SUBMITTED BY:-

MR. AVADHESH KUMAR

1ST YEAR M.Sc. NURSING

CHILD HEALTH NURSING

2008- 2010

SARVODAYACOLLEGE OF

NURSING, BANGALORE- 79

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RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE,

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION:

1. / NAME OF THE CANDIDATE AND ADDRESS / MR.AVADHESH KUMAR,
1ST YEAR M.SC. (NURSING) SARVODAYA COLLEGE OF NURSING NO.11/2 MAGADI ROAD, AGRAHARA, DASARAHALLI, BANGALORE.
2. / NAME OF THE INSTITUTION / SARVODAYA COLLEGE OF NURSING AGRAHARA DASARAHALLI, BANGALORE
3. / COURSE OF STUDY AND SUBJECT / 1ST YEAR M.SC NURSING CHILD HEALTH NURSING
4. / DATA OF ADMISSION OF THE COURSE / 06/06/2008
5. / TITLE OF THE TOPIC / “A Study On The Effect Of Hands On skill training On Neonatal Resuscitation Among Students In Selected Nursing Colleges, Bangalore.”

6. BRIEF RESUME OF INTENDED WORK

“Families with babies and families without babies are sorry for each other”.

~Ed Howe

Passage through the birth canal is a hypoxic experience for the fetus, sincesignificant respiratory exchange at the placenta is prevented for the 50-75 secduration of the average contraction. Newborn infants normally start to breathe without assistance and often cry well. By 1 minute after delivery most infants are breathing well or crying. If an infant fails to establish adequate, sustained respiration after birth, the infant is said to have neonatal asphyxia. These infants do not breathe well after birth. Neonatal asphyxia will result in hypoxia after delivery if the infant is not rapidly resuscitated.1

Resuscitation is a series of actions taken to establish normal breathing, heart rate, color, tone and activity in an infant with depressed vital signs (i.e. a low Apgar score). All infants who do not breathe well after delivery (i.e. infants with neonatal asphyxia) or have a 1 minute Apgar score below 7 need immediate resuscitation. The lower the Apgar score the more urgent is the need for resuscitation. Any infant who stops breathing or has depressed vital signs at any time after delivery or in the nursery also requires resuscitation. Therefore, it is important to formally assess the clinical condition of all infants after delivery.2

Approximately 5% to 10% of the newly born population requires some degree of active resuscitation at birth (e.g., stimulationto breathe),and approximately 1% to 10% born in the hospital are reportedto require assisted ventilation. More than 5millionneonatal deaths occur worldwide each year.It has been estimated that birth asphyxia accounts for 19% ofthese deaths, suggesting that the outcome might be improved formore than 1million infants per year through implementation ofsimple resuscitative techniques. Although the need for resuscitationof the newly born infantoften can be predicted, such circumstances may arise suddenlyand may occur in facilities that do not routinely provide neonatalintensive care. Thus, it is essential that the knowledge and skillsrequired for resuscitation be taught to all providers ofneonatalcare.3

Neonatal resuscitation is a complex procedure that requires the use of specialized knowledge and skills in an emotionally charged and stressful situation. Knowledge about neonatal resuscitation, frequent performance of skills, and comfort level with skill performance is dimensions of quality implementation of neonatal resuscitation. Inexperienced nurses are at very high liability risk. Neonatal nurse lacking the knowledge to detect significant symptomatology will not be able to competently assess the neonate, anticipate complicating factors, or effectively plan for care. This type of nurses will not be reassuring to a parent, physician or other nurses.4

6.1 NEED FOR THE STUDY

Although intrauterine asphyxia is an established cause of neurologic damage, including cerebral palsy, determining the exact role of intrapartum asphyxia as a cause of permanent neurologic damage in a fetus is complicated. It is estimated that the overall incidence of neonatal encephalopathy attributable to intrapartum asphyxia alone (in the absence of antepartum abnormalities) is 1.6 per 10,000 births.Prematurity and infections during pregnancy both appear to be more common causes of cerebral palsy than intrapartum events. Infants weighing <1500 g at birth constitute approximately 25% of all cases of cerebral palsy.5

Every year, there are an estimated 4 million neonatal deaths, accounting for almost 40% of deaths in children younger than 5 years. About a quarter of global neonatal deaths occurs in India, which has a neonatal mortality of neonatal mortality are crucial if child mortality is to be reduced globally and in India.Globally, the main causes of neonatal deaths are thought to be preterm birth (28%), sepsis or pneumonia (26%), and birth asphyxia (23%). In the South East Asia Region, WHO has attributed 30% of neonatal deaths to preterm birth, 27% to sepsis or pneumonia, 23% to birth asphyxia, 6% to congenital abnormalities, 4% to tetanus, 3% to diarrhea and 7% to other cause.6

In a study it was found that birth asphyxia kills 0.7 to 1.6 million newborns a year globally with 99% of deaths in developing countries. Effective newborn resuscitation could reduce this burden of disease but the training of health-care providers in low-income settings is often outdated. Our aim was to determine if a simple one day newborn resuscitation training (NRT) alters health worker resuscitation practices in a public hospital setting in Kenya. Trained providers demonstrated a higher proportion of adequate initial resuscitation steps compared to the control group. Implementation of simple, one-day newborn resuscitation training can be followed immediately by significant improvement in health workers' practices. However, evidence of the effects on long term performance or clinical outcomes can only be established by larger cluster randomized trials.7

As the teaching community strive to familiarize nursing students with all of the crucial issues surrounding neonates. Health care workers all over the world face a lot of challenges. We need more nurses and other medical staff.Considering the positive effect of giving hands on skills training to studentsthe researcher felt it necessary to conduct this study.

HYPOTHESIS:

H1: There is an increased skill on neonatal resuscitation among students after hands on skill training than before hands on skill training.

6.2 REVIEW OF RELATED LITERATURE

The review of literature is a summary of current knowledge about a particular practice problem and includes what is known and not known about the problem. The literature is reviewed to summarize knowledge for use in practices or to provide a basis for conducting a study.

A study was conducted to determine the safety and efficacy of neonatal nurses attending at-risk deliveries. Twenty-three children required intermittent positive pressure ventilation via endotracheal tube and/or cardiac massage. All but five of these were deliveries where both a neonatal nurse and pediatricians were present. Three of these five deliveries had foetal tachycardia. There were 33 deliveries managed by the neonatal nurse alone where the 1-min Apgar was three or less. All achieved a 10-min Apgar of seven or greater. Over the study interval, the proportion of deliveries attended only by a neonatal nurse increased and intensity of resuscitation administered decreased. Conclusion: Appropriately trained neonatal nurses can safely resuscitate newborns. Addition of foetal tachycardia to the indications for pediatrician attendance identifies infants likely to require more resuscitation.8

Astudy was conducted on new evidence-based guidelines, it have been launched with recommendations that may impact how resuscitations, particularly of low birth weight infants, are enacted. To determine current resuscitation practices in Maternity units in Ireland and benchmarked these results to a recent study in the United States. Neonatal resuscitation program is now an obligatory feature in all NICU's in Ireland compared to the 1990s when resuscitation training was disorganized and inconsistent. Variations in resuscitation practices still exist among different units. Many units may not be able to apply 2006Neonatal resuscitation program guidelines especially for very low birth weight infants unless there is a significant investment in air/oxygen blenders, pulse oximeters, CO2 detectors and resuscitators that control peak pressures.9

A study was conducted on,various methods have been used to revive apparently stillborn infants; many were of dubious efficacy and had the potential to cause harm. Based largely on studies of acutely asphyxiated term animal models, clinical assessment and positive pressure ventilation have become the cornerstones of neonatal resuscitation over the last 40 years. Over the last 25 years, care of extremely preterm infants in the delivery room has evolved from a policy of indifference to one of increasingly aggressive support. The survival of these infants has improved considerably in recent years; this has not, however, necessarily been due to more aggressive resuscitation. Clinical assessment of infants at birth is subjective. Also, many techniques used to support preterm infants at birth have not been well studied and there is evidence that they may be harmful. It may thus be argued that many of our well-intentioned resuscitation interventions are of dubious efficacy and have the potential to cause harm. 'Resuscitation' is an emotive term which means 'restoration of life'. Death, thankfully, is a rare presentation in the delivery room. Therefore, concerning neonatal 'resuscitation', it is time to 'call it' something else. This will allow us to dispassionately distinguish preterm infants who are dead, or nearly dead, from those who are merely at high risk of parenchymal lung disease. We may then be able to refine our interventions and determine what methods of support benefit these infants most.10

Astudy wasconducted on effective andefficient on time techniques of newborn resuscitation, because dubitation or delay may be very dangerous for the infant. In Italy courses of equipment in newborn resuscitation are regularly performed, but an excellent level of technique can be obtained only with continuous daily practice. Then, particularly in little hospitals where it is unusually necessary to act resuscitation on a newborn, courses of simulation for medical and nursing staff would be opportune to prevent neonatal handicap and to deal with the professional liability in the best way. The Italian current jurisprudence, in fact, has slowly confined the application of 2236 article of civil code about professional liability in particularly difficult efforts. The Italian law asserts that a professional specialist is trained to be able resolve any type of problem among those of his specialist competence, even if technically very difficult. It should be opportune to train health staff with practical exercises, in order to obtain complete technical skills in all neonatal centres.11

It was found that the need for conventional mechanical ventilation (CMV) is a common one in the neonatal intensive care unit (NICU). The goals of CMV are to facilitate adequate gas exchange, minimize the risk of lung injury/damage, decrease the patient's work of breathing, and optimize the patient's comfort. Although time-cycled, pressure-limited ventilation remains the most common CMV modality, volume-cycled ventilation, assist-control ventilation, pressure-support ventilation, and pressure-control ventilation are sometimes used in the NICU. Pressure-regulated volume control, volume-guaranteed ventilation, volume-assured pressure-support ventilation, and proportional-assist ventilation are emerging hybrid modes of CMV. Although CMV is frequently life saving, it can cause complications if improperly used. Nurses are responsible for the ongoing assessment and care of infants undergoing CMV and are becoming frequently more involved in the weaning process of CMV. This article provides an overview of conventional ventilation, with a focus on common modalities, and ventilation-related nursing interventions.12

6.3 OBJECTIVES OF THE STUDY

  1. To assess the practice of students on Neonatal resuscitation before and after Hands On skill training.
  2. To evaluate the effectiveness of hands on skill training on neonatal resuscitation among students.
  3. To find out the association between practice score on neonatal resuscitation and selected variables.

OPERATION DEFINITION

EFFECT-Itrefers to the significant improvement in the skill of students regarding neonatal resuscitation after hands on skill training and it is elicited by post test.

HANDS ON SKILL TRAINING- It refers to the demonstration ofneonatal resuscitation with necessary equipments.

NEONATAL RESUSCITATION-It refers to Neonatal Resuscitation is an intervention after a baby is born to help him\ her breathe and to help his\ her heart beat. Resuscitation is helping with Airway, Breathing, and Circulation.

STUDENTS- It refers to those who are studying in 4th year B.Sc. Nursing.

Variables

Independent variables -Hands On skill training onneonatal resuscitation.

Dependent variables -Skills on neonatal resuscitation

Demographic variable - Sex, Age,

- Has attended any workshop, seminar, conference,

- Source of information

7. MATERIAL METHODS

7.1. SOURCE OF DATA

Data will be collected from students in selected nursing colleges in Bangalore.

7.2 METHODOLOGY OF THE STUDY

  1. Research design- Quasi Experimental design- one group pre- test, post- test design
  2. Sample - Students in selected nursing colleges
  3. Sampling criteria -

Inclusion criteria:

  • Students who are available at the time of study.
  • Students who are willing to participate in the study.
  • Students who can speak and write English.

Exclusion criteria:

  • Students who are appearing for supplementary examination.
  • Students who are not willing to participate in the study.
  • Students who are not available at the time of data collection.
  1. Sample technique- Simple Random Sampling
  2. Sample size - 50 Student nurses
  3. Method of data collection - Questionnaire method.
  4. Tool for data collection - Self-Structured practice checklist.
  5. Method of data analysis- The researcher will use appropriate statistical technique for data analysis and present in the form of table and diagrams. The data will be analyzed by using descriptive and inferential statistics. Frequency and percentage distribution will be used for the demographic profile. Practice of students on Neonatal resuscitation will be analyzed by mean and standard deviation.Chi- Square will be used to determine the association betweenpractice on neonatal resuscitation and selected variables.
  6. Duration of the study - 4 weeks

7.3Does the study require any investigation or intervention to be conducted on the patient or other human beings or animals?

NO

7.4 Has ethical clearance been obtained from your institution?

YES, ethical clearance report is herewith enclosed.

LIST OF REFERENCE:

  1. Newborn life support; resuscitation council (UK). Available on: URL://http:
  1. Deve woods. Perinatal education programme- care of infant at birth. [One line] 2008 Sept 4 [cited on 19- 10- 2008]; V- 36, P- 31- 51. Available on: URL://http:
  1. Saugstad OD. Practical aspects of resuscitating asphyxiated newborn infants. EurJ Pediatr. 1998; P.157. Available on: URL://
  1. A Jukkala, S. Henley. Applied nursing research- Readiness for neonatal resuscitation. [Serial online] 2003 April. [Cited on 19- 10- 2008]; V- 20, (issue 2), page no- 78- 85. Available on:URL://
  1. The relationship between intrapartum Asphyxia and neurologic injuries in the fetus. Available on:URL://
  1. Lawn J E, Cousens S, Zupan J; Intentional journal of Epidemiology; 2005 May 28. V- 365. (Issue 9474) page no. 891- 900. Available on:URL://
  1. Opiyo N, Were F, Govedi F, Fegan G, Wasunna A, English M. “Effect of newborn resuscitation training on health worker practices in Pumwani Hospital, Kenya”. Plos one.3(2):e1599,2008 feb[cited on2008 October 15]. Available on: URL:
  1. Neal.D, Stewart. D, Grant. C. C. “Nurse- ledNewborn Resuscitation in an urban neonatal unit. Acta Paediatr. 2008 August 27 [ cited on 2008 October12]URL:
  1. Braima O, Ryan CA. “Neonatal resuscitation programme guidelines 2006: ready steady go!” Ir Med J.2008 May;101(5):142-4. [cited on 2008 October15]Availableon:URL:
  1. O'Donnell CP. Resuscitation of extremely preterm and/or low-birth-weight infants -time to 'call it'Neonatology. Jun 5; 2008; V.93 (4); P 295-301.

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  1. Molinelli A, Landolfa MC, Rocca G, D'Agostino I, Nardelli E. Newborn resuscitation. From necessity of continuous practice to professional liabilityMinerva Pediatr. Aug 2008; V.60 (4): P. 411-5.

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  1. Snow TM, Brandon DH. A nurse's guide to common mechanical ventilation techniques and modes used in infants. Nursing implications. Adv Neonatal Care. Feb; 2007; V. 7(1): P. 8-21.Availableon:URL:

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