Nurses’ Knowledge Regarding Management of Pre-Eclampsia in Rangpur Community Medical College Hospital in Rangpur, Bangladesh: A Cross-Sectional Study

1. Introduction

1.1. Background

Pre-eclampsia is a multisystem vascular disorder characterized by endothelial dysfunction and generalized vasospasm, clinically defined by blood pressure ≥140/90 mmHg on two occa-sions at least four to six hours apart and proteinuria >0.3 g per 24 hours after 20 weeks of gestation [1]. The condition may also present without proteinuria, involving other signs of end-organ damage such as thrombocytopenia, renal insufficiency, impaired liver function, pul-monary edema, or cerebral disturbances [2].

Globally, pre-eclampsia complicates approximately 5% to 70% of pregnancies, reflecting vari-ations in diagnostic criteria, population characteristics, and healthcare access [3]. The World Health Organization (WHO) estimates that the prevalence of pre-eclampsia is seven times higher in underdeveloped countries compared to developed nations [4]. Hypertensive disorders of pregnancy account for nearly 14% of all maternal deaths—approximately 42,000 annually—predominantly in developing countries [5]. Beyond maternal mortality, pre-eclampsia con-tributes to intrauterine growth restriction in 30% of cases and preterm delivery before 37 weeks in 73.3% of affected pregnancies [6].

1.2. Burden in Bangladesh

In Bangladesh, pre-eclampsia is a substantial cause of perinatal and maternal mortality, with approximately 1,000 to 1,500 women dying annually due to this preventable condition [7]. Studies conducted in major tertiary facilities have found that nearly one-fourth (24.7%) of pregnant women show signs of pre-eclampsia or eclampsia during their antenatal or intrapartum period [8]. About 76% of deaths due to pre-eclampsia occur in rural and hard-to-reach areas, often due to limited access to emergency obstetric care, delayed referrals, and lower antenatal care attendance [9]. Approximately 51% of women in Bangladesh are unaware of their raised blood pressure before or during early pregnancy, leading to late diagnosis and increased risk of complications [10].

1.3. Role of Nurses

Nurses are often the first caregivers to have contact with pregnant women in obstetric emer-gency settings, particularly in Upazila Health Complexes and Union-level facilities where doc-tor availability may be limited [11]. Timely and effective care administered to pre-eclamptic women can prevent the majority of deaths. Nurses play a critical role in collecting detailed patient history, monitoring vital signs and fetal heart rate, preparing and administering mag-nesium sulfate and antihypertensive drugs, implementing seizure precautions, and promptly recognizing complications requiring escalation of care [12].

1.4. Knowledge Gaps

Research has identified that the primary reason for the occurrence of pre-eclampsia-related complications is a lack of knowledge and skills among healthcare providers in diagnostic mea-sures, including proper urinalysis, accurate blood pressure measurement, and interpretation of laboratory findings [13]. Studies conducted in the Democratic Republic of Congo, Burundi, Tanzania, and Nepal found that large proportions of healthcare workers, including nurses and midwives, lacked adequate understanding of critical management aspects, particularly the cor-rect administration of magnesium sulfate and monitoring for signs of magnesium toxicity [14].

1.5. Study Rationale

A considerable discrepancy exists between theoretical understanding and practical application regarding the management of pre-eclampsia among nursing professionals in Bangladesh. This study seeks to address this gap by assessing nurses’ knowledge regarding the management of pre-eclampsia at Rangpur Community Medical College Hospital, Rangpur. The findings may assist nursing educators and healthcare administrators in developing appropriate educational programs and training to strengthen nurses’ clinical knowledge and skills, ultimately contribut-ing to improved maternal healthcare services in Bangladesh.

1.6. Research Question

What is the knowledge of nurses regarding the management of pre-eclampsia?

1.7. Objectives

1.7.1. General Objective

To assess nurses’ knowledge regarding the management of pre-eclampsia.

1.7.2. Specific Objectives

• To identify the socio-demographic characteristics of respondents.
• To assess the theoretical understanding of pre-eclampsia among nurses.
• To evaluate awareness about guidelines for managing pre-eclampsia.
• To observe the association between socio-demographic variables and knowledge levels.

2. Literature Review

2.1. Global Burden of Pre-Eclampsia

Pre-eclampsia and eclampsia remain among the leading causes of maternal mortality and mor-bidity worldwide. In 2002, there were over 4 million cases of pre-eclampsia and eclampsia globally, of which 63,000 resulted in maternal death [15]. Globally, pre-eclampsia and eclamp-sia account for 10–15% of maternal deaths [3]. The majority of maternal deaths in developing countries result from eclampsia, while in developed countries, complications of pre-eclampsia are more often the cause [16].

The global burden of pre-eclampsia is substantial, with an estimated 343,000 annual deaths globally, with the vast majority occurring in developing regions (341,000 annual deaths), pri-marily in sub-Saharan Africa (209,000 annual deaths) and Southern Asia (80,000 annual deaths), compared with developed regions (only 1,900 annual deaths) [17]. The lifetime risk of mater-nal death from pre-eclampsia and other hypertensive disorders is approximately 1 in 1,700 in developed countries, but rises dramatically to 1 in 39 in developing countries [4].

2.2. Regional Perspectives

In Egypt, a 0.3% incidence of pregnancy-induced pre-eclampsia has been reported, which is relatively low compared to other African nations [18]. In Nigeria, annual estimation ranges of pre-eclampsia are between 2% and 16.7%, with approximately 37,000 pregnant women dying as a result of pre-eclampsia each year [19]. In Northern Nigeria specifically, 40% of maternal deaths occur due to the combined effect of deficit knowledge among healthcare workers and inadequate referral systems [20].

In Tanzania, pre-eclampsia remains the second leading cause of maternal deaths after postpar-tum hemorrhage, indicating that training coverage and retention of knowledge remain subopti-mal [21]. A study conducted at the University of Lahore Teaching Hospital in Pakistan revealed that while 73.3% of nurses demonstrated good knowledge regarding pharmacological manage-ment of pre-eclampsia, 26.7% still exhibited inadequate understanding of critical aspects such as fluid management, seizure precautions, and postpartum monitoring [22].

2.3. Knowledge of Healthcare Providers

Research has consistently identified knowledge deficits among healthcare providers as a key barrier to effective management of pre-eclampsia. A study conducted in Mexico and Thailand found that only 36% of hospitals used magnesium sulfate for pre-eclampsia and eclampsia [23]. The use of magnesium sulfate is affected by several factors, including healthcare workers’ reluctance to adopt new practices requiring intensive monitoring, drug licensing restrictions, and procurement system delays [24].

In a study done in Zambia to assess barriers to the availability and use of magnesium sulfate, lack of stock, lack of licensing, and low numbers of pre-eclampsia patients were identified as reasons for its unavailability in health facilities [25]. The procurement system causes delays in the availability of this drug, especially at lower facility levels.

2.4. Magnesium Sulfate in Management

The Eclampsia Collaborative Group in 1995 produced compelling evidence in support of mag-nesium sulfate as the anticonvulsant of first choice both to control seizures and to prevent recur-rence in eclampsia [26]. In a systematic review involving more than 11,000 women, magnesium sulfate significantly reduced the risk of eclampsia among patients with severe pre-eclampsia compared to phenytoin and diazepam [27]. WHO estimates that use of magnesium sulfate can reduce deaths due to eclampsia by half [15].

There are principally two main regimens available for administration of magnesium sulfate. The Pritchard Regimen involves a loading bolus dose of 4 grams given slowly intravenously over 5–10 minutes, followed by 10 grams intramuscularly (5 grams in each buttock), and sub-sequently 5 grams intramuscularly into alternate buttocks every 4 hours [28]. The Zuspan regimen consists of an initial intravenous dose of 4 grams slowly over 5–10 minutes followed by a maintenance dose of 1–2 grams every hour given continuously by an infusion pump [29].

Magnesium sulfate toxicity is manifested by loss of deep tendon reflexes, respiratory depres-sion, and cardiac arrest [30]. Detection of toxicity is mainly clinical; the parameters that need to be monitored are the knee jerk (should be present), respiratory rate (should be >16 breaths per minute), and urine output (should be >25 mL per hour) [31]. Calcium gluconate is the antidote for magnesium sulfate toxicity [32].

2.5. Nursing Knowledge and Practice

Studies indicate that nurses generally possess fair to high knowledge regarding pre-eclampsia management, with local research showing that 70.5% to 73.3% of nurses correctly identify ba-sic management techniques, particularly anticonvulsant usage and blood pressure monitoring [33]. However, only a fraction of nurses (less than 30% in some studies) have ever received formal, structured training specifically focused on pre-eclampsia management, and most (ap-proximately 65%) have less than five years of clinical experience in obstetric care [34].

Actions carried out by nurses that ensure excellence of care and reduction of maternal and fetal morbidity and mortality include collection of detailed patient history, careful physical examina-tion with emphasis on blood pressure measurement using correct technique, vigilant monitor-ing for pre-eclampsia signs and symptoms, accurate fluid balance documentation, preparation and administration of magnesium sulfate and antihypertensive drugs, seizure precautions, and prompt recognition of complications [35].

3. Methodology

3.1. Study Design

A descriptive cross-sectional study design was employed to assess nurses’ knowledge regarding the management of pre-eclampsia at a specific point in time. This design was selected because it allows the researcher to collect information from selected participants during a defined study period and describe their existing characteristics, knowledge, and practices.

3.2. Study Setting

The study was conducted at Rangpur Community Medical College Hospital, Rangpur, Bangladesh. The hospital provides healthcare services to a large number of patients and has dedicated de-partments and wards for maternal and obstetric care, making it an appropriate setting for con-ducting the study among nurses involved in providing care to pregnant mothers.

3.3. Study Population

The study population comprised senior staff nurses working at Rangpur Community Medical College Hospital who were directly involved in providing care to pregnant mothers. Partici-pants were selected because of their direct involvement in maternal and obstetric nursing care and their relevant professional experience in the study setting.

3.4. Study Duration

The study was conducted from January 2026 to June 2026. During this period, the researcher planned and conducted all study activities, including selection of participants, data collection, and organization of the collected information for analysis.

3.5. Sample Size

The total sample size of the study was 50 nurses. The sample size was calculated using Ya-mane’s formula:

$${\displaystyle \frac{N}{n=1+\mathit{Ne}2}}$$

(1)

where N = population = 85, e = expected error = 0.05

$$n={\displaystyle \frac{85}{1+85\times {0.05}^2}}$$

(2)

= 70.1035 ≈ 71

(3)

Although the calculated sample size was 71, a sample of 50 was selected due to financial constraints and time limitations faced by the student researcher.

3.6. Sampling Technique

A purposive sampling technique was employed to select participants who fulfilled the prede-termined eligibility criteria and were willing to participate in the study.

3.7. Eligibility Criteria

3.7.1. Inclusion Criteria

• Registered nurses currently employed in the Gynaecology and Obstetric ward
• At least 6 months of working experience in the respective unit
• Willing to participate in the study

3.7.2. Exclusion Criteria

• Nurses unwilling to participate
• Nurses who decline to provide consent
• Nurses on long-term leave

3.8. Data Collection Instrument

A self-administered structured questionnaire was developed by reviewing relevant literature. The instrument consisted of two parts:

3.8.1. Part A: Demographic Questionnaire

Included items on age, gender, marital status, residence, religion, academic qualification, work-ing department, years of clinical experience, monthly income, specialization course on pre-eclampsia, and length of service.

3.8.2. Part B: Knowledge Questionnaire

Comprised 20 items assessing knowledge regarding pre-eclampsia management. Knowledge-related questions were converted into ‘Yes’/‘No’ and best-answer questions. For each question, one (1) score was given for the correct response and zero (0) for the incorrect response. The knowledge score was calculated by summing individual item scores, with a total score ranging from 0 to 20. Knowledge levels were categorized as:

• High: 16–20
• Moderate: 10–15
• Low: 0–9

3.9. Data Collection Procedure

Data were collected through face-to-face interviews with nurses working in the Gynaecology, Obstetrics, Labour, and CCU/ICU wards, with the assistance of the Nursing Superintendent. Before initiating data collection, the researcher explained the purpose, objectives, and signif-icance of the study to each respondent. Verbal and written informed consent were obtained from respondents who agreed to participate. The researcher provided necessary clarification regarding questions without influencing respondents’ answers. Each respondent was given ap-proximately 30 minutes to complete the questionnaire. Completed questionnaires were checked for completeness and consistency immediately after collection. Confidentiality and anonymity of respondents were maintained throughout the data collection process.

3.10. Data Analysis

Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20 and MS Excel. After collection, data were checked thoroughly for consistency, verified, edited, cleaned, and analyzed according to objectives and variables. Descriptive statistics (frequencies, percent-ages) were used to present demographic characteristics and knowledge responses. Chi-square tests were employed to examine associations between socio-demographic variables and knowl-edge levels. A p-value <0.05 was considered statistically significant. Results were presented in tables, figures, and graphs.

3.11. Ethical Considerations

Ethical clearance was obtained from the Ethical Committee of Rangpur Community Medical College at the start of the study. Permission from the authority of Rangpur Community Medical College Hospital was obtained through a formal approach letter. Prior consent was taken from respondents, and full freedom to refuse or withdraw from the study at any time was ensured.

4. Results

4.1. Demographic Characteristics of Respondents

A total of 50 nursing professionals participated in the study. The demographic characteristics are summarized in Table 1.

The majority of respondents belonged to the 26–30 years age group, with the highest frequency observed at 26 years (n=9, 18.0%). Female respondents constituted 80.0% (n=40) of the sam-ple, while males represented 20.0% (n=10). Regarding marital status, 68.0% (n=34) were married and 32.0% (n=16) were single. Most respondents (78.0%, n=39) resided in rural areas. The religious distribution was predominantly Muslim (90.0%, n=45), with Hindu respondents constituting 10.0% (n=5). Regarding educational qualification, 60.0% (n=30) held a B.Sc. in Nursing degree, while 40.0% (n=20) had a Diploma in Nursing. In terms of working depart-ment, the largest proportion worked in the Obstetrics ward (38.0%, n=19), followed by the Gynaecology ward (32.0%, n=16), CCU/ICU ward (20.0%, n=10), and Labour ward (10.0%, n=5).

4.2. Knowledge Regarding Pre-Eclampsia Management

4.2.1. Key Findings

High Knowledge Areas: All respondents (100%) correctly identified 24-hour urine protein as the most indicative diagnostic test for worsening pre-eclampsia. Nearly all (98.0%) correctly identified labetalol as the first-line antihypertensive drug. High correct response rates were also observed for ensuring airway patency during seizures (84.0%), identifying ≥90 mmHg as high diastolic reading (86.0%), and recognizing magnesium sulfate as the recommended IV line (90.0%).

Critical Knowledge Gaps: Only 22.0% of respondents correctly identified preventing seizures as the goal of magnesium sulfate therapy, with the majority (78.0%) incorrectly selecting low-ering blood pressure. Similarly, only 16.0% knew calcium gluconate as the antidote for mag-nesium sulfate toxicity, while 84.0% incorrectly chose diazepam.

Moderate Knowledge Areas: Correct responses ranged from 68.0% to 88.0% for items on gestational age of pre-eclampsia development (68.0%), risk factors (74.0%), postpartum devel-opment (74.0%), proteinuria in all cases (76.0%), symptom presentation (80.0%), and nursing diagnosis (88.0%).

Table 2. Distribution of Respondents by Knowledge Items (n=50).

Knowledge Item	Correct Response	Frequency (n)	Percentage (%)
High diastolic reading during preg-	≥90 mmHg	43	86.0
nancy
Immediate management during fit	Ensure airway is open	42	84.0
Recommended IV line for pre-	Magnesium sulfate	45	90.0
eclampsia
Risk factors of pre-eclampsia	Family history	37	74.0
First-line antihypertensive drug	Labetalol	49	98.0
Most indicative diagnostic test	24-hour urine protein	50	100.0
Most appropriate nursing diagnosis	Ineffective thermoreg-	44	88.0
	ulation
Goal of magnesium sulfate therapy	Preventing seizures	11	22.0
Antidote of magnesium sulfate	Calcium gluconate	8	16.0
Gestational age of pre-eclampsia de-	After 20 weeks	34	68.0
velopment
Can pre-eclampsia occur without prior	Yes	36	72.0
history?
Do all women with pre-eclampsia have	No	38	76.0
proteinuria?
Does high blood pressure always cause	No	40	80.0
symptoms?
Can pre-eclampsia affect baby’s	Yes	44	88.0
health?
Can pre-eclampsia develop after birth?	Yes	37	74.0
Is normal pregnancy swelling same as	No	35	70.0
pre-eclampsia?
Do you advise avoiding fatty diet?	Yes	45	90.0
Do you advise controlling blood pres-	Yes	46	92.0
sure?
Do you know how to monitor fetal con-	Yes	45	90.0
dition?
Do you recommend low-dose aspirin?	No	48	96.0

Table 2. Distribution of Respondents by Knowledge Items (n=50).

Knowledge Item	Correct Response	Frequency (n)	Percentage (%)
High diastolic reading during preg-	≥90 mmHg	43	86.0
nancy
Immediate management during fit	Ensure airway is open	42	84.0
Recommended IV line for pre-	Magnesium sulfate	45	90.0
eclampsia
Risk factors of pre-eclampsia	Family history	37	74.0
First-line antihypertensive drug	Labetalol	49	98.0
Most indicative diagnostic test	24-hour urine protein	50	100.0
Most appropriate nursing diagnosis	Ineffective thermoreg-	44	88.0
	ulation
Goal of magnesium sulfate therapy	Preventing seizures	11	22.0
Antidote of magnesium sulfate	Calcium gluconate	8	16.0
Gestational age of pre-eclampsia de-	After 20 weeks	34	68.0
velopment
Can pre-eclampsia occur without prior	Yes	36	72.0
history?
Do all women with pre-eclampsia have	No	38	76.0
proteinuria?
Does high blood pressure always cause	No	40	80.0
symptoms?
Can pre-eclampsia affect baby’s	Yes	44	88.0
health?
Can pre-eclampsia develop after birth?	Yes	37	74.0
Is normal pregnancy swelling same as	No	35	70.0
pre-eclampsia?
Do you advise avoiding fatty diet?	Yes	45	90.0
Do you advise controlling blood pres-	Yes	46	92.0
sure?
Do you know how to monitor fetal con-	Yes	45	90.0
dition?
Do you recommend low-dose aspirin?	No	48	96.0

4.3. Overall Knowledge Level

The overall knowledge assessment revealed that exactly half of the respondents (50.0%, n=25) demonstrated a high level of knowledge. A substantial proportion (46.0%, n=23) showed mod-erate knowledge, while only 4.0% (n=2) had low knowledge.

Table 3. Distribution of Respondents by Overall Knowledge Level (n=50).

Knowledge Level	Score Range	Frequency (n)	Percentage (%)
High	16–20	25	50.0
Moderate	10–15	23	46.0
Low	0–9	2	4.0
Total		50	100.0

Table 3. Distribution of Respondents by Overall Knowledge Level (n=50).

Knowledge Level	Score Range	Frequency (n)	Percentage (%)
High	16–20	25	50.0
Moderate	10–15	23	46.0
Low	0–9	2	4.0
Total		50	100.0

4.4. Association Between Working Department and Knowledge Level

Among the Gynaecology ward (n=16), 0.0% had low knowledge, 62.5% had moderate knowl-edge, and 37.5% displayed high knowledge. In contrast, among the Obstetrics ward (n=19), there were no low knowledge cases, 47.4% displayed moderate knowledge, and 52.6% showed high knowledge levels. The Labour ward (n=5) showed 40.0% with low knowledge, 0.0% with moderate knowledge, and 60.0% with high knowledge. The CCU and ICU ward (n=10) had no low knowledge cases, 40.0% with moderate knowledge, and 60.0% with high knowledge.

Table 4. Cross-tabulation of Working Department and Knowledge Level.

Working Department	Knowledge Level			Total
	Low n (%)	Moderate n (%)	High n (%)
Gynaecology ward	0 (0.0)	10 (62.5)	6 (37.5)	16
Obstetrics ward	0 (0.0)	9 (47.4)	10 (52.6)	19
Labour ward	2 (40.0)	0 (0.0)	3 (60.0)	5
CCU and ICU ward	0 (0.0)	4 (40.0)	6 (60.0)	10
Total	2 (4.0)	23 (46.0)	25 (50.0)	50

Table 4. Cross-tabulation of Working Department and Knowledge Level.

Working Department	Knowledge Level			Total
	Low n (%)	Moderate n (%)	High n (%)
Gynaecology ward	0 (0.0)	10 (62.5)	6 (37.5)	16
Obstetrics ward	0 (0.0)	9 (47.4)	10 (52.6)	19
Labour ward	2 (40.0)	0 (0.0)	3 (60.0)	5
CCU and ICU ward	0 (0.0)	4 (40.0)	6 (60.0)	10
Total	2 (4.0)	23 (46.0)	25 (50.0)	50

4.4.1. Chi-Square Test Interpretation

The Pearson Chi-Square test value was calculated as 22.159 with 6 degrees of freedom (df=6). The asymptotic two-sided significance value (p-value) was .001. Since the p-value (.001) is less than the standard significance limit of 0.05 (p < 0.05), the null hypothesis was rejected. This indicates a statistically significant association between working department and knowl-edge level.

4.5. Association Between Academic Qualification and Knowledge Level

Table 5. Cross-tabulation of Academic Qualification and Knowledge Level.

Academic Qualification	Knowledge Level			Total
	Low n (%)	Moderate n (%)	High n (%)
Diploma in Nursing	1 (5.0)	12 (60.0)	7 (35.0)	20
B.Sc. in Nursing	1 (3.3)	11 (36.7)	18 (60.0)	30
Total	2 (4.0)	23 (46.0)	25 (50.0)	50

Table 5. Cross-tabulation of Academic Qualification and Knowledge Level.

Academic Qualification	Knowledge Level			Total
	Low n (%)	Moderate n (%)	High n (%)
Diploma in Nursing	1 (5.0)	12 (60.0)	7 (35.0)	20
B.Sc. in Nursing	1 (3.3)	11 (36.7)	18 (60.0)	30
Total	2 (4.0)	23 (46.0)	25 (50.0)	50

Among the Diploma in Nursing group (n=20), 5.0% had low knowledge, 60.0% had moderate knowledge, and 35.0% displayed high knowledge. In contrast, among B.Sc. in Nursing degree holders (n=30), only 3.3% showed low knowledge, 36.7% displayed moderate knowledge, and a much higher 60.0% showed high knowledge levels.

4.5.1. Chi-Square Test Interpretation

The Pearson Chi-Square test value was calculated as 3.004 with 2 degrees of freedom (df=2). The asymptotic two-sided significance value (p-value) was .223. Since the p-value (.223) is more than the standard significance limit of 0.05 (p > 0.05), the null hypothesis was not re-jected. This indicates no statistically significant association between academic qualification and knowledge level. However, B.Sc. nurses displayed higher competency percentages compared to diploma nurses.

5. Discussion

5.1. Demographic Profile

The present study evaluated a sample of 50 nursing professionals working in obstetric and critical care settings at Rangpur Community Medical College Hospital. The majority of re-spondents were young adults aged 26–30 years, with the highest frequency at 26 years. This age distribution is consistent with the typical demographic profile of nursing professionals in Bangladesh, where many enter the workforce in their mid-twenties after completing their nurs-ing education [36].

The gender distribution showed a predominance of female respondents (80.0%), which reflects the historical gender composition of the nursing profession in Bangladesh and many other countries [37]. However, the 20.0% male representation indicates increasing gender diversity in the nursing workforce.

Most respondents were married (68.0%) and resided in rural areas (78.0%). The rural predomi-nance may reflect the location of the study hospital and the recruitment patterns of nursing staff in regional medical college hospitals in Bangladesh. The religious distribution was predomi-nantly Muslim (90.0%), consistent with the demographic composition of the Rangpur region [38].

Regarding educational qualification, 60.0% held a B.Sc. in Nursing degree, while 40.0% had a Diploma in Nursing. This reflects the ongoing transition in Bangladesh from diploma-level to degree-level nursing education, with increasing numbers of nurses pursuing higher qualifica-tions [39].

5.2. Knowledge Regarding Pre-Eclampsia Management

The findings demonstrated that respondents had generally satisfactory knowledge in several important areas, while critical gaps were identified regarding magnesium sulfate therapy and toxicity management.

5.2.1. High Knowledge Areas

The study found that 100% of respondents correctly identified 24-hour urine protein as the most indicative diagnostic test for worsening pre-eclampsia. This finding demonstrates ex-cellent knowledge regarding proteinuria assessment, which is a cornerstone of pre-eclampsia evaluation. This is consistent with findings from a study conducted in Pakistan where 73.3% of nurses demonstrated good knowledge regarding pharmacological management [22].

The finding that 98.0% correctly identified labetalol as the first-line antihypertensive drug was one of the strongest areas of knowledge. This suggests that respondents were highly familiar with labetalol as an important medication for controlling severe hypertension in pregnancy. This is particularly encouraging given that rapid control of high blood pressure is critical in preventing maternal complications such as stroke and eclampsia [40].

Additionally, 90.0% correctly identified magnesium sulfate as the recommended intravenous line for managing pre-eclampsia, and 84.0% correctly identified ensuring airway patency as the immediate management during a seizure. These findings indicate a high level of awareness regarding the central role of magnesium sulfate in seizure prevention and management, as well as the importance of basic airway management in obstetric emergencies [1].

5.2.2. Critical Knowledge Gaps

Despite the overall satisfactory knowledge, significant gaps were identified. Only 22.0% of respondents correctly identified preventing seizures as the goal of magnesium sulfate therapy, with the majority (78.0%) incorrectly selecting lowering blood pressure. This represents a fun-damental misunderstanding of the pharmacological action of magnesium sulfate, which is an anticonvulsant rather than an antihypertensive agent [41]. This knowledge deficit is concerning, as it may lead to inappropriate use of magnesium sulfate and failure to administer appropriate antihypertensive therapy when needed.

Even more concerning was the finding that only 16.0% of respondents knew calcium gluconate as the antidote for magnesium sulfate toxicity, while 84.0% incorrectly chose diazepam. This represents a critical patient safety gap, as magnesium toxicity can lead to respiratory depres-sion, cardiac arrest, and death if not promptly recognized and treated with calcium gluconate [42]. The lack of knowledge regarding the antidote suggests that nurses may not be adequately prepared to recognize and respond to magnesium toxicity, which is a life-threatening emer-gency.

These findings are consistent with studies conducted in other low- and middle-income coun-tries. Research conducted in the Democratic Republic of Congo, Burundi, Tanzania, and Nepal found that large proportions of healthcare workers lacked adequate understanding of critical management aspects, particularly monitoring for signs of magnesium toxicity [14]. A study in Zambia similarly identified lack of knowledge as a barrier to the safe use of magnesium sulfate [25].

5.3. Overall Knowledge Level

The overall knowledge assessment revealed that 50.0% of respondents demonstrated a high level of knowledge, 46.0% showed moderate knowledge, and only 4.0% had low knowledge. This distribution is encouraging and suggests that the majority of nurses have a reasonable foundation of knowledge regarding pre-eclampsia management. These findings are comparable to studies conducted in Bangladesh that reported 70.5% to 73.3% of nurses correctly identifying basic management techniques [33].

However, the finding that 46.0% of respondents had only moderate knowledge indicates room for improvement. The presence of 4.0% with low knowledge is also concerning, as these nurses may not be able to provide safe and effective care to pre-eclamptic women without additional training and support.

5.4. Association Between Working Department and Knowledge Level

A statistically significant association was found between working department and knowledge level (χ² = 22.159, df=6, p = .001). Nurses working in the Obstetrics ward and CCU/ICU ward demonstrated higher proportions of high knowledge (52.6% and 60.0%, respectively) compared to those in the Gynaecology ward (37.5%). Interestingly, the Labour ward showed a bimodal distribution, with 40.0% having low knowledge and 60.0% having high knowledge, which may reflect the small sample size (n=5) and varied levels of experience in this setting.

This finding suggests that the clinical environment and nature of work experience significantly influence knowledge acquisition and retention. Nurses working in Obstetrics and critical care settings are likely exposed to more complex cases and have greater opportunities for hands-on management of pre-eclampsia, contributing to their higher knowledge levels [43]. This highlights the importance of ensuring that all nurses, regardless of their primary work setting, receive adequate training and exposure to pre-eclampsia management.

5.5. Association Between Academic Qualification and Knowledge Level

No statistically significant association was found between academic qualification and knowl-edge level (χ² = 3.004, df=2, p = .223). However, B.Sc. nurses displayed higher competency percentages compared to diploma nurses, with 60.0% of B.Sc. nurses showing high knowl-edge compared to 35.0% of diploma nurses. This trend, while not statistically significant in this small sample, is consistent with the expectation that higher academic qualifications may provide a stronger theoretical foundation for clinical practice [44].

The lack of statistical significance may be due to the small sample size (n=50) and the relatively small number of diploma nurses (n=20). A larger study with greater statistical power might detect a significant difference. Nevertheless, the trend suggests that efforts to increase the proportion of B.Sc.-qualified nurses in the workforce may have a positive impact on overall knowledge levels.

5.6. Implications for Practice

The findings of this study have several important implications for nursing practice, education, and policy in Bangladesh:

• Targeted Training: The critical gaps in knowledge regarding magnesium sulfate ther-apy and toxicity management highlight the need for targeted educational interventions. Training programs should emphasize the pharmacological action of magnesium sulfate, its role in seizure prevention, and the recognition and management of magnesium toxic-ity, including the use of calcium gluconate as the antidote.
• Continuing Professional Development: Regular refresher training and continuing pro-fessional development should be arranged to maintain and update nurses’ knowledge regarding current guidelines, preventive measures, early identification of complications, and appropriate management of pre-eclampsia.
• Clinical Exposure: The significant association between working department and knowl-edge level suggests that clinical exposure plays an important role in knowledge acquisi-tion. Nursing administrators should ensure that nurses in all departments have opportu-nities for hands-on experience and mentoring in pre-eclampsia management.
• Educational Advancement: The trend toward higher knowledge among B.Sc. nurses supports the ongoing transition to degree-level nursing education in Bangladesh. Efforts should continue to increase the proportion of nurses with advanced qualifications.
• Supportive Supervision: Strengthening the relationship between knowledge and actual clinical practice through supportive supervision, regular monitoring, and constructive feedback is essential to ensure that theoretical knowledge translates into safe and effective patient care.

6. Conclusions

Pre-eclampsia is a significant contributor to maternal and perinatal morbidity and mortality, posing a major challenge to maternal and newborn health in Bangladesh. Inadequate knowl-edge and clinical skills among healthcare providers remain significant barriers to the timely diagnosis and effective management of pre-eclampsia. As nurses are often the first point of contact for pregnant women in obstetric emergency settings, their competence in early as-sessment, accurate blood pressure measurement, proteinuria detection, recognition of warning signs, continuous monitoring, and timely intervention is crucial for preventing severe maternal and neonatal complications.

This study demonstrated that the majority of nurses at Rangpur Community Medical College Hospital had a satisfactory level of knowledge regarding key aspects of pre-eclampsia manage-ment. Most respondents correctly identified magnesium sulfate as the appropriate medication, ensuring airway patency as an immediate management measure, pre-eclampsia development after 20 weeks of gestation, and ≥90 mmHg as the high diastolic blood pressure threshold dur-ing pregnancy. However, critical gaps were identified regarding the goal of magnesium sulfate therapy and the management of magnesium sulfate toxicity, with only 22.0% and 16.0% of respondents answering correctly, respectively.

The inferential statistical analysis revealed a statistically significant association between work-ing department and knowledge level (p = .001), but no significant association between aca-demic qualification and knowledge level (p = .223). Nevertheless, B.Sc. nurses displayed higher proportions of high knowledge scores compared to diploma nurses.

Overall, the findings highlight the importance of strengthening nurses’ knowledge through con-tinuous professional development, targeted training, and evidence-based educational interven-tions to enhance the effective management of pre-eclampsia. Such initiatives may contribute to improving the quality of maternal care and ultimately reducing adverse maternal and perinatal outcomes in Bangladesh.

7. Recommendations

Based on the findings of this study, the following recommendations are made:

• For Hospital Authorities and Nursing Administrators:
  • Develop administrative strategies to minimize excessive workload, ensure adequate staffing, and facilitate proper distribution of responsibilities so that nurses can apply their knowledge effectively in the management of patients with pre-eclampsia.
  • Arrange regular refresher training, continuing professional development, and evidence-based educational updates to maintain nurses’ existing knowledge and keep them informed about current guidelines.
  • Particular emphasis should be placed on strengthening the relationship between knowledge and actual clinical practice through supportive supervision, regular mon-itoring, and constructive feedback.
• For Nursing Educators:
  • Integrate comprehensive pre-eclampsia management, including magnesium sulfate therapy and toxicity recognition, into nursing curricula at both diploma and degree levels.
  • Use simulation-based training and competency assessments to ensure that nursing students and practicing nurses can safely administer magnesium sulfate and recog-nize and manage toxicity.
• For Policymakers:
  • Support the ongoing transition to degree-level nursing education and increase op-portunities for practicing nurses to upgrade their qualifications.
  • Develop national guidelines for pre-eclampsia management that clearly outline nurs-ing responsibilities and provide standardized protocols for magnesium sulfate ad-ministration and monitoring.
• For Future Research:
  • Conduct larger, multi-center studies with greater statistical power to further inves-tigate the association between academic qualification and knowledge level.
  • Implement and evaluate the effectiveness of targeted educational interventions on nurses’ knowledge and clinical practice regarding pre-eclampsia management.
  • Explore the relationship between nurses’ knowledge and actual patient outcomes in pre-eclampsia management.

8. Limitations

While optimal care was taken at each step of the study, the following limitations should be acknowledged:

• This study was conducted in a purposively selected area with a limited sample size (n=50). The findings may not reflect the entire population of nurses in Bangladesh and may lack external validity.
• The time frame for the study was limited, which may have restricted the ability to explore all relevant factors.
• The study was conducted in only one hospital, so the findings may not be representative of nurses working in other hospitals or healthcare settings.
• Data were collected through a structured questionnaire, which may be influenced by respondents’ understanding, recall, and willingness to provide accurate information.
• The small sample size may have limited the statistical power to detect significant associ-ations, particularly for the academic qualification analysis.
• The study relied on self-reported knowledge rather than direct observation of clinical practice, which may not fully reflect actual clinical competence.

9. Implications of Findings

• Nursing Education: The findings highlight the need for enhanced pre-eclampsia con-tent in nursing curricula, with particular emphasis on magnesium sulfate therapy and toxicity management. Simulation-based training and competency assessments should be incorporated.
• Nursing Practice: The study identifies critical knowledge gaps that must be addressed through targeted training and continuing education. Standardized protocols for magne-sium sulfate administration and monitoring should be developed and implemented.
• Best Patient Care: Improving nurses’ knowledge through targeted educational interven-tions can contribute to timely management, prevention of complications, and enhance-ment of the quality of maternal healthcare services.
• Nursing Research: Future research should focus on evaluating the effectiveness of ed-ucational interventions, exploring the relationship between knowledge and patient out-comes, and conducting larger multi-center studies.