Abstract

Preeclampsia/Eclampsia is a pregnancy-specific disease process that impacts approximately 3-5% of all births. This study to assess the management of preeclampsia among nurses working at Buea Regional Hospital. A cross-sectional descriptive study design was done where nurses were conveniently sampled and those who accepted to be part of the study were given a self-administered questionnaire and the result analyzed using excel 2016. For the results, Majority of the respondents; 13 (31.7%) were between 31 and 35 years. Of the 41 respondents sampled, 37 (90.2%) were involved in managing preeclampsia 48.65% could manage preeclampsia and 30.3% got their expertise from training schools. The most common challenges sited was equipment shortage (B.P machine, monitor, suction) (91.9%) and Irregular availability of drugs (Mgso4, and antihypertensive) (89.2%). Concerning suggestions to overcome the challenges, availability of drugs (70.3%) and equipment’s (62.2%) were the most mentioned suggestions. In conclusion, the study revealed that Nurses who participated in this study demonstrated mastery in area of managing woman with preeclampsia. The most gaps identified were physical examination needed after convulsion and assessing a woman for toxicity of magnesium sulphate (respiratory rate, urinary output and patella reflex). Few Nurses reported to have attended in service training on managing women with preeclampsia. Most of their expertise was gotten from Nursing schools, on job training workshops and observing colleagues work. It can be recommended that hospital administrators should make sure improvement of Nurses skills and practice should be parallel with the improvement of resuscitative equipment and essential drugs for managing preeclampsia. This should be done through continuing education, seminars and in-service training.

CHAPTER ONE

INTRODUCTION

1.1.Background

Preeclampsia is a pregnancy-specific disease process that impacts approximately 3-5% of all births. It is one of the primary causes of maternal, fetal, and neo-natal mortality, particularly in low socioeconomic settings and third-world countries (Mol et al., 2016). Traditionally, it is diagnosed when a pregnant woman presents with symptoms of hypertension and proteinuria. If preeclampsia continues untreated, patients often advance to eclampsia, experiencing severe complications. These complications often involve seizures, liver rupture, pulmonary edema, stroke, or kidney failure (Mol et al., 2016). Preeclampsia also affects the growth of the baby, as it affects uterine perfusion. Due to hypertension involved in preeclampsia, blood flow to the fetus is altered, leading to fetal growth restriction and preterm birth, either spontaneous or through iatrogenic delivery. In addition to impacting the fetus during pregnancy, children who are born to mothers with preeclampsia can be permanently impacted as they have a high risk of bronchopulmonary dysplasia and cerebral palsy (Mol et al., 2016). These complications and others are caused by altered blood flow to the fetus during pregnancy and by preterm birth, as many preterm neonates are small for gestational age.

Risk factors for preeclampsia are: family history of eclampsia or previous history of pre-eclampsia and eclampsia, teenage pregnancy, patient older than 35 years, multi-fetal gestation, primigravida and poor outcome of previous pregnancies including intrauterine growth retardation, abruption in placenta and fetal death (Hadad et al., 2000; Mattar & Sibai, 2000). The earliest symptoms of preeclampsia are hypertension, protein in the urine and edema. When symptoms advance, headache, blurred vision and bloating develop. Primary symptoms of severe preeclampsia are seizures or convulsions in a pregnant woman, woman in labour or within 42 days after delivery who does not have a history of epilepsy. Supportive care for preeclampsia includes close monitoring, air way support, adequate oxygenation, anti-convulsant therapy and blood pressure control (Sibai, 2005). Placing the patient in left lateral position to decrease the risk of aspiration and helps to improve uterine blood flow by relieving obstruction of venacava by gravid uterus, protecting the patient against injury during the seizures, using a padded tongue blade between the teeth and suctioning the oral secretions as needed (Nahar et al., 2013; Thompson, Neal & Clark, 2004). Nurses are in the best position to put the above strategies into practice as they are at the patient ‘s bedside for 24 hours a day and therefore they play an important role in the prevention of maternal death related to preeclampsia. Nurses are assessed during their training for skills in management of preeclampsia as described above.

Each year Nurses are trained in colleges and training schools for health personnel in Cameroon. The course is a three to four-year basic nursing and midwifery course. The management of preeclampsia is included in the curriculum. In addition to the training in colleges and training schools for health personnel in Cameroon, short courses are provided on an ad hoc basis. Advanced lifesaving in obstetrics and basic emergency management of obstetric and newborn care are among recently introduced short courses for practicing nurses.

1.2. Statement of the problem

Preeclampsia affects 5-10% of all pregnancies and contributes to 10-15% of maternal deaths worldwide (Say L, et al, 2014). Estimated case fatality rate due to eclampsia is 14 times higher in developing countries compared to developed countries (Duley, 2012). The case fatality rate due to eclampsia at Buea regional Hospital is 7.02% (Buea regional hospital archives). Knowledge of health care workers in managing eclampsia is essential in reducing maternal morbidity and mortality.

Preeclampsia has been documented as the period 20 weeks’ gestation, third trimester of pregnancy and even six weeks’ post-partum. It is known to be a very delicate period for the mother and fetus, the nurses are aware of the dangers that exist in this pathology and are taking great care to follow up the situation in order to avoid complications. Despite the attention given to this pathology, it still remains a greater cause of preterm births, and even neonatal and maternal deaths. That is why nurse’s skills in management of this condition was considered necessary, because it can help pregnant women to attend their antenatal visits and take advice on how to prevent this pathology, if not present or take medications control if present.

There are about 150 Nurse-midwives at Buea Regional Hospital currently practicing; only 32 are posted in the maternity and gynecological wards. While all the nurse-midwives have been fully trained, their retention and development of skills to effectively manage women with pre-eclampsia and eclampsia is currently unknown. Furthermore, there is no documented study conducted at Buea Regional Hospital to assess the Nurse-midwives skills in managing pre-eclampsia and eclampsia nor the ability of nurses to use the skills they do have.

1.4. Research questions

How do 41 Nurses manage Preeclampsia at Buea Regional Hospital?
What are the factors associated with Nurses procedures in managing preeclampsia at Buea Regional Hospital?
What are the challenges faced by Nurses at Buea Regional Hospital in managing preeclampsia?
1.5. Research Objectives

1.5.1. Main objective

To assess how nurses working at the Buea Regional Hospital manage preeclampsia.

1.5.2. Specific objectives

To determine how nurses, manage patients with preeclampsia at Buea Regional Hospital.
To determine factors associated with knowledge in the management of preeclampsia
To determine challenges faced by Nurses in the management of women with preeclampsia.