To Assess the Effectiveness of Planned Teaching on Knowledge Regarding Mid-Wife Led Continuity of Care Model (MLCC) on Final Year Nursing Students

Background: In many parts of the world, midwives are the primary providers of care for childbearing women. There are considerable variations in the organisation of midwifery services and in the education and role of midwives. Childbearing women are often faced with different opinions as to which option might be best for them. The midwife‐led continuity model of care is based on the premise that pregnancy and birth are normal life events. Pregnancy and birth are significant life events for women and their families and midwife supports a woman throughout pregnancy, birth, and the postnatal period. So, the demand for services that are family friendly, women focused, safe and accessible is increasing. Objectives: 1) To assess the existing knowledge regarding mid-wife led continuity of care model on final year nursing students. 2) To evaluate the effectiveness of planned teaching on knowledge regarding mid-wife led continuity of care model (MLCC) on final year nursing students. 3) To find out the association between knowledge regarding mid-wife led continuity of care model (MLCC) with selected demographic variables. Materials and Methods: In this study, evaluatory research approach and one group pre-test posttest research design was used. The study was conducted at a Selected Nursing College. The sample was collected from final year nursing students (120) by using non-probability convenient sampling technique. Original Research Article Lalawmpuii and Taksande; JPRI, 33(58B): 508-516, 2021; Article no.JPRI.77092 509 Results: In this study the study of the findings shows that 10.83% had good level of knowledge score in pre-test. While in post-test, out of 120 subjects the majority of the subjects and 92.50% had good level of knowledge score. This statistically shows that there is profound level of improvement on knowledge. Conclusion: Hence, this implies that the planned teaching was effective. Also, the study shows that the knowledge scores of final year nursing students is associated with the age in year and course of study. Hence, this means that greater the number of age in years and the course, greater level of knowledge scores. However, gender was not found to be associated.


INTRODUCTION
The midwife-led continuity model of care is based on the premise that pregnancy and birth are normal life events. Pregnancy and birth are significant life events for women and their families and midwife supports a woman throughout pregnancy, birth, and the postnatal period. So, the demand for services that are family friendly, women focused, safe and accessible is increasing [1].
A midwife is a health professional who cares for mothers and new-borns around childbirth, a specialization known as midwifery [2].
The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; concentrating on being experts in what is normal and identifying conditions that need further evaluation. In most countries, midwives are recognized as skilled healthcare providers. Midwives are trained to recognize variations from the normal progress of labor and understand how to deal with deviations from normal. They may intervene in high risk situations such as breech births, twin births, and births where the baby is in a posterior position, using non-invasive techniques. For complications related to pregnancy and birth that are beyond the midwife's scope of practice, including surgical and instrumental deliveries, they refer their patients to physicians or surgeons. In many parts of the world, these professions work in tandem to provide care to childbearing women. In others, only the midwife is available to provide care, and in yet other countries, many women elect to utilize obstetricians primarily over midwives [2].
Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care [3].
Midwife-led continuity models of care vary but the defining feature is that a midwife, working with the woman, takes the lead in planning, organising, and delivering her care from her first antenatal booking to the postnatal period [4].
Midwife-led care was associated with several important benefits for mothers and babies and had no more adverse effects than other models of care. Women who had midwife-led care were less likely to experience regional analgesia, instrumental vaginal birth, preterm birth less than 37 weeks and fetal loss before 24 weeks gestation. They were more likely to have a longer labour, spontaneous vaginal birth and be attended at birth by a known midwife. There was no difference between the groups for several other outcomes including caesarean birth or intact perineum [4].
The midwife-led continuity model of care includes: continuity of care; monitoring the physical, psychological, spiritual and social wellbeing of the woman and family throughout the childbearing cycle; providing the woman with individualised education, counselling and antenatal care; continuous attendance during labour, birth and the immediate postpartum period; ongoing support during the postnatal period; minimising technological interventions; and identifying and referring women who require obstetric or other specialist attention [4].

MATERIALS AND METHODS
In present study, evaluatory research approach with one group pre-test post-test research design was used. 120 final year nursing students were selected by using non -probability convenient sampling technique from the selected nursing college and the tool was validated by experts from obstetrics and gynaecological nursing.
Inclusion criteria were final year nursing students who are willing to participate and final year nursing students who are available during data collection. The data gathering process began from 10 th -23 rd August 2021. The investigator visited to select nursing college and obtained the necessary permission from the concerned authorities. She enquired their willingness of the final year nursing students to participate in the study and obtain consent from them. Assessed the knowledge about mid-wife led continuity of care model by pre-test first then implement planned teaching regarding mid-wife led continuity of care model and again assessed the knowledge by taking post-test after 7 days of planned teaching. Data collection was carried out within the stipulated period. After the cycle of data collection, each student was given feedback regarding vote of thanks due to their active participation and good cooperation during data collection.
Based on the objectives and the hypothesis the data were analysed by using various statistical tests such as frequency, percentage, mean, and standard deviation, paired and unpaired 't' test, one way analysis of variance (ANOVA). The level of significance set for testing the hypothesis was at 0.05.
Data collection instruments consist of the following sections. Section-A: It consists of demographical data like age, gender and course of study. Section-B: Consist of knowledge questionnaire regarding mid-wife led continuity of care model (MLCC).

RESULTS
64.20% of final year nursing students were in the age group of 20-24 years, 30% were in the age group of 25-29 years, 5% were in the age group of 30-34 years and 0.80% of final year nursing students were in the age group of 35-39 years.
23.30% of final year nursing students were males and 76.70% of them were females.   This Table 5 shows the association of knowledge score with age in years of final year nursing students regarding mid-wife led continuity of care model. The tabulated 'F' values were 2.68(df=3,116) which is much less than the calculated 'F' i.e., 3.99 at 5% level of significance. Also, the calculated 'p'=0.009 which was much less than the acceptable level of significance i.e., 'p'=0.05. Hence it is interpreted that age in years of final years nursing students is statistically associated with their post-test knowledge score.
This Table 6 shows the association of knowledge score with gender of final year nursing students regarding mid-wife led continuity of care model. The tabulated 't' values were 1.98(df=118) which is much higher than the calculated 't' i.e., 0.42 at 5% level of significance. Also, the calculated 'p'=0.66 which was much higher than the acceptable level of significance i.e., 'p'=0.05.
Hence it is interpreted that gender of final years nursing students is statistically not associated with their post-test knowledge score. This Table 7 shows the association of knowledge score with course of study of final year nursing students regarding mid-wife led continuity of care model. The tabulated 'F' values were 2.68(df=3,116) which is much less than the calculated 'F' i.e., 4.12 at 5% level of significance. Also, the calculated 'p'=0.008 which was much less than the acceptable level of significance i.e., 'p'=0.05. Hence it is interpreted that course of study of final years nursing students is statistically associated with their posttest knowledge score.

DISCUSSION
To assess the effectiveness of planned teaching on knowledge regarding mid-wife led continuity of care model (MLCC) on final year nursing students.
Present study shows that the study population does not have good level of knowledge on Mid-Wife Led Continuity of Care Model (MLCC) as the majority of the subjects 41.67% had poor level of knowledge score, 47.50% had average and 10.83% had good level of knowledge score. Minimum knowledge score in pre-test was 1 and maximum knowledge score in pre-test was 13. Mean knowledge score in pre-test was 6.33±3.25 and mean percentage of knowledge score in pretest was 42.22±21.71.
In the pre-test, the samples score proved that they did not have good knowledge on Mid-Wife Led Continuity of Care Model. However, in posttest, out of 120 subjects the majority of the subjects 0.83% of the final year nursing students had poor level of knowledge score, 6.67% had average and 92.50% had good level of knowledge score. Minimum knowledge score in post-test was 5 and maximum knowledge score in post-test was 15. Mean knowledge score in post-test was 13.68±2.07 and mean percentage of knowledge score in post-test was 91.22±13.82.
This study shows that the knowledge scores of final year nursing students is associated with the Age in year. The tabulated 'F' values were 2.68(df=3,116) which is much less than the calculated 'F' i.e., 3.99 at 5% level of significance. Also, the calculated 'p'=0.009 which was much less than the acceptable level of significance i.e., 'p'=0.05. Hence it is interpreted that age in years of final years nursing students is statistically associated with their post-test knowledge score.
This study shows that the knowledge scores of final year nursing students is associated with the course of study. The tabulated 'F' values were 2.68(df=3,116) which is much less than the calculated 'F' i.e., 4.12 at 5% level of significance. Also, the calculated 'p'=0.008 which was much less than the acceptable level of significance i.e., 'p'=0.05. Hence it is interpreted that course of study of final years nursing students is statistically associated with their posttest knowledge score.

In Comparison of the Current Study with Other Study
Currently, up to my knowledge, there is no such study that had been conducted in relation with the comparison of knowledge and Mid-Wife Led Continuity Care Model. However, there had been certain research study that shows the effectiveness of this model on the mothers and babies; the perception and satisfaction of this model by the mothers, caregivers and nursing students.
The study was done on the views of Chinese women and health professionals about midwifeled care in China at university teaching hospital in a major city in eastern China with the aims to explore Chinese women's and health professionals' views of the first midwife-led normal birth unit in China to facilitate normal birth and enhance midwifery practice. The main outcome measures participants' satisfaction, continuity of care/carers, choice and control. It concluded that women appreciated the midwifeled service, which provides an environment where they are more likely to aim to give birth without intervention. This model of care is good for its association with increased satisfaction in a context of extraordinarily high caesarean rates [5].
A study was done on women and healthcare providers' perceptions of a midwife-led unit in a Swiss university hospital: a qualitative study. In which a descriptive research study using qualitative methods was conducted among pregnant women and new mothers in a Swiss maternity unit, including also midwives and medical staff. This concluded that alternative models to provide maternity care for low-risk women have been developed and evaluated widely in several countries outside Switzerland. This study showed that women and healthcare providers were favourable towards the development of a new care model, while taking into account the specific expectations and barriers raised by participants [6].
A study on the experiences of new graduate midwives working in midwifery continuity of care models was done in Australia. With the aims to explore the experiences of the new graduate midwives who have worked in midwifery continuity of care, in particular, the support they received; and, to establish the facilitators and barriers to the expansion of new graduate positions in midwifery continuity of care models. The study concluded that this is the first study to demonstrate that new graduate midwives value working in midwifery continuity of care -they felt well prepared to work in this way from their degree and were supported by midwives they worked alongside. The participants reported having more confidence to practice when they have a relationship with the woman, as occurs in these models [7].
A study was done on the future in their hands: Graduating student midwives' plans, job satisfaction and the desire to work in midwifery continuity of care. The aim of this study is to explore the immediate and aspirational employment plans and workforce choices, reasons for staying in midwifery and perceptions around factors likely to influence job satisfaction of midwives about to graduate from one Australian university during the years 2012-2016. This study concluded that aligning early graduate work experiences with continuity of care models may have a positive impact on the confidence and professional development of graduate midwives, which in turn may lead to greater satisfaction and retention among a workforce already committed to supporting the maternity healthcare reform agenda [8].

CONCLUSION
From the results of the study, it is concluded that there is improvement in knowledge of study subjects. The levels of knowledge during the pretest and post-test are compared to prove the effectiveness of planned teaching. Hence, it is statistically interpreted that planned teaching on knowledge regarding midwife led continuity of care model (MLCC) was effective.

CONSENT
As per international standard or university standard, respondents' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
Study was approved by the Institutional Ethical Committee.