Rajivgandhi University of the Health Sciences

RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

01 / NAME OF THE CANDIDATE AND
ADDRESS / MS. SELVAPACKIAMANI.A
Ist YEAR M.Sc NURSING
RAJEEV COLLEGE OF NURSING, HASSAN.
02 / NAME OF THE INSTITUTION / RAJEEV COLLEGE OF NURSING,
KR PURAM, HASSAN
03 / COURSE OF THE STUDY AND SUBJECT / M.Sc NURSING Ist YEAR
CHILD HEALTH NURSING
04 / DATE OF ADMISSION TO COURSE / MAY 15TH 2007
05 / TITLE OF THE STUDY / EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON PREVENTION AND FIRST AID MEASURES FOR BURNS
5.1 / STATEMENT OF THE PROBLEM / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PREVENTION AND FIRST AID MEASURES FOR BURNS AMONG MOTHERS OF UNDERFIVE CHILDREN IN ALUR VILLAGE AT HASSAN.

6. BRIEF RESUME OF INTENDED WORK

6.1. INDRODUCTION

“OF ALL GREATEST THINGS THE LOVELIEST

AND MOST DIVINE ARE CHILDREN”

Caring and caressing the baby is the most lovable job in the world, God’s creation is at the best in a baby’s smile and it is the masterpiece of all arts. When the baby wreathes in pain, it indeed wrecks havoc in one’s heart. Accidents are not other incidents, they create in desirable marks sometimes1.

Accidents at home are more common than on the roads & relatively few occurs in outdoor. Death by fire or smoke inhalation is the commonest cause of mortality from

accidents in the home2.

Burns are injuries to tissues caused by heat, friction, electricity, radiation, or chemicals. Scalds are a type of burn caused by a hot liquid or steam. About 75 % of all burn injuries are preventable

Burns may be caused in a variety of ways. In every case, the burn results from the death of skin tissue and, in some cases, underlying tissue. Burns caused by hot objects result from the death of cells caused by heat. In many cases, contact with a very hot object can damage tissue extensively. The contact may last for no more than a second or so, but the damage still occurs.

Although children are often burned by contact with hot liquids, household appliances, sun exposure, etc, scalding burns are the most common burn injury in younger children. These burns can occur as a toddler knocks over a coffee cup or grabs the handle and spills a pot of boiling water on the stove. Curling irons and other household appliances also commonly burn toddlers and preschool age children. Unfortunately, burns are also a common cause of intentional injuries or child abuse. Chemicals can also cause burns. The chemicals attack and destroy cells in skin tissue. They produce an effect very similar to that of a heat burn.

Burns are classified according to how seriously tissue has been damaged. The following system is used:

• A first degree burn causes redness and swelling in the outermost layers of the skin.
• A second degree burn involves redness, swelling, and blistering. The damage may extend to deeper layers of the skin.
• A third degree burn destroys the entire depth of the skin. It can also damage fat, muscle, organs, or bone beneath the skin. Significant scarring is common, and death can occur in the most severe cases.

Burns in a child are a triple tragedy. First is the injury, which requires prolonged, painful and costly treatment. Secondly, the scars are visible and lifelong , deep burns to the skin even with optimal treatment heal to become unsightly fibrous scars. Thirdly ,are the psychological problems , there is considerably parental guilt and the child has to endure the treatment and adjust to their new physical appearance. The tragedy is all the more poignant because it is so unnecessary because burns are eth most preventable injuries.

Therefore any efforts to treat the disease of burns must focus not just on the surgery but also burn prevention.

The World Health Report on Violence & Injury prevention [2002] stated that, low socio economic status is widely acknowledged risk factors for burns in both developed & developing countries. Over crowded living conditions, lack of proper safety measures & insufficient parental supervision of children are some of the factors associated with low socio economic status can contribute in the occurrence of burns morbidity & mortality due to burn injuries are particularly having bearing on the socioeconomic status3

In Shehy’s Emergency Nursing 1998, more than 90% of burns are preventable. Education to people is particularly needed, combined with legislative efforts will help to decrease the number of burn injuries4

An article on Injury Prevention [1998], stated that home related injuries are a major problem in young children, especially toddlers. According to the National center for Health Statistics [says that unintentional nonfatal accidents in underfive children are due to the decreased knowledge of mothers regarding accident prevention, decreased maternal supervision and limited environmental safety measures by the parents5.

A study on Thermal Injuries 1995 had stated that thermal injuries comprises 60% of all burns may result from flame, blast steam, or scalding liquids6.

Under five children never know the risk around them, which leads to accidents. The parents are the one who brought them into this world have the responsibility to control such risk factors. The most neglected aspect are not aware of the methods of prevention of accidents and if it is failed in that aspect, atleast they can provide some succor of first aid to their child. If one acts with some deligence in the time of need, the fatal accidents can be changed into the non-fatal. If the parents are not aware of the methods & procedures to follow in such tight situations, the non-fatal accidents turn into fatal one. Through the genies attempt of teaching to the mothers help to prevent burns or to make them knowledged in the first aid measures for burns in case of actual accidents.

6.2. NEED FOR THE STUDY

“ PREVENTION IS BETTER THAN CURE’

The underfive children’s age is a troublesome age. Although this can be challenging time for parents and child as both of them learn to know each other better, it is extremely important period for developmental achievement and intellectual growth Although underfive children have real drive for autonomy or independence, their judgment about safety and appropriate behavior is still virtually nil. It is important to supervise these young explorers so that their natural curiosity does not lead them into dangerous situations that can result in injury.

A retrospective study were analyzed among 532 paediatric patients admitted to tertiary burn unit in[2005] Kanchi Kamakoti Child’s Trust Hospital at Chennai, India. These children are belong to the age group of 0-18 years [as WHO has increased the paediatric age group range to 0-18 years]. They were classified according to age, sex, TBSA and occurrence of infection during the course of treatment. Inhalation burns were not very common in this age group and were associated only with large flame burns, which occurs when a child is burnt while the mother commits suicide , or in cases of abuse of female children in a closed room with lots of inflammable upholstery. Scalds were the common type of burn among children 4 years of age. Flame burns predominated the older age group. Although 13 deaths among the entire group., the majority occurred with in 2-4 years of age group. There was no significant difference in respect to mortality. Large burn size and infection were the strongest predictors of mortality 7

Electrical Injuries [2007] study stated that in Lithuania stated that Burn Injury can be caused by low voltage Current [from 60 to 1000 V], high voltage current [more than 1000 V], current, lightning and volcanic arc. Often victims are little children. Lightning causes serious injuries in 1000-1500 individuals every year worldwide. The case of fatality rate is about 20% to 30% with as many as 74%of survivors experiencing to be nuclear in nature and most of the parents are working and many do not have adequate knowledge on safety measures needs of the child, all these can be the reason for accidents in children8

Burns [2005 ] study reports that in UK. By administering the standard questionnaire to the mothers of 630 under five children to elicit the information on the socio demographic variable & the circumstances of burn event. This study reveals that the 90% of burns occurs in home, particularly in Kitchen [51%],house yard [36%] & the most of the burns happen in the late morning & around the evening meal, Main causes of the burns are scalds [45%], contact with the hot object [34%]and flame [20%].Further education is require to improve the knowledge in the prevention of burns & first aid for burns9

WHO conducted study on facts about burns 2002, Burns is the fourth leading cause of unintentional injury death in USA. Annually, to close to 2.5 million people are treated for burn injuries, out of which 10,000 are died & 60,000 to 1,00,000 require hospitalization. Careless smoking causes over 10,000 fatalities each year in USA, which usually occurs in home. Children are at greatest risk of death from burns. In Ireland, Paediatric burns have been reported 1,300 deaths per year. In France, Childhood burns have been reported to account for between 3% to 8% of all injuries in children. In Saudi Arabia, 70.6% admitted to burn units are children under 12 years of age10

A retrospective study was carried out based on 110 pediatric burns [0-14 years] seen at the burn unit, [2001] Choithram Hospital & research center. Indore, India. Epidemiological data included age, sex, seasonal variation, place of burn ,the cause and mode of burn. Hospitalized paediatric burns constituted 13.5% of total burn accidents. These children are categorized into 3 groups, the infants & toddlers [0-2 yrs], early childhood [> 2-6 yrs], & late childhood [> 6-12 yrs]. In this two groups scalding was the predominant cause of injury while in late childhood there were many more flame & electric burns. Males were mainly affected. Most of the burns [53.6%], occurred in the winter season between October & February. 95% of accidents occurred at home. The Overall mortality rate was 21.8%. This study recommended that an intense campaign to make people aware of the risk factors & their avoidance is required to reduce the number of burn accidents in children11

In present situation, many of the families are found to be nuclear in nature & most of the parents are working and many parents even do not have adequate knowledge on the safety needs of child, all these can be one of the reason for accidents in children.

Our present concept is “We two ours one”. So the precious child is to be given more importance and care in preventing accidents. When the investigator came across burn victims & their family members during in her clinical experiences. She found that many of the victims are of underfive children related home accidents. She also found that they had limited knowledge about prevention & first aid measures for burns.

In case of a crisis, basic knowledge on prevention & first aid measures for burns will help to reduce morbidity & mortality rate due to burns in underfive children. That’s why the investigator had taken the effort to give health education to the mothers of underfive children on prevention & first aid measures for burns that can be given by themselves to prevent further complications.

6.3. STATEMENT OF THE PROBLEM:

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PREVENTION AND FIRST AID MEASURES FOR BURNS AMONG MOTHERS OF UNDERFIVE CHILDREN IN ALUR VILLAGE AT HASSAN”

6.4. OBJECTIVES OF THE STUDY:

* Assess the level of knowledge among mothers of underfive children regarding

prevention & first aid measures for burns in children.

* Educate the mothers of underfive children of experimental group through the

structured teaching programme on prevention & first aid measures for burns

in children.

* Evaluate the posttest knowledge of mothers of under five children regarding

prevention & first aid measures for burns in children.

* Compare the level of knowledge among mothers of underfive children between

the experimental and control group

* Associate the posttest knowledge level among mothers of underfive children of

experimental group with selected demographic variable.

6.5 HYPOTHESIS:

H1 : There will be a significant difference between the pretest and posttest level

Of knowledge among mothers of under five children regarding prevention and

First aid measures for burns.

6.6 OPERATIONAL DEFINITION:

1. Assess:

It is the statistical measurement of knowledge on prevention and first aid measures for burns as observed by close-ended questionnaire.

2. Effectiveness:

The changes in the level of knowledge after the structured teaching programme on prevention and first aid measures among mothers of underfive children being measured through the structured tool.

3. Structured teaching programme:

It is a planned instruction regarding prevention and first aid measures for

burns for underfive children. It consists of definition, causes, types, signs &

symptoms, common approach for burns prevention and first aid measures for

burns. It will be explained to the mothers of under five children for 20 –30

minutes after the pretest.

4. Prevention :

Prevention means educating the mothers of under five children how to avoid

their children from burns

5. First aid:

It is a immediate measures or treatment given to the underfive children by

their mothers during burn injury.

6. Burns:

Burns are the injuries caused by the hot flame / fire contact with a hot object

or hot liquid other than water such as from a cooker, chip pan fire or hot

oil spillage.

7. Mothers

The mothers who are having children below five years of age group.

6.7: Inclusion & exclusion criteria :

I. Inclusion criteria:

1. Mothers who are having underfive children [0-5 yrs].
2. Mothers who are willing to participate
3. Mothers who are residing in Alur village at Hassan.

II. Exclusion criteria:

1. Mothers who are not having underfive children.
2. Mothers who are not willing to participate
3. Mothers who are not residing in Alur village at Hassan.
4. Mothers who are not available during the collection of data

6.8. DELIMITATION:

1. The sample size is limited to 50 mothers of underfive children.
2. Prescribed data collection is only 4-6 weeks.
3. Study design is limited to true experimental design

6.9 SIGNIFICANCE OF THE STUDY:

The study signifies the prevention and first aid measures for burns among

mothers of underfive children.

6.10. CONCEPTUAL FRAMEWORK:

It is based on Wiedenbach’s Theory

6.11: REVIEW OF LITERATURE:

Literature review is a standard requisition of scientific research. It means

reading and writing the pertinent information of the attempt in research topic to

understand better about the proposed topic. It also supports and explains why the

proposed topics taken for research and avoid unnecessary duplication, explore the

feasibility and illuminate way to new research12

The Review of Literature consists of 3 parts.

Part- I – Studies related to Burns.

Part-II - Studies related to Prevention of Burns.

Part III- Studies related to First aid measures for Burns.

PART I

Studies related to Burns.

A Retrospective study were analyzed among 309 children of burns injuries treated in Kasturba Hospital, Manipal, India.[2001] Data was collected regarding the incidence, severity, extent, causes , risk factors & overall mortality. Children of age <5 years were affected more than children of age > 5 years of age [76.1% Vs 23.9%], Females were affected more than males [74% Vs 25.9%]. Most of the children received burn injuries in the range of 0 to 20%. BSA [63.8%], Scald [72.5%], followed by flame [22.7%] & electrical burn [3.2%] were most common cause of burn mortality was 7.4%

Further education should be given to the people regarding burns13

In Rujia Hospital at china study was carried out by review of all medical records of

acute pediatric burn patient [age < /6 yrs old] admitted [2006]. A total of 1494 pediatric burn patient are admitted. 68% patients were from the migrant population. Scalding was the main causes of pediatric burns .Children 0-3 yrs old were the most common victims of scalding, chemical burns & contact burns. Domestic burns resulted in [86.5%] injuries followed by burn occurring while playing public. The median total body surface area was 4%of mild burn, 10% for moderate burns, 18% for extreme burns. This study

concluded that education should focus on parents and caretakers of under five

children regarding burns14.

A cross sectional study of 111 burn patients was conducted in Pakistan

[2006] In this included patients of any age, both sexes, & any degree of burns. In

this 37.8% of patients were children less than 5 yrs of age [Group I], 39.8% were

males more than 10 yrs of age [Group II]& 22.5% were females more than 10 yrs

of age group[Group III], In group I patients, the place of burns was their home.

The burns occurred at home in 31.8% of Group II patients & 26% of Group III.

The mechanism of burn was scalding in 73.8% of Group I, flame burns in 40.9%

of Group II patients & 72% of Group III patients. 25% of Group II patients got

electrical burn. The cause of burn was scalding at home in the majority of children

less than 5 yrs of age. This study recommended that health education on burns is

needed for the mothers to prevent the childhood burns15

Peadiatric homicides related to burn injury study was conducted on 124 cases [2004]. In this 121 cases are fire related fatalities & 3 are scaldfatalities. 90 of burn victims were in the 0-5 years age group. The manner of deathshowed 108 accidents & 12 homicides. In this 11 of 12 burns related to homicidesoccur at home with all victims in the 0-6yrs age group. This study concluded thatfurther education should be given to the mothers regarding burns will reduce themorbidity & mortality rate of peaditric death16

In London a questionnaire was administered to all consenting 740 guardian of children admitted in the burns unit [2002] Data was collected regarding etiology of the injury, demographic& socio economic variables. 77.5% of the cases occurred in the patient’s home with 67.8% in the kitchen, 74% were due to the scalding. Most involved children younger than 5 yrs of age group. Lack of water supply 95%, Low income 94%, crowding 95% were associated with an increased risk factors. Further education should be designed accordingly to the low socioeconomic status group of people to prevent the risk factors for burns17