NURSES KNOWLEDGE AND SKILLS TOWARDS PREVENTION OF POSTPARTUM HEMORRHAGE IN TERTIARY CARE HOSPITAL

Abstract

Background: Postpartum hemorrhage (PPH) is one of the most serious obstetric emergencies and is an important cause of maternal morbidity and mortality. Timely recognition of excessive postpartum bleeding, identification of risk factors, appropriate preventive measures, effective monitoring, and prompt initial response are essential for reducing complications associated with PPH. Nurses have a critical role in the prevention and early recognition of PPH because they are directly involved in monitoring women during labour, delivery, and the immediate postpartum period. Adequate knowledge and appropriate clinical skills are therefore essential for safe and effective nursing care. Objective: To assess the knowledge and skills of nurses regarding the prevention of postpartum hemorrhage in a tertiary care hospital and to determine the relationship of knowledge and skills with selected demographic and professional characteristics of the nurses. Methods: A quantitative cross-sectional study was conducted among 120 nurses working in a tertiary care hospital. Data were collected through three components: a demographic and professional information section, an 18-item structured knowledge questionnaire, and a 20-item skills observation checklist. Each knowledge item was scored as 1 for a correct response and 0 for an incorrect or “I don't know” response, giving a total knowledge score of 0–18. Knowledge was categorized as poor (0–8), average (9–13), and good (14–18). Clinical skills were assessed through direct observation using a 20-item checklist covering preparation and prevention, early recognition of PPH, immediate response, escalation, communication, reassessment, and documentation. Skills were scored from 0 to 2 for each item, producing a maximum skill score of 40. Descriptive and inferential statistical analyses were performed to assess knowledge, skills, and their associations with selected characteristics. Results: The study included 120 nurses with a mean age of 30.21 ± 6.85 years. The mean knowledge score was 12.29 ± 2.32 out of 18. Regarding knowledge level, 6 (5.0%) nurses had poor knowledge, 76 (63.3%) had average knowledge, and 38 (31.7%) had good knowledge. The mean observed skills score was 36.21 ± 1.91 out of 40, with all 120 (100%) nurses classified as having good skills according to the predefined skill-level criteria. The mean combined knowledge-and-skills percentage was 79.41 ± 6.95%, with 93 (77.5%) nurses classified as having a good overall knowledge-and-skills level and 27 (22.5%) classified as moderate. Previous training was reported by 57 (47.5%) nurses, while 63 (52.5%) had not received training. Nurses who had received training had a significantly higher mean knowledge score than those who had not received training (13.18 ± 2.02 vs. 11.49 ± 2.29; p < 0.001). Knowledge score also differed significantly according to qualification (p = 0.002) and designation (p = 0.005). No significant difference in knowledge score was found across experience groups (p = 0.544). The mean skill score did not differ significantly according to training status (p = 0.300). The correlation between knowledge and observed skill scores was weak and non-significant (r = 0.039, p = 0.670). Conclusion: The study found that the majority of nurses demonstrated an average level of knowledge regarding the prevention of postpartum hemorrhage, whereas observed clinical skills were generally high according to the study's predefined criteria. Previous training was significantly associated with higher knowledge scores, and knowledge also differed significantly according to qualification and professional designation. However, the absence of a significant relationship between knowledge and observed skills suggests that theoretical knowledge and practical performance may represent different dimensions of competency. Regular PPH-focused continuing education, simulation-based training, competency assessment, and reinforcement of evidence-based clinical protocols are recommended to strengthen nurses' preparedness for prevention and early response to PPH.

Keywords: Postpartum hemorrhage; Nurses; Knowledge; Clinical skills; PPH prevention; Obstetric nursing; Maternal health; Tertiary care hospital.