Rajiv Gandhi University of Health Sciences, Karnataka s1

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF PREGNANT WOMEN REGARDING KANGAROO MOTHER CARE AT SELECTED URBAN AREA IN BANGALORE CITY WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET.”

SUBMITTED BY,

Miss. HONEYMOL T S,

1ST YEAR M.Sc. NURSING,

ROYAL COLLEGE OF NURSING,

UTTARAHALLI,

BANGALORE-560061

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOSPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / Name of the Candidate and Address / Miss. HONEYMOL T. S,
1ST YEAR M.Sc. NURSING,
ROYAL COLLEGE OF NURSING,
7TH MAIN, 1ST BLOCK, UTTARAHALLI,
BANGALORE-560061
2. / Name of the Institution / Royal College Of Nursing, Bangalore
3. / Course of study / 1st Year M.Sc. Nursing,
Paediatric Nursing
4. / Date of admission to course / 01.06.2012
5. / Title of the Topic:
“A Descriptive Study To Assess The Knowledge Of Pregnant Women Regarding Kangaroo Mother Care At Selected Urban Area In Bangalore City With A View To Develop An Information Booklet.”
6. / Brief resume of the intended work:
6.1 Need for the study
6.2 Review of literature
6.3 Objectives of the study
6.4 Operational definitions
6.5 Assumptions
6.6 Delimitations of the study
6.7 Pilot study
6.8 Variables / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / Materials and methods
7.1 sources of data- Data will be collected from pregnant women residing at selected urban area In Bangalore City.
7.2 Methods of data collection- structured knowledge questionnaire.
7.3 Does the study require any interventions or investigation to the patients or other human being or animals? No
7.4 Has ethical clearance been obtained from your institution?
Yes ethical committee’s report is here with enclosed.
8. / List of references / Enclosed

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

“The mother loves her child most divinely, not when she surrounds him with comfort and anticipates his wants, but when she resolutely holds him to the highest standards and is content with nothing less than his best.”
- Hamilton Wright Mabie

The parent-child bond is one of life's great joys. Learn more about the many, all-important ways for parents to bond with new born baby. There's nothing more precious than a new born baby.1

Studies have shown that infants who have been the recipients of positive touch experience more benefits as they develop emotionally and socially. Experiments have done with infants up to four months of age using both positive touch (stroking or cuddling) and negative touch (poking, pinching or tickling). The infants who received the positive touch cried less often and also vocalized and smiled more than the infants who were touched negatively. Infants who were the recipients of negative touching have been linked with emotional and behavioural problems later in life. A lower amount of physical violence in adults has been discovered in cultures with greater levels of positive physical touching. Human infants have a primal need to be carried close to their mother's body. They need constant physical contact for their first few weeks or months of life.2

Kangaroo careis a technique practiced on newborn, usuallypreterm, infants wherein the infant is held, skin-to-skin, with an adult. Kangaroo care for pre-term infants may be restricted to a few hours per day, but if they are medically stable that time may be extended. Some parents may keep their babies in-arms for many hours per day. Kangaroo care, named for the similarity to how certainmarsupialscarry their young, was initially developed to care for preterm infants in areas where incubators are either unavailable or unreliable.3

Kangaroo care seeks to provide restored closeness of the newborn with mother or father by placing the infant in direct skin-to-skin contact with one of them. This ensures physiological and psychological warmth and bonding. The kangaroo position provides ready access to nourishment. The parent's stable body temperature helps to regulate the neonate's temperature more smoothly than an incubator, and allows for readily accessiblebreastfeeding.3

Originally babies who are eligible for kangaroo care include pre-term infants weighing less than 1500grams, and breathing independently. Cardiopulmonary monitoring,Oxymetry, supplemental oxygen or nasal (continuous positive airway pressure) ventilation, intravenous infusions, and monitor leads do not prevent kangaroo care. In fact, babies who are in kangaroo care tend to be less prone toapnoeaandbradycardiaand have stabilization of oxygen needs.3

In kangaroo care, the baby wears only a diaper and a hat and is placed in a flexed with maximal skin-to-skin contact on parent's chest. The baby is secured with a stretchy wrap that goes around the naked torso of the adult, providing the baby with proper support and positioning (maintainflexion), constant containment without pressure points or creases, and protecting from air drafts (thermoregulation). If it is cold, the parent may wear a shirt or hospital gown with an opening to the front and a blanket over the wrap for the baby.3

"Birth Kangaroo Care" places the baby in kangaroo care with the mother within one minute after birth and up to the first feeding. The American Academy of Pediatrics recommends this practice, with minimal disruption for babies that don't require life support. The baby's head must be dried immediately after birth and then the baby is placed with a hat on the mother's chest. Measurements, etc. are performed after the first feeding. According to the US Institute of Kangaroo Care, healthy babies should maintain skin-to-skin contact method for about 3 months so that both baby and mother are established in breastfeeding and have achieved physiological recovery from the birth process.3

Kangaroo care arguably offers the most benefits for preterm and low birth weight infants, who experience more normalized temperature, heart rate, and respiratory rate,increased weight gain,fewer nosocomial infections and reduced incidence of respiratory tract disease.Additionally, studies suggest that preterm infants who experience kangaroo care have improved cognitive development, decreased stress levels, reduced pain responses, normalized growth, and positive effects on motor development.Kangaroo care also helps to improve sleep patterns of infants, and may be a good intervention for colic.Earlier discharge from hospital is also a possible outcome.Finally, kangaroo care helps to promote frequent breastfeeding, and can enhance mother-infant bonding.3

6.1 NEED FOR THE STUDY

“The mother-child relationship is paradoxical and, in a sense, tragic. It requires the most intense love on the mother's side, yet this very love must help the child grow away from the mother, and to become fully independent.”
- Erich Fromm

Human babies are biologically extremely immature when they are born. The new-born’s brain size is only 25% of its final size, which he compares with 45% in chimpanzees and 80% in antelopes. Not until around one year of age does the human baby's brain reach 80% of its final size. Compared with other mammals, we should have a 21-month pregnancy. The reason human babies are born so early and so immature is the fact that the width of the birth canal through the mother's pelvis was reduced when our ancestors started walking upright. At the same time the brain volume increased. The evolutionary solution was that babies began to be born earlier and therefore more immature, and in need of constant parental care.4

The greatest advantage of the baby being kept skin-to-skin with the mother for 24 hours a day, and being breastfed freely, is the development of the brain. A baby is born with a maximum number of synapses (that is, potential connections) between the nerve cells. Neurological pathways become established between the synapses that are used, and unused synapses die off. By 6 months of age, all the baby's brain cells are fully developed. After that, it is the neural pathways that have been formed which become the important determining factor in the quality of life that the individual will experience. These neural pathways can be stress-related or pleasure-related paths, depending on the environment in which the baby is placed - closeness to the mother, or separation from her. If the baby has to use the stress-related paths in infancy, the pleasure-related paths are pruned away. The stress-driven neurological pathways then become dominant for the rest of the life of the individual. We talk about the plasticity of the brain, and the fact that the brain can compensate for various losses, but this does not apply to these very early and fundamental nerve pathways, which become permanently set in the brain.4

A study was conducted at the Department of Child Health, Komfo Anokye Teaching Hospital, Ghana to evaluate its in-hospital and continued practice in the urban among mothers of low birth weight (LBW) infants discharged from two hospitals in Kumasi, Ghana. A longitudinal study of 202 mothers and their inpatient LBW neonates was conducted from November 2009 to May 2010. After discharge, the mothers reported at weekly intervals for four follow up visits where data about their perceptions, attitudes and practices of KMC were recorded. At recruitment 23 (11.4%, 95%CI: 7.4 to 16.6%) mothers knew about KMC. At discharge 95.5% were willing to continue KMC at home with 93.1% willing to practice at night. 95.5% thought KMC was beneficial to them and 96.0% beneficial to their babies. 98.0% would recommend KMC to other mothers with 71.8% willing to practice KMC outdoors.At first follow up visit 99.5% (181) were still practicing either intermittent or continuous KMC. This proportion did not change significantly over the four weeks (OR: 1.4, 95%CI: 0.6 to 3.3, p-value: 0.333). Over the four weeks, increasingly more mothers practiced KMC at night (OR: 1.7, 95%CI: 1.2 to 2.6, p = 0.005), outside their homes (OR: 2.4, 95%CI: 1.7 to 3.3, p < 0.001) and received spousal help (OR: 1.6, 95%CI: 1.1 to 2.4, p = 0.007). Household chores and potentially negative urban perceptions of KMC did not affect its practice with odds of 0.8 (95%CI: 0.5 to 1.2, p = 0.282) and 1.0 (95%CI: 0.6 to 1.7, p = 0.934) respectively. During the follow-up period the neonates gained 23.7 sg (95%CI: 22.6 g to 24.7 g) per day. Maternalknowledgeof KMC was low at outset. Once initiated mothers continued practicing KMC in hospital and at home with their infants gaining optimal weight.5

A study was conducted at the Department of Obstetrics and Gynaecology, Oestfold Hospital Trust, Norway, to explore experiences of skin-to-skincarein healthy mothers of healthy, full-term infants in the first days after birth. Using a life world phenomenological approach, 20 women who had childbirth in hospital and were practising skin-to-skincarewere interviewed 1-2 weeks after birth. The mothers wanted to give their newborn child the best possiblecareand the skin-to-skincarestarted a positive spiral. A mutual interaction developed which acted as a generator releasing energy to themotherwho wanted to continue the practice which in terms increased mother-infant affinity. Happiness, peace and satisfaction were expressed by the newborns; also a child who was crying or troublesome exhibited a positive response to skin-to-skincare. The study provides insight andknowledgewhich should guide attitudes and promote practices of this simple healthcare intervention; skin-to-skin contactcareto healthy infants born at term. Healthcare professionals should support affinity between amotherand her newborn through facilitation and the provision of information about its benefits.6

A study was conducted at the Department of Neonatology, Fernandez Hospital, Hyderabad, India, to study the effect ofKangaroo mother carein theKangarooward in comparison with conventionalcareat neonatal unit on growth and breastfeeding in very low birth weight infants at 40 weeks' corrected gestational age. Methods: One hundred and forty neonates with birth weight <1500 g were randomized. The primary outcome was the average weight gain (g/kg/day) from the time of randomization to term gestational age. Results: Mean birth weight, age in days and weight at randomization were similar in both the groups. At term gestational age, average weight gain (g/kg/day) post randomization (23.3 ± 8.7 g vs. 22.64 ± 9.1 g, p = 0.67) and breastfeeding rate (85.9% vs. 87.0%) were comparable. There was no difference in weight gain (g/kg/day) from randomization to hospital discharge between theKangaroocaregroup and conventionalcare group (18.01 g vs. 15.64 g, p = 0.12). Mortality, morbidities like sepsis, hypothermia, apnea, hypoglycemia and duration of hospitalization were equally distributed. On average, 11.5 days of intermediatecarewere saved in thekangaroogroup. Kangaroo mother carein the Kangarooward is as effective as conventionalcarein the neonatal unit without any increase in morbidity or mortality in stable VLBW infants.7

The above mentioned studies show the importance of kangaroo mother care on new born babies as well as on mother. Studies suggest that preterm infants who experience kangaroo care have improved cognitive development, decreased stress levels, reduced pain responses, normalized growth, and positive effects on motor development.Kangaroo care also helps to improve sleep patterns of infants, and may be a good intervention for colic.Earlier discharge from hospital is also a possible outcome.Finally, kangaroo care helps to promote frequent breastfeeding, and can enhance mother-infant bonding.3

So the researcher intended to conduct a study to assess the knowledge of pregnant women regarding kangaroo mother care at selected urban areas in Bangalore city and to develop and generate an information booklet on the basis of the knowledge score obtained from the pregnant women.

6.2 REVIEW OF LITERATURE

Researchers almost never conduct a study in an intellectual vacuum; their studies are usually undertaken within the context of an existing knowledge base. A Literature Review helps to lay the foundation for the study and can also inspire new research ideas.