Summer FieldObservation

Report

Max Super Speciality Hospital, Saket

SUBMITTED BY: Ms Angel Thomas

MSc Nursing 1st year (RCON)

SUBMITTED TO: Mrs. Somibala Thokchom

Tutor (RCON)

EAST BLOCK

WEST BLOCK

RECEPTION COUNTER

AREA : Max Healthcare Super Speciality

Hospital, New Delhi

SUBJECT : Obstetrics & Gynaecology

DURATION: 11th May 2015- 5th June 2015

ADVISOR : Dr Manju Chhugani

(Principal, Rufaida College of Nursing)

IndexS.No. CONTENT PAGE

NO.1. Acknowledgement

2. Introduction

3. General Objectives

4. Section 1- Institutional Profile

5. Section II - Advance competency gained in nursing practice in the area of specialization maternity nursing.

6. Section III - Ability develops in Management and Supervision in clinical area.

7. Section IV - Problem Solving ability

8. Critical appraisal of hospital

9. Annexuresa. Letter of permissionb. Tool- Structured Questionnairec. Leaflet on Essential New-born cared. Certificate of experience

AcknowledgementI take this opportunity to express my heartfelt thanks and deep regards to Dr. Manju

Chhugani (Principal, Rufaida College of Nursing) and Mrs Somibala (Tutor, Rufaida

College of Nursing) for her kind approval for my posting in Max Healthcare Super

Speciality Hospital, New Delhi.

I am highly grateful to Dr. S Warsi (Medical Superintendent, Max Healthcare Super

Specialty Hospital) & Dr. Arthur Pinto (Medical Director) for his cooperation all

through the Posting in the hospital.

My special thanks to Dr. Anuradha, H.O.D, Obstetrics and Gynecology and Dr.

Shrishtha, Senior Consultant, Obsteritics and Gynaecology for her guidance and

support.

I am extremely thankful to, Dr. Anuradha, H.O.D Obstetrics and Gynaecology and Dr

A. Goel, H.O.D, Paediatrics for validating my tool and for their expert guidance.

I express my sincere thanks to all Nursing staff, Doctors, ANMs, paramedical and

other clerical staff for helping me to complete my experience in Max Healthcare

Super Speciality Hospital, New Delhi.

Above all, I express my deep sense of gratitude to the Supreme Lord, the Almighty

God for his abiding grace and magnanimity in completion of the summer field

posting

Introduction Maternal health is the health of women during pregnancy, childbirth, and the

postpartum period. India continues to contribute about a quarter of all global

maternal deaths On the other hand; one million children born in India are dying every

year even before they become 28 days old. A child born in India is 14 times more

likely to die during the first 28 days than one born in the US or UK. Despite health

improvements over the last thirty years, lives continue to be lost to early childhood

diseases, inadequate new born care and childbirth-related causes. More than two

million children die every year from preventable infections. According to the World

Health Organisation (WHO) globally, 30% of children under five are estimated to be

stunted and 18% have low weight-for-height, and 43 million children are overweight.

Optimal breastfeeding could save the lives of 1.5 million children under five every

year. Promoting something such as simple as breastfeeding can reduce infant

mortality by 11.6%. But though India has among the worst infant and child mortality

figures in the world, 75% of the nation’s children are not breastfed from birth and

over 50% are not exclusively breastfed. Maintaining health care standards requires

interdisciplinary collaboration among doctors, midwives, auxiliary nurses and other

paramedical staff.

General

Objectives To gain competencies in nursing

practice in the area of obstetrical &

gynaecological Nursing.

To develop problem solving

ability in the clinical area.

To develop further abilities in

Management and supervision in

Clinical area.

To record & report summer field

experience effectively & develop

report writing ability.

Section 1INSTITUTIONAL

PROFILEAbout the Hospital

Max Super Specialty Hospital, Saket (MSSH) is a Multi-specialty hospital, owned and operated by Max Healthcare Institute Limited (MHIL).the hospital is designed by architect Mr Richard wood. Located in the heart of South Delhi, Max Super Speciality Hospital, Saket (a unit of Devki Devi Foundation), is one of the premier names in health care domain in the world.Designed by internationally renowned architect Mr Richard wood and constructed in accordance with globally-accepted standards for hospitals, quality is our top priority. A 490-bedded healthcare facility, we are approximately 15km from New Delhi railway station and 12km from the domestic airport.

Spread in an area of 132348 sq. ft., Max Super Speciality Hospital, East Block Saket is a forward looking healthcare center offering most advanced medical treatments to the patients. The hospital was aesthetically designed with a view to make the patients as relax and comfortable as possible. A unit of Devki Devi Foundation, this international standard hospital focuses on offering world class cardiovascular care to the patients. The hospital is also engaged in independent as well as collaborative researches that cover diverse aspects of cardiology, cardiothoracic, vascular surgery, Cancer Care and Minimal Access, Metabolic and Bariatric Surgery.

Designed by the internationally acclaimed designer Mr. Richard Wood, all the five patient floors of the hospital are equipped with avant-garde amenities. Keeping in mind the security and emergency concern of the patients, the hospital developed a group of specialists who are well trained to handle any situation with an expert hand. The proper distribution of the services to all the five floors helps the hospital authorities to streamline their services and offer proactive help in case of any emergency need.

Passion

“Our passion well reflects in the fact that we set the industry standards when it comes to cure, care and comfort.”

To deliver International Class healthcare with a total service focus, by creating an institution committed to the highest standards of medical & service excellence, patient care, scientific knowledge and medical education.

Campus and Location

This 490-bedded healthcare facility is located in the Saket area of South Delhi, approximately 15 km from New Delhi Railway Station and 12 km from the domestic airport. There are two blocks in this hospital – East Block and West Block.

Accreditation, Awards & Recognition

• Max Institute of Minimal Access, Metabolic & Bariatric Surgery has been accredited as a Centre of Excellence for providing state-of-the-art Clinical Services and Surgical Training Programs for Abdominal Wall Hernia Surgery.

• FICCI awarded Max Super Specialty Hospital, Saket (West) with the Award for Operational in Healthcare Delivery on September 7, 2010.

Floor Plan of Max Super Speciality Hospital, East Block, Saket

The ground floor houses services like emergency service, diagnostic (including non-invasive cardiology), OPD, radiology & nuclear medicine and Apex coronary care

CTVS ICU/HDU, cardiac cath labs, cath recovery and operations theatres are housed in the first floor

Dialysis unit, inpatient area and high dependency unit are located in the second floor of the hospital

Third floor is completely covered with impatient area The fourth floor continues with the impatient area Fifth floor houses the blood bank along with the impatient area Facilities at Max Super Speciality Hospital, East Block, Saket

It is the availability of most modern medical facilities that make this hospital stand tall and offer the best of treatments to its patients. The following are some of the facilities that are available in this super specialty center -

490 beds (Suite, Deluxe, Standard and Economy) 20 operation theatres 2 cardiac cath labs 17 - bed CTVS ICU 16 - bed apex coronary care 11 - bed cath recovery 9 - Bed Onco Surgical ICU 12 - Bed Medical ICU 11 - Bed Minimal Access Surgery recovery 8 - bed high dependency unit 17 - bed Dialysis Unit 2 Cath labs 5 types of ICUs 2 MRIs and 1 CTs across an integrated network

The blood bank of this super specialty hospital is among the few blood banks in the country to get NABH (National Accreditation Board for Hospitals & Healthcare Providers) accreditation in the year 2009.

Medical Services

A wide range of medical services is available at Max Super Specialty Hospital, Saket including:

• CARDIAC SCIENCES

Max Department of Cardiac Sciences strives to provide patients with expert treatment and care. We believe in offering the patients with an ethical and open environment to recover. Our team of expert Cardiologists, Cardiac Surgeons and Vascular Surgeons believe in carrying out an in-depth investigation of patient condition taking into account patient’s complete medical history, therefore strategizing a tailored treatment and recovery plan for each. Our expertise in cardiac care helps us in caring for patients with heart disease by providing complete all-round care. From diagnosis, prevention, treatment, surgical care to cardiac rehabilitation and wellness services, we look after your heart A to Z.

• NEUROSCIENCES

Max Institute of Neurosciences is designed to provide the highest levels of professional expertise and leadership in all major disciplines of neurosciences through an integrated team dedicated towards providing total patient care.The Institute boasts of high-end technology, including the first integrated Brain SUITE (most advanced Neuro-surgical operating room with high field MR), the first of its kind in Asia-Pacific.

• ONCOLOGY

Max Cancer Centre - a centre of excellence in patient care, medical education and research. Our doctors and surgeons in the oncology Department are specialists in this field and aim to provide coordinated and holistic care that is focused on the complete needs of the patients. Right from cancer screening, early detection, multi-disciplinary treatment to rehabilitation, Max Healthcare provides complete cancer care to patients. Max Cancer Centre is the first ever internationally recognised Novelise Certified Radiosurgery Centre in whole Asia-Pacific.

• ORTHOPAEDICS & JOINT REPLACEMENT

At Max Institute of Musculoskeletal Sciences, our primary objective is "early mobilisation, minimal discomfort". This state-of-the-art specialised health care facility is designed to provide the highest levels of professional expertise and patient care. Here, every patient is tended to by a multi-disciplinary unit.

• KIDNEY TRANSPLANT

A kidney transplant is a surgical procedure performed to replace a diseased kidney with a healthy kidney from another person. The kidney may come from a deceased organ donor or from a living donor. Family members or individuals who are unrelated but make a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. Individuals who donate a kidney can live healthy lives with the remaining kidney. A person receiving a transplant usually receives only one kidney, but, in rare situations, he or she may receive two kidneys from a deceased donor. In most cases, the diseased kidneys are left in place during the transplant procedure. The transplanted kidney is implanted in the lower abdomen on the front side of the body.

• UROLOGY

The Department of Urology at Max Healthcare offers comprehensive diagnostic and treatment services for adult and paediatric urological conditions. The Department always strives to deliver the best health care to our patients who seek advanced urological treatments in India. The hospital is committed to maintain the highest clinical governance standards and patient-centric care, incorporating the latest advances in the field. This is the reason why a large number of patients worldwide choose Max Healthcare as their most preferred health care partner.

• DENTAL CARE

With experienced dentists, sophisticated tools and the most advanced technology, Max Dental Care has raised dental surgery standards in India. Our comprehensive range of dental services comes with the same care, comfort, and quality that brand Max Healthcare is associated with.

• INTERNAL MEDICINE

The institute of Internal Medicine comprises of a group of doctors with diverse interests and expertise. Our Staff is dedicated to providing patient-centred, evidence-based medical care in a clinical environment, supported by education and research. The clinicians at the institute of internal medicine work as a team with specialists to achieve the best possible treatment outcomes and to obtain a high degree of patient satisfaction. The team serves a wide spectrum of patients, including adolescents, adults and those with advanced age. The institute also provides routine and preventative care, consultative services for patients with complex clinical conditions, inpatient care, care to critically ill patients, consultative services for patients who require surgery and international patient services. We are a recognized teaching department by the NBE, India and train students for degrees like DNB (General Medicine) and DNB (FM)

• EYE CARE

With the best eye surgeons, the latest and highly sophisticated medical equipment and facilities, Max Eye Care definitely makes for the best choice when it comes to eye care. What’s more, being a part of the Max Healthcare group, you can rest assured of the quality of service and the care and comfort that you will get here.

ENT

The Department of ENT is a full-fledged super speciality centre, ready to meet the health care needs associated with Ear, Nose and Throat. Our aim is to make available best ENT care which is accessible and affordable.

• AESTHETIC & RECONSTRUCTIVE SURGERY

Whether you want to look as young as you feel or fix a lifelong flaw that makes you conscious of your appearance, Max Institute of Aesthetic & Reconstructive Surgery can help shape your dream into reality in a natural and safe way. With state-of-the-art facilities, advanced technology, and world class surgeons, we offer an endless array of options to help improve your appearance and function.

• MENTAL HEALTH & BEHAVIOURAL SCIENCE

The Department of Mental Health & Behavioural Sciences is committed to provide the highest level of comprehensive care to all those who seek world-class treatment from minor stress and interpersonal problems to major neurobehavioral/neurocognitive and psychiatric problems. The Department also lends its support to people who are essentially well adjusted and ‘normal’ but have problems in specific areas like work, social or home environment.

• DIABETES & ENDOCRINOLOGY

Known for its world-class health care services to patients all across the world, the Department of Endocrinology and Diabetes is a full-fledged facility involved in evaluating and treating patients for diabetes, obesity and endocrine disorders. A dedicated team of Endocrinologists, Bariatric surgeons, Podiatrists, Diabetes educators, Ophthalmologists works together to provide patients with the advanced therapies in the care and management of complex endocrine diseases and diabetes. The department also plays an active role in conducting various public awareness programs to allay social myths associated with hormonal disorders and conditions.

• GASTROENTEROLOGY & ENDOSCOPY

The Department of Gastroenterology & Endoscopy at Max Healthcare is committed to provide health care services to patients with diseases of the digestive system. Our gastroenterology & endoscopy specialists diagnose and treat diseases and disorders of the stomach, duodenum and small and large bowel (colon). A dedicated team of Endocrinologists, Bariatric surgeons, Podiatrists, Diabetes educators, Ophthalmologists works together to provide patients with the advanced therapies in the care and management of complex endocrine diseases and diabetes.

• PAEDIATRICS

Max Institute of Paediatrics is one of the renowned centres of childcare in the country and works on the principle of "WHERE CHILDREN COME FIRST". The Institute is dedicated to deliver complete, compassionate, state-of-the-art health care services for children from birth to sixteen years-of-age (and older in some cases) who have special health care needs that are different from adults.

• PULMONOLOGY AND RESPIRATORY MEDICINE

The Department of Pulmonology at Max Healthcare is committed to deliver superior clinical services and transforming our research findings into new and effective treatments for respiratory disease. Our clinical and research programs are focused on interstitial lung disease, pulmonary vascular disease, heart-lung and lung transplantation, and non-tuberculosis mycobacterial disease. We have a team of experienced clinicians, scientists, and scholars committed to improving the lives of patients with serious lung disease.

• OBSTETRICS & GYNAECOLOGY

Max Institute of Obstetrics and Gynaecology is fully committed to deliver world-class health care services to women looking for gynaecological solutions. We have a dedicated team of obstetricians and gynaecologists offering a wide range of services. From pre-pregnancy care to childbearing and post-menopausal care, there is a solution for all health concerns a woman experiences during these stages. The primary objective of this Institute is to promote health of women by providing them complete support, care and, empathy that they require.

DERMATOLOGY

The Department of Dermatology at Max Healthcare is dedicated to provide superior level of skin care to patients. The Department takes a comprehensive approach to patient care and offers a wide range of speciality services in medical, paediatric, surgical and cosmetic dermatology. From treating recurrent skin cancers to performing various facial treatments to prevent acne and maintain healthy skin, our skilled dermatologists provide patients with a range of world-class services and personalized care.

EMERGENCY SERVICES

We provide the best of medical evacuation and air ambulance services in India. We provide retrieval and repatriations of critically ill people and injured to and from India and abroad. Our emergency assistance and medical air ambulance services are managed by highly experienced and qualified personnel 24 hours a day, 365 days a year. We have a 24 hours Command and Control Centre manned by Doctors to provide advice and assistance to those in need.

Air Ambulance

Air ambulance services from IERS ensure you the safest and most secure shifting to our hospitals or medical centres located across India. For air ambulance, please dial: 011-40554055 (from India) and +91 11 4055 4055 (From India and across the globe). Services include:

Transporting patients on special aircraft - AIR AMBULANCE / commercial airlines/ choppers

Special trained team of doctor/nurse accompanying the patient from "bedside to bedside" throughout the transfer

Ticketing and ground transport for the patient

Special assistance at the airport for speedy and comfortable boarding

Arrangement of portable life- saving equipment like defibrillators , ventilators , infusion pumps , spine board , balloon pumps , pacemakers , monitors , oxygen cylinders, stretchers and other special requirements in the aircraft.

Surface Ambulance

In case of a medical emergency, just call the Max Emergency Services at 011 4055 4055 and a well-equipped ambulance with trained emergency staff will reach you within 30 minutes*. The ambulances are equipped with state-of-the-art medical equipment like cardiac monitors, defibrillator, airway equipment etc. Transport ventilator is also available for transport of intubated and ventilated patients.

Hospital Services

We believe that services and amenities play a highly significant role in healthcare industry, which is why we have only the BEST. Listing the services and amenities that we provide:

Blood Bank 24*7 Max Pharmacy Regional Translators Cafeteria Waiting Lounge Prayer Room Bank /ATM Business Associates TPAs Alliance Partners

Lab Services 24 *7 Max Labs is a 24x7 facility providing services for Max patients, walk-in patients

and non-Max clients as well. Fully automated 24x 7 lab with state-of-the-art equipment Fully integrated lab information system interfaced with Hospital Information

System across all the eight hospitals of Max Healthcare Stress Thallium On-going DNB Programme Home collection facility available

Speciality Clinics Women's Heart Clinic Multiple Sclerosis (M.S.) Clinic

Headache Clinic Geriatric Neurology Clinic Movement Disorder Clinic Pacemaker Clinic Arrhythmia & Electrophysiology Clinic

A Specialised Dialysis Unit Conforms with international standards Haemodialysis for patients with end-stage kidney disease/requiring renal

replacement therapy.

OPD & IPD Timings

To ensure privacy and maximum comfort for our patients, we request visitors to follow the below mentioned guidelines.

Visiting Hours IPD Rooms - One visitor is allowed to visit the patient between 4:00 pm to 7:00

pm. ICUs - One visitor is allowed to visit the patient between 11:30 am to 12:00 pm

& 5:00 pm to 5:30 pm. One attendant is allowed to stay with the patient in Single, Twin Sharing and

Suite.

Visitor Do's Follow the directions of the senior person in charge of each area and/or

department if there is an emergency such as fire. Patients are requested to wear hospital dress during hospitalization. Security personnel might check your belongings at any point of time; please

cooperate. Do be considerate of others present in the hospital.

Visitor Don'ts Smoking is prohibited, so please do not smoke. Outside eatables, sweets are not allowed in the hospital premises. Do not bring incense to burn in the patient's room as it may cause a fire or

affect the patient's health. Please do not bring flowers, handy cameras, and visitors below 12 years to the

hospital.

Section 2ADVANCED

COMPETENCIES GAINED IN NURSING

PRACTICE IN THE AREA OF

SPECIALIZATION

S.No ACTIVITIES COMPETENCIES ACHIEVED

1. Planned the total learning

programme according to

the objectives and

proposal.

Developed initiative and gained confidence in

planning one’s own learning programme.

Selected the Hospital for getting experience

according to the objectives.

Collected the permission letters for gaining

experiences.

Made plan for one month.

2. Visited and worked in

different areas of the

Hospital and got oriented

with the physical set up of

the Hospital.

Gained knowledge about:

Physical setup & different facilities.

Administration.

Important works.

3. Labour Room Studied different protocols and policies in

Labour room.

Gained proficiency in intra-partum monitoring

of mother and foetus.

Developed skill in setting up of a Labour room.

Developed competency in immediate

assessment and management of new born &

newborn resuscitation.

Developed skill in the active management of

third stage of labour and management of PPH,

Able to give health education to postnatal

mothers about postnatal care especially self-

Perineal care, exclusive breast feeding and

new born care.

Developed competency in immediate

assessment, care and daily observation of

newborn (Respiration, temperature, weight,

feeding schedule, eyes, mouth, number

character of stool, umbilical cord).

(ADD FOR NURSERY IF POSSIBLE)

4. Maternity Wards &

Maternity OPD

Gained in depth knowledge and skill in

management of in antenatal, intra-natal and

post-natal period.

Gained knowledge about management of high

risk pregnancy.

Observed different antenatal investigations.

Given health education to antenatal mothers

according to their need for education after

assessing their knowledge. Gained skill in

assessment of the pregnant mothers.

Observed different antenatal investigations.

Gained skill in HB testing, Urine testing, T.T

injection.

Observed various activities and type of care

provided by the staff and nursing personnel.

Participated and gained ability to conduct

such sessions independently.

6. Observed the Family

Welfare

Identified and oriented to physical setup of

family welfare.

Section 3DEVELOPED PROBLEM

SOLVING ABILITY IN THE CLINICAL

AREA TO IMPROVE THE NURSING

CARE PRACTICE AND

MANAGEMENT OF CARE

S.N

O

ACTIVITIES ABILITIES DEVELOPED

1. Planned the total

learning experience

Developed abilities to plan my own

learning programme according to the

objectives.

Gained experience in taking help from

experts and supervisors to make the

posting more fruitful.

2. Gathered factual

information of the

hospital from the

medical superintendent

and other officer.

Gained knowledge about staffing pattern,

administration, policies of the hospital.

3. Worked with sister in

charge

Read policies and

protocols.

Gained skill in taking administrative

rounds. Took rounds with sister in

charge.

Gained knowledge about division of

responsibilities and job delegation.

Gained knowledge and skill in:

Preparing duty roster for staff

nurses.

Planning patient assignment

and nursing activities in the

ward.

Management of ward supplies

and equipments.

Maintenance of records and

reports.

Gained experience in preparing

census.

Saw the management of ward

supplies and equipment and

ward as a whole.

4. Worked with the Staff

Nurses of a ward, labour

room and nursery

Gained skill in following administrative

functions

Management of patient care

Admission discharge and transfer of the

patient

Assessment of nursing needs and

assignment of patient care

Ensuring safety and care of patients

supervised the diet distribution and

discussed with ward in charge regarding

the diet.

Supervision and provision of health

education

Meeting the needs of the patient and

providing direct care to the patient

Making rounds and coordinating patient

care with other health team members

Maintenance of safe environment

Maintaining optimum environment for

patient

Supervised the ward cleanliness and to

maintain an aesthetic environment

Learned about the waste management

and supervised the personnel

Maintenance of supplies and equipments

I learned about the:

Indenting articles and maintaining

records

Checking of inventory

Checking and maintaining emergency

drugs in the ward

Check the stock of sterile and unsterile

item

Careful storage of the items

Recording and reporting:

Gained knowledge about the:

Various records maintained in the ward

Writing daily census

6. Health education given

to the patients and their

relatives after assessing

their learning need.

Improved communication skill and

problem solving ability.

Identified “knowledge deficit on breast

feeding practices among lactating

mothers” as a problem

Conducted Planned Teaching

programme on Breast feeding

practices as a problem solving

approach.

7. Worked in OPD in

maternity section.

Improved ability in supervision of nursing

personnel.

Learned about the management of OPD

patients and staff.

8 Visited Family Welfare

Unit and Learned

various procedure

Learned about the management and

supervision of staff and patients in Family

Welfare Unit

Learned how to motivate the mothers for

Copper ‘T’ insertion& Lap ligation

procedure.

Gained knowledge regarding Incentive

Policy (write down the policy.

9 Prepared a report on

experience.

Gained skill in reporting in N.S.

Gained experience on how to work in co-

operation with the concerned authorities.

Section # 4PROBLEM

SOLVING ABILITY

DEVELOPING PROBLEM SOLVING ABILITY IN CLINICAL AREA TO

IMPROVE NURSING CARE PRACTICE AND MANAGEMENT OF

CARE

PROBLEM SOLVING

Definition-

It is a systematic process of solving simple or complex, short term or long

term problems, by applying certain observational thoughts and action process

in scientific way.

It is a process of proceeding from a state of dissatisfaction to a state of

satisfaction, which is the attainment of desired objectives or goals.

It is a scientific process that provides a theoretical framework utilized in

attaining the solution to complex problem

PROBLEM SOLVING PROCESS

I NTRODUCTION :

Defining the problem

Collection of data

Implementation and review

Data analysis

Finding alternatives

Evaluation of alternatives

Mother’s education is not luxury but a necessity if mothers are to receive the

maximum benefits from today’s knowledge of the possible treatment, prevention and

control of the disease. Health education is essentially a process that enables people

to find out their health needs and match them with suitable behaviour. If the high risk

mothers are aware of the risk of probable future health problems, it helps them to

take action early in the pregnancy to avoid the risk factors and ensure that an

appropriate care is available whenever the problem occurs. The individual and the

community have to play a very important role and participate in the effort aimed at

improving maternal and child health. Their involvement is essential for awareness,

which will lead to action. But this awareness and involvement can only come through

right kind of educational approach, which results in self-care structure and

meaningful interlocking between the community and health care providers. This will

contribute substantially in reducing maternal mortality rate and ensuring the

improvement in health of mothers and herald a healthier 21st century.

WHO (2011) report that “breastfeeding is an unequalled way of providing ideal food

for the healthy growth and development of infants; it is also an integral part of the

reproductive process with important implications for the health of mothers. The World

Health Organization (WHO) and UNICEF jointly developed the Global strategy for

infant and young child feeding in 2002 which feels malnutrition responsible, directly

or indirectly for 60% of the 10.9 million deaths annually among children under five

and over two thirds of these deaths associated with inappropriate feeding practices,

occur during the first year.

Mother’s education is not luxury but a necessity if mothers are to receive the

maximum benefits from today’s knowledge of the possible treatment, prevention and

control of the disease. Health education is essentially a process that enables people

to find out their health needs and match them with suitable behaviour. Thus one of

the key to successful breastfeeding is Information, Education and Communication

(IEC) strategies aimed at behavior change. Very few women in India have access to

counseling services on infant and young child feeding

IDENTIFICATION OF PROBLEM

Following measures were used for identification of problem:

Problem identification was done by formal and informal talks and discussion

with sister in charge and staff nurses.

Observing the Essential new-born care practices of post natal mothers

admitted in the ward.

Questioning & discussing with the mothers regarding Essential new-born

care.

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF MOTHERS REGARDING ESSENTIAL NEW BORN CARE IN A SELECTED HOSPITAL OF NEW DELHI, AND DISSEMINATING LEAFLETS.

OBJECTIVES1. To assess the knowledge of mothers regarding Essential new-born care.2. To assess the practice of mothers regarding Essential new-born care.3. To correlate mothers knowledge and practice with demographic variables.

METHODOLOGY

APPROACH

Evaluative approach was considered appropriate because the primary objective of

study was to determine the knowledge deficit in mothers & the effectiveness of

Dissemination of Leaflets.

RESEARCH DESIGN

Pre-test Post-test only group design.

METHOD OF DATA COLLECTION

Structured questionnaire

TOOL

The structured questionnaire contains 20 items to judge the knowledge and practice

of postnatal mothers regarding Essential new-born care.

VALIDATION OF TOOL

Tool was validated by:

Dr Anuradha, H. O. D of Obsteritics and Gynaecology, Max Super Speciality

Hospital, New Delhi.

Dr A. Goel, H. O. D of Paediatrics, Max Super Speciality Hospital, New Delhi.

SAMPLE

Sample consists of 10 postnatal mothers admitted in the postnatal ward at Max

Super speciality Hospital, Saket, New Delhi.

SETTING

The study was conducted in Max Super Speciality Hospital, New Delhi.

SAMPLE SIZE

10

SAMPLING TECHNIQUE

Purposive Sampling

SAMPLING CRITERIA

Purposive sampling method was used.

Post natal mothers admitted at Max Super Specilaity Hospital.

Post natal mothers available during the study period

Post natal mothers willing to participate in the study

ASSESSMENT OF THE PROBLEM

A pre-test was conducted to assess the knowledge of mothers regarding essential

new-born care practices. Data analysis revealed that there was knowledge deficit in

mothers regarding the above topic.

After this a leaflet was disseminated and an explanation was given about the various

aspects of Essential new-born care practices. Later a post-test was conducted.

CRITERIA FOR SELECTION OF SOLUTION OF PROBLEM

The above mentioned solutions were implemented depending upon:

1. Ability of the sample group

2. Practicability

3. Utility

4. Resources available

5. Availability of time

6. Economy

ALTERNATIVE SOLUTIONS PLANNED

Arrange a group discussion

Plan for incidental teaching

Planned teaching programme

Preparation of charts on the selected topic

SELECTION OF BEST ALTERNATIVE

Considering the feasibility, time, resource, economy and availability of mothers’

dissemination of leaflets was chosen from the alternatives.

IMPLEMENTATION OF THE PROGRAMME

The programme was conducted in Maternity ward on 25th May 2015 between 10-11

am. 10 mothers had participated.

Information regarding the programme was given to the Doctor and Sister

in charge well in advance.

Interviews were conducted to assess the existing knowledge of the

mothers.

The participants were able to clear their doubts by asking questions.

The programme was appreciated by Doctors, Sister-in-Charge and staff

nurses.

EVALUATION

Post- Test was conducted after the Dissemination of the leaflets. Evaluation of

leaflets was done statistically by analysing pre-test and post-tests score. Result

showed marked improvement in knowledge regarding Essential new-born care.

RESULT

The mean post-test knowledge score (18.5) is more than mean pre-test knowledge

score (9.2). There is mean difference of 9.3 between mean pre-test and post-test

score. Hence the teaching programmed was found to be effective in improving the

knowledge of the mothers regarding Kangaroo Mother Care.

TABLE - 1

Pre-test & Post-test Knowledge Scores of Postnatal Mothers Regarding Essential New-born Care.

Total Items: 20 Maximum Score: 20

S.No. PRE-TEST SCORE POST-TEST SCORE

1. 12 20

2. 8 18

3. 8 19

4. 7 19

5. 13 20

6. 6 15

7. 7 18

8. 8 18

9. 13 19

10. 10 17

Total score

92 185

INFERENCE OF TABLE 1Data presented in table 1 shows that lowest score in pre-test is 6 while lowest score in post-test is 15 and total post-test score is greater than the total pre-test score.

TABLE- 2

Mean Difference Of Pre-test Knowledge & Post-test Knowledge Score of the

postnatal mothers regarding Essential new-born care.

KNOWLEDGE

SCORES

MEAN MEAN DIFFERENCE

Pre-test Knowledge 9.2

Score

Post-test Knowledge

Score

18.5

9.3

INFERENCE OF TABLE 2

Data presented in table 2 shows that mean Post-Teaching Score is higher than

mean Pre- Teaching Score by a mean difference of 9.3 indicating that the Planned

Teaching Programme was effective to increase knowledge among postnatal mothers

regarding essential new-born care.

CONCLUSION

On the basis of the findings of study the following conclusion were drawn:

Mothers were having less knowledge regarding Essential new-born care.

The dissemination of leaflet was found to be effective in increasing the

knowledge of the mothers regarding essential new-born care.

CRITICAL APPRAISAL OF THE HOSPITAL

EVALUATION OF EXPERIENCE

My one month experience at Max Super Speciality Hospital, New Delhi

provided me a very informative experience in the field of nursing services, education

and administration. The experience helped me in fulfilling my objectives and

enriching my knowledge in the area of clinical specialisation. Personnel at hospital

were friendly.

I could achieve all the objective of my posting that is gaining advanced

competencies in Nursing practice, developing management and supervision abilities

in the clinical area of specialisation and developing problem solving abilities in the

clinical area to improve nursing care practice and patient care management and in

turn enhancing the reporting abilities.

The posting helped me to gain advanced knowledge, skills and competencies

in almost area of Nursing practice, Nursing administration and Nursing education as

well as orientation to nursing research thus contributing to my personnel as well as

professional development.

SUMMARY

Max Super Speciality Hospital is well developed Hospital. It provides various

services like MCH & family planning to the people. The experience in this upper

speciality hospital was very much helpful in gaining knowledge & competencies in

nursing practice. Also it added my experience to develop abilities in management,

leadership & problem solving through observations involving activities & co-operative

efforts.

CONCLUSION

The summer field experience in Max Super Speciality Hospital Delhi helped me a

lot in gaining advanced competencies in obstetric nursing, management and

administration.

The summer field experience in this Hospital was very much helpful in

gaining competencies in nursing practice and also improving the knowledge, skill

and attitude in obstetric nursing. It also added my experience to develop abilities in

management, leadership and problem solving through observations involving in

activities and co-operative efforts. It was an overall good learning period as I could

co-relate my theoretical understanding with the practical and apply it in the field.

ANNEXURESa) Letter of permissionb) Tool on “Essential new-

born care”c) Leaflet made for the

planned teaching programme.

d) Certificate of experience from Max Super Speciality Hospital

Letter of Permission

Tool on

“Essential New-born Care”

PROBLEM STATEMENT

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF MOTHERS REGARDING ESSENTIAL NEWBORN CARE IN A SELECTED HOSPITAL OF NEW DELHI, AND DISSEMINATING LEAFLETS.

STRUCTURED QUESTIONNAIRE TO ASSESS THE KNOWLEDGE OF MOTHERS ON ESSENTIAL NEWBORN CARE PRACTICES

INSTRUCTIONS This questionnaire consists of two parts- Section A and Section B Section A: Demographic Profiles of mothers and new-born. Section B: Questions related to Essential new-born care. Read the statements carefully and tick (√) the appropriate answer.

SECTION-ADEMOGRAPHIC PROFILE OF MOTHERS

1. Age of the mothera.) Less than 25 years. { }b) 26-30 years. { }c) 31-35 years. { }d) Above 40 years. { }

2. Religiona) Hindu { }b) Christian { }c) Muslim { }d) Others { }

3. Educational qualification a) Illiterate { }b) Primary School { } c) Higher Secondary { }d) Graduate and above. { }

4. Occupationa) House wife { }b) Government Employee { }c) Private Employee { }d) Labour { }

5 Income of the family per montha) Rs. ≤5000 { }b) Rs. 5001-10000 { }c) Rs. 10001-15000 { }d) Rs. 15001 and above. { }

6. Place of residencea) Metro { }b) Urban { }c) Semi urban { }d) Rural { }

7. No. of pregnancya) One { } b) Two { }c) Three { }d) Above three { }

8. No. of deliveriesa) One { } b) Two { } c) Three { }d) Above three { }

9. Type of deliverya) Normal delivery { }b) Forceps delivery { }c) LSCS { }d) Vacuum extraction { }

10. Antenatal check-up during pregnancya) Yes { }b) No { }

11. Any illness during pregnancya) Yes { }b) No { }

DEMOGRAPHIC PROFILE OF THE NEWBORN

12. Sex of the babya) Male { }b) Female { }

13. Birth weight of the babya) 1-1.5kg. { }b) 1.5-2kg. { }c) 2-2.5kg. { }d) Above 2.5Kg. { }

14. Status of the babya) Healthy { }b) Sick { }

SECTION-BKNOWLEDGE AND PRACTICE REGARDING KANGAROO CARE

1. Essential new-born care meansa. Skin to skin contact with the baby and mother and maintain his body warmth ( )b. providing adequate care to reduce neonatal morbidity and mortality ( ) c. Mother carries the children wherever she go { }

2. The specific basic needs of a LBW baby area. play needs { }b. body warmth { }c. mother’s love { }

3. The first Breastfeed is offered to the new-born within,a. 2 to 3 hours of birth { }b. ½ to 1 hour after birth { }c. be secured { }

4. Kangaroo mother care can be initiateda. Soon after birth of a baby. { }b. After one week of birth { }c. After two weeks of birth { }

5. The feed essential for the new-born is,a. Breast milk containing colostrum { }b. Cow milk rich in required fat and protein { }c. Mother Dairy skimmed milk { }

6. Oil-massage of the new-born improves,a. Blood circulation, muscle tone and strengthen the maternal-child bonding { }b. the sleeping habit of the new-born { }c. sucking ability of the new-born { }

7. The baby should be nursed in close proximity to the mother so that,a. baby gains heat from maternal body heat { }b. baby does not cry more { }c. baby is not afraid of the doctors and nurses { }

8. The new-born should be bathed in a room which is,a. fully ventilated { }b. maintained warm without open windows and doors { }

c. fully air-conditioned { }

9. The umbilical cord falls off naturally withina. 3 weeks { }b. 24 days { }c. 5-10 days { }

10. The umbilical cord should be kept dry a. till it falls off naturally { }b. for 1 month { }c. till 2 days after birth { }

11. Eye care should be done daily with sterile water and sterilea. cloth { }b. cotton swabs { }c. gauze pieces { }

12. The practice of applying kajal in eyes of the new-born babya. causes eye irritation and infection { }b. makes the eyes look big and beautiful { }c. protects the new-born from the evil eye { }

13. The clothes of the new-born should be preferably made ofa. soft non-irritant cotton material { }b. soft synthetic material { }c. nylon material { }

14. Frequency of feeding the baby isa. every three hours { }b. only after cry { }c. as frequent as possible { }

15. If the new-born baby’s skin appears yellow in colour within first 24 hours of birth it indicates,a. skin infection { }b. lack of haemoglobin { }c. neonatal jaundice { }

16. The new-borns normally lose weight during,a. First 10 days ( )b. First 2-3 days { }c. First 30 days { }

17. Care of the baby after kangaroo mother care mainly isa. monitoring baby's temperature { }b. observe cleanliness ` { }c. observe the cloths { }

18. Regular monitoring of weight of the new-born is necessarya. to assess the effective weight gain { }b. to check the reflexes of the baby { }c. to assess the effectiveness of breastfeeding { }

19. The vaccination that is given at the time of birth is,a. Rubella vaccine { }b. Rota virus vaccine { }c. BCG vaccine { }

20. AS a part of the New-born care Kangaroo mother care can be provided by,a. any relative { }b. father { }c. mother { }

SCORING:

Each correct answer is given ‘one’ marko Good - 16 to 20o Average - 8 to 15o Poor - 0 to 7

ANSWER KEY

QUESTION NO CORRECT RESPONSE SCORE1 b 12 b 13 b 14 a 15 a 16 a 17 a 18 b 19 c 110 a 111 b 112 a 113 a 114 c 115 c 116 b 117 a 118 a 119 c 120 c 1

TOTAL 20

Leaflet “Essential new

born care”

Rufaida College Of Nursing, Jamia Hamdard University

INTRODUCTIONMaintaining body temperature is an integral part of resuscitation of the

premature infant but is extremely challenging. Low temperature on admission to neonatal intensive care has been demonstrated to be an independent risk factor for mortality in extremely premature infants.

DEFINITIONS

Low birth weight (LBW) - infant born weighing less than or equal to 2500g.

Very low birth weight (VLBW) - infant born weighing less than 1500g.

Thermoregulation –maintaining the heat (body temperature)

Submitted by: ANGEL THOMAS

M..Sc NURSING 1st YEAR

MAINTAINING ADEQUATE THERMOREGULATION

Adequate environmental temperature in delivery suite- currently under review by labour ward, minimize environmental difficulties, deliver-in room is adjacent to the resuscitation bay, record the ambient environmental temperature.

Warming the delivery room- pre heating of the delivery room about 28˚C, this helps in reducing the heat loss of the newborn.

Use of tranwarmers for infants <29 weeks- a transwarmer should be used when ambient temperature is <25˚C.

Hats & swaddling- a well fitting hat should be placed immediately on all premature infants. Swaddling around the infant in addition to occlusive wrapping is essential.

Skin-to-skin method –keeping them in upright position. The kangaroo method can positively provide a thermo-neutral environment for these LBW babies maintaining temperature.

Breast feeding and keeping the mother and baby together- the newborn baby immediately after being dried and wrapped should then be encouraged to suck on the mother’s breast. With breast feeding, the baby’s heat maintenance is assured by close contact with the mother’s hemo-thermic body. Frequent breast feeding of every 30-60 minutes should be encouraged.

Water filled heated mattress (WHM)- it consist of a poly- urethane bag filled with 10 litres of water which is placed in the locally available baby cot. The mattress is heated by a heating plate with

heating foil. The starting temperature of the mattress should be 37˚C.

Occlusive plastic wrapping or cling film wrapping at delivery for infants <32 weeks.

Maintaining temperature stability during stabilization in NICU.

Certificate of

Experience