RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFROMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the candidate and Address / Mr.JOMON MATHEW,Istyear M. Sc. Nursing Student,
Shanti Dhama College of Nursing,
Sunkadakatte, Magadi Main Road,
Bangalore.
2 / Name of the Institution / Shanti Dhama College of Nursing,
Sunkadakatte,
Magadi Main Road, Bangalore.
3 / Course of study and Subject / I year M. Sc. Nursing
Child Health Nursing
4 / Date of Admission / 27/10/2011
5 / Title of the Topic / “A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE(SIM) ON KNOWLEDGE REGARDING KANGAROO MOTHER CARE (KMC) AMONG III rd YEAR B.Sc. NURSING STUDENTS IN SELECTED COLLEGES, BANGALORE.”
6 / Brief Resume of the intended work
INTRODUCTION
New born care techniques are advancing in day-to-day life. In spite ofthose advancement in new-born care, a simple, low cost and effective method, i.e, Kangaroo Mother Care has been evolved in last few decades. Kangaroo care is a technique of direct skin - to - skin contact between mothers (or fathers) and their premature infants. It has shown to improve the mother’s psychological state, strengthen mother and infant bonding and stimulate maternal lactation.
Dr. Nils Bergman, Medical Superintendent of Mowbray Maternity Hospital in Cape Town, South Africa, has been researching KMC for twelve years. He believes restoring the original model of the infant-mother early care rather than our present incubator, bottle and feeding formula model can result in happier and healthier babies.1
Inferring from mammalian animal behaviour, believe that there is much wrong with our present way of treating the new-born. On recent findings in neuro-endocrinology. Bergman explains that it is the new-born infant itself which begins and directs the attachment process that is aided by skin contact with the mother. The mother responds to her infant’s “attachment program” and mother and infant set up a mutually stimulating system to which both respond by altering hormonal outputs. As an example, Bergman says that if the new-born is placed on the mother’s chest, within one hour, the baby will pull itself to the breast, find the nipple and begin nursing.
A recent research conducted by Dr. Joy Lawn of‘Save the Children’ which revealed the most effective intervention to reduce newborn and child deaths globally. The most fascinating finding arising from Dr Lawn’s study was the suggestion that up to half of these deaths could be prevented if Kangaroo Mother Care was readily available for preterm babies.2
6.1 Need for the study
Kangaroo mother care is a type of care for pre-term by their parents that provides early skin-to skin contact between the baby and the parents.
Low birth weight is one of the major health problems throughout the world. All such neonates can benefit from an effective and efficient human care model –“Kangaroo Mother Care”.Kangaroo Mother Care is important because it reduces pain and infections, shortens hospitalization, favorsbreast-feeding: in comparison to neonates treated conventionally. This method results in an earlier and better cognitive and motordevelopment3.
Worldwide more than 20 million babies are born each year with low birth weight. This represents 15.5% all births. Of these low birth weight babies, 95.6% are born in developing countries. The World Health Organization defines low birth weight baby at birth less than 2500grams. Of these babies, approximately one third die before stabilization or first twelve hours. Low birth weight and very low birth weight babies require intensive neonatal nursing and care from often limited resources at a vast expense4.
As India is a developing country, where in many places the availability of incubators and warmers are not seen. Hence Kangaroo mother care(KMC) method of caring can be used as a substitute for conventional way of caring the babies, which needs very less equipment and less costly way of caring with little knowledge.
Newborn care has greatly benefited from major technical advances in the last four decades, showing substantial improvements in the mortality and morbidity of the high-risk neonate. In addition, there has been a heightened awareness of the psychological and emotional burden encountered by the parents of the premature neonate. From birth, primary care for the infant is transferred from the mother to the professional caregivers of the neonatal unit5.
Today’s nursing students will be tomorrow’s full-fledged nurses who will be practicing at bed side.The educational offerings highlighting the knowledge and skills needed to provide kangaroo care safely and effectively enable the student nurses to overcome barriers to the practice of kangaroo care. In addition knowledgeable practitioners need for develop evidence based procedures that will lead to successful kangaroo care which can minimize the infant mortality rate to certain extant.
6.2 Review of Literature:
Review of literature is an essential step in the development of a research project. It helps to develop an insight into the area of investigation and directs the researcher to develop a plan.
The review of literature is presented under the following headings-
6.2.1 Literature related to Kangaroo mother Care (KMC).
6.2.2Literature related to Knowledge and attitudes of nursing staff mothers towards KMC
6.2.3 Literature related to effectiveness of self -instructional module
6.2.1 Literature related to KMC:
A descriptive study conducted on Kangaroo Mother Care(KMC) for Low Birth Weight infants; a randomized controlled trail, in a teaching institution with a tertiary level of neonatal intensive care unit(NICU) in Western India over a period of 9 months, among 206 neonates with birth weight <2000g. The subjects were randomized into two groups, the interventional group(KMC-103) received Kangaroo mother care and the controlled group(CMC-103) received conventional care. The results shown that, the KMC babies h better average weight gain per day(KMC: 23.99g vs CMC: 15.58g, P< 0.0001) This study shows Kangaroo mother care improves growth and reduces morbidities in low birth weight infants. It is simple, acceptable to mothers and can be continued at home6.
A descriptive study conducted on Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. The aim of this study was to determine whether the implementation of Kangaroo Mother Care (KMC) to low birth weight infants would improve physical growth, breastfeeding and its acceptability. A randomized controlled trial was performed over 16 months in which 110 neonates were randomized into a KMC group and a control group using a random number table. Weight, length and occipito-frontal circumference (OFC) were measured weekly for three months. The acceptability of KMC by mothers and nursing staff was assessed on day 7 after the start of KMC using a questionnaire incorporating the Likert scale. Breastfeeding rates were calculated based on history at end of three months. The exclusive breast-feeding rate at end of three months was 88% in the KMC group compared to 72% in the control group (P < 0.05).The result shown that, KMC improved physical growth, breastfeeding rates and was well accepted by both mothers and nursing staff7.
A descriptive study conducted on Kangaroo Mother Care. The review examined 15 studies in eight low- and middle-income countries, including three randomized controlled trials, and found a 51 percent reduction in newborn mortality when stabilized babies weighing less than four pounds (2,000 gm) received warmth and breast milk through continuous skin-to-skin contact on the chest of their mothers. The findings suggest that up to half a million newborn deaths due to preterm birth complications could be prevented each year if Kangaroo Mother Care were available for all preterm babies, particularly in low-income countries, where newborn mortality rates are highest. The results show that, 'Kangaroo Mother Care' Reduces Newborn Deaths More than 50 percent8.
A descriptive study conducted on Kangaroo-Mother Care: scientific evidence and impact on breastfeeding. The analysis of randomized trials showed that Kangaroo mother care consists in a protection factor to breastfeeding at discharge (relative risk 0.41, 95% confidence interval 0.25 to 0.68). The method was always associated with the following reduced risks: nosocomial infection at 41 weeks' corrected gestational age (relative risk 0.49, 95% confidence interval 0.25 to 0.93), severe illness (relative risk 0.30, 95% confidence interval 0.14 to 0.67), lower respiratory tract disease at 6 months (relative risk 0.37, 95% confidence interval 0.15 to 0.89) and better gain of weight per day (weighted mean difference 3.6 g/day, 95% confidence interval 0.8 to 6.4). Psychomotor development at 12 months' corrected age was similar in the two groups. The study concludes the Kangaroo mother care appears to reduce severe infant morbidity without any serious deleterious effect reported9.
A descriptive study conducted on Kangaroo mother care and the bonding hypothesis. The randomized controlled trial was conducted on a set of 488 infants weighing <2001 g, with 246 in the KMC group and 242 in the traditional care (TC) group. Two series of outcomes are assessed as manifestations of a mother's attachment behavior. The first is the mother's feelings and perceptions of her premature birth experience, including her sense of competence, feelings of worry and stress, and perception of social support. The second outcome is derived from observations of the mother and child's responsiveness to each other during breastfeeding at 41 weeks of gestational age. The studyshow that, a change in the mothers' perception of her child, attributable to the skin-to-skin contact in the kangaroo-carrying position. These results suggest that KMC should be promoted actively and that mothers should be encouraged to use it as soon as possible during the intensive care period up to the 40 weeks of gestational age. Thus, KMC should be viewed as a means of humanizing the process of early new-born care10.
A descriptive study conducted on Cerebral oxygenation responses during kangaroo care in low birth weight infants. The objective of this study was to evaluate the response of cerebral hemodynamics during Kangaroo care(KC) in low birth weight infants. Near infrared spectroscopy measured regional cerebral oxygenation (rSO2), heart rate (HR), respiration rate (RR) measured by electrocardiogram, and percentages of oxygen saturation (SpO2) measured by pulse oxymetry was monitored in 16 preterm infants (< 1600 g) in three sessions: before, during, and after KC. The study reports that, KC intervention appears to have influence on cerebral hemodynamics as well as cardiorespiratory parameters. The study concludes of rSO2 and HR might be associated with quiet sleep states. The results of this study may indicate the contribution of KC intervention to the activation of central nervous system and brain function11.
A descriptive study conducted on Use of “Kangaroo Care” to Alleviate the Intensity of Vaccination Painin Newborns. This study was a randomized case-control clinical trial. Subjects were 60 healthy full term newborns delivered in a general Hospital, in Iran, from March to July 2006. They were randomly assigned to case and control groups. The case group received 30 minutes skin to skin contact, whereas infants in the control group were put, wrapped in a blanket, aside the mothers. Behavioral changes of newborns were evaluated and observed 2 minutes before, during, and 3 minutes after the intervention. All procedures were filmed. The finding show, Mean pain intensity during the intervention v was significantly lower in the case group(P<0.006). Mean pain intensity 3 minutes after intervention was also significantly lower in the case group (P<0.021). Mean duration of crying was significantly lower in case group as well (P<0.001).The study concludes that, Kangaroo care may be used to decrease pain intensity in newborns undergoing painful procedures. According to the results of this study KMC decreased pain severity in neonates of the case group during the intervention and 3 minutes afterwards12.
6.2.2 Literature related to Knowledge and attitudes of nursing staff and mothers towards KMC
A descriptive study conducted on Knowledge and attitudes of nursing staff and mothers towards kangaroo mother care in the eastern sub-district of Cape Town, R.S.A. A multi-stage sample of 30 kangaroo care mothers admitted to the Helderberg District Hospital (HDH); six nurses from the HDH; and nine nurses from the seven antenatal clinics that the mothers attended. The respondents were interviewed using a pretested questionnaire. The result shown that, Most of the mothers lacked prior knowledge of KMC, and were only informed about it when they were admitted to the KMC ward. All of the nursing staff who were engaged in KMC (n = 15) had a positive attitude towards Kangaroo mother care13.
6.2.3 Literature related toSelf -Instructional Module
Valsa (2010) conducted a study to evaluate the effectiveness of a Self Instructional Module for staff nurses prepared on phototherapy for neonatal jaundice. The sample consisted of 50 Staff nurses from various hospitals in Mangalore. One group pre-test post-test design was used. The mean post-test knowledge scores were higher than pre test scores indicating the effectiveness of self -instructional module14.
Gracemol GS (2009) conducted a study on effectiveness of SIM on pregnancy related highrisk conduction among antenatal mothers in selected maternity hospital in Mangalore. The sample comprised of 50 antenatal mothers selected by using purposive sampling technique. One group pre-test post-test design was adopted. The findings revealed that the SIM was very effective (p<0.05). The mean post test score (56%) was higher than the mean pre-test score (87%)15.
6.3.Statement of Problem;
A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE(SIM) ON KNOWLEDGE REGARDING KANGAROO MOTHER CARE(KMC) AMONG IIIrd YEAR B.Sc. NURSING STUDENTS IN SELECTED COLLEGES, BANGALORE.
6.4 Objectives of the Study:
1. To Assess the existing knowledge ofB.Sc. nursing IIIrd year students regarding Kangaroo Mother Care(KMC) in terms of pre-test knowledge score.
2. To assess the effectiveness of SIM on B.Sc. nursing IIIrd year students regarding Kangaroo Mother Care(KMC) in terms of post-test knowledge scores.
3. To find out the association between knowledgeof B.Sc. nursing III year studentswith selected demographic variables.
6.5 Variables
Independent Variables: Self -Instructional Module.
Dependent Variable :Knowledge of B.Sc. nursing III year students
6.6 .Operational Definitions
Assessment:It refers to measurement of knowledge of III year B.Sc. nursing students.
Effectiveness: It means producing the intended result, In the present study it refers to knowledge gained by B.Sc. nursing III year students through SIM.