Synopsis Proforma for Registration of Subject

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MR.RAMACHANDRA.V.KALE. I YEAR M.Sc. NURSING PAEDIATRIC NURSING 2012 – 2013

TULZA BHAVANI COLLEGE OF NURSING NO.899/3, NEAR HAZRAT JUNEEDI DARGA, GYANG BOWDI, BIJAPUR-586101

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE

KARNATAKA

1. NAME OF THE CANDIDATE Mr.RAMACHANDRA. V. KALE AND ADDRESS I YEAR MSc NURSING TULZA BHAVANI COLLEGE OF NURSING, BIJAPUR-586101

2. NAME OF THE INSTITUTE TULZA BHAVANI COLLEGE OF NURSING,No.899/3 NEAR HAZRAT JUNEEDI DARGA, GYANG BOWDI, BIJAPUR-586101

3. COURSE OF THE STUDY AND I YEAR MSc NURSING SUBJECT PAEDIATRIC NURSING

4. DATE OF ADMISSION TO THE COURSE 25/06/2012

5. TITLE OF THE STUDY “ A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF NEONATAL EMERGENCY MANAGEMENT AMONG III YEAR GNM AND IV YEAR BSc NURSING STUDENTS IN SELECTED SCHOOLS AND COLLEGES AT BIJAPUR, WITH A VIEW TO DEVELOP INFORMATION BOOKLET”.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

2 6. BRIEF RESUME OF INTENDED WORK:

6.1 INTRODUCTION:

“Todays childrens tommorrows citizens”

The four basic needs of all babies at the time of birth, Warmth, Normal Breathing, Mothers milk and Protection from these basic need indicate that a baby’s survival is totally dependent upon its mother and other care givers. Therefore it is important to provide proper care to all the neonates immediately after birth.1

A baby's focus of vision is best at about 8 to 12 inches - just the distance from the baby cradled in a mother's arms to her face.“The right to life is a fundamental human right, implying not only the right to protection for life and survival. Human rights are universal and must be applied without discrimination on any grounds whats ever against arbitrary execution by the state.2

All newborns require essential newborn care to minimize the risk of illness and maximize their growth and development. This care will also prevent many newborn emergencies. For example, the umbilical cord may be the most common source of neonatal sepsis and also of tetanus infection and good cord care can dramatically reduce the risks of these serious conditions. Exclusive breast feeding has a significant protective effect against infections. Early breast feeding and keeping the baby close to the mother reduce the risk of hypothermia and hypoglycemia.3

An understanding of child care since it begin is essential for the nurse to gain an appreciation of the trends leading to our present concepts and practices specific to children. Some of todays philosophic beliefs can be attributed to evolving civilization. Littel is known about life in prehistoric times, but child care is believed to have been similer to that among cultural groups living today in areas hardly touched by civilization .In such groups children usually are not valued for themselves but as future adults. Health of children has been considered as the vital importance to all societies because children are the resource of the future of

3 humankind. Nursing care of children is concerned for both the health of children and for the illness that affect their growth and development. The increasing complexity of medical and nursing science has created a need for special area of child care, i.e. pediatric nursing.4

The physical and mental well-being of an individual depends on the correct management of events in the parinatal period. The morbidity and mortality rates in new born infants are high. In India almost 7 out of 100 babies do not see their first birthday and nearly 65%of these infant deaths occurs in the neonatal period. Death is the time when something ends and birth is the time when something begins. The neonatal emergencies are the leading cause of death in most of the developed and developing countries. The young are often among the most vulnerable for disadvantaged in society and thus their needs require special attention.5

The major causes for infant deaths are preterm birth, asphyxia, low birth weight and sepsis. “We insist on transporting the sick baby in a special vehicle to avoid infection, ICH receives at least 10 to 15 such babies every day. Specialised intensive neonatal care units in government hospitals in Madurai and Tiruchi also receive an equal number of such babies. Since June 29, 2011, when the State government introduced its first neonatal ambulance, which is part of the Emergency Management and Research Institute (EMRI) 108 fleet, around 930 babies less than 28 days old, and weighing less than 2 kg, have been transported for emergency care to tertiary hospitals for treatment. While ICH accounts for 671 cases, the Chengalpet Medical College Hospital's neonatal unit accounts for 259 babies. “Ninety percent of the babies we transported were critical and would not have survived if they did not have facilities like oxygen supply, warmers and a sterile atmosphere,” said Adeline Dhivya Israel, an emergency physician at the EMRI 108 control room. With better awareness about the need for cleanliness, death or complications due to sepsis are on the decline. But birth asphyxia is a challenge, as it requires a team effort. “The first 24 hours are crucial. We are losing low birth weight babies. If a baby does not cry at birth even though efforts are made to make it cry, then we generally ask that it be referred to a neonatal care unit for observation and assess”.6

4 6.2. NEED FOR THE STUDY:

“Prevention is better than cure”

Need for the study means scientific method which refers to a body of technique for investigation phenomena, acquiring new knowledge or collecting and integrating previous knowledge to be termed scientific method of enquiry must be based on gathering empirical and measurable evidence subject to specific principles of reasoning. When the baby arrives, the days will be so much happier. However, must also be prepared for bad situations. Newborn baby is very likely to face some of the common health problems in her early days. Mother usually get overly worried and panic finding their precious newborns sick.

Most maternal and neonatal deaths in developing countries happen at home, beyond the reach of health facilities. India contributes about 1 million new born and infant deaths to the global burden and its infant mortality is 43/1000 live births globally ,in India its 53/1000 live births in Karnataka 45/1000 live births , a high rate that has not declined much in the recent past. In Karnataka, major health indicators- infant mortality rate (IMR) and maternal mortality rate (MMR) –show that state in poor light. The Mysore city infant mortality rate is 29 per thousand.7

By immediate and exclusive breastfeeding, mothers can protect their newborns from a wide variety of risks, including hypothermia, hypoglycemia and infections. Infants who are breastfed also have improved chances for survival. The review identified two priority interventions during labour and delivery: reducing the risk of infection to mothers and newborns by keeping the birth attendant’s hands and all contact with the newborn’s umbilical cord (especially cutting instruments and ties) clean and resuscitating newborns who are not breathing normally after birth. Having a skilled nurse present can save lives.8

Child mortality is a sensitive indicator of a country’s development. In India, the Infant Mortality Rate (IMR) (under one year) has shown a modest decline in recent years. The average decline of IMR per year between the years 2004 to 2008

5 has been about 1 per cent peryear. The IMR was 53/1,000 live births. Eight states contribute to 75 per cent of infant mortality: Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Andhra Pradesh, Orissa, Gujarat and Assam. At the current rate of decline, India will miss the XI plan goal of reduction in IMR and the Millennium development Goal-4 on child survival respiratory infections (22 per cent) and diarrhea (13.8 per cent). Malnutrition is an underlying cause responsible for about one third of all deaths.9

According to World Population report, the World Population is seven billion, the hungry people in the world is about 925 million. In developed countries it is 19 million and in Asia it is 578 million. Children are the more visible victims of undernutrtion. A survey by the World Health Organization -the number of underweight pre-school children (0-5 years of age) is 40 %. Every 6 seconds a child dies from malnutrition and related causes. Other deficiencies, such as lack of vitamin A or zinc, account for 1 million.10

The current world population is 7 billions. Current population of India in 2011 is estimated to be 1.21 billion. Most growth retardation occurs by the age of two, and most damage is irreversible. The prevalence under weight in rural areas 50 percent versus 38 percent in urban areas and higher among girls (48.9 percent) than among boys (45.5 percent) .Current Population of Karnataka in 2011 is 6.1 crore. In this state 37.6% of children are underweight 28.1% of the population is undernourished and 5.5% of children who die under the age of 5 from hunger.11

Worldwide about 8 newborn babies die every minute. Every year more than 4 million babies die during first week of life due to inadequate care. Further reduction of newborn mortality can be accomplished by improving the quality of care provided to newborn babies. Globally, the average NMR has fallen by more than a quarter over 20 year, (1990-2009) from 33.2 to 23.9 per 1,000 live births, or an average of 1.7% per year. Over 130 million babies are born every year, and more than 10 million infants die before their fifth birthday, almost 8 million before their first.10

During the past two decades, infant mortality rate has declined very slowly. This is as a result of a very slowly declining neonatal mortality rate. There has been

6 relatively little change in neonatal mortality despite proven cost-effective solutions to reduce neonatal mortality, such as promoting tetanus toxoid immunization, skilled attendance during delivery, immediate and exclusive breastfeeding and clean cord care. Two-thirds of all deaths that occur during the first year of life occur in the neonatal period. More than half occur in the first 24 hours after birth an indication of how hazardous this time is for an infant. Close observation of a newborn for this indication of distress is essential during this period.12

Diarrhoea is a common but potentially serious illness in early childhood. A child suffers, on an average with 10 to 15 episodes of diarrhoea in the first five years of life. Of these, three to five occur in the first year of life. A child may loss almost as much water and electrolytes from the body during an episode of diarrhoea as an adult, since the length and surface area of intestinal mucosa of a child, from where the diarrhoeal fluids are secreted, are fairly large.13

A study was conducted at Uttar Pradesh , Barabanki and Unnao, India to assess the rates, timing and causes of neonatal deaths and the burden of still birth ; there were 430 stillbirths reported, comprising 41% of all deaths in sample. Of the 618 live births, 32% deaths were on the day of birth, 50% occurred during the first 3 days of life and 71% were during the first week. The primary causes of death on the first day of life were birth asphyxia or injury (31%) and preterm birth (26%). During days 1-6, the most frequent causes of death were preterm birth (30%) and sepsis or pneumonia (25%). Half of all deaths caused by sepsis or pneumonia occurred during the first week of life. The proportion of deaths attributed to sepsis or pneumonia increased to 45% and 36% during days 7-13 and 14-27 respectively. The recommendation is provide to prevent 32% of deaths of neonatal.13

In the changing trends and changing attitude towards care of children, the pediatric nurse has to face various challenges on the following aspects. Emergence of medical speciality and super-speciality of pediatric care need specialized education and training of pediatric nurse. Nurses required to be up to date in the field of specialized care to be at per with their co-worker and team members especially medical counterpart in intensive care, neonatalogy and in any special care system. Increasing numbers of HIV infected innocent children create problems in

7 pediatric care and nursing practices which need for specialized approach. Increasing numbers of psychological problems among children due to unhealthy competition, comparison, single parent and family disruption call for special attention of pediatric nurse in child care. Thus investigator felt to compare the knowledge of emergency neonatal management in between GNM and BSc nursing students, So conducted a study on comparative study to assess the knowledge and practice of neonatal emergency management among IIIrd year GNM and IVth year BSc nursing students in selected schools and colleges of Bijapur with a view to develop information booklet.

8 6.3 REVIEW OF LITERATURE:

The review of literature in a research report is a summery of current knowledge about a particular problem and includes what is known and not known about problem. Review of literature is one of the most important steps in research process. The major goals of review of literature are to develop a strong knowledge base to carry out research and non research schoolary activity.

A study was conducted to determine the most effective method of delivering training to staff on the management of neonatal emergency management. The research was conducted in District General Hospital in U.K delivering approximately 3500 women per year. The samples was 36 staff, including the junior and senior medical and midwifery staff. There are three teaching method were employed. The team knowledge and performance were assessed pre-training, post-training, and at three months later. The study was revealed that all the team member improved their performance and knowledge. Obstetrics is a high risk specially in which the emergencies are to some extent, Training staff to manage emergencies is a fundamental principles of risk management. The study was recommended that, stimulation based training is an appropriate proactive approach to reducing errors and risks in obstetrics, improving team work and communication giving the students a multiplicity of transferable skill to improve their performance.14

A study was conducted in rural India on the effect of knowledge of community health workers on essential newborn health care. Data collected from 302 anganwadi workers (AWWs) and 86 auxiliary nurse midwives (ANMs ) and data from recently delivered women. Coverage of antenatal home visits and newborn care practices were positively correlated with the knowledge level of AWWs and ANMs. Initiation of breastfeeding in the first hour of life (odds ratio 1.97; 95% confidence interval (CI): 1.55–2.49 for AWW, and odds ratio 1.62; 95% CI: 1.25–2.09 for ANM), clean cord care (odds ratio 2.03; 95% CI: 1.64–2.52 for AWW, and odds ratio 1.43; 95% CI: 1.17–1.75 for ANM) and thermal care (odds ratio 2.16; 95% CI: 1.64–2.85 for AWW and odds ratio 1.88; 95% CI: 1.43–2.48 for ANM) were students significantly recommended that higher among women visited by AWWs or ANMs who had better knowledge compared with those with poor knowledge.15

9 A study was conducted in rural Nepal, birth attendant hand washing was related to a statistically significant lower mortality rate among neonates (adjusted relative risk [RR] = 0.81; 95% confidence interval [CI], 0.66–0.99). Also in Nepal, a study on hand washing at home births found the adjusted risk of newborn cord infection was 27% (95% CI: 17–36) lower among infants where the birth assistant washed her hands with soap before delivery. A 2009 review found evidence that nosocomial infections can be reduced by 40% with adequate hand hygiene. Clean birth kits that have been shown to reduce neonatal sepsis include a clean, unused razor blade, a clean surface for the delivery, clean cord ties and a bar of soap. Although the students recommended that clean birth kits were developed for non-facility births, all settings for childbirth require excellent hygiene, and clean birth kits brought to the facility by the mother may be a way to reduce neonatal sepsis.16

A cross - sectional survey was done, In Medak District using Simple random sampling technique to assess the knowledge levels of Integrated Management of Neonatal and Childhood Illness . Where a total of 36 round- the-clock Primary Health Centers were functioning with 453 Auxiliary Nurse Midwives and 43 Staff Nurses. The average score among all Health Care Providers was 37.01% points. The trained Health Care Providers had an average score of 40.31 points and untrained Health Care Providers had scored 33.71 points. The study found a significant difference in scores obtained by Integrated Management of Neonatal and Childhood Illness untrained and trained Health Care Providers, Students recommended that play a pivotal role in neonatal survival such as identifying a neonate at risk, maintaining clean chain to prevent neonatal sepsis, maintaining warm chain to prevent hypothermia and breast feeding.17

The study was conducted in health care facilities within two districts of Gujarat. 70% of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70%. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. A few facilities had data on infections and reported rates of 3% to 5%. By this study the researcher was felt that the need

10 of improved information systems, protocols and procedures, and for training and research to improve the status. 18

A study was conducted in Philippines trained physicians observed 481 consecutive deliveries in 51 hospitals using a standardized tool to record practices and timing of immediate newborn care procedures. Drying, weighing, eye care and vitamin K injections were performed in more than 90% of newborns. Only 9.6% were allowed skin-to-skin contact. Interventions were inappropriately sequenced, e.g. immediate cord clamping (median 12 sec), delayed drying (96.5%) and early bathing (90.0%). While 68.2% were put to the breast, they were separated two minutes later. Unnecessary suctioning was performed in 94.9%. Doctors trained in neonatal resuscitation were 2.5 (1.1–5.7) times more likely to unnecessarily suction vigorous newborns. 2% died and 5.7% developed sepsis ⁄ pneumonia the researcher was found this minute-by-minute observational assessment revealed that performance and timing of immediate newborn care interventions below WHO standards and deprive newborns of basic protections against infection and death.

Hence the study was recommended that promote skin to skin contact and safe and sterile methods using in delivery.19

A cross-sectional survey of nurses of secondary health care level in the South-Western geopolitical zone of Nigeria, conducted between February and March 2006. The participants were drawn from four hospitals using the random sampling technique. A total of 179 nurses were interviewed. Overall, 78.8% of the participants had adequate knowledge of Neonatal Resuscitation. Specifically, 95.5% had adequate knowledge of evaluation. While 49.7% had adequate knowledge of appropriate decisions and actions. 130 (72.6%), 162 (90.5%), 130 (72.6%) and 173 (96.6%) had adequate knowledge about provision of warmth, tactile stimulation, airway clearance and ventilation, respectively. Who had previously worked in the delivery room and special care baby unit had better knowledge of Neonatal Resuscitation than those who had not & similarly, a significantly higher proportion

11 of participants who had recently attended an Neonatal Resuscitation training course than who had no such training had adequate knowledge of Neonatal Resuscitation . The introduction of routine and periodic Neonatal Resuscitation training programs may improve the Neonatal Resuscitation skills of nurses, who often attend deliveries in the developing world. This is essential for improved survival of newborn infants. 20

A study was conducted on Newborn Care Practices including Delivery Practices, Immediate Care given after birth and Breast-feeding Practices in an Urban slum of Delhi. They found out more than half of home deliveries 26, (56.1%), are mostly conducted by dais 24, (91.3%) or relatives 4(8.7%) . Finger was used to clean the air passage in most of the home deliveries . The study was also suggested that there is an urgent need to reorient health care providers and to educate on clean delivery practices and early neonatal care21 .

A cross sectional comparative study was conducted during June and July in 2005 in Mardan district, Pakistan in hospital-based and community-based deliveries to assess the essential Newborn emergency management Practices. Using convenient sampling Information from 30 delivery cases was gathered ; half of the cases were hospital-based and half at homes. The result showed that among hospital deliveries 80% were conducted by Nurses , 20% by Skilled dais and non by Doctor. Among these cleanliness was kept in 33%, cord care 100%. All the home based deliveries were conducted by unskilled birth attendants. Among these : cleanliness 16.6%, cord care 80% .In both of these groups eye care was 0% and immunization was 100%.This study highlighted the deficiencies in the newborn care. Both hospital practices and traditional ones neglected the basic principals of newborn cleanliness, early breast feeding, eye care and cord care.22

A cohort observational study to evaluate the obstetrical emergency care improves the neonatal outcomes. The samples are the term, cephalic presenting single ton infant born at 1998 and 2003.The setting of the study was the south med hospital, university of Bristol, UK. The method for the study was five minitues Apgar score was reviewed. The study reveals that the five minitue Apgar score decreases from

12 86.4 to 44.6% and those with HIE decreased from 27.3 to 13.6% following the introduction of the training courses in 2000.23

A study conducted to evaluate the effectiveness of a training program for care providers in improving practice of essential newborn care in obstetric units of 5 hospitals in Puttalam district, Sri Lanka. 4 days training program was implemented for doctors, nurses and midwives. Outcome was measured by direct observation, practices of essential newborn care at delivery in the labour room on a subsample, interviewing mothers, immediate skin-to-skin contact and early initiation of breast feeding. From health records, “undesirable health events’’ of the newborns. Practices of cleanliness, thermal within one hour after birth was constrained by inappropriate practices in private or maternity hospitals. The group effect of maternity hospitals and the absence of individual maternal-related factors that explain the outcome suggest that mothers have little or no autonomy to breastfeed their babies within the first hour of life, and depend on the institutional practices that prevail at the maternity hospitals. 33protection and neonatal assessment improved significantly. Improved in skin-to-skin contact by 1.5 times, early initiation in breast feeding by 2 times, undesirable health events declined from 32 to 21 /223 newborns.24

The researcher concluded that in all the neonatal assessments neonmatal emergency management is the vital role of all the personnels, so this is most important step in the development of a research project. It review of literature is the systemic and critical review of the most important published schoolary literature on a perticular topic. This helps the investigator to find what is investigations. Literature in a research report is a summery of current knowledge about a particular already known and what problems remain to be solved. Since effective research is based upon past knowledge, this exercise provides useful hypothesis and suggestions for significant problem and includes what is known and not known about the problem. The literature is reviewed to summerise knowledge for use in practice or to provide a basis for conducting a study. Review of literature section includes a description of the current knowledge of a perticular problem, the gaps in this knowledge base and the contribution of the study to development of knowledge in the area. Review of literature is a key steps in research this knowledge base and the contribution oftudy to

13 development of knowledge in the question to identify what is known and what is unknown about the topic. The major goals of review of literature are to develop a strong knowledge base to carry out research and process, Review of literature is an important step in the development of a research project. It involves systemic identification, location, scrutiny and summery of written materials that contain information on research problems.

6.4 STATEMENT OF PROBLEM:

“A Comparative study to assess the knowledge and practice of neonatal emergency management among III year G.N.M. and IV year B.Sc. nursing students in selected schools and colleges at Bijapur , with a view to develop information booklet.”

6.5 OBJECTIVES OF THE STUDY:

1. To assess the knowledge and practice regarding emergency management.

2. To prepare and administer information booklet.

3. To find the association between knowledge scores with selected socio demographic variables.

6.6 OPERATIONAL DEFINITIONS:

Comparative study: In this study, it reffers to the study, In which comparision of knowledge between two groups.

Assess: In this study, it reffers to the total observation of the topic or person.

Knowledge: In this study , It refers to the correct response of students on topic to aseliated through Self Administered Knowledge Questions (SAKQ).

Practice: In this study ,It refers to the performance of students according to the prepared checklist regarding neonatal emergency management.

Neonatal: In this study, it reffers to, the baby From the birth to four weeks.

14 Emergency Management: In this study, it reffers Where the immediate care needed and the solution is found.

Information Booklet: In this study, it reffers to, It is the teaching method/ tool pepared by the researcher regarding neonatal emergency management.

G.N.M. Students: In this study, It refers to students who are learning and enrolled to General Nursing Midwifery course.

B.Sc. Students: In this study, It refers to students who are learning and enrolled to Bachelor of Science in Nursing course.

6.7 ASSUMPTIONS:

The assumptions of the study are,

1. Students have inadequate knowledge about neonatal emergency management.

2. Information booklet will improve the knowledge of students.

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA:

Data will be collected from the Nursing students regarding neonatal emergency management in selected schools and colleges at Bijapur.

7.2 METHODS OF DATA COLLECTION:

7.2.1 RESEARCH DESIGN: Non Experimental comparative study design.

7.2.2 RESEARCH VARIABLES:

DEPENDENT VARIABLE: Knowledge of students regarding neonatal emergency management.

INDEPENDENT VARIABLE: Information booklet.

15 EXTRANEOUSVARIABLES: Extraneous variables such as age, gender, religion, occupation, income, family etc.

7.2.3 SETTING: Selected nursing schools and colleges at Bijapur.

7.2.4 POULATION: III year G.N.M. and IV year B.Sc. nursing students.

7.2.5 SAMPLE: III year G.N.M .and IV year B.Sc. nursing students.

7.2.6 SAMPLE SIZE: Sample size is 200.

7.2.7 CRITERIA FOR THE SAMPLE SELECTION:

INCLUSION CRITERIA: III year G.N.M. and IV year B.Sc. nursing Students at the age group of 20 to 25 years.

EXCLUSION CRITERIA:

1) Students who are not available during data collection.

2) Students other than III year G.N.M. and IV year B.Sc. nursing.

3) Students who are bellow 20yrs of age and more than 25yrs of age.

7.2.8 SAMPLING TECHNIQUE: Purposive samplling technique.

7.2.9 TOOL FOR DATA COLLECTION:

SECTION A: Includes socio-demographic variables.

SECTION B: Self administered knowledge questionnaire on neonatal emergency Management.

7.2.10 METHOD OF DATA COLLECTION: On first day pre test will be conducted to assess the knowledge of III year G.N.M and IV year B.Sc. nursing students regarding neonatal emergency management. On the same day informational booklet will be distributed to improve their knowledge.

7.2.11 PLAN FOR DATA ANALYSIS: The collected data will be analyzed using desciptive and Inferential Statestics.

DESCRIPTIVE STATISTICS: Frequency, percentage, mean, median and standard deviation will be used.

16 INFERENTIAL STATISTICS: “t” test and chi-square test will be used.

7.3 Does the study requires any investigation or intervention to be conducted on patient or other human or animal?

Yes, there is an intervention as information booklet.

7.4 Has ethical clearance been obtained from your institution?

Yes, the ethical clearance will be obtained from the institution.

17 8.0.REFFERENCES:

1. De Macedo EC, Cruvinel F, Lukasova K, D'Antino ME. The mood variation in mothers of preterm infants in Kangaroo mother care and conventional incubator care. J Trop Pediatr. [online] 2007 Oct;53(5):344- 6. Epub 2007 Sep 19. [cited on 2008 Oct 26]. Available from URL:http/www.ncbi.nim.nih.gov. Retrived on 20.11.12. 2. Pillitteri Adele, “”Maternal And Child Health Nursing”: Care of the Childbearing and Childrearing Family, 6th Edition , Lippincott Williams and Wilkins,2009,pp-447-457Retrived on 20.11.12. 3. Baby Care: How to take Immediate Care of Newborn (2011-04-12) Available from www.onlymyhealth.com/baby-care-how-take-immediate care-newborn Retrived on 20.11.12.. 4. Baby Care: How to take Immediate Care of Newborn (2011-04-12) Available from www.onlymyhealth.com/baby-care-how-take-immediate- care-newborn Retrived on 20.11.12. 5. Care of the Baby at Birth, During first hour after birth (National division, AIIMS, New Delhi),available from URL: www.newbornwhocc.org/ enn/Care_at_Birth1.pdf Retrived on 20.11.12. 6. K. Vidhya, Teaching Newborn Care to antenatal mothers “ Nightingale Nursing Times” Vol. 7, No. 10,January 2012 Retrived on 20.11.12. 7. Available (http://newbornbabyzone.com/health-safety/, Minor, common, newborn ailments, April 2006.)Retrived on 20.11.12. 8. Evidence-Based Essential Newborn Care: Using Evidence to Save Newborn lives, available from : URL: www.prb.org/Publications/ policyBrie.... Retrived on 20.11.12. Retrived on 20.11.12. 9. WHO, Neonatal and Perinatal Mortality; Country, Regional and Global Estimates. URL:whqlibdoc.who.int/publications/2006/9241563206_eng. pdf Retrived on 20.11.12. 10. World pop.estimate.US censes beureau. www.censes gov/egi-bin/ipc/ popclock 2011-05-154 Retrived on 20.11.12.

18 11. Current population of India available on En.wikipedia.org/wiki/ malnutrition.in.india. Retrived on 20.11.12. 12. State of the Art: Research Priorities for the Reduction of Perinatal and Neonatal Morbidity and Mortality in Developing Country Communities: Available URL:www.nature.com Retrived on 20.11.12. 13. (Common Ailments among Children october 8, 2010 12:23 amyou are here home parenting common ailments among children Written by Anita Chanda on April 6, 2010 in Parenting.)Retrived on 20.11.12. 14. UNICEF,WHO,WORLDBANK;Levels&TrendsiChildMortality,URL;ww w.unicef.org/media/files/Child_Mortality_Report_2011_Final.pdf- Retrived on 20.11.12. 15. Praween K Agrawal et al, Effect of knowledge of community health workers on essential newborn health care: a study from rural India, URL: www.nejm.org. Retrived on 20.11.12. 16. USAID; Better Intrapartum Practices to Reduce Newborn Infection: ww.mchip.net. Retrived on 20.11.12. 17. Raddy Satti, Assessment of knowledge levels of Integrated Management of Neonatal and Childhood Illness among health care providers working in round the clock PHCs, available from URL: www.articlesbase.com.Retrived on 20.11.12. 18. Sobel HL et al, Immediate Newborn Care Practices delay Thermoregulation and Breastfeeding initiation. WHO Representative's Office in the Philippines, Manila, Philippines, 2011. URL:www.mdlinx. com/ pediatrics. Retrived on 20.11.12. 19. Sobel HL et al, Immediate Newborn Care Practices delay Thermoregulation and Breastfeeding initiation. WHO Representative's Office in the Philippines, Manila, Philippines,2011. URL: www.mdlinx.com/pediatrics. Retrived on 20.11.12. 20. Tinuade A Ounnlesi, et al, Neonatal Resuscitation – Knowledge and practice of Nurses in Western Nigeria, 2008, available from URL:www.mdlinx.co/pediatrics. Retrived on 20.11.12. 21. Rahi M et al, Newborn care practices in an urban slum of Delhi. Indian J Med Sci .2006 Dec ; 60 (12) : 506-13. Retrived on 20.11.12.

19 22. Khan. Md. Hussain et al. Essential Newborn Care Practice in Hospital Verses Home Deliveries: Gomal Journal of Medical Sciences, available from: URL:www.gims.com.pk/../71. Retrived on 20.11.12. 23. Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, Whitelaw A. Does training in obstetric emergencies improve neonatal outcome. BJOG. 2006 Feb; 113(2): 177-82. Available from URL: http://www.pubmed.com. . Retrived on 20.11.12. 24. Effect of training for care providers on practice of essential newborn care in hospitals in Sri Lanka. Available from URL: www.ncbi.nlm.nih.gov/pubm/ 17973696 Retrived on 20.11.12.

20 9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE :

11. NAME AND DESIGNATION OF 11.1 GUIDE : Mr. Nagaraj G.J Associate Professor Department of Paediatric Nursing, Tulza Bhavani College of Nursing, Bijapur

11.2 SIGNATURE :

11.3 CO-GUIDE (IF ANY) : 11.4 SIGNATURE :

11.5 HEAD OF THE DEPARTMENT : Mr. Nagaraj G.J Associate Professor Department of Paediatric Nursing, Tulza Bhavani College of Nursing, Bijapur

11.6 SIGNATURE :

12. 12.1 REMARKS OF THE PRINCIPAL : 12.2 SIGNATURE :