RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Ms. RAJEE ELIZABETH VARGHESE,
MSc NURSING, 1st YEAR,
WOCKHARDT INSTITUTE OF NURSING,
#20/5, YELACHENAHALLI,
KANAKAPURA MAIN ROAD,
BANGALORE-560 078.
2 / NAME OF THE INSTITUTION / WOCKHARDT INSTITUTE OF NURSING, BANGALORE-560 078.
3 / COURSE OF STUDY AND SUBJECT / MSc NURSING, 1stYEAR,
OBSTETRIC AND GYNAECOLOGICAL NURSING.
4 / DATE OF ADMISSION TO THE COURSE / 31-10-2009
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING BREAST FEEDING TECHNIQUE AMONG PRIMIPARA MOTHERS IN SELECTED HOSPITALS, BANGLORE”.

INTRODUCTION:

“THERE IS NO SUBSTITUTE FOR MOTHER’S LOVE,

THERE IS NO SUBSTITUTE FOR MOTHERS MILK.”

William Gouge

The birth of the baby is an important event in the family. It is therefore important for the mothers to have a healthy baby. Breast milk is the best food for the babies as breast fed babies are healthier than formula fed babies.1

Child birth and breast feeding are unique experiences for women. They can only be cherished and nurtured by the health care workers, the baby friendly way.2

Human milk is a remarkable and renewable resource. It cannot be duplicated. Human milk has no substitute and the breast is nature’s apparatus for feeding the baby. Breast feeding is an art. In recognition of the immense importance of breast feeding, the Baby Friendly Hospital Initiative (BFHI) was launched by UNICEF/WHO in 1991. Breast feeding results in decreased problems such as infections and such other medical problems to the mother as well as the baby.2

Breast milk is not only the best but also the must for the babies. Lack of breast feeding – especially exclusive breast feeding during first few months of life is important as it reduces the risk factors for the infant mortality and the morbidity rate. WHO estimates that 1.5 million of infants life can be saved each year through increased breast feeding.3

Breast feeding is the most important thing for every mother. It is the unique experience to be cherished. Sometimes certain simple problems faced by the mothers results in stoppage of the breast feeding or started giving artificial milk or commercial infant formula feeds to the baby. Problems may be like the flat nipples, inverted nipples, breast engorgement, swelling, sore nipples or not enough milk. These problems are preventable if due care is taken from the pregnancy period to prepare for the breast feeding.4

Breast milk is the best source of nutrition for the baby. The foundation for breast-feeding is established in the first few weeks after delivery. Proper techniques are crucial for successful breast-feeding. Although some aspects of breast-feeding technique comes naturally, learning new skills also is important.5

Most of the mothers don't know the correct technique of breast feeding. This leads to many unnoticed and biased problems in babies and lactating mothers. These include improper nutrition to baby, altered growth, Oral thrush, low secretion of milk, inadequate feeds, nipple problems etc. There are few simple ways to practice the art of breast feeding techniques like starting breast feeding immediately after birth, proper positions, latching up and burping up the baby. Minor problems may occur during breast-feeding. But with proper planning, knowledge, and support, mothers can overcome these challenges and continue breast-feeding. Before the baby is born, attending classes, reading books, and watching videos that demonstrate breast-feeding techniques will help the mothers in promoting breast feeding practices.5

6.0 A BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY:

Breast feeding is one of the first bonding experiences between the mother and the child. Breast milk is constantly available and it is the safest and the most secure source of nourishment for the babies. It protects the baby against illness and ensures warmth and comfort of the baby that is held close to the nursing mother.1

Though breast feeding pattern is practical, economically efficient, needs very little investment, gives invaluable returns to the family, and the nation, breast feeding pattern particularly exclusive breast feeding pattern is on the decline, despite efforts at various levels. In India exclusive breast feeding rate at 6 months is only 40% (BPNI 2004). So it is important that midwives should attempt to promote enthusiasm and interest in breast feeding pattern.2

According to Centres for Disease Control and Prevention (CDC), a nationwide survey conducted in 2008, of the infants who were 19-35 months of age, 74% were breastfed at birth, 43% were breastfed at 6 months, 21% were breastfed at 12 months, 32% were exclusively breastfed at 3 months, and 12% were exclusively breastfed at 6 months.6

According to NIS (National Immunization Survey) results, 23 states have greater than 75% of women breastfeeding at hospital discharge. 10 states have greater than 50% of their infants being breastfed at 6 months of age. 12 states have greater than 25% of their infants being breastfed at 1 year of age. 10 states have greater than 40% of their infants being exclusively breastfed through 3 months of age. 8 states have greater than 17% of their infants being exclusively breastfed through 6 months of age. The 8 states of Alaska, California, Hawaii, Idaho, Oregon, Utah, Vermont, and Washington have achieved the three Healthy People 2010 objectives above. More than 60% of mothers of all racial/ethnic groups and of all education levels are initiating breastfeeding. Only teenagers with 51% initiating breastfeeding are less than the 60% initiation rate.7

A study conducted aimed at investigating the effectiveness of the computer assisted instruction about breast feeding technique during early stages of labour on knowledge and breast feeding technique among early primigravida mothers. The sample size comprises of 50 primiparous mothers who delivered and received care at Siriraj Hospital. The findings showed that the mean post test knowledge of breast feeding scores in the experimental group after computer assisted instruction was higher than the pre test scores before computer assisted instruction at a statistically significant less(P<0.001). The result suggest that the nurses in the labour room who are involved in breast feeding promotion should apply this computer assisted instruction to continuously promote successful breast feeding in adolescent mothers during early labour and through the post partum period.8

Breastfeeding technique is a learned skill for both mother and newborn. Breast feeding techniques comprises of commencement of breast feeding, breastfeeding positions, latching on, taking your baby off the breast and burping .9

From the observation in the post natal ward, the researcher found that the mothers especially primipara mothers were not aware of the facts regarding breast feeding techniques of their babies. They were often complaining of problems like baby is not sucking well, less milk, flat nipple, pain at the surgical site or at the episiotomy wound site, pain in the breast, breast engorgement etc.

Most problems in feeding the baby are related to the insufficient knowledge, inappropriate routines and lack of confidence of mothers and it can be easily managed or prevented by prenatal education, anticipatory guidance and adequate support. Many women decide the mode of infant feeding early in the antenatal period. Hence mothers need to be motivated to attend prenatal breast feeding classes.1

The world breast feeding week 2010 also laid emphasis on the 10 successful steps of breast feeding technique. Researches also proved that video assisted teaching programme will improve the knowledge of the participants of the study. As a result of the observations and related literature reviews the researcher realize that, giving a video assisted teaching programme to primipara mothers regarding the breast feeding technique will be beneficial for the improvement of the breast feeding practice, prevention of breast complications as well as for the health of the baby.

6.2 REVIEW OF THE LITERATURE

Review of literature of the present study has been organized under the following headings;

6.2.1 STUDIES RELATED TO THE KNOWLEDGE AND PRACTICE REGARDING THE BREAST FEEDING TECHNIQUE:

6.2.2 STUDIES RELATED TO VIDEO ASSISTED TEACHING PROGRAMME:

6.2.1 STUDIES RELATED TO THE KNOWLEDGE AND PRACTICE REGARDING THE BREAST FEEDING PATTERN:

A study was conducted to assess the knowledge and attitude of primigravida mothers regarding colustrum feeding on 50 primigravida mothers. A descriptive study was conducted. The finding of the study shows that the overall knowledge of the respondents was 41.9%. 5 point Likert scale is used to determine the knowledge of colustrum feeding. The results also showed that there is statistically significant association between the demographic variables and the knowledge level (p<0.05).10

A study was conducted to determine breast-feeding knowledge and practices among mothers before and after an educational intervention on breast feeding. Cross-sectional, descriptive study using a face-to-face questionnaire.158 women in the early postpartum period were taken as sample. 10.8% of women were not aware that they should offer colustrum to their babies. Only 43.7% of women commenced breast feeding within the first 30 minutes of giving birth. Prior to receiving the educational intervention, 55.7% of mothers knew how often they should feed their baby, 48.7% knew that they should breast feed their baby for two years together with additional food, although 55.1% of women did not know how to hold their breast during a feed. The mean pre-test score was 9.9, and the mean post-test score was 12.6. The difference between the mean pre- and post-test scores was statistically significant.11

A study was conducted to assess the knowledge, attitude and practice of breast feeding among employed mothers who were attending in the paediatric OPD’s in Salem. 60 mothers were selected by convenient sampling method and the findings revealed that majority of the mothers have average knowledge and 67% had positive attitude towards breast feeding but the practices were partially adoptive for 52% and completely adoptive for 43% of mothers. The study concluded that mothers had positive attitude towards exclusive breast feeding up to 6 months but practice is poor related to their ignorance.12

A study was conducted to assess the knowledge and confidence of the primipara mothers regarding exclusive breast feeding. Non probability purposive sampling technique was used to select the sample size of 110 registered primipara mothers. The findings were 15.45% had good knowledge, 65.45% had average knowledge and 19.09% of them had poor knowledge. 34.58% mothers were very confident; only 21.81% were not at all confident to breast feed their babies.13

A study was conducted in 30 primigravida mothers on their knowledge and practice of breast feeding in Ahmadabad, Gujarat. A knowledge check list and an observation schedule were used as tools. The findings revealed a significant gain in knowledge and practice in mothers who are exposed to a significant programme. This study was helpful for the investigator to construct the observation schedule and in designing research methodology to present the study.14

A study was conducted to test the mother’s knowledge regarding breast feeding. A simple education curriculum designed for use in promoting breast feeding, among low income postnatal women was developed along with reliable instruments, suitable for use as pre test and post test in such a group. Those who chose breast feeding scored higher in post test than those who bottle feed their infants. The results of the study show that the subjects of the experimental group exhibited a more positive breastfeeding attitude (88%), a higher 24 hours rooming-in rate - 87% and a higher exclusive breastfeeding rate - 79.6% during hospital stays and a higher exclusive breastfeeding rate - 75.9% for the one month postpartum period. Wide spread use of such information has the potential to improve the incidence of breast feeding among low income groups in the society.15

6.2.2 STUDIES RELATED TO VIDEO ASSISTED TEACHING PROGRAMME

A study was conducted to evaluate a video-based breastfeeding education programme provided to primigravida in the third trimester of pregnancy with the aim of deepening breastfeeding knowledge and enhancing skills of 60 mothers in Taiwan. Results suggest that the rate after the intervention has significantly increased from 32% to 44% at 1 week of age and from 18% to 28% at 9 months of age. Video-based breastfeeding education may contribute to breastfeeding knowledge and attitude and improved breastfeeding rate. Video-based breastfeeding education programme can achieve success in promoting breastfeeding and provide health professionals with an evidence-based intervention.10

A study was conducted to assess the effectiveness of video assisted nursing intervention on lumbo-sacral pain and activities of daily living among antenatal primi mothers at SRH. The study was conducted on 60 primi mothers and the post test knowledge of the mothers regarding pain and daily living activities are higher than the pre test scores before video assisted teaching programme. The findings indicate that 65.45% has good knowledge, while 15.45% had average knowledge and 19.09% had poor knowledge after the video assisted program. The study concluded that video assisted teaching programme will improve the knowledge of the mother and it helps in regaining their activity level than those who were not participated in the study.15

A video assisted study was conducted on error persistence and crisis management in the operation room. A quasi-experimental study with 39 mostly second- and third-year anaesthesiology residents from Boston-area teaching hospitals participated in this study. 40% were women, 60% were men; 62.5% were of European extraction, 38.5% were of East or South Asian origin. Effective (23% of cases) in which the clinician generates and tests diagnoses systematically; Diagnostic Vagabonding, (44%) in which the clinician jumps from diagnosis to diagnosis without systematically treating or ruling any one out, In-the-Doldrums, (5%) in which the clinician neither generates diagnoses nor treats symptoms; and Fixation (28%) in which the clinician focuses on treating one diagnosis and ignores other possible etiologies.11

6.3 PROBLEM STATEMENT:

“A study to assess the effectiveness of video assisted teaching programme on knowledge and practice regarding breast feeding technique among primipara mothers in selected hospitals, Bangalore.”

6.4 OBJECTIVES OF THE STUDY:

1.  To assess the knowledge and practice of primipara mothers regarding breast feeding technique in terms of pre-test scores.