Rajiv Gandhi Universiyt of Health Sciences

RAJIV GANDHI UNIVERSIYT OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATON OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE : Ms. SHILPA G.K

AND ADDRESS 1st Year, M.Sc. Nursing,

Rajarajeswari College of Nursing,

Kambipura, Mysore road, Bangalor-74.

2. NAME OF THE INSTITUTION : Rajarajeswari College of Nursing,

Kambipura, Mysore road, Bangalore-74.

3. COURSE OF STUDY AND : 1st Year M.Sc. Nursing,

SUBJECT Pediatric Nursing

4. DATE OF ADMISSION TO : 31-10-2009.

COURSE

5. TITLE OF THE TOPIC : A STUDY TO EVALUATE THE

EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON

KNOWLEDGE AND KNOWLEDGE

ON PRACTICE OF COMMON

NEWBORN CARE AMONG PRIMI

MOTHERS IN RAJARAJESWARI

HOSPITAL AT BANGALORE. 6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

The birth of an infant is one of the most awe-inspiring and emotional events that can occur in one’s lifetime. After 9 months of anticipation and preparation, the neonate arrives amid of flurry of excitement. Immediately after birth the newborn must make rapid adjustment to successfully adapt to life outside the womb.1

Before birth the fetus is fully dependent upon the mother for all vital needs such as oxygen, nutrition, waste removal. The most profound physiologic change required of the newborn is transition from fetal or placental circulation to independent respiration. The loss of placental connection means the loss of complete metabolic support, especially the supply of oxygen and the removal of carbon dioxide. The normal stresses of labor and delivery produce alterations of placental gas exchange patterns, acid base balance in the blood and cardiovascular activity in the neonate.2

Newborn period encompasses the first 4 weeks of extra-uterine life. It is an important link in the chain of events from conception to adulthood. The physical and mental well being of an individual depends on the correct management of events in perinatal period.3

The newborn’s body is the most super sensitive, delicate and susceptible from which can easily harmed if not taken car of . To ensure that the body has the best possible start in life there are critical aspects of newborn care, which all birth attendants and families should be aware of.4

Neonatal outcomes are affected by maternal health and other factors such as care during pregnancy, childbirth and immediately after birth. Globally, about three-fourths of all neonatal deaths occur during the early neonatal period (0-7days). Further, 25-45% of all neonatal deaths occur in the first 24 hours after birth. Maternal complications carry a high risk of neonatal death, particularly in the early neonatal period. Newborns can become seriously ill and any sort of infections may be dangerous, so illness at this age requires immediate attention. Health of children has been considered of vital importance to all societies because children are the basic resources for the future of mankind.5

Proper care of the newborn babies forms the foundation for the subsequent life not only in terms of longevity or survival but also in terms of qualitative outcome without any mental and physical abilities.6

6.2 NEED FOR THE STUDY Newborn mortality is one of the World’s most neglected health problem. In our World 140 million children are born every year. Where as 8 million infants die out of which 4 million infants die during the neonatal period, 98% of them do so in developing countries. Neonatal Mortality Rate is higher in Rural area i.e. 49 per 1000 live birth and 27 per 1000 live birth in Urban area.7

The global burden of neonatal death is estimated to be 5 million of which 3.2 million death occur during the first week of like. Global under five and infant mortality rate have declined over the past four decades but high neonatal mortality rate have remained relatively unchanged. The primary causes of neonatal death [all over the World] are believed to be complications of prematurity [28%], Sepsis and Pneumonia [26%], birth asphyxia and injuries [23%], Congenital anomalies [7%], Diarrhea [3%] with low birth weight to a large proportion of death. To reduce neonatal mortality strategies must be developed, many of life threatening conditions can be prevented with improved labor and delivery care and attention to the physiological needs of newborn. In India nearly 26 million babies born in each year, accounts for 20% of global birth in which 1.2 million of these nearly die before completing 4 weeks of life. India thus contributes 30% of total 3.9 million death Worldwide and accounts for one quarter of all neonatal deaths in World.8

Current neonatal mortality rate is 44 per 1000 live birth, accounts for nearly 30% of total 39 million neonatal deaths Worldwide and it accounts for 2/3 of infant mortality rate and half of under 5 mortality rate. Two newborns death occur every minute in this vast country. India contributes to 25% of the over 10 million under 5 death occurring Worldwide each year. Nearly half of the under 5 death occur in neonatal period.9

Poor perinatal and neonatal care is responsible for many deaths even during later childhood. They also account for mental retardation and other neurological handicaps of later life which are largely preventable. Improved neonatal care lead a better and intact infant survival, which will pave the way for better acceptance of small family norm. Mother plays a key role in identifying minor developmental deviations and early evidence of disease process because she is constantly and closely watching her baby. Participation of mother in the nursing care of baby infuses self confidence in her and reduces demands on nursing personnel. So she needs the basic knowledge and skills pertaining to child feeding, personal hygiene, immunization and other common problems in children.10

It was identified by investigator during her clinical experience at Rajarajeswari Hospital, Bangalore that many primi mothers had lack of knowledge regarding newborn care. Investigator observed, some mothers were giving pre-lacteal fluid such as sugar syrup, honey before initiating breast feeding to their baby and they were following unhygienic practices while handling newborn which may lead to frequent infections among newborns. Hence forth the investigator personally felt that there is a need for the above studies and statistics was inspired in selection of this dissertation.

6.3 REVIEW OF LITERATURE The study conducted on neonatal care, healthy and harmful practices, the potential for change. The study was carried out in rural Karnataka. It uses quantitative data from a prospective survey following mothers through their experience of pregnancy and postnatal period; and qualitative data from in-depth interviews and focus group discussions conducted with mothers, grand mothers, and birth attendants. The study reveals that many potentially harmful newborn care practices are being carried out in study area, such as unhygienic cord cutting, delayed breast feeding and early bathing.11

The study conducted on breast feeding practices and newborn care in rural areas. The study was conducted in primary health care centre that is attached to a medical college in Kengeri i.e. in rural part of Bangalore. Mothers with children who were 9 months old who came to PHC for measles vaccination were included in the study and data was collected using the pre- tested questionnaire on breast feeding and newborn practices. The study reveals that 97% of the mothers initiated breast feeding, 19% used pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and 50% used a house knife to cut the umbilical cord among home deliveries. 12

The study conducted on prevention of neonatal Hypothermia in Himalayan villages. This is a retrospective study, 202 babies were studied from a population of 16,425 in three districts of a Himalayan state of North India. The study reveals that a warm heated room for delivery and lying in, rooming in, oil massage and layers of warm clothing are traditional means of thermoregulation as practiced by mothers, birth attendants and relatives.13

The study conducted on a qualitative assessment of potentials and barriers in the promotion of exclusive breast feeding in Southern Zambia. A study was conducted in Mazabaka, nine focus group discussions with mothers and total 18 in depth interviews with fathers, grand mothers, health staff and traditional birth attendants were performed in both rural and urban areas. The study reveals that breast feeding was reported to be universal, the use of pre lacteal feeds appeared to be low colostrums was rarely discarded, attitudes and knowledge about exclusive breast feeding were generally good.14

The study conducted on perception and health care seeking about newborn danger signs among mothers in rural Wardha. A cross sectional study was undertaken in 3 PHC of Wardha district, 1160 mothers in the area were interviewed by house to house visits. A triangulation of formative research methods like chapatti diagram and focus group discussion was undertaken. The study reveals that about 67.2% mothers new at least one newborn danger sign. Majority of mothers[87.4%] responded that the sick child should immediately taken to the doctor, but only 41.8% of such sick newborns got treatment either from Government or Private hospitals[20%], and 46.1% of sick babies received no treatment. Reasons for not taking action even in presence of danger signals is due to ignorance of parents, lack of money, faith in supernatural causes.15

The study was conducted on Practices on immediate care of newborn in the communities of Kailali district. This formative research was conducted in 6 purposely selected village Development Committees (VDCs) of Kailali. Altogether 17 Focused Group Discussions (FGDs) were conducted with 106 parents. To triangulate the findins, 58 in-depth interviews were conducted with various individuals. The study reveals that most people are unaware of importance of immediate care of newborn and many unsafe behavior do exist such as common use of untrained attendants, unsafe cord care, immediate bathing of baby. Most of the existing practices are based on deep seated traditional beliefs. Some used Clean Home Delivery Kit [CHDK] and a few used knife to cut the cord. All had tied stump with thread and applied mustard oil to prevent infection.16

The study conducted on impact of training of traditional birth attendants on the newborn care. Analysis was done by using Mc. Nemer’s test, Chi-square test with Yates’s correction and Fischer’s exact test. The study participants were 50 Traditional Birth Attendants [TBAs] who conduct home deliveries in the PHC area. Training was conducted for two days which included topics on techniques of conducting safe delivery and newborn care practices. The study reveals that Pre-test evaluation showed that, knowledge and practices about newborn care services provided by the previous trained TBAs and untrained TBAs were poor. Early and late post-test evaluation showed that there was a progressive improvement in the newborn care provided by both the groups. Pre-intervention period (one year prior to the training) and post-intervention period (one year after the training) showed that there was a statistically significant (p<0.05) reduction in the perinatal deaths (11 to 3) and neonatal deaths (10 to 2) among the deliveries conducted by TBAs after the training.17

The study conducted on newborn care practices in an Urban Slum of Delhi. Semi-Structured pre-tested schedule was use to interview 82 mothers of newborn in the study area. The study reveals that bathing the baby immediately after birth was commonly practiced in 38 [82.6%] of home deliveries. Finger was used to clean the air passage in most of the home deliveries [63%] , about 61% of home delivered newborns were not weighed at birth. A few home delivered neonated were given Tetanus Toxide injection by un-qualified practitioners.18

The study conducted on newborn cared giving by Primipara and Multipara mothers at home in Tanta city. Interviewed questionnaires and observation checklists were designed to fulfill the aim of study. The study revealed that mothers knowledge and practices were within good and satisfactory average scores in most of the studied items related to newborn care giving at home except breast feeding. Significant differences were found between Primipara and Multipara mothers for most of the studied topics related to different topics of newborn care giving.19

The study conducted on Understand Home based Neonatal Care practice in rural southern Tanzania. In-depth interviews, focus group discussions and case studies were used through a network of female community-based informants in eight villages of Lindi Rural and Tandahimba Districts. The study reveals that most home births are assisted by un-skilled attendants who contribute to a lack of immediate appropriated care for both mother and baby. The umbilical cord is thought to make the baby vulnerable to witchcraft and great care is taken to shield both mother and baby from bad spirits until the cord stump falls off. Some neonates are denied colostrums, which is perceived as dirty. Behavior-change communication efforts are needed to improve early newborn care practices.20

6.4 PROBLEM STATEMENT

A Study to evaluate the effectiveness of Structured Teaching Programme on knowledge and knowledge on practice of common newborn care among primi mothers in Rajarajeswari Hospital, Bangalore.

6.5 OBJECTIVES OF THE STUDY

1. To assess the pre test knowledge and knowledge on practice among the mother regarding newborn care.

2. To assess the post test knowledge and knowledge on practice among the mother regarding newborn care.

3. To compare the pre and post test score knowledge and knowledge on practice among mothers regarding newborn care.

4. To find the association between post test score and demographic variables of mother regarding newborn care.

6.6 ASSUMPTIONS

1. Primi mothers who have lack of knowledge, and knowledge on practice of newborn care.

2. The structured teaching programme will help to improve the knowledge of mothers regarding newborn care.

3. Awareness or increasing mothers knowledge regarding newborn care enable them to provide good care to their neonates and help to prevent neonatal infections among their babies.

6.7 HYPOTHESES

1. There is a significant difference between pre and post test knowledge and knowledge on practice scores of the primi mothers on neonatal care.

2. There is a significant association between post test scores and selected demographic variables.

6.8 VARIABLES 6.8.1 Dependent Variables: primi mothers

6.8.2 Independent Variables: structured teaching programme on common new born care

6.9 OPERATIONAL DEFINITIONS

Knowledge: It refers to state of knowing information regarding newborn care among primi mothers.

Newborn: It refers the baby from birth to 28th day following birth.

Newborn Care: It refers to care given to the baby from birth to the following 28 days birth.

Primi Mother: The women who is pregnant or delivered for the first time.

Structured Teaching Programme: It refers to a planned, sequenced and organized educational activity that inform regarding knowledge on practices of newborn care among primi mothers.

7. MATERIAL AND METHODS

7.1 Source of Data : Primi mothers admitted in ante natal post-

natal ward at Rajarajeswari Hospital, Bangalore.

7.2 Method of Collection of Data

7.2.1 Definition of the study subject : The women who is pregnant or delivered for the first time.

7.2.2 Inclusion and Exclusion Criteria

a) Inclusion Criteria:

i) Primi mothes who are admitted in post natal and antenatal ward at Rajarajeswari Hospital, Bangalore.

ii) Primi mothers who are willing to participate in the study.

iii) Primi mothers who are available during the time of study.

iv) Primi mothers who are not having any complications.

b) Exclusion Criteria: i) Multi para mothers admitted in post natal ward at Rajarajeswari Hospital, Bangalore.

ii) Primi mothers who are not willing to participate in the study.

7.2.3 Research Approach : Quantitative Approach

7.2.4 Research Design : Pre-experimental one grouppre-test and post

test design.

7.2.5 Setting : Primi mothers in postnatal and antenatal

ward at Rajarajeswari Hospital, Bangalore

7.2.6 Sampling Technique : The purposive sampling technique.

7.2.7 Sample Size : 50 primi mothers in postnatal ward.

7.2.8 Duration of the study : 4 weeks

7.2.9 Tool of Research : Structured questionnaires schedule 2 parts of collecting data. It consists of

Part I : Sociodemographic data

Part II: Structured questionnaire knowledge and knowledge on practice of common newborn care.

7.3 Collection of data : The investigator herself will collect data from Primi mothers using structured interview schedule. After selecting the sample by purposive sampling the investigatror administers pretests questionnaires to the mother and then Structured Teaching Programme will be conducted to the mother and post test will be conducted from mother.

7.3.1 Method of Data Analysis and Presentation:

The investigator will use descriptive statistical techniques such as mean, median, standard deviation and Inferential statistics like t-test will be used to determine association between demographic variable.

The analyzed data will be presented in the form of tables, diagrams and graphs .

7.4 Does the study require any investigations or interventions to be conducted on mothers or other humans or animals?

Yes, with prior consent from sample the study will be conducted in postnatal ward regarding knowledge and knowledge on practice of newborn care at Rajarajeswari Hospital.

7.5 Has ethical clearance has been obtained from your institution? Yes, permission will be obtained from concerned person and authority of Institution before the study.

 Privacy, Confidentiality and anonymity will be guarded.

 Scientific objectivity of the study will be maintained with honesty and impartiality.

8. LIST OF REFERENCES

1. Marlow DR, Redding BA.Text book of Pediatric Nursing. 6th ed, New Delhi:Elsevier publication; 2007.

2. Marilyn J, Hockenberry. Wong’s Nursing Care of Infants and Children. 7the ed. Philadelphia, USA. Elseviers publication. Ghai OP. Essential Pediatrics.6th ed. New Delhi:CBS publishers;2008.

3. Margaret EB, Desouza A, Tesline. Effectiveness of an awareness programme on care of newborn for mothers of neonate. Nightingale Nursing Times:Aprl2009;5(1).

4. Santhi MD. Effectiveness of compact disc on knowledge and practice of neonatal care among primi mothers. Nightingale nursing times: Jan 2009;4(10):48-51.

5. Yagan, Myanmar. Training of Trainess in WHO essential newborn care course. World Health Organization. New Delhi: Jun 2006;20-4.

6. Suraj Gupte. The short textbook of Pediatrics. 10th ed. New Delhi: Jaypee brothers medical publishers (p) Ltd.2004.

7. Santhi MD. Effectiveness of compact disc on knowledge and practice of neonatal care among primi mothers. Nightingale nursing times: Jan 2009;4(10):48-51.

8. Gupta P, Srivastava Vk, Kumar V, Jain S, Newborn Care Practices in Urban Slums of Lucknow City, 2010;35(1):82-5.

9. D kumar. Neonatal Mortality rate. Indian journal of community medicine. 2007.

10. Achar. Text book of Pediatrics 3rd ed, New Delhi, J Viswanathan, AB Desai [Orient Longman], Orient Longman Private Ltd 2007.

11. Kesterton AJ, Cleland J.Neonatal care in nural Karnataka. Healthy and harmful practices the potential for chance. BMC pregnancy child birth 2009.

12. Madhu K, Choudary S, Masthi R. Breast Feeding practices and newborn care.Indian Journal of Community Medicine 2009 July;34(3):243-6.

13. Iyengar SD, Bhakoo ON.Prevention of neonatal hypothermia in Himalayan villages, role of domiciliary care taker. Action Research and training for Health, Udaipur, Rajasthan. 1991 July;43(3):293-6. 14. Fjeld E, Siziya S, Ketepa-Bwalya M, Kankasa C, Moland KM, Tylleskar T.No sister the breast alone is not enough for my baby, a qualitative assessment of potentials and barriers in the promotion of exclusive breast feeding. Southern Zambia.Introduction breast feed journal 2008 Nov 5;3-26.

15. Dongre AR, Deshmukh PR, Gary BS.Perceptions and health care seeking about newborn danger signals among mothers. Indian Journal of Pediatrics 2008 Apr; 75(4):325-9 .

16. Gurung G. Practices on immediate care of newborn in the communities. Kailali District. Nepal Medical College Journal 2008 Mar;10(1):41-4.

17. Sathish Chandra DM, Naik VA, Wantamutte AS, Mallapur MD. Impact of training of traditional birth attendants on the newborn care. Indian Journal Pediatrics 2009 Jan;76(1):33-6.

18. Rahi M, Tanya DK, Misra A, Mathur NB, Badhan S. Newborn care practices in an Urban slum, New Delhi. Indian Journal of Medical Science. 2006 Dec;60(12):506-13.

19. Helmy FE, Bahgat RS. Newborn care giving by primi mother and multi para mothers at home in Tanta city, Egypt. Journal of Public Health Association 1998;73(5):51-18.

20. Mrisho M, Schellenberg JA, Mushi AK, Orbist B, Mshinda H, Tanner M et al. Ifakara Health Research and Developmental centre. Dar cs salaam, Tanzia 2008 July;102(7):669-78.

9. Signature of the Candidate :

10.Remarks of the Guide : This study will provide knowledge to mothers regarding care of newborn. It

prevents the frequent neonatal

infection.

11. Name and Designation of

11.1 Guide : Ms. MAHALAKSHMI M.SC (N)

Head of Department of Pediatric(N)

Rajarajeswari College of Nursing,

Bangalore.

11.2 Signature :

11.3 Co-Guide (if any) : Mrs. Parvathi M.Sc(N)

Lecturer Rajarajewari College of Nursing, Bangalore.

11.4 Signature :

11.5 Head of Department : Ms. Mahalakshmi M.Sc. (N)

Rajarajeswari College of Nursing

Bangalore.

11.6 Signature :

12.1 Remarks of the Principal : The topic selected for the study is

relevant and forwarded for needful action.

12.2 Signature :

ETHICAL COMMITTEE CLEARANCE

13. TITLE OF THE DISSERTATION: A Study to evaluate the effectiveness of Structured Teaching Programme on knowledge and knowledge on practice of common newborn care among primi mothers in Rajarajeswari Hospital, Bangalore.

14. NAME OF THE CANDIDATE : Miss Shilpa G.K

AND ADDRESSS 1st Year M.Sc Nursing

Rajarajeswari College Of Nursing

Bangalore.

15. SUBJECT : M.Sc Nursing

Child Health Nursing

16. NAME OF THE GUIDE : Miss.MAHALAKSHMI M.Sc nursing Head of the department of Peadiatric Rajarajeswari College of nursing Bangalore 17. APPROVED/NOT APPROVED :

(If not approved, suggestion

Head of the department of Head of the department of Community Health Nursing Medical surgical Nursing Rajarajeswari College of nursing Rajarajeswari College of nursing Bangalore. Bangalore.

Head of the department of Head of the department of Peadiatric Nursing OBG Nursing Rajarajeswari College of nursing Rajarajeswari College of nursing Bangalore. Bangalore.

Head of the department of Psychiatric Nursing Rajarajeswari College of nursing Bangalore. Principal

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