Background: Birth asphyxia, which is defined as the failure to establish breathing following delivery and causes an estimated 900,000 deaths each year. This investigation tries to measure the efficiency of an instructional program on the knowledge of pediatric nurses concerning neonatal birth asphyxia management in Mosul Hospitals.
The Methodology: A quasi-experimental one-group pretest and posttest study design was used at Mosul hospitals' pediatric units from 3rd October/2021 to 1st March/2022. A not-randomly purposive sample was used, the whole number of sample (32) nurses, drawn from five Mosul City hospitals. Nurses were given access to the program lectures and the questionnaire. Five lectures made up the program's five lectures, and then questionnaire remained divided into two parts. The initial part of the questionnaire asked about socio-demographic data, while the part second asked about the knowledge of nurses on the management of newborn birth asphyxia and included five components. The validity was examined by thirteen expert committees. The pilot study's dependability was used from 16-17/November/2021 by use of Cronbach's Alpha (0. 831) using SPSS version 26.
The Result: Most of the sample was females at age (20-29) years-old, who graduated from the institute stage had less than five years of service, and not had training courses, and also reading resources related to neonatal birth asphyxia. There was the extremely substantial correlation between the pediatric nurse's knowledge of newborn birth asphyxia between the Pretest with Posttest results demonstrates the educational program's success at P. value ≤ 0.05.
The Recommendations: Widespread training courses, also special programs, and necessity be designed and implemented in other Nineveh hospitals.
Evaluation, Pediatric nurses, Knowledge, Neonatal birth asphyxia
Neonatal birth asphyxia is a serious disorder that develops when a newborn is unable to resume normal breathing shortly after delivery. It is a medical emergency that calls for urgent treatment to avoid long-term problems including neuro developmental impairments or even death. Understanding the risk factors and adopting suitable therapies are essential in improving outcomes for newborns suffering from neonatal birth asphyxia. The reasons of this disease might include issues with the placenta, umbilical cord, or the baby's own breathing system [1].
The management of neonatal birth asphyxia involves a multidisciplinary approach, including skilled obstetricians, neonatologists, and pediatric nurses; the main objective is to restore and maintain an adequate oxygen supply to the baby's vital organs, especially the brain; this may involve actions like resuscitation, ventilation support, and/or oxygen therapy. As a result, it is a life-threatening and time-sensitive emergency that requires immediate action to ensure the newborn's well-being [2].
According to the WHO, 4 million deaths annually result from birth asphyxia, which accounts for 38% of all pediatric fatalities under the age of five, although the exact definition of birth asphyxia is unclear, it is associated with 23% of all newborn fatalities in low-income nations [3].
The primary goal of neonatal birth asphyxia management is to ensure adequate oxygenation and provide immediate resuscitation, if necessary. This includes opening the airway, giving extra oxygen, and possibly starting cardiopulmonary resuscitation (CPR) if the baby's heart rate remains low or absent. In severe cases, the baby may need mechanical ventilation to support breathing [2].
What is the evaluation of instructional programs on pediatric nurses’ knowledge regarding the management of neonatal birth asphyxia in Mosul hospitals?
1. To measure the knowledge levels of pediatric nurses concerning the Management of neonatal birth asphyxia in Mosul Hospitals.
2. To evaluate effective of an instructional program for knowledge of pediatric nurses concerning the Management of neonatal birth asphyxia in Mosul Hospitals.
A quasi-experimental one-group pretest and posttest study design was used at Mosul hospitals' pediatric units from 3 rd October/2021 to 1 st March/2022.
A not-randomly purposive sample was used, the whole number of a sample (32) nurses employed inside pediatric wards of five Mosul Teaching Hospitals; Al-Salam Teaching Hospital, Ibn Al-Atheer Teaching Hospital, General Mosul Teaching Hospital, Al-Kanssa’a Teaching Hospital, and Ibn-Sina Teaching Hospital.
Nurses who are working in pediatric wards on the morning and night shifts. Nurses who agreed and were willing to participate were also ready to fill out the online instrument questionnaire of the study. Students' nurses from both sexes (male and female).
The program lectures and questionnaires were generated and made available to nurses so they could assess the educational program's impact on their understanding of how to manage newborn birth asphyxia. Two lectures each week made up the program's five lectures, and the questionnaire included two separate parts:
The initial part contains socio-demographic data including data connected to the nurses' sample such as gender, age, level of education, service, training course, and reading source.
The second part consists of a questionnaire related to the knowledge of nurses concerning the management of neonatal birth asphyxia. Questionnaire consists of five sections each section contains five multiple-choice questions in regard to the knowledge of nurses: The first section focuses on knowledge of nurses concerning neonatal birth asphyxia in general. The second section focuses on the knowledge of nurses concerning the symptoms and signs of birth asphyxia. The third section focuses on the knowledge of nurses concerning the causes of birth asphyxia. The fourth section focuses on the knowledge of nurses concerning the management of birth asphyxia, and the fifth section focuses on the knowledge of nurses concerning nursing care of birth asphyxia.
The extent of the nurses' knowledge, as estimated: Failure equals a knowledge score of 0 to 1 and a total knowledge score of 1 to 5. Non-Acceptable = total knowledge score (6-10) and knowledge score (2) on the solution. Acceptable is equal to a total knowledge score of (11-15) and a knowledge score of (3). Good = (4) knowledge score on the question and (16-20) overall knowledge score on the question. Excellent equals a total knowledge score of (21-25) and a knowledge score of (5).
A panel of experts evaluated the content validity by (13) specialists in various medical and nursing professions to determine the legitimacy of the program lectures and questionnaire. It was requested of the experts to evaluate the text for appropriateness, relevance, and clarity.
From November 16-17, 2021, a pilot study was conducted before the practical phase began. To evaluate the internal consistency of the questionnaire, it comprised (10) nurses who were arbitrarily chosen from Ibn Al- Atheer teaching hospitals (this sample was left out of the original research sample). The study employed Cronbach's Alpha to assess pediatric nurses. The results (0. 811) using SPSS version 26.
The instruction program lectures were applied in Ibn Al-Atheer Hospital Hall after collecting all the nurses from all hospitals that participated in the study, where the data were collected Pretest then application of five program lectures, two lectures every week, after one week of completing the program lectures than a collection of Posttest, all time of data collection occurs during the period from 29 of November till 30 of December/2021.
In the current research, the statistical package for social science (SPSS), version 26, is used for analyze of data. Descriptive statistical data analysis (frequencies, percentages), inferential statistical data analysis, paired samples t-test, ANOVA - pair wise comparison, and degree of significance are among the statistical techniques used for data analysis and outcome assessment.
Table 1, Table 2, Table 3, Table 4 and Table 5.
Table 1: Socio-demographic results of the sample of pediatric nurses in the study. View Table 1
Table 2: Statistical result for knowledge of pediatric nurses at pretest with post test concerning neonatal birth asphyxia. View Table 2
Table 3: Statistical result for total knowledge of pediatric nurses at pretest with posttest concerning neonatal birth asphyxia. View Table 3
Table 4: Statistical association results (paired samples t-Test) for knowledge of pediatric nurses at pretest with posttest regarding neonatal birth asphyxia. View Table 4
Table 5: Statistical association results (ANOVA - Pairwise Comparison) for knowledge of pediatric nurses at pretest with posttest regarding neonatal birth asphyxia. View Table 5
Socio-demographic characteristics of the study sample, are 46.9% (15) of the sample at age (20-29) years, and 78.1% (25) of the sample are female. 43.8% (14) of the sample at the institute stage of educational level, 50.0% (16) of the sample at (1-5) years of general service, and 56.3% (18) of the sample at (1-5) years of service in the current ward. 59.4% (19) of the total sample not having training courses related to the study subject. Lastly, 53.1% (17) of the sample did not have a reading source as shown in Table 1. This result disagrees with Ezenduka, et al. (2016) that demonstrates in their study the majority 22 (44%) of the sample fell within 31-40 years, 15 (24%), and 1 (2%) were within 21-30 years. 21 (42%) of the sample were Nurses/Midwives, 6 (12%) were nurses, 10 (20%) were Midwives, and 5 (10%) of them worked with children. 8 of them (16%) were nurses with a bachelor's in science. A majority of 17 (34%) are between the ages of 6 and 10. Additionally, 21 (42%) of the sample had no training, whereas 19 (38%) received training [4].
The statistical knowledge results result for pediatric nurses' knowledge on Pretest with Posttest regarding neonatal birth asphyxia, that knowledge of nurses concerning neonatal birth asphyxia in general Pretest 50.0% (16) of them at a failure level, Posttest 56.3% (18) of the sample at an excellent level. Knowledge of nurses concerning signs and symptoms of birth asphyxia in the Pretest is 46.9% (15) at the failure level of them; Posttest is 65.6% (21) at an excellent level of them. Knowledge of nurses concerning causes of birth asphyxia on the Pretest is 62.5% (20) at a not acceptable level; Posttest is 59.3% (19) at an excellent level. Knowledge of nurses concerning of birth asphyxia management in the Pretest was 56.3% (18) at a failure level, and Posttest is 56.3% (18) at an excellent level. Knowledge of nurses concerning the care of birth asphyxia in the Pretest is 46.9% (15) at a failure level; Posttest is 43.7% (14) at a good level as shown in Table 2. These results agree with Al-Wily and Aziz (2020) were describing in their research that, whereas 57.7% (15) of the general knowledge and purpose or intent of usage in the Pretest were at a not acceptable level, 57.7% (15) of them in the Posttest were at an exceptional level. In the Pretest, 69.2% (18) of the normal values and nursing considerations are at a failure level, while in the Posttest, 65.4% (17) are at a good level. In the Pretest, 46.2% (12) of them had clinical manifestations that were not acceptable; in the Posttest, 53.8% (14) had clinical manifestations that were acceptable. In the Pretest, 69.2% (18) of the influencing elements and methods were at the failure level, whereas in the Posttest, 61.5% (16) of them were at the good level [5].
The statistical knowledge results result for the total knowledge of pediatric nurses on the Pretest with Posttest regarding neonatal birth asphyxia, that 68.8% (22) at an unacceptable level, but in the Posttest 59.4% (19) of the at an excellent level as shown in Table 3. These results agree with Subbiah, et al. (2012) showed in their research that the Posttest knowledge scores were more homogenous (SD 6.74) than the Pretest knowledge scores (SD 5.53) and showed the mean knowledge score on the posttest (30.71) was greater than the mean knowledge score on the pretest (19.11) [6].
Statistical association results (paired samples test) for knowledge of pediatric nurses at Pretest with Posttest concerning neonatal birth asphyxia. The results are highly significant association relationships among Pretest with Posttest results for all knowledge parts of pediatric nurses at the Pretest with Posttest concerning neonatal birth asphyxia at a p.value equal to or less than 0.05 level as shown in Table 4 these results agree with Kuriakose, et al. (2021) in a study, it was discovered that there was a substantial difference (8.23) between the two, with the mean Posttest knowledge score (26.03) being higher than the mean Pretest score (17.8). At the 0.05 level of significance, the estimated "t" value was (5.71), showing a significant shift in knowledge between the pre- and post-implementation periods. Thus, it was discovered that staff nurses' comprehension of birth asphyxia dramatically enhanced after the adoption of a structured education program [7].
The statistical association (ANOVA - pair wise comparison) for knowledge of pediatric nurses at the Pretest with Posttest regarding neonatal birth asphyxia. The results are highly significant association relationships among Pretest with Posttest results for all knowledge parts of pediatric nurses regarding neonatal birth asphyxia at a p-value equal to or less than 0.05 levels as shown in Table 5. These results agree with Draiko, et al. (2019) using ANOVA measurements, researchers in one study were able to demonstrate that there were substantial improvements in knowledge between the pretest with the post-test for the sample's mean scores at the pretest and posttest, there was a mean difference increase of 55.2 (50.9-59.6; p0.05) [8].
1. The Socio-demographic characteristics greatest of the sample was female gender at 20-29 years age-old, graduated from the institute stage that had less than five years of service, and not had training course, also reading resources related to neonatal birth asphyxia.
2. The pediatric nurses in Mosul teaching hospital do have not appropriate and not adequate knowledge before the application of the instructional program regarding neonatal birth asphyxia.
3. There was an extremely substantial correlation between the knowledge of pediatric nurses of newborn birth asphyxia between Pretest with Posttest scores, demonstrating the instructional program's efficacy and effectiveness.
1. Training courses and special programs for all nurses in all Nineveh hospitals regarding neonatal birth asphyxia to enhance knowledge and management.
2. Increasing the number of bachelor's degrees nurses in nursing science to work at pediatric departments in Mosul teaching hospitals for their background and ability.
3. Another study regarding birth asphyxia for all nurses in pediatric departments also enhances future nurses’ knowledge.
The approval getting first from the University of Mosul/ Collegiate Committee for Medical Research Ethics at the code: CCMRE-Nu-21-41, then the ethical committee of Nineveh Health Directorate after that the approval of the Teaching Hospitals in Mosul City.
Nobody professed.
There is no funding for this project.
The University of Mosul in Iraq's College of Nursing provided some funding for this study. We appreciate all of the contributing samples as well as our knowledgeable colleagues.
Mohammed Ahmed Sultan Alwily is in charge of authoring the whole book. The last draft of the work was reviewed and approved by both writers.