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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA. PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME OF THE CANDIDATE AND ADDRESS : Ms. SATHYAVATHI.P 1ST YEAR M.Sc. NURSING. GOVERNMENT COLLEGE OF NURSING, FORT, BANGALORE-02 2. NAME OF THE INSTITUTION : GOVERNMENT COLLEGE OF NURSING, FORT, BANGALORE-02 3. COURSE OF STUDY & SUBJECT : 1ST YEAR M.Sc. NURSING. CHILD HEALTH NURSING 4. DATE OF ADMISSION : 19-06-2009 5. TITLE OF THE TOPIC : TO ASSESS THE KNOWLEDGE AND ATTITUDE OF STAFF NURSES REGARDING BABY FRIENDLY HOSPITAL INITIATIVE POLICY IN SELECTED BFHI HOSPITAL, BANGALORE. 6. BRIEF RESUME OF THE INTENDED WORK INTRODUCTION ”The more we know about human breast milk the more we discover about its value in human nutrition and development”. Breast feeding is a natural way of feeding the infant with the milk directly from the mother’s breast. It is a living fluid and contains exactly the right amount of nutrients required by a baby, in the right proportions, to ensure that the baby gets the perfect balanced meal. No manufactured milk, no matter how fortified it may be, comes even close to being as nutritious as breast milk. …..The benefits of breast milk are incalculable and incomparable. It’s a complete mix of nutrients & antibodies. Varying composition of breast milk keeps pace with the infant’s individual growth and changing nutritional needs. Prevents many gastro-intestinal disorders in infants. Reduces the risk of breast, ovarian, cervical, and endometrial cancers in mothers. Helps delay return of fertility and to space subsequent pregnancies. Reduced health care costs; breast fed infants typically need fewer sick care visits, prescriptions, and hospitalizations1. The social change brought about by the nuclear type of family has forced many to ask whether our practices, prejudices, recommendations, commensurate with the scientific reality. With this background, world alliance for breastfeeding promotion started the program appropriately BABY FRIENDLY HOSPITAL INITIATIVE to promote, protect, and encourage exclusive breastfeeding in all hospitals. In 1991, the UNICEF and the WHO launched this global campaign. The initiative encourages health professionals to promote, protect, and support breastfeeding as the optimal method of infant nutrition and enables families to make an informed choice about infant feeding2. The Baby Friendly Hospital Initiative was started in India in1993. The Breast Feeding Network Of India (BPNI) is the agency responsible for implementing this program in our country. Under this, the hospitals with maternity services have to follow the Ten steps. These hospitals are assessed and certified as Baby Friendly Hospital once they adopt the “Ten steps to successful breastfeeding”. Objectives of BFHI is to achieve the goal of promoting breastfeeding practices in the hospitals both in government and private sectors, this is one of the key interventions towards achieving the goal of reducing infant mortality rates. Have a written breastfeeding policy that is routinely communicated to all the health care staff, Train all health care staff in skills necessary to implement this policy, Inform all pregnant women about the benefits & management of breastfeeding, Help mothers to initiate breastfeeding within half an of birth, Show mothers how to breast feed& how to maintain lactation even if they should be separated from their infants, Give the infant no food or drink other than breast milk, unless medically indicated, Practice rooming-in. Allow mother & infant to remain together 24 hrs a day, Encourage breastfeeding on demand, Give no artificial teats or pacifiers to breastfeeding infants, Foster the establishment of breastfeeding support groups & refer mothers to them on discharge from the hospital or clinic. In this context, to create awareness, the world breast feeding week is celebrated every first week of August with a theme every year. The theme for the year 2009 is ‘’Breast Feeding a vital emergency response, are you ready?”3. Recognizing the vital role of nurses as patient advocates and health promoters, and their position as the largest group of hospital-based health care workers, WHO and UNICEF are asking nurses to facilitate the implementation of the initiative in their hospital. Hence nurses play a key role in the implementation of the initiative in hospitals4. 6.1 NEED FOR THE STUDY The benefits of breastfeeding are tremendous and the following benefits in Baby Friendly Hospital Initiative hospitals are immediate, obvious and substantial; decrease in infection rate, improved survival of low birth weight infants, Easing of the hospital burden due to vast savings on infant formula purchase, Reduction in nursing load as rooming in and demand feeding make nursery care easier5. Statistics from Infant Survival and Development Report Card Karnataka shows that in our state, Initiation of breast feeding within 1hr is 35.7%, Exclusive breast feeding 0-6months is 58%, Infant Mortality rate per 1000 live birth is 43.2%, Children below 3yrs who are underweight is 37.6%. From the report it is clearly stated that initiation of breastfeeding within 1hr of birth is not satisfactory. In India, hospitals are still in the stages of joining this movement. The National statistics shows that , more than 11 lakh babies die during first month of life, and another 5 lakh during 2 to 12 months of age. Twenty two percent of all neonatal deaths could be reduced if breast feeding is initiated within one of birth by all mothers (March 2006; 117:380-386). More than 15% of 24 lakh child deaths could be averted in India, if optimal breastfeeding practices were scaled up to 90 %.( 2003). UNICEF’s, WHO’s, and World bank’s 2005 report- clearly recognize the need to scale up optimal infant and young child feeding practices in order to tackle child malnutrition and infant mortality6. A study was conducted regarding Optimizing Breastfeeding in the Newborn. The results show that the ‘Ten steps to successful breastfeeding’ and the Baby Friendly Hospital Initiative are effective measures to increase breastfeeding initiation, duration, and exclusivity. A recent national survey reveals that significant health care workers are not providing evidence based recommendations for breastfeeding guidance and support7. A study was conducted regarding Policy on Breastfeeding Training of doctors and nurses in Breastfeeding and lactation management results show that almost all staff reported that they have a policy on breastfeeding in the hospitals. Only 44% doctors and 30% nurses reported that they received ‘any length of training’ in breastfeeding and lactation management. It varied from 1 hour to more than 20 hours. Only 1/3 rd of those trained, received training of more than 20 hours. This is important as training of health care providers determines the success of breastfeeding. If the staff is adequately trained they are more likely to help women and support her to establish exclusive breastfeeding while she is in the hospital and counsel breastfeeding for first six months at home8. An article regarding Baby-Friendly Hospital Initiative (BFHI) which attempts to check the cause of infant mortality and morbidity. Malnutrition, infections, diarrheal disease, and particularly the effects of unhygienic feeding practices have raised a global infant mortality. Infants and children are likely to suffer from permanent growth and developmental impairment just because they were not breast-fed. It has been determined that breast-feeding could prevent deaths of at least 1 million children per year. BFHI services helped to turn the health care providers and mothers to the real needs of the baby9. Investigators personal experience from day to day staff’s practices in hospitals, though nurses play a pivotal role in supporting and motivating mothers regarding breastfeeding, many hospitals in India still are lagging behind in implementing the policy either due to insufficient staff, excessive tasks performed by nurses, lack of continuity in the health team work, out-of-context guidelines, lack of commitment with the proposal, lack of continuing education program, of the staffs regarding the policy. They find no time to educate mothers regarding the policy. Hence it is required to timely evaluate knowledge and to bring about positive attitude in the staffs regarding the implementation of ten steps of Baby Friendly Hospital Initiative policy in their hospitals and thus contribute in the reduction of infant mortality and morbidity. 6.2 REVIEW OF LITERATURE. Review of Literature is mainly divided into two headings. 1. Studies related to Baby friendly hospital initiative 2. Studies related to Knowledge and Attitude of Nurses regarding BFHI policy. Studies related to Baby friendly hospital initiative A study was conducted in the year 2009 regarding Evaluation of lactation support in the workplace or school environment on 6-month breastfeeding outcomes in Yolo County, California. Six-month breastfeeding outcomes (almost exclusive breastfeeding, partial breastfeeding, and not breastfeeding) were analyzed for 201 infants born to Yolo County, California, mothers who returned to work or school. Twenty-two percent of workplaces and 17% of schools did not provide a lactation room. Although part- or full-time status, knowledge of breastfeeding rules, and support from colleagues were independently associated with the outcome, they were not significant in the multivariate analysis. In the selected model, maternal age (odds ratio [OR] = 2.3; 1.3-3.9 for a 10-year difference), college or above versus <or= high school education (OR = 9.1; 4.2-19.6), and exclusive breast milk feeding in the hospital (OR = 2.1; 1.1-4.0) were associated with better breastfeeding outcomes at 6 months postpartum. Receipt of discharge gift packs containing formula (OR = 0.5; 0.3-1.0) was inversely associated with the degree of breastfeeding exclusivity. The 2 latter findings underscore the importance of hospitals adhering to specific guidelines of the Baby-Friendly Hospital Initiative10. A descriptive study was conducted in the year 2008 at USA to explore the association between the Ten Steps of the Baby Friendly Hospital Initiative (BFHI) of the World Health Organization Geneva, Switzerland and breastfeeding at 2 days and 2 weeks. A 65-question institutional survey assessing compliance with the Ten Steps was used to determine an overall breastfeeding Support Score for each of Oregon's 57 birthing hospitals. Hospital breastfeeding outcomes were obtained from the newborn metabolic screening forms. Results show that increases in overall hospital breastfeeding Support Scores were associated with increases in breastfeeding percentage at 2 days (p = 0.021) and at 2 weeks postpartum (p = 0.011). In analyzing each Step individually, however, only the presence of a written hospital policy was independently associated with breastfeeding percent (p = 0.028). They concluded hospitals with comprehensive breastfeeding policies are likely to have better breastfeeding support services and better breastfeeding outcomes. Hospitals may consider using these results to prioritize breastfeeding support services through development of hospital breastfeeding policies and to utilize institutional surveys as a component of breastfeeding quality improvement initiatives11. A Cross-Sectional study was conducted in the year 2007 to evaluate the impact of the Baby-Friendly Hospital Initiative on the breastfeeding practices of mothers from the urban area of Montes Claros, MG, Brazil. A comparative analysis was performed of two cross-sectional breastfeeding indicator studies with randomized samples of children under 2 years of age. One study was carried out before and the other after the Baby-Friendly Hospital Initiative had been implemented throughout all public pregnancy and childbirth care services in the city. Kaplan-Meyer survival curves were constructed for different breastfeeding patterns. Log rank testing was used to calculate the level of significance of differences between curves for before and after the Initiative. The survival curves demonstrate that breastfeeding rates increased during the study period. The log rank test detected significance for increases in all patterns of breastfeeding (p < 0.000). Median overall breastfeeding duration increased from 8.9 to 11.6 months and median duration of exclusive breastfeeding rose from 27 days to 3.5 months. They concluded that, Implementation of the Baby-Friendly Hospital Initiative in all public maternity units in Montes Claros significantly increased breastfeeding rates in the city. Since the ideal state of affairs has not yet been reached, further strategies must be implemented to promote and support breastfeeding practices12. A descriptive study was conducted in Pierto Rico in 2007 regarding Full breastfeeding during the postpartum hospitalization and mothers' report regarding baby friendly practices. 200 postpartum women age 20 or greater who had delivered a healthy full-term baby 37 weeks gestation participated in the study. Data were gathered by means of a semi-structured questionnaire in the Spanish language. Descriptive and inferential statistics (Chi-square) were used for data analysis. Results show that, Full breastfeeding was being practiced by 43.5% of the mothers in the study, whereas 53.0% were breastfeeding partially. Compliance with the Ten Steps was perceived as deficient by 52% of the mothers, whereas only 5.5% perceived compliance as excellent. The perceived level of compliance with the Ten Steps is significantly associated with the type of breastfeeding (full or partial) in the inferential analyses (X(2) [3, n = 193] = 33.74, p = 0.00) and in the multiple logistic regression analyses (OR = 1.27, confidence interval [CI] = 1.14 - 1.43, p = 0.00). As the level of perceived compliance with the Ten Steps increases, the probability of full or exclusive breastfeeding also increases. They concluded that compliance with the Ten Steps of the Baby Friendly Hospital from the perspective of the postpartum mother has an impact on the type of breastfeeding13. Studies related to Knowledge, and Attitude of staff nurses regarding BFHI policy A study was conducted in the year 2009 at Boston, USA, regarding Closing the quality gap: promoting evidence-based breastfeeding care in the hospital in the United States. Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. 24% of facilities reported regularly giving nonbreast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding14. A study was conducted in the year 2009 at Montreal, to examine the experiences on mothers with regard to the breastfeeding support and management provided by healthcare professionals on an acute care postpartum unit in a multiethnic obstetrical referral center in Montreal, Canada. The study survey was largely based on the UNICEF/World Health Organization's (1998) ten steps to successful breastfeeding. The convenience sample included 60 recently-delivered mothers. Findings indicated that primiparous women and women who delivered by caesarean section consistently received more information about breastfeeding management than multiparous women and women who delivered vaginally. However, the study does suggest that all women, regardless of parity or type of delivery, have information and support needs related to breastfeeding. A total of 29 mothers (67%), who intended to breastfeed exclusively, supplemented with artificial baby milk. Of these mothers, 16 (55%) stated 'milk insufficiency' as their primary reasons for supplementing. Overall, respondents perceived healthcare professionals to be encouraging of breastfeeding, and 48 mothers (80%) were 'moderately' to 'very' satisfied with the breastfeeding education and support received. These findings suggest that overall adherence to breastfeeding best practices in the current study hospital are below targets set by the World Health Organization for 'Baby Friendly' status. Results from the study can be used to target areas for improvement15. A quasi experimental study was conducted in 2008, at Korea to investigate the effects of the professional nurse's postpartum breast-feeding support on breastfeeding prevalence for mothers who delivered in Baby-Friendly Hospitals (BFH). The subjects of this study were 55 mothers who were hospitalized in the delivery room of a university hospital which was selected as a BFH in Daegu from October 1, 2005 to June 30, 2006. Twenty nine mothers were assigned to the experimental group and 26 mothers to the control group. Postpartum breast-feeding support by nurses' telephone calls to the experimental group was provided once a week for 4 weeks postpartum and then once a month for 16 weeks postpartum. Four post tests were given at postpartum week 4, 8, 12, and 16. The control group was given a telephone call at postpartum week 4, 8, 12, and 16. Results showed that the breastfeeding prevalence of the experimental group was significantly higher than that of the control group for each period. They concluded that Postpartum breastfeeding support by nurses may be a useful intervention to increase breast-feeding prevalence16. A study conducted in 2007 in de Saúde do Município does Rio Grande, regarding promotion of breastfeeding by the nursing staff of a Children-friendly hospital. This study derived from the observation of the difficulties in breastfeeding experienced by mothers dismissed from a university hospital. Nurses were interviewed, and observations were made to identify problems and possible strategies in order to make the proposal of becoming a children-friendly hospital feasible. The identified problems were insufficient staff excessive tasks performed by nurses, lack of continuity in the health team work, out-of-context guidelines, lack of commitment with the proposal. Health professionals suggested the following strategies: health team meetings, better articulation of tasks, systematic assessments, and higher commitment of all workers of the maternity ward.17 STATEMENT OF THE PROBLEM TO ASSESS THE KNOWLEDGE AND ATTITUDE OF STAFF NURSES REGARDING BABY FRIENDLY HOSPITAL INITIATIVE POLICY IN SELECTED BFHI HOSPITAL, BANGALORE. 6.3 Objectives of the Study 1. To assess the knowledge of staff nurses regarding Baby Friendly Hospital Initiative policy. 2. To assess the attitude of staff nurses regarding Baby Friendly Hospital Initiative policy 3. To find the co- relation between knowledge, and attitude regarding Baby Friendly Hospital Initiative Policy among staff nurses. 4. To find the association between knowledge, and attitude regarding Baby Friendly Hospital Initiative Policy among staff nurses with selected demographic variables. 6.3.1 Assumptions : 1. Staff nurses may have some knowledge regarding BFHI policy 2. Staff nurses may have favorable attitude towards BFHI policy 6.3.2 Variables Demographic variables ; Age, sex, marital status, type of family, General qualification, Professional qualification, designation, religion, total years of experience, total years of experience in BFHI hospital, In-service education program . 6.3.3 Operational Definitions a)Assess; It refers to the statistical measurement of knowledge and attitude among staff nurses regarding Baby Friendly Hospital Initiative Policy b) Knowledge: It refers to correct response of the staff nurses to the structured knowledge questionnaires regarding Baby Friendly Hospital Initiative Policy c) Attitude: Attitude in this study refers to an expressed opinion of staff – nurses to attitude Scale regarding Baby Friendly Hospital Initiative Policy d) Staff nurses: A registered nurse with requisite professional qualification, working in selected BFHI hospital. f) Baby Friendly Hospital Initiative Policy: It is a ten step policy adopted by a Baby friendly hospital to initiate, encourage, promote, and support breast feeding practices in hospital. 7. MATERIALS AND METHODS 7.1 Source of Data : Data will be collected from Staff nurses of Selected BFHI Hospital, Bangalore. 7.2 Method of Collection of Data 7.2.1 Definition of the Study Subject : Staff nurses of Selected BFHI Hospital, Bangalore. 7.2.2 Inclusion and Exclusion Criteria a) Inclusion Criteria : 1.Staff nurses of Selected BFHI Hospital 2. Staff nurses who are willing participate in the study. 3. Staff nurses who are present a the time of data Collection. b) Exclusion Criteria : 1.Staff nurses who are not willing to participate in the study. 7.2.3 Research Approach : Non-Experimental Research approach 7.2.4 Research Design : Descriptive Research design 7.2.5 Setting : The study will be conducted In Selected BFHI Hospitals, Bangalore. 7.2.6 Sampling Technique : The investigator will use Convenient Sampling technique to draw the Samples 7.2.7 a) Sample Size : The sample of the study consists of 50 staff Nurses. b) Duration of the Study 7.2.8 Tools of Research : 4 weeks :1) Structured Knowledge questionnaire will be constructed in two parts Part I – Socio-demographic data Part II—Knowledge based Questions regarding BFHI policy 2) Attitude based questions using Modified Likerts-5 Points Attitude Scale 7.2.9 Collection of data : The data will be collected from staff nurses using 1) Structured Knowledge questionnaire To assess the knowledge regarding Baby Friendly Hospital Initiative policy. 2) Modified Likerts-5 Points attitude Scale to assess the Attitude of staff nurses regarding Baby Friendly Hospital Initiative policy. 7.2.10 Method of Data Analysis : 1) The investigator will use And Presentation descriptive statistical techniques such as mean median, mode, standard deviation and inferential statistics like Chi-square test,Karl Pearson’s co- relation test and relevant statistical techniques 2) The analyzed data will be presented in the form of tables, diagrams, & graphs 7.3 Does the study require any investigation to be conducted on patients or other human or animals? If so please describe briefly? Yes, with prior consent from samples the study will be conducted on staff nurses regarding knowledge and attitude regarding Baby Friendly Hospital Initiative policy in selected BFHI hospitals, Bangalore. 7.4 Has ethical clearance has been obtained from your institution in case of 7.3? Yes, permission will be obtained from the concerned person and authority of the institution before the study. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the study will be maintained with honesty and impartiality. 8. LIST OF REFERENCES 1. Parul Datta. Pediatric Nursing. 2nd edition. New Delhi: Jaypee publishers; page no. 24, & 51 2. RamanTSR, Parimala.V, Iyengar A. Baby friendly hospital initiative experiences from a service hospital Medical Journal Armed Forces India(serial online) 2001 Jan; 57(1):23-5 3. Gupte suraj. The short textbook of Pediatrics. 11th edition. NewDelhi: Jaypee publishers; page no. 80 4. Jones F, Green M,. Baby friendly care. Can Nurse (serial online) 1993;89(9):36-9.Available from: URL: http://www. pubmed.com 5. Ghai OP. Essential of Pediatrics. 6th ed. Delhi: Dr. O.P Ghai Publications; 2005. Page no; 6. WHO. Country Profile: Atlas, Geneva.(serial online) 2006 Mar; 117:380386. 7. Cramton R, Zain-Ul-Abideen M, Whalen B, Optimizing successful breastfeeding in the newborn. CurrOpinPeditr(serialonline)2009Jun.; 21(3):38696,Availablefrom:URL:http://www.Pubmed.com. 8. Dr. Arun Gupta, Dr. G.P. Mathur, Dr. Jagdish C. Sobti & Dr. (Mrs.) Rita Gupta, etal, Policy on Breastfeeding Training of doctors and nurses in Breastfeeding and lactation management. Breastfeeding Promotion Network of India (BPNI) Available from [email protected], Website: www.bpni.org 9. Sial IP. Redefining infant care the Baby-Friendly Hospital Initiative.HealthAug;25(4):38. Availablefrom:URL:http://www.pubmed.com 10. Dabritz HA, Hinton BG, Babb J. Evaluation of lactation support in the workplace or school environment on 6-month breastfeeding outcomes. J Hum Lact (serial online) 2009 May;25(2):182-93. Available from:URL:http://www.pubmed.com 11. Rosenberg KD, Stull JD, Adler MR, Kasehagen LJ, Crivelli-Kovach A, etal, Impact of hospital policies on breastfeeding outcomes, Breastfeed Med. (serial online) 2008 http://www. pubmed.com. Jun;3(2):110-6. Available from:URL: 12. Caldeira AP, Gonçalves E. Assessment of the impact of implementing the Baby-Friendly Hospital Initiative. J Pediatr (serial online)2007 MarApr;83(2):127-32. Available from: URL: http://www. pubmed.com. 13. Rivera-Lugo M, Parrilla-Rodríguez AM, Dávila-Torres RR, Albizu-García C, Rios-Motta R, etal, Full breastfeeding during the postpartum hospitalization and mothers' report regarding baby friendly practices.Breastfeed Med (serial online) 2007 Mar;2(1):19-26., Available from:URL: http://www. pubmed.com. 14. Bartick M, Stuebe A, Shealy KR, Walker M, Grummer-Strawn LM,Closing the quality gap: promoting evidence-based breastfeeding care in the hospital, Pediatrics.(serial online) 2009 Oct;124(4):e793-802. Available from:URL:http://www.pubmed.com. 15. Sarasua I, Clausen C, Frunchak V, Mothers' experiences with breastfeeding management and support: a quality improvement study, Breastfeed Rev. 2009 Mar;17(1):19-27., Available from: URL: http://www. pubmed.com. 16. Jang GJ, Kim SH, Jeong KS. [Effect of postpartum breast-feeding support by nurse on the breast- feeding prevalence] Taehan Kanho Hakhoe Chi (serial online) 2008 Feb;38(1):172-9. Available from : URL: http://www. pubmed.com. 17. Bulhosa MS, Lunardi VL, Lunardi Filho WD, Gonçales SA. Promotion of breastfeeding by the nursing staff of a children-friendly hospital. Rev Gaucha Enferm (serial online) 2007 Mar;28(1):89-97. Available from: URL: http://www. pubmed.com. 9. Signature of the Candidate : 10. Remarks of the Guide : The present study helps the staff nurses to improve their knowledge and develop positive attitude in implementing BFHI policy in hospital which improves the quality of nursing services. 11. NAME AND DESIGNATION OF 11.1 GUIDE 11.2 SIGNATURE : Smt. RENUKA. N, M.Sc. (N) LECTURER AND HOD DEPARTMENT OF PEDIATRIC NURSING, GOVERNMENT COLLEGE OF NURSING, FORT, BANGALORE-02. : 11.3 CO-GUIDE (IF ANY) : Mr. R.K. MUNISWAMY, M.Sc. (N) LECTURER PEDIATRIC NURSING GOVERNEMTNT COLLEGE OF NURSING, FORT, BANGALORE-2. 12. 11.4 SIGNATURE : 11.5 HEAD OF THE DEPARTMENT : Smt. RENUKA .N, M.Sc. (N) LECTURER AND HOD DEPARTMENT OF PEDIATRIC NURSING, GOVERNMENT COLLEGE OF NURSING, FORT, BANGALORE-2. 11.6 SIGNATURE : 12.1 Remarks of the : The topic selected for the study is relevant Principal 12.2 SIGNATURE and forwarded for needful action ETHICAL COMMITTEE CLEARANCE 1. TITLE OF THE DISSERTATION 2. NAME OF THE CANDIDATE AND ADDRESS : “TO ASSESS THE KNOWLEDGE AND ATTITUDE OF STAFF NURSES REGARDING BABY FRIENDLY HOSPITAL INITIATIVE POLICY IN SELECTED BFHI HOSPITAL, BANGALORE”. : MS. SATHYAVATHI. P 1st Year M.Sc. Nursing. Government College of Nursing. Fort, Bangalore-560 002. 3. SUBJECT : CHILD HEALTH NURSING 4. NAME OF THE GUIDE : Smt N. RENUKA, M.Sc. (N) LECTURER AND HOD DEPARTMENT OF PEDIATRIC NURSING. GOVERNMENT COLLEGE OF NURSING FORT, BANGALORE-02. 5. APPROVED/NOT APPROVED (If not approved, suggestion) Smt. LALITHA HOSMANE Principal and HOD Government College of Nursing, Fort, Bangalore-2 Smt. RENUKA. N Head of the Department of Child Health Nursing, Government College of Nursing, Fort Bangalore-2 Sri. BASAVARAJU Head of the Department of Medical Surgical Nursing. Government College of Nursing Fort Bangalore-2 Sri. PRASANNAKUMAR.O. Head of the department of Community Health Nursing Government college of nursing Fort Bangalore-2 Sri. REVANNA.T.V Head of the Department of Psychiatric Nursing. Government college of Nursing Fort, Bangalore-2 LAW EXPERT Smt. LALITHA HOSMANE Principal Government College of Nursing, Fort, Bangalore-2