SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Mrs. SHAMI KHAN FAROUQUE

I YEAR M. Sc NURSING

OBSTETRICS AND GYNAECOLOGICAL NURSING

YEAR 2012-2013

TULZA BHAVANI COLLEGE OF NURSING

NO, 899/3, NEAR HAZRAT JUNEEDI DARGA, GYANG BOWDI,

BIJAPUR – 586101.
RAJIVGANDHI UNIVERSITY OF THE HEALTH SCIENCES,

KARNATAKA, BANGALORE

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

01 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. SHAMI KHAN FAROUQUE
I YEAR M. Sc NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
TULZABHAVANI COLLEGE OF NURSING,
BIJAPUR.
02 / NAME OF THE INSTITUTION / TULZABHAVANI COLLEGE OF NURSING,
BIJAPUR.
03 / COURSE OF THE STUDY AND SUBJECT / I YEAR M.Sc NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
04 / DATE OF ADMISSION TO COURSE / 06/06/2012
05. / STATEMENT OF THE PROBLEM / “ ASTUDY TO EVALUATE THE EFFECTIVENESS OF COPE PROGRAM (CREATING OPPORTUNITIES FOR PARENT EMPOWERMENT) ON THE STRESS LEVEL AMONG MOTHERS OF LOW BIRTH WEIGHT INFANTS ADMITTED TO NICU IN A SELECTED HOSPITAL AT BIJAPUR.

6. INTRODUCTION

Everyone in the modern world experiences stress at least occasionally in life. Stress has been conceptualized in multiple ways, and its various psychological definitions are discussed. Stress has been defined as “psychological and physical strain or tension generated by physical, emotional, social, economic, or occupational circumstances, events, or experiences that are difficult to manage or endure”. This definition highlights the different components of stress, including the psychological component which is the focus of this study. Stress has devastating effects on individual, interpersonal, and societal level. 1

Stress affects an individual positively or negatively by way of an evolutionary conceptnamed the fight or flight response. A threatening situation puts stress on an individual, triggering the fight or flight response: an increase in metabolism and blood flow throughout the body, increasing the capacity to protect one’s self or escape from the situation. The fight or flight response is often accompanied by cognitive appraisal of the situation, leading to emotions such as anger and fear. With regard to positive effect on an individual, when the situation is immediately threatening, for example the presence of a predator, the fight or flight response promotes survival. In contrast, negative effects occur when the situation is not immediately threatening, for example threat to a person’s job, health, or important relationships, which are common in the modern world. When changes in the body repeatedly occur from the fight or flight response, it becomes susceptible to disease such as heart attack, stroke, hypertension, and cancer and to mental illness such as anxiety and depression. Therefore, it is important to understand its nature to assist development of interventions to mitigate these effects.2

One potentially stressful life event is the birth of a child. It is not surprising then that the birthof a fragile child, who is then cared for in a NICU, can be particularly stressful for the parents. This response has been revealed by comparing parents of infants who were cared for in a NICU with parents of full-term infants, at various points in time. In the first week after their infant’s birth, parents of NICU infants were more upset, anxious, and depressed compared with parents of full-term infants.3

In typical circumstances, the parent–infant bonding process that occurs during the newborn period establishes the foundation for a lifelong relationship. This typical process does not necessarily occur, however, when the infant is born prematurely or at risk, and spends the first several weeks or months in the NICU. The complexity of the neonatal intensive care environment, the medical care, individual circumstances, and the appearance of the infant can all be factors that influence and perhaps lessen the families’ role with their baby . In addition, neonatal environmental stress can be a major factor contributing to the parents’ distress, and may influence their parenting behaviors. 4

COPE program is one among the programs developed in University of Rochester School of Nursing by Bernadette Melynk and her colleagues. COPE – Creating Opportunities for Parent Empowerment is a theory based educational- behavioral program that consists of two types of educational information. It teaches parents about normal physical, developmental and behavioral characteristics of preterm infants and the best ways to interact with them and facilitate their development. Many studies have been conducted using COPE program to reduce the stress level of mothers of children admitted in NICU, and were found effective. 5

6.1 NEED FOR THE STUDY

Parents are the most crucial and immediate environment in which the infant survives and develops. During pregnancy, parents develop an anticipatory set on the images of the child that provides the experiential basis for “knowing” the newborn child. This anticipatory set anchors the parental perception process of the newborn with regard to the objective references: sex, size and shape, condition, appearance, and behavior. Parents of premature infants experience multiple stressors related to preterm birth, the medical condition of the postpartum mother and/or infant, admission of their infant to the neonatal intensive care unit (NICU) and perceived vulnerability of the infant, in addition to stressors associated with the normal transition process to parenthood. Clinical practice and research in the NICU have focused on facilitating psychosocial adjustment to parenthood. Most research has focused on understanding and improving the mother–infant dyad interaction in the NICU.6

In a study of 212 parents using the PSS: NICU, Shields-Poe and Pinelli determined that the parents’ greatest stress was due to their infants’ appearance and behavior. These results were related to how sick they perceived their infant to be.4

A study conducted by Priya Joseph on Stress, family support and the expectation of the mothers of newborns admitted in NICU in selected hospitals in Karnataka revealed that 65% of the mothers experienced moderate to high stress when their neonates were admitted in the NICU. Findings showed that majority of the mothers experienced high stress in the area of their child’s appearance. 7

Studies have found that parent empowerment program in NICU had reduced the length of hospital stay of the newborn, reduced stress of mothers, improved coping ability of mothers and improved the cognitive and behavioral outcome of infants. 8

Especially in India, only few hospitals have programs to encourage parent- infant interaction and care giving. So the investigator strongly felt the need to empower parents to manage the stress of their child being admitted in NICU.9

6.2 REVIEW OF LITERATURE:

Literature review is a standard requisition of scientific research. Review of literature is an important step in the development of a research project. It refers to both the activities involved in searching information on a topic, as well as to the actual written report that summarizes the state existing knowledge on a topic that is generally facilitated by the use of various abstracting and indexing services.Review of literature involves the systemic identification, location and survey of written material that contain varied information on research problem.

A descriptive correlation study was conducted to explain therelationships among stress, social support and depressionin mothers of preterm infants. 31 mothers were selected for this study by using convenience sampling method. Data collection was done by using demographic inventory, mastery of stress instrument, the center for epidemiologic studies, depression scale. The study revealed mothers of preterm infants experience significant level of stress and depression in the early post partum period .Social support was positively related to mastery of stress and inversely related to depression.10

A comparative descriptive study was conducted in a large tertiary hospital, Oklahoma; USA consisted of 51 parents (31 NICU and 20 PICU) whose children had been admitted to the NICU and PICU for at least three days. The results of the study showed that parents in both units experienced the most stress for alteration in their parenting role and in their infant’s behavior and appearance. When compared there was no difference of perception of stress between parents whose children were admitted to PICU (mean 3.35, SD 1.42) and parents whose children admitted to the NICU (mean 3.35, SD 1.06). When difference between subscale scores for children in NICU and parents of children in PICU were examined, there was statistically significant difference with scores on one subscale, the assistance with parenting role (t =2.28, p = 0.03) subscale scores were higher for parents of children in PICU than for parents of children in NICU, indicating that parents of children in PICU found staff interventions related to assisting them more helpful than did NICU parents.11

A randomized controlled trail was conducted to evaluate the effect of COPE program to reduce hospital length of stay among 260 families with preterm infants, from 2001-2004. Parents in the COPE group received information and behavioral activities about the appearance and behavioral characteristics of Preterm infants and how best to parent them. The comparison group got information regarding hospital services and policies. Study revealed infants in the COPE group had a 3.8 day shorter NICU length of stay (mean: 31.86 Vs 35.63 days) and 3.9 day shorter total hospital length of stay (mean 35.29 Vs 39.19 days) than did comparison infants. 12

A randomized controlled trail was conducted to assess the effects ofCOPE program on the mental health and coping outcomes of critically illyoung children and their mothers. The sample included 174 mothers and their 2-7 year old children. Mothers in the experimental group received a 3 phase educational-behavioral intervention program at 1) 6-16 hours after PICU admission 2) 2-16 hours after transfer to the general pediatric unit and 3) 2-3 days after their children were discharged from the hospital. Control mothers received a structurally equivalent control program. Follow up assessments were done at 1,3,6 and 12 months after hospitalization. Parental stress inventory was used to collect the data. The study results showed COPE mothers reported significantly less parental stress and participated more in their children’s care compared with control groups. One year after discharge, a significantly higher percentage of control group children (25.9%) exhibited clinically significantly behavioral symptoms compared with COPE children (2.3%).13

6.3 STATEMENT OF THE PROBLEM:-

“A STUDY TO EVALUATE THE EFFECTIVENESS OF COPE PROGRAM (CREATING OPPORTUNITIES FOR PARENT EMPOWERMENT) ON THE STRESS LEVEL AMONG MOTHERS OF LOW BIRTH WEIGHT INFANTS ADMITTED TO NICU IN A SELECTED HOSPITAL AT BIJAPUR.

6.4 OBJECTIVES OF THE STUDY:-

To assess the stress level among mothers of LBW infants admitted to NICU.

To measure the effect of COPE program on the stress level and coping ability among mothers of LBW infants admitted to NICU.

To find an association between selected demographic variables and stress level of mothers of LBW infants admitted to NICU.

6.6 OPERATIONAL DEFINITION:-

.

  1. Evaluate:In this study, “evaluate” refers to the outcome of COPE program on stress among mothers of low birth infants as measured by Parental stressor scale.
  2. Effectiveness: In this study effectiveness refers to the outcome of cope program on stress level of mothers of LBW infants which will be measured by post test scores of parental stressor scale.
  1. COPE Program: COPE- Creating Opportunities For Parent Empowerment:- In this study COPE program refers to providing information and behavioral activities to the mothers of low birth weight infants about the appearance and behavioral characteristics of their infants and how best to parent them.
  2. Stress level: - The intensity of stress experienced by mothers of LBW infants admitted in NICU as measured by a standardized rating scale. (Parental stressor scale).
  3. Mother: In this study term mother refers to the women of age group between 20-35 and whose LBW children are admitted in NICU.
  1. Low birth weight infant: In this study, low birth weight infant refers to babies with birth weight less than 2.5 kg.

6.7ASSUMPTION:

  1. All the mothers who give birth to LBW infant will undergo some amount of stress.
  2. COPE program is an effective method for reducing stress.
  3. There will be a significant reduction in the stress level of mothers who receive COPE program.

6.8RESEARCH HYPOTHESIS:-

H1: There will be a significant reduction in the stress level of mothers after participating in COPE program.

H2:There will be a significant association between selected demographic variables and stress level of mothers of LBW infants admitted to NICU.

6.9 DELIMITATIONS:

  1. Mother of LBW babies who are admitted to NICU
  2. Mother of babies who are admitted to only one selected hospital
  3. Mothers who are available at the time of data collection
  4. Mothers who are willing to participate

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA : Mothers of LBW infants who are admitted

in the NICU.

7.2 MATERIAL AND METHODS

7.2.1. Research Design:Pre-experimental, one group pre-test, post-test design. Research approach in this study is evaluative approach.

7.2.2. Research Variables

Independent variables: Creating Opportunities For Parent Empowerment Program

Dependent variables:Stress level among the mothers of LBW infants

Extraneous variables: Extraneous variables such as age,, religion, type of family, family income and source of Information.

7.2.3. Setting :Selected hospital at Bijapur,

7.2.4. Population :Mothers of low birth weight infants

admitted in NICU.

7.2.5. Sample size : The sample consists of 50 subjects.

.

7.2.6. Criteria for the sample selection

Inclusion criteria: 1. Mothers of Infants whose birth weight is less than

2.5 kg

Exclusion criteria:

  1. Mothers of Infant on ventilator or CPAP
  2. Mothers who are not willing to participate.
  3. Mothers with postpartum discomforts/

diseases that restrict their involvement in

care of their newborn.

4. Those are not available during thestudy.

7.2.7. Sampling technique: Purposive sampling techniques

7.2.8. Instrument used : Parental stressor scale to assess the

stress level of mothers

7.2.9. Steps of data collection:

A written permission will be obtained from the

hospital authority prior to the onset of study. The

purpose of the study and the method of data

collection will be explained to the participants and

informed consent will be taken from them. Pre test

will be conducted on day 2 of admission of the baby in

NICU by administering parental stressor scale for

parents to assess the stress level. Structured COPE

program will be given to the mothers on the same

day. After 4 days of intervention, post test will be

conducted to assess the stress level by using the same

tool.

7.2.10. Plan for the data analysis:The collected data will be analyzed using descriptive and inferential statistics.

Descriptive statistics:Mean, mode and median standard deviation will be used.

Inferential statistics:t-test and chi-square testwill be used.

7.3. Does the study REQUIRE any investigation orintervention to be conducted on patient other human or animals?

: Yes,

This study requires administration of rating scale to mothers of low birth

weight infants to assess their stress level and coping ability It requires

involvement of the mother in the care of newborn in NICU.

7.4. Has ethical clearance been obtained from your

institution

: Yes,

Ethical clearance will be obtained from higher authorities of hospital.

8. LIST OF REFERENCES

1. “Colman, A. M. (2003). Oxford Dictionary of Psychology. Oxford: Oxford

University Press.

2. Schooler, T. Y., Dougall, A., & Baum, A. (2000). Stress: Impact on health. In A.

E. Kazdin (Ed.), Encyclopedia of psychology (Vol. 7, pp. 487-489). New York:

Oxford University Press.

3. Trause, M. A. & Kramer, L. I. The effects of premature birth on parents and their

relationship. Developmental Medicine & Child Neurology1983; 25: 459-465.

  1. Dudek shriber. Parent stress in the neonatal intensive care unit and the influence of parent and infant characteristics. American journal of occupational therapy 2004: 58: 509-510
  2. Melynk BM, Grillis LA, Fairbanks E, Sinken RA, Stone PN et al. Reducing premature infant’s length of stay and improving parents mental health outcomes with the COPE NICU progam. J Padiatr Nurs 2006; 118 (5): 1474-1477.
  3. Young,Mee Ahn. Parental perception of neonates, Parental stress and education for NICU parents. J Asian nursing research 2007:1(5): 199-200.
  4. Joseph P. A study of the stress, family support and the expectation of mothers of neonates admitted in NICU in selected hospitals in KarnatakaState, Master’s dissertation, MCON, MAHE, Manipal, 2004.
  5. Melynk BM, Grillis LA, Fairbanks E, Sinken RA, Stone PN et al. Reducing premature infant’s length of stay and improving parents mental health outcomes with the COPE NICU progam. J Padiatr Nurs 2006; 118 (5): 1474-1477.
  6. Melynk BM. Intervention studies involving parents of hospitalized young children: An analysis of the past and future recommendations. J Pediatr Nurs 2000; 15 (1): 4-10.
  1. Younger JB, kendell MJ, Pickler RH. Mastery and stress of mothers of premature children. Journal society of pediatric nursing 1997; 2 (1): 123-134.
  2. Sidemen R. Parent stress and coping in NICU and PICU.

J Pediatr Nurs 1997;12(3): 169-176.

  1. Melynk BM, Grillis LA, Fairbanks E, Sinken RA, stone PN, small L. Reducing premature infants length of stay and improving parents mental health outcomes with the COPE new program. J Pediatr 2006; 118 (5): 1474-1477.
  2. Melynk BM, Gillis LA, Fenstein NF, Johnson J, fiarbanks LS, Rubenstein J. COPE program effects on the mental health and coping outcomes of critically ill young children and their mothers. J Pediatr 2004;113 (6) :597-607.

9. Signature of the candidate:

10. Remarks of the guide:

11. Name and designation of

11.1 Guide: PROF. PRABHAVATI .R. KALE

PROFESSOR AND HOD

DEPT OF OBSTETRICS AND GYNECOLOGICAL NURSING

TULZA BHAVANI COLLEGE NURSING, BIJAPUR.

11.2 Signature:

11.3 Co-Guide (if any) :MRS. LALITA . RATHOD

LECTURER

DEPT OF OBSTETRICS AND

GYNECOLOGICAL NURSING

TULZA BHAVANI COLLEGE OF

NURSING, BIJAPUR. .

11.4 Signature:

11.5 Head of the department: PROF. PRABHAVATI .R. KALE

PROFESSOR AND HOD

DEPT OF OBSTETRICS AND GYNECOLOGICAL NURSING

TULZA BHAVANI COLLEGE NURSING, BIJAPUR.

11.6 Signature:

12. 12.1 Remarks of the principal:

12.2 Signature:

1