Assessment of Nurses Knowledge Regarding Care of Preterm and Term Babies in Golden Hour in Maternity and Children Hospital Hafar Albatin 2024

Assessment of Nurses Knowledge Regarding Care of Preterm and Term Babies in Golden Hour in Maternity and Children Hospital Hafar Albatin 2024

Bashayer M. Alshammari^1*, Sitelgeel Ali Hamouda Babiker ²

1. Neonatal Intensive Care Unit Head Nurse, Maternity and Children Hospital in Hafr Albatin, Saudi Arabia.

2. Assistant professor, College of Applied Medical Sciences, University of Hafr AL Batin, Kingdom of Saudi Arabia.

*Correspondence to: Bashayer M. Alshammari, Neonatal Intensive Care Unit Head Nurse, Maternity and Children Hospital in Hafr Albatin, Saudi Arabia.

Copyright
© 2025: Bashayer M. Alshammari. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received:  14 December 2024

Published: 02 January 2025

Abstract

Background: The "golden hour" is a crucial period immediately after birth, particularly for preterm and term neonates, involving essential resuscitation and stabilization efforts. This study aimed to assess the knowledge of nurses during this critical time to ensure the highest standard of neonatal care.

Methods: A descriptive, quantitative study was conducted between February and May 2024 at the Maternity and Children Hospital in Hafr Albatin, Saudi Arabia. The study included 65 nurses working in the operation room, delivery room, and Neonatal Intensive Care Unit. Data were collected using structured questionnaires and observational checklists and analyzed using SPSS version 28.0.

Results: The majority of nurses (52.9%) were aged 25-35 years, predominantly female (95.6%), with slightly more than half being Saudi nationals (51.5%). Most nurses (54.4%) held a bachelor degree. While 72.1% of nurses understood the importance of the golden hour, and 80.9% were familiar with its key components, gaps were identified in specific areas, such as only 51.5% recognizing that the golden hour begins before delivery. Additionally, 85.7% conducted prenatal history checks, and 88.6% consistently asked critical questions during deliveries, but only 65.7% performed pre-resuscitation team briefings, and 51.4% maintained effective team communication. Non-Saudi nurses demonstrated significantly higher knowledge scores than their Saudi counterparts (P = .003), and more experienced nurses also tended to have higher knowledge scores (P = .055).

Conclusion: While the majority of nurses demonstrated good knowledge during the golden hour, significant gaps were found in understanding its initiation, conducting team briefings, and preparing the environment. These findings highlight the need for targeted educational interventions to improve neonatal care and collaboration among nursing staff during this critical period.

Keywords: Golden hour, neonatal care, preterm babies, neonatal resuscitation, NICU, neonatal outcomes, nursing knowledge, neonatal mortality, Hafar Albatin, Saudi Arabia

 Introduction

The "Golden Hour" refers to the critical period immediately following birth, typically lasting for the first hour of life, during which prompt and appropriate medical intervention is crucial for optimizing outcomes, particularly for preterm and term infants. This period is marked by rapid physiological adjustments and necessary interventions aimed at stabilizing the newborn and preventing complications (Peleg et al., 2019). Preterm babies, defined as infants born before 37 weeks of gestation, often face numerous health challenges due to incomplete development, necessitating specialized care and monitoring, especially during the immediate postnatal period (Lawn et al., 2023).

Recently, the concept of the "Golden Hour" has gained significant attention in neonatology, underscoring the importance of neonatal care within the first hour of life after birth. This critical period is particularly vital for both preterm and term neonates, as it involves essential resuscitation and stabilization efforts aimed at improving short-term and long-term outcomes (Shah et al., 2018). Golden Hour encompasses evidence-based interventions designed to reduce complications, especially for extremely low gestational age neonates. Key components during this period include antenatal counseling, delayed cord clamping, prevention of hypothermia, respiratory and cardiovascular support, and early nutritional care (Sharma et al., 2017). The connection between gestational age and neurodevelopmental outcomes, as well as mortality rates, highlights the urgency of prompt resuscitation and stabilization during this time (Croop et al., 2020). Effective resuscitation team arrangements, where each member is well aware of their role, are essential to avoid complications and ensure quality care. The Golden Hour demands a standardized approach, effective communication, teamwork, and clinical knowledge to achieve optimal outcomes (Wyckoff et al., 2014).

The care provided by nursing professionals during the Golden Hour is critical for ensuring positive neonatal outcomes. However, there is a notable gap in the assessment of nurses' knowledge regarding neonatal care during this period (Sharma et al., 2017). Globally, complications from preterm births are the leading cause of neonatal mortality, with approximately 15 million babies born prematurely each year (WHO). In Saudi Arabia, despite advancements in healthcare infrastructure and services, neonatal mortality rates remain a concern, with preterm birth complications being a leading cause (Al-Salam et al., 2016). This concern is compounded by the lack of comprehensive assessment of nurses' competencies, particularly in areas such as timely resuscitation, thermoregulation, and initial stabilization of preterm and term neonates. Addressing these gaps through targeted educational interventions is crucial for improving neonatal outcomes, reducing morbidity and mortality rates, and ensuring the provision of high-quality, evidence-based care (Peleg et al., 2019).

Previous studies predominantly focused on intervention strategies aimed at enhancing knowledge in neonatal care or provided reviews of applied protocols, often without addressing the specific setting or context relevant to the current study. For instance, Bijou et al. (2022) conducted an educational intervention designed to reduce hypothermia in preterm infants, which resulted in a significant increase in nurse knowledge post-intervention. Similarly, Wallingford et al. (2021) implemented and evaluated "Golden Hour" knowledge in infants younger than 33 weeks' gestation, observing a decreased incidence of chronic lung disease as a result of adherence to standardized protocols. Welch et al. (2024) also introduced a quality improvement initiative aimed at enhancing the timeliness of Golden Hour care for premature infants, which led to notable improvements in various aspects of care delivery. Additionally, Bataille (2023) conducted a doctoral project assessing the impact of nursing education on newborn care during the golden hour, highlighting the critical role of education and regular reminders in improving nurse knowledge.

These studies collectively showed the importance of addressing the identified gap in the literature. Unlike previous studies that have concentrated on broader aspects of neonatal care or specific interventions, the current research attempted to fill this gap by conducting a comprehensive assessment of nurses' knowledge specifically concerning the care of preterm and term babies during the golden hour in this unique setting. Given the critical importance of the Golden Hour, assessing and enhancing nurses' knowledge during this period is justified as a means to improve neonatal outcomes significantly. The aim of this study is to evaluate the knowledge of nurses at the Maternity and Children Hospital in Hafar Albatin, Saudi Arabia, regarding the care of preterm and term babies during the Golden Hour. Through identifying gaps and implementing targeted educational interventions, the study seek to enhance the quality of neonatal care, ultimately reducing neonatal morbidity and mortality in this vulnerable population.

Methods

The study applied a quantitative, observational, descriptive cross-sectional design to assess nurses' knowledge regarding neonatal care during the golden hour. This research was conducted between February and May 2024 at the Maternity and Children Hospital in Hafr Albatin, Saudi Arabia. A total coverage sampling technique was applied, which included all 65 nurses working in the operation room, delivery room, and Neonatal Intensive Care Unit (NICU) at the hospital. This approach ensured that the study captured the full range of experiences of nurses directly involved in neonatal care during the golden hour, making the sample highly relevant and appropriate for the study objectives.

Data were collected using a structured questionnaire and an observational checklist, both of which were adapted from relevant previous studies and validated through a pilot study to ensure their reliability and applicability in the specific hospital setting. The structured questionnaire was designed to comprehensively assess various aspects of the nurses' knowledge and was divided into three sections. The first section gathered sociodemographic information, including details such as age, gender, nationality, marital status, qualifications, years of experience, and any training courses related to the care of neonates in the first hour of life. The second section focused on the nurses' general knowledge about the golden hour, including the care of preterm and term babies, the classification of neonates, the essential components of the golden hour, and the short-term and long-term complications associated with premature babies.

Once the data were collected, they were entered into a digital database and analyzed using SPSS version 28.0. The analysis involved descriptive statistics, including frequencies, percentages, means, and standard deviations, to summarize the data effectively. Bivariate analysis was conducted to explore relationships between variables, with chi-square tests applied to categorical variables and t-tests used for quantitative variables. Pearson correlation coefficients were calculated to assess the correlation between overall perceived barriers and demographic data. A p-value of 0.05 or less was considered statistically significant, indicating the level at which the findings could be considered reliable.

To ensure the integrity and confidentiality of the data, each participant was assigned a unique identifier, and all data were securely stored on a server with restricted access. The study adhered to strict ethical guidelines, obtaining approval from the Institutional Review Board (IRB) and informed consent from all participating nurses. These measures were implemented to protect the rights and privacy of participants, ensuring that the study was conducted according to the highest standards of ethical clinical research.

Results

This study involved 65 nurses who participated in the research. The analysis of demographic and professional characteristics revealed that the majority of participants (52.9%) were between the ages of 25 and 35, indicating a relatively young nursing workforce. A significant gender imbalance was observed, with 95.6% of participants being female. In terms of nationality, slightly more than half of the nurses were Saudi nationals (51.5%), reflecting a diverse and multicultural workforce within the hospital. The marital status of participants showed that most were married (64.7%), while a smaller proportion were single (25%), divorced (4.4%), or widowed (5.9%). Educational attainment varied, with most nurses holding a bachelor degree (54.4%), while others had a diploma (41.2%) or a master degree (4.4%). The professional characteristics of the participants indicated that a significant portion of the nurses (42.6%) had between one and five years of experience, which was the largest group.

A significant proportion (27.9%) had more than ten years of experience, highlighting the presence of highly experienced staff within the hospital. However, the study also revealed a gap in specialized training related to neonatal care during the golden hour, as only 42.6% of the nurses had received such training. Among those who had undergone training, the most attended course was the Neonatal Resuscitation Program (NRP) stable course (20.6%), followed by intensive trauma medicine training (10.3%). Other courses such as Advanced Cardiac Life Support, Basic Life Support, and the golden minute course were less commonly attended. A significant 57.4% of the nurses had not taken any of these courses as detailed in table 1.

Table (1) the distribution of the participants according to their demographical characteristics (n = 65 nurses in maternity and children hospital, Hafar Albatin, Saudi Arabia in 2024)