL: W. http://en.wikipedia/org wiki/shoulder dystocia.

6. Elizabeth G. Baxley, Robert w. Gobbo, American family physician. Available from

URL:http://www.aafp.org/afp/2004/0401/p1707/.httr.

7. Dr: Henry Learner, shoulder dystocia. Available from

URL:http://shoulderdystociainfo.com.

8. Martin Gimovsky, Gregory Michael, Delivery dilemmas – shoulder dystocia. Available

from URL:http://WWW.jf ponline.com.

9. Inspirational child birth quotes, Available from

URL:Birth-http://WWW.bestquotes.poems.com.

10. “Quotations on child birth. Available from URL:http://WWW.qutesea.com/quote/im

11. Barbara Camune, Mary c. Brucker, An overview of shoulder dystocia. Available from

URL:http://ps.mcic.com.

12. Basavanthappa B T .Nursing Research .1st edition; Jaypee Brothers publishers, p. 49-50

13. Rahman J, Bhattee G, Rahman MS. (2009), Shoulder dystocia in a 16-year experience in

a teaching hospital. Available from URL:http:www.ncbi.nlm.nib.gov/pubmed:19639928

14. Bingham J, Chauhan SP (2010), recurrent shoulder dystocia. Available from

URL:http:www.ncbi.nlm.nib.gov/pubmed:20214833

15. Aust N Z J Obstet Gynaecol. (1988), Shoulder dystocia: risk factors and prevention.

Available from URL:http:www.ncbi.nlm.nib.gov/pubmed:3228402

16. Al-Najashi S, al-Suleiman SA. (1989), Shoulder dystocia-a clinical study of 56 cases.

Available from URL:http:www.ncbi.nlm.nib.gov/pubmed:2803124.

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17. Gynecol Obstet Fertil. (2009), Shoulder dystocia: a ten-year descriptive study in a level-

III maternity unit. Available from URL:http:www.ncbi.nlm.nib.gov/pubmed:19375371

18. Gherman RB, Chauhan S.(2006), Shoulder dystocia: the unpreventable obstetric

emergency with empiric management guidelines. Available from

URL:http:www.ncbi.nlm.nib.gov/pubmed:16949396

19. Neill AM, Sriemevan A. (1999), Shoulder dystocia: room for improvement? Available

from URL:http:www.ncbi.nlm.nib.gov/pubmed:155122 51.

20. Crofts JF, Bartlett C. (2007), Management of shoulder dystocia. Available from

URL:http:www.ncbi.nlm.nib.gov/pubmed:17978121.

21. Koregol MC , Bellad MB. Shoulder dystocia leading to an obstetric catastrophe. Available

from URL:http:www.ncbi.nlm.nib.gov/pubmed:20507601.

22. Birch L, Jones N A. (2007), Obstetric skills drills: evaluation of teaching methods.

Available from URL:http:www.ncbi.nlm.nib.gov/pubmed:17376563

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9.SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11.11.1 NAME AND DESIGNATION OF GUIDE

11.2 SIGNATURE

11.3 CO-GUIDES

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12.12.1 REMARKS OF THE CHAIRMAN AND THE PRINCIPAL

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12.2 SIGNATURE

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