“EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP) ON KNOWLEDGE REGARDING BILIBLANKET PHOTOTHERAPY AMONG STAFF NURSES IN SELECTED PEDIATRIC HOSPITALS AT BIJAPUR”.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MR. JAKKAPPA.BASARAGI
CHILD HEALTH NURSING
FIRST YEAR M.Sc NURSING
YEAR 2012 -2014
BLDEA’S SHRI B M PATIL
INSTITUTE OF NURSING SCIENCES
SOLAPUR ROAD, BIJAPUR - 586103
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / MR. JAKKAPPA.BASARAGI.I YEAR M. Sc. NURSING
BLDEA’S SHRI B.M.PATIL INSTITUTE OF NURSING SCIENCES, BIJAPUR-586103
2 / NAME OF THE INSTITUTION / BLDEA’S SHRI B.M.PATIL INSTITUTE OF NURSING SCIENCES, BIJAPUR -586103
3 / COURSE OF THE STUDY AND SUBJECT / I YEAR M. Sc. NURSING
CHILD HEALTH NURSING
4 / DATE OF ADMISSION TO THE COURSE / 27.07.2012
5 / TITLE OF THE STUDY
“EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP) ON KNOWLEDGE REGARDING BILIBLANKET PHOTOTHERAPY AMONG STAFF NURSES IN SELECTED PEDIATRIC HOSPITALS AT BIJAPUR.”
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8 / BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Our children are our most precious resources”
The birth of an infant is one of the most awe inspiring and emotional events that can occur once in life time. After nine months of anticipation and preparation the neonates arrives aimed a flurry of excitement. But most often the enjoyment of parents and the bonding with new born will be disturbed due to certain common neonatal disorders. One such common health problem is neonatal jaundice. The word jaundice is derived from the French word Jaune which means Yellow. Clinical jaundice manifests as yellowish discoloration of the skin of the face when the serum bilirubin level exceeds 5mg/dl. As the degree of jaundice increases, there is a cephalocaudal progression of the yellowishness of the skin. When the trunk of the baby is distinctly yellow stained, the serum bilirubin levels is likely to range between 10 to 15mg/dl. The yellow staining of the palms and soles indicates that serum bilirubin level has exceeded 15mg/dl.1
Neonatal jaundice affects 60%of full term infants and 80% of preterm infants, bilirubin level greater than 5mg/dl in the first week of life and about 6% of term babies will have bilirubin levels exceeding 15mg/dl. Neonatal jaundice is a yellowing of the skin and other tissues of a newborn infant with a bilirubin level of more than 5mg/dl.2
A biliblanket is a portable soft flexible pad woven of fiber optic pad placed with disposable cover and exposed emitting lights in 400 to 500 nanometer range for therapeutic blue violet range. Biliblanket is trade mark of general electric’s datex – ohmeda subsidiary. It is an obvious combination of bilirubin and blanket. Others names used are home phototherapy system, bilirubin blanket or phototherapy blanket or fiber optic phototherapy. It can be used in the home situation and hospital setup also. It is available in standard size mat, large fiber optic mat and double fiber optic mat.3
6.2 NEED FOR THE STUDY
More than 40% of the population of our country falls in the age spectrum covered by paediatrics. Infants (0-1 years) constitute 2.82% of the total population in India.4 The WHO reveals that the incidence of hyperbilirubinemia is 50 to 60 thousands neonates among these 2% has total serum bilirubin levels over 20mg/dl, the total serum bilirubin level in normal range is0.3 to 1mg/dl.0.15%had levels over 25 mg/dl and 0.01% has over 30mg/dl5.Three methods of treatment modalities are used to reduce the level of conjugated Bilirubin. They are phototherapy, pharmacological therapy and exchange transfusion. The phototherapy is best in moderate case where the bilirubin raises above 12mg/dl. In pharmacological therapy, Phenobarbital induces hepatic microsomal Enzymes and increases bilirubin conjugation and excretion. Exchange transfusion is used to prevent kernictreus and replace 85 % of circulating red blood cells and reduces bilirubin level by 50%.6
There are two types of biliblanket phototherapy one is ohmeda system, it consists of standard size fiber optic biliblanket with a halogen lamp and attached fiber optic cable containing 2400 optic fibers. The ends spread out in a flat mat emission of blue green light. Intensity of light ranges from 15mw/cm2 – 35mw/cm2.The second one is health dyne wallaby system, this devices has long flat florescent panel attracted to the main unit by short connector3.
A study was conducted to evaluate the efficacy of fiber-optic phototherapy using the standard OhmedaBiliblanket, a large version, double standard Biliblanket, and conventional phototherapy using daylight fluorescent lamps in full-term, healthy infants with nonhemolytic hyperbilirubinemia.Among171 infants full-term, healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 micro mol/L or 222 micro mol/L at <48 hours of age) were allocated randomly to one of four modes of phototherapy: standard fiber-optic mat (OhmedaBiliblanket), a large version, double standard Biliblanket, and conventional phototherapy. Bilirubin levels were monitored every 12 hours. Exposure was stopped when bilirubin levels were less than 185 micro mol/L, the minimum duration being 24 hours. 42 were exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy, 42 to double-fiber-optic phototherapy, and 44 to conventional phototherapy. The result shown that the efficacy of double-fiber-optic phototherapy and conventional phototherapy was similar and significantly better than that of the large fiber-optic mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall decline rate. The large mat was slightly better than the standard-size mat with regard to 24-hour decline rate and overall decline rate, but this difference was not significant. Failure of phototherapy occurred only in the large fiber-optic mat group (3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other two groups, but differences not statistically significant. The nursing personnel were more comfortable with single fiber-optic phototherapy, which caused no initial disturbance to the swaddled infants as did conventional phototherapy, but found double-fiber-optic phototherapy difficult to use. The researchers concluded that for efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of our conventional phototherapy, the light dose of the standard mats needs to be doubled.7
To compare with other phototherapy it has a advantages. It helps the mother and baby bonding , mother can nurse, swaddle and hold the baby ,skin temperature will not raised , no need for eyes pad, a greater flexibility of use may be used in a incubator , radiant warmer , bassinet or at home diaper can be worn , baby can be clothed , it can be Used for 24 hours a day.3
A study has been conducted to compare the use of standard overhead fluorescent phototherapy units with the biliblanket a woven fibreoptic pad which delivers high intensity light with no ultraviolet or infrared irradiation in the treatment of jaundice in preterm infants. Infants between 800g to 2500 g, were included in the study with strict criteria for commencing and ceasing phototherapy. Serum bilirubin levels were followed at 12-24 h intervals until 24 h after cessation of phototherapy. Infants were allocated at random to receive either conventional phototherapy or the biliblanket. There were 24 infants in the conventional group and 20 in the biliblanket group. Mean duration of phototherapy was compared and was 44 h for the conventional group versus 42 h for the biliblanket group. The researcher has concluded that the biliblanket is as effective as conventional phototherapy and was well accepted by nursing staff and parents.8
The biliblanket phototherapy is one of the advanced technology for treatment of the jaundice. In Indian context, the use of Biliblanket phototherapy is very minimal in paediatric health set up. Health professionals in general, nurses in particular may not have adequate knowledge regarding this procedure. Hence the researcher is interested to conduct a study on the effectiveness of structured teaching program on knowledge regarding Biliblanket phototherapy among staff nurses.
6.3 REVIEW OF LITERATURE
A Study was conducted To compare the effectiveness of various phototherapy systems in lowering serum bilirubin levels among 140 preterm infants. Eligible infants were randomly assigned to four study groups: conventional, fiber optic Wallaby, fiber opticBiliblanket, and combined phototherapy. Efficacy was assessed by comparing highest serum bilirubin levels, duration of treatment, and number of infants requiring exchange transfusion. Result shows that fiber optic phototherapy, both Wallaby andBiliblanket, had the same effectiveness of conventional phototherapy. The best results have been obtained using combined phototherapy, which allowed to reach lower serum bilirubin levels, a shorter duration of treatment and a significant reduction of exchange transfusions. The researcher concluded that combined phototherapy should be the method of choice in treating hyperbilirubinemia in very preterm infants.9
The study was conducted to evaluate the efficacy of fibreoptic phototherapy. In the management of newborn infants with hyperbilirubinaemia.with sample size of thirty-one subjects were identified of which 24 met inclusion criteria. They evaluated the efficacy of fibreoptic phototherapy in a number of different clinical situations and patient populations. Result shown that combination of fibreoptic and conventional phototherapy was more effective than conventional phototherapy alone .Researcher concluded that fibreoptic phototherapy has a place in the management of neonatal hyperbilirubinemia. It is probably a safe alternative to conventional phototherapy in term infants with physiological jaundice.10
A study was done to compare special blue compact fluorescent lamp (CFL) phototherapy with special blue standard-length tube lights. Sample size of study was 293 consecutive babies with gestation more than 34 weeks who received photo-therapy, 100 babies, who satisfied the eligibility criteria, were enrolled and randomized. There were 50 babies in each group. The results of the study shown that baseline characteristics, causes of jaundice, hemolysis, baseline TSB and irradiance were similar in both groups. Mean duration of phototherapy (P = 0.98) was similar in both groups. Kaplan-Meier analysis of phototherapy duration showed no difference in the survival curves of the two groups (P = 0.6). Auxiliary temperature was similar in both groups and no baby has dehydrated. The study concluded that CFL phototherapy has no superiority over STL phototherapy in terms of efficacy and adverse effects on the neonate and effects on nursing staff darted.11
A study was conducted on treatment of neonatal hyperbilirubinemia, with aim of, focusing on practical aspects that are relevant to paediatricians and neonatologists. The study findings suggest that jaundice is very common among infants during the first days of life. Several factors such as maternal and neonatal history have to be considered before implementing treatment. Significant advances have been made in the past few years concerning the treatment of jaundiced newborn infants. The conclusion of the study shown that nowadays, the in-depth knowledge about the mechanism of action of phototherapy, the development of intensified phototherapy units and the use of drugs to reduce bilirubin formation, have contributed to significantly decrease the need for exchange transfusion.12
A study was conducted to compare of double phototherapy (conventional plus biliblanket) versus conventional single phototherapy in the management of neonatal hyperbilirubinemia. The sample size of study was 90 ,with divided in to two groups.45 new born in each groups, those who got conventional single phototherapy were taken in group one and babies who got double phototherapy were taken in group two. Each group was again divided in to three subgroups according to their birth weight (NBW, LBW&VLBW).The result shows that decrement rate of serum bilirubin per day was 2.4+-1.20 mg/dl in NBW babies with the use of conventional single phototherapy compared to 4.97±1.05 mg/dl with the use of double phototheraphy.In LBW babies, decrement rate of serum bilirubin per day was 2.45±1.9mg/dl with conventional single phototherapy but 4.99±0.59mg/dl with double phototherapy. In VLBW babies decrement rate of serum bilirubin per day was 2.49±0.59 mg/dl with conventional single phototherapy but with double phototherapy this decrement rate was5.21±1.13mg/dl per day. Double phototheraphy.In was more effective than conventional single therapy all three groups of babies however the rate of fall of bilirubin was higher in VLBW group. This study concluded that decrement rate of serum bilirubin more than two folds with double phototherapy (conventional plus biliblanket) compared with single phototherapy.13
6.4 STATEMENT OF PROBLEM
“Effectiveness Of Structured Teaching Programme (STP)On Knowledge
Regarding Biliblanket Phototherapy Among Staff Nurses In Selected Paediatric
Hospitals At Bijapur”.
6.5 OBJECTIVES:
1. To assess the knowledge regarding Biliblanket phototherapy among staff nurses as measured by structured knowledge questionnaire.
2. To evaluate the effectiveness of structured teaching programme (STP) on knowledge regarding Biliblanket phototherapy.
3. To find out the association between pre-test knowledge score with selected demographic variables.
6.6 OPERATIONAL DEFINITION
· Effectiveness: - In this study effectiveness means improving knowledge regarding Biliblanket phototherapy among staff nurses by structured teaching programme which may results from differences between pre and post test knowledge score.
· Structured teaching programme :- In the present study it refers to systematically planned teaching programme designed to provide information regarding biliblanket phototherapy
· Knowledge: - It refers to the ability of the staff nurses in giving correct responses to the questions asked as measured by structured knowledge questionnaire about biliblanket Phototherapy.
· Biliblanket phototherapy: - A biliblanket is a portable soft flexible pad woven of fiber optic pad placed with disposable cover and exposed emitting lights in 400-500 nm.range for therapeutic blue violet rays.
· Staff nurses :- In this present study staff nurses refers to those who are providing professional nursing care in paediatric hospitals with minimum qualification of general nursing ,B.Sc Nursing , PBBSc Nursing
6.7 ASSUMPTIONS
The study assumes that:
1. Staff nurses may have inadequate knowledge regarding biliblanket phototherapy.
2. Structured teaching programme will improve the knowledge regarding
Biliblanket phototherapy among staff nurses.
6.8 HYPOTHESES
The following hypotheses will be tested at 0.05 level of significance.
H1. There will be significance difference between pre test and post test
knowledge Score.
H2: There will be significant association between pre test knowledge score and