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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 8. REFERENCES: 1. Bond C. Positive Touch and massage in the neonatal unit: a British approach. Semin Neonatal [Serial online] 2002 Dec; 7(6):477-86 [Cited 2011Nov 4]; Available from http://www.ncbi.nlm.nih.gov/pubmed/12614600. 2. Jane Sheppard. The Benefits and Joys of Infant Massage. [Cited 2011 Available from Nov 5]; http://www.healthychild.com/massage/the-benefits-and-joys-of- infant-massage 3.Massage overview. [Cited 2011 Nov 8]; Available from http://www.umm.edu/altmed/articles/massage-000354.htm 4. Kulkarni A, Kaushik JS, Gupta P, Sharma H, Agrawal RK. Massage and touch therapy in neonates: the current evidence. Indian Pediatr [Serial online] 2010 Sep; 47(9):771-6[cited 2011 Nov 14]; Available from http://www.ncbi.nlm.nih.gov/pubmed/21048258 5. Eichenfield LF, McCollum A, Msika P. The benefits of sunflower oleodistillate (SOD) in pediatric dermatology. Pediatr Dermatol [Serial online] 2009 Nov-Dec; 26(6):669-75 [Cited 2011 Nov 8]; Available from http://www.ncbi.nlm.nih.gov/pubmed/20199440 6. Nicole Langton. Coconut oil health benefits. [Online] Jun 11, 2010[cited Nov 5]; Avilable from http://www.livestrong.com/article/146084-coconut-oil-health- benefits/ 7. Sankaranarayanan K, Mondkar JA, Chauhan MM, Mascarenhas BM, Mainkar AR, Salvi RY. Oil massage in neonates: an open randomized controlled study of coconut versus mineral oil. Indian Pediatr [Serial online] 2005 Sep; 42(9): 16 877- 84[Cited 2011 Nov 12]; Avilable from http://www.ncbi.nlm.nih.gov/pubmed/16208048 8. Beachy JM. Premature infant massage in the NICU. Neonatal Netw [Serial online] 2003 May-Jun; 22(3):39-45[cited 2011 Nov 22]; Available from http://www.ncbi.nlm.nih.gov/pubmed/12795507 9. R Saeedi, M Gholami, SH Dinparva, M Kabirian. Transcutaneous Feeding: The Effect of Massage with Coconut Oil on Weight Gain in Preterm Newborns. Iranian Red Crescent Medical Journal. [Online]. [Cited 2011 Nov 10]; Available from http://ircmj.com/?page=download&file_id=3789 10. Dr. Neeru Singh, Dr. Kalyan B. Saha, Dr. Rakesh C. Mishra. Newborn Health among Tribes of Madhya Pradesh- An Overview. [Online]. [Cited 2011 Nov 25]; Available from http://icmr.nic.in/000519/updatevol4no1.pdf 11. Jean L, Duffy, Rebecca M, Ferguson, Gary L. Darmstadt Opportunities for Improving, Adapting and Introducing Emollient Therapy and Improved Newborn Skin Care Practices in Africa. [Online]. [Cited 2011 Nov 12]; Available from http://tropej.oxfordjournals.org/content/early/2011/05/10/tropej.fmr039.abstract 12. Chang SM, Sung HC. Application of massage therapy in premature infant nursing care. Hu Li Za Zhi [Serial online] 2007 Feb; 54(1):78-82 [Cited 2011 Nov 23]; Available from http://www.ncbi.nlm.nih.gov/pubmed/17340551 13. Anjali kulkarni, Jaya Shankar kaushik, Piyush gupta, Harsh Sharma, RK Agrawal. Massage and touch therapy in neonates: the current evidence. Indian pediatrics. [Online]. Vol 47. Sep17. 2010. [Cited 2011 Nov 15]; Available from http://medind.nic.in/ibv/t10/i9/ibvt10i9p771.pdf 17 14. Lahat S, Mimouni FB, Ashbel G, Dollberg S. Energy expenditure in growing preterm infants receiving massage therapy. J Am Coll Nutr [Serial online] 2007; 26: 356-359 [Cited 2011 Nov 27]; Available from http://medind.nic.in/ibv/t10/i9/ibvt10i9p771.pdf 15. Diego MA, Field T, Hernandez-Reif M. Preterm infant massage elicits consistent increase in vagal activity and gastric motility that are associated with greater weight gain. Acta Paediatr [Serial online] 2007; 96: 1588-1591[Cited 2011 Nov 27]; Available from http://medind.nic.in/ibv/t10/i9/ibvt10i9p771.pdf 16. Afsar FS. Skin care for preterm and term neonates. Clin Exp Dermatol [Serial online] 2009 Dec; 34(8):855-8 [Cited 2011 Nov 20]; Avilable from http://www.ncbi.nlm.nih.gov/pubmed/19575734 17. Darmstadt GL, Saha SK. Traditional practice of oil massage of neonates in Bangladesh. J Health Popul Nutr [Serial online] 2002 Jun; 20(2):184-8[Cited 2011 Nov 15]; Available from http://www.ncbi.nlm.nih.gov/pubmed/12186200 18. The benefits of baby massage. [Online]. [Cited 2011 Nov 16]; Available from http://iaimbabymassage.co.uk/baby-massage-benefits.html 19. Arora J, Kumar A, Ramji S. Effect of oil massage on growth and neurobehavior in very low birth weight preterm neonates. Indian Pediatr [Serial online] 2005 Nov; 42(11):1092-100 [Cited 2011 Nov 11]; Available from http://www.ncbi.nlm.nih.gov/pubmed/16340050 20. Agarwal KN, Gupta A, Pushkarna R, Bhargava SK, Faridi MM, Prabhu MK. Effects of massage& use of oil on growth, blood flow & sleep pattern in infants. Indian J Med Res [Serial online] 2000 Dec; 112:212-7 [Cited 2011 Nov 8]; Available from http://www.ncbi.nlm.nih.gov/pubmed/11247199 18 21. Massaro AN, Hammad TA, Jazzo B, Aly H. Massage with kinesthetic stimulation improves weight gain in preterm infants. J Perinatol [Serial online] 2009 May; 29(5):352-7 [Cited 2011 Nov 17]; Available from http://www.ncbi.nlm.nih.gov/pubmed/19148112 22. Wheeden A, Scafidi FA, Field T, Ironson G, Valdeon C, Bandstra E. Massage effects on cocaine-exposed preterm neonates. J Dev Behav Pediatr. [Serial online] 1993 Oct; 14(5):318-22[cited 2011 Nov 11]. Available from http://www.ncbi.nlm.nih.gov/pubmed/8254063 23. Gonzalez AP, Vasquez-Mendoza G, García-Vela A, Guzmán-Ramirez A, SalazarTorres M, Romero-Gutierrez G. Weight gain in preterm infants following parentadministered Vimala massage: a randomized controlled trial. Am J Perinatol [Serial online] 2009 Apr; 26(4):247-52 [Cited 2011 Nov 22]; Available from http://www.ncbi.nlm.nih.gov/pubmed/19023851 24. Vickers A, Ohlsson A, Lacy JB, Horsley A. Massage for promoting growth and development of preterm and/or low birth-weight infants. Cochrane Database Syst Rev [Serial online] 2004 ;( 2):CD000390 [Cited 2011 Nov 23]; Available from http://www.ncbi.nlm.nih.gov/pubmed/15106151 25. Darmstadt GL, Saha SK, Ahmed AS, Ahmed S, Chowdhury MA, Law PA,et al. Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics [Serial online] 2008 Mar; 121(3):522-9 [Cited 2011 Nov 11]; Available from http://www.ncbi.nlm.nih.gov/pubmed/18310201 26. Lee HK. The effect of infant massage on weight gain, physiological and behavioral responses in premature infants. Taehan Kanho Hakhoe Chi [Serial 19 online] 2005 Dec; 35(8):1451-60 [Cited 2011 Nov 25]; Available from http://www.ncbi.nlm.nih.gov/pubmed/16415626 27. Kim, T.I., Shin, Y.H., White-Traut, R.C. Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Res Nurs Health. [Online] 2003.26, 424-33. [Cited 2011 Nov 27]; Available from http://www.diannalindensportsmassage.com/abstracts/abstracts-infantmassage.html 28. Field T. Massage therapy facilitates weight gain in preterm infants. Current Directions in Psychological Science. [Online] 2010 10, 51-54. [Cited 2011 Nov 28];http://www.diannalindensportsmassage.com/abstracts/abstracts-infantmassage.html 29. Lee HK. The effects of infant massage on weight, height, and mother-infant interaction. Taehan Kanho Hakhoe Chi [Serial online] 2006 Dec; 36(8):1331-9 [Cited 2011 Nov 16]; http://www.ncbi.nlm.nih.gov/pubmed/17215606 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