"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PHOTOTHERAPY

FOR NEONATAL JAUNDICE AMONG

STAFF NURSESIN SELECTED

HOSPITALS OF RAICHUR”

Proforma for registration of subjects for

dissertation

yadvendra goyaner

navodaya college of nursing

raichur, 2007

6.BRIEF RESUME OF INTENDED WORK

6.1 Need for the study:

“The children of today are the adult of tomorrowthe deserve to inherit a safer, fairer and the healthier world there is no task more important than safe guarding their environment”

WHO,2003

The world IMR (Infant Mortality Rate) an on average is 43.52 per 1000 live and the world incidence rate for neonatal jaundice is 1-10 of about 1,33,000 Among that our country has the highest IMR estimation to about 34.6 per 1000 live birth and Indian Incidence rate for neonatal jaundice is 1-10 for about 1,12000.

(CIA world feet book 2007)

The most common and relatively non-invasive treatment for Jaundice is Phototherapy (Light therapy) around 1958, a very intelligent nurse in England noticed that the babies near the window in the hospital nursery were less likely to become Jaundiced. Eventually it was discovered that light causes a chemical reaction in the bilirubin changing it to a form which can be excreted directly without needing to be conjugated in the liver.1

Health care is continually changing in the way nurses organize and deliver care to clients for this reason, nursing knowledge must continuously grow and expand to keep nursing care approaches relevant, current , and appropriate, without, new knowledge, nursing can not improve techniques for therapies such as infant care, client education . Research based practice is essential if the nursing profession is to meet the needs of society for safe effective, and efficient nursing care.2

Neonatal hyperbilirubinemia or, known as jaundice of the new born is the most common clinical problem in the new born period.Visible jaundice is seen in 30 percent to 50 percent of infants and in about 10 percent the hyperbilirubinemia requires treatment. The critical father that leads to the accumulation of this yellow pigment bilirubin is the immaturing of the new borns liver and its inability to excrete the natural from of unconjugated bilirubin in the past two decades .phototherapy has become the routine both for treatment of neonates with hyperbilirubinwmia and for prophylaxis in high risk patients such as preterm infants3

Evidence for efficacy of treatment for neonates hyperbilirubinemia was limited.Phototherapy had an absolute risk reduction rate of 10 percent to 17 percent for prevention of serum bilirubin levels higher than 20mg/dl in healthy infants with Jaundice. There is no evidence to suggest that phototherapy for neonatal hyperbilirubinemia has any long-term adverse neurodevelopmental effects.4

New born infants often develop Jaundice which is concerning as an conjugated serum bilirubin can damage the developing brain.Since the 1960`s jaundice has been treated with phototherapy. Fibroptic phototherapy is new type of phototherapy.5

The purpose of this study was to evaluate the development of significant hyperbilirubinemia in a large unselected newborn population in a metropolitan area with particular attention to the relationship between type of feeding and incidence of neonatal Jaundice in the first week of life.6

Term new born with uncomplicated neonatal jaundice presenting in the first week of life photo therapy with white curtains hanging from the sides of the phototherapy unit the mean decrease in total serum bilirunin levels after 4 hour of

phototherapy. No difference in adverse events was noted in terms of hyperthermia or hypothermia weight loss, rash, loss stools or feeling intolerance.7

Curtain precautions must be taken to prevent injury to the infant during the use of phototherapy. Because the side effects that can occur with phototherapy include loose green stools due to accelerated intestinal transit time a rash “Bronze body syndrome “ (a bronzing or greenish brown discolouration of the skin if phototherapy is used in the presence of underlying liver disease ). Hyperthermia, priapism increased. Insensible water loss, lethargy , and possibly behaviour difficulties due to deprivation of visual stimulation because of eye batching8

”Phototherapy is new the preferred method of treatment for neonatal hyperbilirubinemia by virtue of its noninvasive nature and its relative freedom from major complications. It`s also convenient, easy to use, and inexpensive in terms of personnel, equipment , and disposals.Long-term experience with photo therapy has demonstrated it`s safety as well as efficacy, with high intensity phototherapy at saturation dose, even severe hemolytic hyperbilirubinemia can be adequately controlled; only pack-cell transfusions are required to correct the resulting anemia. Adequate monitoring of the well-being of the baby together with the bilirubin levels should always be observed carefully.The lamps shouldbe kept cool during phototherapy and be changed regularly after every 2000 hours of use. Observing such precautions willensure the efficacy and safety of photo therapy 11

6.2. REVIEW OF LITERATURE

Review of literature is to find out the methods for research study it helps to find out the aspects of study that must be included to confirm or refuse earlier finding. It provides basis to locate pertinent data and new ideas that need to be included in the present study. It helps the investigator find the comparative data that could be used for supporting present finding and drawing conclusion (Gupta K,1997)

A comparative study was conducted to assess management of neonatal hyperbilinubinemia. Pediatricians practices and educational needs,New Jersey, USA.They had selected pediatricians practices and beliefs regarding the management of neonatal jaundice by survey questionnaire was mailed to a random sample of 300 pediatricians selected from a list of 1623 New jersey, the result of the study the adjusted response rate of 49.1 percent.(in=365 was calculated from the 725 eligible respondents. They concluded the pediatrician practices regarding the low utilization of laboratory diagnosis for the quantification of jaundice after discharge and underestimation of risk factor that contribute to the development of severe hyperbilirubinemia are associated with initiation of photo therapy at lower than American Academy of pediatrics (AAP) recommended treatment para- meter and recognition of neonatal hyper –bilirubinemia as an important public health concern.15

A comparative study was conducted to assess photo therapy use in Jaundiced newborns in California. They had selected new born infant included were at least 37 weeks of gestation had birth weight ofat least 2500g. The primary out-come variable for the study was receipt of photo therapy total serum bilirubin and infant age in hours of the time bilirubin measurement. The result of the study showed that compared with chart review, photo therapy codes in the data base were 94.4 percent

sensitive and 100 percent specifies among the 47801 infants eligible, 2.3 percent received phototherapy. They concluded that clinicians provided photo therapy to only 54 percent of term infants with hyper-bilirubinenia.14

A descriptive study was conducted to assess the knowledge of primary health care worker’s about the description, causes effective treatment and photo therapy, and squealer of neonatal jaundice in Nigeria.They had selected a local government area i.e. an administrative district, south western part of Nigeria. Community health workers in this area were interviewed by means self administered questionnaire which focused on neonatal jaundice and its causes, treatment complication. The result of the study sixty six community health workers participated in survey and male to female ratio was 1.5 they concluded that primary health care workers may have inadequate knowledge and misconceptions on neonatal jaundice, they recommended regular training workshops and seminars for this purpose.9

A comparative study was conducted to detect irradiance and are effectiveness of photo therapy between inside and outside of different types of incubators in selected hospitals of Taiwan. Forty four incubators of two different types and with ages up to 18 years were included for the study in comparison with the measurement taken outside an incubator, the mean spectral irradiance detected with in a single walked incubator was scientifically decreased (p<0.001) in conclusion, the spectral irradiance received with in an incubator was influenced by the type of incubator and the well damage. Measuring the irradiance with in an incubator prior to photo therapy should be emphasized, especially for those incubators with severely damaged walls.10

A analytical study was conducted to assess the belief and feelings experienced by mother of children under photo therapy held in Brazil.They had selected the

mothers before the treatment and the data were collected in an interview performed with two open questions about the mother beliefs and feelings the result was 36.5 percent of the mothers feel fear and sadness: 27.3 percent with sorrow and fault. Regarding belief, 45.5 percent of the mothers think that the baby feels uncomfortable; 23.3 percent think that the baby is at risk of life, they concluded that the mothers feel insecurity and unhappiness before the photo therapy, treatment and they think that the treatment is incomfortable for the new born.13

A comparative study was conducted to assess preparation for discharge material satisfaction and new born readmission for Jaundice in Canada.They had selected the eligible mother were those who head spent less then 60 hours in hospital after an delivery of this group; 70.8 percent participated in telephone inter views conducted 1 month after their deliveries. Newborns who had presented with signs of Jaundice identified statement. The results of the participating new born, 45.5 percent signs of Jaundice and 32 percent were readmitted for Jaundice. Conclusion of study as effective co-ordination between community prenatal services and hospital linked, home phototherapy in the form of an integrated network for improved monitoring of newborns .12

A descriptive study was conducted to assess phototherapy and exchange transfusion for neonatal hyperbilirubinemia neonatal academic hospital at South Africa.They had selected the current leck of consensus regarding the management of hyperbilirubinemia in neonates in South Africa. Sever neonatal hyperbilirubinemia may cause Karnicterus and ultimately death and the severity of neonatal Jaundice is often underestimated clinically. The result of the study showed that a simplified version for use in a primary care setting is

also presented. All academic heads of neonatology department throughout South Africa were consulted in the process of drawing up this document and consensus was achieved.16

Problem of statement

"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PHOTOTHERAPY FOR NEONATAL JAUNDICE AMONG STAFF NURSES IN SELECTED HOSPITALS OF RAICHUR”

6.3 Objectives of the study:

  1. To determine the knowledge of staff nurses regard to photothererapy for neonatal jaundice.
  2. To evaluate the effectiveness of structural teaching programme on phototherapy for neonatal jaundice.
  3. To find the relationship between knowledge of staff nurses regarding therapy for neonatal jaundice with demographic variable.

6.4 OPERATIONAL DEFINITIONS :

  • Knowledge: It is the verbal response of staff nurses to the items in the interview schedule regarding photo therapy for neonatal Jaundice.
  • Staff nurses: It refers to the nursing personnel who have completed general nursing and midwifery courses with one year of experience and are working in a selected hospital at Raichur.
  • Neonate: In this study "Neonate" refers to a neo born between the age of birth to 29 Days.
  • Phototherapy: It refers to the therapeutic treatment by exposing the Jaundiced new born to fluorescent light.
  • Jaundice: It refers to the yellowish discolouration of the sclera, skin and mucus membrane due to accumulation of bilirubin in serum above normal level (0.1-1.0mg/dl)
  • Structured teaching program: It refers to systematically developed instrument designed for the group of staff nurses to provide information regarding phototherapy for neonatal Jaundice.
  • Effectiveness:It refers to the extent to which the planned teaching programme develop, has achieved the desired result as expressed in terms of gain in knowledge score regarding phototherapy as measured by the knowledge.

7. MATERIAL AND METHOD:

7.1. Sources of data:

Data will be collected from staff nurses of selected hospitals of Raichur.

  1. Research Design: The research approach adopted for this study is a pre-experimental one group pretest and post test design.
  1. Setting of the study: The study will be conducted in selected

hospitals of Raichur.

  1. Population: In this study population consists of staff nurses of selected hospitals of Raichur.
  1. Sample:The sample consists of 60 staff nurses working in different hospitals of Raichur.
  1. Sampling technique:Convenient sampling techniques will be used to select the subjects for the sample a convenient sampling is a non probability sampling technique which entails the use of most conveniently available people or subjects in a study the staff nurses who are working in the hospital and willing to participate in the study will be selected.
  1. Inclusion criteria for sampling:
  • Staff nurses who are willing to participate in the study.
  • Staff nurses who are able to read and write English.
  • Staff nurses who are present at the time of data collection.
  1. Exclusion criteria for sampling:
  • Staff nurses who are not willing to participate in the study.
  • Staff nurses who are unable to read and write English.
  • Staff nurses who are not present at the time of data collection.

7.2 Selected Variables:

Variables included in the present study are:

Dependent Variable:

Knowledge of staff nurses regarding photo therapy in neo natal Jaundice.

Independent Variable:

The utilization of the structured teaching programme will improve the knowledge of staff nurses with regard to care of two neonates under phototherapy for neonatal Jaundice.

Extraneous Variables:

1. Age: Age in the present study was categorized as

  • 20 -25 Years
  • 26 - 30 Years
  • 31 -35 Years
  • 36 -40 Years

2. Gender: Gender is categorized as

  • Male
  • Female

3. Religion:Religion of the sample in the present study is classified as

  • Hindu
  • Muslim
  • Christian
  • Others

4. Educational Status: Educational status for the present study was

categorized as

  • General nursing and mid wifery
  • General nursing and midwifery with One year experience
  • General nursing and midwifery with two year experience.
  • General nursing and midwrifery with three to ten year of experience
  1. Source of information : source of information for the present study was categorized as
  • Mass media
  • Literature
  • Health team member
  • Family members

7.3 Hypotheses

H1-There will be significant association between the age and knowledge of staff nurses an phototherapy for neonatal jaundice

H2-There will be significant association between the gender and knowledge of staff nurses on phototherapy for neonatal jaundice

H3-There will be significant association between the religion and knowledge of staff nurses in phototherapy for neonatal jaundice

H4-There will be significant association between the educational staff nurses on phototherapy for phototherapy for neonatal jaundice

H5-There will be significant association between the source of information and knowledge of staff nurses on phototherapy for phototherapy for neonatal jaundice

7.4 METHODS OF DATA COLLECTION

  • Data collection instrument:

A structured interview schedule will be developed and used for collecting the data. The interview schedule contains of two sections, namely part-I and part-II. Part-I consists of demographic data and part-II consists of question on knowledge regarding phototherapy for neonatal Jaundice.

Data Collection method

  • After obtaining permission from the nursing superintendent.
  • The investigator will be obtaining written permission from college authority (Ethical committee).
  • The data will be collected by face to face interview with the staff nurses by the investigator. Personally by using the structured interview schedule. The duration of the study will be of one month.

Plan for data analysis

Numerical data obtained from the sample will be organized and summarized with the help of descriptive statistics like percentages. Meanand standard deviation.

Testing the level of significance of hypotheses identification of relationship between knowledge of staff nurses on photo therapy for neonatal Jaundice with selected variable will be done with the help of inferential statistics like chi-square test and paired't' test will be used.

7.5 Projected out come

The mean post test knowledge score of staff nurses completing the structured teaching programme significantly higher than that of the mean Pre testknowledge score.

7.6Does the study require any investigation or interventions to be conducted on patient or other human or animal? If so please describe briefly.

Yes,the Study requires intervention of structured teaching programme and active involvement of staff nurses.

7.7 Has ethical clearance has been obtained from your institution in case of 7.6?

  • Permission will be obtained from institutional ethical committee, Navodaya college of nursing, Raichur.
  • Permission will be obtained from nursing superintendent, Navodaya Medical college and ResearchCenter.

8. List of references:

1.

2. Palricia A, potter, Anne Griffin perry.

“Fundamentals of Nursing”, 6th edition, mos by 2005;P. No.74.

3. J.Perinatal. 1989 mar; 9(1):69-71 PMID 2651596

4.TI,AU,SO; Pediatrics 2004 Jul; 114(1); e130-53 PMID 15231986

5. Mills JF, Tude hope D. The Cochrane Library (ISSN 1464-780X)

6. Giovanna Bertini, carlo Dani, Michele Tronchin. University of FlorenceSchool of Medicine, Florence, Italy.

7. S.Djoko muljanto, B.S.quah, Department of Pediatric,University Sains Malaysia.

8. Dorothy R Marlow, Barbara. A Redding“Text book of Pediatric”; 6thedition P. No 415-416.

9. B.Mc Public Health 2006 Jan 27; 6:19. PMID: 16441888

10. Zhongua Min Guoxiao Er Key xue Haiza zhi. 1996 mar-Apr; 37(2): 92-5 PMID- 8935405.

11. Clin Perinatal. 1991 Sep; 18(3): 423-39 PMID: 1934850.

12. Birth 2007 Jun, 34(2): 131-9 PMID: 17542817.

13. Revgaucha Enferm. 2005; Apr; 26(1): 56-6 PMID:16130677.

14. Pediatrics. 2003; May: 111(spt1): e555-61 PMID 12728109.

15. BMC Pediatr. 2006;Mar 6; 6:6 PMID: 16519797.

16. S Afr. med J. 2006; Sep; 96(9): 819-24 PMID 17068653.