American Journal of Nursing Science

2017; 6(5): 418-425

http://www.sciencepublishinggroup.com/j/ajns
doi: 10.11648/j.ajns.20170605.16
ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online)

Developing Nursing Management Protocol for Maternity

Nurses Regarding Emergency Obstetric Care
Eman Mohammed Abdelhakm, Amira Refaat Said*
Faculty of Nursing, Benha University, Benha, Egypt

Email address:
Amira.refaat [email protected] (A. R. Said)
*
Corresponding author

To cite this article:

Eman Mohammed Abdelhakm, Amira Refaat Said. Developing Nursing Management Protocol for Maternity Nurses Regarding Emergency
Obstetric Care. American Journal of Nursing Science. Vol. 6, No. 5, 2017, pp. 418-425. doi: 10.11648/j.ajns.20170605.16

Received: August 19, 2017; Accepted: September 4, 2017; Published: October 11, 2017

Abstract: The aim of the study was to develop nursing management protocol for maternity nurses regarding obstetric
emergencies. An intervention (quasi experimental) study design was used. The study was conducted in the Obstetrics and
Gynecology Emergencies Department at Benha University Hospital. A convenient sample of all nurses working in Obstetrics
and Gynecology emergencies department at Benha University Hospital (40 nurse). Two tools were used for data collection; I) A
structured interviewing questionnaire: include two parts; Part 1: Socio demographic characteristics of the study nurses:
included (Age, educational level, years of experience, previous training program). Part 2: Assessment of nurses’ knowledge
regarding obstetric emergencies such as definition, causes, basic priorities and preparations for emergency obstetrics care. II)
Observational checklist for evaluating nursing management regarding obstetric emergencies such as resuscitation, nursing
management of preeclampsia, eclampsia, infection, trauma & shock and assessment of fetal wellbeing. The study results
showed that 88.7% of nurses had poor knowledge before intervention of the protocol. However, 75.7% of them had good
knowledge after intervention respectively. As well as, 77.5% of them had unsatisfactory practices toward emergency obstetrics
care before intervention of the protocol. Meanwhile, after intervention 82.3% had satisfactory practices respectively. The study
concluded that Nurses’ management protocol has appositive effect on nurse’s knowledge and practices regarding obstetric
emergencies. There was a highly statistically significant difference before / after protocol of the studied nurses’ knowledge and
practice regarding obstetrics emergencies (P ≤ 0.001). The study recommended that Simple guidelines regarding emergency
obstetrical nursing care can be attributed to nurses in the emergency obstetrics department. Continuous refreshment courses
and follows up programs for nurses regarding emergency obstetrics care.
Keywords: Emergency Obstetrics Care, Nursing Management Protocol

conditions as obstetrical emergencies, ectopic or tubal

1. Introduction pregnancy, abruptio placenta, placenta previa, sever
Obstetrical emergencies are life threatening medical preeclampsia & eclampsia or pregnancy induced
condition that occurs during pregnancy, labor, or the post- hypertension, premature rupture of membranes, amniotic
partum period. Globally, every year an estimated 287,000 fluid embolism, inversion or rupture of uterus, placenta
women die of complications during pregnancy or childbirth accreta, prolapsed umbilical cord, shoulder dystocia,
There are a variety of obstetrical emergencies of pregnancy postpartum hemorrhage and postpartum infection [23].
that can threaten the well-being of both mother and child. Obstetrical emergencies are the leading causes of maternal
The five major global causes of maternal death are severe mortality worldwide particularly in developing countries
bleeding; infections, unsafe induced abortion, hypertensive where lack of transport facilities, financial constraints due to
disorders of pregnancy (eclampsia) and obstructed labor yet poverty, illiteracy, ignorance, inadequate health infrastructure
many of these deaths are preventable [16]. and meager blood bank facilities. Although most of
The world health organization posits the following obstetrical emergency situations have been well described
and have widely accepted management strategies, the reports
419 Eman Mohammed Abdelhakm and Amira Refaat Said: Developing Nursing Management Protocol for
Maternity Nurses Regarding Emergency Obstetric Care

of maternal mortality continue to highlight wide spread and 1.2. Aim of the Study
substandard care of obstetrical emergencies probably
contributed to mortality reports [9]. This study was aimed to develop nursing management
Obstetrics emergency protocols are strategies geared protocol for maternity nurses regarding obstetric
towards reducing maternal deaths. The core elements of emergencies. This aim was achieved through:
obstetrics emergency protocols include availability of skilled 1. Assessing nurses' knowledge and practices regarding
personnel to carry out effective interventions during obstetric emergencies.
pregnancy, delivery and postnatal period, availability of 2. Designing and implement nursing management protocol
essential drugs and supplies and patient referrals. Skilled regarding obstetric emergencies.
health professionals working in favorable environment should 3. Evaluating nursing management protocol after
be available and able to attend to every pregnancy, delivery application regarding obstetric emergencies.
and must be available 24 hours a day, seven days a week [6]. 1.3. Research Hypothesis
The goals of nursing management protocol of critically ill
obstetric women involve intensive monitoring and Nurses’ management protocol has appositive effect on nurse’s
physiologic support for women with life-threatening to detect knowledge and practices regarding obstetric emergencies.
abnormal findings or subtle signs and symptoms of
developing complications. Thus, the nursing contribution is 2. Subjects and Methods
very important to the rescue and mobilization of the team
process to provide proper immediate care for the mother and 2.1. Research Design
the newborn and prevent any complication to be arises [4].
Nurses have a crucial role in the care of the woman during Quasi experimental design was used for conducting the study.
pregnancy and childbirth in the obstetric department being 2.2. Setting
considers the first members of the healthcare team to detect
abnormal findings or subtle signs and symptoms to provide The study was conducted at Benha University Hospital in
proper immediate care for the pregnant woman & her fetus to Obstetrics and Gynecology Emergencies Department.
prevent any complication to be arises so, it important to have
be knowledgeable a well-trained nurse about the normal and 2.3. Subjects
abnormal processes of child birth appropriate technical skills; 2.3.1. Subject Type
communicate and collaborate well with the health care team, A convenient sample of a total nurse’s works in Obstetrics
self-confidence and possess the necessary judgment, skills to and Gynecology emergencies department at Benha
cope with stressful and emergency conditions [17]. University Hospital were recruited for the study (40 nurses).
1.1. Significance of the Study 2.3.2. Subject Size
Obstetrical emergencies can occur at any time in the birthing Size of the sample was completed during 6 months /three
process; therefore all health professionals involved in caring days per week, all nurses who worked at previous mentioned
for women should be competent in both accurate diagnosing setting.
and appropriate and timely management of an obstetrical 2.4. Tools of Data Collection
emergency. An obstetrical emergency therefore requires an
immediate and appropriate response to prevent complications Two tools were utilized for data collection, prepared by the
that may affect not only the childbearing woman [13]. researchers after reviewing related literature and tested by a
Every day around the world, approximately 830 women die panel of experts for validity.
from preventable causes related to pregnancy and childbirth.
The maternal mortality ratio in developing countries in 2015 is 2.4.1. First Tool
239 per 100 000 live births versus 12 per 100 000 live births in A structured interviewing questionnaire: include two parts;
developed countries. Integrated care before, during and after Part 1: Socio demographic characteristics of the study nurses:
childbirth can save the lives of women and newborn babies. included (Age, educational level, years of experience, previous
Between 2016 and 2030, as part of the Sustainable training program). Part 2: Assessment of nurses’ knowledge
Development Goals, the target is to reduce the global maternal regarding obstetric emergencies which includes (definition,
mortality ratio to less than 70 per 100 000 live births [24]. causes, basic priorities and preparations for emergency
In Egypt the maternal mortality ratio was 33 obstetrics care- causes of bleeding during pregnancy, labor &
deaths/100,000 live births [21]. In order to assist nurses to be post natal- priorities of nursing care for bleeding- causes, signs
competent in delivering care for high risk women, & symptoms of maternal infection and priorities of nursing
Developing nursing management protocol was applied for care for infection- priorities of nursing care for external
nurses to update and upgrade their knowledge, skills and to trauma- priorities of nursing care for toxemia.
be reference guide whenever needed, also, it should be Scoring system:
utilized and integrated through educational modalities, The questions were scored as the following; score (1) was
therefore this study was conducted. given for the correct answer and (0) for the incorrect answer
 American Journal of Nursing Science 2017; 6(5): 418-425 420

before and after application of the protocol. The scores of study due to no modification done in the tool.
total knowledge was considered as more than 60% was
adequate and less than 60% was in adequate. 2.5.5. Procedures
Incorporate the following phases as following
2.4.2. Second Tool 1) Assessment phase:
Observational checklist: it was adapted from the (Royal Nurses were assessed for their needs prior implementation
College of Obstetricians and Gynecologists guidelines, 2016) of the nursing management protocol regarding obstetric
guidelines present recognized methods and techniques for emergencies care.
clinical practice, based on published evidence for 2) Planning phase:
management of obstetric emergency situations to evaluate The content of the nursing management protocol related to
nursing practices regarding obstetric emergencies which obstetric emergencies was designed to meet the following
includes basic nursing care in obstetrics emergency such as objectives:
resuscitation ( air way, oxygen administration, breathing and a) General objective:
circulation) – nursing management of preeclampsia, At the end of nursing management protocol sessions each
eclampsia, infection, trauma and shock- assessment of fetal nurse should be able to acquire essential knowledge and
wellbeing- Perineal care- catheter care – partial path. skills needed to provide competent care to women with
Scoring system: obstetric emergencies.
The checklist items were scored (2) for done each step b) Specific objectives
correctly while (1) score was given for done incomplete At the end of protocols sessions each nurse should be able
correctly and (zero) score for not done. The scores of total to:
practice were considered as ≥ 80% was satisfactory and ≤ 1. Define emergencies in obstetrics.
80% was unsatisfactory. 2. List and discuss causes of emergencies in obstetrics.
3. Give priorities of nursing care for obstetric
2.5. Methods emergencies.
The study was executed according to the following steps 4. Apply preparations needed for emergency obstetric
care.
2.5.1. Approvals 5. Discuss causes of bleeding in obstetrics.
A written official approval to conduct this research was 6. Determine priorities of nursing care for bleeding in
obtained from the director of Benha University hospital that obstetrics
was taken and delivered to the director of the Obstetrics and 7. Apply the nursing care for trauma in obstetrics
Gynecology Emergencies Department, in order to obtain their 8. Explain causes, signs and symptoms of infection in
agreement to conduct the study after explaining its purpose. obstetrics
9. Determine priorities of nursing care for infection in
2.5.2. Tools Validity and Reliability obstetrics
The developed tool was reviewed for appropriateness of 10. Recognize priorities of nursing care for toxemia during
items and measuring the concepts through five an expert jury pregnancy in obstetrics
panel in the field of maternity nursing and obstetric medicine As well as the nurses should be able to practice proficiently
specialty to assure content validity. The questionnaires were all procedures related to obstetric emergency situations.
modified according to the panel judgment on clarity of Implementation phase: The nursing management protocol
sentences and appropriateness of content (The reliability was was carried out at Obstetrical and Gynecological Emergency
done by Cronbach's Alpha coefficient test equal 0.87). Department at Benha University Hospital. Based on the
2.5.3. Ethical Considerations results obtained from pre training assessment using the
All ethical issues were assured, participants were given interviewing questionnaire and observation checklists,
explanations about the purpose of the study, and they were teaching and training were constructed to satisfy the studied
also informed that they could withdraw from the study at any nurses’ deficit knowledge and practice about obstetrics
time before the completion of the study. Participants who emergencies care. Implementation of teaching and training
agreed to complete in this study were asked to sign a consent took (12) weeks period and were implemented for a group of
form. Confidentiality of participants‟ information was (4) nurses according to working circumstances, nurses’
assured and the data were accessed only by the investigators physical and mental readiness. The researcher visited the
involved in the study. setting three days per week. The overall sessions were 8
sessions were devoted to (3 theory and 5 practical), nurses
2.5.4. The Pilot Study were divided into 10 groups and the content was
The pilot study was conducted on 4 nurses (10% of 40 implemented for each group separately. The duration of each
nurses) to test the clarity and the applicability of the tool, find theory session was ranged from 20-30 minutes while
out the possible obstacles and problems that might face the practical session was ranged from 30-60 minutes including
researchers and interfere with data collection. The study periods of discussion according to their achievement,
sample included in the pilot study was included also into the progress and feedback. The researchers went to the unit two
421 Eman Mohammed Abdelhakm and Amira Refaat Said: Developing Nursing Management Protocol for
Maternity Nurses Regarding Emergency Obstetric Care

days per week from 9.00 A.M to 1.00 P.M for six months significant difference before / after training protocol during
starting from the beginning of June 2016 till end of emergency situations in obstetrics procedures.
November 2016. At the beginning of first session an Table (4) shows that, there was positive statistically
orientation to the program, general and specific objectives significant correlation between knowledge and age before &
were explained. Arabic languish was used to suit all level of after protocol. Also, there was positive statistically
education. Different methods of teaching and training significant correlation between knowledge and years of
strategies were used such as lecture, group discussion, experience before & after protocol.
demonstration and re-demonstration for clinical procedures Table (5) shows that, there was positive statistically
Instructional media included, handout prepared by the significant correlation between practice and age before and
researcher and distributed to all nurses in the first day of the after training. Moreover, there was positive statistically
training. After each session feedback was done. Most nurses significant correlation between practice and years of
were cooperating and interested by the topic. experience before and after training.
3) Evaluation phase: Table (6) reveals that, there was no statistically significant
After completion of the protocol sessions the questionnaire correlation between knowledge before teaching and practice
format and observation sheet were filled again to evaluate before training. On the other hand, there was statistically
effectiveness of the protocol with the same pretest questionnaire. significant correlation between knowledge after teaching and
practice after training.
2.5.6. Statistical Analysis Figure (2) Illustrates that (77.5%) of studied nurses have
Data was collected, presented in tabular form. Percentages unsatisfactory practice before protocol compared to (82.3%)
were calculated for qualitative data and x2 for test of after protocol have satisfactory practice respectively.
significance, mean and standard deviations were calculated
for quantitative data using the Statistical Package for Social Table 1. Distribution of the studied nurses according to their socio
Sciences (SPSS version 20) for statistical analysis. demographic characteristics (n=40).

n= 40
Characteristics of nurses
3. Results Number Percent
Age ( years)
Table (1) shows that, 47.5% of studied sample were over 30 < 20 5 12.5
years, the mean age was 29.5 ±6.7. Regarding qualification, 20 - 7 17.5
25 - 9 22.5
most of them 77.5% had secondary school diploma and only ≥ 30 19 47.5
5.0% had bachelor degree. As regards years of experience, Mean ± SD 29.5 ± 6.7
more than half of them 60.0% had more than ten years of Educational qualification
experience, while 17.5% had less than 5 years of experience, Secondary school diploma 31 77.5
the mean years of experience 11.5 ±6.4. The majority of the Technical institution 7 17.5
Bachelor degree 2 5.0
studied nurses 87.5% did not receive any training program Experience (years)
regarding obstetric emergencies in the department. <5 7 17.5
Table (2) shows that, there was a highly statistically 5 – 10 9 22.5
significant difference before and after protocol regarding the >10 24 60.0
Mean ± SD 11.5 ± 6.4
studied nurses’ knowledge.
Training about emergency obstetric care courses
Figure (1) Illustrates that, (88.75%) of studied nurses have Yes 5 12.5
inadequate knowledge before protocol compared to (75.75%) No 35 87.5
after protocol have adequate knowledge respectively.
Table (3) clears that; there was highly statistically
Table 2. Distribution of the studied nurses’ regarding their knowledge about obstetrics emergencies in obstetric department before / after protocol (n=40).

Before program After program

X2
correct answer Incorrect answer correct answer Incorrect answer p-Value
Obstetric Emergencies test
No % No % No % No %
Definition of obstetric emergencies 11 27.5 29 72.5 28 70 12 30 31.2 <0.001**
Causes of obstetric emergencies. 8 20 32 80 24 60 16 40 42.7 <0.001**
Basic Priorities & Preparations needed 18 45 22 55 28 70 12 30 13.8 <0.001**
Causes of bleeding 9 22.5 31 77.5 33 82.5 7 17.5 56.6 <0.001**
Priorities of nursing care for bleeding 12 30 28 70 31 77.5 9 22.5 45.5 <0.001**
Causes of infection 2 5 38 95 33 82.5 7 17.5 64.2 <0.001**
Signs and symptoms of infection 7 17.5 33 82.5 28 70 12 30 96.6 <0.001**
Priorities of nursing care for infection 5 12.5 35 87.5 25 62.5 15 37.5 40.1 <0.001**
Priorities of nursing care for trauma 12 30 28 70 21 52.5 19 47.5 34.1 <0.001**
Priorities of nursing care for toxaemia
7 17.5 33 82.5 39 97.5 1 2.5 101.1 <0.001**
during pregnancy

** A highly statistical significant difference (P ≤ 0.001)

 American Journal of Nursing Science 2017; 6(5): 418-425 422

Table 3. Distribution of the studied nurses’ regarding practices about obstetric emergencies in obstetric department before / after management protocol
(n=40).

Before management protocol After management protocol

Complete Incomplete Correct Complete Incomplete Correct X2
Items p-Value
Correct & Incorrect Correct & Incorrect test
No % No % No % No %
Basic nursing care (ABCs of resuscitation: airway,
10 25 30 75 29 72.5 11 27.5 10 < 0.001**
oxygen admin. breathing, and circulation )
Management of bleeding 6 15 34 85 31 77.5 9 22.5 35.6 < 0.001**
Management of preeclampsia and eclampsia 10 25 30 75 36 90 4 10 65.2 < 0.001**
Infection control measures 4 10 36 90 26 65 14 35 45.9 < 0.005*
Management of trauma 6 15 34 85 34 85 6 15 55.3 < 0.001**
Management of shock 10 25 30 75 37 92.5 3 7.5 56.5 < 0.001**
Assessment of the fetal wellbeing 4 10 36 90 35 87.5 5 12.5 35.8 < 0.001**
Perineal care 12 30 28 70 36 90 4 10 37.8 < 0.001**
Catheter care 12 30 28 70 30 75 10 25 29. 6 < 0.001**
Partial bath 10 25 30 75 38 95 2 5 45.6 < 0.001**

*A statistical significant difference (P ≤ 0.05)

** A highly statistical significant difference (P ≤ 0.001)

Table 4. Correlation coefficient between total nurses’ knowledge scores

regarding emergency obstetric care before /after protocol, age and years of
experience.

Total knowledge
Variable Pre Post
R P R P
Age 0.531 < 0.01 0.635 < 0.01
Years of experience 0.528 < 0.01 0.636 < 0.01

Table 5. Correlation coefficient between total nurses’ practices scores

regarding emergency obstetric care before / after training, age and years of
experience.

Total knowledge
Variable Pre Post Figure 2. Percentage distribution of the studied nurse’s regarding total
R P R P nursing practices pre/ post training program.
Age < 0.01 0.692 < 0.01 0.436
Years of experience < 0.01 0.635 < 0.01 0.421 4. Discussion
Table 6. Correlation coefficient between total scores of nurses’ Knowledge Developing protocols regarding obstetric emergencies is
and practice before / after protocol.
essential to provide the highest quality and most cost-
Knowledge before Knowledge after efficient nursing care. To advance quality of care provided by
teaching teaching nurses, increase satisfaction of women. The quality of
Variable obstetric emergencies and new-born care services are very
R P R P
important, particularly in countries with a high burden of
Practice before training 0.283 >0.05
Practice After training 0.427 < 0.01 maternal and new-born mortality, appropriate care when
emergencies arise according to accepted clinical standards
and protocol, providing services in a manner corresponding
to the rights and needs of all clients which include continuity
of care, information and informed choice, privacy and
confidentiality, dignity, comfort and expression of opinion
Otolorin et al. [19].
This study was aimed to develop protocol for nurses
regarding obstetric emergencies in obstetrical and
gynecological emergency department at Benha University
Hospital. This aim was achieved through assessing nurses’
knowledge & practices regarding obstetrics emergencies,
design & implements training protocols & evaluates nurses’
knowledge and practical skills after nursing management
protocol application regarding obstetric emergencies.
Figure 1. Percentage distribution of the studied nurses in relation to their
total knowledge score pre/ post program. Regarding characteristic of the studied nurses, the study
423 Eman Mohammed Abdelhakm and Amira Refaat Said: Developing Nursing Management Protocol for
Maternity Nurses Regarding Emergency Obstetric Care

showed that, near to half of studied sample were over 30 knowledge and the gap of knowledge couldn't be overcome
years. Most of nurses had secondary school diploma. More by simply providing more training, so most of staff reported
than half of the nurses had more than ten years of experience. perception of poor quality of care.
Majority of the studied nurses did not receive any training Regarding practical skills of nurses during emergency
program regarding management of obstetric emergency situations in obstetrics, results of the present study revealed
situations. that, nearly three quarters of the studied nurses had incorrect
This interpretation is in the same line with the finding of practice regarding management of obstetrical emergencies in
Islam et al, [14]. who studied “The Implementation of the unit before protocols implementation. This could be
Emergency Obstetrics Care Training in Bangladesh”. This explained by their lack of knowledge regarding management
study found that the majority of nurses who were included in of obstetrical emergencies, absence of protocol related to
the study had diploma nurse that were graduated since long emergency obstetric care and lack of training programs.
period of time and did not attend any refreshing courses that This unsatisfactory level of practice showed the
affected negatively on the quality of obstetrics care. Also, importance of continuous education, protocols and regular
this finding agrees with Attia. [3]. who found that about two updating clinical courses for nurses to promote knowledge
third of the nurses expressed that there is no protocol related and practice. Therefore, it is important and essential that
to obstetrical emergency nursing care that reflect on their nurses are well trained and educated on obstetrical
performance. emergencies especially in the emergency department as they
Regarding nurses' knowledge about obstetrical have the vital role to play to inform the doctor and begin the
emergencies in obstetric and gynecological emergency initial assessment and management of such cases.
department, results of the present study revealed that there The present study revealed improvement in nurses’
was more than half of the nurses included in the study had practice after nursing management protocol. This is
incorrect knowledge regarding obstetrical emergencies that supported by Traoré et al., [22]. Who mentioned, there was a
negatively reflected upon the nursing care offered for the relation between the availability of guidelines for the
admitted cases with obstetrical emergencies. This result management of obstetrical emergencies and the higher
may be due to absence of educational program regarding competency of physicians, health technicians, and obstetric
emergency situations in the unit. Also, this lack of nurses (P<0.001).
knowledge may be related to the level of education and This result is supported by Islam et al., [14]. Who
could be interpreted that nearly most of the studied nurses indicated that regular training of nursing personnel will
were diploma nursing graduate that were graduated since improve and enhance quality of health care. Also, this result
long period of time that might led them to lose too much of agrees with El-Bahy et al., [12]. Who stated that, the majority
their basic graduation knowledge and skills, as well as of nurses before training had incorrect practice regarding
absence of training programs related to obstetrical basic care for women with pregnancy induced hypertension
emergencies care. and concentrate that partial care & perineal care are also
This result is congruent with El-Bahy et al., [12]. Who important components of health care for women during
studied “Effect of Educational Program for Nurses about pregnancy and should not be neglected. Bradley et al., [7],
Pregnancy Induced Hypertension on their Knowledge in Port found that inadequate obstetric skills, undermining
Said, Hospitals, Faculty of Nursing, Cairo University”. This performance and professionalism were main factors that
study found that the nurses had incorrect knowledge about effect on the quality of care.
nursing care for preeclampsia and eclampsia. This may be In addition to Alderman, [2], reported that effective
due to the fact that nurses did not receive adequate communication between nurses and other members of the
information or may need for refreshing in-services training health care team is an essential component of patient safety.
regarding management of pre-eclampsia and eclampsia Furthermore Alam et al., [1] who found that the main reason
during labor. for non-availability of obstetric emergency care services was
The results of the present study revealed also that there the lack of specialists and trained nursing providers. And
was significant improvement of nurses’ knowledge after also, this result agrees with Chodzaza & Bultemeier, [10]
protocols application compared to before it. This finding was who found that there were facility/ staff themes which
agreement with Brenner., et al [8]. who reported that, emerged as contributing to the poor care and included
training health-care providers in obstetric emergency and inadequate resources, inadequate staffing, poor teamwork,
newborn care concentrate the need to build the capacity of and inadequate knowledge.
health-care providers to recognize and manage complications Results of the present study revealed that there was
during pregnancy, labor and the post-partum period through positive statistically significant correlation between
providing skills and competency-based training in skilled knowledge before and after training in age and years of
birth attendance, emergency obstetric care and early newborn experience, this result is disagree with Kavitha et al., [15]
care which considered an approach that was successful in who found that there was no significant relation between
improving skills & improved availability and quality of care. nurses ‘knowledge regarding emergency obstetric
This result is contradicted with Bayley et al, [5]. Who management and their age.
concluded that training had little impact on levels of Also, results of the present study revealed that there was
 American Journal of Nursing Science 2017; 6(5): 418-425 424

positive statistically significant correlation between practice Acknowledgements

and age before & after training. Moreover, there was positive
statistically significant correlation between practices before The researchers would like to express gratitude and
& after nursing management protocol and years of appreciations to the nurses who participated in this study for
experience. This result disagrees with Attia [3] who found their effective cooperation.
that there was no statistically significant relation between
nurses’ performance & their age. Also, this result agrees with
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