Download rajiv gandhi university of health sciences

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1.
NAME OF THE CANDIDATE
AND ADDRESS (IN BLOCK
LETTER)
MRS.NITHYAKALAIVANI.C
IKON NURSING COLLEGE
BHEEMANAHALLI
RAMANAGAR (DIST)
B.M.MAIN ROAD, BIDADI,
BANGALORE.
2.
NAME OF THE
INSTITUTION
IKON NURSING COLLEGE
BHEEMANAHALLI
RAMANAGAR (DIST)
B.M.MAIN ROAD, BIDADI,
BANGALORE.
COURSE OF STUDY AND
SUBJECT
I st YEAR M.SC NURSING
4.
DATE OF ADMISSION TO
THE COURSE
28.09.2009
5.
TITLE OF THE TOPIC
A Study To Evaluate The
Effectiveness Of Structured
Teaching Programme On
Knowledge Regarding Kangaroo
Care Among Postnatal Mothers
Having Low Birth Weight Babies In
Selected Hospital At Bangalore.
3.
CHILD HEALTH NURSING
6 BRIEF RESUME OF THE INTENDED WORK:
6.1 INTRODUCTION:
“Children are the wealth of the nation,
Take care of them,
If you wish to have a strong India”
- NEHRU
Yes, child health is the foundation of the family and wealth of the Nation.
Newborn is the very important personality of the home. All family members give
him or her warm welcome.
Among the major child health challenges facing the world at the turn of
the new millennium is the problem of high neonatal mortality. The global burden
of newborn deaths is estimated to be a staggering five million per annum. Only
2% (0.1 million) of these death occur in developed countries, the rest 98% (4.9
million) take place in the developing countries. The highest neonatal mortality
rates are seen in countries of South Asia resulting in almost 2 million newborn
deaths in the region each year, with India contributing 60% (1.2 million) of it.1
Globally about 25 million Low Birth Weight babies are born each years
consisting of 17% of all live births. Approximately 16 to 18% neonates born in
developing world are of Low Birth Weight having a weight of less than 2500
gram. The World Health Organization defines low birth weight infants
(irrespective of gestational age) as neonates born less than 2500 grams (5 pounds)
and extremely low birth weight as less than 1500 grams. Of these babies,
approximately one third dies before stabilization or in the first twelve hours.1
Premature birth imposes a tremendous stress for both the baby and the
mother. To save the baby life, infant is monitored under the incubator and warmer
surrounded by unfamiliar sounds like buzzers, bells but lies all by himself in
warmer. The treatment and routine care giving procedures cause pain and
discomfort making it difficult for very low birth weight infants to experience
restful and undisturbed periods of sleep. An alternative method, which is easy and
cheap to practice, having more advantage is kangaroo care provided for the
satisfactory improvement in infant health.1
More than 20 million babies are born each year with low birth weight.
This represents 15.5% of all births. Of these low birth weight babies, 95.6% are
born in developing countries. One in 12 babies (8.3% of live births) was low birth
weight in 2005 in India. Between 1995 and 2005, the number of infants born low
birth weight infants born in India increased to 11%. Because of the poor care and
resources, this rate was increasing steadily.2
Infants who weigh less than 2500 grams at birth represents about 26% of
all live births in India. More than half of these are born at term. The preterm
infants with greater body surface area in relation to their body weight and have
difficulty in maintaining normal body weight due to inadequate brown fat stores.
He further explains that premature infants have a disproportionate ratio of body
surface to body weight, thin skin, fewer fat stores, immature neurological system
and less available metabolic substrate than full term infants and adults. Therefore,
heat transfer through internal gradient is increased four times more in preterm
infants in adults.3
Based on Maslow's hierarchical theory, the basic need of every individual
are love, security and affection. All of which can be expressed through the most
old fashioned and natural way of cuddling. The baby through out the nine-month
period in the mother's womb recognizes this sensation of being cuddled in the
environment of the womb. This sensation and feeling of security is ended
prematurely in the case of the preterm infants, since they have to face extra uterine
life before time. Hence preterm infant need more cuddling and security,
mimicking the intrauterine environment. 4
Kangaroo Mother Care was initially conceived in Bogota, Colombia in
1978 as an alternative to incubator care for the low bi11h weight baby. Kangaroo
Mother Care is a humane, low cost method of care of low birth weight (LBW)
infants particularly for those weighing less than 2000gram at birth. It consists of
skin-to-skin contact, exclusive breast feeding early discharge and with an
adequate follow-up.5
Incubator care causes dehydration in preterm and full term. There is a
similar effect of maintaining temperature by a cost effective method of care
named as kangaroo care. Kangaroo Care, when replaced by an incubator, leads to
many benefits for both the baby and mother. In India, most of the population
t~l11S' below poverty line, thus restraining them' from sophisticated care for their
row birth weight infants.6,7
Thus, Kangaroo Care ensures people from all economic standards to give
the needed care for their preterm babies. The preterm babies gain temperature
slowly and prevent hypothermia. Therefore, the preterm baby becomes calm and
relaxed. It also helps the baby to conserve energy and bring the organs to normal
functioning.
6.2 NEED FOR THE STUDY:
In general, prematurity and intra uterine growth retardation or low birth
weight are the leading cause of neonatal morbidity and mortality. WHO (2001)
stated that 16% of infant deaths (109.5 per 1000 live births) is due to specified
low birth weight. 1
Infant mortality rate is 60 per 1000 live births and neonatal mortality rate
is 40 per 1000 live births in India and 44 per 1000 live births in Tamil Nadu and
40 per 1000 live births in Karnataka. Data indicates an alarming situation. The
Health for All by 2010 aims for 20 Infant Mortality Rate makes it imperative to
develop and low cost effective modality while for caring low birth weight
infants. 8
The newborn should maintain a temperature of 37 degree C. hypothermia
in newborn babies’ results in immature development of central nervous system,
birth asphyxia, intracranial hemorrhage and failure to maintain an effective
thermo neural environment. In preterm and small for gestational age infant’s heat
loss is due to high surface area, reduced subcutaneous tissue, reduced brown fat
and reduced glycogen stores.6
Hypothermia in low birth weight babies, leads to increase in surfactant
synthesis and surfactant efficacy, decreased PH, reduced partial pressure of
Oxygen (PO2), hypoglycemia, less O2 consumption, diversion of cardiac output
to brown fat, increased utilization of caloric reserves, reduced weight gain of
infant and reduced blood coagulability. Therefore, it increases neonatal mortality.6
Preterm babies who are not developed completely found that the skin-toskin contact with mother helps in improvement of neurobehavioral development.
In 1979, Colombian physician Ray and Martinez suggested mothers to become
“human incubators” by holding their premature infants skin-to-skin like kangaroo
style. It is an alternative to NICU care because of high rate of nosocomial
infections and lack of resources. Because of Colombian experience, many
European countries have introduced Kangaroo care in their nurseries
physiological, emotional and physical benefits for both parents and infants by
Kangaroo care. 6
A study conducted on the effects of kangaroo care on sleep. The
importance of sleep to the infant’s developmental outcome was recognized and
the use of skin-to-skin holding as a means of increasing stable infant sleep and
rest was implemented. 9
A study to assess the heart rate variability responses of a preterm infant to
kangaroo care. The main outcome measure was heart rate variability, especially
the parasympathetic component, was high when the infant was fussy in the open
crib, indicating increased autonomic nervous system activity. With kangaroo care,
the infant fell asleep and both sympathetic and parasympathetic components of
heart rate variability decreased. Overall kangaroo care produced changes in heart
rate variability that illustrates decreasing stress. 10
A study on the influence of feeding patterns and other factors on early
somatic growth of healthy, preterm infants in home-based Kangaroo care. The
sample included was 115 mothers and their 129 healthy, preterm infants. 126
(98.4%) infants were available for evaluations at term infant’s weight were
monitored daily until they achieved 15g per kg per day. The result revealed that
sixty (4.6%) infants gained weight adequately with exclusive breast-feeding. In 14
of those who needs supplements adequate weight gain was achieved before
reaching term and supplements could be stopped. 11
A study to assess the effect of skin-to-skin contact (Kangaroo care) shortly
after birth on the neurobehavioral response of the term newborn by a randomized,
control trial. Study subjects were 47 healthy mother infant pairs. Kangaroo care
began at 15 to 20 minutes after delivery and lasted for one hour. Control group
infants and kangaroo care infants were brought to the nursery 15 to 20 and 75 to
80 minutes after birth respectively. The result showed during an hour long
observation starting at 4 hours postnatal, the kangaroo care infants slept longer,
were mostly in a quiet sleep state, exhibited more flexor movements and postures
and showed less extensor movements. 12
A study conducted on kangaroo care in clinical setting with full term
infants who were having breast feeding difficulties. This clinical experience
suggested that Kangaroo care is a worthwhile intervention to try when a mother
and her full term infant are struggling to achieve successful breast feeding. 13
The above mentioned studies show that Kangaroo care has many
advantages over the conventional incubator care and it improves the health of the
newborn. This care is a cheapest method and can be given even for the babies
from below poverty line. In addition, it emphasizes that qualified nurse specially
educated on Kangaroo care is an integral part of the newborn care team for
ensuring quality care to the neonates. Therefore, the investigator felt the need to
undertake this study to evaluate the effectiveness of structured teaching
programme on knowledge regarding kangaroo Care among post natal mothers
having low birth weight babies.
6.3 REVIEW OF LITERATURE:
A thorough literature review helps to lay the foundation for a study and
can inspire new research ideas. Review of literature is arranged under the
following headings:
1. Reviews related to low birth weight
2. Studies related to physiological changes of neonates in kangaroo care
3. Studies related to neurobehavioral changes of neonates in kangaroo care
4. Studies on various medical personnel and their involvement in kangaroo
care.
1) Reviews related to low birth weight:
Low birth weight is one of the most serious challenges in maternal and
child health in both developed and developing countries. Its public health,
significance may be described to numerous factors its high incidence, its
association with mental retardation and a high risk of perinatal and infant
mortality and morbidity (half of all perinatal and one-third of all infant deaths are
due to low birth weight), human wastage and suffering, the very high cost of
special care and intensive care units. Many of them die during their first year. The
infant mortality rate is about 20 times greater for all low birth weight babies than
for other babies. The lower the birth weight, the lower the survival chance. 3
The set goal of government of India in health for all by 2000 with regard
to low birth weight is to reduce its incidence to 10% level. A birth weight of less
than 2500 grams is considered less favorable for the survival and well-being of a
newborn and hence the weight of 2500 grams is being used as a cut off point. But
in India the cut off point for low birth weight babies occur in babies with birth
weight below 2000 grams. There are two main groups of low birth weight babies.
Those born prematurely (before 37 weeks of gestation) and babies born with fetal
growth retardation are referred as term, small for gestational age (TSGA). 14
Low birth weight is a strong predictor of neonatal mortality and it is
associated with health problems of infants, which includes many chronic
disabilities lasting beyond infancy. 15
2) Studies Related To Physiological Changes In Kangaroo Care:
A randomized control trial to compare the effect of Kangaroo Mother Care
(KMC) and Conventional Methods of Care (CMC) on growth in low birth weight
babies. The subjects were 206 neonates with birth weight less than 2000 grams.
The findings of the study revealed that the KMC babies had better average weight
gain per day (KMC: 23.99g Vs CMC: 15.58g, P<0.0001). The weekly increment
in the head circumference (KMC: 0.75cm Vs CMC: 0.49cm, P=0.02) and length
(KMC: 0.99cm VS CMC: 0.7cm, P=0.0008) were higher in the KMC group.
Therefore, the study revealed that babies under kangaroo care were started earlier
on breast feeds (98% Vs 76%). The study concluded that KMC is a simple and
acceptable method for the mother can be continued at home and thereby improves
the infant growth and reduces morbidity. 16
A descriptive study to explore the supportive behavior of nurses as
experienced by mothers of premature infants. A convenience sampling of 37
mothers in a neonatal intensive care unit were recruited. These findings
demonstrated that parents desired more nursing support than they received
particularly in the area of supportive communication and health information. Thus
the nurses should be aware of the importance of tailoring nursing support to meet
the needs of parents with premature infants. 17
A study to find out the various beneficial effects of kangaroo mother care
in low birth weight babies. The sample size was 50 low birth weight infants,
weighing less than 2000 grams. The mean birth weight was 1.487-0.175 kg. The
mean age at discharge was 23.6-3.52 days and mean duration of hospital stay was
15.5-11.3 days. The study concluded that KMC is effective than traditional care
with incubators is safe on stable preterm infants. KMC because of its simplicity
would be preferred in home care of low birth weight babies.18
A study to introduce community-based skin-to-skin care in low birth
weight babies. The study findings revealed that the incidence of hypothermia was
significantly reduced in (36.5 degrees C) both low birth weight and normal birth
weight infants (49.2%, [361/733] and 43% [418/971], respectively). Acceptance
of skin-to-skin contact (STSC) was nearly universal. No adverse events from
STSC were reported. The study revealed that mother perceived STSC as a way of
preventing newborn hypothermia, enhancing mother’s capability to protect her
baby from evil spirits, and make the baby more content. The STSC is said to be
highly acceptable in rural India when introduced through appropriate cultural
paradigms. STSC may be of benefit for all newborns and for many mothers as
well. New approaches are needed for introduction of STSC in the community
compared to the hospital.19
A randomized control trial to compare the effectiveness of using early
Kangaroo care for extra uterine temperature adaptation against that of using
radiant warmers. Trial subjects included 78 consecutive cesarean newborn infants
with hypothermia problems. The Kangaroo care group received skin-to-skin
contact with their mothers in the post-operative room. While infants in the control
group received routine care under radiant warmers. The mean temperature of the
Kangaroo care group was slightly higher than that of the control group (36.29
degrees C vs. 36.22 degrees C, p=0.044). After four hours, 97.43% of kangaroo
care group infants had reached normal body temperatures, compared with 82.05%
in the radian warmer group. Results demonstrated the positive effects of kangaroo
care for extra uterine temperature adaptation in hypothermia infants. In the course
of evidence-based practice, kangaroo care could be incorporated into the standard
care regimen of low birth weight infants in order to improve hypothermia care
against that of using radiant warmers.20
Two case studies to determine the temperatures of Breast and infant
temperature with twins during shared kangaroo care. Twins were being
simultaneously kangarooed and the temperatures of maternal breasts during
shared kangaroo care. Two sets of premature twins were held in shared kangaroo
care for 1.5 hours. Infant temperatures were recorded from those on incubators
and on breast. Infant temperatures remained warm and increased during kangaroo
care and each breast appeared to respond to the thermal needs of the infant on that
breast. Physiological explanations for thermal synchrony exist. These data
suggested because each breast responds individually to the infants thermal needs.
21
A retrospective study to evaluate the efficacy of Kangaroo method on
thermoregulation and weight gain of a cohort of preterm. It covers 56 preterm
babies. The mean gestational age was 33+/-, 6 weeks and mean birth weight was,
1488+/-277,6g (median=1500g). Mean temperature was satisfactory during follow
up and was stable around 37+/-, 5 degrees C at discharge of program with mean
daily weight gain of 33+/-7,6g. The results of this study pointed out the efficacy
of kangaroo method on thermoregulation, weight gain and survival of preterm
babies. Thus the group advocates Kangaroo care for developing countries because
of its low cost. 22
3) Studies Related To Neurobehavioral Changes In Kangaroo
Care:
A randomized control trial to evaluate the effect of Kangaroo Care (KC),
used shortly after delivery, on the neurobehavioral responses of the healthy
newborn. The subjects included were 47 healthy mother-infant pairs. KC began at
15 to 20 minutes after delivery and lasted for one hour. Control infants and KC
infants were brought to the nursery 15 to 20 and 75 to 80 minutes after birth,
respectively. During a one hour long observation, starting at 4 hours postnatal, the
KC infants slept longer, were mostly in a quiet sleep state, exhibited more flexor
movements and postures and showed less extensor movements. KC seems to
influence state organization and motor system modulation of the newborn infant
shortly after delivery. The significance of our findings for supportive transition
from the womb to the extra uterine environment is discussed. Medical and nursing
staff may be well advised to provide this care shortly after birth.12
A study about the history of the Kangaroo Mother Care and present
scientific evidence about benefits of this practice on morbidity and mortality,
psychological and neurological development and breastfeeding of low birth
weight infants. Sources of data were papers about Kangaroo Mother Care
published from 1993 to 2004 were consulted, selected in Medline and lilacs as
well as books, thesis and technical publications from the Brazilian Health
Department. The findings were since its first description; Kangaroo Mother Care
has been extensively studied. The method was always associated with reduced
risks like nosocomial infection, severe illness and lower respiratory tract disease
at six months and better gain of weight per day. There was no evidence of a
difference in infant’s mortality. The investigators concluded that positive impact
of KMC on breastfeeding was found. The method appears to reduce severe infant
morbidity. 23
An exploratory descriptive analysis to explore relationships among
physiological stress, behavioral stress and motor activity cues in preterm infants
when they were not being handled or disturbed. The convenience sample included
42 preterm infants who had been 27 to 33 weeks gestational age at birth and were
from 6 to 19 days old at the time of data collection in the neonatal intensive care
unit. In each 10 minute observation, heart rate and oxygen saturation levels were
recorded every 5 seconds and observational measures of behavioral distress and
motor activity were recorded twice a minute. The physiological data were coded
to reflect the percentage of each 10 minute period during which heart rate levels
were less than 100bpm or more than 200bpm or oxygenation saturation levels
were abnormally low (less than 90 mg%). Data were analyzed with correlation
and general linear mixed models procedures. Stress cues and motor activity were
more often related to low levels of Oxygen saturation than to low or high heart
rate. Physiological status was more often related to motor activity than to stress
cues. Few differences in the relationships were observed between younger and
older preterm infants. Although these results are preliminary, they suggest that
neonatal nurses should monitor preterm infants, behavioral stress and motor
activity cues in response to care giving and minimize stimuli that evoke stress
responses linked to physiological instability.24
4) Studies on Various Medical Personnel and Their Involvement in Kangaroo
Care:
A study to assess the nurses understanding about the delivery of Family
Centered Care (FCC) in the neonatal unit. A qualitative approach was used. Audio
taped interviews were conducted with seven nurses with varied experience of
delivering FCC. They also described a lack of confidence, associated with less
experience, as having an impact on the capacity to provide it. None of the nurses
interviewed had received specific training with regard to this area of practice and
all felt more could be done to improve nursing education in this area. This study
highlighted the deficiencies in the training and experience of nurses in the
delivery of FCC. Further research and development within this field is required
with the aim of improving educational opportunities and resources for both juniors
and seniors.25
A descriptive survey to describe factors identified by nurses that promote
Kangaroo holding in the special care nursery environment. 67 experienced
registered nurses completed a survey to identify factors that support the
implementation of kangaroo mother care holding. The primary factor for
implementing Kangaroo holding was the assessed physiologic stability of the
infant (stated by 98.5% of nurses). The other factors identified as integral
components included adequate staffing patterns, maternal readiness and
encouragement from the institution. To institute effective Kangaroo care, the
factors to be ensured are educational programs, adequate staffing and
encouragement. 26
A study to assess knowledge and practice of midwives regarding neonatal
care. In seven hospitals of Mount Lebanon, 44 midwives taking care of 204 term
neonates were addressed. Questionnaires and checklists were constructed to
evaluate knowledge of midwives and their practice with respective neonates
regarding neonatal care. They found out that midwives had acceptable knowledge
regarding neonatal care, but the application of this knowledge in practice
measures was limited. Neonates were thus at risk of hypothermia, physical pain
and psychological distress.27
A survey on the attitudes and practices of neonatal nurses in the use of
Kangaroo care and identifies possible concerns with promoting kangaroo care in
the neonatal intensive care unit. The sample size was thirty four nurses working in
the NICU of a large public hospital in Melbourne completed a survey
questionnaire. Four respondents were subsequently selected for follow-up
interview to explore in greater depth issues associated with promoting kangaroo
care in the NICU. The nurse’s attitudes, practices and role of the neonatal nurse in
promoting kangaroo care were analyzed. This study confirms neonatal nurses
strongly support the use of kangaroo care in the NICU. Although the majority of
nurses reported positive attitudes and practices, they did identify a number of
educational and practical concerns that need to be addressed to ensure kangaroo
care with low birth weight infants is safe and effective.28
STATEMENT OF THE PROBLEM:
A study to evaluate the effectiveness of structured teaching programme on
knowledge regarding kangaroo care among postnatal mothers having low birth
weight babies in selected hospital at Bangalore.
6.4 OBJECTIVES OF THE STUDY:
1. To assess the level of pretest knowledge score regarding Kangaroo care
among post natal mothers having low birth weight babies.
2. To find the effect of structured teaching programme on Kangaroo care in
terms of gain in knowledge among subjects.
3. To determine the association between post test knowledge with the
selected demographic variables of subjects.
6.5 OPERATIONAL DEFINITIONS:
EFFECTIVENESS:
It refers to the output of structured teaching programme in terms of gain in
knowledge among postnatal mothers having low birth weight babies as assessed
by a structured questionnaire.
STRUCTURED TEACHING PROGRAMME:
Structured teaching programme is designed to provide information about
kangaroo care on all domains among postnatal mothers. The content includes the
concept of kangaroo care, components of kangaroo care, preparation and
procedure and maintenance of kangaroo care, benefits of kangaroo care,
knowledge of caregivers regarding kangaroo care and post discharge follow up.
KNOWLEDGE:
It refers to the level of understanding on kangaroo care as expressed
through written responses by the postnatal mothers.
KANGAROO CARE:
It refers to the practice of skin-to-skin contact between mother and infant
in order to transfer the heat from the parent to the neonate. This helps to prevent
hypothermia enables better neurological development and thereby promotes the
child’s physical and psychological health with a resultant weight gain.
POSTNATAL MOTHERS:
It refers to the postnatal mothers (mothers after the delivery of the baby)
having low birth weight babies in selected hospital at Bangalore.
6.6 ASSUMPTION:
A structured teaching programme will help in enhancing the knowledge of
postnatal mothers, which in turn will improve the practice related to kangaroo care
and reduce the length of hospitalization among low birth weight babies.
6.7 HYPOTHESIS:
1. There will be a significant difference between pretest and post test score
on knowledge regarding kangaroo care after post test score among
postnatal mothers having low birth weight babies in selected hospital.
2. There will be a significant association between selected demographic
variables and post test knowledge regarding kangaroo care among
postnatal mothers having low birth weight babies in selected hospital.
7 MATERIALS AND METHODS:
7.1 Source of data:
The data will be collected from postnatal mothers having low birth weight
babies in selected hospital.
7.2 Method of data collection:
i) Research design:
Quasi experiment design will be used in the study.
ii) Research Variables:
1. Dependent Variable: Knowledge of postnatal mothers on kangaroo care.
2. Independent Variable: Structured teaching programme on knowledge
regarding kangaroo care among postnatal mothers having low birth weight
babies.
3. Demographic Variable: Demographic Variables of postnatal mothers such
as age, gender, education, occupation, income, awareness about kangaroo
care, source of information, and previous practice of kangaroo care.
iii) Setting:
The study will be conducted in selected hospital.
iv) Population:
Postnatal mothers having low birth weight babies are included in this
study.
v) Sample size:
Based on the objectives of the study, 100 samples will be taken from
selected hospital.
vi) Sampling Criteria:
Inclusion criteria:
1) Postnatal mothers having low birth weight babies.
2) Postnatal mothers who are willing to participate in the study.
3) Postnatal mothers who are available at the time of data collection.
Exclusion criteria:
1) Postnatal mothers having normal birth weight of the babies.
2) Postnatal mothers who have been exposed to similar teaching
programme.
3) Postnatal mothers who are discharged from the hospital.
vii) Sampling technique:
Purposive sampling technique is used in this study.
viii) Tool for data collection:
The tool consists of the following sections:
Section A: Demographic data which gives baseline information
obtained from the postnatal mothers having low birth weight babies such as
age, age, gender, education, occupation, income, awareness about kangaroo
care, source of information, and previous practice of kangaroo care.
Section B: Self administered structured questionnaire to assess the
knowledge of postnatal mothers having low birth weight babies regarding
Kangaroo care.
Section C: Structured teaching programme on knowledge of
postnatal mothers regarding kangaroo care in selected hospital at Bangalore.
ix) Method of data collection:
Phase I – assess the existing knowledge of postnatal mothers with the help
of structured questionnaire.
Phase II – structured teaching programme will be given to the postnatal
mothers for 45 minutes with the help of power point presentation.
Phase III- After a period of one week level of knowledge will be assessed
with in the same group using same questionnaire.
x) Data analysis method:
Data will be analyzed by using descriptive and inferential statistics.
Descriptive statistics: Frequency, percentage distribution, mean,
median and standard deviation will be used to assess the knowledge of
postnatal mothers having low birth weight babies on kangaroo care in
selected hospital at Bangalore.
Inferential statistics: Paired‘t’ test will be used to compare the pre
and post test knowledge, chi-square test will be used to associate
knowledge of postnatal mothers having low birth weight babies with
selected demographic variables.
ix) Projected outcome:
1. A structured teaching programme will helps to improve the knowledge of
postnatal mothers having low birth weight babies regarding Kangaroo
care.
2. The mothers will apply the gained knowledge regarding kangaroo care
into practice effectively while giving care for their low birth weight
babies.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS
INTERVENTION TO BE CONDUCTED ON PATIENTS OR
OTHER HUMAN BEING OR ANIMALS? IF SO PLEASE
DESCRIBE BRIEFLY?
Yes, structured teaching programme will be administered for the postnatal
mothers having low birth weight babies.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTIUTION IN CASE OF 7.3?
Yes. The permission will be obtained from the Medical Officer of the
hospital at Bangalore. The investigator will take informed consent from the
subjects.
8 REFERENCES:
1. Essential newborn care, Report of a technical working group, World
Health Organization, (WHO/FRH/MSMM/13).
2. Indian Statistics of newborn (2004), www.Health statistics.com.
3. Park.K.(2007), Textbook of preventive and social medicine,19th edition,
Jabalpur; Banarsidas Bhanot; ed.19.353-355.
4. Pilliteri A, Maternal and child health nursing care of child bearing and
childrearing family, Philadelphia, Lippincott Company; ed.15.2000.698.
5. Price, Gwin, Pediatric Nursing, 10th edition, Saunders Elsevier, 2008, Page
No: 81-82.
6. Roberts K.L, Paynter.C, A comparison of kangaroo mother care and
conventional cuddling care, Neonatal Network, Jun 2004.Vol-19(4);31-35.
7. Lakshmi Priya, Nurses of India, Kangaroo Mother Care, Vol.9, May15,
2008, Pg.No:9-14.
8. Sample Registration System of India, WWW.census in child health.com,
2006.
9. SmithK.M, Effects of kangaroo care on sleep in Ireland, Journal of
perinatology, sep.2007, vol2: 212-218.
10. Mc Cain.GC, Lunington-Hoe.SM, Heart rate variability responses of a
preterm infant to kangaroo care, Journal ob obstetrics and gynecological
neonatal nursing, Nov-2007, Vol-34 (6); 689-694.
11. Charpak, N, Kangaroo mother care vs. traditional care for newborn
infants< 2000grams, A randomized control trial, Pediatrics, 2006.Vol
100(4); 682-688.
12. Ferber and Makhoul, Randomized control trial to evaluate the effect of
Kangaroo Care, International Journal of Gynecology and Obstetrics,
Apr.2007,Vol 13(4);300-318.
13. Meyer K, Anderson G.C, Using Kangaroo care clinical setting with full
term infants having breast feeding difficulties, American Journal of
Maternal and Child health nursing, Jul-Aug,2004,Vol 24;190-192.
14. Mangrulker and Syamalamba(2005),Health For All by 2000AD,
WWW.answers.com.
15. Crawford.D, Morris M, Neonatal Nursing, Chapman & Hall; 2004,635.
16. Suman and Udanio, To compare the effect of kangaroo mother care and
conventional methods of care on growth in low birth weight babies,
American Journal of maternal and child health Nursing, sep-2008,
Vol41:203-206.
17. Mok and Leung, To explore the supportive behavior of nurses as
experimental by mother of premature infants, Pediatric Nursing, Aug2007, Vol 21: 308-316.
18. Gupta M.Jora.R, Kangaroo Mother Care in LBW infants, Indian Journal of
Pediatrics, Aug.2007, and Vol74 (8):747-749.
19. Darmstadt G.L, Kumar, Introduction to community based skin to skin care
in rural Uttar Pradesh, India, Journal of perinatology, Oct 2006, Vol26(10);597-604.
20. Hung, Temperature control or premature infants the delivery room,
Clinical Perinatology, March 2006.Vol-33(1); 43-53.
21. Ludington.Hoe SM, Breast and infant temperatures with twins during
shared Kangaroo care, March-2006.Vol-35(2); 223-231.
22. Ndiae, Efficacy of Kangaroo method on thermoregulation and weight gain,
Candian nurse, Decemer-2006, Vol 6; 891-895.
23. Venancio and Almedia (2004), Kangaroo care how does it work?
International Midwife (Medline), 236-238.
24. Harrison (2004), Physiologic measures, Journal of obstetric Gynecologic
and neonatal nursing, March-April-2004, Vol 24; 219-226.
25. Wendy and Karan (2008), Kangaroo Method and Care, Archeology of
Pediatrics”, Dec-2008. Vol-24,189-192.
26. Johnson.A.N, Factors influencing implementation of kangaroo holding in a
special care nursery, Maternal and Child health nursing”, Jan-2007, Vol32(1); 25-29.
27. Pascale anf Bernadette (2007), Midwives regarding neonatal care, Herald
of health, 2007, Vol .89(12); 24.
28. Chia.P, The attitude and practices of neonatal nurses in the use of
kangaroo care, Australian Journal of Nurses, Jun 2006.Vol-23(4); 20-27.
9.
SIGNATURE OF CANDIDATE
10.
REMARKS OF THE GUIDE
11.
NAME & DESIGNATION OF
11.1 GUIDE
MRS.MAHESWARI
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE
12.
12.1REMARKS OF THE
PRINCIPAL
-
12.2 SIGNATURE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
MRS.NITHYA KALAIVANI.C
FIRST YEAR M.SC (NURSING)
CHILD HEALTH NURSING
YEAR 2009-2010.
IKON NURSING COLLEGE
BHEEMANAHALLI
RAMANAGAR (DIST)
BANGALORE.