RAJIV GANHI UNIVERSITYOF HEALTH SCINCES,BANGALORE, KARNATAKA.
A STUDY TO EVALUATE THE IMPACT OF VAT (VIDEO ASSISTED TEACHING) ON ESSENTIAL NEWBORN CARE AMONG ANTENATAL MOTHERS ATTENDING ANTENATAL CLINIC IN A SELECTED BOWRING AND LADY CURZON HOSPITAL OF BANGALORE
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
VINODINI.CHUKKA
BANGALORE CITY COLLEGE OF NURSING
BANGALORE-560043(KARNATAKA).
RAJIV GANHI UNIVERSITYOF HEALTH SCINCES,BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. VINODINI.CHUKKA1St Year M.Sc(N)
Bangalore City College Of Nursing,
Bangalore-560043
Karnataka.
2. / NAME OF THE INSTITUTION / Bangalore City College Of Nursing, Bangalore.
3. / COURSE OF THE STUDY AND SUBJECT / 1st Year M.Sc(N),
Child Health Nursing
4. / DATE OF ADMISSION / 12-07-2010
5. / TITLE OF THE TOPIC / "A Study to evaluate the impact of video assisted teaching on essential newborn care among antenatal mothers attending antenatal clinic in a selected Bowring and Lady Curzon Hospital of Bangalore".
6. BRIEF RESUME OF THE INTENTED WORK
INTRODUCTION
The primary goal of essential newborn care is to reduce perinatal and neonatal mortality1
The antenatal care which a woman receives can have a strong influence on her Health potential for survival. Research has shown that a narrower range of services During fewer visits also improve maternal and newborn health.2
Ninety-eight percent of the 3.7 million neonatal deaths and 3.3 million stillbirths each year occur in developing countries. Aa.Carlo,M.D; was designed to train birth attendants ,including doctors, midwives, nurses and trained birth attendants in hospitals and in 96 communities worldwide.3
Most neonatal deaths take place at home indicating the problem in health care access.
An estimated 43 neonatal deaths occur per 1000 live births.4
Nearly 75% of neonatal deaths occur in first 7 days of life. Most of them are preventable, if evidence based practices are followed by all health care professionals.Pre- service education of under graduate medical and nursing students can improve skills for care of pregnant mother and the newborn.5
Most mothers observe their babies carefully and are often worried by minor physical and physiological peculiarities. Adequate explanation and reassurance is necessary to allay her anxiety which may lead to lactation failure.6
Each year some 500000 infants die of neonatal tetanus and a further 460,000 die as a consequence of severe bacterial infection. A substantial proportion of deaths from infections are due to cord infection.7
The knowledge regarding various development variations and physiological and their evolution is important for giving proper advice guidance and assurance to the mother as often mothers are worried by minor physical peculiarities.8
Concurrent expansion and scaling-up of clinical care for sick neonates is essential to achieve the reduction in neonatal deaths to meet the millennium goal for child survival. Therefore strengthening the clinical services within the health care system is much needed to reduce neonatal deaths.9
Factors that are to be considered in the care of a newborn are infant family history, extremes of body temperature, poor feeding, vomiting, failure to pass urine or me conium, rapid breathing with or without cyanosis, jaundice, rashes, and birthmarks “jitteriness”, unusual collapse features.10
6.1 NEED FOR THE STUDY
Most newborns are born and at home in developing countries. So research into attitudes and dynamics of decision making at family and community levels will contribute to improved maternal and newborn care practices and appropriate use of services.
In newborn period, the physical and mental well being depends upon the correct management of the events. The current neonatal mortality rate in India is 45 per 1000 live births, so
it was reported that mortality rates in infant newborn were very high.11
The United Nations Millennium submits in 2000, one of the key goals of the Millennium declaration is to reduce the number of women who die in pregnancy and child birth every year.12
The main causes of neonatal death include low birth weight, infection, diarrheas and sequel of birth injuries and prolonged labor. These deaths could be prevented through simple and cost-effective essential newborn care interventions.13
Community-Based interventions for essential newborn care is followed as14
Antenatal Care / Labor and Delivery care / Postnatal Care*provide tetanus toxic immunization / *ensure clean delivery / *prevent and treat newborn hypothermia by drying and warming
*promote proper nutrition including iron, foliate, and iodine supplements and balanced protein and energy consumption / *provide newborn resuscitation / *prevent and treat newborn hypoglycemia
*Treat maternal infections / *encourage immediate, exclusive breast feeding
*provide breast feeding counseling / *provide newborn eye care
*prevent and treat infections
*encourage birth spacing
The rural women often lack the authority to make health care decisions for themselves where women health is very low on the priority list that is communicable diseases, general illness, pregnancy and pregnancy related complications.15
Up to 15% of pregnant women in all population groups experiences potential fatal complications. Because of these complications pregnancy and delivery are at high risk.16
Prevent and manage hypothermia by drying and wrapping the entire baby right after delivery, breast feeding immediately, delaying the baby’s first bath, providing close contact with the mother, keeping the room warm and the baby properly wrapped. Kangaroo Mother Care”, which involves constant skin-to-skin contact between mother and newborn.17
Prevent and manage infection through clean cord care and timely recognition. Antibiotic treatment to be given for life-threatening infections such as pneumonia, sepsis and meningitis.18
Eye infection in newborn can be prevented by providing topical antibiotic treatment and for sticky eyes prophylactic instillation of human colostrum.19.
Encourage birth spacing. Women who have babies at intervals of less than 36 months have significantly increased risk of delivering low birth weight, premature babies and of having newborn die. Family planning programs can increase women’s knowledge about and access to contraceptive methods that will help them space their bitrhs.20
6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to research project. Is defined as a broad comprehensive in depth, systematic and critical review of scholar publications, unpublished scholarly print material audio-visual material and personal communications.21
Review of literature helps to lay the foundation for a study and can inspire new research ideas. Literature reviews also play a role at the end of the study, when researchers are trying to make some sense of their findings.22
The review of literature in a research report is a summery of current knowledge about a particular problem and includes what is known about the problem. The scope of a literature review should be broad enough to allow the reader to become familiar with the research problem and narrow though to include predominantly relevant resources.23
Research and non-research literature were reviewed and organized under the following headings.
1. REVIEW OF LITERATURE RELATED TO KNOWLEDGE OF ANTENATAL MOTHERS REGARDING ESSENTIAL NEWBORN CARE.
2. REVIEW OF LITERATURE RELATED TO COMPONENTS OR INTERVENTIONS OF NEWBORN CARE.
REVIEW OF LITERATURE RELATED TO KNOWLEDGE OF ANTENATAL MOTHERS REGARDING ESSENTIAL NEWBORN CARE.
Based on mothers education and neonatal mortality study was done in Ghana. The study showed that there is an inverse relationship between mothers education and child survivorship.24
A study was conducted on decision making processes regarding health care for their children. Result has been showed that deu to illiteracy low decisions are made by mothers regarding their children’s health about a sample of 114rural mothers.25
Another study on utilization of antenatal and maternity services by mothers. The result showed that the proportion of mothers who utilized antenatal and maternity services were about 97.5% and 52% because of lack of knowledge.26
Another study was conducted to discover the underlying cause of non utilization of services. Result were like this among 1041 married couples in spite of increased services more than 33% of the women did not use either antenatal or delivery services, nearly 33% did not get their children immunized and those of who initiated immunization only 31% completed it the reasons being ignorance, lack of co-operation among family members and rude behavior by hospital staff.27
2. REVIEW OF LITERATURE RELATED TO COMPONENTS OR INTERVENTIONS OF NEWBORN CARE.
Based on neonatal mortality rate in district hospital a study was conducted. Results shows that NMR was reduced by 14% in the first year and 21% by the second year after sick newborn care unit became functional. Estimated neonatal deaths averted were 329, which would reduce NMR of the district from 55 to 47 in 2years.28
A study was done regarding the rates, timing and causes of neonatal deaths. Result shows that there were about 430 stillbirths and among 618 live births 32% deaths were on the day of birth, 50% occurred during the first 3 days of life and 71% were during the first week.29
In November 2008, a non peer reviewed study was presented bacteria levels present after the use of paper towels, warm air hand dryers and modern jet air hand dryers. The result showed that paper towels reduce the bacteria on hand for the prevention of complete infection.30
A prospective study found that in 47% of infants hospitalized with sepsis, cord infection was the source of infection and that of 21% of infants admitted for other reasons had Omphalitis. Incidence for umbilical sepsis of 30/1000.32
Based on exclusive breast feeding one study shows that early initiation of breast feeding will improve the relationship between the mother and newborn and also it reduces the post partum relapses in women with multiple sclerosis. Result were 52% of women with MS did not breast feed within 2 months post partum, 87% had a post partum relapse, compared with 36% of the women with MS who breast fed exclusively for 2 months of post partum.33
A study on a randomized control trial to study the effect of Kangaroo Mother Care (KMC) on breast feeding Rates, weight gain and length of hospitalization of neonates. Result showed that Neonates in the KMC group demonstrated better weight gain after the first week of life and earlier hospital discharge.(15.9+/-4.5 gm/day vs. 10.6+/-4.5 gm/day in the KMC group and control group respectively.34
A quasi-experimental study was done to know the effects of neonatal resuscitation on mortality.18 experts estimated that immediate newborn assessment and stimulation would reduce both intrapartum related and preterm deaths by 10%, facility based resuscitation would prevent a further 10% preterm deaths, and community based resuscitation would prevent further 20% of intrapartum related and 5% of preterm deaths.35
STATEMENT OF THE PROBLEM
A study to evaluate the Impact of VAT(video assisted teaching) on essential newborn care among the antenatal mothers attending antenatal clinic in a selected Bowring And Lady Curzon hospital of Bangalore.
6.3 OBJECTIVES OF THE STUDY
1. To assess the existing knowledge of antenatal mothers regarding Essential newborn care.
2. To evaluate the impact of VAT regarding essential newborn care.
3. To find out association between pretest knowledge score with their selected sociodemographic variables.
6.4 OPERATIONAL DEFINITIONS
1. Impact- It refers to the influences of changes in their knowledge after giving instructional module.
2. Knowledge- It is the acquired information about facts, objects and events.
3. Newborn- Is a period from the time of birth up to 7 days of life.
4. Antenatal mothers- A women during pregnancy is called as antenatal mother.
Referred to the gravid women are attending the antenatal clinic between 24- 38 weeks of gestation.
5. Video Assisted Teaching- It is not just sitting down and watching television.
There are 3 parts in this
Ø First, there is a facilitator who guides the discussion.
Ø Second, the video cassette that contains consistent current information.
Third, handout for the participants so they can be actively involved in the process
. VAT- It is a system of giving clear information to the participants by recording moving pictures and sound by using a camera.
6. Evaluation- It is a systematic examination of educational and social programs.
6.5 ASSUMPTIONS
1. Antenatal mothers may have knowledge regarding essential newborn care.
2. VAT on essential newborn care may enhance the knowledge of antenatal mothers.
6.6 HYPOTHESIS
H0- There will be no significant between pretest and posttest knowledge score.
H1- The mean posttest knowledge score of antenatal mothers on essential newborn care will be significantly higher than that of their mean pretest knowledge score as measured by structured knowledge questionnaire.
6.7 VARIABLES UNDER STUDY
6.7.1 Dependent variables- Improving knowledge of antenatal mothers regarding essential newborn care.
6.7.2 Independent variables- Video assisted teaching.
6.7.3 Attributed variables- Age, sex, education, occupation and family income.
7. MATERIALS AND METHODS
7.1 Sources of data- Antenatal mothers attending the antenatal clinic of Bowring and lady Curzon hospital.
7.2 Methods of data collection-
7.2.1 Research design- Quasi experimental study.
7.2.2 Setting- The study will be conducted in a Bowring and lady Curzon hospital antenatal clinic. It is 700 bedded hospital and 14 kms away from Bangalore City College of Nursing.
7.2.3 Population- Antenatal mothers.
7.2.4 Sample size- 50 antenatal mothers.
7.2.5 Sample technique- Non probability purposive sampling technique will be used to select the samples depending on the availability.
7.2.6 Sampling criteria-
1. Inclusion criteria-
* The study will includes antenatal mothers attending the antenatal clinic of Bowring and lady Curzon hospital, Bangalore.
* The study will includes antenatal mothers who are willing to participate in the study.
* The study will includes antenatal mothers who are able to read and write Kannada and English.
2. Exclusion criteria
* The study will not includes antenatal mothers of other hospitals.
* The study will not include antenatal mothers who are not willing to participate in the study.
* The study will not include antenatal mothers who do not understand Kannada and English.
7.2.7 Tools of data collection
Structured questionnaire will consist of 2 parts.
· Part one consists of objective questions related to demographic data.
· Part two consists of questions regarding essential newborn care.