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A DESCRIPTIVE STUDY ON ACTIVITY ANALYSIS OF THE HEALTH
PERSONNEL REGARDING ESSENTIAL NEW BORN CARE IN LABOUR
ROOM IN SELECTED HOSPITALS AT BANGALORE
M.Sc. Nursing Dissertation Protocol Submitted to
Rajiv Gandhi University of Health Sciences, Karnataka
Bangalore – 560041
By
Ms. AYEKPAM PRIYOBALA DEVI(M.Sc. Nursing. 1st Year)
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY,KTG COLLEGE OF NURSING,
HEGGANAHALLI CROSS,VISHWANEEDAM POST,SUNKADAKATTE ROAD,
BANGALORE – 91.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION
1. NAME OF THE CANDIDATE ANDADDRESS
Ms. AYEKPAM PRIYOBALA DEVIKTG COLLEGE OF NSGHEGGANAHALLI CROSS,VISHWANEEDAM POST,SUNKADAKATTE ROAD,BANGALORE – 91.
2.NAME OF THE INSTITUTION
KTG COLLEGE OF NSGHEGGANAHALLI CROSS,VISHWANEEDAM POST,SUNKADAKATTE ROAD,BANGALORE – 91.
3.COURSE OF STUDYAND SUBJECT
1ST YEAR M.Sc. NURSINGOBSTETRICS AND GYNECOLOGICAL NURSING
4. DATE OF ADMISSION TO COURSE 15th May 2009
5. TITLE OF THE TOPIC
A DESCRIPTIVE STUDY ON ACTIVITY ANALYSIS OF THE HEALTH PERSONNEL REGARDING ESSENTIAL NEW BORN CARE IN LABOUR ROOM AT SELECTED HOSPITALS IN BANGALORE.
6.0 BRIEF RESUME OF INTENDED WORK
INTRODUCTION
The Life begins much before the actual birth. The concept of
prevention, therefore must be extended to even before conception. It is
possible increase the perinatal survival and adequate management of the
newborn.1
In a Historical perspective, the development of obstetrics, has great
significance. Hippocrates (460 – 370 BC) “The father of medicine” took
some part in the management of child birth and care of the newborn. He
wrote a book on references to child birth. Child birth among ancient people
was usually a process of social process of social importance to the entire
tribe. Rituals and customs carried out by the female healers and other child
birth attendants, customs took importance in their practices. Some tribes
used some special places for child birth. 2
Susrutha an early Hindu writer (600 BC and 500 AD), described
management of normal and abnormal labour and gave excellent antepartum
and post partum advices. He advised cleanliness on the part of the attendant
such as cutting the bread, the hair and the nails closely, wearing clean gowns
and disinfecting the room and equipment prior to delivery. Ancient Jews,
were interested in the hygiene and cleanliness at the time of child birth,
Hygiene and sanitation were practices integrated into religious law. 3
Although most maternity and newborn care were provided by
midwives, a gradual shift in attitude began during 15th and 16th centuries.
Prominent people and nobility increasingly sought male physicians and birth
attendants, probably because a perceptions that they possessed new
scientific knowledge. 4
During 1779 to 1817 John Peter Frank in Germany made
recommendations concerning child births. He insisted that all child births
be attended by trained persons. 5
Charles While published a thesis on obstetrics advocating the
scrubbing of the hands and general cleanliness on the part of the accoucheur.
He was the pioneer in aseptic midwifery. 6
At the turn of 19th century almost all women were delivered at home
by a midwife or a physician. At the present time, more than 90 percent of
mothers deliver in the hospital. Two other factors in turn brought about this
change to hospital deliver and helped the kind of care received. An increase
in the understanding of asepsis made the physician much more attentive to
the care of the mother and infant and their relationship. 7
Thus many changes had been made during this period by the five
year plan. Recommendations of WHO, UNICEF were implemented to
protect the newborn. 8
The word essential means intervention and basic components of
newborn care. The birth of an infant is one of the most awe inspiring and
emotional events that can occur in ones life time. After nine months of
anticipation and preparation, the neonate arrives with a flurry of excitement.
The Newborn says. 9
The concept of “Essential Newborn Care” was developed on the
assumption that all newborns irrespective of the place of birth, person
conducting the birth, birth weight or gestational age and with or without
medical problems, need care. 10
Newborn are very precious to the parents and they are the torch
6.1
barriers of future generation. Hence mankind should have compassion to
take good care of them. Newborns are not full citizens. Being babies are
having the right of caring. Since they are smaller, weak, more vulnerable
unable to help themselves and voice their rights, also their preferences and
they represent the future. 11
During mid 1997, the CSSM program has been replaced by the
Integrated RCH program. The RCH package is a constitution and
enlargement of the scope of CSSM initiative. There is a grater emphasis to
provide essential newborn care by strengthening of PHC’s, FRU’s and
district hospitals and training physicians and TBA’s. The country currently
plan’s to launch Phase – II RCH programme for the next five years (2004 –
2009) include antenatal care, Institutional deliveries, emergency obsttrics
and essential newborn care. Essential newborn care would be provided as a
home based model with the help of Angan wadi workers, TBS’s, ANM’s
and village based newborn workers. 12
NEED FOR THE STUDY :
Today’s children are tomorrow’s youth. The health personnel are the
source of health care and health information as they hold an important role
in taking care the newborn. Care of the newborn can greatly influence the
growth and development of the children. 13
The majority of newborn problems are specific to the perinatal
period. They cause not only deaths but also substantial morbidity and
disability. These problems are the results of poor maternal health,
inadequate care during pregnancy, inappropriate management and poor
hygiene during delivery, lack of newborn care and discriminatory care. If a
mother dies during childbirth, her baby will have an even smaller chance of
survival. Death among newborn infants is so frequent that it is accepted as
routine by many families and community members. In some societies a
child is named only if she or he survives the critical neonatal period. 14
Newborn deaths cannot be substantially reduced without efforts to
reduce maternal deaths and improve maternal health. However, care during
pregnancy and delivery must be accompanied by appropriate care of
newborns and measures to reduce newborn deaths due to postnatal causes
such as infections (tetanus, sepsis), hypothermia and asphyxia. Most
postnatal deaths are caused by preventable and or treatable diseases.
Preventive interventions are simple, inexpensive, available and cost
effective. 15
Most newborn deaths can be avoided by both preventive measures
(such as clean delivery) and by effective management of complications
(such as resuscitation, management of infections). Other interventions also
have important preventive effects (thermal protection, breast feeding, eye
care to reduce blindness). 16
In 1994 WHO convened a technical working group to define
essential newborn care at three levels at home in the family at the health
centre. 17
Although the mother is the first person who takes care of the
newborn, a health personnel as a mother has got the significant role in
primary execution of care to the newborn18
The National health policy is to achieve the “Health for all by 2000
A.D” WHO and UNICEF included reduction in the neonatal mortality and
low birth weight infants among their priority objectives for the 1990. it was
proposed to achieve infant mortality to 15/1000 live births by 2020. 19
All the above statistics and neonatal problems shows the importance
of the essential newborn care. So the investigator planned to do the study on
essential newborn care and to assess activities of essential newborn care.
REVIEW OF LITERATURE
Review of literature is an ongoing process and covers the entire
planning stage. The term “Literature Reivew” refers to the activities
6.2 involves in identifying and searching for information on a topic by further
developing a comprehensive picture on the topic. In order to make research
findings useful, there should be an extensive of previous knowledge and
theory as well as a guide for future research study. 21
The literature are presented in the following sub headings :-
Part – 1 literature related to health personnel
Part – 2 Literature related to essential newborn care
PART – I : LITERATURE RELATED TO HEALTH PERSONNEL
Study on Doctors and Nurses :
A study was conducted on comparison of two training strategies for
essential newborn care in Brazil. The objective was to compare the
effectiveness of two training strategies for improving the essential newborn
care. Eight hospitals were selected, divided into two groups of four doctors
and nurses working at Hospitals in Group – I they given a conventional
training course for 5 days and Group – II was given the same manual used
by Group- I, but the training course was organized as self directed learning.
Participants practices were observed before training and 3 – 6 months after
training during 20 births and by interviewing 20 mothers before discharge.
The findings indicate an improvement in knowledge among those in Group-
2 than those in Group – I. Practices related to thermal control after birth
improved among those in Group – 2 after training but practices related to
thermal control in the ward worsened. The promotion of breast feeding
improved in both groups. 19
The study concluded that there was no difference between the two
training strategies, although self learning was cheaper than conventional
training. Neither strategy brought about the expected improvements in the
quality of care. 20
Study on nursing personnel :
A study was conducted on Integrated nursing care : vital issues
important in the human care of the newborn. Neonatal nurses are in a
unique and powerful position to influence the lives of the infants and
families. The essence of the protection is an obligation to care. Nursing is a
process of facilitation that involves mutual interactive communication
towards an individual, family or community. When the nurses
communication towards an individual, family or community. When the
nurses relationship is one of mutuality with the family, there is a
synchronous process of the nurse supporting the family in supporting the
infant care. 17
This study is on the activities performed and task performance of
female MPHW in relation to maternal and child health services at Burdwan
district (West Bengal). The objectives of the study were to identify different
activities performed by the MPHW (F) at their place of work, to find out the
time spent on each activity to analyse the actual task performed by the
female multipurpose health worker in area of maternal and child health
services in relation to antenatal, internatal and postnatal care, Newborn care,
family welfare, nutrition, immunization and other activities, related to
maternal and child health services cluster sampling technique was used to
select the samples. Analysis of date revealed that all the MPHW (F) were
performing all activities related to maternal and child health services as laid
down by the Government of India like immunization, antenatal care,
postnatal care and nutrition. Due to lack of time they are not able to spend
much time over the activities. 17
Mark J. Yanover MD did a comparative study which insists the
importance of home care after discharge from the hospital.
The study was done on the sample of 44 persons treated (Study
group) and with 44 receiving traditional care (controls). A family centered
perinatal care program featuring collaboration by nurse practitioners,
obstetricians, pediatricians and paramedical personnel was developd to
enhance family participation and achieve a shortened but safe hospital stay.
Discharge from the hospital was permitted as early as 12 hrs after delivery.
21 study families, but no control families went home with in 24 hrs. The
study and control groups had no significant differences (or) trends in
number (or) types of morbidity during hospitalization on the 6 week post
partum period. The expense of the program is approximately equaled by
hospital costs saved through early discharge. 8
The results indicate that early discharge with home care, follow up
observation as described is safe, economically feasible and well accepted by
patients.
Study related to thermo regulation in neonate :
This study was conducted by S.B. Badekar, Manisha Bavdekar and
Armida Fernandez in Children’s Hospital, San Francisco 1971.
The importance of thermal environment has been known for a long
time. It has been considered a good thing to keep babies warm and
attendants were expected help babies maintaining body temperatures.
Pierre Budin. Historically the first neonatologist had perhaps the
earliest insight into the clinical importance of thermal environment. He
observed that the survival rate in newborn is higher if their temperature is
maintained between 36 to 37 degrees centigrade. 5
By controlling environmental temperature but varying humidity, h
found no significant change in survival rate. Silverman and his co-workers
also showed that a newborn baby has all the responses of a homeotherm.
The increased survival rate was observed by Budin and Silverman. This
was explained on basis of decreased oxygen consumption when thermal
environment is optimum. 16
PART – 2
Study on Managing First Breath :
Touch SM and Shaffer TH et al conducted study (2002) in Thomas
Jefferson University USA on “Managing our first breaths ; a reflection on
the past several decades of Neonatal pulmonary therapy.
Lund disease has been a leading cause of significant morbidity and
mortality since neonates first drew breath. We constantly modify the
therapies we offer to preterm and term infants . This article reviews
advances in mechanical ventilation and adjuvant therapies.
Newborns in an experimental group were bathed within first hour of
birth, those in control group were bathed at 4 – 6 hours of age. Auxiliary
temperatures were measured before the bath and after the bath, one hour
later and two hours later. Results are temperatures did not differ
significantly between infants bathed with in one hour and 4 – 6 hours after
birth. So a flexible bathing time is recommended. 23
Study on Skin cleaning in Neonates :
Tyebkhan G. (2002) conducted a study on “Skin Cleaning in
Neonates and Infants basics of Cleansers”. The objective in using proper
cleaner for bathing neonatal skin is of primi importance considering the
anatomical differences with regard to adult skin. Results show the majority
of cleansers do not mention their ingredients, a non soap, lipid free liquid
cleanser clinically has been proved to be non irritating by the Chamber
Scarification test. 24
Study on oil massage of Neonates :
Darmstadt GL, Saha S.K. conducted a study in (2002) in Department
of International Health, Bloomberg school of Public Health, USA on
“Traditional Practices of Oil Massage of Neonates in Bangladesh”.
Topical application of Natural oils practiced in many countries may
either improve skin barrier functions and health or have detrimental
cutaneous and systemic effects. This study was undertaken to gain insight
into the epidemiology, practices and perceptions regarding traditional oil
message of neonates both term and preterm infants. More than 96% of care
given practiced oil massage, 72% in both term and preterm infants. 22
Perceived benefits included prevention of infections 69% and
hypothermia 2%. Further research is needed to optimize its beneficial
effects.
Study related to in neonatal infection :
This study was conducted by Dr. P.A. Devies Roayl PG Medical
School, Hammer Smithy Hospital, Londs, 1973. The most common and
important ways of infection are via the hands of his attendants, nurses,
doctors and less frequently the mother. The humidification units of
specialized apparatus such as resuscitation and suction machines, incubators
and mechanical ventilators may be the source of infection. Epidemics of
septicemia, meningitis in neonatal intensive care nurseries was reported
frequently just over 10 years ago and source of infection was often traced to
a piece of contaminated equipment. 21
Droplet infection can certainly occur in nurseries of newborn. There
are possibilities for reducing perinatal infection, screening for maternal TB,
Syphilis during pregnancy has largely eradicated the risk of these diseases in
neonate. The nursing staff must have an important role in preventing
serious infection and in early detection of infection before irreversible
damage occurs, the appreciation of vital need for very careful aseptic
techniques with maintenance of scrupulously clean apparatus are of
paramount importance. 7
SUMMARY :
Review of literature related to problem it was useful to the
investigator to select and justify the choice of the problem for the study, to
prepare appropriate research tools and to select methodology.
STATEMENT OF THE PROBLEM :
“Activity analysis of the health personnel regarding essential
newborn care in labour room at selected hospitals in Bangalore.
6.3
6.4
6.5
6.6
OBJECTIVES :
1. Assess the activities of health personnel regarding essential
newborn care in labour room.
2. Analysis the activities of the health personnel related to essential
newborn care with selected variables.
HYPOTHESIS
H1 : There will be significant association between activity level of
health personnel regarding essential new born care and selected variable.
OPERTIONAL DEFINITIONS :
1. Activity Analysis : Interpret the activities carried out by health
personnel regarding essential newborn care in labour room with the
help of observational checklist prepared for study.
2. Essential newborn care : Interventions or basic components of
normal newborn care in labour room for all babies, to meet their
physiological needs, such are :
Immediate care at birth
Resuscitation of the newborn with asphyxia
Prevention of infection
Prevention of hypothermia
Early breast feeding
Referral of sick newborn
Immunization
Recording and reporting
3. Health Personnel : Different cadre of employees involved in
essential newborn care and working in labour room at the time of data
collection. They include :
Doctors – Professionals with M.B.B.S, D.G.O and Post graduate
qualifications.
6.7
6.8
6.9
Nurses – All registered nurses and registered midwives including head
nurses.
ANM – Multipurpose health worker (female)
Students – Pupils undergoing medical and nursing education
4. Institute of Obstetrics and Gynaecology :Government teaching,
tertiary care and referral hospital providing obstetric and Gynaec
services.
ASSUMPTIONS :
1. Health personnel with work experience in labour room and NICU will be efficient in essential newborn care.
2. Health personnel with higher qualification perform quality essential newborn care.
3. Health personnel having special training in NICU and labour room, execute better essential newborn care.
DELIMITATIONS :
1. The study is delimited to the health personnel working in labour room available at the time of date collection.
2. The study is delimited to essential newborn care in labour room.
PROJECTED OUTCOME :
The study will help the health personnel about the Essential New Born
Care in labour room and hence help to improve their theoretical knowledge
and practical skill
MATERIALS AND METHODS :
SOURCE OF DATA
a) Health Personnel
b) Labour Room
7.1.1 RESEARCH DESIGN :
7.0
7.1
7.2
The Research Design used is the unvariate descriptive study, non-
experimental research.
RESEARCH APPRAOCH :
A descriptive approach is used for the study
7.1.2 RESEARCH SETTING :
The Research Setting are selected hospitals in Bangalore.
7.1.3 POPULATION :
The Population selected is health personnels.
METHOD OF COLLECTION OF DATA : Interview will be conducted between 9:00 AM to 4:00 PM. Data will be
collected from six (6) samples per day. The duration of the study will be
four (4) weeks. The duration of 40 minutes will be spent for each sample.
7.2.1 SAMPLE TECHNIQUE :The purposive sampling technique will be used for this study.
7.2.2 SAMPLE SIZE : The sample size is 50.
7.2.3 INCLUSION CRITERIA FOR SAMPLING : The criteria for sampling selection are :
Health personnel working in the labour room
Health personnel available at the time of data collection,
7.2.4 EXCLUSION CRITERIA FOR SAMPLING :
The criteria for sampling selection are :
Health personnel not working in labour room.
Health personnel not available at the time of data collection
Who are not present in labour room
7.2.5 INSTRUMENT INTENDED TO BE USED : SELECTION OF TOOL :It consists of 2 parts
Part – I : It consists of demographic variables such as age, sex and qualificationPart –I I : Questionnaire will be used to assess the knowledge, 20 question will sbe asked.
SCORING PROCEDURE
For knowledge assessment if answer is Yes – 1
If answer is No - 0
SCORING INTERPRETATION
Excellent Above 90 %
Good 65 – 90 %
Average 50 – 65 %
Poor Below 50 %
7.2.6 DATA COLLECTION METHOD
The prior permission from the authorities of selected Hospitals of Obstetric
and Gynecology in Bangalore. The investigator will use questionnaires to asses
the knowledge regarding essential new born care in labour room. Interview will
be conducted between 9:00 AM to 4:00PM. Data will be collected six (6) samples
per shift. The duration of the study will be four (4) weeks. The duration of 40
minutes will be spent for each sample.
7.2.7 PILOT STUDY
Five (5) samples will be selected and study will be conducted to find out
the feasibility.
7.2.8 DATA ANALYSIS PLAN
Descriptive statistics such as mean standard deviation will be used for
assessing the knowledge. Inferential statistics such as chi-square and test will be
used for activities performed by health personnel in the labour room concerned
with essential new born care.
DOES THE STUDY REQURIE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS
- Y E S -
HAS ETHICAL CLEARANCE BEEN OBTAINED YOU’RE YOUR
7.3
7.4
INSTITUTION ?
Ethical clearance will be obtained from the research committee of K.T.G.
College of nursing .
Consent will be taken from the Head of College and school of nursing and
study subjects before collection of data.
# # #
BIBLIOGRAPHY
1. Achar S.T. and Viswanathan. J. (1995). Text book of Pediatrics indeveloping Tropical Countries, (3`d edition). Madras, Orient Longman.
2. Bobak Jensen "Maternity and Gynaecologic Care the and the Family", Edition, 1992, Mosby Company, London.
3. Dickson Silver Man and Schult "Maternal Infant Nursing Care", 2nd edition, 1993
Mosby Publication, Philadelphia.
8.0 4. Dutta D.C. "Text Book of Obstetrics including Perinatology and Contraception", 4th edition, 1998, New Central Book Agency, Calcutta.
5. Manual for Health Assistants (Male and Female), (1st edition), Ministry of Health and Family Welfare, New Delhi.
6. Marlow Dorothy R. et al (1988). Text book of Pediatric Nursing. (6tn edition). Philadelpiha, W.b.Saunders Company.
7. Nelson. E.Waldo. (1991). Text book of Pediatrics Philadelphia, W.B.Sunders Company.
8. Park.K. (1997). Preventive and Social Medicine. (18th edition), Jabalpur Benarsidas Bhannot Publishers.
9. Paula. J.Christengen. (1988). Nursing Process Application of Conceptual Models.
10. Polit. F.Denise and Hungler P.Barnadelti. (1983). (2"d edition), Philadelphia, J.B. Lippincott Company.
11. Whaley and Wong. (1997). Essentials of Pediatric Nursing, (5t" edition) Mosby Company New York.
12. Agarwal, V.K. and Gupta. (July 1964). Resuscitation of the Newborn. The Indian Practitioner XVII; 7 ; 641 - 644.
13. Athavcle, V.B. (July 1963). Some observations on Temperature in the New Born. Indian Journal of CHID HEALTH. 12: 17, 381 -410.
14. Binzley, V. (Jan. 1977), State ; Overlooked factor in Newborn Nursing. A.J.N., 77:1; 102-103.
15. Chandra, R.K. (Feb. 1965). Staphylococcal infections in the New born. Indian Pediatrics 2 : 2; 37 - 42.
16. Daitany , S.S. and others. (March 1980). Oral thrush in the New born. Ind. Pediatrics, XVII; 3; 1343-1345, 24.
17. Ghosal, S.P. and Others. (April 1975). Incidence of hyperbilirubline - mia in the Newborn. Ind. Paediatrics. XII 4 : 317 - 324.
18. Ghosl, Shanthi and Bali, Lata. (July 1963), Congenital Malformations in the New Born. Indian Journal of Child Health, 12: 7; 448 - 451.
19. Hemrajani, K.H. Others. (Jan. 1971). Congenital malformations in newborn, Pediatric Clinics of India, 6:1, 51-54.
20. Khanijo, S.K. and Shrivastava, D.K. (Aug. 1965). DLG Vaccination in New
Born. Indian Practitioner.XVII; 8;619-622.
21. Mathur, B.C. and Others. (Feb. 1974). Congenital malformations in the Newborn, Ind. Pediatrics, XIII ; 2 ; 179 -183.
22. Merrifield, A.J. (March 1964). The breathing of the New born baby Nursing Mirror-117; 3063; 531-2.
23. Misra, P.K. & Sharma, B.Hypoglycemia in Newborns - a prospective study. Ind. Pediatrics, XIV; 2 :129-132.
24. Mortimer, Edward A. and Others. (April 1966). The effect of rooming - in on the acquisition of hospital staphylococci by New born infants. Pediatrics 37 ; 4 ; 605-609.
# # #
9 SIGNATURE OF THE CANDIDATE
Ms. AYEKPAM PRIYOBALA DEVI
10. REMARKS OF THE GUIDE
11. NAME AND DESIGNATION
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE
12. REMARKS OF THE CHAIRMAN / PRINCIPAL
12.1 SIGNATURE
# # #