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.

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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.

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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

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