Download 6. breif resume of the intended work introduction

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION:
1
NAME
OF
THE
MS. SALMA THABASSUM.T
CANDIDATE
AND
FIRST YEAR M.Sc NURSING
ADDRESS
DAYANANDA SAGAR COLLEGE OF NURSING
KUMARASWAMY LAYOUT BANGALORE-78
2
NAME
OF
THE
DAYANANDA SAGAR COLLEGE OF NURSING.
INSTITUTION
3
COURSE OF STUDY
DEGREE OF MASTER OF SCIENCE IN NURSING,
PEDIATRIC NURSING.
4
DATE
06/06/2011.
OF ADMISSION
5
TITLE
TOPIC
OF
THE
A STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED
TEACHING
KNOWLEDGE
OF
PROGRAMME
MOTHERS
ON
REGARDING
IMPORTANCE OF SELECTED OILS FOR MASSAGE
AMONG INFANTS IN SELECTED HOSPITAL,
BANGALORE.
1
6. BREIF RESUME OF THE INTENDED WORK
INTRODUCTION:
“A new baby is like the beginning of all things-wonder, hope, a dream of
possibilities.”
Human touch has been shown to be emotionally and physically healing for
centuries. Touch is a primal need, and the first important mode of communication
between a mother and her new baby.1
Baby friendly approach suggests that positive touch and massage are
important aspects of child care as it promotes health on all levels – physiologically,
psychologically, emotionally and developmentally.2
Massage is a "hands-on" treatment in which a therapist manipulates muscles
and other soft tissues of the body to improve health and well-being which ranges from
gentle stroking and kneading of muscles and other soft tissues to deeper by using
techniques. It has also been practiced as a healing therapy for centuries in nearly
every culture around the world.3
Though baby and infant massage is a tradition in India and other Asian
countries now it has been emerged in all over the world as it has positive effects in
terms of weight gain, better sleep-wake pattern, enhanced neuromotor development,
emotional bonding, reduced rates of nosocomial infection, jaundice, hypothermia,
skin disorder etc.4
Massage is found to be more useful when some kind of lubricant oil is used.
Various oil preparations are used depending on the regional availability; the common
oils used are sunflower and coconut oil.4
For millennia, sunflower seed oil has been used in folk medicine for both skin
care and the treatment of skin disorders. It has been shown to accelerate recovery of
2
the skin barrier function, improve skin condition, and reduce the risk of both
nosocomial infections and neonatal mortality. 5
A study published in Indian Pediatrics journal has shown that massaging
premature babies with coconut oil is helpful in gaining weight, building bone mass
and leaving the hospital sooner by up to 47%.6
A quasi experimental study was conducted to compare the effect of massage
with coconut oil on growth and neurobehavior among infants. The result of the study
as shown that coconut oil as greater impact on weight gain. The study concluded that
weight is a important factor and oil massage must e followed to increase weight of the
baby.7
Each parent and baby bond is very unique. Interaction is a very complex
process, and many factors can affect it. The one important factor is massage, which
enhances bonding between parent and child and also prevents complications. Hence it
is the responsibility of nurses to teach parents on administration of massage therapy
on their newborn and infants.8
3
6.1 NEED FOR STUDY:
“A baby is a heaven on earth”
Growth status and growth velocity are important markers of the health and
wellbeing of newborns. It is influenced by the health of mother and the care she
receives during the pregnancy and postnatal period.9
About 1.2 million neonates die annually in India alone, amounting to almost
one-fourth of all global newborn deaths. Two-third of infant deaths in India occur in
the first month of life, and three-fourth of newborn deaths occur in first week and 90
percent of all neonatal deaths occur by the fifteenth day of life. Most (70%) of
newborn in India die due to low birth weight, infections and complications of
pregnancy. About one-third of newborn children in India are of low-birth weight.10
Recent evidence has demonstrated that the topical oil or emollient massage
therapy is effective in reducing the neonatal infections and mortality by 41 and 26%,
respectively, emollient therapy is a promising option for improving newborn care.11
Oil Massage therapy has been used in the care of premature and term infants
for many years in western countries, and a significant body of research has already
shown the effectiveness of massage therapy in significantly increasing body weight,
reducing skin infections, maintain thermoregulation, decreasing infant hospital
durations, enhancing bone formation, and improving the neurological behavior12
Weight gain is the most consistent parameter associated with massage therapy
in neonates. In a study by Scafidi, forty preterm infants were subjected to tactile/
kinesthetic stimulation of 45 minutes per day for 10 days. It was observed that infants
who received massage had 21% greater weight gain.13
4
A randomized controlled trial was conducted where sixty clinically stable
newborns with a corrected gestational age of 30 to 35 weeks receiving enteral
nutrition in the hospital nursery were included. There were no differences between
groups in gender, gestational age, initial weight, head circumference, and caloric
intake and type of nutrition at baseline. Infants receiving massage had a larger weight
gain versus the control group since the third day.14
In a study conducted by Diego, a significant increase in vagal activity was
noticed during the period of 15 minute massage therapy. The vagal activity was
interpreted from ECG as a measure of heart rate variability. It was also seen that there
was a significant increase in gastric motility in post massage period. It was postulated
that massage causes increase in vagal activity, hence improved gastric motility; this
leads to better absorption of nutrients resulting in better weight gain.15
Neonatal skin experiences a progressive adaptation to the extra uterine
environment during which special care is needed. The immaturity of the epidermal
barrier in the neonatal period may cause dry skin, vulnerability to trauma, rapid onset
of microbial colonization and percutaneous drug toxicity.16
Recent evidence from human and animal study suggests that topical
application of certain oils such as sunflower oil, coconut oil and mustered oil may
improve the skin barrier function resulting in a number of potential benefits to
neonatal health.17
Hence, oil massage has been proposed as a way of facilitating development
and growth of newborns. Needless to say, the benefits are overwhelmingly positive
and the research indicates that infant massage is increasingly recognized as a
legitimate health care treatment. Based on the available literature on the benefits of oil
massage for infant, the researcher felt the need for assessing the knowledge of
mothers and to give structured teaching programme on selected oil massage as it
would be beneficial for the mothers and their infants’ equally.18
5
6.2. REVIEW OF LITERATURE
The review of literature for the present study are organized and presented as
followed:
6.2.1
Review of literature related to effect of oil massage on gain of weight
among infants:
A study was conducted to assess the effect of oil massage on growth and
neurobehavior in babies less than 1500gms. Eligible neonates were randomized to one
of the three groups, massage with oil, massage without oil and no massage. Weight,
length, head circumference and triceps skin fold thickness were measured in the three
groups at regular intervals. Neurobehavior using Braselton’s Neonatal Behaviour
assessment Scale was assessed at enrolment and after 10 days of intervention. Weight
gain in the oil massage group (365.8 +/- 165.2g) was higher compared to the only
massage group (290.0 +/- 150.2g) and no massage group (285.0 +/- 170.4g) .The
study concluded that oil application may have a potential to improve weight gain
among preterm very low birth weight neonates.19
A study was conducted to assess the use and benefits of oil massage among
infants in Assam Full term born healthy infants (n = 125), weight > 3000 g were
randomly divided into five groups. Infants received herbal oil, sesame oil, mustard oil,
or mineral oil for massage daily for 4 wk. The fifth group did not receive massage and
served as control. The study shown that, massage improved the weight, length, and
mid arm and mid leg circumferences as compared to infants without massage.20
A quasi-experimental study was conducted from August 2007 to March 2008
in Iran to evaluate the effect of massage with coconut oil on weight gain in preterm
and term newborns. Seventy-three newborns were randomly assigned to 3 groups.
The weights of the newborns in all 3 groups were measured daily by a nurse who was
blinded to the study. The results showed that there was a significant difference
between the weight gain in the 3 groups after the intervention and hence concluded
that massage with coconut oil has a positive effect on weight gain in preterm
newborns.21
6
A prospective randomized clinical trial study was conducted to evaluate the
effects of massage with or without kinesthetic stimulation on weight gain and length
of hospital stay in the preterm infant. Infants were randomized to receive no
intervention, massage therapy alone, or massage therapy with kinetic stimulation .A
total of 60 premature and term infants were selected for this study. For infants with
body weight >1000gm, average daily weight gain was increased in the intervention
groups compared to control. 22
In a study, thirty preterm cocaine-exposed preterm neonates were randomly
assigned to a massage therapy or a control group as soon as they were considered
medically stable. The treatment group (N = 15) received massages for three 15-minute
periods 3 consecutive hours for a 10-day period. Findings suggested that the
massaged infants averaged 28% greater weight gain per day although the groups did
not differ in intake , showed significantly fewer postnatal complications and stress
behaviors than did control infants, and demonstrated more mature motor behaviors on
the Brazelton examination at the end of the 10-day study period.23
A randomized controlled trial was conducted in which sixty clinically stable
preterm newborns with a corrected gestational age of 30 to 35 weeks receiving
enteral nutrition in the hospital nursery were included. There were no differences
between groups in gender, gestational age, initial weight, head circumference, and
caloric intake and type of nutrition at baseline. Infants receiving massage had a larger
weight gain versus the control group since the third day (188.2 +/- 41.20 g/kg versus
146.7 +/- 56.43 g/kg, P < 0.001). Hospital stay was shorter in infants receiving
massage and usual nursery care (15.63 +/- 5.41 days versus 19.33 +/- 7.92 days, P =
0.03). The addition of parent-administered Vimala massage to usual nursery care
resulted in increased weight gain and shorter hospital stay among clinically stable
preterm newborns.24
A comparative study was carried out to determine whether preterm and/or low
birth-weight infants exposed to massage experience improved weight gain and earlier
7
discharge compared to infants receiving standard care and to determine whether
massage has any other beneficial or harmful effects on this population. Massage
interventions improved daily weight gain by 5.1g. Massage interventions also
appeared to reduce length of stay by 4.5 days. There was also some evidence that
massage interventions have a slight, positive effect on postnatal complications and
weight at 4 - 6 months.25
A prospective, randomized, cross-over design study was conducted on
massage therapy to increase weight gain in preterm and term infants. Infants were
randomized to 5 days of massage followed by 5 days of no massage (n = 5) or the
opposite sequence (n = 5). During the massage therapy period, massage was provided
daily for three 15 minute periods at the beginning of each 3 hour period every
morning. The result of
the study has shown that the energy expenditure was
significantly lower in infants after the 5 day massage therapy period than after the
period without (p = 0.05).The study concluded that, energy expenditure is
significantly lowered by 5 days of massage therapy in metabolically and thermally
stable preterm and term infants. This decrease in energy expenditure may be in part
responsible for the enhanced growth caused by massage therapy.26
An experimental study was conducted to evaluate the responses of premature
and term infants to massage. These responses measured by weight, physiological
(vagal tone, heart rate, oxygen saturation) and behavioral responses (behavioral states,
motor activities, and behavioral distress). The data were collected for 10 minutes prior
to and 10 minutes after the massage. The result of the study showed that the weight of
the baby was significantly increased after massage; vagal tone was significantly
higher after massage than before massage in the experimental group, while no change
in the control group. The experimental group had significantly higher scores for
awake state and motor activity than the control group. The study concluded that
massage therapy might enhance optimal physiological responses.27
8
In this study, preterm and term infant massage therapy studies are reviewed.
Massage therapy has led to weight gain in preterm and term infants when moderate
pressure massage was provided. In studies on passive movement of the limbs, preterm
and term infants also gained significantly more weight, and their bone density also
increased. The use of oils including coconut oil and sunflower oil enhanced the
average weight gain. In addition, the use of synthetic oil increased vagal activity,
which may indirectly contribute to weight gain. The weight gain was associated with
shorter hospital stays and, thereby, significant hospital cost savings. 28
6.2.2
Literature related to effect of oil massage on parent child interaction
The purpose of this study was to test the effects of infant massage in related to
auditory, tactile/kinesthetic (massage) and visual stimulation on weight and height of
infant and mother-infant interaction with normal infants over a period of 4 weeks.
Comparison of the total scores for the mother-infant interaction between the two
groups showed a significant difference. There were also significant differences on
maternal response, infant response and dyadic response in the mother-infant
interaction between the two groups. Overall, the results of this study reassure that
infant massage facilitates the mother-infant interaction for infants and mothers who
give massage to their baby.29
A review of the literature to look at the various techniques of providing
massage, its benefits, possible mechanism of action and adverse effects was done. The
review suggests that massage has several positive effects in terms of weight gain,
better sleep-wake pattern, enhanced neuromotor development, better emotional
bonding, and reduced rates of nosocomial infection and thereby, reduced mortality in
the hospitalized patients. Many studies have described the technique and frequency of
this procedure. Massage was found to be more useful when some kind of lubricant oil
was used. Harmful effects like physical injury and increased risk of infection were
encountered when performed inappropriately.4
9
STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of structured teaching programme on
knowledge of mothers among infants regarding importance of selected oils for
massage in selected hospital, Bangalore.
6.3 OBJECTIVES OF THE STUDY:
The objectives of the study are to
1. assess the pretest and posttest knowledge scores of mothers of infants
regarding importance of selected oils for massage among infants.
2. determine the effectiveness of structured teaching programme on
importance of selected oils for massage.
3. determine the association between pretest and posttest knowledge scores
of mothers with selected socio demographic variables.
6.4 ASSUMPTIONS:
1. The mothers may have some knowledge regarding importance of selected
oils for massage among infants.
2. The knowledge of the mothers may have some association with their
selected socio demographic variables.
6.5 NULL HYPOTHESIS:
H01→ There will not be statistically significant difference between pretest and
posttest knowledge scores of mothers on importance of selected oils for
massage.
H02→ There will not be statistically significant association between pretest and
posttest knowledge scores of the mothers with selected socio
demographic variables.
10
6.6 RESEARCH VARIABLES:
6.6.1 Independent variable:
The independent variable in the present study is structured teaching programme
on importance of selected oils for massage among infants.
6.6.2 Dependent variable:
The dependent variable in the present study is knowledge of mothers on
importance of selected oils for massage among infants.
6.7 OPERATIONAL DEFINITIONS:
Effectiveness:
In this study it refers to the extent to which the structured teaching program has
achieved the desired outcome as measured in terms of knowledge scores of mothers
of infants.
Structured teaching programme:
In this study it refers to systematically developed teaching module designed for
educating mothers on importance of selected oils for massage among infants.
Knowledge:
In this study it refers to the appropriate responses received from the mothers to
the items elicited through a structured knowledge questionnaire.
Mothers:
In this study it refers to the mothers who are in the period beginning
immediately following the birth of the baby to one year.
11
Importance of selected oil:
In this study it refers to the gain in weight, reducing skin infection and improved
sleeping patterns by using selected oils such as sunflower oil and coconut oil.
Massage:
In this study it refers to the manipulation of the soft tissues of the body as an
emollient for the purpose of normalizing them.
Infant:
In this study it refers to the children ranging between ages one day to one year
of life.
6.8 DELIMITATION:
1. The study is delimited to the mothers who are available at the hospital during
the time of data collection.
2. The study is delimited to the selected oils such as sunflower oil and coconut
oil.
6.9 MATERIALS AND METHODS:
6.9.1 Sources of data:
Data will be collected from the mothers in selected hospital, Bangalore.
6.9.2 Method of data collection:
The data for this study will be collected using a structured questionnaire on
importance of selected oils for massage among infants, whose contents will be
validated by the experts and will be pretested and standardized through pilot study.
6.9.3 Research Design:
The research design will be used for the present study is quasi experimental, one
group pretest- post test design.
12
6.9.4 Research Approach:
Evaluative approach will be adopted for conducting the study.
6.9.5 Setting:
Study will be conducted in selected hospital, Bangalore.
6.9.6 Population:
Population of the present study comprises of all mothers who are admitting to
the in selected hospital, Bangalore.
6.9.7 Sample:
It is a subset of the population selected for the study comprising of mothers in
selected hospital, Bangalore.
6.9.8 Sample Size:
The sample size for the present study consists of 60 mothers.
6.9.9 Sampling technique:
Purposive sampling technique will be adopted for selecting the samples for the
present study.
6.9.10 Sampling criteria:
Inclusion criteria:
1. Mothers who are available in the hospital during the study period.
2. Mothers who are willing to participate in the study.
Exclution criteria:
1. Mothers whose new born and infants are admitted in ICU.
6.9.11 Tools for data collection:
Structured knowledge questionnaire will be used for data collection, which will
be divided as part A and part B.
13
PART A:
Consists of items in the socio demographic variables such as age,
religion,
education, occupation, income, previous knowledge
(yes or no), if yes source of information.
PART B:
Consists of structured knowledge questionnaire on importance of
selected oils for massage among infants.
7. DATA ANALYSIS METHOD:
Data analysis is done through descriptive and inferential statistics.
7.1 Descriptive statistics:
Frequency, mean, mean percentage and standard deviation will be used to
explain the selected socio demographic variable and compute the pretest and posttest
knowledge scores.
7.2 Inferential statistics:
 Parametric test:
Paired‘t’ test will be used to compare the pretest and posttest knowledge scores.
 Non-Parametric test:
Chi –square test will be used to find out the association between the pretest and
post test knowledge scores with selected demographic variables.
The results are statistically interpreted at the level of significance, P ≤ 0.05.
7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE
CONDUCTED ON PATIENTS OR ANY OTHER HUMANS OR ANIMALS?
Yes, structured teaching questionnaireis programme among mothers in selected
hospitals, Bangalore.
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION?
1. Permission will be obtained from the institutional ethical research committee
of Dayananda Sagar College of Nursing, Bangalore.
14
2. Permission will be obtained from the authorities of the selected hospitals,
Bangalore.
3. Informed consent will be obtained from the mothers who are willing to
participate in the study.
4. Confidentiality and anonymity of the mothers will be guarded.
15
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http://www.livestrong.com/article/146084-coconut-oil-health-
benefits/
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Salvi RY. Oil massage in neonates: an open randomized controlled study of
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[Cited
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16];
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20
Available
from
9.
9. SIGNATURE OF THE STUDENT:
10
The research topic is relevant as the
study empowers the knowledge of post
natal mothers regarding the benefits of
oil massage.
10. REMARKS OF THE GUIDE:
11. NAME AND DESIGNATION OF
THE GUIDE:
Asst. Professor & HOD
Department of pediatric nursing
Kumaraswamy Layout,
Bangalore- 560078
GUIDE NAME AND ADDRESS:
1
11.2 SIGNATURE OF THE GUIDE:
1
11.3 HEAD OF DEPARTMENT:
NAME AND ADDRESS :
Asst.Professor & HOD
Dept of Pediatric Nursing,
Dayananada Sagar college of nursing
Kumaraswamy Layout,
Bangalore – 560078.
11.4 SIGNATURE OF HOD:
REMARKS OF THE PRINCIPAL:
SIGNATURE
OF
The study is feasible to be conducted in
Selected hospitals.
THE
PRINCIPAL:
21