“A STUDY TO ASSESS THE EFFECTIVENESS OF BREAST FEEDING IN REDUCING PAINDURING DPT
VACCINATION AMONG INFANTS AT
SELECTED HOSPITAL OF
RAICHUR”
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
ARUNA JYOTHI
NAVODAYA COLLEGE OF NURSING RAICHUR.
DECEMBER -2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
- Name of the candidate: Ms. Aruna Jyothi And address M.Sc Nursing 1st Year,
Navodaya College of Nursing
Mantralayam Road,
Raichur – 584103.
- Name of the Institution: Navodaya College of Nursing,
Raichur
- Course of study : M.Sc Nursing 1st Year
and subject Child Health Nursing
- Date of admission : 25/07/2011
- Title of the Topic:
“A Study to Assess the Effectiveness of Breast
Feeding In Reducing Pain during DPT
Vaccination among Infants at
Selected Hospital of
Raichur”
- BRIEF RESUME OF THE STUDY
“Just as there is no substitute for mother’s love, there is no substitute for mother’s milk”
6.1 NEED FOR THE STUDY
The term infant is derived from the Latin word infants, meaning "unable to speak" or "speechless." It is typically applied to babies between the ages of 1 to 12 months.
Immunisation is one of the most importanttool for protecting individuals and the community from serious infectious diseases.
Vaccination is used to refer to all procedures for immunisation. The main aim of vaccination programme is to reduce the incidence and to eliminate a particular disease. It is the administration of antigenic material (vaccine) to stimulate the immune system of an individual to develop adaptiveimmunity to a disease.1
A vaccine is a biological preparation that improves immunity to a particular disease. Typicallyit contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins. The agent stimulates the body's immune system to recognize the foreign agent, destroy it, and "remember" it, so that the immune system can more easily recognize and destroy any of these microorganisms, that it later encounters infectious diseases.2
Diphtheria, Pertussis and Tetanus toxoid (DPT) is a combined vaccine,given to protect against diphtheria, pertussis and tetanus. 3 primary doses of DPT vaccine are given as intramuscular injection, at 4 weeks interval starting at 6 weeks of age, 10 and 14 weeks, with 2 booster doses at 15-18 month and 5 years.3
Pain is a global health problem which exists from the birth to the last stage of the life. It has been proven that infants are able to feel the painful stimulus and they routinely experience the pain in the hospitals especially during the vaccination procedure.
Infants are large number of communities therefore assessing thefactors that affecting their health promotion such as theprocedures that reduce pain is necessary. Vaccination isresulting from increased injections that these may delay invaccination program of children by parents and it can also cause frequent visits, additional costs and reduced resistance to diseasethat are preventable by vaccination.4
If the pain of vaccination does not relieve, it will be the causeof scaringchildren from all health care visits in future and itconflicts and challenges between the child, parents and health care professionals. Itis estimated that upto25% of adults have fear of needles with the most fear developing in childhood and about 10% of population avoids immunization and other needle procedure because of needle fear.Therefore any procedures in reducing pain of vaccination are included as an important part of health care.5
Infants are capable of developing a physiological memory of pain and it may be manifested for months in exaggerated form or activity. Many pharmacological and non-pharmacological interventions have been proved effective in pain reduction during immunisation. Despite the proven benefits of the immunisation procedure, the pain associated with these injections is a source of great anxiety and distress for the infant as well as the parents. The non pharmacological method of pain management helps reduce the pain perception, makes pain more tolerable, decreases anxiety and enhances well-being.6
Breastfeeding is the preferred method of feeding infants in the first year of life. It is one of the most useful, natural, non pharmacological, ready made form of intervention in reducing pain during painful procedures. WHO published an article on breast feeding for procedural pain. It suggested that breast feeding alleviate procedural pain in infants.7Some evidences have shown that breast feeding and other distraction methods are very effective in reducing pain during immunisation.8
Breast milk is the preferred agent of antino-ciception in newborns when compared with other non-pharmacological methods, since it is readily available and has no potential side effects. The analgesic effects of breast milk have been investigated in a limited number of studies, and. On the other hand, the analgesic effect of formula and its components (fat and protein), are effective in reducing pain. Breast milk not only reduces pain as it is rich source of nutrients and other agents that fight against infections.9
Composition of human breast milkFat
total (g/100 ml) / 4.2
fatty acids - length 8C (% ) / trace
Polyunsaturated fatty acids (%) / 14
Protein (g/100 ml)
Total / 1.1
casein 0.4 / 0.3
a-lactalbumin / 0.3
Lactoferrin / 0.2
IgA / 0.1
IgG / 0.001
Lysozyme / 0.05
serum albumin / 0.05
ß-lactoglobulin / -
Carbohydrate (g/100 ml)
Lactose / 7
oligosaccharides / 0.5
Minerals (g/100 ml)
Calcium / 0.03
Phosphorus / 0.014
Sodium / 0.015
Potassium / 0.055
Chlorine / 0.043
Breastfeeding is considered a combined analgesic intervention because several aspects of breastfeeding (e.g., holding the child, skin-to-skin contact, the sweet-tasting milk and the act of sucking) may individually attenuate pain responses
Because of all these above benefits of breast milk, the researcher felt to assess the effectiveness of breast feeding in reducing pain during immunisation.
6.2 REVIEW OF LITERATURE
A review of literature on the research topic makes the researcher familiar with the existing studies and provides information which helps to focus on a particular problem, lays a foundation upon which to base new knowledge. It creates accurate picture of the information found on the subjects.
An experimental study was conducted to assess the effect of breast feeding and distraction in reducing pain due to vaccination in infants, in Karaj Medical University, Iran. a sample of 153 healthy infants were randomly assigned to 3 groups namely, distraction-51, breast feeding group-51 and control group-51.the data were gathered by using questionnaire for demographic data and the symptoms associated with pain while DPT vaccination measured by modified behavioural pain scale used for assessment of pain the results of ANOVA showed that f=132/789, df=2, p=0/00. The study concluded there was significant difference (p<0/00) reduction in breast feeding group than distraction group.10
A quasi experimental study was conducted on role of breast feeding in reducing pain responses during injectable immunisation among infants, inMangalore, Karnataka. A sample of 40 infants receiving 1st, 2nd and 3rd dose of DPT immunisation were selected ,out of which 20 assigned to the experimental group and 20 for control group by non probability purposive sampling technique. The interview and record analysis was done to collect the demographic data and technique of observation was used to assess pain scores by using infant pain scale. The results of the study in experimental group .i.e. 40 percent of infants had pain scores range of 4-5; where as in control group 100 percent infants had pain scores of 6-7. The study concluded that breast feeding plays an effective role in reducing pain during immunisation.11
An experimental study was conducted on the use of breast feeding for pain relief during neonatal immunisation injections in AK denzi University, Antalaya, Turkey. Infants were assigned randomly to 2 groups, experimental -33(breast feeding), and control-33.the data was collected by audio recording of infants cry up to maximum time of 3 min, the total duration was significantly shorter in the breast feeding group (M ±SD; 35.85±40.11 seconds), versus the control group (M± SD; 76.24 ± 49.6 seconds). The study concluded that the duration of cry was shorter in experimental group than in control group.12
A qausi experimental study was conducted to assess the effectiveness of oral sucrose 25%, breast feeding, and sterile water in pain during routine heel prick, at a hospital of Turkey. A healthy infants n=130 were undergoing a routine heel prick were assigned to 4 groups, group1=35 was given oral sucrose 25%, group2=33 was given mother’s milk, group3 =34 was given sterile water and group4 =28 were the control group without any intervention. Crying time and heart rate was assessed over 3 min, from the time of heel prick. The infant behavioural coding scale was used to measure variables. The results concluded that there was significant reduction of pain only in oral sucrose 25% group and breast feeding group, the scorings of both groups were 3 versus5.(p=0.001).13
A quasi experimental study was conducted in two maternal and child health centres in Jordan, to determine the effects of breast feeding on pain relief during neonatal immunisation injections. The neonates were divided into 2 groups of 60 neonates for each group.i.e. intervention group (breast feeding ) and control group (without breast feeding). The interview method was used to collect the demographic data and pain responses were assessed by using facial pain rating scale and neonatal pain scale. Neonates were observed during routine immunisation. The results shown that mean crying time score was decreased (26 seconds) in intervention group and (51 seconds) in control group. The study concluded that the crying time was shorter in intervention group than in the control group.14
6.3 STATEMENT OF THE PROBLEM:
“A study to assess the effectiveness of breast feeding in reducing pain during DPT vaccination among infants at selected hospital of Raichur.”
6.4 OBJECTIVES OF THE STUDY:
- To assess the pain responses of infants, 10 minutes after DPT vaccination in experimental group and control group.
- To compare the pain responses of infants of experimental group and control group, 10 minutes after DPT vaccination.
- To evaluate the effectiveness breast feeding in reducing pain among infants during DPT vaccination.
- To determine the association between the pain responses of infants after DPT vaccination with selected variables.
6.5 OPERATIONAL DEFINITION
1.Effectiveness:For the present study ‘effectiveness’ refers to determining the extent to whichbreast feeding has reduced the pain during DPT vaccination.
2. Breast feeding:For the present study ‘breast feeding’ refers to the act of giving breast milk by the mothers to infants during DPT vaccination.
3. Infants:For the present study ‘infants’ refers to the babies at the age 6th week who are receiving 1st dose of DPT vaccination.
4. Pain:For the present study ‘pain’ refers to an unpleasant sensory and emotional experience of an infant with DPT vaccination.
5. Vaccination:For the present study ‘vaccination’refers to the infants who are receiving prophylaxis against diphtheria, pertusis and tetanus.
6.6 HYPOTHESES
On the basis of the objectives the following hypotheses have been formulated,
H1: There will be a significant difference in pain responses of infants, 10 minutes afterDPT vaccination, between experimental group and control group.
H2: There will be a significant relationship between breast feeding and pain responses of infants among experimental group and control group
H3: There will be a significant association between pain responses of infants in experimental group and selected demographic variables.
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA:
Design:
True experimental, post test only design will be used for the present study
R X O1 (Experimental group)
R O1 (Control group)
Setting of the study:
The present study will be conducted in Raichur Institute of Medical Science, Raichur and is situated near gunj road, Hyderabad highway.
Raichur is located in northern pole of Karnataka and is bounded by the Krishna River on the north and Tungabhadra River on the south. Raichur is considered the Rice bowl of India. The population of Raichur district is 19,24,773 and population density of 228 inhabitants per square kilometre. It consists of 5 towns. The total area of this district is 8440 sq kilometre. The population of Raichur city is
2, 32,456; of which males are 117,408 and females are 115,048. The total children (0-6) is population27,924, of which 14,286 boys and 13,638 girls.
Population:
The population of the present study comprises of infants at the age of 6th week, who are receiving 1st dose of DPT vaccination at Raichur Institute of Medical Science, Raichur.
Sample size:
Sample size for the present study consists of 60 infants i; e 30 infants in experimental group and 30 infants in control group.
Sampling technique:
For the present study, convenient sampling technique will be used to select the hospital and the simple random technique will be used to select the sample i.e. every alternate infant will be allotted to experimental group and control group.
Inclusion criteria:
The study includes the infants:-
-who receiving 1st dose of DPT vaccination
-who come for DPT vaccination in Raichur Institute of Medical Science, Raichur
-available at the time of data collection
-mothers, who are willing to participate in the study
Exclusion criteria:
The study excludes the infants:-
-who are not vaccinated in Raichur Institute of Medical Science, Raichur
-who are receiving 2nd or 3rd dose of DPT vaccination
-who are not accompanied with mother
-mothers, who are not willing to participate in the study
-with current illness like fever, seizures, any reaction towards vaccination.
Selected variables:
The selected variables of the present study are:-
-Independent variable: Is breast feeding during DPT vaccination.
-Dependent variable: Is the pain responses of infants during DPT vaccination.
Extraneous variables:
- Gender: refers to the sex of the infants, receiving DPTvaccination
a.Baby girl
b.Baby boy
- Mother’s education: refers to the educational status of infant’s mother
a.Illiterate
b.Primary
c.Secondary
d.PUC and above
- Religion:refers to the system of faith of worship, by infants parents
a.Hindu
b.Muslim
c.Christian
d.Others.
4. Current weight of the infant:
a. < 3 kgs
b. 3.1- 3.5 kgs
c. 3.6- 4 kgs
d. 4.1 & above
5. Previous exposure to any vaccination / injection
a. Yes
b. No
c. If yes, specify…
7.2 METHODS OF DATA COLLECTION:
Data collection instrument:
The instrument used to collect data are categorised as,
Part 1: It consists of an interview which includes socio demographic variables.
Part 2: It consists of assessment of pain responses of infants by usingModified Riley Pain Scale for Infants.
Data collection:
After obtaining prior permission from the concerned authorities, data willbe collected to assess the pain responses of infant by using Modified Riley Pain Scale for Infants.
7.3 PLAN FOR DATA ANALYSIS:
Data analysis is the systematic organisation and synthesis of research data, and the testing of the research hypothesis by using the obtained data.
The following methods are planned to analyse the data:-
-Frequency and percentage distribution will be used to summarize the sample characteristics.
-Mean, standard deviation and paired‘t’ test will be used to evaluate the effectiveness of breast feeding during DPT vaccination.
-Unpaired’ test will be used to compare pain responses of experimental group and control group.
-Chi-square test will be computed to find out the association between pain responses of infants after DPT vaccination with selected variables.
7.4 PROJECTED OUTCOME:
The result of the present study will give an insight for the future researcher to inculcate different non-pharmacological methods in reducing pain during vaccination of infants and also helps to improve the skills of nurses in reducing pain during vaccination.
7.5 DOES THE STUDY REQUIRE ANY INVESTIGATION OF INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR HUMANS OR ANIMALS? IF SO, DESCRIBE BRIEFLY?
Yes, the study requires intervention because mothers breast feeding will be used to reduce pain during vaccination, hence the investigator will assess the effectiveness of breast feeding during vaccination.
7.6 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION?
- Permission will be obtained from Institutional Ethical Committee, Navodaya College of Nursing, Raichur.
-Permission will be obtained from the Medical Superintendent, Raichur Institute of Medical Sciences, Raichur.
-Consent will be obtained from all mothers of infants (participants).
8. LIST OF REFERENCES:
- Gartner LM, Morton J, Lawrence Aliwalise RA,et al, Breast feeding and the use of human milk, Paediatrics 2005; 115: 496-506
- Shah P.S, L, Shah, Breast feeding and breast milk to alleviate procedural pain in neonates; a systematic review, Breast feed Med 2007;2:74-8
- /for patient /vaccination /dpt.asp.
- Ranger M, Johnston C, Anand KJ. Current controversies regarding pain assessment in infants. Sem Perinato.2007; 31(5): 283-288.
- Bente JV, Geir EE, Gerd K. Psychometric testing of a Norwegian version of the Premature Infant Pain Profile: An acute pain assessment tool. Int J Nurs Pract 2006; 12(6):334-336.
- Larry G, Lisa WM, Barbara LP, Elliot MB (2002). Breastfeeding is Analgesic in Healthy Newborns. Pediatrics, 109(4): 590-93
- American Academy of Paediatrics vol 119 No 5, May 1,2007,pp e1184-e1198.
- Altun-K oroglu o,ozek,E,Bilgen H, Cebeci.D,Hind milk for procedural pain interm neonates; Turk,J.Pediatrics.2010;52;623-629
- International Journal of Current Scientific Research 2011;1(4);183-186
- The Nursing Journal of India’s role of breast feeding in pain responses during immunisation, vol.c11, no.8, 2011
- Ozer Zc Turkey the use of breast feeding for infants to reduce pain.
- Turkey International Journal, Bilgen et al. the effectiveness of oral sucrose 25%, breast feeding and sterile water.
- Abel RA,Az EC,Dein.N (2009) effect of breast feeding on pain relief during immunisation; International Journal of Nursing Practice;15(2);99-15
9. Signature of the Candidate:
10. Remarks of the Guide :
11. Name and Designation of the
11.1 Guide : Mrs.Shameem G.U
Vice Principal & HOD
Child Health Nursing
Navodaya College of Nursing
Raichur
11.2 Signature :
11.3 Co-guide (if any) :
11.4 Signature :
11.5 Head of the department : Mrs.Shameem G.U
Vice Principal & HOD
Child Health Nursing
Navodaya College of Nursing
Raichur
11.6 Signature :
12. Remarks of the Chairman
And Principal :
12.1 Signature :