Download RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

“EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME (STP) ON KNOWLEDGE REGARDING
BILIBLANKET PHOTOTHERAPY AMONG STAFF NURSES IN
SELECTED PEDIATRIC HOSPITALS AT BIJAPUR”.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MR. JAKKAPPA.BASARAGI
CHILD HEALTH NURSING
FIRST YEAR M.Sc NURSING
YEAR 2012 -2014
BLDEA’S SHRI B M PATIL
INSTITUTE OF NURSING SCIENCES
SOLAPUR ROAD, BIJAPUR - 586103
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1
NAME OF THE CANDIDATE
AND ADDRESS
MR. JAKKAPPA.BASARAGI.
I YEAR M. Sc. NURSING
BLDEA’S SHRI B.M.PATIL INSTITUTE
OF NURSING SCIENCES, BIJAPUR-586103
2
3
NAME OF THE
BLDEA’S SHRI B.M.PATIL INSTITUTE OF
INSTITUTION
NURSING SCIENCES, BIJAPUR -586103
COURSE OF THE STUDY
AND SUBJECT
4
DATE OF ADMISSION TO
I YEAR M. Sc. NURSING
CHILD HEALTH NURSING
27.07.2012
THE COURSE
5
TITLE OF THE STUDY
“EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP)
ON KNOWLEDGE REGARDING BILIBLANKET PHOTOTHERAPY AMONG
STAFF NURSES IN SELECTED PEDIATRIC HOSPITALS AT BIJAPUR.”
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6.
BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Our children are our most precious resources”
The birth of an infant is one of the most awe inspiring and
emotional events that can occur once in life time. After nine months of anticipation
and preparation the neonates arrives aimed a flurry of excitement. But most often the
enjoyment of parents and the bonding with new born will be disturbed due to certain
common neonatal disorders. One such common health problem is neonatal jaundice.
The word jaundice is derived from the French word Jaune which means Yellow.
Clinical jaundice manifests as yellowish discoloration of the skin of the face when
the serum bilirubin level exceeds 5mg/dl. As the degree of jaundice increases, there
is a cephalocaudal progression of the yellowishness of the skin. When the trunk of
the baby is distinctly yellow stained, the serum bilirubin levels is likely to range
between 10 to 15mg/dl. The yellow staining of the palms and soles indicates that
serum bilirubin level has exceeded 15mg/dl.1
Neonatal jaundice affects 60%of full term infants and 80% of preterm
infants, bilirubin level greater than 5mg/dl in the first week of life and about 6% of
term babies will have bilirubin levels exceeding 15mg/dl. Neonatal jaundice is a
yellowing of the skin and other tissues of a newborn infant with a bilirubin level of
more than 5mg/dl.2
A biliblanket is a portable soft flexible pad woven of fiber optic pad placed
with disposable cover and exposed emitting lights in 400 to 500 nanometer range for
therapeutic blue violet range. Biliblanket is trade mark of general electric’s datex –
ohmeda subsidiary. It is an obvious combination of bilirubin and blanket. Others
names used are home phototherapy system, bilirubin blanket or phototherapy
blanket or fiber optic phototherapy. It can be used in the home situation and hospital
setup also. It is available in standard size mat, large fiber optic mat and double fiber
optic mat.3
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6.2 NEED FOR THE STUDY
More than 40% of the population of our country falls in the age spectrum
covered by paediatrics. Infants (0-1 years) constitute 2.82% of the total population in
India.4 The WHO reveals that the incidence of hyperbilirubinemia is 50 to 60
thousands neonates among these 2% has total serum bilirubin levels over 20mg/dl,
the total serum bilirubin level in normal range is0.3 to 1mg/dl.0.15%had levels over
25 mg/dl and 0.01% has over 30mg/dl5.Three methods of treatment modalities are
used to reduce the level of conjugated Bilirubin. They are phototherapy,
pharmacological therapy and exchange transfusion. The phototherapy is best in
moderate case where the bilirubin raises above 12mg/dl. In pharmacological
therapy, Phenobarbital induces hepatic microsomal Enzymes and increases bilirubin
conjugation and excretion. Exchange transfusion is used to prevent kernictreus and
replace 85 % of circulating red blood cells and reduces bilirubin level by 50%.6
There are two types of biliblanket phototherapy one is ohmeda system, it
consists of standard size
fiber optic biliblanket with a halogen lamp and attached
fiber optic cable containing 2400 optic fibers. The ends spread out in a flat mat
emission of blue green light. Intensity of light ranges from 15mw/cm2 –
35mw/cm2.The second one is health dyne wallaby system, this devices has long flat
florescent panel attracted to the main unit by short connector3.
A study was conducted to evaluate the efficacy of fiber-optic phototherapy
using the standard Ohmeda Biliblanket, a large version, double standard Biliblanket,
and conventional phototherapy using daylight fluorescent lamps in full-term, healthy
infants with nonhemolytic hyperbilirubinemia.Among171 infants full-term, healthy
infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 micro
mol/L or 222 micro mol/L at <48 hours of age) were allocated randomly to one of
four modes of phototherapy: standard fiber-optic mat (Ohmeda Biliblanket), a large
version, double standard Biliblanket, and conventional phototherapy. Bilirubin
levels were monitored every 12 hours. Exposure was stopped when bilirubin levels
were less than 185 micro mol/L, the minimum duration being 24 hours. 42 were
exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy,
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42 to double-fiber-optic phototherapy, and 44 to conventional phototherapy. The
result shown that the efficacy of double-fiber-optic phototherapy and conventional
phototherapy was similar and significantly better than that of the large fiber-optic
mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall
decline rate. The large mat was slightly better than the standard-size mat with regard
to 24-hour decline rate and overall decline rate, but this difference was not
significant. Failure of phototherapy occurred only in the large fiber-optic mat group
(3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other
two groups, but differences not statistically significant. The nursing personnel were
more comfortable with single fiber-optic phototherapy, which caused no initial
disturbance to the swaddled infants as did conventional phototherapy, but found
double-fiber-optic phototherapy difficult to use. The researchers concluded that for
efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of
our conventional phototherapy, the light dose of the standard mats needs to be
doubled.7
To compare with other phototherapy it has a advantages. It helps the
mother and baby bonding , mother can nurse, swaddle and hold the baby ,skin
temperature will not raised , no need for eyes pad, a greater flexibility of use may be
used in a incubator , radiant warmer , bassinet or at home diaper can be worn , baby
can be clothed , it can be Used for 24 hours a day.3
A study has been conducted to compare the use of standard overhead
fluorescent phototherapy units with the biliblanket a woven fibreoptic pad which
delivers high intensity light with no ultraviolet or infrared irradiation in the
treatment of jaundice in preterm infants. Infants between 800g to 2500 g, were
included in the study with strict criteria for commencing and ceasing phototherapy.
Serum bilirubin levels were followed at 12-24 h intervals until 24 h after cessation
of phototherapy. Infants were allocated at random to receive either conventional
phototherapy or the biliblanket. There were 24 infants in the conventional group and
20 in the biliblanket group. Mean duration of phototherapy was compared and was
44 h for the conventional group versus 42 h for the biliblanket group. The researcher
has concluded that the biliblanket is as effective as conventional phototherapy and
was well accepted by nursing staff and parents.8
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The biliblanket phototherapy is one of the advanced technology for
treatment of the jaundice. In Indian context, the use of Biliblanket phototherapy is
very minimal in paediatric health set up. Health professionals in general, nurses in
particular may not have adequate knowledge regarding this procedure. Hence the
researcher is interested to conduct a study on the effectiveness of structured teaching
program on knowledge regarding Biliblanket phototherapy among staff nurses.
6.3 REVIEW OF LITERATURE
A Study was conducted To compare the effectiveness of various
phototherapy systems in lowering serum bilirubin levels among 140 preterm infants.
Eligible infants were randomly assigned to four study groups: conventional, fiber
optic Wallaby, fiber optic Biliblanket, and combined phototherapy. Efficacy was
assessed by comparing highest serum bilirubin levels, duration of treatment, and
number of infants requiring exchange transfusion. Result shows that fiber optic
phototherapy, both Wallaby and Biliblanket, had the same effectiveness of
conventional phototherapy. The best results have been obtained using combined
phototherapy, which allowed to reach lower serum bilirubin levels, a shorter
duration of treatment and a significant reduction of exchange transfusions. The
researcher concluded that combined phototherapy should be the method of choice in
treating hyperbilirubinemia in very preterm infants.9
The study was conducted to evaluate the efficacy of fibreoptic
phototherapy. In the management of newborn infants with hyperbilirubinaemia.with
sample size of thirty-one subjects were identified of which 24 met inclusion criteria.
They evaluated the efficacy of fibreoptic phototherapy in a number of different
clinical situations and patient populations. Result shown that combination of
fibreoptic and conventional phototherapy was more effective than conventional
phototherapy alone .Researcher concluded that fibreoptic phototherapy has a place
in the management of neonatal hyperbilirubinemia. It is probably a safe alternative
to conventional phototherapy in term infants with physiological jaundice.10
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A study was done to compare special blue compact fluorescent lamp (CFL)
phototherapy with special blue standard-length tube lights. Sample size of study was
293 consecutive babies with gestation more than 34 weeks who received phototherapy, 100 babies, who satisfied the eligibility criteria, were enrolled and
randomized. There were 50 babies in each group. The results of the study shown that
baseline characteristics, causes of jaundice, hemolysis, baseline TSB and irradiance
were similar in both groups. Mean duration of phototherapy (P = 0.98) was similar
in both groups. Kaplan-Meier analysis of phototherapy duration showed no
difference in the survival curves of the two groups (P = 0.6). Auxiliary temperature
was similar in both groups and no baby has dehydrated. The study concluded that
CFL phototherapy has no superiority over STL phototherapy in terms of efficacy
and adverse effects on the neonate and effects on nursing staff darted.11
A study was conducted on treatment of neonatal hyperbilirubinemia, with
aim of, focusing on practical aspects that are relevant to paediatricians and
neonatologists. The study findings suggest that jaundice is very common among
infants during the first days of life. Several factors such as maternal and neonatal
history have to be considered before implementing treatment. Significant advances
have been made in the past few years concerning the treatment of jaundiced
newborn infants. The conclusion of the study shown that nowadays, the in-depth
knowledge about the mechanism of action of phototherapy, the development of
intensified phototherapy units and the use of drugs to reduce bilirubin formation,
have contributed to significantly decrease the need for exchange transfusion. 12
A study was conducted to compare of double phototherapy (conventional
plus biliblanket) versus conventional single phototherapy in the management of
neonatal hyperbilirubinemia. The sample size of study was 90 ,with divided in to
two groups.45 new born in each groups, those who got conventional single
phototherapy were taken in group one and babies who got double phototherapy were
taken in group two. Each group was again divided in to three subgroups according to
their birth weight (NBW, LBW&VLBW).The result shows that decrement rate of
serum bilirubin per day was 2.4+-1.20 mg/dl in NBW babies with the use of
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conventional single phototherapy compared to 4.97±1.05 mg/dl with the use of
double phototheraphy.In LBW babies, decrement rate of serum bilirubin per day was
2.45±1.9mg/dl with conventional single phototherapy but 4.99±0.59mg/dl with
double phototherapy. In VLBW babies decrement rate of serum bilirubin per day
was 2.49±0.59 mg/dl with conventional single phototherapy but with double
phototherapy
this
decrement
rate
was5.21±1.13mg/dl
per
day.
Double
phototheraphy.In was more effective than conventional single therapy all three
groups of babies however the rate of fall of bilirubin was higher in VLBW group.
This study concluded that decrement rate of serum bilirubin more than two folds
with double phototherapy (conventional plus biliblanket) compared with single
phototherapy.13
6.4 STATEMENT OF PROBLEM
“Effectiveness Of Structured Teaching Programme (STP)On Knowledge
Regarding Biliblanket Phototherapy Among Staff Nurses In Selected Paediatric
Hospitals At Bijapur”.
6.5 OBJECTIVES:
1. To assess the knowledge regarding Biliblanket phototherapy among staff
nurses as measured by structured knowledge questionnaire.
2. To evaluate the effectiveness of structured teaching programme (STP) on
knowledge regarding Biliblanket phototherapy.
3. To find out the association between pre-test knowledge score with selected
demographic variables.
6.6
OPERATIONAL DEFINITION

Effectiveness: - In this study effectiveness means improving knowledge
regarding Biliblanket phototherapy among staff nurses by structured teaching
programme which may results from differences between pre and post test
knowledge score.

Structured teaching programme :- In the present study it refers to
systematically planned teaching programme designed to provide information
regarding biliblanket phototherapy
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
Knowledge: - It refers to the ability of the staff nurses in giving correct
responses to the questions asked as measured by structured knowledge
questionnaire about biliblanket Phototherapy.

Biliblanket phototherapy: - A biliblanket is a portable soft flexible pad
woven of fiber optic pad placed with disposable cover and exposed emitting
lights in 400-500 nm.range for therapeutic blue violet rays.

Staff nurses :- In this present study staff nurses refers to those who are
providing professional nursing care in paediatric hospitals with minimum
qualification of general nursing ,B.Sc Nursing , PBBSc Nursing
6.7 ASSUMPTIONS
The study assumes that:
1. Staff nurses may have inadequate knowledge regarding biliblanket
phototherapy.
2. Structured teaching programme will improve the knowledge regarding
Biliblanket phototherapy among staff nurses.
6.8 HYPOTHESES
The following hypotheses will be tested at 0.05 level of significance.
H1. There will be significance difference between pre test and post test
knowledge Score.
H2: There will be significant association between pre test knowledge score and
selected demographic variables
6.9 DELIMITATION
1. No effort will be made to assess the perception or practice of nurses
regarding care of child with Biliblanket phototherapy
2 .The area or setting for the study is delimited to staff nurses of selected
paediatric hospitals, at Bijapur
3. Study period is limited to 4 to 6weeks
4, No effort will be made to assess the effectiveness of biliblanket phototherapy
on reduction of neonatal jaundice
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7.
MATERIALS AND METHOD.
7.1 SOURCE OF DATA
The data will be collected from the staff nurses in selected pediatric hospitals.
7.1.1 RESEARCH DESIGN
Pre experimental design (One group pre test-post test design)
7.1.2 RESEARCH APROACH
Evaluative research approach will be used for this study.
7.1.3 SETTING
The study will be conducted in selected paediatric hospitals, at Bijapur.
7.1.4 POPULATION
The population for the present study comprises of staff nurses from paediatric
Hospitals at Bijapur.
VARIABLES

Independent variable
:
Structured teaching programme

Dependent variable
:
Knowledge of staff nurses
regarding
Biliblanket phototherapy.
 Demographic variables
:
Age, Gender, Educational status, Year of
experience, Economic status etc.
7.2 METHOD OF DATA COLLECTION
7.2.1 SAMPLING PROCEDURE
Non probability sampling procedure
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
Sampling technique
Convenient sampling technique
7.2.2 SAMPLE SIZE
In this study the sample size will be 40 staff nurses from selected
Paediatric hospitals.
7.2.3 INCLUSION CRITERIA
1. Staff Nurses who have minimum qualification of GNM, B.Sc Nursing,
PBBSc Nursing and registered to KNC.
2. Staff Nurses who are willing to participate.
7.2.4 EXCLUSION CRITERIA
1. Staff Nurses who are not available during data collection.
2. ANM, nurse aides
7.2.5 INSTRUMENTS INTENDED TO BE USED

Proforma for collecting data regarding demographic variables

Structured knowledge questionnaire to assess the knowledge regarding
Biliblanket phototherapy.
7.2.6. DATA COLLECTION METHOD
Prior to data collection, permission will be obtained from concerned authority
After obtaining the permission the following steps will be taken by the
Investigator. The researcher introduces himself and explains the purposes of
the study to the subject.

Administration of pre-test on knowledge regarding biliblanket phototherapy.

Introduce the structured teaching programme.

Administration of post test on knowledge regarding biliblanket phototherapy
after one week.
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7.2.7
DATA ANALYSIS PLAN
The data would be analyzed by using descriptive (mean, median, frequency,
range, percentage) and inferential statistics (paired t- test, Chi-square test) on
the basis of objectives and the hypotheses
7.2.8
DURATION OF STUDY
Study period is 4-6 weeks.
7.3 DOES THE STUDY REQUIRE ANY INTERVENATION TO BE
CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL?
Yes ,Structured teaching programme will be administered to staff nurses
regarding Biliblanket phototherapy
7.4
HAS
ETHICAL
CLEARANCE
BEEN
OBTAINED
FROM
INSTITUTION IN CASE OF 7.3?
Yes, Ethical clearance is obtained from the institutional ethical committee.
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LIST OF REFERENCES
1. Gupta R. Neonatal surgical jaundice revised 4th ed .Delhi: Jaypee; 2005.
2. Mary Fran Hazinski. Nursing care of the critically ill child. Princeton.1st ed.
Mosby publication; 1984.
3. Suseela.T. biliblanket phototherapy. Nightingale Nursing Times. 2012
march; 7(12):40-42.
4. Whaley and Wong. Essentials of paediatric nursing. 7th ed. St Louis: Mosby
publication; 2004.
5. Robertson. Text book of Neonatology. 2nd ed. Tokyo: Churchill living stone;
1992.
6. Ghai O.P, Piyush Gupta. V.K.Paul.Essential peaditrics.6th ed. Delhi : CBS
publication; 2005.173.
7. Tan K L. Efficacy of bidirectional fiber-optic phototherapy for neonatal
hyperbilirubinemia;1997 may; 99(5): 13.
8. Costello SA, Nyikal J, Yu VY. McCloud P. Biliblanket phototherapy system
versus conventional phototherapy: a randomized controlled trial in preterm
infant’s. J Paediatric Child Health;1995 Feb; 31(1): 13.
9. Romagnoli C. Zecca E. Papacci P. Vento G. Girlando P. Latella C.et all.
Which phototherapy system is most effective in lowering serum bilirubin in
very preterm infants;2006 May; 21 (2): 204-09.
10. Mills.J.F.Tudehope .Fiberoptic Photo therapy for neonatal jaundice.2011
Aug; 78 (8) : 996-08.
11.Sarin M Dutta. S Narang A. Randomized controlled trial of compact
fluorescent lamp versus standard phototherapy for the treatment of neonatal
Hyperbilirubinemia;2006 Jul; 43 (7 ): 583-90.
12. Manoel de Carvalho. Treatment of neonatal hyperbilirubinemia. Journal de
Pediatria;2001;7(1):71.
13. Chiranjib Baura,et all. compare of double phototherapy (conventional plus
biliblanket)versus conventional single phototherapy in the management of
Neonatal hyperbilirubinemia.Jcmcta.2007;18(2):21-25.
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