RUFAIDA COLLEGE OF NURSING

JAMIA HAMDARD

SUMMER FIELD REPORT

Submitted To: Submitted By:

Mrs. Mikki Khan Ms. Shabnam Nesha
Assistant professor M.Sc. Nursing I year
 SUMMER FIELD REPORT

Area: Bhagwan Mahavir Hospital

Subject: Obstetrical & Gynaecological Nursing

Duration: 17. 06. 2024 to 12.07. 2024

Advisor: Mikki Khan (Assistant Professor)

 INDEX

S.NO. CONTENT

1. Acknowledgement

2. Introduction

3. General Objectives

4. Section I - Institutional Profile

5. Section II - Advance competency gained in nursing practice in
the area of specialization maternity nursing.

6. Section III - Ability develops in Management and Supervision in

clinical area.

7. Section IV - Problem Solving ability

8. Critical appraisal of hospital

9. Summary

10. Conclusion

11. A.V. Aids

12. Appendices-Experience Letter

13. Structured Interview Schedule on warning signs during
pregnancy.

15. Planned Teaching Programme in lesson plan format

 ACKNOWLEDGEMENT

I would like to express heartfelt thanks to Mikki Khan (Assistant Professor) and Madam
Veena Sharma Principal Rufaida College of Nursing for their kind approval for my
posting in Bhagwan Mahavir Hospital, Pitampura, New Delhi.

I am highly grateful to Head of Department (Dr. Shalja R. R.), Obstetrics and

Gynaecology, Bhagwan Mahavir Hospital, New Delhi for their cooperation and expert
guidance all through the Posting in Hospital.

My special thanks to Sister Shakuntala lakara (Sister Incharge) Obstetrics and

Gynaecology department, Bhagwan Mahavir Hospital, New Delhi for her Guidance
help and support.

I express my sincere thanks to all Nursing staff, Doctors and other clerical staff for
helping me to complete my experience in Bhagwan Mahavir Hospital, New Delhi.

Above all, I express my deep sense of gratitude to Supreme Lord, the Almighty God for
his abiding grace in completion of the summer field.
INTRODUCTION

Birth is the time of physical and emotional crises for women, her child and her
family. It requires collaborative care between the obstetric team, the pregnant woman and
the family. The birth of healthy baby is a dream of every mother; it is a joyful and
thrilling experience. The mere thought of becoming parents is the most amazing
adventure and has a profound impact on the best of individual’s life. To achieve a healthy
pregnancy, women must maintain holistic good health, right from adolescence. Maternal
care is very important aspect during pregnancy to prevent morbidity and mortality in not
only in western countries but in India also. It has seen that improper care cause death of
mother. Because of its large prevalence Doctors, Nurses, need to be updated in the skills
of assessment, management and possibly the prevention of these disorders.

General objectives

 To gain competencies in Nursing practice in the area of obstetrical &

gynaecological Nursing.
 To develop problem solving ability in the clinical area.
 To develop further abilities in Management and supervision in Clinical area.
 To record & report summer field experience effectively & develop report writing
ability.
SECTION -I

Hospital
PROFILE
Bhagwan Mahavir Hospital

 Bhagwan Mahavir Hospital is a 325 bedded – multi specialty hospital

situated at H-4/5, Guru Harkishan Marg, Pitampura, Delhi-110034.

 Its main objective is to provide free basic health care services. Standards
of services may be influenced by workload & availability of resources at
that particular time. Yet it is intended that all users receive courteous &
prompt attention.

 The hospital campus is spread over 40043.26 Sq. mtrs.

 The hospital has been established with a view to provide primary &
secondary treatment for 10-20 lakhs (approx) population of the urban area
including the bordering area of North West District of Delhi.

FUNCTIONS OF BMH Hospital

1. Medical Care: Clinical Health Services may include, but not be restricted to, the
following
Services provided by medical practitioners and/or appropriately qualified.
 Diagnostic and clinical care
 Treatment of illness/disease
 Referral Services
  Senior Residents and Junior Resident (Residential facility) and Tertiary health
care (specialist services and care).
1. Health professionals
2. Sterilization of equipment meeting
3. MCH including Family Planning
4. Safe Water Supply and basic sanitation.
5. Prevention and control of locally endemic diseases.
6. Collection and reporting of vital statistics.
7. Education about health
8. National health programmes
9. Referral services
10. Training of health guides, health workers, nurses and health assistants
11. Basic laboratory services

ORGANIZATION SETUP
Bhagwan Mahavir Hospital

Medical superintendent DNS

(Dr. Rajiv gupta) (Sister Renu
Sehgal)

DMS SNO.
(Dr. Daljeet)

NO
SR

JR
CLINICS CONDUCTED AT OPD

DAY TIMINGS (8.00 A.M. TO 2.00 P.M.)

Monday Obstetric +Family Planning
Tuesday Gynae OPD
Wednesday Antenatal OPD+ Family Planning
Thursday Obstetric OPD
Friday Obstetric OPD +Family Planning
Saturday Gynae OPD

NOTE: Copper-T insertion is done on family planning days from 12.00 to 2.00 P.M.

Facilities Available in Bhagwan Mahavir Hospital

1) Antenatal, natal and postnatal care

2) Family planning
3) Well baby clinic (Immunization)
4) Child clinic
5) Laboratory: free investigations are done for all patients.
 Blood : Hb (by HCL dilution method), TLC, DLC, Bl group + Rh factor
and blood glucose(by glucometer)

 Urinalysis : Routine and Microscope

Pregnancy test (by pregcard)
Albumin/Sugar (by urostick)
Bile Salts & Bile pigments

 Stool : Routine & microscopic

  X-rays
 USG
 Operation Theatre-Major and minor surgeries
 Casuality services

6) Sterilization of instruments
7) Pharmacy service
 Standard medicines are provided free of cost to the patient from the
Centre’s pharmacy.
 There are many qualified pharmacist who dispenses medicines and
maintains monthly stock of medicines.

Free Drugs available at PHC pharmacy are

 Metronidazole & Clotrimazol tabletss.

 Alercuro syrup
 Nimesulede
 Ciproflox
 Soliwax
 Norflox
 Iron & Folic acid tablets
 Rabeprazol
 Paracetamol & Combiflame
 Abendazole
 Secandazole
 ORS and Contraceptive devices
 Cetrizine
VARIOUS REGISTERS MAINTAINED IN PHC & MATERNITY
HOME

 Registration register
 Antenatal register
 Family Planning register
 Postnatal register
 Immunization register
 Stock register
 Attendance & leave record register of staffs
 Census register
 Pharmacy (drug) register
 Admission & discharge register
 Delivery record register
 Referral register
 Indent register
 Incentive record register (ASHA incentive)
 Infectious diseases register
 Eligible couple register
 Jannani Suraksha Yojana record register
 Birth register
 Death register
SERVICES AVAILABLE AT BHAGWAN MAHAVIR HOSPITAL

1. Child Care Clinic

Children in the age group of 0-14 years constitute about 40% of the total population
& they are the most important age group in all societies as the determinants of chronic
diseases later lift and health behaviour are laid down at this stage. Family influences and
education are of the highest importance as it influences patterns of their future life, styles,
occupational skills, political attitudes & leadership, transmission of attitudes, customs &
behaviours. They are vulnerable to disease, death & disability. Children Under 5 years
of age constitute 15-20% of population & 35-60% of all death occurs in the age group
due to diarrhoea disease, malnutrition & acute infectious diseases. Childhood is also a
period of rapid growth & best combination of curative, preventive, & promotive care
services.

AIMS & OBJECTIVES OF UNDER FIVE CLINIC

Health Education Care in

illness Health Education

Growth Family Preventive

monitoring planning care

Health Education

Symbol of Under Five Clinic

Care in illness: the apex of the triangle represents “care and treatment of sick children.

Preventive care: It includes Immunization

Nutritional surveillance: food supplements are an integral part of child health care &
ICDS has taken up supplementary feeding of children below 6 years.

Health check-up: undertaken every 3 to 6 months. The child health card provides a
checklist for these examinations.

Family planning: In the centre of triangular area, red colour stands for family planning
& it is an important component of child welfare.

Health education: Around the whole symbol is a border that touches all the other areas,
represents health education which is necessary for each part of service and binds them all
together.

Growth Monitoring:

Growth monitoring is one of the basic activities of the under 5 clinics where the child is
weighed periodically at monthly intervals during the 1st year, every 2 months during the
2nd year and every 3 months thereafter up to the age of 5 to 6 years.
Growth monitoring is viewed in most programs as an activity for weighing
children regularly and plotting weight on growth charts to identify under nutrition
(mostly severe Protein Energy Malnutrition) for feeding programs or to provide data on
nutritional status. There are no national policies for growth monitoring beyond the age of
6 years.
Growth Monitoring is a screening tool to diagnose nutritional, chronic systemic
and endocrine disease at an early stage. It has been suggested that growth monitoring has
the potential for significant impact on mortality even in the absence of nutrition
supplementation or education. Monitoring the growth of a child requires taking the same
measurements at regular intervals, approximately at the same time of the day, and seeing
how they change. A single measurement only indicates the child’s size at that moment.

Aims And Rationale For Growth Monitoring, Growth Charts, Intervals For
Monitoring And Criteria For Referral.

Aims and Rationale

Primary aims

To identify children with growth deviation i.e., under nutrition and over nutrition and to
identify diseases and conditions that manifest through abnormal growth.

Secondary aims

1. To discuss health promotion related to feeding, hygiene, immunization and

other aspects of the child’s health and behavior; education of parents to allay their
anxiety about their child’s growth.

2. To sensitize pediatricians to use growth charts.

2. FAMILY PLANNING SERVICES

Family planning being a national programme and the operational goals

of FP are:

 To promote the concept of small family & child spacing.

 To ensure adequate supplies of contraceptives.
  To disseminate information to all eligible couples about family
planning methods.
 Family planning services are provided 7 days in a week.
 Patients are examined, counselled & motivated for adoption of
small family norms. Cu-T insertion removal & reinsertion are done
by expert doctors of PHC. Mala N & condoms are also made
available to people free of cost.

Diagram showing family planning devices

 Copper -T & its placement in uterus

 Mala N
Condom

3. IMMUNIZATION SERVICES

Immunization is the birth right of any child. Immunization is the best and cheapest
investment in the health of children. A National immunization programme has been in
operation in India Since 1978, under the banner of Universal immunization programme to
protect all children by 2000 AD against 7 most common diseases which are preventable.
Immunization is done according to the schedule recommended by the Govt. of India in
the MOH & family welfare.
National Immunization Schedule

Vaccine Age
14 9-12
6 10
Birth
weeks weeks
weeks months
Primary vaccination
BCG X
Oral polio X X X X
DPT X X X
Hepatitis B* X X X
Measles X
Booster Doses
DPT + Oral polio 16 to 24 months
DT 5 years
Tetanus Toxoid (TT) At 10 years and again at 16 years
Vitamin A 9, 18, 24, 30 and 36 months
Pregnant women
Tetanus toxoid (PW): 1st dose As early as possible during pregnancy (first
contact)
nd
2 dose
1 month after 1st dose
Booster
If previously vaccinated, within 3 years
JOB DESCRIPTION OF MEMBERS OF THE HEALTH TEAM

Medical officer
 He is the captain of health team of hospital.
 Attends patients in OPD
 Supervision of Field Work
 Visit of sub-centre regularly on fixed days
 Provide guidance supervision and leadership to the health team
 Organizing staff meetings at PHC to discuss the problems and review the
progress.
 Medical officer is the planner, promoter, the director, the supervisor & the
coordinator as well as the evaluator.

Ward In-charge

 Supervision of Staff Nurses work in maternity home patient care

 Maintenance of records
 Responsible for the house keeping
 Update of supplies.
 Training of staffs working under her.

Staff Nurses

 Directly responsible for patient care

 Conducting normal deliveries
 Attending the discussion held in the ward by doctors, ward by doctors, ward in-
charge
 Any other duties assigned by her superiors

Pharmacist
  To distribute medicines available in stock for patients.
 To keep record of all medicines of pharmacy.
 Indent medicines

Laboratory Technician

 To do tests which are ordered by physician.

 Maintaining records of investigations done at hospital.
 Maintaining laboratory stock.
 To dispatch the reports.

ROLE OF ANM’s

 Daily visit to the area and collection of information about death, birth, marriage,
new family etc.
 All collected information is update in family records – Health education
 ANM’s in each visit cover 20-25 houses covering a population of 6000 year.
 Early registration of pregnancy
 Antenatal care & Distribution of Iran tablets
 Post natal care & monitoring of newborn
 Immunization 0-5 years.
 Identification & referral of patients
 Growth & malnutrition monitoring
 Family planning methods

COMMUNITY HEALTH WORKERS

ASHA (Accredited social Health Activist)

ASHA is a health Activist in the community who will create awareness on health.
Selection of ASHA
 Resident of the village – a woman (married/widow/divorced)
 Preferably in the age group of 25 to 45 years.
 Formal education upto 8th class, with good communication and leadership skills.
 One ASHA for 1000 population.

Responsibilities & Roles of ASHA

1) To create awareness and provide information to community on determinants of

Health.
2) Counsel woman on birth preparedness, importance of safe delivery, breast
feeding, immunization complementary feeding, contraception, hygiene &
prevention of infections.
3) To mobilize the community & facilitate them in assessing health and health
related services available at Anganwadi/sub-centre/PHC.
4) To arrange escort/accompany pregnant woman & children requiring treatment to
nearest health centre.
5) She will inform about the births and deaths in here village and any unusual health
problems/disease outbreaks in community to the PHC/sub-centre.
6) ASHA will provide primary medical care for minor ailments such as diarrhea
fevers & first aid for minor ailments.

ACTIVITIES CARRIED OUT BY ANGANWADI

Adolescent Health Meeting

The habits developed during adolescent period stays for life. So it is the responsibility of
parents and health workers to develop healthy & responsible behaviour in adolescents.
The following interventions are necessary to promote optimal health & development of
adolescents.
 A - Adoption of healthy life style

D - Developing appropriate information, Education, Communication Strategy,

Discouraging early marriage & Teen-age pregnancies.

O - Organizing adolescent friendly clinics

L - Life skills training, legal support

E - Educating about sexuality safe sex.

S - Safe, secure & supportive environment.

C - Counselling Services

E - Enabling & Empowering adolescents to be responsible citizens.

N - Good Nutrition & food hygiene.

T - Training adolescents for income generation skills

Once in a month (Last Saturday) Dr. Bhatt along with ANM + ASHA from school health
conduct adolescent meet for a group of 13-18 girls.

IPP-8 Maternity home

There are 15 beds.with Separate nursery

Nursery has -

Incubators-1
Radiant warmer -2
Phototherapy unit - 1

Maternity Home covers sub-center and clusters. Patients are admitted in Maternity home
from clinics during working hours .After 2pm in case of emergency patients are admitted
directly in maternity home.
All normal cases are conducted at maternity home by ‘A’ grade staff nurses (Having
special training of 15 days regarding conducting normal delivery at MCD head office)

Cases referred to hospitals are

1) Meconium stained liquor
2) Preterm <35 works.
3) Intra uterine growth retardation
4) Bad obstetrical history
5) Twins
6) Malpresentation (Oblique, foot presentation, cord prolapse, breach, transverse
lie.)
7) Multigravida
8) Primigravida <18 years.
9) Pregnancy induced hypertension
10) CPD
11) Previous LSCS
12) Poly/Oligohydramnios
13) Antepartum haemorrhage
14) Fetal distress
15) Post dated by 10 days
16) Placenta Praevia grade-III
17) Severe anaemia
18) Multigravida with complications
 SECTION-II

ADVANCED
COMPETENCIES
GAINED IN
NURSING PRACTICE
IN THE AREA OF
SPECIALIZATION
 LABOUR ROOM

It is situated at the first floor. It has 2 labour tables. Baby resuscitation facilities are
available. After the delivery mother is kept in post natal ward. Immunization of baby is
done in OPD.

S.No ACTIVITIES COMPETENCIES ACHIEVED

1. Planned the total learning  Developed initiative and gained confidence in planning
programme according to the one’s own learning programme.
objectives and proposal.  Selected the PHC for getting experience according to
the objectives.
 Collected the permission letters for gaining experiences.
 Made plan for one month.

2. Visited and worked in different Gained knowledge about:

areas of the BMH and got  Physical setup & different facilities.
oriented with the physical set up  Administration.
 Important works.

3. Labour Room  Studied different protocols and policies in Labour room.

 Gained proficiency in intra-partum monitoring of
mother and foetus.
 Developed skill in setting up of a Labour room.
 Developed competency in immediate assessment and
management of new born & newborn resuscitation.
 Developed skill in the active management of third stage
of labour and management of PPH,
 Able to give health education to postnatal mothers
about postnatal care especially self-Perineal care,
 exclusive breast feeding and new born care.
 Developed competency in immediate assessment, care
and daily observation of newborn (Respiration,
temperature, weight, feeding schedule, eyes, mouth,
number character of stool, umbilical cord).
4. Maternity Wards & Maternity  Gained in depth knowledge and skill in management of
OPD in antenatal, intra-natal and post-natal period.
 Gained knowledge about management of high risk
pregnancy.
 Observed different antenatal investigations.
 Given health education to antenatal mothers according
to their need for education after assessing their
knowledge. Gained skill in assessment of the pregnant
mothers.
 Observed different antenatal investigations.
 Gained skill in HB testing, Urine testing, T.T injection.
 Observed various activities and type of care provided
by the staff and nursing personnel.
 Participated and gained ability to conduct such sessions
independently.
6. Worked in family welfare  Identified and oriented to physical setup of family
welfare.
 SECTION-III

DEVELOPED PROBLEM
SOLVING ABILITY IN
CLINICAL AREA TO
IMPROVE NURSING CARE
PRACTICE AND
MANAGEMENT OF CARE

COMPETENCIES GAINED IN NURSING PRACTICE

Abilities developed in management and supervision in the clnical area

S.N ACTIVITIES ABILITIES DEVELOPED

O
1. Planned the total learning  Developed abilities to plan my own
experience and shown to learning programme according to the
medical officer, and sister in objectives.
charge.  Gained proficiency in making effective
rotation plan according to the time
availability.
 Gained experience in taking help from
experts and supervisors to make the
posting more fruitful.

2. Discussed with medical officer  Gained knowledge about staffing

and sister in charge about the pattern, administration, policies of the
Maternity home administration & maternity home.
functioning of the maternity
Home. Gathered factual
information of Maternity Home.

3. Worked with sister in charge  Gained skill in taking administrative

and staff nurses rounds. Took rounds with sister in
charge. Gained knowledge about
Observed many problem solving organisational set up and nursing
activities done by sister in organisation chart.
charge.
 Gained knowledge about division of
Read policies and protocols. responsibilities


4. Worked with ward in-charges Gained knowledge and skill in:
 Preparing duty roster for staff nurses.
 Planning patient assignment and
nursing activities in the ward.
 Management of ward supplies and
equipments.
 Maintenance of records and reports.
 Gained experience in preparing
census.
 Saw the management of ward supplies
and equipments and ward as a whole.
5. Worked with the Senior Staff Gained skill in following administrative
Nurse of a ward functions
Management of patient care
 Admission discharge and transfer of
the patient
 Assessment of nursing needs and
assignment of patient care
 Ensuring safety and care of patients
supervised the diet distribution and
discussed with ward in charge
regarding the diet.
 Supervision and provision of health
education
 Meeting the needs of the patient and
providing direct care to the patient
 Making rounds and coordinating
patient care with other health team
members

Management of personnel

 Supervision of staff nurse work

 Maintaining discipline and
interrelationship among staff
 Evaluation of staff and personal
counselling when required
 Maintaining ward standard protocols,
manuals
 Analysis of common pattern, team
work among the staff is done

Maintenance of safe environment

 Maintaining optimum environment

for patient
 Supervised the ward cleanliness and to
maintain an aesthetic environment
 Learned about the waste management
and supervised the personnel

Maintenance of supplies and

equipments
I learned about the:
 Indenting articles and maintaining
records
 Checking of inventory
 Checking and maintaining emergency
 drugs in the ward
 Check the stock of sterile and unsterile
item
 Careful storage of the items

Recording and reporting:

Gained knowledge about the:

 Various records maintained in the
ward
 Writing daily census

6. Health education given to the Improved communication skill and

patients and their relatives after problem solving ability.
assessing their learning need.

7. Worked in OPD in maternity  Improved ability in supervision of

section. nursing personnel.
 Learned about the physical set up of
Labour Room,
 Learned about the management of
OPD patients and staff.
8 Visited Maternity O.P.D &  Learned about the management and
Family Welfare Unit and supervision of staff and patients in
Learned various procedure OPD & Family Welfare Unit
 Learned how to motivate the mothers
for Copper ‘T’ insertion& Lap ligation
procedure.
 Gained knowledge regarding Incentive
Policy.

9 Prepared a report on  Gained skill in reporting in N.S.

experience.  Gained experience on how to work in
co-operation with the concerned
authorities.
SECTION-IV

Problem
solving
ability

DEVELOPING PROBLEM SOLVING ABILITY IN CLINICAL

AREA TO IMPROVE NURSING CARE PRACTICE AND
MANAGEMENT OF CARE
Problem Solving:
Definition-
 It is a systematic process of solving simple or complex, short term or long term
problem, by applying certain observational thoughts and action process in
scientific way.
 It is a process of proceeding from a state of dissatisfaction to a state of
satisfaction, which is the attainment of desired objectives or goals.
 It is a scientific process that provides a theoretical framework utilized in attaining
the solution to complex problem.

PROBLEM SOLVING PROCESS

Defining the problem

Collection of data

Data analysis

Finding alternatives

Evaluation of alternatives

Implementation and review

INTRODUCTION:

All human life on the planet is born because of women. A woman is an

important person for her family. She nourishes her foetus and gives birth to her child.
Health of mother is tender and vital component of total care and cannot be neglected
because of the fact that if mother is healthy, the children will be healthy which in turn
affects nation’s health. So mental, physical and physiological health affect the family and
nation.

Mother’s education is not luxury but a necessity if mothers are to receive the
maximum benefits from today’s knowledge of the possible treatment, prevention and
control of the disease. Health education is essentially a process that enables people to find
out their health needs and match them with suitable behaviour. If the high risk mothers
are aware of the risk of probable future health problems, it helps them to take action early
in the pregnancy to avoid the risk factors and ensure that an appropriate care is available
whenever the problem occurs. The individual and the community have to play a very
important role and participate in the effort aimed at improving maternal and child health.
Their involvement is essential for awareness, which will lead to action. But this
awareness and involvement can only come through right kind of educational approach,
which results in self-care structure and meaningful interlocking between the community
and health care providers. This will contribute substantially in reducing maternal
mortality rate and ensuring the improvement in health of mothers and herald a healthier
21st century.
Mothers are vulnerable during their pregnancy, we need to intensify
commitment to the health of women, as they bring new life into the world. It is reported
that 40% of all women need obstetric care to manage complications which is potentially
life threatening to mothers or fetus. If proper care and health education is given to
pregnant mothers during antenatal period, most of the complications can be avoided.
.

IDENTIFICATION OF PROBLEM

Following measures were used for identification of problem:

  Problem identification was done by formal and informal talks and discussion with
sister in charge and staff nurses.
 Observing the mothers during their antenatal checkups.
 Interviewing & discussing with the mothers about warning signs during
pregnancy.
 Review of literature.

Statement Of Problem

“A Study to evaluate the effectiveness of plan teaching programme on knowledge of

pregnant mothers regarding warning signs during pregnancy”

Specific Objectives

 To assess the knowledge of pregnant mothers regarding warning signs during

pregnancy.
 To plan and implement appropriate intervention to solve and reduce the problem.
 To evaluate the effectiveness of planned teaching programme.

Methodology

Approach

Evaluative approach was considered appropriate because the primary objective of study
was to determine the knowledge deficit in mothers & the effectiveness of planned
teaching program.

Research Design
Single group design with pre and post test O1 x O2.

Method of data collection

Structured interview schedule
Tool
Structured interview schedule. It contains 15 items to judge the knowledge regarding
warning signs during pregnancy.

Validation of tool
Tool was validated by Dr SHALIJA (HOD Of OBG Departement)

Sample

Sample consist of 60 pregnant mothers up to 28 weeks of gestation attending OPD at

Bhagwan mahavir Hospital.
Setting
The study was conducted in OPD at Bhagwan mahavir Hospital, New Delhi.

Sample size
60

Sampling criteria
 Purposive sampling method was used.
 Mother up to 20 weeks of gestation attending clinic at PHC Badarpur.
 Mother available during the study period
 Mothers willing to participate in the study

Assessment of the problem

A pre-test was conducted to assess the knowledge of mothers regarding warning signs
during pregnancy. Data analysis revealed that there was knowledge deficit in mothers
regarding the above topic.

Criteria for selection of solution of problem

The above mentioned solutions were implemented depending upon:
1. Ability of the sample group
2. Practicability
3. Utility
4. Resources available
5. Availability of time
6. Economy

Alternative solutions planned

 Arrange a group discussion
 Plan for incidental teaching
 Give hand outs, pamphlet
 Planned teaching programme
 Preparation of posters and charts on the selected topic

Selection of best alternative

Considering the feasibility, time, resource, economy and availability of mothers

planned teaching programme was chosen from the alternatives.

Implementation of the programme

The programme was conducted in Ante-natal OPD on 15 June 2011 between 10-
11 am. 20 mothers had participated.
 Information regarding programme was given to the Sister in charge well in
advance.
 One room was arranged.
 Interviews were conducted to assess the existing knowledge of the mothers.
 The teaching programme was conducted for 20 min with displayed a charts
 The participants were able to clear their doubts by asking questions.
 The programme was appreciated by Sister-in-Charge and staff nurses.
Evaluation
The same interview was conducted after one week on 10 July 2024 .Evaluation of
PTP was done by statistically analyzing pre test and post tests score. Result
showed marked improvement in knowledge regarding warning signs during
pregnancy.

Result
The mean post-test knowledge score (10.8) is more than mean pre-test knowledge score
(6.9). There is mean difference of 3.9. between mean pre-test and post-test score. Hence
the teaching programme was found to be effective in improving the knowledge of the
mothers regarding warning signs during pregnancy.
 TABLE - 1
Pre-teaching & Post-teaching Knowledge Scores Of Samples On Item Related Among
Mothers Regarding Knowledge Of Warning Signs During Pregnancy.

Total Items: 15
Maximum Score: 15

Code No Of Pre Teaching Score Post teaching

Sample score
1 8 12
2 6 10
3 7 10
4 9 13
5 5 11
6 7 12
7 6 11
8 7 11
9 8 12
10 5 10
11 6 9
12 7 10
13 9 12
14 8 11
15 6 10
16 4 8
17 8 12
18 7 10
19 9 12
20 6 10
Total Score 138 216

Data presented in table 1 shows that lowest score in pre teaching is 4 while lowest
score in post teaching is 8.
 TABLE: 2

Mean Difference Of Pre-Teaching Knowledge & Post-Teaching Knowledge Score

Of The Sample On Items Regarding Warning Signs During Pregnancy.

Knowledge Score Mean Mean Difference

Pre Teaching 6.9

3.9
Post Teaching 10.8

Data presented in table-2 shows that mean Post-Teaching Score is higher than mean Pre-
Teaching Score by a mean difference of 3.9 indicating that the Planned Teaching
Programme was effective to increase knowledge among mothers regarding warning signs
during pregnancy.

12

10

0
Pre-test Post-test
 Figure:1 Bar Diagram Depicting Comparison Between Pre-Test And Post-Test
Knowledge Scores Of Samples Regarding Warning Signs During Pregnancy.

CONCLUSION
On the basis of the findings of study the following conclusion were drawn:
 Mothers were having less knowledge regarding warning signs during pregnancy.
 The PTP was found to be effective in increasing the knowledge of the mothers
regarding warning signs during pregnancy.

CRITICAL ANALYSIS OF ORGANISATION & MANAGEMENT

STRENGTH WEAKNESS

 BMH is functioning according to

 Episiotomy is given in each
its objective normal delivery.
 They are not having Partograph in
 Good record & report system.
their PHC.
 Proper aseptic technique is used  Proper documentation of tearing is
not there.
while rendering technique.
 fistuala cases are not recorded.
 Proper treatment
 Good rapport with the patients.
 Good laboratory facilities.
 Good pharmacy
 Nursing Officers are
knowledgeable
 EVALUATION OF EXPERIENCE

My one month experience at Bhagwan Mahavir Hospital, New Delhi provided me

a very informative experience in the field of nursing services, education and
administration. The experience helped me in fulfilling my objectives and enriching my
knowledge in the area of clinical specialisation. Personnel at hospital were friendly.

I could achieve all the objective of my posting in gaining advanced competencies

in Nursing practice, developing management and supervision abilities in the clinical area
of specialisation and developing problem solving abilities in the clinical area to improve
nursing care practice and patient care management and in turn enhancing the reporting
abilities.

The posting helped me to gain advanced knowledge, skills and competencies in

almost area of Nursing practice, Nursing administration and Nursing education as well as
orientation to nursing research thus contributing to my personnel as well as professional
development.

SUMMARY

Bhagwan Mahavir Hospital is a 325 bedded – multi specialty hospital situated at H-4/5,
Guru Harkishan Marg, Pitampura, Delhi-110034.
It provides various services like MCH & family planning to the community. The
experience in this BMH was very much helpful in gaining knowledge & competencies in
nursing practice. Also it added my experience to develop abilities in management,
leadership & problem solving through observations involving activities & co-operative
efforts.
CONCLUSION

Bhagwan Mahavir Hospital is a 325 bedded – multi specialty hospital situated at H-4/5,
Guru Harkishan Marg, Pitampura, Delhi. Helped me a lot in gaining advanced
competencies in obstetric nursing, management and administration.

The summer field experience in this hospital was very much helpful in gaining
competencies in nursing practice and also improving the knowledge, skill and attitude in
obstetric nursing. It also added my experience to develop abilities in management,
leadership and problem solving through observations involving in activities and co-
operative efforts. It was an overall good learning period as I could co-relate my
theoretical understanding with the practical and apply it in the field.
A.V. Aids
 appendices

STRUCTURED INTERVIEW SCHEDULE

To assess the knowledge of Primigravida mothers regarding warning signs

during pregnancy

Instructions-
Interviewer will ask questions listed in interview schedule on knowledge data & no
necessary explanation or suggestion to answer will be given. The interviewer is requested
to put a tick (√) mark in the space provided against each statement based on correct
response given by the interviewee.

Total marks-15
Marks obtained-

DEMOGRAPHIC DATA

Name:
Age:
Religion:
Address: ______________________________________________
______________________________________________
______________________________________________
Parity:
Educational status:
Occupation:

KNOWLEDGE REGARDING WARNING SIGNS

1) Do you know that warning signs of pregnancy includes?

i. Persistent headache
ii. Increased blood pressure
iii. Dimness of vision
iv. Swelling of legs & face
v. Excessive or less fetal movement
vi. Premature rupture of membrane
vii. Fever
viii. Bleeding or leaking per vagina
ix. Epigastric pain
x. All of the above

2) Do you know the warning signs during pregnancy endanger?

 i. Life of pregnant mother
ii. Life of baby
iii. Life of mother & baby
iv. Any other

3) What are the causes of warning signs during pregnancy?

i. Lack of regular antenatal check-up
ii. Poor nutrition
iii. Inadequate rest
iv. Elderly & young first time pregnant
v. All of the above

4) Do you know what normal blood pressure is?

i. 120/80 mm of Hg
ii. 130/90 mm of Hg
iii. 140/90 mm of Hg
iv. Don’t know

5) Do you know that in high blood pressure headache occurs at the?

i. Forehead
ii. Back of the head
iii. Forehead & back of the head
iv. Don’t know

6) Do you know, high blood pressure due to pregnancy causes following

complications/dangers?
i. Bleeding after delivery
ii. Fits during pregnancy
iii. Less urine
iv. All of the above

7) High blood pressure due to pregnancy causes following complications/dangers in

baby:
i. Fetal distress
ii. Intra-uterine death
iii. Excessive fetal movements
iv. All of the above

8) Do you know that, the baby in the uterus can be affected by following?
i. High blood pressure during pregnancy
ii. Premature rupture of membrane
iii. Severe anaemia
iv. All of the above

9) What will you do if warning signs appear during pregnancy?

 i. Take medicine early
ii. Take rest immediately
iii. Take doctor’s advice immediately
iv. Take food immediately

10) What can you do in severe headache?

i. Take bath
ii. Take more diet
iii. Seek medical advice
iv. None of the above

11) When should you inform to health personnel if fetal movement is:
i. Excessive
ii. Less
iii. Absence of movement
iv. All of the above

12) What is premature rupture of membrane?

i. Spontaneous rupture of membrane before onset of labour
ii. Spontaneous rupture of membrane during labour
iii. Spontaneous rupture of membrane before 28 weeks of pregnancy
iv. Spontaneous rupture of membrane after delivery

13) What are the signs of premature rupture of membrane?

i. Gush of liquor amni & under wear getting wet
ii. Intermittent or slow leaking vulval pad with urine
iii. Staining vulva pad with fecal matter
iv. Staining with gush of blood

14) What does high fever during pregnancy indicates:

i. Loss of fluid
ii. Infection
iii. High B P
iv. Don’t know

15) What will you do if high fever continues during pregnancy?

i. Consult the doctor
ii. Do some blood test
iii. Do some urine test
iv. Don’t know

ANSWER KEY
Q. No. Answer Q. No. Answer

1 x 9 iii
2 iii 10 iii
3 v 11 iv
4 i 12 i
5 ii 13 i
6 iv 14 ii
7 iv 15 i
8 iv

WARNING SIGNS DURING PREGNANCY

Lesson plan

S.No Specific Content T/L Activity Evaluation

Objective with A.V Aids
1
Introduction
Pregnancy is
normal
physiology or
phenomenon in
the life of any
women. But it
can land into
high risk at any
moment.

High risk
pregnancy is
defined as one in
which mother,
foetus and
newborn is or
will be at
increased risk
for morbidity
due to the
problems and
complications
during
pregnancy.

2 Announcement
of the topic

Today we will
discuss about
warning signs
during
pregnancy.

3. Group will Warning signs during Investigator Define

be able to pregnancy defines warning warning
define signs during signs
 warning Definition pregnancy with during
signs during Warning signs during pregnancy, the help of pregnancy.
pregnancy. which caution or threaten the Charts.
lives of and foetus pregnant
mothers and foetus.
These includes:
 Severe headache
 Blurred vision
 Swelling of feet, legs,
face and abdomen.
 Excessive/less fetal
movement
 Excessive vomiting
especially after first
trimester
 Vaginal bleeding
 Fever
 Leaking of watery fluid

4. Group will Warning signs during Investigator What are

be able to pregnancy with possible causes: explains causes the
explain of warning signs different
causes of Warning Possible during causes of
warning signs causes pregnancy with warning
signs during the help of signs
pregnancy. Swelling of Hypertension Charts. during
face and legs due to pregnancy?
pregnancy
Blurred vision PIH
Severe PIH
continuous
headache
Excess or less Fetal distress
fetal which can be
movement in cases of
PIH, from
severe
anemia.
Leaking of Premature
fluid from rupture of
vagina membrane
Fever Infection

5 Group will Pregnancy induced Investigator What is

be able to classify the normal
classify the hypertension hypertension B.P.?
pregnancy Increase in blood pressure during with the help of
induced pregnancy. charts.
hypertensio
n.
Normal blood pressure is
120/80mm Hg

Pre-eclampsia: This is a specific

condition of pregnancy which
develops after 20 weeks and
characterized by hypertension,
oedema of feet and albuminuria
(140/90mmHg).

Proteinuria: protein present in

urine. Urinary excretion of
>3oomg in a 24 hrs specimen.
Eclampsia: Pre-eclampsia when
complicated with convulsion is
called eclampsia.

Hypertension:

Mild to moderate hypertension:

Blood pressure more than
140/90mmHg but less than
160/110mmHg without
proteinuria

Severe hypertension: blood

pressure more than
160/110mmHg or more with
proteinuria.

Warning signs of pregnancy

induced hypertension (PIH)
Swelling of face and legs
Blurred vision
Severe continuous headache
6 Group will Predisposing factors of PIH: Investigator List the
be able to explains predisposin
list  Elderly and young primi predisposing g factors of
predisposin gravida factors of PIH PIH.
g factors of  Ignorance in antenatal with the help of
PIH. care charts.
 Pregnancy complication-
multiple pregnancy,
hydramnios.
 Medical disorders-
hypertension, nephritis,
diabetes.

7 Group will Swelling can be detected: Investigator How to

be able to  By observing swelling of explains how detect
detect face. swelling can be swelling?
swelling of  Tightening of rings, detected.
face and bangles, slippers.
legs.  By applying pressure if
dipping last more than
one minute, indicate
presence of swelling.
 Urine output decreases
when oedema increases.

Abnormal weight gain:

More than half per Kg per week
after 20 weeks of pregnancy.

7 Group will Management of PIH: Investigator How many

be able to Rest in left lateral position describes antenatal
state Diet: well balanced diet rich in prevention of visits
prevention protein, food like-milk, cheese PIH. should be
of PIH. attained by
Prevention of PIH: every
 By restricting regular pregnant
activities. woman?
 Rest 2hrs during day time
and hrs at night.
 Rest in left lateral
position, which increase
urine output and increases
uterine blood flow
 Avoid prolonged standing
 Regular antenatal check-
up upto 20 weeks.
 As per national rural health
mission:- Govt of India has
given schedule for antenatal
visits:

 At least three chekup/visit

should be done when
pregnancy is confirmed
 Second visit should be at
nine months
 Additional visits should
be as per need

8 Group will Nausea and vomiting in Investigator What

be able to pregnancy describes about should be
describe Nausea and vomiting are more nausea and done if
nausea and common in the first trimester of vomiting during nausea and
vomiting pregnancy, in 75% of pregnant pregnancy. vomiting
during women. Where the extreme form persists?
pregnancy. of vomiting is called hyperemesis
gravidarum

Management

 Multivitamin taken in
preconception stage
reduces incidence of
nausea and vomiting.
 Counselling and support
from doctor and strong
family.
 Frequent small meals.
 Food causing vomiting to
be avoided.
 Change of environment
may help.

If no relief seen consult a doctor.

If vomiting still persists seek
admission in the hospital for
further investigations to rule out
other causes.
9 Group will Investigator What
be able to Vaginal bleeding: explains vaginal should be
explain It is the bleeding which occurs bleeding, sign done in
 vaginal and symptoms case of
bleeding, during pregnancy through vagina. and management vaginal
sign and Sign and symptoms: with the help of bleeding
symptoms charts. during
and Light/heavy bleeding P/V pregnancy?
managemen
t. Lower abdominal pain
Passing of blood clots completely
or incompletely.
Prevention and management
 If light bleeding, mother
is advised to take
complete rest.
 Reassurance
 Avoid strenuous exercise.
 Avoid sexual intercourse.
 If bleeding does not stop
 Consult a doctor

10 Group will Investigator What

be able to Leaking of watery fluid during describes should be
describe pregnancy: management of done in
managemen When mother passes watery fluid leaking of case of
t of leaking vaginally, there are possibilities watery fluid leaking of
of watery of premature rupture of during watery
fluid during pregnancy with fluid during
membranes.
pregnancy. the help of pregnancy?
Management charts.

 Complete bed rest after

leakage of watery fluid
vaginally till subsides
 Apply sterile vulval pads
 Preserve all pads for
inspection of blood
 Medication as per doctor
advice.
 Perineal hygiene
 Continuous maternal and
fetal monitoring.
11 Group will Investigator What
be able to Fever is another warning sign describes fever should be
describe of pregnancy. and management done in
fever and during case of
managemen Management pregnancy with fever?
t during  Fever should be recorded. the help of
pregnancy.  Don’t take any medicine charts.
 Consult the doctor to rule
out the cause of infection
 Take plenty of fluid
12
Conclusion:

Warning signs
during
pregnancy affect
fetus and mother
both therefore
regular antenatal
care is needed to
identify them
early and
manage them
accordingly.

References

 Dutta. DC, Text Book of Obstetrics, 6th edition, New Central Book Agency.
 Dawn, CS (2001) Text Book of Obstetrics and neonatology, 15th edition, Kolkata:
Dawn books.
 Towler, Jean. (1980) Modern Obstetric for students midwives, 2nd edition:
London: LLOYD-LUKE.
 Rao Kamini Arvind, “textbook of Gynecology”, 1st edition, Elsevier 2008.
 Engebretson c. Joan, Littleton Y. Lynna. “Maternal neonatal and women’s health
nursing”.
 Salhan Sudha, “text book of obstetrics” 1st edition, jaypee brothers medical
publishers (p) limited New Delhi 2007.