International Journal of Scientific and Research Publications, Volume 6, Issue 11, November 2016 605

ISSN 2250-3153

Effectiveness of Educational Program on Nurses'

Knowledge RegardingPartographin Al-Najaf City
ZainabNeamatJumaah Al-Taee, M.Sc.*, Kafi Mohammed Nasir Al-Asadi, Ph.D. **
*
M.Sc.Maternal and Newborn Health Nursing, Faculty of Nursing, University of Kufa.
**
Assistant Professor, Community Nursing Branch / MCH, Faculty of Nursing, University of Kufa.

Abstract- Objective:this study aimedtoevaluating the nurse’s 2015from preventable causes related to pregnancy and childbirth.
knowledge regarding partographand to determine the (2).Obstructed labor remains not only the important cause of
effectiveness of nursing educational program by comparing the maternal death but also short- and long-term disability.
pre-test and post-test score on nurse's knowledge regarding Obstructed labor comprises one of the five major causes
partograph.Methodology: A quasi-experimental (pre and post- (obstructed labor, postpartum, hemorrhage, puerperal sepsis,
test) study had been used through the present study with eclampsia, and abortion) of maternal morbidity and mortality in
application of pre and post-test approach for both studied and developing countries.(3,4).Initial detection of unusual progress of
controlled groups during the period fromNovember1st, 2015 to labor and the avoidance of prolonged labor would considerably
July1st, 2016.In this study the target population was consisted of reduce the risk of postnatal hemorrhage, sepsis, reduce
all nurses who working in delivery room ofAl-Zahra Maternity obstructed labor, uterine rupture and its squeal. A partograph is a
and Pediatric Teaching Hospital and Al-Furat Al-Awsat detailed record of development of labor and noticeable
Hospitalat Al Najaf city.Purposive sample was selected which conditions for mothers and fetus(5).The first graphic assessment
consist of (80) nurses. The sample is divided in to two groups; of progress of labor was designed by Friedman in 1954 and
(40) nurses as a study group are exposed to the nursing education further improved by Philpott and Castle in1972(6).Rapid increase
program, and the other (40) nurses are not exposed to the in rate of cesarean births without evidence of associated
program considered as the control group. The measurement decreases in maternal or neonatal morbidity or mortality raises
effectiveness of the educational program through the knowledge noteworthy concern that cesarean delivery is overworked. uterine
assessment includes (56) items. Data was analyzed by rupture, anesthetic problems, shock, cardiac arrest, acute renal
usingdescriptive data analysis and inferentialdata failure, mechanical ventilation, venous thromboembolism, major
analysis.Results: the results show that the educational program infection, or nosocomial wound infection or hematoma have
was effective on nurses' knowledge regarding partograph. It also increased threefold for cesarean delivery as compared with
shows that there is good improvement with highly significant vaginal delivery(7,8,9).Partograph is a useful graphical record of
differences in study group between pre and post-test, in overall labor course for optimum results in labor management. Its
items.Conclusion:The study concludes that partograph usefulness and efficiency cut across developed and undeveloped
educational program is the effective and appropriate method to countries. Acquisition of knowledge of its use and guaranteeing
increase nurse’s knowledge. Recommendation: This study proper application of that knowledge would reach a peak in
recommends Asserting on Ministry Of Health to offer in service reduction of the incidence and outcomes of prolonged and
training programs for nurses and midwives in order to improve obstructed labor, related with 8%–10% of maternal mortality(10,
11).
their knowledge. Using partograph for labor management reveals to be
beneficial in distinguishing normal from abnormal progress in
Index Terms- effectiveness, educational program, Partograph, labor and recognizes women probably who are in need for
nurses, knowledge. intervention.A Modified WHO Partograph with a simple
management protocol improves childbirth outcome for mothers
and neonates prospectively(12).Partograph requires skill-nurse
I. INTRODUCTION plotting information regarding normal labor and childbirth,
performing Leopold’s maneuver to determine fetal descent and
M aternal deaths are preventable with access antenatal care in
pregnancy, skilled care during childbirth, and support in
the postnatal weeks after childbirth. Maternal health is closely
vaginal examination to define cervical dilation on a
graph(13).Nursing and midwifery services are a vital source for
related to newborn health, approximately 2.7 million newborn attaining well-being and developmental goals. They create the
babies die every year, and an additional 2.6 million are mainstay of health systems in any country and provide a policy
stillborn. Time management and treatment for all births are for supporting efforts to reduce illnesses that cause infirmity and
attended by skilled health professionals that make the difference disease. Iraq needs experienced health team of nurses &
between life and death for both mothers and the babies(1).WHO midwives who are able to convey quality care of nursing services
reported that of the estimated 211 million pregnancies occur each in a favorable well measured environment are crucial health
year, 46 million end with abortion. Maternal mortality due to services(8,14). Training nurses on partograph can help in
pregnancy complications is 830 women around the world every behavioral reinforcement and early decision making about
day and roughly 303 000 women will have died by the end of augmentation of childbirth, enabling practicing nurse-midwives
to identify approaching problems during management of labor in

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International Journal of Scientific and Research Publications, Volume 6, Issue 11, November 2016 606
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mother and fetus. Knowledge, and practice of nurses is important and duration of participation in partograph training sessions in
in improving labor results and to maintain mother’s condition in the hospital).
the labor ward and the delivery rooms(15).
II. Self-administered questionnaire sheet related to (nurses
knowledge regarding Partograph.
II. METHODOLOGY It was constructed to assess nurse's knowledge about
Design of the Study:A quasi-experimental (pre-post test) partograph in maternity units and labor rooms. The questionnaire
study had been used through the present study with application of sheet is also filled by the nurses, purpose of the study is
pre-post test approach for both studied and controlled group explained prior to get questionnaire sheet. The participants are
during the period of 1st November, 2015 to 1st July, requested to answer the questionnaire within 60 minutes.
2016.Purposive sample consist of (80) nurses. The sample is This knowledge test was composed of (53) multiple choice
divided in two groups; (40) nurses as study group are exposed to question. The test is covered with the relevant points from the
the nursing education program, and the other (40) nurses are not major content area of educational program. For the purpose of
exposed to the program considered as the control group. The two this study, the number of correct responses of the knowledge
groups have proximately the same demographic questionnaire is used as the measure of the level of knowledge.
characteristics.Those who met the criteria for selection were Each question is scored as the correct answer get (2) score and
nurses who were working at the maternity units and delivery the wrong answer get (1) score.
rooms.
The educational program is designed to provide the nurses Statistical Analysis
with information to partograph, Fetal condition, Membranes and Data was analyzed through the use of SPSS (Statistical
liquor, Fetal head molding and caput formation, Uterine Package for Social Science) version (19) application statistical
Contraction, Cervix dilation and effacement, Decent of fetal analysis system and Excel application. Data analyzed through the
head, The Alert and Action lines in partograph, Obstructed labor application of two statisticalapproaches. Adescriptive data
and labor dystocia, Oxytocin Administration, Fetal distress analysis includes a-Tables (Frequencies, Percentages, and Mean
during labor, Maternal condition, Recording and interpreting the of scores), b- Cutoff point (0.66), c- Statistical figure (Bar
progress of labor on partograph. Charts) and d- Pearson's Correlation Coefficients (Reliability),
The study instrument was constructed by the researcherin and Inferential Data Analysis includes a- Chi-Square, b- t-test
order to reached aims of the study. It is consists of (2) parts: independent sample between study and control group and finally
I. Self-administered questionnaire sheet related to c- t-test paired t-test between pre and post-test.
(demographic characteristic of the nurses).
This part is concerned with the collection of basic socio- Objective of the study:
demographic data, this part is filled by the nurses (age, level of This study aimed to assess the nurses' knowledge regarding
education, duration of nursing experiences at the hospitals, partograph and to determine the effect of nursing educational
duration of nursing experiences at the Maternity unit, number program by comparing the pre-test and post-test score on nurse's
knowledge regarding partograph.

III. RESULTS
Table (1): Statistical Distribution of the Study and Control Groups Demographic Data with Statistical Difference

Study Control
Sig Difference
Demographic Group Group
Rating and Intervals
Data T- P-
Freq. % Freq. % D.F.
Value Value
<= 27.00 9 22.5 6 15
28.00 - 35.00 14 35 16 40
36.00 - 43.00 8 20 6 15 0.14 0.889
Age / Years 58
44.00 - 51.00 6 15 8 20 Ns
52.00+ 3 7.5 4 10
Mean 35.5 34.6
Nursing college graduated 2 5 0 0
Institute graduated / Nursing
7 17.5 12 30
Levels of Department 0.669
0.43 58
Education Nursing & Midwifery Ns
27 67.5 26 65
Secondary school graduated
Other 4 10 2 5
Years of 1-5 4 10 2 5 0.557
0.591 58
Experience 6.00 - 10.00 22 55 22 55 Ns

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11.00 - 15.00 7 17.5 2 5

16.00 - 20.00 4 10 2 5
21.00 - 25.00 2 5 10 25
26.00+ 1 2.5 0 0
Mean 9.42 9.9
1-5 29 72.5 22 55
6.00 - 10.00 3 7.5 6 15
Years of 11.00 - 15.00 3 7.5 6 15
38 0.584
experience in 16.00 - 20.00 1 2.5 4 10 0.551
Ns
maternity units 21.00 - 25.00 1 2.5 0 0
26.00+ 3 7.5 2 5
Mean 7.22 7.25
Participation in Yes 19 47.5 0.18
a training 58 0.858
No 21 52.5
sessions
No participation 21 52.5 20 50
Number of 0.839
1 12 30 12 30 0.205 58
training sessions Ns
2 5 12.5 6 15
3 2 5 2 5
No participation 21 52.5 20 50
0.791
Duration of 1 10 25 14 35 0.266 58
NS
training sessions 2 4 10 2 5
3 5 12.5 4 10
0.856
Use of Yes 17 42.5 16 40 0.182 58
NS
Partograph No 23 57.5 24 60

Sig: Significant; No.: Number %: percentage; Freq.: Frequency; Ns: Non-significant P Value: probability value; Df: degree of
freedom;T value: t-test

This table shows that the mean of study sample age is (35.5 study results indicate that the mean of years of experience in
years) at the study group and (34.6 years) at the control group. maternity units is (7.2 years) at both study and control groups.
Regarding the level of education in both study and control groups Furthermore, the study results indicate that (57.5% and 60%) of
the highest percentage of participants were nursing and the nurses at study and control groups respectively had never
midwifery secondary graduates (67.5% and 32.5%) respectively. used a Partograph form before. Finally in this table, the study
Concerning year of employment, the study results indicate that results indicate that there is a non-significant difference between
the mean of the nurses’ years of experience is (9.4 and 9.9 years) the study and control group demographic data at p-value more
at the study and control groups respectively. In addition, the than 0.05.

Table (2): Distribution of the Study group by their Responses to Pre-Test and Post-Test Items

Pre-Test Post - Test

List Items
M.s. Assess M.s. Assess
Partograph is a valuable tool to help nurse to detect the unusual progress
1 1.575 Good 1.95 Good
in birth
Partograph has been designed to record information on fetus health
2 1.4 Poor 2 Good
condition, birth progress And mother health status
Partograph helps the nurse to identify and avoid prolonged birth and
3 1.575 Good 1.95 Good
dystocia, fetal distress and maternal bleeding and infection
The most appropriate definition of the Partograph is an official record
4 composite of key data of the mother and fetus health condition during 1.65 Good 1.95 Good
labor that recorded in especial intervals on one page of sheet
In the identification sections of the Partograph ,Gravida stand for number
5 1.425 Poor 1.975 Good
of the previous pregnancies
Multipara is a medical term for woman who has given birth more than
6 1.8 Good 1.85 Good
once to live babies
7 gestational age should be recorded in the identification section of 1.275 Poor 1.875 Good

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Partograph
8 fetal heart rate is Recorded at first and then every30 minutes 1.55 Good 2 Good
9 Partograph covers fetal heart rate in the range of 60-190 beats per minute 1.525 Good 2 Good
The normal heart rate for the term fetus with gestational age of 37 weeks
10 1.7 Good 1.875 Good
and more is 120-160 beats / minute
The reasons for the fatal heart rate deviation is placental aging or
11 damage, decreased blood volume in pregnant woman and 1.6 Good 1.85 Good
oligohydramnios
Fetal Heart rate less than 120 and more than 160 beats / min indicate
12 1.6 Good 1.925 Good
fetus distress
When the nurse detects any abnormalities in the fetal heart rate, Should
13 repeat counting and if the condition persists for more than 10 minutes 1.125 Poor 1.95 Good
must report to medical staff
Fetal heart rate deviation is immediate indicator on fetus distress during
14 1.25 Poor 1.7 Good
childbirth
Liquor is the term for amniotic fluid that surrounds the fetus in
15 1.5 Good 1.875 Good
Partograph
Amniotic fluid color must be recorded at least every 4 hours in
16 1.175 Poor 1.9 Good
Partograph
Stained liquor accompanied with fetal heart rate deviation is an indicator
17 1.55 Good 1.975 Good
to fetus distress
If amniotic sack is ruptured but amniotic fluid not comes out "A"
18 1.65 Good 1.8 Good
(Absent) should record on Partograph
19 The extent of overlapping of fetal skull bones is Definition of molding 1.7 Good 1.925 Good
Nurse should identify and record the molding degree on the Partograph
20 By palpating the suture lines and fontanels of the fetal head during a 1.55 Good 2 Good
vaginal examination
+4 Bones are overlapping and fused completely is not within the
21 1.275 Poor 1.925 Good
Moulding degrees recorded on Partograph
The molding degree +3 with the very slow progress in the birth, refers to
22 blockage or disproportion between the fetus head and the mother pelvis, 1.7 Good 1.775 Good
which leads to dystocia
23 Nurse must assess the degree of Moulding at first and then every 2 hours 1.175 Poor 1.8 Good
Caput is the swelling on one side of the newborn’s head due to blood or
24 other fluid accumulation in the skin where pressing on the cervix during 1.825 Good 1.925 Good
labor
25 Caput or swelling in the fetus head is normal if develops centrally 1.425 Poor 1.9 Good
Good and effective uterine contractions necessary for the progress of
26 1.425 Poor 1.8 Good
birth are Strong contractions and last for more than 40 seconds
Uterine contractions assessed by putting hand on the abdomen and feel
27 1.575 Good 1.95 Good
the contraction
In Partograph sheet, contractions recorded every 30 minutes and scaled
28 1.3 Poor 1.875 Good
from 1 to 5 squares, Each square represents a contraction
To stimulate effective uterine contractions physician may prescribe
29 1.8 Good 1.875 Good
oxytocin
During oxytocin administration, nurse should Note and record the
30 number, duration and severity of contractions on the Partograph every 1.275 Poor 1.85 Good
half hour
31 At the beginning of labor the cervix is thick and long 1.225 Poor 1.925 Good
32 Cervical Effacement is the softening and thinning of the cervix 1.55 Good 1.85 Good
33 The complete effacement known as100% effaced 1.375 Poor 1.95 Good
34 The measurement of cervical dilatation is from 0 to 10 cm 1.475 Poor 1.775 Good
35 cervical dilation is the result of uterine contractions 1.475 Poor 1.925 Good
36 Partograph recording begins at which labor stage first of labor 1.2 Poor 1.875 Poor
The nurse perform vaginal examination to assess Cervical dilation and
37 1.55 Good 1.875 Good
effacement, fetal membranes status and fetus molding and presentation
38 Active phase of labor begins when the cervical dilation is 4 cm and ends 1.675 Good 1.95 Good

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with 10 cm dilation
39 On the Partograph sheet, cervical dilation marked by (X) 1.6 Good 1.875 Good
If the normal childbirth progress, the recording cervical dilation remain
40 1.15 Poor 1.825 Good
on The Left of alarm line
Action line on the Partograph is Parallel to the alarm line and located 4
41 1.1 Poor 1.625 Good
hours to the right of the alert line
Nurse estimates the descent of the fetus head by measuring fetal head
42 1.575 Good 1.95 Good
station through vaginal examination
When the fetus head is in the same level as the ischial spine in the
43 1.325 Poor 2 Good
estimation called station zero
Negative number in the station such as -3 or-4 mean the fetal head is still
44 1.3 Poor 1.925 Good
‘floating’ and not yet engaged
If the fetus head is lower the birth canal than the ischial spines station is
45 1.275 Poor 1.875 Good
given a positive number
In +3 station the fetus head crowning, that means the presenting part of
46 1.3 Poor 1.9 Good
the baby’s head remains visible between contractions
47 To record the level of the fetal head descent, using the scale -3 to 3+ 1.325 Poor 1.825 Good
48 On Partograph sheet, fetal head descent is marked by (O) 1.525 Good 1.95 Good
49 The maternal health monitored by measuring vital signs 1.8 Good 2 Good
50 Pregnant temperature should be recorded every two hours 1.25 Poor 1.925 Good
51 Nurse must measure pregnant blood pressure every 4 hours 1.1 Poor 1.925 Good
52 Pulse are measured every 30 minutes and recorded as points 1.5 Good 1.875 Good
The amount of urine should be record each time when the pregnant
53 1.225 Poor 1.9 Good
urinating and analyzed for the presence of protein and acetone
Ms: Mean of score (1.5)

This table shows that most the study group have been poor educational program. Furthermore the residual (22%) of items
in (78%) of the items in pre-test, while they knowledge level which was good in pre-test shows progress in their mean of score
become (98%) of the items in post-test after exposed to in post-test.

Table (3): Statistical distribution of the study group by their overall responses with Significant Difference between Pre-Test
and Post-Test Scores

Overall assessment for Pre-test Post-test

study group Freq. % M.s. Assessment Freq. % M.s. Assessment
Good 8 22 1.44 39 98 1.89
Poor Good
Poor 32 78 1 2
t-value (20.843), d.f.( 39), p-value (0.001)HS

%: percentage; Freq.: Frequency HS: High significant; P Value: probability value; Df: degree of freedom T value: t-test

The results of this table shows that high Significant Difference between pre-test and post-test scores of study group members at
p-value (0.001).

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Mean of Study Group Responses in Both Pre-test and

Post-test
2.5

1.5

0.5

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

Pre-test Post-test

Figure (1): Assessment of study group knowledge in pre-test and post-test.

Table (4):Distribution of the Control Group by their Responses to the Pre-Test and Post-Test Items

Pre-Test Post - Test

List Items
M.s. Assess M.s. Assess
Partograph is a valuable tool to help nurse to detect the unusual progress in
1 1.55 Good 1.55 good
birth
Partograph has been designed to record information on fetus health
2 1.2 Poor 1.2 Poor
condition, birth progress And mother health status
Partograph helps the nurse to identify and avoid prolonged birth and
3 1.45 Poor 1.25 Poor
dystocia, fetal distress and maternal bleeding and infection
The most appropriate definition of the Partograph is an official record
4 composite of key data of the mother and fetus health condition during labor 1.4 Poor 1.45 Poor
that recorded in especial intervals on one page of sheet
In the identification sections of the Partograph ,Gravida stand for number of
5 1.3 Poor 1.4 Poor
the previous pregnancies
Multipara is a medical term for woman who has given birth more than once
6 1.45 Poor 1.45 Poor
to live babies
gestational age should be recorded in the identification section of
7 1.4 Poor 1.35 Poor
Partograph
8 fetal heart rate is Recorded at first and then every30 minutes 1.4 Poor 1.4 Poor
9 Partograph covers fetal heart rate in the range of 60-190 beats per minute 1.2 Poor 1.25 Poor
The normal heart rate for the term fetus with gestational age of 37 weeks
10 1.55 Good 1.4 Poor
and more is 120-160 beats / minute
The reasons for the fatal heart rate deviation is placental aging or damage,
11 1.35 Poor 1.35 Poor
decreased blood volume in pregnant woman and oligohydramnios
Fetal Heart rate less than 120 and more than 160 beats / min indicate fetus
12 1.6 Good 1.55 Good
distress
When the nurse detects any abnormalities in the fetal heart rate, Should
13 repeat counting and if the condition persists for more than 10 minutes must 1.15 Poor 1.05 Poor
report to medical staff
Fetal heart rate deviation is immediate indicator on fetus distress during
14 1.3 Poor 1.25 Poor
childbirth
15 Liquor is the term for amniotic fluid that surrounds the fetus in Partograph 1.4 Poor 1.4 Poor
16 Amniotic fluid color must be recorded at least every 4 hours in Partograph 1.1 Poor 1.05 Poor
Stained liquor accompanied with fetal heart rate deviation is an indicator to
17 1.45 Poor 1.55 Good
fetus distress
18 If amniotic sack is ruptured but amniotic fluid not comes out "A" (Absent) 1.3 Poor 1.35 Poor

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should record on Partograph

19 The extent of overlapping of fetal skull bones is Definition of molding 1.65 Good 1.5 Good
Nurse should identify and record the molding degree on the Partograph By
20 palpating the suture lines and fontanels of the fetal head during a vaginal 1.25 Poor 1.35 Poor
examination
+4 Bones are overlapping and fused completely is not within the Moulding
21 1.35 Poor 1.25 Poor
degrees recorded on Partograph
The molding degree +3 with the very slow progress in the birth, refers to
22 blockage or disproportion between the fetus head and the mother pelvis, 1.45 Poor 1.5 Good
which leads to dystocia
23 Nurse must assess the degree of Moulding at first and then every 2 hours 1.15 Poor 1.1 Poor
Caput is the swelling on one side of the newborn’s head due to blood or
24 other fluid accumulation in the skin where pressing on the cervix during 1.5 Good 1.65 Good
labor
25 Caput or swelling in the fetus head is normal if develops centrally 1.25 Poor 1.2 Poor
Good and effective uterine contractions necessary for the progress of birth
26 1.5 Good 1.45 Poor
are Strong contractions and last for more than 40 seconds
Uterine contractions assessed by putting hand on the abdomen and feel the
27 1.15 Poor 1.3 Poor
contraction
In Partograph sheet, contractions recorded every 30 minutes and scaled
28 1.25 Poor 1.15 Poor
from 1 to 5 squares, Each square represents a contraction
29 To stimulate effective uterine contractions physician may prescribe oxytocin 1.55 Good 1.65 Good
During oxytocin administration, nurse should Note and record the number,
30 1.2 Poor 1.15 Poor
duration and severity of contractions on the Partograph every half hour
31 At the beginning of labor the cervix is thick and long 1.25 Poor 1.2 Poor
32 Cervical Effacement is the softening and thinning of the cervix 1.35 Poor 1.25 Poor
33 The complete effacement known as100% effaced 1.15 Poor 1.2 Poor
34 The measurement of cervical dilatation is from 0 to 10 cm 1.25 Poor 1.15 Poor
35 cervical dilation is the result of uterine contractions 1.3 Poor 1.35 Poor
36 Partograph recording begins at which labor stage first of labor 1.25 Poor 1.2 Poor
The nurse perform vaginal examination to assess Cervical dilation and
37 1.25 Poor 1.25 Poor
effacement, fetal membranes status and fetus molding and presentation
Active phase of labor begins when the cervical dilation is 4 cm and ends
38 1.1 Poor 1.25 Poor
with 10 cm dilation
39 On the Partograph sheet, cervical dilation marked by (X) 1.45 Poor 1.45 Poor
If the normal childbirth progress, the recording cervical dilation remain on
40 1.15 Poor 1.1 Poor
The Left of alarm line
Action line on the Partograph is Parallel to the alarm line and located 4
41 1.3 Poor 1 Poor
hours to the right of the alert line
Nurse estimates the descent of the fetus head by measuring fetal head
42 1.25 Poor 1.3 Poor
station through vaginal examination
When the fetus head is in the same level as the ischial spine in the
43 1.3 Poor 1.2 Poor
estimation called station zero
Negative number in the station such as -3 or-4 mean the fetal head is still
44 1.3 Poor 1.15 Poor
‘floating’ and not yet engaged
If the fetus head is lower the birth canal than the ischial spines station is
45 1.25 Poor 1.15 Poor
given a positive number
In +3 station the fetus head crowning, that means the presenting part of the
46 1.15 Poor 1.25 Poor
baby’s head remains visible between contractions
47 To record the level of the fetal head descent, using the scale -3 to 3+ 1.3 Poor 1.1 Poor
48 On Partograph sheet, fetal head descent is marked by (O) 1.35 Poor 1.35 Poor
49 The maternal health monitored by measuring vital signs 1.5 Good 1.6 Good
50 Pregnant temperature should be recorded every two hours 1.2 Poor 1.2 Poor
51 Nurse must measure pregnant blood pressure every 4 hours 1.05 Poor 1.05 Poor
52 Pulse are measured every 30 minutes and recorded as points 1.2 Poor 1.15 Poor
The amount of urine should be record each time when the pregnant
53 1.1 Poor 1 Poor
urinating and analyzed for the presence of protein and acetone

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Ms: Mean of score (1.5)

This table shows that knowledge level of control group were unobservable progress in good items among control group
have been poor in (95%) of the items in pre-test, While in the post-test because they did not exposed to any intervention related
post-test the same group pass only (10%) of the items, and there to knowledge.

Table (5):Statistical distribution of the Control group by their overall responses with Significant Difference between Pre-Test
and Post-Test Scores

Overall assessment for Pre-test Post-test

control group Freq. % M.s. Assessment Freq. % M.s. Assessment
good 2 5 4 10
1.31 Poor 1.28 Poor
poor 38 95 36 90
t-value (0.56) ;d.f.(19) ;p-value (0.57) ;significance:NS
%: percentage; Freq.: Frequency; NS: non-significant; P Value: probability value;Df: degree offreedom T value: t-test; Ms:
Mean of score

The results of above table shows that no Significant Difference between Pre-Test and Post-Test Scores of control group members at p-
value (0.577).

Mean of Control Group Responses in Both Pre-test and

Post-test
2

1.5

0.5

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

Pre-test Post-test

Figure (2): Assessment of control group knowledge in pre and post-test.

Table (6):Significant Difference between Study and Control Groups regarding Pre-Test Scores

Study group Control group

Pre-test
Freq. % M.s. Assessment Freq. % M.s. Assessment
Good 8 22 2 5
1.44 Poor 1.31 Poor
Poor 32 78 38 95
t-value (0.676); d.f.( 58); p-value (0.502); significant: NS

%: percentage ; Freq.: Frequency; NS: non-significant; P Value: probability value; Df: degree of freedom T value: t-test;
Ms: Mean of score

Table (6) shows that there is no significant differences between study and control groups in pre-test at p-value (0.502) which
clearly indicated poor knowledge of both groups in pre-test.

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Table (7): Significant Difference between Study and Control Groups regarding Post-Test Scores

Study group Control group

Post-test
Freq. % M.s. Assessment Freq. % M.s. Assessment
Good 39 98 4 10
1.89 Good 1.28 Poor
Poor 1 2 36 90
t-value (14.607); d.f.( 58); p-value (0.001); significant: HS

%: percentage; Freq.: Frequency; HS: High significant; P Value: probability value;Df: degree of freedom T
value:t-test;Ms: Mean of score
knowledge with years of experience and attendance in maternity
The results of table (7) shows that a highly significant units(20).
difference found between the post-test of the study group About training sessions regarding partograph, the study
members at p-value (0.001) who were participated in the result reveals that the majority (52.5%, 60%) in the study and
educational program and the control group who did not exposed control groups respectively have no a chance to attend training
to any intervention related to knowledge. sessions or unable to participate the continuous teaching
programs. This result come along with Khomeiran andothers,
(2010) their study reveals that (48.0%) were able to participating
IV. DISCUSSION in training programs(21).
According to (Table 1) in the results, the study shows no Regarding use of partograph the study indicated that the
significant difference between both study and control groups majority of (57.5%) in the study and (60%) control groups had
regarding all demographic data.In regards to age, the majority of never used or applied Partograph before. This finding is
study and control groups were at age group of (28-35) years. Age consistent with that of Toppo (2010) and Lavender (2013) who
of nurses in this study is in agreement with other study done by stated that majority of the study subjects never used partograph
(22, 23)
Oladapo and others (2011) in Nigeria that studied the Knowledge during labor .
and utilization of partograph among healthcare providers at According to the results shows in tables 2; 3; 4 and 5. The
(16)
maternity centres. .besides that, the present results are similar present study indicated that the study sample knowledge was
to the conducted study Salama & Heeba, (2010) in Cairo who poor that less than fourth of study group had passed the pre-test,
found the majority of nurse’s age-group (28.5- 36.5) years was and 5% of control group had almost passed the pre-test. Many
(17)
(69.6%). . studies found that there is a non-significant difference between
Regarding the level of education, the majority of the study and control groups for pre-test related to nurses’
(20,23)
sample in both study and control groups the highest percentage knowledge at P>0.05 .Elbashir,et al., (2015) concluded in
of participants were nursing and midwifery secondary graduates their study they that there is a deficit in nurse’s knowledge and
(67.5% and 65%) respectively.Other studies are in consistent skills regarding partograph prior to participation in the
(24)
with this study which shows that the nursing and midwifery educational Training Program .In Toppo(2010)study
secondary school graduates with Diploma degree are the main mentioned that there were obvious difference between pretest
health care staffs in health facilities and with more educational and posttest as the study sample nurses answering questions
level more practical care can be delivered. Many previous studies showing that the mean percent in pretest was 34.3% and it
were in agreement with this result they found that the majority of became 92.5% in posttest which shows an increase about 58.2%
(22)
study subjects in maternity units were graduate from nursing and in most questions in posttest .
midwifery secondary school(12,18). In regards to the result in tables 3; 5; 6 and 7, these tables
Concerning years of experience, this study illustrates that shows that nurse's knowledge regarding partograph in the study
the majority (55%) in the study and control groups had been group has been improved after exposure to educational program.
working in maternity units between (1-5) years of nursing This was indicated by the significant difference between pre-test
experience.This result is in agreement with Clarke & others and post-test results, which was supported by another studywhich
(2012) who stated that the mean of experience level was less than reveals that there is a high significant difference between pre-
(20, 22, 23)
5 years among the employed nurses indicates mainstream of low posttest . In addition another study found that there is
average nurse’s experience in American hospitals but nurses recognized improvement in nurses' knowledge regarding
(19)
remain the largest human resources of health care providers . partograph after exposing the study sample to educational
Regarding to the years of experience in maternity units,the program. Moreover the study claimed that a significant increase
(16)
present study shows thatthe majority (72.5%, 55%) in the study in posttest score was recognized . In the present study the
and control groups had been working in maternity units between researcher confirm that nurses’ knowledge deficit in pretest in
(1-5) years of nursing experience.these findings are in the same both study and control groups regarding partograph might be due
line with the study conducted by Mohamed, Abd Elati and Zaki to less emphasize on nurses filling partograph sheet in maternity
in Egypt (2015), on Knowledge and attitude of maternity nurses units with inadequate participation in educational sessions. The
about partograph, they discoveredthat the mean of educational program regarding partograph associated with a
experience level was less than 5 years among the employed significant increasing knowledge of study group. This result was
nurses and there is a significant association between nurse’s in agreement with Jaber,(2014), who indicated that providing
partograph educationalsessions to nurses and midwives can be

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International Journal of Scientific and Research Publications, Volume 6, Issue 11, November 2016 614
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successful in increasing their knowledge(2). Therefore, the [8] Liu, S.; Liston, R.; Joseph, K.; Heaman, M.; Sauve, R.; Kramer, M.:
Maternal mortality and severe morbidity associated with low-risk planned
implemented educational program was effective and has an cesarean delivery versus planned vaginal delivery at term. Maternal Health
impact on nurse's knowledge about partograph. Present study Study Group of the Canadian Perinatal Surveillance System. CMAJ, 2007,
was supported by many studies which mentioned that there are 17(2), P.P.455–60.
highly significant difference about nurses' knowledge in post-test [9] Spong, C.; Berghella, V.; Wenstrom, K.; Mercer, B.; Saade, G.: Preventing
between study and control groups(2, 22, 24). The First Cesarean Delivery: Summary Of A Joint Eunice Kennedy Shriver
National Institute Of Child Health And Human Development, Society For
Maternal-Fetal Medicine, And American College Of Obstetricians And
Gynecologists Workshop. Obstetrics and Gynecology. 2012, 120(5), P. 81.
V. CONCLUSIONS [10] Taukuheke, L.: Midwives knowledge of the use of the Partograph in the
regional training Hospital in Namibia. Common wealth nurses conference
The study concluded that majority of nurses are young age Journal, 2014, 2(1), P.8.
and had few years of experience in nursing field with lack of [11] Tayade, S.; Jadhao, P.: The impact of use of modified who partograph on
educational training sessions regarding partograph, whichmakes maternal and perinatal outcome. International Journal of Biomedical and
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knowledge deficiency concerning partograph usage. [12] World Health Organization, Preventing Prolonged Labor: a practical guide.
The partograph. Part I: Principles and Strategy, 2014.
Educational program was found to be an appropriate and
[13] Daniel, G.: The Partograph: An Essential Tool for Decision-Making during
effective way to improve the nurses' knowledge regarding Labor. Nutrition and Maternal Health, U.S. 2012, 12(2), P.38.
partograph. [14] MOH, Iraq: National strategy and plan of action for nursing and midwifery
development in Iraq 2003–2008, P.5.
[15] Neal, J.; Lowe, N.; Patrick, T.; Cabbage, L.; Corwin, E.: What is the
VI. RECOMMENDATIONS Slowest‐Yet‐Normal Cervical Dilation Rate among Nulliparous Women
with Spontaneous Labor Onset. Journal of Obstetric, Gynecologic, &
Based on the study results discussion and conclusions the Neonatal Nursing. 2010, 39(4),P.P.361-369.
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1. Asserting on Ministry of Health to offer in service Partograph Among Healthcare Personnel At The Peripheral Maternity
training programs for nurses and midwife,also Centres In Nigeria. Journal Of Obstetrics And Gynaecology. 2011,
26(6),P.P.538-541.
encouraging nurses to be enrolled in educational
[17] Lindelow, M.; Kanchanachitra, C.; Johnston, T.; Hanvoravongchai, P.;
sessions and programs to improve their knowledge and Lorenzo, F.; Huong, N.; Wilopo, S.; Rosa J.: Human Resources For Health
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2. Developing of follow up system in maternity units to [18] Thompson, J.; Fullerton, J.; Sawyer, A.: The International Confederation Of
Midwives: Global Standards For Midwifery Education (2011) With
evaluate the performance of nurses who had previously Companion Guidelines. Midwifery. 2011, 27(4), P.P.409-416.
attended the partograph teaching program and [19] Clarke, S.; Rockett, J.; Sloane, D.; Aiken, L.: Organizational Climate,
encourage peer mentoring for nurses to learn from Staffing, And Safety Equipment As Predictors Of Needlestick Injuries And
other. Near-Misses In Hospital Nurses. American Journal of Infection Control.
2012 Jun 30;30(4):207-16.
3. Emphasize on the importance of using partograph in [20] Mohamed, A.; Abd Elati, I.; Zaki, M.: Knowledge And Attitude Of
Maternity Nurses Regarding Perinatal Care. Journal of Nursing Education
delivery rooms in all Iraqi governorates. and Practice, 2015, 5(2).P. 141.
[21] Khomeiran, T.; Yekta, P.; Kiger, A.; Ahmadi, F.: Professional Competence:
Factors Described By Nurses As Influencing Their Development.
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2008,16(8),P.527 AUTHORS
[6] Yisma, E.; Dessalegn, B.; Astatkie A.; Fesseha N.: Knowledge and
Utilization Of Partograph Among Obstetric Care Givers In Public Health
First Author – ZainabNeamatJumaah Al-Taee, M.Sc,
Institutions Of Addis Ababa, Ethiopia. BMC Pregnancy and M.Sc.Maternal and Newborn Health Nursing, Faculty of Nursing,
Childbirth.2013, 13(1), P.P.101-109. University of Kufa.
[7] Aaron, R.: Safe Prevention of the Primary Cesarean Delivery. Obstetric Second Author – Kafi Mohammed Nasir Al-Asadi, Ph.D,
Care Consensusno. The American College of Obstetricians and Assistant Professor, Community Nursing Branch / MCH, Faculty
Gynecologists. Obstet Gynecol. 2014, 23(1), P.P.693_711. of Nursing, University of Kufa.

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ISSN 2250-3153

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