RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
1. / NAME OF THE CANDIDATEAND ADDRESS / Mr.PRASAD.N.PATIL
IST YEAR M.Sc NURSING STUDENT, N.D.R.K. COLLEGE OF NURSING, B.M.ROAD, HASSAN-573201
2. / NAME OF THE INSTITUTION / N.D.R.K. COLLEGE OF NURSING, B.M.ROAD, HASSAN-573201
3. / COURSE OF THE STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
(CHILD HEALTH NURSING)
4. / DATE OF ADMISSION OF THE COURSE / 25-05-2007
5. / TITLE OF THE STUDY / “EFFECTIVENESS OF THE INCUBATOR CARE MODULE ON KNOWLEDGE AND SKILL OF THIRD YEAR B.Sc NURSING STUDENTS FOR NEONATES ADMITTED IN THE NEONATAL INTENSIVE CARE UNIT AT S.C. HOSPITAL, HASSAN, KARNATAKA.”
5.1 / STATEMENT OF THE PROBLEM / “Á STUDY TO ASSESS THE EFFECTIVENESS OF THE INCUBATOR CARE MODULE ON KNOWLEDGE AND SKILL OF THIRD YEAR B.Sc NURSING STUDENTS FOR NEONATES ADMITTED IN THE NEONATAL INTENSIVE CARE UNIT AT S.C. HOSPITAL, HASSAN, KARNATAKA.”
6. BRIEF RESUME OF THE INTENDED STUDY:
6.1) INTRODUCTION
. “I wish you could realize that the destiny of our beloved land lies not with us but in our children”
Mahatma Gandhi
When the expression of premature birth was first coined, infants before term were usually referred to as “weakling” or “congenitally debilitated” babies (Cone 1985). Indeed prior to 1872 infants were not even weighed at birth whether full term or premature. In 1900 Ransom wrote that in the United States “of the thousands of the premature infants born….. most are quietly laid away with…… little if any effort being made for their rescue”. As the 20th century progressed there was an increasing awareness that preterm infants required special care, as evidenced by the development of incubators and Intensive Care Nurseries2.
The incubators provide special environment for high risk babies till they adapt themselves to standard nursery or home conditions. Incubators allow optimal heat balance and provide isolation from air-borne infections. Incubators are mainly used for low-birth weight or premature babies, infants recovering from stress of birth and sick babies requiring special observation or ambient oxygen. 3
Thermo neutral zone is the narrow range of temperature in which the infant uses fewer calories for heat regulation and thus has a low metabolic rate and oxygen consumption. Thermo neutral environment can be maintained in the incubator in the following ways.
Servo control: - This is a special adaptor for the incubator which provides constant monitoring of the infant’s body temperature to maintain the body temperature at a prescribed level.
Manual control: - Using this method the infant’s crib temperature is set at a prescribed level and intermittent recording of the infant’s body temperature is carried out
6.2) NEED FOR STUDY
The magnitude of low-birth weight infants in developing world is enormous. Out of a total of 22 million such infants in the world 21 million belongs to the developing countries. India’s share is quite substantial 7 to 10 million low-birth weights constitute 30% of live births in India14.
After the establishment of respiration, the most crucial need of the Low-Birth Weight (LBW) infant is application of warmth and prevention of heat loss in the distressed infant is absolutely essential for survival, and maintaining a neutral thermal environment is a challenging aspect of neonatal intensive nursing care. Heat production is a complicated process that immature neonate has all of the problems related to heat production that involves the cardiovascular neurological and metabolic systems and the problems related to heat production that are faced by the full term infant. However Low-Birth Weight (LBW) infants are placed at further disadvantage by a number of additional problems. They have a smaller muscle mass and fewer deposits of brown fat for producing heat, lack of insulating subcutaneous fat and have poor reflex control of skin capillaries1.
The most important indication for incubator is pre-maturity. The infants borne sooner than three weeks before term, those that weigh less than 5 and half pounds and are shorter than 46cm should be put at once in the incubator. Because first few hours are especially dangerous and they need the protection that the apparatus affords4.
Induced labours especially indicate the incubator because in addition to pre-maturity there is the shock of the interference. Congenital feebleness infants of fair size are sometimes born weak and with poor resistance, shown by sub-normal temperature, slight cyanosis, tendency to edema or sclerema .They should be treated as premature a neonates. The premature infants are seldom subjected to general edema, beginning at the feet it may be unattended with cyanosis or with urinary changes. Its cause is unknown. The incubator is the quickest way to relieve the condition. Cyanosis with or without edema, due to feeble circulation, is very common with small infants and sometimes present with those at full term. The warm moistened; oxygenated air of the couveuse does wonders in these cases sub-normal temperature from any cause. After difficult operative deliveries, the baby is often is in acondition of shock, and the infant should be placed as soon aspossible in the incubator for one to four days. Hemorrhagic diasthesis, Melena neonatorum is an indication for incubator. The incubator has been used for the treatment of collapse from any cause. Secondary asphyxia or atelectasis, respiratory affections for chronic enteritis and in the arthrepsia of wasting diseases. The pre-mature infant must be placed in the incubator at the earliest possible movement after birth. Every minute’s exposure to outside influences lessens the chance of life 4.
During clinical posting investigator found that atleast 1-2 neonates are admitted in the Neonatal Intensive Care Unit (NICU) for incubator care per day. The investigator has observed the climate of the Hassan, Karnataka is cool and moist and it is challenging for premature neonates to survive
.
The investigator has also observed that the students are given chance to provide care for neonates who are in the incubator. And the student nurses were performing incubator care in an unhygienic manner and aseptic precautions and techniques were not followed. First of all the neonates who are in the incubator are more susceptible to infection. These improper aseptic techniques and precautions followed by the student nurses in providing care may further increase the risk of complications in neonates. Hence the investigator felt that there is a need to improve the knowledge and skill of the student nurses who are directly involved in the care of neonates who are in the incubator.
6.3) STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of incubator care module on knowledge and skill of third year B.Sc nursing students for neonates admitted in Neonatal Intensive Care Unit (NICU) at S.C hospital, Hassan, Karnataka.”
6.4) OBJECTIVES OF THE STUDY IS TO :-
1) identify the knowledge and skill of the 3rd year B.Sc nursing students regarding
incubator care during the pre-test.
2) assess the knowledge and skill of 3rd year B.Sc nursing students after the
administration of incubator care module.
3) determine the knowledge and skill of 3rd year B.Sc nursing students regarding
incubator care during the post-test.
4) compare the knowledge score and skill score of 3rd year B.Sc nursing students regarding incubator care module.
5) associate the knowledge and skill of 3rd year B.Sc nursing students regarding
incubator care with selected socio-demographic data.
6.5) HYPOTHESIS
There will be significant difference in the level of knowledge and skill of 3rd year B.Sc Nursing students who have received incubator caremodule and demonstration regarding incubator care in the in Neonatal Intensive Care Unit, S.C Hospital, Hassan, Karnataka.
6.6) ASSUMPTION
This study will:-
1) Explore the knowledge and improve the skill of the 3rd year B.Sc nursing students in
providing incubator care to the neonates.
2) Enhance the knowledge and skill of the 3rd year B.Sc nursing in the clinical practice
related to incubator for neonates.
6.7) OPERATIONAL DEFINITION:-
1) Assess: - an activity to estimate the out come of knowledge and skill related to the planned teaching module and demonstration of incubator care for neonates.
2) Effectiveness: - It is defined as a significant increase in the level of knowledge and
skill of 3rd year B.Sc nursing students regarding incubator care which is a measure from the response of the pre-test and planned teaching module and including the post-test and demonstration of incubator care for neonates.
3) Planned teaching module: - It is a pre–planned explanatory document which helps
in the learning process for 3rd year B.Sc nursing students about incubator care .It includes explanation with pictures and various aspects of the incubator.
4) Knowledge: - refers to the understanding and awareness regarding incubator care.
5) Skill: - refers to respondent’s physical ability to do the procedure regarding the use of
incubator among 3rd year B.Sc nursing students.
6) Third year B.Sc nursing students: - the students of N.D.R.K. College of nursing
Hassan those who have completed 2nd year B.Sc nursing and are presently studying in
the 3rd year B.Sc nursing and are posted in Neonatal Intensive Care Unit (N.I.C.U) for
clinical experience.
7) Incubators :-incubators provide a special environment for high risk babies till they
adopt themselves to standard nursery or home conditions.
6.8) CRITERIA FOR SELECTION SAMPLE
Inclusion criteria
1) Male and female students studying in the 3rd year B.Sc nursing at N.D.R.K College
of nursing Hassan.
2) Students, who know to read, write and speak English and Kannada.
3) 3rd year B.Sc nursing students who are willing to participate.
Exclusion criteria
1) Students those who are not willing to participate.
.
6.9) DELIMITATION
This study is limited to:-
1) 3rd year B.Sc nursing students regarding neonatal incubator care in the Neonatal
Intensive Care Unit (N.I.C.U).
2) A period of 4 to 6 weeks.
3) Only for those neonates who require incubator care and are admitted in the Neonatal
Intensive Care Unit (N.I.C.U) at S.C Hospital, Hassan, Karnataka.
6.10)ROJECTED OUT COME
This study will:-
1) Promote knowledge and clinical skill among 3rd year B.Sc nursing students who will
become bed side nurses or nurse educators in future.
2) Provide up-dated knowledge and skill for providing quality neonatal incubator care by
3rd year B.Sc nursing students
6.11) CONCEPTUAL FRAME WORK
This study is based on Imogene king’s “Goal attainment theory”.
6.12) REVIEW OF LITERATURE
Review of literature is a key step in the research process. It refers to an extensive, exhaustive and systematic examination of publications relevant to the research project. A literature review helps to lay the foundation for a study and can also inspire new research ideas. It can help with orientation to what is known and not known about an area of inquiry, to ascertain what research can best make a contribution to the existing base of evidence13.
A study was conducted on neonatal nurses to determine nurses practice regarding skin temperature probes. Data was collected by using a anonymous questionnaire which was returned by mail. Questionnaire was distributed by volunteer neonatal nurses. Items included frequency of probe change, position of probe, use of probes in skin and air servo controlled incubators and radiant warmers, as well as demographic data. The samples were eighty three neonatal nurses. The result of the study was nurses reported that skin servo controlled incubators are used widely, but generally only for infants less than 28 weeks gestational age. Although most nurses reported positioning infants to prevent them lying on the probe, 21%reported using the same probe site regardless of infant position. So the result indicates practices were influenced by individual knowledge, beliefs and experience as well as by unit products which varied widely5.
A randomized trial has shown that the neonatal mortality rate of low-birth weight babies can be reduced by keeping them warm. For low- birth weight babies nursed in incubators, warm conditions may be achieved either by heating the air to a desired temperature or by servo-controlling the baby’s body temperature at a desired set point .The objective of the study was in low-birth weight infants, to determine the effect on death and other important clinical out comes of targeting body temperature rather than air temperature as the end point of control of incubator heating. A randomized or quasi-randomized trials which tests the effect of having the heat out put of the incubator servo- controlled from body temperature with setting a constant incubator air temperature. A trial methodological quality was systematically assessed. Out come measures included death, timing of death, cause of death and other clinical out comes. The result of two eligible trials was found. In total the study included 283 babies 112 deaths. Compared to setting constant incubator air temperature of 31.80C, servo-control of abdominal skin temperature at 360C reduces the neonatal death rate among low-birth weight relative risk 0.72, risk difference 12.7%.This effect is even greater among very low-birth weight infants. So the conclusion is at least in the first week after birth, low-birth weight babies should be provided with a carefully regulated thermal environment that is near the thermal point6.
A study was conducted to document whether medically stable infants at 1,500g of weight can be transferred safely from incubators to unheated open cots. Four cohorts were recruited in a stepwise observational trial aimed to transfer the first 15 infants into cots on reaching a weight1,800g, the second at 1,700g, the third at 1,600g and the fourth at 1,500g at the nursery temperature 25oC. The primary out-come measure was failure of transfer defined as the inability to maintain body temperatures in a cot despite additional coverings .Secondary aims were to determine temperature stability, growth, medical complications and time to discharge were recorded. A total of 61 infants were recruited and transferred into cots and they were similar in gestation and sex. Infants recruited to 1,500g and higher birth weights than the other cohorts. There was no difference in the rate of infants failing transfer into cots between cohorts. So the result of the pilot study indicates the potential to transfer very low-birth weight infants to an open unheated cot at a body weight of 1,500g7.
Astudy was conducted to assess the effect of radiant warmers versus incubators on neonatal fluid and electrolyte balance, mortality and morbidity. Randomized or quasi-randomized trials in whichradiant warmers were compared to incubators in a neonatal population. Independent data extraction and quality assessment of included trials was conducted by the author. Results were presented with 95% confidence interval.8 studies were included in this review, 6 employed a crossover design, radiant warmers caused a statistically significant increase in insensible water loss and a trend towards increased oxygen consumption which was not statistically significant. So the conclusion of the study was radiant warmers results in increased insensible water loss compared to incubator8.