PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
DISSERTATION PROPOSAL
A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON KNOLWDGE OF STAFF NURSES REGARDING IMPLICATION AND BENEFITS OF BABY FRIENDLY HOSPITAL INITIATIVE (BFHI) IN PEDIATRIC AND POST NATAL WARD IN SELCTED HOSPITALS AT TUMKUR KARNATAKA
SUBMITTED BY:
Mr. KIRAN
FIRST YEAR M.SC NURSING
PEDIATRIC NURSING
BHARATHI COLLEGE OF NURSING
TUMKUR-572102
YEAR 2010-2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS /Mr. KIRAN
I YEAR M.SC NURSING,BHARATHI COLLEGE OF NURSING
TUMKUR-02
2 / NAME OF THE INSTITUTE / BHARATHI COLLEGE OF NURSING
TUMKUR-02
3 / COURSE OF THE STUDY AND SUBJECT / I YEAR M.SC NURSING
PAEDIATRIC NURSING
4 / DATE OF ADMISSION / 18-05- 2010
5 / TITLE OF THE STUDY / A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON KNOWLEDGE OF STAFF NURSES REGARDING IMPLICATION AND BENEFITS OF BABY FRIENDLY HOSPITAL INITIATIVE (BFHI) IN PAEDIATRIC AND POST NATAL WARD IN SELCTED HOSPITALS AT TUMKUR, KARNATAKA.
6. BRIEF RESUME OF THE INTENDED WORK
6. 1 INTRODUCTION
“A healthy body and soul come from an unencumbered mind and body.”
Ymber Delecto
The Baby Friendly Hospital Initiative (BFHI) is an international project that aims to give every baby the best start in life by creating a health care environment where breastfeeding is the norm and practices known to promote the health and well-being of all babies and their mothers are followed. The BFHI Ten Steps to Successful Breastfeeding are the global standard by which hospitals are assessed and accredited. A 'Baby Friendly' hospital is one where mothers' informed choice of feeding is supported, respected and encouraged1.
Babies who are breastfed are generally healthier and achieve optimal growth and development compared to those who are fed formula milk. If the vast majority of babies were exclusively fed breast milk in their first six months of life – meaning only breast milk and no other liquids or solids, not even water – it is estimated that the lives of at least 1.2 million children would be saved every year. If children continue to be breastfed up to two years and beyond, the health and development of millions of children would be greatly improved2.
Infants who are not breastfed are at an increased risk of illness that can compromise their growth and raise the risk of death or disability. Breastfed babies receive protection from illnesses through the mother's milk2.
Breastfeeding is the natural and recommended way of feeding all infants, even when artificial feeding is affordable, clean water is available, and good hygienic conditions for preparing and feeding infant formula exist2.
BABY FRIENDLY HOSPITAL INITIATIVE (TEN STEPS TO SUCCESSFUL BREASTFEEDING): INDICATOR 7 in WBTi, an innovative initiative of the International Baby Food Action Network (IBFAN) Asia for tracking assessing and monitoring the Global Strategy for Infant and Young Child Feeding3
The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies or feed formula safely, and gives special recognition to hospitals that have done so5.
Exclusive breastfeeding is becoming an endangered practice. Breastfeeding has fallen from the foundation of public health to something that is nice but not necessary in the minds of many consumers and health care professionals. Numerous international initiatives have been created to improve the initiation, duration, and exclusivity of breastfeeding throughout the world5.
Health workers should be motivated and convinced that, breast milk is the best milk for babies, there is no real alternative to breast milk-, they are key people in the success or failure of lactation, promoting breastfeeding contributes to the long-term health and economic interests of a society and their efforts to promote breastfeeding are worth-while and should be commended including,
- Initiating breastfeeding with- in a half-hour of birth;
- Breastfeeding on demand;
- Rooming-in - 24 hours a day;
- No supplementary food or drink other than breast milk, unless medically
indicated;
- No bottles, artificial teats or pacifiers for breastfeeding infants6.
6.2 NEED FOR THE STUDY
Hospitals and maternity units set a powerful example for new mothers. The Baby-Friendly Hospital Initiative (BFHI), launched in 1991, is an effort by UNICEF and the World Health Organization to ensure that all maternities whether free standing or in a hospital, become centers of breastfeeding support4.
,
More than one million infants worldwide die every year because they are not breast fed, or are given other foods too early. Millions more live in poor health, contract preventable diseases, and battle malnutrition. Although the magnitude of this death and disease is far greater in the developing world, thousands of infants in the United States suffer the ill effects of suboptimal infant feeding practices. A decreased risk of diarrhea, respiratory and ear infections, and allergic skin disorders are among the many benefits of breast feeding to infants in the industrialized world. In the United States, these benefits could translate into millions of dollars of savings to our health care system through decreased hospitalizations and pediatric clinic visits. For diarrhea alone, approximately 200,000 US children, most of whom are young infants, are hospitalized each year at a cost of more than half a billion dollars. Many of these cases of diarrhea could have been prevented with breastfeeding. In a study of the morbidity in an affluent US Population, Dewey and colleagues found that the reduction in morbidity in breastfed babies was of sufficient magnitude to be of public significance. For example, the incidence of prolonged episodes of otitis media (ear infections) was 80% lower in breastfed as compared to non-breastfed infants. The cost savings to the health care system could be enormous if breastfeeding duration increased, given that ear infections alone cost billions of dollars a year. It is a rare exception when a woman cannot breastfeed her baby for physical or medical reasons. Yet, a woman’s ability to feel self confident and secure with her decision to breastfeed is challenged by her family and friends, the media, and healthcare providers. Much has been done in the past few years to strengthen the sources of support for women to breastfeed. Although the hospital is not and should not be the only place a mother receives support for breastfeeding, hospitals provide a unique and critical link between the breastfeeding support provided prior to and after delivery5.
The Baby Friendly Hospital Initiative (BFHI) is the result of the WHO/UNICEF statement and is based upon the Ten Steps to Successful Breastfeeding6. Health workers should understand the importance of the breastfeeding management strategies incorporated in the Ten Steps,
Step 1. A written breastfeeding policy that is routinely communicated to all health care staff.
Step 2. Training all health care staff in skills necessary to implement this
policy.
Step 3. Informing all pregnant women about the benefits and management of breastfeeding.
Step 4. Helping mothers initiate breastfeeding within a half an hour of birth.
Step 5. Showing mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
Step 6. Giving newborn infants no food or drink other than breast milk.
Step 7. Practicing rooming-in, allow mothers and infants to remain together –24 hours a day.
Step 8. Encouraging breastfeeding on demand.
Step 9. Giving no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
Step 10. Fostering the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic6.
A study was conducted in Brazil, to evaluate the impact of training based on the Baby Friendly Hospital Initiative on breastfeeding practices in maternity wards and during the first 6 months of life.. Ninety percent of nursing auxiliaries and midwives were trained at two institutions (A and B) in Palmares, Pernambuco state. Three hundred and thirty-four mothers were interviewed within the first 48 hours and 10 days after childbirth to evaluate breastfeeding practices at the maternities and fulfillment of steps 4 through 10 of the Baby Friendly Hospital Initiative. A subset of 166 mothers received seven home visits to evaluate breastfeeding practices throughout the first 6 months of life The findings shows that The performance of maternity B was significantly better than that of maternity A, from steps 4 to 10 and also in terms of exclusive breastfeeding and offering less water or tea to infants (p < 0.001).. The study concludes that, the training promoted partial change to some practices related to breastfeeding, having a positive effect on total and exclusive breastfeeding at the maternity wards. However, there was no significant change to these practices over the first 6 months of life, suggesting the need for effective interventions to support exclusive breastfeeding in the health sector and in the community7.
When the investigator was posted in the clinical, he had communication with the staff nurses while providing care. During that communication the investigator understood that, the staff nurses had a lack of health awareness regarding Implication and benefits of baby friendly hospital initiative. Hence this information made me to this study among the staff nurses, with the help of health education in the form of Implication and benefits of baby friendly hospital initiative.
So the staff nurses need to acquire knowledge regarding Implication and benefits of baby friendly hospital initiative because to promote breast feeding practices and for the future healthy baby
6.3 REVIEW OF LITERATURE.
A study was conducted in Australia, the objective was to examine the factors perceived to promote or hinder BFHI accreditation. It was a group interview and the samples were 31 staff nurses and explored opinions of participants, in differing roles and levels of employment, across midwifery, medical, nursing and ancillary staff at six South Australian maternity hospitals. The result suggests that staffs’ understanding and personal views are often discordant with BFHI aims. Perceived difficulties include the accreditation process, hospital dynamics, and the Ten Steps implementation plus a bottle feeding culture and maternal employment that impact upon continued breastfeeding. The study had concluded that, Upper management support, specific funding, a dedicated co-coordinator with “area leaders”, development of a specific breastfeeding policy incorporating various disciplines and staff, containing detailed protocols that comply with the International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly (WHA) resolutions are all required. Staff and mothers require multiple modes of education to understand the BFHI, including sponsorship for training of lactation consultants and improve breastfeeding outcomes8.
A study was conducted in Nigeria; the objective was to assess the effect of BFHI training on knowledge, attitudes and support practices of nurses with regards to exclusive breastfeeding. . A total of 298 nurses in maternal and child health care units were interviewed, of these 113 (37.1%) had participated in the BFHI training workshop. Significantly higher proportions of the BFHI trained nurses had the correct knowledge regarding the causes and management of common breastfeeding problems. The overall knowledge scores of the BFHI trained nurses were significantly higher than that of the untrained (11.9 +/- 1.8 versus 10.7 +/- 2.4 P < 0.01). The findings show that nurses who had participated in the BFHI training workshop were significantly more knowledgeable about some aspects of exclusive breastfeeding; they had more positive attitudes and were more likely to employ correct practices for the promotion of exclusive breastfeeding.9
A study was conducted in University of York, UK; the objective was to evaluate the effectiveness and cost-effectiveness of interventions that promote or inhibit breastfeeding or feeding with breast milk for infants admitted to neonatal units, and to identify an agenda for future research. The data source was taken from the Health Technology Assessment Database, National Research Register) from inception to February 2008. . The results shows that, Forty-eight studies met the selection criteria for the effectiveness review, of which 65% (31/48) were RCTs, and 17% (8/48) were conducted in the UK. Seven were rated as good quality and 28 as moderate quality. No studies met the selection criteria for the health economics review. There is strong evidence that short periods of kangaroo skin-to-skin contact increased the duration of any breastfeeding for 1 month after discharge [risk ratio (RR) 4.76, 95% confidence interval (CI) 1.19 to 19.10] and for more than 6 weeks (RR 1.95, 95% CI 1.03 to 3.70) among clinically stable infants in industrialized settings. The study had concluded that, despite the limitations of the evidence base, kangaroo skin-to-skin contact, peer support, simultaneous breast milk pumping, multidisciplinary staff training and the Baby Friendly accreditation of the associated maternity hospital have been shown to be effective, and skilled support from trained staff in hospital has been shown to be potentially cost-effective10.
A study was conducted in Edwardsville, IL 62062, USA, the objective was to examine to test an educational intervention designed to improve lactation knowledge, attitudes, and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support. The study design was a Quasi-experimental, time-series pretest/posttest. The setting was NICU of a Midwestern, free-standing, tertiary-care children's hospital. The sample s were 64 NICU nurses and 2 separate convenience samples of mothers of infants hospitalized in the NICU (n=19 and 13, respectively). The study had measured regarding Nurses' lactation knowledge, attitudes, beliefs, and intentions to support lactation and mothers' perceptions of lactation support in the NICU. The Findings suggest that this educational intervention was effective for improving NICU nurses' lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU significantly improved following the implementation of the educational intervention for nurses. The study had concluded that, Intermittent, short educational programs which include practical how-to's and motivational encouragement for staff may provide the empowerment nurses need in order to be supportive of lactation11.