Download 1. - Rajiv Gandhi University of Health Sciences

Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
Name of the Candidate and Address
Mrs. MANJU MATHEW
1st YEAR M.Sc. NURSING
ROYAL COLLEGE OF NURSING,
7th MAIN, 1st BLOCK, UTTARAHALLI,
BANGALORE- 560 061.
2
Name of the Institution
Royal College of Nursing, Bangalore
1st Year M.Sc. Nursing,
3.
Course of study and subject
Pediatric Nursing.
4.
Date of admission to course
01-06-2009.
Title of the Topic:
5.
6.
“A quasi experimental study to assess the effectiveness of structured teaching programme regarding
common bacterial infections in children among staff nurses working in selected pediatric hospitals in
Bangalore.”
Brief resume of the intended work:
6.1 Need for the study
6.2 Review of literature
6.3 Objectives of the study
6.4 Operational definitions
6.5 Hypothesis of the study
6.6 Assumptions
6.7 Delimitations of the study
6.8 Pilot study
6.9 Variables
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
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Enclosed
Enclosed
7.
Materials and methods:
7.1 Source of data- Data will be collected from staff nurses working in selected Pediatric hospitals in
Bangalore.
7.2 Methods of data collection- Structured questionnaire.
7.3 Does the study require any interventions or investigation to the patients or other human being
or animals? No
7.4 Has ethical clearance been obtained from your institution?
Yes, ethical committee’s report is here with enclosed.
8.
List of references
Enclosed
Rajiv Gandhi University of Health Science, Karnataka,
Bangalore
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
Name of the Candidate and Address
Mrs. MANJU MATHEW
1ST YEAR M.Sc. NURSING
ROYAL COLLEGE OF NURSING
7TH MAIN ,1ST BLOCK ,
UTTARAHALLI, BANGALORE-61
2.
Name of the Institution
Royal College of Nursing
3.
Course of study and subject
1ST year M.Sc. nursing
Pediatric Nursing
4.
Date of admission to course
5.
Title of the Topic
01/06/2009
“A quasi experimental study to assess the Effectiveness of Structured Teaching Programme
regarding Common Bacterial Infections in Children among Staff Nurses working in selected
Pediatric hospitals in Bangalore.”
1
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
"Viruses and bacteria are not the sole cause of infectious disease, there is something else".
Rene Dubois
Bacteria existed long before humans evolved, and bacterial diseases probably co-evolved with
each species which involuntarily hosts them. Many bacterial diseases that we see today have been
around for as long as we have, others may have developed later. In either case, for the longest time we
were not aware of the cause of infectious diseases.1
The word bacteria derived from a Greek word meaning “small staff”. Bacteria’s are unicellular
organisms that lack membrane-bound organelle. Bacteria are a few micrometers in length; bacteria have
a wide range of shapes, ranging from spheres to rods and spirals. Bacteria are ubiquitous in every habitat
on Earth, growing in soil, acidic hot springs, radioactive waste, water, and deep in the Earth's crust, as
well as in organic matter and the live bodies of plants and animals. There are typically 40 million
bacterial cells in a gram of soil and a million bacterial cells in a milliliter of fresh water; in all, there are
approximately five nonillion (5×1030) bacteria on Earth, forming much of the world's biomass.2
Bacteria were first observed by Antonie van Leeuwenhoek in 1676, using a single-lens
microscope of his own design. The name bacterium was introduced much later, by Christian Gottfried
Ehrenberg in 1838. If bacteria form a parasitic association with other organisms, they are classed as
2
pathogens. Pathogenic bacteria are a major cause of human death and disease and cause infections such
as tetanus, typhoid fever, diphtheria, syphilis, cholera, food borne illness, leprosy and tuberculosis.3
The most common bacterial infections among children are skin infections (including impetigo),
ear infections, and throat infections (strep throat). These and many other less common bacterial disorders
are treated similarly in adults and children. Other infections occur at all ages but have specific
considerations in children. Certain children are at particular risk of bacterial infections. These children
include infants younger than 2 months, children who have no spleen or who have an immune system
disorder, and children who have sickle cell disease.
3
6.1 NEED FOR SYUDY
“Hundreds of people are lining up to take tests for infections, heart and kidney problems and
dehydration”.
Julie Ferguson
The most obvious diseases caused by bacteria among children are infectious diseases. Bacteria
can cause a wide range of illnesses, from gastrointestinal upset to skin disorders to life-threatening
illnesses that require immediate attention. Dangerous bacteria that cause illness include Streptococcus
species, E. coli, and salmonella.4
Impetigo is the most common bacterial skin infection in children worldwide. Approximately 10%
of children presenting to U.S. medical clinics with skin complaints are diagnosed with this condition.
The annual incidence of impetigo in the U.K. is approximately 80/100,000 in children aged 0 to 4 years,
decreasing to approximately 50/100,000 in those aged 5 to 14 years.5
Upper respiratory tract infections are a leading cause of time lost from school. Bacteria account
for up to 25 percent of upper respiratory tract infections. Streptococcus throat is most common bacterial
infections in children and adolescents (aged 3 years to 18 years). Strep throat is called ‘strep’ throat
because the bacterium that causes belongs to Group A Streptococcus.40% of strep throats are treated
with antibiotics. The easiest place to catch strep throat is in a hospital. Hospital workers and inpatients
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more likely to carry Group A Streptococcus. Children who attended day care are also at high risk of
catching bacterial infections. Other pathogens include Haemophilus influenza. Middle ear infections are
the most common bacterial infections in children in the United States. By the age of 3 years, two-thirds
of American children have had at least one episode of otitis media, and the other third has had three or
more episodes.
Bacterial infection of the trachea can result in inflammation, swelling, purulent secretions and
life-threatening narrowing of the upper airways, causing asphyxia and cardio-respiratory arrest. The
incidence of bacterial tracheitis, which has become now more common than epiglottis, is estimated to be
8 per million children aged 0-5 years. Children may present with a brief period of rhinorrhea, fever,
cough, sore throat and hoarse voice. Typically, the patient deteriorates rapidly, with respiratory distress,
airway compromise and toxic appearance.
Researcher had an experience while working as a staff nurse. The researcher met many children
admitted in the hospital with many complications like respiratory distress and secondary infections that
have arisen due to the ignorance of common bacterial infections by staff nurses. So, the researcher
thought of taking the task of assessing the knowledge of staff nurses who are working in paediatric
hospitals regarding common bacterial infections in children with a view to improve the knowledge.
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6.2. REVIEW OF LITERATURE
“Literature review to the activities involved in identifying and searching for information or a
topic and developing a comprehensive picture of the state of knowledge on that topic”.
A study was conducted in Department of Pediatrics Chandigarh, India regarding nosocomial
pneumonia in a pediatric intensive care unit. Nosocomial pneumonia is the second most common
hospital acquired infection. Understanding the pattern of occurrence, and etiological agents nosocomial
infection in a pediatric intensive care unit is essential for developing effective infection control
measures. Children admitted in the pediatric intensive care unit over a period of 1 year who had
endotrachial intubation were enrolled in to the study. The result showed that in 72 children with a
median age of 3.7 years.22/72 (30.5%) developed nosocomial pneumonia. Additionally 18(39%) had
evidence of endotrachial bacterial colonization.Re intubation, prolonged duration of intubation were the
risk factor of developing nosocomial pneumonia. Overall mortality was 21 % (15/72). 7 (47%) of these
death were secondary to nosocomial pneumonia. The study concluded that reintubation, prolonged
duration of intubation were the significant factors for development of nosocomial pneumonia. So the
nurses who working in pediatric intensive care unit should have proper knowledge about developing
effective infection control measures.6
A study was conducted in Postgraduate Institute of Medical Education and Research,
Chandigarh, India regarding the effect of interrupted 5-day training of neonatal and childhood illness on
the knowledge and skills of primary health care workers. A 5 day training package was developed and
6
administered in Haryana state. Improvement the knowledge and skills of 50 primary health care workers
following the interrupted 5day training was compared with that of 35 primary health care workers after
the conventional 8-day training package. The average score increased significantly from 46.3-74.6 in
8day training and from 40.0-73.2 in 5day training. Average skills score for respiratory problems
increased from 38-57 in 8day training. Average counseling skill score also rose from 42-89 in 8 day and
from 37-70 in 5 day training. The study concluded that proper training of health care workers will
improve the quality of management of neonatal childhood illness.7
A cross sectional study was conducted in Maulana Azad Medical College, New Delhi, regarding
knowledge of general public and health professionals about tetanus immunization. They done a cross
sectional study at a perfect health mela and all the government allopathic health agencies in Delhi. Result
showed that the knowledge of tetanus immunization was poor among general public as well as health
care providers. The knowledge of tetanus immunization schedule for adults was poor though it was
comparatively better for pregnant females, but only 75% of doctors and 51.1% of nursing personnel
correctly knew the immunization schedule against tetanus in children. The study concluded that there is
a need to upgrade the level of knowledge among health care providers so as to ensure that schedules of
tetanus are followed properly and unnecessary repeated immunization are avoided.8
A study was conducted in National Institute of Communicable Diseases, Delhi. India regarding
diphtheria is declining but continues to kill many children. In 1997,of 143 clinically suspected cases
admitted to hospital 45(32%) died. All the deaths and 92 %( 131/143) of cases occurred in children
below 10 years of age. Only 12% cases had received one or more doses of DPT. Mortality rate were
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significantly higher in young (p=0.03) and unvaccinated (p=0.01) children. The study concluded that
importance of improved vaccine coverage and early diagnosis will reduce mortality rate of children with
diphtheria in Delhi.9
A study was conducted in Public Health Services in United State regarding nosocomial
septicemia and meningitis in neonates. Most of these infections were caused by multiple antibiotic
resistant gram negative enteric bacteria, staphylococcus aureus. Risk for nosocomial infection was
related primarily to factors which enhance infant contact with these bacteria in combination with those
poorly defined determinants of bacterial virulence and host defense. Control measures for preventions of
these infections are aimed at decreasing the neonates contact with the outbreak strains, improvement in
hand washing practices and equipment sterilization processes.10
A study was conducted in John’s Hopkins University School of Nursing, Baltimore regarding
hand washing practices and resistance and density of bacterial hand flora. The hand washing practices
and bacterial flora of 62 pediatric staff members were studied. Hand washing followed patient contact
29.3% of the time (204/697 contacts).Mean duration was 14.5 seconds, and significant differences in
practices were found by unit. Mean count of colony formed units was log10 5.87+/-0.41,with significant
differences in effect of hand washing on counts of colony forming units. Significant differences were
also found by unit and by staff position with regard to species isolated and antimicrobial resistance of
isolates. The study concluded that a more efficacious and use of antimicrobial agent in hand washing is
more effective for preventing bacterial infections.11
8
A study was conducted in Aga Khan Health Service, Pakistan regarding management of child
hood pneumonia. Acute respiratory infections mostly pneumonia, are one of the leading causes of death
in young children, accounting for 28% of child hood mortality. The research and technical development
efforts made in the last 15 years which contributed to improving the effectiveness of the case
management strategy to reduce mortality from pneumonia in children. Clinical studies provided the
rational for improving the sensitivity and specificity of pneumonia, and enhancing the therapeutic
efficacy of home treatment. A socio cultural knowledge about family practices regarding pneumonia and
acute respiratory infection in children was built up and provided effective communication between
health workers and families about home care of children with acute respiratory infections. Health system
research focused on methods for surveillance of bacterial drug resistance and evaluating the control
programmes. The study concluded that proper management of child hood pneumonia will reduce
mortality rate in children.12
A study was conducted in Department of Pediatrics, Australia regarding pediatric nurse’s
knowledge, attitudes and factors influencing fever management and the predictors of their intensions to
administer paracetmol to febrile child.51 pediatric nurses participated in the study. A self report
temperature is often unrelated to illness severity. Attitudes towards febrile convulsion were highlighted;
by belief that antipyretic do not prevent initial febrile convulsions. Nurses reported strong intension to
administer paracetmol. The study concluded that fever management is an integral aspect of pediatric
nursing. The fever management of nurses knowledge must improve, their positive attitudes enhanced and
negative attitudes challenged.13
9
A study was conducted in Department of Pediatrics, Burundi regarding knowledge and practices
of physicians and nursing personnel about respiratory infections in children. A survey was under taken in
1993 including 9 paediatricians,27 general practitioners and 58 nurses .a questionnaire including 15 main
items was used . The result showed that a poor understanding of risk factors in 62% of population,
especially among general practitioners and nurses. Clinically 79% were able to make a proper diagnosis
of pneumonia. The duration of antimicrobial therapy was unnecessarily long for 49.4%. 70.5% of the
population considered the state of their knowledge and practices to be sufficient, 93.6% indicated that
specific training in this field would be useful. The study concluded that training is needed for health care
workers at all levels specifically in the management and prevention of acute respiratory infection in
children.14
A study was conducted in Herberpur Christian Hospital, India regarding immunization status of
children under 7 years in the Vikas Nagar area. Immunization has played a major part in reducing
childhood mortality so knowledge of vaccine coverage and reasons for poor uptake is essential for
achievement of immunity. A total of 470 families were visited. Age range of children included 9 months
to 6 years. The result showed that over all primary immunization rate was 77.2%,children receiving the
first booster was 73% and children receiving the second booster was 58.4%.Measels was the most
frequently omitted vaccination. The study concluded that poor education was the most frequent reason
for failure of vaccine, so the nurses should provide expanded programme of immunization, and will have
important implications for areas with similar cultural demographics.15
10
A study was conducted in children’s hospital USA regarding nursing care of child with
neutropenic enterocolitis. Neutropenic enterocolitis is a serious complication in neutropenic children.
The pathophysiology of neutropenic enterocolitis is not completely understood but involvement of
neutropenic, mucosal barrier damage and infection resulting a necrotizing process of the bowel wall. The
outcome for the child with neutropenic enterocolitis has improved with better diagnostic imaging
techniques and antibiotics. Most children can be successfully managed with broad-spectrum antibiotics
and supportive care. The study concluded that nursing care of neutropenic enterocolitis children requires
knowledge of the disease process, excellent clinical assessment skills and a well family centered
approach.16
A study was conducted by school of medicine, national yang Ming university Taipei, Taiwan
antibiotic prescribing for children with nasophryngitis, upper respiratory infection and bronchitis who
have health professional parents. This study investigated whether children having health professionals as
parents, a group whose parents are expected to have more medical knowledge and are less likely than
other children to receive and are less likely than other children to receive antibiotics for common colds,
upper respiratory infections and acute bronchitis. A total of 53733 episodes of samples were analyzed.
The study found that after adjusting for characteristics of children with physicians (odds ratio0.50: 95%
confidence interval ((1) 0.36-0.68) or a pharmacist (odds ratio 0.69: 95%, confidence interval 0.52-0.91)
as a parent less likely to receive antibiotic prescriptions. The like hood of receiving antibiotics for the
children of nurses was similar to that for children in the comparison group. This study supports that
better parental education does help to reduce the frequency of injudicious antibiotic prescribing. Medical
knowledge alone may not fully reduce the overdose of antibiotics.17
11
A study was conducted in Spain, regarding the vaccination coverage in children under 16 years
of age. A transverse study by interviewing parents was made. Children were distributed into three groups
A(0-4 years of age), B(5-9 years of age) and C(10-16 years of age). Their results showed a correct global
vaccination coverage rate of 58.4%. The correct vaccination coverage rate 94.5% in group A, 74.7% in
B, and 30.8% in group C. the correct coverage for specific vaccination was measles 74.6%, rubella 69%,
mumps 63.1%, diphtheria – tetanus – pertussis and polio 67.6%. This coverage was also greater in the
younger children of those parents interviewed 94.8% thought that vaccines were good for health.
Information about vaccinations was received from pediatrics in 31.3% of the cases and from nurses in
24.8% with the majority of the cases classifying the information as sufficient. The study concluded that
the vaccination coverage found in children up to 4 years old was very suitable, but it was worse in old
children.18
A study was conducted in Ghent University Ghent Belgium regarding nurse’s knowledge of
evidence based guidelines for the preventions of surgical site infection in children. The aim of study was
the development of an evaluation tool and subsequent evaluation of intensive care unit nurses knowledge
of the surgical site infections and preventions. After assessment of its face and content validity the test
was used in a survey among 809 intensive care unite nurses. Based on the test results and an item
analysis were performed. Face and content validity were achieved for 9 out of 10 items of the
questionnaire. Form the survey; they collected 650 questionnaires (response rate 80.3%). The item
difficulty ranging from 0.1-0.5 for eight questions, while
one question had a value of 0.02
discriminative values ranging from 0.27-0.53 and values for the quality of the response alternatives
between 0.1 and 0.7. The nurses mean score on the knowledge test was 29%. The study concluded that
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opportunities exist to improve intensive care unite nurses knowledge about surgical site infection
prevention recommendations. Current guidelines should support their ongoing training and education.19
A study was conducted in Children’s Medical Centre in Israel, regarding physicians, nurses and
parents attitudes to and knowledge about fever in early childhood. A total of 2059 questionnaires was
completed by the three groups. The most of the responds believed that fever is a helpful bodily
mechanism of the body. Regarding antipyretic medication 92.3% of the physicians and 84% of the
nurses would start treatment for a fever of 38 to 40 0C whereas 38.8% of parents would do so for a fever
of 37 to 38 0C. Febrile seizure served as reason for antipyretic treatment for 34.3% of the nurses and
20% of the patients. Study concluded that fear of brain damage due to fever was noted in almost twice as
many nurses as physicians. Parents and some nurses consider fever a risk factor for serious morbidity.20
.
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6.3 OBJECTIVES OF THE STUDY
1. To assess the knowledge of staff nurses regarding common bacterial infection in children in
selected pediatric hospitals.
2. To develop and conduct a structured teaching programme to the staff nurses in selected pediatric
hospitals regarding common bacterial infections in children.
3. To assess the effectiveness of structured teaching programme on common bacterial infections in
children by a post test.
4. To compare pre and post test knowledge scores on common bacterial infections in children.
5.
To find out the association between the knowledge scores of staff nurses regarding common
bacterial infections in children and selected demographic variables.
6.4. OPERATIONAL DEFINITIONS
1. ASSESS: Assess refers to the process of critical analysis and valuation or judgments of the status or
quality of a particular condition or situation.
2. EFFECTIVENESS: Effectiveness is a measure of the ability of a program, project or task to produce a
specific desired effect or result can be qualitatively measured.
3. STRUCTURED TEACHING PROGRAMME: It is a structured systematic information, instruction or
training given to a person or group.
4. BACTERIAL INFECTION: Invasion of harmful bacteria in the body and causing infectious diseases like
Impetigo, Ear infections, Strep throat, Pneumonia, Diphtheria and Nasophryngitis.
14
5. CHILDREN: A young person of either sex, especially one between 0-12 years of age.
6. STAFF NURSE: Is a person who has successfully completed diploma in general nursing and midwifery
course which is recognised by Indian nursing council and registered in the state nursing council.
6.5. HYPOTHESIS OF THE STUDY
H1 :-
There will be statistically significant association between pre and post test knowledge scores of the staff
nurses regarding common bacterial infections in children.
H2 :-
There will be statistically significant association between knowledge regarding common bacterial
infections and years of experience.
6.6. ASSUMPTIONS
1. Staff nurses may possess some knowledge regarding common bacterial infections in children.
2. Staff nurses knowledge regarding common bacterial infection can be measured by using a
structured questionnaire.
3. Staff nurses knowledge regarding common bacterial infections in children can be improved by
administrating a structured teaching programme.
4. Effectiveness of structured teaching programme can be assessed by a post test.
15
6.7. DELIMITATIONS OF THE STUDY
1. The study is limited to staff nurses who have completed Diploma in General Nursing and
Midwifery course, recognized by Indian Nursing Council and registered in State Nursing
Council.
2 .The study is limited to staff nurses working in selected paediatric hospitals in Bangalore.
3. The study is limited to staff nurses who are between the age group of 22-50 years.
6.8. PILOT STUDY
The study will be conducted with 6 samples. The purpose to conduct the pilot study is to find out
the feasibility for conducting the study and design on plan of statistical analysis.
6.9. VARIABLE
Variables are qualities, properties or characteristics of a person, things or situation that change or
vary.
Dependent variable: Knowledge level of staff nurses regarding common bacterial infections in
children.
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Independent variable: Age, Gender, General educational status, presently working ward, years of
experience and course attended regarding common bacterial infections.
7.0. MATERIAL AND METHODS
7.1 SOURCE OF DATA
The data will be collected from staff nurses who are working in selected pediatric hospitals in
Bangalore.
7.1.1 RESEARCH DESIGN
Quasi experimental design
The research design adopted for this study is quasi experimental in nature. One group pre test post test
design
7.1.2 RESEARCH APPROACH
Evaluative research approach
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7.1.3. SETTING OF THE STUDY
The study will be conducted at selected pediatric hospitals in Bangalore.
7.1.4. POPULATION
All staff nurses who meet inclusion criteria and are working in selected pediatric hospitals in Bangalore.
7.2. METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE)
The data collection procedure will be carried out for a period of one month. This study will be
conducted after obtaining permission from the concerned authorities. The investigator will collect data
from staff nurses by using a structured questionnaire, before and after a structured teaching programme.
Data collection instrument consists of the following sections:
Section A :
Demographic data.
Section B :
Questions related to assess the level of knowledge regarding common bacterial infections
in children.
7.2.1. SAMPLING TECHNIQUE
Sampling technique adopted for the selection of sample is non probability convenience
sampling.
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7.2.2. SAMPLE SIZE
The sample consists of 60 staff nurses working in selected pediatric hospitals in Bangalore.
SAMPLING CRITERIA
7.2.3. INCLUSION CRITERIA
1. Nurses who are working in selected pediatric hospitals in Bangalore.
2. Nurses who are willing to participate in the study.
3. Nurses who are between the age group of 22-50 years.
4. Nurses who are available at the time of study.
5. Nurses who have undergone Diploma in General nursing and Midwifery course which is
recognized by Indian Nursing Council and registered in the State Nursing Council.
7.2.4. EXCLUSION CRITERIA
1. Nurses who are working in hospitals other than pediatric hospitals.
2. Nurses who are not available at the time of study
3. Nurses who are not willing to participate in the study.
4. Nurses who have already attended the pilot study.
5. Nurses who are ANM, graduates and post graduates in nursing.
6. Nurses who have more than 50 years of age.
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7.2.5. TOOL FOR DATA COLLECTION
Structured questionnaire is used to collect the data from the staff nurses who are working in
selected pediatric hospitals in Bangalore.
7.2.6. DATA ANALYSIS METHOD
The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive statistics: Frequency and percentage will be used for analysis of demographic data
and mean, mean percentage and standard deviation will be used for assessing the staff nurses
level of knowledge regarding common bacterial infection in children.

Inferential statistics: Chi–square test will be used to find out the association between knowledge
score and selected demographic variable and paired‘t’-test for assessing the effectiveness of
structured teaching programme. Product moment correlation coefficient ‘r’ will be used to find
out comparison of pre and post test knowledge scores.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE
CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
Since the study design is quasi-experimental in nature, investigation or interventions are not required.
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7.4. ETHICAL CLEARANCE
The main study will be conducted after the approval of research committee of the college.
Permission will be obtained from the head of the institution. The purpose and details of the study will be
explained to the study subjects and assurance will be given regarding the confidentiality of the data
given.
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8.LIST OF REFERENCES: [VANCOUVER STYLE FOLLOWED]
1. T.M.Wassenaar. Bacterial Diseases in History. Washington State Uni.2008 December. Available
from URL: http://www.bacteriamuseum.org.
2. Wikipedia the free encyclopedia. Article related to bacteria. Available from URL:
http://www.en.wikipedia.org
3. Howard B.J. Bacterial infection 1994. Article available from URL: http://www.lef.org
4. Life
extension
foundation.
Bacterial
infections
protecting
yourself
from
commonpathogens:2006:January.Availablefrom URL: http://www.garynull.com
5. Best practice impetigo Basic Epidemiology. Available from URL: http://bestpractice.bmj.com.
6. P.K
Patra,
M.Jayashree.
Nosocomial
Pneumonia
in
a
pediatric
intensive
care
unit.Indianpediatrics:2007July:44(7):511518.AvailablefromURL:http://www.ncbi.nlm.gov/pubm
ed.com
7. Kumar D, Aggarwal AK. The effect of interrupted 5-day training on integrated management of
neonatal and childhood illness on the knowledge and skills of primary health care workers.
Health
policy
and
planning
:
2007
march;24(2):94-100.
Available
from
URL:http://www.ncbi.nlm.nih.gov/sites/entrez.
8. Dabas.P.AgarwalC.M. knowledge of general public and health professional about Tetanus
immunization, Indian journal of pediatrics: 2005 December: 72(2):1035-1037:
Available
from URL: http://www.ncbi.nlm.nih.gov/pubmed. com
22
9. Singh J,Harit AK. Diphtheria is declining but continues to kill many children: analysis of data
from a sentinel centre in Delhi,1997.Epidemology andinfection.1999October:123(2):20915.Available from URL:http://www.ncbi.nlm.nih.gov/pubmed.com
10. C.Baker
nosocomial
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and
meningitis
in
neonates.
The
AmericanJournalofMedicine2009:70(3):698-701Availablefrom
URL:http://www.elesvier.com
11. Larson EL, Foglia A. Hand washing practices and resistance and density of bacterial hand flora
on
two
pediatric
units
in
Lima,Peru.1992April:20(2):65-72.Available
from
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12. Rasmussen Z,Pio A. Case management of childhood pneumonia in developing countries : recent
relevant research and current initiatives. International journal of tuberculosis and lung disease .
2000 September ; 4 (9):807-26. Available from http://www.ncbi.nlm.nih.gov/pubmed.com
13. Walsh, Anne. Pediatric nurse’s knowledge, attitudes and factors influencing fever management.
Journal
of
advanced
nursing.
2005
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49(5):
453-464.
Available
fromhttp://www.ncbi.nlm.nih.gov/pubmed.com
14. Baribwira C, Kalambay K, Knowledge and practice of physicians and nursing personnel about
respiratory infections in children. French article of pediatrics.1996;56(1):95-8.Available from
http://www.ncbi.nlm.nih.gov/pubmed.com
15. Elliott C, Farmer K. Immunization status of children under 7 years in the Vikas Nagar area,
North
India. Child care health development. 2006 July ;32(4):415-21. Available from
http://www.ncbi.nlm.nih.gov/pubmed.com
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16. King N. Nursing care of the child with neutropenic enterocolitis.journal of pediatric oncology
nursing 2002 november; 19 (6):198-204.available from
http://www.ncbi.nlm.nih.gov/pubmed.com
17. Nicole Haung. Laurq Morlock. Antibiotic prescribing for children with nasopharingitis (common
cold) upper respiratory infections and bronchitis who have health professional pare.nts. Journal
of pediatrics : 2006 September: 118(3):1323: Available from
URL:http://www.ncbi.nlmonih.gov/pubmed.com
18. Sarasa M.A, Alonso Greyoriom. Child Vaccination the coverage knowledge and attitude of the
population. A study in a health area. Article i9n Spanish : 1996 may:44(5):464468:AvailablefromURL: http://www.ncbi.nlm.nib.gov/sises/entrez
19. Labeau SO, Witdouck SS, Nurses knowledge of evidence based nursing : 2009
november16(epob ahead of print). Available from URL: http://www.pubmed.com
20. Sarell.M, Cohen H.A, Physician nurses and parents attitudes to the knowledge about fever in
early childhood. Patient education and counseling: patient education and counseling : 2002
January: 46(1): 61-65. Available from : URL:http://www. Pubmed.com
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9.
Signature of the Candidate.
10.
Remarks of the Guide.
11.
Name and Designation.
11.1 Guide
11.2 Signature
11.3 Co-Guide
11.4 Signature
11.5 Head of the Department
11.6 Signature
12.
12.1 Remarks of the Chairman &
Principal
12.2 Signature.
25