RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

ANNEXURE – II

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / Name of the candidate and address (in block letter) / MR.VIMAL.K.VIJAYAN
1st YEAR M Sc. NURSING
AL-KAREEM COLLEGE OF NURSING,
BAREY HILL,RING ROAD,
GULBARGA- 585105
2. / Name of the Institution / AL-KAREEM COLLEGE OF NURSING,
BAREY HILL,RING ROAD,
GULBARGA- 585105
3. / Course of study and subject / M Sc. NURSING, PAEDIATRIC NURSING
4. / Date of admission to the course and batch / 20/10/2010
2010-2011 (mid-stream batch)
5. / Title of the topic:
“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING FIRST AID OF FRACTURE AND BURNS AMONG MOTHERS OF PRESCHOOL CHILDREN IN A SELECTED AREA AT GULBARGA.”
6.
7. / BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Thousands of children suffer burn-related injuries each year. Children ages 4 and under are at the greatest risk, with an injury death rate more than two times that of children ages 5 to 14. Burns have long been recognized as among the most painful and devastating injuries a person can sustain and survive. Burns often require long periods of rehabilitation, multiple skin grafts and painful physical therapy, and they can leave victims with lifelong physical and psychological trauma.
Scald burn injury (caused by hot liquids or steam) is the most common type of burn-related injury among young children, while flame burns (caused by direct contact with fire) are more prevalent among older children. All children are also at risk for contact, electrical and chemical burns. Because young children have thinner skin than older children and adults, their skin burns at lower temperatures and more deeply. A child exposed to hot tap water at 140 degrees Fahrenheit for three seconds will sustain a third-degree burn, an injury requiring hospitalization and skin grafts. Children, especially those ages 4 and under, may not perceive danger, have less control of their environment, may lack the ability to escape a life-threatening burn situation and may not be able to tolerate the physical stress of a burn injury.
When a fracture, or broken bone, occurs in a child, the injury must be treated differently then when the patient is fully grown. Children's bones have an amazing capacity to heal, but broken bones in kids must have appropriate treatment. Achild bone fractureis a medical condition in which aboneof a child (a person younger than the age of 18) is cracked or broken. About 15% of all injuries in children are fracture injuries.Bone fracturesin children are different than adult bone fractures because a child’s bones are still growing. Also, more consideration needs to be taken when a child fractures a bone since it will affect the child in his or her growth. Bone fracture types differ depending on the age and sex of the child. The changes in the bones over time cause variance in the pattern and number of bone fracture injuries. The probability of bone fractures in children increases with age.For a small child, injuries will most likely be minimal because the child doesn’t have the speed or mass to cause serious injuries.When age increases, so does mass and speed resulting in more serious fractures. The age when girls usually fracture a bone is twelve and for boys the age is fourteen.Also, girls statistically have fewer fractures than boys. About half of boys and one-fourth of girls are likely to have a fracture during childhood. Thewristis also the most likely part of the body to be injured. As sport activities increase, the fractures in children increase as well, especially for boys who participate in eitherwrestlingorfootball. Much like bone types in the different stages of childhood are varying, so the bone fracture injuries in infants, children, and adolescents vary. Careful evaluation for the best treatment of each child is needed.
6.1 Need for the study
According to WHO, an accident is an event independent of human will caused by an outside force acting rapidly and resulting in bodily or mental injury. So first aid has an important role in accidents. First is the initial care of ill or injured. The aim of first aid are to preserve and protect life, prevent further injury or deterioration of illness and help to promote recovery Fracture is a break in the continuity of bone, when a fracture or broken bone, occurs in a child the injury must be treated differently than when the patient is fully grown. Children’s bones have an amazing capacity to heal, but broken bones in kids must have appropriate treatment. Burns are an important cause of mortality and disability in children in developing countries. Scald burns from hot water and other liquids are the most common burns in early childhood. Because burns range from mild to life threatening some can be treated at home, while others need emergency medical care.
A cohort study was conducted to examine incidence of fracture and associated activity restriction among 193540 children aged 0-12 years. The result of the study shows that the incidence increases linearly with age. Boys and girls showed similar pattern of fracture occurrence. The mean and 95% confidence interval of activity restricted days for leg fracture were 26 (95% CI 7 to 45) days, for arm fracture, 14 (95% CI 8 to 20) days, and other fractures 5 (95%CI 1 to 8) days. Arm fractures represented 66% of the cases and 62% of activity restricted days. Leg fractures 19% of cases and 33% of all activity restricted days and other fractures 16% of the cases but only 5% of the activity restricted days in this population.1
A study was conducted on “Epidemiology of paediatric burns in Indore”, India, a retrospective study was carried out based on 110 paediatric burns (0-14 years) seen at the burns unit, Choithram Hospital and Research center, Indore, over a period of 7 years. The results concluded that the infants (0-2 years) and toddler (2-6 years), group scalding was predominant cause injury and in childhood there were no more flame and electric burns. Males (95%) were mainly affected group. 2
Three hundred and nine children of burns injuries treated over last 10 years (1989-1998) in Kasturba Hospital, Manipal (India) were studied retrospectively and were analysed for incidence, severity, extent, causes, risk factors and overall mortality. Children of age < 5 years were affected more than children of age > 5 years (76.1 vs. 23.9%). Females were affected more than males (74.1 vs. 25.9%). Most of the children received burn injuries in the range of 0 to 20% BSA (63.1%). Scald (72.5%) followed by flame (22.7%) and electrical burn (3.2%) were most common cause of burn injuries. Overall paediatric burn mortality was 7.4%.3
Every parent think that they are good parents and take great care in protecting children from any harm or dangers yet there is one place where the child is more a risk than anywhere else, and that is their own homes. No matter how careful parents are, there will be time when child is unsupervised. It takes only a second for the child to fall and get fractured or to get a burns. Child hood is the age when children has a lot of play facilities and falls from stairs or while climbing chairs are common causes of fracture in home environment. Lack of play facilities outside is also a responsible factor for burn injuries. Household materials like kerosene, burning stove, and remains as danger object. Fracture and burns need immediate first aid management. Parental carelessness, especially mother’s lack of supervision and ignorance towards the first aid management are the chief factors of complications of fracture and burns.
Thus the researcher felt that this is essential to emphasize awareness among
parents especially mothers. Child protection and parent education are the key elements in preventing injury and associated complications. Educated parents understands the need for first aid in case of emergency like fracture and burns, they will involve in the care and prevent complications. Hence the researcher feels that it is essential to conduct a study on increasing the knowledge of mothers regarding first aid of fractures and burns.
6.2 Review of Literature
A review of literature is important for developing a broad conceptual context, into which research problem fit. The review also serves the essential function of providing the individual researcher, with a perspective on the problem necessary, for interpreting the result of the study.4
A descriptive study was conducted to determine knowledge of first aid practices in parents regarding ill or injured children, 654 adults were survived. A convenient sampling technique was used in adult parents presenting to the emergency department and a multiple choice questionnaire was given to them regarding fractures and sprains, eye injuries, stings and bites, fever, head injuries, dental emergencies etc. Descriptive statistics and chi square test were used for data analysis. The results shows that mean age was 38.5 with SD 13.8, 56% were females and 56% had at least a high school education. Knowledge specific guide lines ranged from 21-90%. The study concluded that many adults were unfamiliar about first aid measures and further education is required to improve knowledge of first aid practices. 5
An intervention study was conducted to develop, implement and evaluate an education training programme for newly graduate nursery school teachers about first aid and emergency occurring to preschooler. A 60 newly graduate nursery teachers. A structured knowledge questionnaire and observation check list were used to assess the knowledge and practice towards first aid for wounds, fractures, fainting, suffocations and burns. The results of the study shows that the knowledge and practice increased on the average from 0-10% to 80-95% in first aid of wounds, fractures, fainting, suffocations and burns. The study concluded that designed health education and training programme led to significant improvement of knowledge and practice of nursery school teachers in first aid and dealing with emergency situations occurring to preschooler.6
A study was conducted on “Incidence and risk factors of fall injuries among infants”. The objective of the study was to assess the incidence of fall injuries among infants in Greece. The study results show that there is an annual incidence rate of 44 injuries per 1000 infants. The incidence of falls increases with increasing infant age. A high percentage of severe injuries were detected, most them were concussions (14.3%) and fractures (99.45%). Approximately 10% of infants with fall related injuries required hospitalization. 7
A study was conducted to determine the prevalence of fracture in children referred for sub speciality abused evaluations because of burns. A retrospective analysis of data were collected for all children below 5 years of age who were refferd to 19 child protection teams for subspeciality child abuse evaluations over one year (N=1676). The results shows that among 1203 children below 24 months of age 649 (53.9%) had fractures,11 children had multiple fracture,12 children had fracture with radiographic evidence of healing. This study concluded that the rate of fractures in children who present with burns and concerns regarding physical abuse is sufficient to support the recommendation for routinely performing skeletal service for children < 2years of age.8
An epidemiological study was conducted regarding paediatric burns in Jaipur, India. A retrospective review contains 127 paediatric burns up to 14 years of age admitted to the burn unit of the department of burns and plastic surgery, SMS Medical College, Jaipur over a period of one year from January 1990. Epidemiological data include age, sex, seasonal variation, place of burn, family size, economic status, period of time between the accident and admission to hospital. The cause and mode of burn, the relationships between mortality and age, cause of burn and extent of burn are discussed. Most of the burn injuries occurred in the winter months between December and March. Males were affected predominantly. The majority of the burns occurred at home. Most of the patients belong to the low socio economic strata and were members of medium or large size families. The commonest cause of injury were scalds in children under 5 years of age and flames in the older children. The overall mortality was 19.68%.9
This is a retrospective study based upon 4327 paediatric burns (0-16 years of age) admitted over a period of 5 years, as from January 1988. Epidemiological data include age, sex, cause of burn, extend of injury, social ansd economic status , period of time between the accident and the admission to hospital. The overall mortality rate was 5.8%. We tried to correlate the mortality rate with the epidemiological data. The recent use of Flamazine cream in our center (as from January 1993) seems to have decreased the mortality rate to 2.6% (12 deaths out of 450 patients admitted during the first seven months of 1993).10
A study was conducted on “Kitchen scalds and Thermal burns in children of five years and younger”. The study was conducted in emergency department and examined treated case of thermal burns and scalds. The results show that, scalds were approximately twice as common burns. The most common scald injury pattern were (1) the child reaching up and pulling a pot of hot water of the stove or other elevated surface,(20 the child grabbing, overturning, or spilled container of hot water on themselves. 11
6.3 Statement of the Problem
“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING FIRST AID OF FRACTURE AND BURNS AMONG MOTHERS OF PRESCHOOL CHILDREN IN SELECTED AREAS AT GULBARGA.”