Women's Health Hospital Research Articles

Assessment of Nurses Knowledge About Preventive and Therapeutic Measures of Postpartum Hemorrhage

Background: Postpartum hemorrhage remains one of the major causes of maternal death that occurs worldwide which can be preventable and treatable. Aims of the Study: Assess of maternity nurses knowledge about preventive and therapeutic measures of postpartum hemorrhage. The effect of teaching program about preventive and therapeutic measures of postpartum hemorrhage on improving maternity nurses knowledge through implementation development. Setting: In woman's health university and El-Mabara hospital at Assiut city. Design: A quasi experimental (pre/post – test) has been used in this study. Sample: A convenient sample (62) has been used (25) of them from woman health hospital, (37) of them from El-Mabara hospital. Tools: Two tools were used (1) self-administrative questionnaire has been used to collect data. (2) Teaching program with booklet. Results: The findings reported that more than half of them aged 30 years or more and had secondary education, Most of them had unsatisfactory knowledge about the prevention of postpartum hemorrhage. But, unsatisfactory this knowledge has been improved after program implemented. Conclusion: Nurses had unsatisfactory knowledge regarding preventive and therapeutic measures of postpartum hemorrhage in the pre-test. The educational program was successful in achieving its goal of upgrading or improving their knowledge. Recommendations: The study recommends focuses on establishing plans for periodical and scheduled training courses and educational programs for nurses

Case Load of Placenta Previa and Accreta at Assuit Women's Health Hospital: Maternal and Neonatal Outcomes

AbstractBackground: Placenta previa and accreta is considered a severe pregnancy complication that may be associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage, so it has become one of the most important leading cause of emergency hysterectomy which represents 40-60% of cases. Maternal morbidity had been reported to occur in up to 60% and mortality in up to 7% of women with placenta accreta. Also the additional potential intra operative and post-operative morbidity were associated with massive blood transfusion, hypovolymea, surgical injury to the ureters, bladder, bowel, or neurovascular structures; adult respiratory distress syndrome, need for blood transfusion, electrolyte imbalance, renal failure and infection.Aim of Study: The aim of the current study was to define the prevalence of placenta previa and accreta in the period from January 2016 to December 2016 and to evaluate the maternal and neonatal outcomes.Patients and Methods: The study design was a retrospec-tive descriptive study from recorded data in the period from January 2016 to December 2016 on all patients delivered at Women's Health Hospital, Assuit University including all cases of placenta previa with or without placenta accretta, maternal and neonatal data was evaluated. Finally, the obtained data was analyzed by means of SPSS software (Version 16.0) and pResults: Total number of deliveries 13486 cases the incidence of placenta previa was 267 cases (1.98%), also the incidence of placenta accreta was 55 cases (0.4%), uterine artery ligation in 166 cases (62.1%), placenta left in situ in one case (0.37%), intra uterine balloon insertion in 6 cases (2.25%), transverse B Lynch in 10 cases (3.75%), internal iliac artery ligation in 4 cases (1.5%), cesarean hysterectomy was performed in 37 cases (13.8%), bladder injury occurred in 33 cases (12.4%), ureteric injury in 3 cases (1.1%), colon injury in one case (0.37%), vascular injury occurred in one case (0.37%), post partum internal hemorrhage occurred in 3 cases (1.1%), post partum pelvic hematoma occurred in one case (0.37%), ICU admission was needed in 20 cases (7.5%), post-operative blood transfusion was needed in 62 cases (23.2%), re intervention needed in 8 cases (2.9%), maternal mortality was 4 cases (1.5%), the mean gestational age was 34.73±2.8 weeks. Also there were 66 neonatal cases (22.1%) needed assisted ventilation in the form of ambu bag or en-dotrachial intubation gestation. NICU admission needed in 41 neonatal cases (15.4%), and neonatal mortality reported in 7 neonatal cases (2.6%). Congenital anomalies were reported in 2 neonatal cases (0.7%).Conclusion: The incidences of placenta previa and placenta accreta were higher than which reported internationally due to increase CS rate. Also there is no definite planned manage-ment method widely accepted except for hysterectomy.

Developing and Implementing Nursing Care Protocol Regarding Management of Postpartum Hemorrhage

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality in developingcountries. PPH is defined as any blood loss >500 ml following vaginal delivery and >1000 ml after cesarean section.It can also be defined as fall in hematocrit >10% or blood loss >15% of total blood volume, or 10% measured perpartum decline in hemoglobin levels. Aim of the study: the aim of this quasi-experimental study was to evaluate theeffect of Developing and implementing Nursing Care protocol regarding management of postpartum hemorrhage onPatients outcomes and complications. Setting: This study was conducted at Assiut Women's Health Hospital,postpartum unit .Sample: Purposive sample with a total of 140 Postpartum Hemorrhage patients was recruited,divided into two groups (control and study) 70 patients for each group Result: this study found that a significantdifference between the routine and designed protocol in nursing management of postpartum hemorrhage . thesefindings show that the patient outcomes improved in study cases when compared with control cases which appearedin stop of bleeding 95.7% in study group, 82.8% in control group and conscious level 87.1%in study group,78.6 incontrol group with normal conscious level Conclusion: This research concluded that nursing care protocol waseffective in reducing postpartum hemorrhage outcome and complications. Recommendations: clearly writtenPostpartum Hemorrhage management protocol, adapted for a particular hospital, should be developed and used inclinical practice.

Educational Program on the Knowledge and Attitude of Pregnant Women Regarding Neonatal Jaundice

Background: Early awareness of pregnant women about neonatal jaundice (NNJ) has an essential role in preventing severe hyperbilirubinemia and its dangerous complications. Aim: the study aimed to assess the level of knowledge and attitude of pregnant women regarding NNJ and to evaluate the effect of an educational program for neonatal jaundice among the target population. Subject and methods: three hundred pregnant women attended the Antenatal Clinic at Women Health Hospital in Assiut University were divided into 150 pregnant women as study and 150 as control groups. Quasi-experimental research design was applied. Tool: Using a structured interview questionnaire including five parts; personal data, obstetric, medical and family history, assessment of knowledge, attitude toward neonatal jaundice, and neonatal follow up. Results: There was a statistically significance difference between level of knowledge and attitude in pre- vs. post-test in the study group compared with the control group and there was statistical evidence of neonatal outcomes for improving women's breast feeding and decrease number of jaundice days. Conclusion: This study revealed that pregnant women had inadequate knowledge regarding NNJ and their attitude was negative while the application of an educational program has led to significant improvement in the level of women's knowledge and attitude in the study group, which was reflected on the newborn positively. Recommendations: Implementing a routine health education program for pregnant women about NNJ and raising awareness of the relatives as they were identified as the main source of knowledge.

Knowledge, Awareness and Risk of Occurrence of Venous Thromboembolism of Perinatal Women.

The purpose of this study is to identify knowledge, awareness, and risk of occurrence of venous thromboembolism among pregnant women. Subjects were 106 pregnant women treated as inpatients and outpatients at a women's health hospital in a metropolitan city February 19-March 22, 2018. Instruments consisted of questionnaires that included knowledge, awareness, and risk of occurrence of venous thromboembolism queries. Collected data were analyzed by t-test, one-way analysis of variance, Mann-Whitney U test and Kruskal-Wallis test. Mean score of subjects' knowledge of venous thromboembolism was 4.47 (0-15), mean score of subjects' awareness of venous thromboembolism was 66.98 (25-100), and mean score of subjects' risk factor of venous thromboembolism was 0.98 (0-44). CONCLUSIONS: Pregnant women's level of knowledge and awareness of prevention and risk factors on venous thromboembolism, is significantly low. To raise their awareness of risk symptoms and prevent occurrence of the disease, it is essential for nurses as well as medical staffs to: 1) provide an educational program on venous thromboembolism for patients; 2) assess and monitor pregnant women with a risk factor of venous thromboembolism; and 3) implement proper prophylaxis for patients.

The effect of hormonal contraception and intrauterine device on the pattern of menstrual cycle

Background Many women discontinue their contraceptives owing to dissatisfaction with the method. Unscheduled bleeding is one of the main reasons cited by women for stopping a birth control method. Improving counseling and management of these adverse effects will aide in increasing satisfaction with contraceptive methods. Objective The aim of the work is to study the effects of hormonal contraceptives and intrauterine device on the pattern of menstrual cycle. Patients and methods This study was a descriptive study in family planning clinic at Women's Health Hospital, Faculty of Medicine, Assiut University, and Childhood and Maternity Care Center in the city of Dirout, Assiut, Egypt, on women using hormonal contraceptives or intrauterine devices. This study was done by using interviewing questionnaire. Results It was observed that the progestogen-only hormonal contraceptives like progestin-only pills (POPs), Depo-Provera, and Implanon produced disturbances in bleeding pattern in the majority of their users. With POPs, it was found that 22.4% of users were amenorrheic and 77.6% were menstruating. The menstrual cycle was regular in 57.9% and irregular in 42.1%. Menstrual disorders were found in 42.1% in the form of polymenorrhea in 62.5% and metrorrhagia in 32.5%. With Depo-Provera, it was found that 76.5% of users were amenorrheic and 23.5% were menstruating. The menstrual cycle was regular in 36.4% and irregular in 58.3%. Menstrual disorders were found in 58.3% in the form of oligomenorrhea in 21.4%, polymenorrhea in 42.9%, and metrorrhagia in 35.7%. With Implanon, it was found that 50.8% of users were amenorrhoeic and 49.2% were menstruating. The menstrual cycle was regular in 53.3% and irregular in 46.7%. Menstrual disorders were found in 46.7% in the form of oligomenorrhea in 50%, polymenorrhea in 14.9%, and metrorrhagia in 35.7%. Combined oral pills produced much better cycle control as compared with any of the other hormonal contraceptives. There were regular cycles in 83.7% of study users and irregular cycles in 16.3%. Menstrual disorders were found in 48.8% of study users. In this group, hypomenorrhea was seen in 66.7% and metrorrhagia was seen in 33.3%. The use of copper intrauterine device (IUD) was associated with regular menstrual cycles in 87.5% of study users and irregular in 12.5%. Menstrual disorders were found in 42.2% of study users. In this group, dysmenorrhea was found in 68.5%, metrorrhagia in 29.6%, and menorrhagia in 48.1% of these women. Conclusion This study concluded that hormonal contraceptive methods and IUD can affect the pattern of menstrual cycle and are considered risk factors for irregularity in vaginal bleeding patterns and discontinuation of the method.

The Effect of Omission of the Bladder Flap Formation at Lower Segment Cesarean Delivery: A Randomized Controlled Trial

Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted in Women Health Hospital, Assiut University, Egypt between March 2017 and May 2018 (ClinicalTrial.gov NCT03016273). Patients were divided into: Non bladder flap group: Uterine incision made 1 cm above the vesico-uterine reflection without incision and dissection of the bladder peritoneum and bladder flap group: Standard cesarean section technique with incision and dissection of a bladder flap prior to uterine incision. Results: The study included 150 patients (75 in each arm). The most common indication for CS in both groups was repeated CS. Non-bladder flap group, compared with flap group, showed shorter skin-incision to delivery time and total operative time, and significantly lower mean estimated blood loss and postoperative pain score. Non-bladder flap group, compared with flap group, was more likely to show postoperative microhematuria. The two groups required approximately the same time for post-operative defecation. Conclusion: Omission of bladder flap formation during CS is associated with shorter operative time, less blood loss, less postoperative pain and lower incidence of postoperative hematuria.

The effect of pregnancy on female sexual function: a cross-sectional study

Objective The current study aims to evaluate the effect of pregnancy in its different trimesters on the female sexual function. A cross-sectional study was conducted at Assiut University Hospital, Assiut, Egypt. Patients and methods We included consecutive healthy sexually active pregnant women aged between 18 and 40 years who had attended the antenatal care clinic of Assiut Women Health Hospital between June 2014 and May 2015. We used the Arabic version of the female sexual function index (FSFI) in the interview to evaluate the sexual functions or problems during the past month. The cutoff score used to indicate sexual dysfunction was 28.1. Results A total of 600 healthy sexually active women were enrolled in this study: 300 women with uncomplicated pregnancy and 300 nonpregnant women. The percentage of women having total female sexual dysfunction during pregnancy was 63.3% compared with 61.2% of nonpregnant women. The percentage of women having total female sexual dysfunction was 70, 44, and 72% in the first, second, and third trimesters, respectively. The second trimester women had the highest total FSFI score, which was not significantly different from the total FSFI score in nonpregnant women (P = 0.922). Conclusion The current study reports no differences in the prevalence and indices of sexual function between pregnant and nonpregnant women. However, the second trimester represents the peak of sexual function throughout pregnancy, and the problem of sexual dysfunction is the highest during the third trimester.

Effect of Cesarean Section on Demand on the phenomena of Increasing Cesarean Section Rate at Women's Health Hospital

Abstract Aims of the study were to determine the hospital based rate of C.S at Assiut Women's Health Hospital and assess the effect of C.S on demand on increasing C.S rate. Setting: This study was conducted at Assiut Women's Health Hospital, postpartum unit .Sample: A convenience sample (1500) of all postpartum women who had C.S during a three months period. Design: A cross –sectional descriptive study design was used in this study. Results: Cesarean section rate in hospital was 47.3% at 2016 and cesarean section on demand accounts for about 5.5% of the rate of C.S and in the present study findings. Conclusion: C.S which was done on maternal demand was accounted for 5.5%, as it might increase the rate of hospital based rate of C.S. Recommendations: Implementation of counseling sessions for pregnant women to improve awareness of vaginal delivery benefits, indications for C.S and the consequences of performing an elective or an unnecessary C.S.

Effect of Cesarean Section on Demand on the phenomena of Increasing Cesarean Section Rate at Women's Health Hospital

Effect of Cesarean Section on Demand on the phenomena of Increasing Cesarean Section Rate at Women's Health Hospital

Disposition of Nursing Staff Toward Using Information Systems

Currently hospitals are spending much money in Information Systems (IS) to enhance quality of care, efficiency and safety. Aim: The study aimed to assess the disposition of nursing staff toward using information systems. Research design: A descriptive design was carried out in this study. Setting: The study was performed at Intensive care units of Assuit University Hospitals (Chief Assuit University Hospital, Women Health Hospital and Pediatric University Hospital) Subjects: A convenient sample (250) of nursing staff from the previous setting. Tools of the study: Two tools were used, the first one was: A self-administered questionnaire about Knowledge of nursing staff about using information systems and the second one was: A self-administered questionnaire about nursing staff attitudes toward using information systems Results: The nursing staff have good knowledge and positive attitudes toward using information systems and there was a positive relationship between all variables of the study participants' knowledge and total score of attitudes toward using information systems with great statistically significant difference. Conclusion: The nursing staff have good knowledge and positive attitudes toward using information systems. Recommendation: The study recommended that, Hospital administration should work to implement a health information system for the hospital.

The Efficacy of Subcutaneous Swabbing of Cesarean Section Wounds with Povidone Iodine to Prevent Post-Operative Wound Infection: A Randomized Controlled Study

AbstractBackground: Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, post-operative infectious morbidity still complicates cesarean deliveries [1]. Wound irrigation with povidone-iodine, an antiseptic solution, may be useful for reducing infection, but it is of uncertain efficacy and risk. Povidone-iodine irrigation is a simple and inexpensive solution with the potential to prevent surgical site infection [2].Patients and Methods: This study was a randomized controlled prospective study in Assiut University Women's Health Hospital on women undergoing cesarean delivery in the period from November 2015 to September 2016. Study group (Group A) the subcutaneous tissue was swabbed with 10cc of undiluted 10% povidone iodine and was not mobbed. Group B; no swabbing.Aim of Study: To assess the efficacy of subcutaneous swabbing of cesarean section wounds with povidone iodine to prevent post-operative wound infection.Results: In our study, there was no statistically significant difference in personal and clinical history as regarding age, education, residence, urgency of cesarean section, presence of labor, gravidity, number of abortion but there was a statistical difference between the study groups in number of living children and number of previous cesarean section. There was no statistically significant difference in clinical examination as regarding BP, temperature, gestational age, presentation, presence of tender scar and rupture of membranes. There was a statistical difference between the study groups in pulse. There was a statistical difference between the study groups in investigations as regarding WBCs, estimated fetal weight and amniotic fluid index but there was a statistical difference in HB and platlets. There was no statistically significant difference in the operative data as regarding visceral and parietal peritoneal closure and duration of the procedure but there was a statistical difference in the level of the surgeon. There was no statistical difference between the study groups in presence of post-operative infection.Conclusion: There was no benefit of subcutaneous tissue swabbing with povidone iodine in decreasing wound infection following cesarean section.

EFFECT OF ANTENATAL CARE ON MATERNAL AND NEONATAL OUTCOMES IN WOMEN'S HEALTH HOSPITAL

Introduction: Good antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. World Health Organization recommendation of initiation of antenatal care within the first four months of pregnancy and at least four antenatal care visits during the course of an uncomplicated pregnancy. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and her neonate. Objectives: The aim of the study was to identify effects of antenatal care on maternal and neonatal outcomes in Women Health Hospital Subjects & Method: Three hundred parous women and their neonates conducted a comparative study. They were divided into two groups' according to parity the first group (primipara =150), and the second group (high parity=150) and divided every group into two groups the first was poor antenatal care and other was adequate antenatal care during the period from February 2017 to August 2017 using a stratified sampling. Results: Most of the primiparous women had poor antenatal care (88%) but high parity (67.3%). There was the highly significant relationship between two groups. More than half were had poor antenatal care (60.3%) but less than half were adequate antenatal care. The most common complication in primipara group was eclampsia (36.4%) while in high parity group was anemia (14.3%) in poor antenatal care. The most common complication in labor was premature rupture of membrane (19.0% & 14.3%) respectively, in poor antenatal care of two groups. In primipara group, the proportion of low birth weight was 16.0% in poor antenatal care, while stillbirth was (11.0%) inadequate antenatal care also neonatal weight in Kg related to poor antenatal care and adequate antenatal care were (2.636 ± 0.659 & 3.050 ± 0.503) respectively. In high parity group, the proportion of Special Care Baby Units admission was 12.2% in poor antenatal care, while Special Care Baby Unit admission was 11.9% inadequate antenatal care also neonatal weight related to poor antenatal care and adequate antenatal care were (2.973 ± .709 & 3.081 ± 0.643) respectively. Conclusion: Good quality antenatal care promote the health of the mother and decreases the percentage of iron deficiency anemia, gestational hypertension and before term labor and promote maternal outcomes, including a reduced risk of under birth weight, preterm neonates and Special Care Baby Unit admission. Recommendations: the women should have access to good quality antenatal care. Both the woman and the neonatal are at a greater risk during pregnancy and labor. This risk can be reduced with good antenatal care and delivery by trained personnel. And awareness of the adverse impact of high parity on obstetric

The effect of maternity nursing logbook on internship students' skills at woman's health hospital, Assiut Governorate

Background and objective: Practical skills in Maternity Nursing are complex actions containing movement abilities, caring intentions, theoretical and practical skills, ethical and moral deliberation. This study aimed to assess the effect of Maternity Nursing logbook on cognitive and practical skills of internship students.Methods: Quasi-experimental research was carried out in this study. 112 internship students of Faculty of Nursing, Assiut University who were enrolled for Maternity training course around one year by using logbook. Setting: The study was done at the Woman's Health Hospital, Assiut University from beginning of September 2015 to the end August 2016 (internship Training year).Results: The total score of internship nursing student's cognitive and practical skills revealed that the vast majority of them (98%) had satisfactory knowledge and practical skills in post training with significant difference between pre and post training of the internship nursing students.Conclusions: The using of logbook was associated with increased clinical, cognitive with highly significant difference between pre and post training of the internship nursing students. Recommendations: Implementation of logbook in undergraduate and postgraduate clinical education for all clinical courses.

Female Sterilization by Tubal Ligation During C-Section in Women with a History of 2 or More C-Section

Objective: The aim of this study is to determine bilateral tubal ligation incidence performed during C-section in women with a history of 2 or more C-section and the factors affecting sterilization demand.Study Design: Patients who were admitted to Zekai Tahir Burak Woman's Health, Education and Research Hospital between February 2017 and June 2017 and who had a history of 2 or more C-section between week 37 and 41 were included in this prospective cross-sectional study. These subjects were separated into 2 groups according to whether they wanted bilateral tubal ligation during C-section. Bilateral tubal ligation was performed by means of modified Pomeroy technique. Both groups were compared in terms of age, gravida, number of children living at home, education level and income status. Patients who did not want bilateral tubal ligation were asked to fill a questionnaire involving reasons for not asking for bilateral tubal ligation.Results: The number of patients who wanted bilateral tubal ligation was 51 (43%) while those who did not want bilateral tubal ligation was 67 (57%). Compared with patients who did not want bilateral tubal ligation, patients who wanted bilateral tubal ligation had more number of children at home and a higher number of previous C-section (p<0.001). Reasons for not wanting bilateral tubal ligation consisted of religious beliefs (26.8%), desire for protection with a reversible contraceptive method (17.9%), partner who does not want bilateral tubal ligation (17.9%), incompletely family size (13.4%), respectively according to their frequency.Conclusion: bilateral tubal ligation for contraception during C-section was performed forty-three percent of women who had had a history of 2 or more C-section. In one fourth of the cases, pregnant women did not want bilateral tubal ligation due to religious beliefs.

Clinical Audit on Quality of postoperative Nursing Care provided to women undergoing Cesarean Section at Woman's Health Hospital, Assuit University

Background: Clinical audit is “a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change”. Objectives: (1) Audit on the current postoperative nursing care provided to women who had Cesarean Section at woman’s health hospital, Assuit. (2)Assess the hospital based rate of Cesarean Section patients and method: A criterion based audit research design was conducted at postpartum ward from February 2016 to July 2016, A total of 618 post cesarean women in preorientation period and 50 women in post orientation period were recruited. Interview questionnaire schedule for mothers and nurses(11) was carried out and observational checklist was used to collect the data. Results: there was significant improvement related to monitoring vital signs, palpating fundus and surgical site care.Conclusion: There was a big gap between the current and the ideal practices of care. The total number of all deliveries was 13115. The number of cesarean sections only was 6064 (46.2%). Recommendations: Increasing number of nursing staff, Nurses in post natal unit should have training courses, qualified staff should be recruited, further research studies are needed.

Effect of Using the Paperless Partograph Versus the original Partograph on Labor Outcomes in Women's Health Hospital.

Background: The paperless partogram refers to monitoring progress of labor and arriving at an accurate decision for intervention to ensure safe delivery. It needs no graph paper, no extra time to do it. Aim: To evaluate the efficacy of using the paperless partograph versus the original partograph on labor outcomes in Women's Health Hospital. Sampling : Random sample of 370 participants. Setting: The study was conducted from April 15th , 2016 to September 30 th , 2016 in Women Health Hospital, Assiut University, Egypt, at reception (emergency ) unit. Design method: quesi-experimental design. Study subjects: This study was randomly assign women into 2 groups. Group (1): was allocated to modified WHO partograph and Group (2): was allocated to paperless partograph. Results : Comparison between studied groups as regards time taken for first stage and second stage revealed a statistical significant difference at P. value (<0.017 & <0.001) respectively. For mode of delivery revealed a statistical significant difference at P. value(<0.0152). For postpartum complications revealed a statistical significant difference at P. value(<0.003).Conclusion: The Paperless partograph was effective positively than the WHO modified partograph in the management of labor. Recommendations: This method should be implemented as essential part of care in all health facilities, and used by all clinical training sites to give trainees (doctors and nurses midwives) an opportunity to use it.

Knowledge and Practices Among Immediate Post Partum Women About Colostrum at Women's Health Hospital

Background: Breast feeding is a basic practice in Egypt but the importance of giving colostrum milk is still poorly known because cultural variations. Aim to assess knowledge and practices among immediate post partum women about Colostrum. Research design: descriptive study design was used to achieve the objective of this study. Subjects and methods: 350 women immediately after birth who met the criteria of selection that were involved in the study at Women's Health Hospital, Assuit University. A structured interview questionnaire developed to assess knowledge and practices of women about colostrum milk. Results: Most of women had not knowledge about the importance of colostrum. Unsatisfactory level of knowledge (82.6%) toward colostrum feeding reported by the studied women. Also poor practices of post partum mothers (58.6%) for feeding colostrum to their newborn were presented by the studied mothers. Conclusion: Most of women unsatisfactory level of knowledge about the importance of colostrum and more than fifth percent of them had poor practices; toward colostrum feeding. Recommendations: Improving Knowledge and Practices of women toward colostrum feeding, through arranged educational programs, health care providers should focus special attention for pregnant women in discussing colostrum feeding in the antenatal care follow up visits.

Effect of Using the Paperless Partograph Versus the original Partograph on Labor Outcomes in Women's Health Hospital.

Effect of Using the Paperless Partograph Versus the original Partograph on Labor Outcomes in Women's Health Hospital.

Head Nurses' Interpersonal Relationship and Its Effect on Work Engagement and Proactive Work Behavior at Assuit University Hospitals

Introduction: Hospitals are challenged to achieve highly patient outcomes while facing mounting financial constraints. Studies of high-performing organizations suggest that one key to success is an engaged workforce that acts proactively to resolve performance problems. Aim: Explore head nurses' interpersonal relationships and it’s effect on work engagement and proactive work behavior. Study design: A descriptive correlational. Setting: This study was conducted in all departments at Assuit University Hospitals includes (Main Hospital, Pediatric Hospital, Women's Health Hospital). Subject and Method: The study subject consisted of (88) head nurse working in all departments of selected Hospitals. The data collected through self – administered questionnaire which includes personal characteristics data, Relational Coordination, Utrecht Work Engagement and Proactive Work Behavior Scale. Results: There was statistically significant relation between interpersonal relationships among head nurses, nurse administrators & physicians with work engagement and proactive work behavior. There was statistically significant relation between work engagement and proactive work behavior. Conclusion: There was a positive correlation between interpersonal relationships with work engagement and proactive work behavior. Recommendations: Implement continuous training programs for the different categories of health care providers to improve interpersonal relationships and work engagement &proactive work behavior.