“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING

PARTOGRAPH AMONG UNDER GRADUATE NURSING
STUDENTS IN SELECTED COLLEGE OF NURSING at Ujjain
(M.P.)”

SYNOPSIS FOR REGISTRATION OF

Dissertation Submitted to the

MADHYA PRADESH MEDICAL SCIENCE UNIVERSITY
JABALPUR, M.P.,

IN PARTIAL FULFILLMENT OF THE REQUIRMENT FOR THE DEGREE

MASTER OF SCIENCE IN

OBSTETRICS AND GYNAECOLOGICAL NURSING

BY

Ms. KAVITA PAWAR

F.Y. M.Sc. NURSING

OBSTETRICS AND GYNAECOLOGICAL NURSING

UNDER THE GUIDENCE OF

Ms. Hiral Dabhi

M.Sc. (N) IN MEDICAL SURGICAL

NURSING HEAD OF DEPARTMENT IN

MSN ASSISTANT. PROFESSOR

EKTA NURSING COLLEGE KHEDBHRAHMA.

 SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Ms. KAVITA PAWAR

NAME OF THE CANDIDATE AND
F.Y. M.Sc. NURSING
ADDRESS M.Sc. (N) IN OBSTETRIC AND

GYNAECOLOGICAL NURSING

NAME OF THE INSTITUTION

NAME OF THE INSTITUTE

COURSE OF THE STUDY AND SUBJECT F.Y. M.Sc. NURSING

M.Sc. (N) IN OBSTETRIC AND
GYNAECOLOGICAL NURSING

DATE OFADMISSION COURSE

“A STUDY TO ASSESS THE
TITLE OF THE STUDY EFFECTIVENESS OF PLANNED
TEACHING PROGRAMME ON
KNOWLEDGE REGARDING
PARTOGRAPH AMONG UNDER
GRADUATE NURSING STUDENTS IN
SELECTED COLLEGE OF NURSING at
Ujjain (M.P.)”
 INTRODUCTION

“Beautiful are those lives

Which sacrifice to care for young one’s”

The birth of a baby is momentous occasion; tiny details of the experiences

surrounding the whole event are etched in the memory forever.1

Motherhood is a beautiful experience whereby the mother safely delivers a child. It’s
the magic of creation.

Onset of labour brings a remarkable change in the relationship between the

woman and her baby. In those hours and moments, the birth process may seem to
carry all the power in the universe. The mother to be may feel stretched beyond their
normal limits of concentration, endurance and pain as they work to bring forth a
precious new life. 2

India with its one billion people contributes to about 20 percent of all
maternal deaths in the world. Approximately 5 lakh women die every year is
maternity related deaths and 1.5 crore women suffer from injuries, infections and
disabilities in pregnancy and child birth annually in India alone.3

Recent scientific evidence shows that access and use of high-quality

emergency obstetric care is the key to reducing maternal mortality.

We as midwives want the autonomy and to claim over rightful place as being with
women during normal pregnancy labour and birth. To achieve that we have to be
responsible, accountable evidence-based practitioners.

So, here midwives carry a huge responsibility in helping women through the
hard work and pain that is labour. Yet what a privilege it is to help women and
their partners to capture the excitement of bringing a new human being into the
world. In today’s health care environment, quality-nursing care is not just a goal of
nursing profession; it’s also an expectation of the public.4

3
 Maternal mortality remains one of the major problems in developing
countries today and studies have revealed that the major cause of maternal mortality
is lack of intrapartum care.

The partogram has been considered as one of the valuable tool in the
improvement of maternity services. Worldwide various designs of partogram are in use,
all of which displays intrapartum details in a pictorial manner. It’s a simple
inexpensive tool to provide a continuous pictorial overview of labour. Its central feature
is the graphic recording of dilatation of the cervix assessed by the vaginal
examination. It’s a decision making tool. Implementation of partograph implies a
functioning referral system with essential obstetric services in place.5

1.1 Background OF THE STUDY

During early fifties large numbers of normal labours were studied and it was
concluded that functionally labour could be divided into two parts i.e. latent phase
and active phase and the cervical dilatation during labour could be plotted
graphically. In late sixties and early seventies several extensive studies were carried
out and it was inferred that labour in primipara and multipara behaved differently
and deviation from normal could be diagnosed by use of the partograph. It provides
a sound scientific basis for an early intervention to prevent prolonged labour and its
sequelae. Over last two decades several developed and developing countries have
used partograph pragmatically in variety of different settings and have found it to be
an inexpensive and effective tool for diagnosing labour outcome.6

Partograph effectively prevents prolonged labour and thus reduces the risk of
postpartum haemorrhage, sepsis, uterine rupture, operative interventions and
improving neonatal outcomes and reducing foetal mortality and morbidity.
Common Partogram designs follow the work of Friedman in 1954 then Philpott-
in 1972 and followed by WHO in 2000- In an attempt to improve the outcome of
labouring women. WHO Revised Partogram demonstrating clear benefits in terms of
obstetric outcome. Its use improves the efficiency of the maternity services.7

4
1.2 Need for the study
Since recorded time, birth has occasioned emotions. Its one of the dramatic episode in
life- a moment when the past merges with the present and the present holds all the potential
for future.8

Sixty percent of total population in India consists of women of childbearing age,

children below 15 years and one fourth of group fewer than five years of age.

Five lakh women die every year in world as a result of pregnancy and childbirth. Every
minute of everyday a woman dies of pregnancy related complications. Is it tolerable to see that
thousands of women are dying in the divine process of giving life.9

Maternal mortality remains one of the major problems in public health today especially
in developing countries where maternal mortality is estimated to be 550 for 1,00,000 live
births, which is 100 times higher than in developed countries. Causes of maternal mortality
according to WHO are unsafe abortion 13 percent, sepsis 15percent, obstructed labor 8percent,
hemorrhage 24percent, indirect causes 20percent, other direct causes 8percent, and
hypertensive disorders 12percent. About two- thirds of labour are normal in the rest, increased
surveillance and sometimes action is required to prevent maternal and fetal problems. All the
primary caregivers need to be able to recognize such variation and to take appropriate
action.10

One of the method introduced to reduce the high incidence of maternal

and neonatal mortality in developing countries, is the “Partogram”. A visual means, used in
evaluating a normal delivery. Which has transformed the subjective management of labour
into a more objective exercise.11

So, here the partogram has been considered as one of the valuable tools in
improvement of intrapartam services worldwide. It acts as an early working system allowing
for the early detection of abnormal evolution in labour.

Oladapo OJ, Daniel OJ, Olantuji AO conducted a study on knowledge and

practice of partograph among health care personnel. The majority of personnel were nurse/
midwives 45.5 percent, CHEW community health extension workers 42.7 percent of 216
personnel, 54.5 percent who were aware of partograph. 16.7 percent, 55.5 percent and
28.2 percent demonstrated poor, fair and good levels of knowledge respectively. No community
health extension workers had a satisfactory knowledge on partograph. Only 9.8 percent of all the
12
 personnel routinely employed partograph for labour management and almost half of these
individuals had a poor level of knowledge.12

STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING PARTOGRAPH AMONG
UNDER GRADUATE NURSING STUDENTS IN SELECTED COLLEGE OF
NURSING at Ujjain (M.P.)”

OBJECTIVES OF THE STUDY

1. To assess the knowledge of Under graduate nursing students on partograph before & after
structured teaching programme.

2. To evaluate the effectiveness of structured teaching programme on partograph.

3. To find out the association between knowledge on partograph and selected demographic
variables.

HYPOTHESIS

At the level of 0.05 significance

 H1 - There will be a significant increase in knowledge regarding partograph among Under

graduate nursing students after structured teaching program than before structured teaching
program.

OPERATIONAL DEFINITIONS

1. Structured teaching programme: It refers to systematically planned group

instruction designed to provide information regarding partograph for Under graduate
nursing students in selected nursing college Ujjain.
2. Effectiveness: Refers to the extent to which the structured teaching programme on
partograph has achieved the desired effect in improving the knowledge of Under
graduate nursing students as evidenced by gain in knowledge scores.
3. Partograph: It’s a pictorial tool used to mark the assessment and progress of a
woman’s labour.
13
 Delimitations

The study result would be limited to antenatal women who are attending the antenatal clinics of
selected Hospital, Ujjain (M.P.).

Conceptual framework
A conceptual framework or model refers to concepts that structure offers a framework of
prepositions for conducting research.

The investigator thus adopted, Wiedenbach’s A Helping Art of Clinical Nursing

{1964} conceptual framework in a modified form, believing that investigator could be of help
to nurses to gain knowledge on partograph. Erneistine Wiedenbach is a nurse theorist, who
has published many articles about nursing.

- She proposed a prescriptive theory for nursing, which is described as a conceiving of

desired situation and the ways to attain it.
- It’s directed on action towards an explicit goal.

Wiedenbach’s theory consists the following factors Central Purpose

Central purpose refers to what the nurse wants to achieve and the overall goal towards
which a nurse strives.
In this study the central purpose is “Under graduate nursing students enhance their
knowledge on partograph and involve partograph as one of the essential tools in evaluating
labor process”.

Prescription: It specifies the nature of action that will fulfill the Under graduate nursing students
central purpose and the rationale for that action. After the prescription is established the bsc
nursing students can implement it.

Realities: It refers to the physical, psychological emotional and spiritual factors that involve
in nursing action.
The 5 (five) realities identified by Wiedenbach are Agent, Recipient, Goal, Means
and Framework.

14
Agent: Agent is the practicing bsc nursing students who has the personal attributes,
capacities, capabilities, commitment and competence to provide nursing care.

Recipient: The recipients are the one’s who receive nurse’s action or on whose behalf actions
are taken. In this study the recipients are Under graduate nursing students.

Goal: The Goal is the nurses desired outcome. Here it is, nurses gaining adequate knowledge
and charting partograph after structured teaching program.

Means: They are the activities and devices used by the nurse to achieve the goal. It includes
phases for achieving the goal like identification, ministration and validation in this study.

Framework: It refers to the facilities in which nursing is practiced, the framework in this
study has been considered as setting in which the study has been conducted.i.e. (Maternity
wards of st. Mary’s, Panacea, Manjunatha and Laxmi Maternity centers)

Nursing Practice
Identification: It involves the process of determining the existence of need.
The investigator after obtaining consent from the participants, to assess pre-test
knowledge by self-administered questionnaire.

Ministration: It refers to provision of a structured teaching program using handouts

and charts; was undertaken to provide knowledge to Under graduate nursing students on
partograph.

Validation: It refers to the collection of evidence that shows need have been met as a direct result
of action. Posttest assessment was done followed by the compilation and analysis of the
collected data to validate if the need was met or not.

15
 REVIEW OF RELATED LITERATURE

Review of related literature is a systematic identification, location, scrutiny and

summary of written materials that contain information on research problems.

Review of related literature is an integral component of any study or research project.

It enhances the depth of Knowledge and inspires a clear insight into the crux of the problem.
Literature review throws light on the studies and their findings reported about the problems under
study.

According to Best a brief summary of previous research and writings of recognized

experts provides evidences that the researcher is familiar with what is still unknown, untested.

The literature review was based on an extensive survey of books, journals,

international nursing studies and medicine search.
The review of literature for the present study has been done from published articles,
textbooks, published reports, newsletters and Internet search on partograph.

The literature review for the present study is organized and presented under the
following headings:

1. Review related to knowledge and practice of partograph.

2. Review related to effect of partograph.

3. Review related to types and use of partograph.

16
1. Review Related to Knowledge and Practice of Partograph

Shah, Bimla (2022)conducted a study to assess the knowledge and practice of nurses
regarding plotting partograph during 1st stage of labour. The study population was ANM/staff
nurses working in labour rooms. The sampling technique was purposive, semi-structured
questionnaire and observation checklist was used. The study revealed that majority of
respondents had adequate knowledge and practice regarding the use of partograph. It also
indicated that the majority of respondents had not participated in training and in service
education regarding plotting partograph, which shows no significant effects of experience to
their knowledge. On the basis of these findings it was suggested that the concerned authority
should guide and supervise the staffs working in the labour room and birthing center.17

Mohammad F, Virasakdi C, (2022) conducted a study to assess the effectiveness of

promoting the use of the WHO partograph by midwives of Medan city, North Sumatra
Province, Indonesia. 20 midwives who regularly conducted births randomly allocated into two
equal groups. Cluster randomized control trial was used. There were 304 eligible women with
vertex presentation among 358 labouring women in the intervention group and 322 among 363
in the control group. Among intervention group 304 partographs were correctly completed. From
71 women with the graph beyond the alert line 42 were referred to hospitals. Introducing
partograph significantly increased referral rate and reduced number of vaginal examination.
Oxytocin used and obstructed labour. So, the WHO partograph should be promoted for use
by midwives who care for labouring women in the maternity home.18

Petterson KO, Svensson ML, Christensson k (2021)conducted a study on Evaluation

of an adapted model of WHO partograph used by Angolan midwives. Objective, to study the
impact of an educational intervention of midwives use of Angolan model of WHO partograph.
The quasi-experimental, one group pre-test post-test design was used. Fifty partographs
plotted with an initial duration <8cm were randomly selected from first period of six months
to form sample II. A team of midwives and Obstetricians performed inservice education.
When comparing sample II with sample I, statistically significant improvements were found in
seven of ten measured variables. This indicates a positive effect of the educational intervention
on a proper use of the partograph.19

26
 Azandegba N, Jesta J, Makoutoda M, (2021)conducted a study on safe motherhood
programme launched in Benin. One of the methods to decrease maternal mortality and
morbidity was partogram. They conducted a survey in maternity facilities in urban and rural
Benin to assess utilisation rate and the questionnarie. Partograms were used in 98% of all cases;
in 13.3 percent partogram completion stopped before delivery. Overall completion was not good:
of 984 partograms examined, administration data were completed only in 20 percent medical
delivery data on 50 percent. Action taken before the alert line was crossed in 13.5 percent of
cases, but correct action always followed. The patient transfer rate was 13 percent and the
caesarean rate 5.2 percent. This result thus shows very high courage of partogram use, but
inadequate quality and thus demonstrates the need for refresher training for maternity staff
about partogram use.20

2. Review related to effect of partograph on outcome of labour

Wacker J, Kyelem D, Bastert G. (2023)conducted a study on introduction of a simplified

round partogram is rural maternity and its effect. After a 3-day seminar on the utilization of a
rectangular world health organization version of partograph and round partograph; both versions
were used under supervision for 3 months; after this a semi- standardized questionnaire was
distributed among partogram users. Using the round partogram with a plastic dial (dilatation
indicates for assessment of labour – DIAL), the two most common errors in the utilization of the
rectangular partogram, incorrect recording at Initial examination and at the transition from latent
to active phase were avoided. Although the partogram was used in only 46.6 percent of all
deliveries at the health unit level, 86 percent of the maternity staff using partograms preferred the
round one because of its time – saving and user – friendly qualities. The wide acceptance of
simplified round partogram around the peripheral health units surveyed shows that partogram
would be an attractive tool for its users when it is made easy to use and a useful
indicationfor determining wheather a patient transfer is necessary.2

3. Review related to types and use of partograph

Tina L, Alfereuic Zarko (2020)conducted a study to assess the effect of three different
partograms in caesarean section and maternal satisfaction. Participants. Nine hundred and twenty-
eight primigravida women with uncomplicated pregnancies who presented in spontaneous labour
at term. The women were randominsed to have their progress of labour recorded on a partograph
with an actions line 2, 3 or 4 hours to the right of the alert line. If the progress reached the
action line, a diagnosis of prolonged labour was made. Prolonged labour was managed according
to the standard ward protocol. Caesarean section rate was lowest when labour was managed

27
using a partogram with a 4 – hour action line. The difference between the 3 and 4 hour
partograms were statistically significant, but the difference between 2 and 4 hours was not
(1.4.95 percent (10.8-2.4). The women in the 2 hours arm were more satisfied with their
labour when compared to the women in the 3 – hours and 4 hours arm.22

Mathews J.E. Rajarathnam A. George A, Mathai M (2021)conducted a study to

compare two WHO partographs – composite partograph including latent phase with a simplified
one without the latent phase. Comparison of the two partographs in a crossover trial. Eigheen
physicians participated in this trial. One or the other partograph was used in 658 parturients. The
mean user – friendliness score was lower for the composite partograph (6.2 (0.9) vs 8.6 (1.0);
P=0.002). Most participants (84 percent) experienced difficulty “sometimes” with the composite
partograph, but no participant reported difficulty with the simplified partograph. The simplified
WHO partograph was

more user-friendly was more to be completed than the composite partograph and was associated
with better labour outcomes.23

Tina, Alfirevic Zarko (2020) conducted a randomized trial of primigravid women

with uncomplicated pregnancies, in spontaneous labour at term. Women were assigned to
have their labours recorded on a partogram with an action line 2 or 4 hours to the right of the
alert line. If progress crossed the action line, diagnosis of prolonged labour was made and
managed according to standard protocol. Primary outcomes were rate of caesarean delivery
and maternal satisfaction. A total of 3,000 women were randomly assigned to groups; 2,975
(99.2 Percent) women. There were no differences in caesarean delivery rate (136/1,490
compared with 135/1,4.85; relative risk (R, R) 1.95 percent, confidence Interval (C1) 0.80 –
1.26) or women dissatisfied with labour experience (72/962 compared with the 81/976; RR
0.89.95 percent (1 0.66-1.21). More women assigned to the 2. hr arm had labours that
crossed the action line received more intervention (772/1,490 compared with 624 / 1,485;RR
1.23.95 percent (1 1.14 – 1.33) and if admitted to the Midwives

– led unit, were transferred for consultant led care.24

28
 Cartmill RS Thorton JG (2019)conducted a study in effect of Parograph. They
assessed whether changing the appearance of the same information on the partograph effects
clinical decision making during labour. Sixteen junior obstetricians were asked about how
they would manage six hypothetical cases of difficult labour. Information was taken from
partograph, in which we varied either the relative scales of the X and Y-axis or whether the
latent phase of labour had been included. Doctors were more likely to intervene more actively:
If the progress of labour curve appeared flat and if the latent phase was included. The shape
and point of origin of the partograph probably influence intervention rates in practice and
may partly explain the low rates of caesarean section in some hospitals.25

METHODOLOGY
29
 The methodology of research indicates the general pattern of an organized procedure
for gathering valid and reliable data for the purpose of investigations.

Research methodology includes research approach, research design, setting, the population,
sample, criteria for sample selection method of sample selection, description of the tools,
testing of the tools, and development of STP, pilot study, procedure for data collection, plan for
data analysis and protection of human subjects.

3.1 Research Approach

Treece and Treece defined the Research approach is the umbrella that covers the basic
procedure for conducting research.

An experimental approach was used to evaluate the effectiveness of structured teaching

programmed on Partograph.

3.2 Research Design

Quasi Experimental One group Pre and Post – test design (O1 X O2) was adopted for
this study.
O1 – Pre-Test X - STP
O2 – Post – Test

The schematic representation of the study is givens in figure – 2.

30
31
 3.3 Variables Independent variable
Structured teaching program on partograph.

Dependent variable

Knowledge of Under graduate nursing students on partograph.

3.4 Setting of the study

The study was conducted in selected nursing college, Ujjain.

3.5 Population

The population for the study was 60 Under graduate Nursing students who were studying in
selected nursing college, Ujjain.

3.6 Sample

The sample of the study consisted of Under graduate Nursing students who were studying in
selected nursing college, Ujjain.

3.7 CRITERIA FOR SAMPLE SELECTION

Inclusion criteria
1. Under graduate nursing students who are studying in selected college.

2. Who are willing to participate.

3. Who are available at the time of data collection.

32
Method of Sample selection

BSc nursing students who fulfilled the inclusion criteria and studying in

selected college were selected as sample by simple random technique.

Development of Structured Teaching Programme

Teaching plan is guide for the teacher because it helps to cover the topic comprehensively
with proper sequence of points.

The structured teaching program will be developed by the investigator after reviewing
the Literature and by obtaining experts opinion. The STP of 45 minutes duration gives the
basic Information on Teaching, General and Behavioral objectives, Content, Teacher’s
learners Activity, Summary and Conclusion. The content area of STP on partograph was
definition, purpose, principles, monitoring, charting, summary and conclusion. The method of
teaching adopted will be lecture cum discussion method. The visual aids were charts and
flash cards.

Development of the Tools Data collection Tools

Data collection is the gathering of information needed to address a research problem.
Tools are the procedures or instruments used by the researches to collect the data. In this
present study structured questionnaire will be used for collecting the data.

Description of the Tool

As per the review of literature and discussions with experts, the investigator decided to
construct a structured questionnaire. The tool consists of 2 parts:

Part I: Demographic Data

It contains 6 items for obtaining information regarding Age, Sex, Occupation,

Experience, Marital Status, Type of family, and Previous source of information.

Part II Structured questionnaire regarding partograph

33
 The structured questionnaire regarding partograph. Consisted of multiple-choice questions
under 3 aspects such as Meaning and Definition, Purpose and Principles, Monitoring
labor, Charting of Partograph. Each question has 3 Responses with 1 correct answer. Score '1'
was given for each correct response in a single question and score '0' was given for wrong
answer.Plan for data analysis:

The data obtain will be tabulate and analyze by using descriptive and inferential statistics and
will be present it the form of figures and tables.

Testing of the Tools Validity

The structured questionnaire will be developed by the investigator based on the review
of literature. 8 experts evaluated the tool for content validity. The experts were 2 doctors
specialized in obstetrics and gynecology, 5 nurse educators specialized in maternity nursing, 1
statistician to establish content validity.

Reliability of the Tool

The reliability of the tool was established by split – half method was used. The tool
was administered to 10 subjects and the test will be first divided into two equivalent halves,
correction of half test was found by using Karl Pearson correlation co-efficient formula and the
significance of the correlation was tested by using probable error. The reliability co- efficient of
the whole test was then estimated by Spearman’s Brown Prophecy formula. The reliability was
(0.98). So, the tool was found to be highly reliable.

Preparation of the Blue Print

A blue print was prepared to the construction of structured questionnaire based on which
the items were developed. It depicted the distribution of items according to the content areas.
Structured questionnaire includes three domains with relevant questions:

 Knowledge.
 Comprehension.
 Application.

34
Pilot study

Pilot study will be conducted in Mittal college of nursing, from 06/08/2020 to

12/08/2020.The investigator obtained prior permission from the authority. The topic will be
explained and confidentiality was assured and the investigator collected data from 10
participants with the purpose of finding feasibility of the study before starting the main study.
STP will be given on the same day after administering Pre-test. On the seventh day post-test
will be conducted with the same tool. The tool and STP were found to be reliable, feasible and
practicable. Data analysis was done using descriptive and inferential statistics. The pilot study
participants were excluded in the main study.

Data collection process

The study was conducted in St. francis college of nursing ajmer.

The period of data collection was from 03.09.2020 to 03.10.2020.

Prior to data collection permission was obtained from the concerned authorities.
The investigator administered the structured questionnaire for assessing their knowledge
regarding Partograph. Every day on an average 3-4 participants were selected by Random
Sampling. The STP was administered after each pre-test. After 6 days post-test was conducted
using the same questionnaire to evaluate the effectiveness of STP.

Plan for Data Analysis

The data is analyzed by both descriptive and inferential statistics on the basis of
objectives and hypothesis of the study. To compute the data, master data sheet was prepared
by the investigator.

The knowledge of Bsc Nursing student on Partograph before and after the
administration of STP was calculated by using range, frequency, mean and standard deviation.
Further statistical significance of the effectiveness of the planned teaching program was
analyzed by the paired ‘t’ test. The association between selected demographic variables and
pre- test score was determined by chi-square test. Data was presented in tables and diagrams.

35
 Ethical consideration:

The research title and objectives will be approved by the research committee. Formal permission will
be obtained from the directors of the hospitals. Confidentiality will be ensured. An informed consent
will be obtained from the individual hypertensive patients.

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SIGNATURE OF THE CANDIDATE

REMARKS OF THE GUIDE

NAME AND DESIGNATION OF GUIDE

SIGNATURE OF THE GUIDE

NAME OF THE CO-GUIDE

SIGNATURE OF THE CO GUIDE

HEAD OF THE DEPARTARTMENT

SIGNATURE OF THE HOD

SIGNATURE OF THE PRINCIPAL

41