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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA,

PROFORMA FOR REGISTRATION OF


SUBJECTS FOR DISSERTATION

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

1st YEAR M.Sc NURSING,


CAUVERY COLLEGE OF NURSING, MYSORE.

CAUVERY COLLEGE OF NURSING, MYSORE-570007

INSTITUTION
COURSE OF
3

STUDY AND

MASTER OF NURSING - OBSTETRICS AND


GYNAECOLOGICAL NURSING.

SUBJECT
4

DATE OF
ADMISSION TO

14-07-2011

COURSE
5.1

A STUDY TO ASSESS THE EFFECTIVENESS OF SELF


TITLE OF THE
STUDY

INSTUCTIONAL MODULE ON KNOWLEDGE AMONG


POSTNATAL MOTHERS REGARDING MANAGEMENT OF
LOW BIRTH WEIGHT BABIES IN SELECTED HOSPITAL,
MYSORE.
A STUDY TO ASSESS THE EFFECTIVENESS OF SELF

5.2

STATEMENT OF
THE

PROBLEM

INSTUCTIONAL MODULE ON KNOWLEDGE AMONG


POSTNATAL MOTHERS REGARDING MANAGEMENT OF
LOW BIRTH WEIGHT BABIES IN SELECTED HOSPITAL,
MYSORE.

[2]

6.

BRIEF RESUME OF THE INTENTED STUDY

6.1 INTRODUCTION:HEALTHY CHILDREN ARE THE STEPPING STONE TO


BUILD A STRONG AND PROSPEROUS NATION
The birth of a child is a significant event in any family, health is
concern of every one to everyone attention to health is central to the objectives of
general education child needs good health for effective growth and development,
protecting children soon after birth is essential to help them remain healthy and
strong throughout life. Various causes of neonatal deaths are immaturity, low birth
weight, infections, congenital malformations etc., lLow birth weight is a common cause
of neonatal deaths.1
New born infant is defined as A healthy infant born at
term(between 38-42weeks) should have an average birth weight for the country 3kg,
cries immediately following birth, establishes independent rhythmic respiration and
quickly adopts to the changed environment.2
In India about 30 to 40 percent neonates are born low birth weight.
Approximately 80% of all neonatal deaths and 50 percent of infant death are related
to low birth weight. These low birth weight babies are more prone to malnutrition,
infections and neurodevelopmental handicapped conditions.1
The gestation period for humans is approximately nine months. The
ideal human baby weight at birth is 2.5kg to 4kg. babies born under 2.5kg are considered
as LBW or under weight babies. A healthy birth weight is extremely important for
newborn this is because babies birth with low birth weight are more susceptible to health
problem, slower development, delayed milestones and low immunity.1
Low birth weight babies are small in size with thin, gelatinous, shining
and pink skin. They have abundant lanugo, Ear cartilage is deficient. They have poor
muscle tone with sluggish automatic reflexes and slow or Ineffective sucking and
swallowing efforts, brest nodule is small or absent. (O.P GHAI, 2003).3
The indications for hospitalization of a low birth weight babies include
birth weight less than 1,800 gram, neonate who is not able to take feeds from mothers or by
katori or a sick neonate. The principles of management of low Birth weight neonate in he
[3]

hospital is temperature maintenance, providing fluids, prevention of infection. (Piyush


Gupta, 2004).6
Indira Shekar Rao.M, 2002 classifies at risk babies as babies weighing
1,500 to 2,000 grams, active at work with no signs of illness, main ting proper body
temperature, with good sucking, ability to feed. All the mothers who delivers such babies
can be trained at

home regarding feeding, warm, monitoring for dangers signs,

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

NEED FOR THE STUDY


Every pregnancy is considered to be a precious pregnancy for the mother.

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

neurological and development problems. Good prognosis in growth and development


problems of such babies is purely dependant on the effectiveness of management.
(Behrman.R. & Shiono.P, 1995)
[4]

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]

2. Literature Related To Management Low Birth Weight Babies.


Short et.al, 1996, in his experimental study on swaddling the preterm babies found,
as swaddling the preterm well in flexed position stimulated the position of the baby in the
uterus, it promoted hypertonicity, quieting behavior and more eye hand mouth coordination.
Rao Nagaraj, M. Etal, (1998) in their descriptive study in primary care of the new born,
reported that umbilical infection is more common in the first three days after delivery. He
suggested that washing hands before handling and feeding the baby prevents 50% of
infection.
Child Survival Safe Mother hood 1998, article on low birth weight discussed that the risk of
infection is higher in low birth weight babies and he emphasized that hand washing with
soap and water for at least four minutes before handling the baby is the most effective
method of prevention infection personnel with skin infection, respiratory infection.
Sinclair J.C, 2000 in his experimental study conducted in Cocharne on servo control for
maintaining abdominal skin temperature at 36 C in low birth weight babies, determined
the effects of death and other important clinical out because targeting body temperature
rather than air temperature. He observed that there was a very important reduction in death
rate of low birth infants attributable to servo control of abdominal skin temperature at 36
C.
Hopkins John, 2001, in his comparative study conducted in Bangladesh on the effect of
exclusive breast feeding on babies born small at birth observed that if such babies are
exclusive breast fed had significantly better chances for catch up growth compared to small
infants given other fluids or foods during first six months which only had detrimental
effect.13
Ramnathan.K, Paul.V.K, Deorari, A.K Etal, 2001 in their experimental study conducted in
AIIMS New Delhi, on kangaroo mother care in low birth weight infants, analyzed the
effect of Kangaroo mother care on breast feeding rates, weight gain and length of

[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]

3. Literatures Related To Self- Instructional Module on Management of Low


Birth Weight Babies.
Pinhate Muss, Gonclaves, And Foss, 1993, in their evaluative study on determine
the effect of BCG vaccination on Intra Uterine Growth Retardation, babies observed that
immunigenicity of BCG vaccines is similar in term infants who have Normal abnormal
Intra uterine growth. Hence BCG vaccination should not be delayed in Intra Uterine Growth
Retardation babies.
Kumar Rajesh And Aggarwal Arun.K 1996, In their no experimental study on assessing
the accuracy of maternal perception of neonatal temperature, reported that mothers could
correctly categorized 24.6% babies as very cold, 46.7% babies as moderately cold and 32%
of babies with cold stress by touching.15
Blake.A , Stewart.A, Turcan.D, 2000, In their long term follow up study to assess the
emotional status of the mothers of low birth weight babies due to their prolonged
hospitalization observed that mothers underwent a stage of emotional crisis until the parents
had the child back at

home. They also observed that parents formed satisfactory

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.

6.7 OPERATIONAL DEFINITIONS


1. Effectiveness: Significant gain in the knowledge as determined by the statistical
difference in the pretest and post test knowledge scores on management of low birth weight
babies among postnatal mothers.

[11]

2. Self Instructional Module: Refers to systematically organized series of content on


management of low birth weight babies. It includes meaning, causes, sign and symptoms,
methods and techniques of management of low birth weight babies.
3. Low Birth Weigh Babies: Refers to the new born whose birth weight is less than 2,000
gram regardless of gestational age.
4. Management: Refers to the rearing and caring practice of low birth weight babies at
home after discharge from the hospital.
5. Postnatal Mother: Refers to a woman admitted in postnatal ward and neonatal intensive
care unit and who had given birth to a baby weighing less than 2,000 grams.
6.8 DELIMITATIONS
The study will delimited to postnatal mothers:1. Who will give birth to a baby with less than 2000 grams,
2. Who will be physically and mentally fit to take care for their babies,
7.

MATERIALS AND METHOD OF STUDY

7.1

SIGNIFICANT OF THE STUDY


Research methodology is the way of doing research to solve the problem. This

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

RESEARCH APPROACH& DESIGN


The research approach adapted in the study was an evaluative approach, as the

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.

METHOD OF DATA COLLECTION


[12]

Experimental design with control group will be used to assess the


effectiveness of self instrumental module on home management of low birth weight babies.
Part A : demographical variables include age, gender, religion, marital status; number of
children, income, source of information etc
7.5.

SAMPLING PROCEDURE

7.5. (1).criteria for sampling selection


Inclusion criteria:

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 are not interested to participate in the study.

Mothers who have less than 1000 gm of low birth weight babies .

Mothers who have previous history of low birth babies.

Mothers who are not available at the time of study.

Mothers who have the illness of eclampsia, PPH.

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

Independent variables. Self instructional module program on management of low birth


weight babies among postnatal mothers.
Dependent variable.

Knowledge and attitude of

postnatal mothers regarding

management of low birth weight babies.


7.7.

PLANS FOR DATA ANALYSIS


Descriptive statistics

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.

7.9(1). ETHICAL OUTCOMES


Ethical clearance will be obtained from the institutions authorities concerned to particular
settings and also from ethical committee.
[14]

Does study require any investigation or intervention to be conducted on the patients or or


other humans or animals? If so, describe briefly.
Yes, study will conducted on mothers with low birth weight babies who admitted in
postnatal ward neonatal intensive care unit.
- Yes
7.9(2). HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION?
YES. Ethical clearance is obtained from concerned authorities.
8. LIST OF REFERENCE:[VANCOUVER STYLE FOLLOWED]:
1. Mrs Rajeshwari, focus on issues in obstetric nursing; on infant rearing practices,

march 2010, P-9-12.


2. Dawn C.S., Textbook of Obstetrics and Neonatology., 12 th
edition.
3. O

Calcutta. New Central Book Agency Private Limited., 1997.


Gahi

Piyush

Gupta

Paul

Essential

pediatrics

5th edition, mehta publishers .,2003.


4. Meharban Singh Essential pediatrics for nurses.,1st edition. sagar publications., new
delhi-2004.
5. Viswanathan.j.etal. Achars Textbook of Pediatrics. 3rd edition., Hyderabad. Orient
Longman Publication.,1995.
6. Piyush Gupta Essential pediatric Nursing, 5th edition, A.P.jain&co ,2004.
7. Prozialeck , Linda L and Persole , Lorne Evalution in a family case management
programe; determining outcomes for low birth weight deliveries. 17 (3) ; 195-201 ,
May/June 2006
8. Em Mc Call, FA Alderdice, HL Halliday JG Jenkins, S.Vohra Interventions to
prevent hypothermia at birth in preterm and /or low birth weight infants2008.
9. Nea , Joffe and Jan hall , Jouranal of neonatal nursing ,June 2006.

[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]

Eups & Clummies Jmcphee , Susan Paterson on Breast feed in preterm


infants. 18th June 2004 P-193-198.
19. Nurosan Dede Cinar and Tuncay muge Filiz , Neonatal Termo
regulation.April 2006

[17]

10.

11.

SIGNATURE OF THE
CANDIDATE

REMARKS OF THE GUIDE

NAME AND DESIGNATION OF


THE GUIDE (IN BLOCK
LETTERS)

11.1.

GUIDE

11.2.

SIGNATURE

11.3.

CO-GUIDE (IF ANY)

11.4.

11.5.

11.6.

SIGNATURE

HEAD OF THE DEPARTMENT

SIGNATURE

12. REMARKS OF THE CHAIRMAN


AND PRINCIPAL
12.1.

SIGNATURE

[18]