Background: Laws can be defined as “the principles and regulations established in a community by some authority and that is applicable to its people. Ethics distinguish between right and wrong. Objectives: (i) To assess the pre-existing knowledge of nurses regarding the legal and ethical aspects in obstetric nursing among registered nurses. (ii) To develop and administered the planned teaching programme regarding legal and ethical aspects in obstetric nursing among the registered nurses. (iii) To evaluate the effectiveness of planned teaching programme regarding legal and ethical aspects in obstetrical nursing among the registered nurses. (iv) To find out the association between pre-test knowledge score and post-test knowledge score with selected demographic variables. Methods and Materials: A pre-experimental study was conducted on 60 registered nurses were selected by convenience sampling technique. A self- structured knowledge questionnaire was used to collect data. Results: Present study revealed that in pre-test knowledge score maximum 39(65%) had moderate knowledge, whereas 15(25%) had adequate knowledge and 6(10%) had inadequate knowledge. In post-test knowledge score, maximum 34(56.7%) had adequate, 26(43.3%) had moderate knowledge and no participant, i.e. 0(0%) had inadequate knowledge. It was found that pre-test knowledge score was found to be significant with source of prior information regarding legal and ethical aspects in obstetric nursing (p = 0.000) at 0.05 level of significant. The post-test knowledge score was found to be significant with academic qualification (p = 0.035) at 0.05 level of significance and prior information regarding legal and ethical aspects in obstetric nursing (p = 0.020) at 0.05 level of significance. Conclusion:The mean post-test knowledge was higher than the mean pre-test knowledge score. Hence, it can be concluded that the planned teaching programme was effective.
As a nurse the duty of care is a fundamental part of nursing and many of the nursing individual follow it while providing the care to the patient. In the nursing curriculum although the topic is there and it explain the standard very well but in spite of that the upgradation of knowledge of registered nurses related to the legal and ethical aspects in obstetric nursing. If the nursing personnel provide the care against the medical standard then it becomes a criminal offence as by the law [1].
Nurses are highly accountable for their services she must be remain constant, promote health, prevent harm to the client and prevent illness. They are the one who provide the constant care to the client .The sound understanding of various legal and ethical issues must be there. Many times the nurses face the legal and ethical issues as they are in close contact with the patient the ethical issues based on the patient profile, medical technology and health care specialties [2,3].
The professional responsibility model of obstetric ethics guides obstetricians in a trustworthy and sensible manner for managing ethical challenges in clinical practice and research. For example, directive counseling for fetal benefit must take account of obligations to the pregnant woman, which creates the possibility of conflict between the physician’s recommendation and a pregnant woman’s autonomous decision to the contrary [4,5].
As per the code of conduct, nurses are held accountable in varying degrees, the public, their employer and their profession and most important their patient. If a patient dies as a result of nurse administering the wrong drug under the orders of a doctor, the nurse could be liable for civil action since he/she failed to deliver a reasonable standard of care expected of a nurse [6-8].
Objectives of the Study
To assess the pre-existing knowledge of nurses regarding the legal and ethical aspects in obstetric nursing among registered nurses in selected Govt. hospitals at Shimla (H.P)
To develop and administered the planned teaching programme regarding legal and ethical aspects in obstetric nursing among the registered nurses in selected Govt. hospitals at Shimla (H.P)
To evaluate the effectiveness of planned teaching programme regarding legal and ethical aspects in obstetrical nursing among the registered nurses in selected Govt. hospitals at Shimla (H.P)
To find out the association between pre-test knowledge score and post-test knowledge score with selected demographic variables.
Research Approach: Quantitative approach
Research Design: Pre-experimental
Setting of the Study: Selected Govt. hospitals Shimla (H.P)
Study Population: Registered nurses in selected Govt. hospitals at Shimla (H.P)
Sample Size: About 60 registered nurses
Sampling Technique: Convenience sampling technique
Informed Consent
Informed consent was taken from the registered nurses and confidentiality was maintained.
Inclusion Criteria
Registered nurses who were working in selected Govt. hospitals at Shimla (H.P). Registered nurses who were willing to participate. Registered nurses who were available at the time of data collection.
Exclusion Criteria
Registered nurses who were not available during the period of data collection. Registered nurses who were unwilling to participate in the study.
Development of Tool
A self- structured knowledge questionnaire was developed to assess the knowledge related to legal and ethical aspects in obstetric nursing. The tool was developed after library search and consultation with various experts. Tool was divided in to two sections:
Section A: It includes questionnaire related to demographic variables of the registered nurses
Section B: It includes self-structured knowledge questionnaire to assess the knowledge about the legal and ethical aspects in obstetric nursing among registered nurses
Validity of Tool
Content validity was done by the experts of this field.
Permission
Obtained from the concerned head of selected Govt. hospitals Shimla (H.P).
The collected data was tabulated, analyzed, organized and presented under the following headings:
Section A: Findings related to socio-demographic variables of registered nurses
Section B: Findings related to pre-test knowledge of registered nurses regarding legal and ethical aspects in obstetric nursing
Section C: Findings related to post-test knowledge of registered nurses regarding legal and ethical aspects in obstetric nursing
Section D: Findings related to the effectiveness of planned teaching programme on knowledge regarding legal and ethical aspects in obstetric nursing
Section E: Findings related to association between the pre-test and post-test knowledge of registered nurses with socio-demographic variables
Section A: Findings Related to Socio-Demographic Variables of Registered Nurses
Finding Revealed That: According to (Table 1) age, 23(38.30%) of registered nurses were between age group of >25-30 years, 21(35.0%) were in between >30-35 years, 10(16.3%) were between >35 years and 6(10.0%) of registered were age group of <25 years. According to marital status, 43 (71.1%) of registered nurses were married and 17 (28.3%) registered nurses were unmarried. None of them were divorced and widow. According to religion, 100 (100%) of the registered nurses belongs to Hindu religion According to academic qualification, 32(53.5%) of registered nurse were 10+2 with arts, 14(23.3%) of registered nurse were 10+2 with science, 13 (21.7%) of registered nurse were graduate and 1(1.7%) of registered nurse was post-graduate. According to professional qualification, 41(68.3%) of registered nurses were GNM, 11(18.3%) of registered nurses were post–basic B.Sc. nursing, 8 (13.3%) of registered nurses were Basic B.Sc. nursing and none of the registered nurse had M.Sc. Nursing. According to total working experience, 24(40.0%) of registered nurses were having 5-10 years of total work experience, 19(31.7%) had <5 years of total work experience, 10(16.7%) of registered nurses had 10-15 years of total work experience and 7(11.7%) of registered nurses had >15 years of total work experience. According to working experience in obstetric area, 41(68.3%) of registered nurses were having <5 years of work experience in obstetric area, 13(21.7%) had 5-10 years of work experience in obstetric area, 5(8.3%) of registered nurses had 10-15 years of work experience in obstetric area and 1(1.7%) of registered nurse had >15years of total work experience.
Table 1: Frequency and Percentage Distribution of Socio-Demographic Variables of Registered Nurses
| Socio-demographic variables | Category | Frequency | Percentage |
| Age | <25 years >25-30years >30-35 years >35 year | 6 23 21 10 | 10.0 38.3 35.0 16.7 |
| Marital Status | Married Unmarried Widow Divorced | 43 17 - - | 71.7 28.3 0.0 0.0 |
| Religion | Hindu Muslim Sikh Other | 60 - - - | 100.0 0.0 0.0 0.0 |
| Academic Qualification | 10+ 2 with Arts 10+ 2 with Science Graduation Post-graduation | 32 14 13 1 | 53.3 23.3 21.7 1.7 |
| Professional Qualification | GNM B.Sc. Basic Nursing Post basic B.Sc. Nursing M.Sc. Nursing Ph.D. Nursing | 41 8 11 - - | 68.3 13.3 18.3 0.0 0.0 |
| Total Working Experience | <5 years 5-10 years 10-15 years >15 years | 19 24 10 7 | 31.7 40.0 16.7 11.7 |
| Working Experience In Obstetric Area | <5 years 5-10 years 10-15 years >15 years | 41 13 5 1 | 68.3 21.7 8.3 1.7 |
| Working Area(Present) | Labour room Antenatal ward NICU Other | 11 9 14 26 | 18.3 15.0 23.3 43.3 |
| Previous Source Of Information | No YES | 44 16 | 73.3 26.7 |
| Specify The Source Of Information | Curriculum Conferences attended Workshop attended Seminar attended Other Workshop+seminar Conference+workshop+seminar | 9 1 2 2 - 1 1 | 15.0 1.7 3.3 3.3 0.0 1.7 1.7 |
| Have You Ever Faced Medicolegal Litigation | No YES | 60 - | 100.0 0.0 |
According to present working (present), 26(43.3%) of registered nurses were presently work in other areas, 14 (23.3%) of registered nurses were presently work in NICU and 9(15.0%) of registered nurses were presently work in Antenatal ward. According to previous source of information, 44(73.3%) of registered nurses had previous source of information while 16(26.7%) of registered nurses had no previous source of information. According to specific source of information, 9(15.0%) of registered nurses had information through curriculum, 2(3.3%) of registered nurses had information through attending workshop, 2(3.3%) of registered nurses had information through attending seminar, 1(1.7%) of registered nurses had information through attending conference, 1(1.7%) of registered nurses had information through attending workshop + seminar and 1(1.7%) of registered nurses had information through attending conference+ workshop + seminar. According to ever faced any medicolegal litigation, 100(100%) of registered nurses never faced any medicolegal litigation.
Section B: Findings Related to Pre-Test Knowledge of Registered Nurses Regarding Legal and Ethical Aspects in Obstetric Nursing
Finding revealed that pre-test knowledge score maximum 39(65%) had moderate knowledge, whereas 15(25%) had adequate knowledge and 6(10%) had inadequate knowledge regarding legal and ethical aspects in obstetric nursing (Table 2).
Table 2: Frequency and Percentage Distribution of Registered Nurses according to Pre-Test Knowledge of Registered Nurses (N = 60)
Knowledge score | Frequency | Percentage |
Inadequate knowledge (0-10) | 6 | 10 |
Moderate knowledge (11-20) | 39 | 65 |
Adequate knowledge (21-30) | 15 | 25 |
Section C: Findings Related to Post-Test Knowledge of Registered Nurses Regarding Legal and Ethical Aspects in Obstetric Nursing
Finding revealed that in post-test knowledge score, maximum 34(56.7%) had adequate, 26(43.3%) had moderate knowledge and no participant, i.e. 0(0%) had inadequate knowledge regarding legal and ethical aspects in obstetric nursing (Table 3).
Table 3: Frequency and Percentage Distribution of Registered Nurses according to Post-Test Knowledge of Registered Nurses (N = 60)
Knowledge score | Frequency | Percentage |
Inadequate knowledge (0-10) | 0 | 0 |
Moderate knowledge (11-20) | 26 | 43.3 |
Adequate knowledge (21-30) | 34 | 56.7 |
Section D: Findings Related to the Effectiveness of Planned Teaching Programme on Knowledge Regarding Legal and Ethical Aspects in Obstetric Nursing
Finding revealed that in pre-test it is found that maximum participants, i.e. 39(65%) had moderate knowledge, 15 (25 %) participants had adequate knowledge and 6(10%) participants had inadequate knowledge regarding legal and ethical aspects in obstetrics nursing.
In post-test it is found that maximum participants, i.e. 34 (56.7%) had adequate knowledge, 26 (43.3%) participants had moderate knowledge and 0(0%) participants had inadequate knowledge regarding legal and ethical aspects in obstetrics nursing. Hence, it is concluded that majority of the registered nurses that is 34(56.7%) had adequate knowledge in post- test that is more than pre-test score 15(25%)(Table 4) .
Table 4: Depicts Comparison of Pre-Test and Post-Test Knowledge of Registered Nurses. N = 60
Score level | Pre-test f (%) | Post-test f (%) |
Inadequate knowledge (0-10) | 6(10) | 0(0) |
Moderate knowledge (11-20) | 39(65) | 26(43.3) |
Adequate knowledge (21-30) | 15(25) | 34(56.7) |
Section E: Findings Related to Association between the Pre-Test and Post-Test Level of Knowledge of Registered Nurses with Socio-Demographic Variables
Finding revealed that by using chi square it was found that pre-test knowledge score was found to be significant with source of prior information regarding legal and ethical aspects in Obstetric Nursing (p = 0.000) at 0.05 level of significant. The post-test knowledge score was found to be significant with academic qualification (p = 0.035) at 0.05 level of significance and prior information regarding legal and ethical aspects in obstetric nursing (p = 0.020) at 0.05 level of significance.
This study was conducted to assess the effectiveness of planned teaching programme regarding legal and ethical aspects in obstetric nursing among the registered nurses in selected Govt. hospitals at Shimla (H.P). Study findings shows that there was a significant difference in the level of knowledge score between pre-test and post-test score after administering the planned teaching programme. Hence, the study concluded that the administration of planned teaching programme had significantly improved the knowledge of registered nurses regarding legal and ethical aspects in obstetric nursing.
Recommendations
(i) A similar longitudinal study can be conducted on a larger scale using a wider sample, to enhance the generalization of the findings. (ii) A similar study can be undertaken by utilizing other domains like attitude and practice. (iii) A similar study can be conducted with quasi-experimental design to find out the effectiveness of the planned teaching progamme in a more reliable manner. (iv) A study similar to the present study can be replicated in different settings. (v) A follow up study in the same areas can be carried out to determine the effectiveness of the planned teaching programme to see the changes if any incorporated in practices of staff nurses regarding legal and ethical aspects in obstetrics nursing. (vi) A descriptive study can be undertaken to assess knowledge using large sample and wider setting like covering various districts in a state, which can be helpful to collect important statistics and then give useful recommendations. (vii) A study can be carried out to assess the knowledge regarding legal and ethical aspects in obstetric nursing among nursing students. (viii) Apart from using staff nurses as study subjects, studies on this topic can also be conducted on nursing and other medical students as well as other health care professionals.
Ethical Approval
Research proposal was approved by the research committees prior to the pilot and the main study. Official permission was sought from the ethical committees of S.N.G.N.C, I.G.M.C.H and Shimla (H.P). After that the permission was sought from the Medical Superintendent and Nursing Superintendent of Deen Dayal Upadhyay Zonal Hospital Shimla (H.P). and Medical Superintendent and Nursing Superintendent Kamla Nehru State Hospital, Shimla (H.P).
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