Professional Documents
Culture Documents
BANGALORE, KARNATAKA,
HARINI.S.N
1ST YEAR M.SC NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
YEAR 2011-2013
CAUVERY COLLEGE OF NURSING,
TERISIAN COLLEGE CIRCLE,
SIDHARTHANAGAR,
MYSORE.
[1]
HARINI.S.N
NAME OF THE
CANDIDATE
AND ADDRESS
NAME OF THE
INSTITUTION
COURSE OF
3
STUDY AND
SUBJECT
4
DATE OF
ADMISSION TO
14-07-2011
COURSE
5.1
5.2
STATEMENT OF
THE
PROBLEM
[2]
6.
immunization, spacing, follow up and screaming . This can bring about 50% reduction if
neonatal mortality rate.
Management is important because low birth weight babies have a higher
risk of dying before their first birthday and other suffer from recurrent infections or
neurological and development problems. Good progonis in growth and development
problems of such babies is purely dependant on the effectiveness of management (Behrman
R& Shiono. P, 1995).
The nurse should give health education on home management of low birth
weight babies like maintenance of temperature, feeding, prevention of infection, recognize
danger signs, immunization and follow up and screening. (Piyush Gupta, 2004.6
6.2
The birth of an infant is an event filled with wonder and joy for most of the families.
(Jacinth Christy Joy, 2004).
New born babies are not mini adults because they have anatomical and
functional immaturity of various body organs at different stages of life. They rapidly
develop life threating medical emergencies due their physiological instability. New born
babies are like flowers, they can rapidly wither following an acute illness but are endowed
with tremendous recuperative capabilities and when tended with care, compassion and due
concern for their physiological handicaps, they bloom back to life with equal case,
(Vishwanathan, J. Etal, 1995).5
Management is important because low birth weight babies have a higher risk
of dying before their first birthday and other suffer from recurrent infections
or
According to Indira Shekar rao, 2002, survival of the low birth weight
babies can be strengthened by training of personnel involved in health care delivery system,
reorientation of medical education and strengthening of the neonatal units. It is universally
accepted that improved survival of low birth weight can be successfully achieved by
training education others and family members and home based care.
Bang Abhay, 2002 says that more than half of the child death could be
prevented if a new module home based neonatal care is tried.
Mothers are the natural custodian of the new born who care for their babies
with love, affection and with sense of commitment. They are the one who first notice any
change in babies condition or behavior. But due to ignorance, they fail in their role and
hence arises the need for sum education and support from health personnel. (Jacinth Christy
Joy, 2004.)
Ravikumar. M and Bhat B.V, 1995 conducted a study to find out early
neonatal mortality in a tertiary care hospital and found that early neonatal mortality rate was
26.6/1000 live birth. In their study, they concluded that health education to the mother on
new born care would significantly reduce early neonatal death.
According to Helen Yeo, 1992 the needs of the small require carefully
management in order to maximize their potential both in present and future. Their needs
encompass respiratory status, thermal environment, nutritions, observation, skin integrity,
positioning stimulation, parental environment.16
The investigator, during her past experience as nice nurse, has observed the
recurrent readmission of low birth weight babies due to infection and with other health
problems. She has also observed lack of confidence and knowledge in caring for such
babies among the mothers and parental anxiety regarding prognosis of the child.
The need for early discharge due to unaffordability of the parents, busy ward
routine has barred the communication of management of low birth weight babies to the
mother by any mean. The poor parental knowledge on management has resulted in poor
child raring practice, frequent hospitalization and an increase in mortality and morbidity
rate.
The
high
cost
of
neonatal care at tertiary level and unaffordabitly of the parents due to poor per capital
income has necessitated the urged to prevent rehospitaliztion through proper health
[5]
education programme. These facts sensitized the investigator to do a study to assess the
knowledge of mothers on management of low birth weight babies.
6.3REVIEWOFLITERATURE
6.3(a) The review of the related literature is an essential aspect of scientific, the study has
been organized under the following headings;
1. Literature related to low birth weight babies.
2. Literature related to management of low birth weight babies.
3. Literature related to self-instructional module on management of low birth
weigh babies.
1. Literature Related To Low Birth Weight Babies
According to NWEP- Pakistan, in his explanatory module on risk factor for low
birth weight in public hospitals at Peshawar, identified his risk factors for small for
gestational age babies as gestational age of less than 37 weeks, and maternal age below 2o
years. Increased the incidence among tribal area with presentation of anemia and the
mothers having previous history of abortions and miscarriage were also found to be
significant independent factors.
Prozialec et.al., (2000) in their article, in the article of Evaluation in a family case
management programme determining outcomes for low birth weight deliveries,
documented that a positive association was shown between the early entry and increased
use of prenatal services to improved birth out comes in the subsequent programme.7
Naran Anil and Sandesh Kiran (2002) did a survey to set the limit for identifying low birth
weigh babies. They observed that when birth weight 2,300 gram was used as limit for low
birth weight. It constituted 29-46 of total infants in India. He observed that babies between
2,000-2,500 gram are mostly term and do not suffer significant in mortality and morbidity
when compared with babies weighing more the 2,500 grams. He recommend that if 2,000
grams is taken as a limit for low birth weight babies. Only 10% infant would require special
care. Therefore the neonatalogists recommended the use of 2,000 grams as the limit for
identifying low birth weight babies.
[6]
[7]
hospitalization. They observed that kangaroo mother care managed babies had better weight
gain, earlier hospital discharge higher exclusive breast- feeding than the control group.
Hopkin John, 2001, in his experimental study conducted in Ivan Hoe on role of zinc in
prevention of infection in low birth weight babies observed that zinc provided substantial
reduction in infectious diseases in low birth weight babies. He also found that low birth
weight infants had low zinc concentration in their blood and zinc supplementation lowered
the mortality rate.14
Joshi Swati, 2002, in her article feeding in the low birth weight new born, Stated that the
composition of low birth weight and preterm mothers milk is suited to increased
requirement of certain nutrients of the preterm babies. Milk of suck mothers contained
higher content of protein, sodium, fatty acids, energy, calcium, magnesium, zinc, copper,
iron, Ig and other host defense factors. Such babies are fed at higher volumes of 180-200
mi\kg\day may catch up growth.
Menon Janaki, 2002, in her descriptive study on relactation in mothers of high risk infants
has observed that reward of breast feed and relactation is possible even in most unlikely of
setting. Delayed initation of breast feed in an infant born with birth weight 700 gram
showed steady weight gain on exclusive breast feed.
Garman et.al, 2004, in their descriptive study conducted in Vermant to assess the parents
behavior on development low birth weight babies observed that low quality parental
behavior resulted in difficult temperament in small infant.12
Sudha, Sujath 2002, In their prospective study on mortality and morbidity in 307 high risk
infants whose birth weight was less than 2000 grams found that, babies less than 2000
grams were hospitalized frequently and showed border line intelligent Quatient at six years
of age.
Camel T Collins, Phillip Ryan, Caroline, Andrew Jmcphee, Susan Petersen, 2004, In their
randomized controlled trial study on effects of bottles, cups and dummies on breast feed in
[8]
preterm infants, evaluated the dummies do not affect breast feed in preterm infants. Cup
feeding significantly increases the likely hood that the baby will be fully breast feed at
discharge time. But has no effect on any breast feed and increases the length of hospital
stay.18
Meharban Singh, 2004, Stated that the low birth weight babies should be kept isolated in
one room and unnecessary visits by relatives should be avoided, strict hand washing with
soap and water before picking the baby or feeding the baby, should be properly washed and
sun dried.4
Nursan Dede Cinar And Tuncay Muge Filiz, 2006, They conducted study on neonatal
thermoregulation investigated the cold stress and hypothermia may have serious metabolic
consequences for all new borns there may be devastating and may increase both morbidity
and mortality rates among preterm.19
Nea, Joffe And Jan Hall, 2006, investigated that low birth weight babies being transported
in car seats are at risk of suffering episodes of apnea, bradycardia, and oxygen desaturation.
To help minimize these risk, the authors have begun the process of implementing car seat
oxygen saturation testing in their own unit as well as informing a car seat manufacturer of
the need to avoid respiratory instability in these vuleranable infants and to improve the
babys sitting position while in the car seat.9
Leanne Monterosso And Linda Kristjanson, 2006, Conducted study on Neuro motor
development and physiologic effects of position in very low birth weight infants, analyzed
that the prone position is physiologically more beneficial for the preterm infants than supine
and lateral positions.10
Em Mc Call, Fa Alderdile, Hl Halliday, Jg Jenkins, S.Vohra, 2008, In their comparative
study on Interventions to prevent hypothermia at birth in preterm and or low birth weight
infants, analyzed that skin to skin care was shown to be effective in reducing the risk of
hypothermia when compared to conventional incubator care for infants of 1,200 to 2,199
grams birth weight. The Tran warmer mattress kept infants less than 1,500 grams
significantly warmer and reduced the incidence of hypothermia and admission to NICU.8
[9]
relationship with their children and they tended to be of over protective and anxious.17
According To O.P. Ghai, 2003, in Essential pediatrics, documented nutritional
requirement of low birth weight babies and method of feeding for low birth weight babies,
micro nutrient supplementation of low birth weight infants fed human milk.
Meharban Singh, 2004, Explained in Essential pediatrics for Nurses that home care of
low birth weight babies, the mother should be given detailed instructions to keep the baby
warm and mother should be trained to assess the temperature of baby by touch.4
Frank.M.Ringstedand Hellasamelsan, 2006, In their Ethnographic study on Early home
based recognition of anemia via general danger signs in children in a malaria endemic
community in north east Tanzania, assessed that the recognition of anemia via general
[10]
danger signs as the infant unable to breast feed, weak, sleeping all time, convulsing, loosing
consciousness, there will be actual of evolving moderate to severe anemia.16
Nirmala.P, Swrna Rekha and Maryam Washigton, 2006, conducted a study on Kangaroo
mother care; effect and perception of mothers and health personnel, assessed no significant
changes were observed all the physiological parameters during kangaroo mother care and
routine care. Perceptions of mothers and health personnel were positive towards kangaroo
mother care.11
6.4 STATEMENT OF THE PROBLEM
A Study To Assess The Effectiveness Of SIM On Knowledge Among Postnatal Mothers
Regarding Management Of Low Birth Weight Babies In Selected Hospital, Mysore.
6.5 OBJECTIVES
1. To assess the knowledge on management of low birth weight babies among postnatal
mothers before intervention.
2. To find the effectiveness of self instructional module on management of low birth weight
babies among postnatal mothers.
3. To find the association between post test knowledge scores of postnatal mothers and their
demographic variables.
6.6 RESEARCH HYPOTHESIS
H1: There will be a significant difference between the pre and post test knowledge
scores of on management of low birth weight babies.
H2: There will be a significant association between the pre test score with selected
demographic variables.
[11]
7.1
chapter deals with the methodology which was followed to assess the effectiveness of SIM
A study to assess the effectiveness of SIM on knowledge among postnatal mothers
regarding management of low birth weight babies in selected hospital, Mysore.
7.2. SOURCE OF DATA
Postnatal mothers with low birth weight babies admitted in the postnatal ward and
Neonatal intensive care unit.
7.3
study aims to evaluate the effectiveness of SIM on knowledge among postnatal mothers
regarding management of low birth weight babies in selected hospital, Mysore.
7.4.
SAMPLING PROCEDURE
Postnatal Mothers who have low birth weight babies without major complications
(CNS, CVS) .
Postnatal Mothers who have low birth weight babies of 1000-2000gm available at
the time of data collection.
Postnatal mothers who knows to read, write and speak Kannada & English.
Exclusion criteria:
Mothers who have less than 1000 gm of low birth weight babies .
7.5(2). Population
Postnatal mothers in selected hospital, Mysore.
7.5(3). Samples
Postnatal mothers with low birth weight babies will be the samples of the study.
7.5(4). Sample size
30 postnatal mother for experimental group and 30 postnatal mother control group postnatal
mothers with low birth weight babies.
7.5(5). Sampling technique
[13]
Purposive sampling techniques will be used to select the postnatal mother will low birth
weight babies.
7.5(6). Settings
This study will be conducted at selected hospital, Mysore.
7.5(7). Pilot study
10% of the population size is planned for the pilot study.
7.6.
VARIABLES
The collected data will be organized, tabulated and analyzed by using descriptive and
inferential statistics. Descriptive statistics includes, mean, median, mode, percentage and
standard deviation. Inferential statistics include Chi square test to assess the effectiveness of
self instructional module. The results will be presented in the form of tables diagrams and
graphs.
7.8.
PROJECTED OUTCOME
The study will enable to identify the knowledge and attitude regarding management
of low birth weight babies among postnatal mothers.
The finding of the study plays a very important role in postnatal mothers.
Piyush
Gupta
Paul
Essential
pediatrics
[15]
10. Leanne monterosso and Linda krist janson Neuro motor development and
physiologic effects of positioning in very low birth weight infant, 9 th march 2006 ,
p 138-146.
11. Nirmala . p , Swarna rekha and Maryam Washington , kangaroo mother
care; effect and perception of mothers and health personnel act 2006
P177-184.
12. Garman, parents behavior affects development of low birth weight
babies,Journal of developmental and behavioral pediatrics,, December
1999, p 112-114.
13. Hopkins john , Exclusive breast feeding in small babies, Journal of
clinical nutrition, March 2001,p 156-158.
14. Hopkins john , Zinc in prevention of infection in low birth weight
babies,Paediatrics, ,January 2001, p 1280-1285.
15. Kumar Rajesh and Aggarval Arun , Accuracy of maternal perception of
neonatal temperature Indian Paediatrics, September 1991,p 553-554.
16. Frank ,m.Ringsted and helle samelsen Early home based recognition of
anemia via general danger signs in young children in a malaria endemic
community in north east Tanzania ,Nov 2006.
17. Blake A, stewart A and Turcan D., Parents of very low birth weight
babies ,Ciba Found Symp., 1995.,P 271-288.
18. Camel T Collins , Philip Ryan , Caroline AndrewEffects of Bottacles ,
[16]
[17]
10.
11.
SIGNATURE OF THE
CANDIDATE
11.1.
GUIDE
11.2.
SIGNATURE
11.3.
11.4.
11.5.
11.6.
SIGNATURE
SIGNATURE
SIGNATURE
[18]