SYNOPSIS
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING CARE OF NEW BORN BABY AMONG PRIMIGRAVIDA MOTHERS IN SELECTED HOSPITALS AT BANGALORE, KARNATAKA .”
PROFORMA FOR RESGISTRATION OF SUBJECT FOR DISSERTATION
PREPARED BY
MS. B. JIJI DONIA
1ST YEAR MSc NURSING
OBSTETRIC AND GYNAECOLOGY NURSING
SMT.LAKSHMI DEVI COLLEGE OF NURSING
BANGALORE.
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. 1. / NAME OF THE CANDITATE / Ms.B.jiji donia.2. / NAME OF THE INSTITUTIONS / Smt.Lakshmi devi college of nursing
3. / COURSE AND SUBJECT / M.Sc nursing
Obstetrics and gynaecology nursing
4. / DATE OF ADMISSION
5. / TITLE OF THE TOPIC / “A STUDY TO EVALUATE THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE REGARDING CARE OF NEW
BORN BABYAMONG PRIMIGRAVIDA WOMAN
IN SELECTED HOSPITALS AT
BANGALORE, KARNATAKA”.
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6.BRIEF RESUME OF INTENDED WORK
“THE NATION WALKS ON THE FEET OF LITTLE CHILDREN.”
-Jawaharlal Nehru
INTRODUTION
Children are our future and our most precious resources. Health of the future children’s depends on the nurturing practice adopted by the family. The first few days of life is a period of transition occurring all of a sudden from parasitic fetal life (intra uterine environment) to a completely independent (extra Uterine life). The process of birth and adaptation to the new surroundings depend upon number of adjustments on the part of the newborn baby especially.1
The first four weeks of life constitute the “neonatal period”. The ideal basic needs for any new born includes breathing, warmth, cleanliness, and feeding mothers milk. Then all new born babies’ requires essential new born care to minimize the illness and maximize their growth and development. Clearly, essential care of new born will help to prevent many newborn emergencies, example umbilical cord may be the most common source of neonatal sepsis and also of tetanus infection, and good cord care could dramatically reduce the risks of these serious conditions. Breast feeding has a significant protective effect against infections, early breast feeding and the baby kept close to the mother reduce the risk of hypothermia, as well a hypoglycemia. 2
Good hygiene would reduce the likelihood of cold, dermatitis, herpes and skin diseases being spread to more sensitive individuals. New born babies are also at risk from maternal infection if hygiene is not adequate. The daily cleaning of the infant affords an excellent opportunity for making the observations that are necessary during the immediate post natal period.3
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A newborn is more prone to develop hypothermia of the large surface area per unit of body weight. Over exposure of the baby should be avoided to prevent hypothermia, the room temperature should be maintained at 19 degree to 21 degree celsius. An important task that the infant most maintain the thermoregulation. Although the fact produces heat in uterus, the constant warm temperature of the amniotic fluid makes thermoregulation unnecessary. However the temperature of the room may be as much as 20◦ F lower than that of the uterus. Neonates must produce and maintain enough heat to prevent cold stress which can have serious and fatal effects. 4
Breast feeding offers many advantages, which although it was one of the major method of feeding in 1988 only 54% of mothers were breastfeeding at discharge from the birth facility and only 21% were breast feeding at 5-6 months . Breast milk contains all nutrients a baby needs for normal growth and development in proper proportion and in a form that is easily digested and observed. 5
There is a little controversy that breast feeding is the best feeding for human infants. The decision to breast feed depends on what would please the women the most and make her most comfortable. If she is comfortable and pleased with what she is doing, her infant will be comfortable and pleased, will enjoy being fed and will thrive. Breast feeding is recognized worldwide as being the optimal method of feeding for the human baby, as well as important benefits for babies and also advantages for mothers. Breast milk is an ideal form of nutrition, containing all that the baby needs and with a greater propensity for digestion and absorption of constituents than artificial formulae. 6
The infant feeding is an important part of parenting. A large amount of time is spent for feeding the infant and women may derive much of her satisfaction as a mother form her perception of success with feeding. Helping the mother to choose a
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feeding method and feed comfortable using it are important contributions of the nurse that requires consciousness of the infants nutritional needs and the techniques to meet those needs.
The challenge of preventing this high toll of lives has been the focus of major initiatives by the government and health professionals in recent years. As neonatal hypothermia, neonatal sepsis birth asphyxia and prematurity are leading causes of neonatal death in home cared, rural newborns, a major reason for the high newborn mortality is the lack of care at birth. Thus improved newborn care can lead to better infant survival. As the mother is the key person in maintaining the health status of her child, the knowledge and skill of the mother should be enhanced to provide newborn care.7
6.1 NEED FOR THE STUDY:
A new born baby is God’s divine precious gift given to a mother. Hence, the birth of a newborn is a joyful event that occurs in every woman’s life time.
Newborn babies constitute the foundation of life. The first week of life is the most crucial period in the life of a newborn. In India 50-60% of all infants i.e., 10 / 100 infant deaths, occur within the first month of life of these more than half may die during the first week of life. This is due to lack of mother’s knowledge regarding neonatal care. The mother and health professionals have an important part to reduce newborn morbidity & mortality rate. 8
In India 25 million newborn infants are born every year. When neonatal mortality was 47 per 1000 live births and it is contributed to 63% of infant’s mortality rate. The current neonatal mortality rate 43.4 per 1000 live births and the current infant mortality rate is 67.6per 1000 live births at the national level.
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A study conducted in rural Nepal on 5411 married women aged 15-19 years who had given birth to a live baby. The study revealed that only 3482 [64%] newborn infants had been wrapped in half an hour of birth and 992 (92%)had been bathed with in the first hour 5362 (99%) breast feed within hours of birth thus we can clearly say that the knowledge of practice of newborn care in inadequate. 9
The proportion babies who are breast fed is high in all regions of the world but there are wide variations in the duration of breast, feeding, sub-optimal breast feeding practice are still the norm in most countries, failure to give newborn infants colostrums is a common example of bad practice, lack of exclusive breast-feeding substantially increase the risk of poor newborn and childhood outcome.10
Neonatal care is not available to most neonates in developing countries because hospital care is costly, “so there is a need of home based delivery and neonatal care”. The neonatal care needs even more special attention because births taking place in home, in unhygienic conditions, due to ignorance, poverty and illiteracy among rural women.11
WHO’s report states that integrated approach, good feeding practice, immunization, improved hygiene and the healthy development of children will help to reduce the child mortality rates. Therefore the investigator strongly feels the need to impart structure teaching programme on prevention of new born hypothermia, initiation of breast feeding and neonatal sepsis, that will help the mothers for better newborn care practice at home after discharge, hence the education place a vital role in reducing newborn mortality to morbidity rates. 12
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6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process. Nursing research may be considered as a continuing process in which knowledge gained from earlier studies is an integral part of research in general. In review of literature a researcher analyses existing knowledge before developing into a new study and when making judgment about application of new knowledge in nursing practice. The literature review is an extensive, systematic, and critical review of the most important published scholarly literature on a particular topic.
1. Review related to knowledge of Primi Para mothers regarding newborn care.
* Prevention of hypothermia
* Establishment of breast feeding
* Prevention of infection
2. Review related to effectiveness of structure teaching programme.
1. Review related knowledge of Prim Para mothers regarding newborn care.
The study was conducted to assess the mothers' knowledge and practices of basic newborn care among 55 primi Para and multipara mothers with newborn babies. They were selected from Obstetric University Hospital in Tanta City. Interview questionnaire and observation checklists were designed to fulfill the aim of the 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.13
Related to prevention of hypothermia
A comparative study was conducted on the effect of timing of initial bath on newborns temperature among 80 healthy full term newborns. 40 neonates were bathed at one hour of age and 40 bathed at 2 hours of age. There was no significant
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difference noted in temperature between two groups before the bath or at 10,20 or 60 minutes after bath. It shows that healthy full term newborns with auxiliary temperature > or = 36.80 C ( 98.20 F) can be bathed after one hour of age when appropriate care is taken to support thermal stability.14
A study was conducted on the impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda. The aim of the study was to elcidate the impact of bathing on the prevalence of hypothermia among newborn babies exposed to the skin to skin (STS) care technique before and after bathing. The results showed bathing of newborns in the first hour after delivery resulted in a significantly increased prevalence of hypothermia. There was no neonatal mortality by this method they have concluded, bathing newborn baby’s shortly after birth increased the risk of hypothermia despite the use of warm water and STS care for thermal protection of the newborn.15
A study was conducted on skin to skin treatment of neonatal hypothermia. It shown that the skin-to skin (STS) care also called kangaroo care, an intervention in which the unclothed diapered infant is place on the mothers bare chest, be used to promote thermo regulation instead of using separation and a warmer, STS care has been recognized as a way to facilitate maternal – infant attachment and promote thermo regulation. The finding of the study concluded that the use of STS care as an alternative to traditional re-warming and the use of STS care in the treating of mild hypothermia in the low-risk infant.16
Related to Establishment of breast feeding
A study was conducted on an maternal attitudes and trends in initiation of new born feeding- in lady Hardinge Medical College, New Delhi in India. In this study 305 of the mothers were primipara and 297 multipara 95.01% of the mothers indicated inclinations about breast feeding 47.37% of the mothers who knew about
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breast feeding had been instructed by the doctors at some stage lastly the study was concluded that clearly, better health education is called for regarding the early initiation of breast feeding and the importance of the colostrums to new born weaning practices.17
A study was conducted to describe the breastfeeding and newborn care practices and to describe the factors affecting the initiation and duration of breastfeeding among primi mothers. The study shows 97% of the mothers initiated breastfeeding, 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 This study emphasizes the need for breastfeeding intervention programs especially for the mother during antenatal and postnatal check-ups and practices like discarding the colostrum and early/late weaning are still widely prevalent and need to be addressed. 18
A study was conducted to assess the knowledge of breast feeding among primi- gravida mothers attending ante-natal clinic and to determine the association between socio-demographic variables with their knowledge from 590 married primi gravid mothers attending anti-natal clinic during study period by utilizing personal interview method. Out of 590 primi gravida mothers, 59.66% showed fair quality of knowledge about breast feeding. knowledge about rooming in, family support for breast feeding & burping after breast feeding was 97.7%, 95.4% , 93.5% however weaning, colostrums feed, hazards of bottle feeding and prelactal food was 84%, 82.7%,75.5% and 54% respectively .knowledge of breast feeding among primi gravida mothers attending ANC clinic was of fair in quality. 19