SYNOPSIS

ON

“A STUDY TO EVALUATE THE EFFECTIVENESS OF

STRUCTURED VIDEO TEACHING PROGRAMME ON

NEONATAL RESUCITATION OF NEWBORNS

DEVELOPING NEONATAL ASPHYXIA

CONDUCTED AMONG STAFF NURSES WORKING

IN SVS HOSPITAL.

BY

SUBMITTED TO

DR. NTR UNIVERSITY OF HEALTH SCIENCES, VIJAYAWADA,

IN PARTIAL FULFILLMENT OF THE REQUREMENT

FOR THE DEGREE OF MASTER OF

SCIENCE IN NURSING

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATIN

1

Name of the candidate and address

2

Name of the Institution

3

Course of Study and Subject M Sc Nursing First YearPediatric Nursing

4

Date of admission to course

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Title of the study “A study to evaluate the effectiveness of structured video teaching programme on neonatal

resuscitation of newborns developing perinatal asphyxia conducted among staff nurses

working in SVS Hospital, Mahabubnagar, AP”

6. BRIEF RESUME OF THE INTENDED WORK

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6.1 INTRODUCTION

“Minds are like parachutes. They only function when they are open”

Sir James Dewar

The birth of an infant is one of the most awe-inspiring and emotional events

that can occur one’s lifetime. After nine months of anticipation and preparation, the

neonate arrives amid a flurry of excitement of parents and also the other family members.

But if the neonate is not the healthy robust infant who was expected it creates problem

. Perinatal asphyxia is a common neonatal problem. The World Health

Organization has defined birth asphyxia as “failure to initiate and sustain breathing at

birth” and based on Apgar score as an Apgar score of <7 at one minute of life. Birth

asphyxia may result in adverse effects on all major body systems. Many of these

complications are potentially fatal. In a term infant with perinatal asphyxia renal,

neurological, cardiac and lung dysfunction occurs in 50%, 28%, 25% and 23% cases

respectively.

Early initiation of basic resuscitation interventions within 60 seconds in apneic

newborn infants is thought to be essential in preventing progression to circulatory

collapse based on experimental cardio-respiratory responses to asphyxia. Basic

resuscitation would substantially reduce itrapartum-related neonatal deaths. Where births

occur in facilities, it is a priority to ensure that nurses attending the births and also those

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working in the neonatal units are competent in resuscitation. Strategies to address the gap

for home births are urgently required. Fetal surveillance and attention to signs of

asphyxia must be improved; there should be cooperation between professionals in the

labour unit and, to create security barriers.

Even though all nurses are trained in cardiopulmonary resuscitation, or CPR,

they may not realize that newborns have different needs. American Heart Association

recently issued guidelines that effective chest compressions are far more important than

ventilations for adult victims while newborns primarily need ventilation. Suction devices

are not necessary to remove mucus from the newborn nose and throat. The lungs of the

rescuer can remove such secretions or they can be allowed to drain naturally by tipping

the baby's face down and holding the baby's body aloft on one arm. Vigorous babies can

clear their own airways. Such measures should be considered by the nurse while

resuscitating a newborn with asphyxia.

China’s Neonatal Resuscitation Program (NRP), also known as Freedom of

Breath, Fountain of Life launched in 2004. Since the program neonatal mortality caused

by birth asphyxia has declined in China by more than 53 percent, based on evaluated

program sites in 20 target provinces (each of which has more than 20,000 hospitals). The

success of the program has led to a policy change in China. Now, neonatal resuscitation

certification is a professional requirement for nurses, midwives and obstetricians working

in labor and delivery.

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6.2 NEED FOR THE STUDY

The National Neonatology Forum of India has defined asphyxia as “gasping or

ineffective breathing or lack of breathing at one minute of life”. . In India, between

250,000 to 350,000 infants die each year due to birth asphyxia, mostly within the first

three days of life. The National Neonatal Mortality Rate is 44 per 1000 live births per

year. The Neonatal Mortality Rate in the A P state is between 45 and 50.

Perinatal asphyxia is a serious neonatal problem and contributes significantly to

neonatal morbidity and mortality. It ranks as the second most important cause of neonatal

death after infections accounting for around 30% mortality worldwide. Each year

approximately 10 million babies do not breathe immediately at birth, of which about 6

million require basic neonatal resuscitation. The major burden is in low-income settings,

where health system capacity to provide neonatal resuscitation is inadequate.

Between 5%–10% of all babies born in all facilities need some degree of

resuscitation, such as tactile stimulation or airway clearing or positioning and

approximately 3%–6% require basic neonatal resuscitation, consisting of the simple

initial steps and assisted ventilation.

Delays in assisting the non-breathing newborn to establish ventilation may

exacerbate hypoxia, increase the need for assisted ventilation, and contribute to neonatal

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morbidity and mortality. Each year there is an estimated 904000 neonatal deaths

immediately after birth due to lack of proper resuscitative measures.

Experience over the last century has demonstrated that perinatal mortality can be

reduced by improved obstetrical and neonatal care. With the aim to avoid errors in care

by implementing system-based changes, a systematic review of the pitfalls and mistakes

in the clinical practice of perinatal medicine can be useful.

An evaluative study was conducted by Sophie Berglund and Mikael Norman of

Department of Clinical Science and Education, Stockholm, (2008), on neonatal

resuscitation after sever asphyxia in selected hospitals, Sweden among 177 cases. The

results showed that there are possibilities for improvement in the immediate neonatal

resuscitation within labour units. The most important contributions may be made by

improving compliance with the guidelines concerning ventilation, and the paging for the

early assistance of skilled personnel in cases of imminent asphyxia. The researchers

concluded that it is crucial that all of the staff on the labour ward is familiar with how to

initiate extensive neonatal resuscitation. Every case of unexpected asphyxia, also those

that recover without sequelae, should be scrutinized to enable the creation of security

barriers and improvements in each labour unit, concerning both obstetrical care and

neonatal resuscitation. They also stress the importance of improving the documentation

of neonatal resuscitation to enable accurate and reliable evaluation.

Vinod Paul of the All India Institute of Medical Sciences in New Delhi

presented a perspective on birth asphyxia in India. As in some other developing regions,

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birth asphyxia is the cause of 20% of neonatal deaths in India. Dr. Paul referred to the

studies of Bang et al who found that the incidence of severe birth asphyxia (no cry or

breath absent, slow or gasping at five minutes) was 4.6% of all births. He described

Dr.Bang’s studies of community-based interventions that involved training health

workers in neonatal resuscitation. These interventions resulted in a significant reduction

of asphyxia-related deaths.

When the necessary skills are learned, the attending nurse can approach any

resuscitation with a good comprehension of transitional physiology and adaptation, as

well as an understanding of the infant's response to resuscitation. Resuscitation involves

much more than possessing an ordered list of technical skills and having a resuscitation

team; it requires excellent assessment skills and a grounded understanding of physiology.

Competency in neonatal resuscitation should be developed and maintained by every

practicing nurse-midwife, although it is difficult to obtain the necessary experience. Thus

training the nurses on neonatal resuscitation can contribute a lot in reducing mortality and

morbidity due to birth asphyxia.

The above facts and findings along with the personal clinical experience

motivated the researcher to plan an educational programme on neonatal resuscitation for

staff nurses, helping them to give better care to their little clients; so that the mortality

and morbidity due to birth asphyxia can be reduced.

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6.3 STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of structured video teaching programme

on neonatal resuscitation of newborns developing birth asphyxia conducted among staff

nurses working in SVS Hospital, Mahabubnagar, AP”

6.4 OBJECTIVES OF THE STUDY

To assess the existing knowledge of staff nurses on neonatal resuscitation of

newborns developing birth asphyxia by pretest on staff nurses at SVS Hospital,

Mahabubnagar, AP.

To develop and implement structured video teaching programme on neonatal

resuscitation of newborns developing birth asphyxia to staff nurses working in

SVS Hospital, Mahabubnagar, AP.

To analyze the effectiveness of structured video teaching programme on neonatal

resuscitation of newborns developing birth asphyxia in terms of gain in

knowledge scores in post-test on staff nurses at SVS Hospital, Mahabubnagar,

AP.

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To determine the association between the pretest knowledge on neonatal

resuscitation of newborns developing birth asphyxia of staff nurses working in

SVS Hospital, Mahabubnagar, AP, with their selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

Evaluate: It refers to grading based on statistical scale the knowledge of staff nurses ,to

determine the significance, importance or value of knowledge on neonatal resuscitation

of newborns developing birth asphyxia by a structured questionnaire among the staff

nurses.

Effectiveness: It refers to determine the extent to which the video teaching programme

has achieved the desired effect in terms of gain in knowledge scores obtained on a

structured questionnaire among the staff nurses.

Structured video teaching programme: It refers to planned video teaching on neonatal

resuscitation of newborns developing birth asphyxia by health education and by using

various teaching aids.

Knowledge:It refers to information or skills acquired through education or experiences.

Neonatal resuscitation: Neonatal resuscitation refers to the set of interventions at the

time of birth to support the establishment of breathing and circulation of a newborn

Newborns: Babies of age from birth to 28 days.

Birth asphyxia: In this study, birth asphyxia refers to the failure of newborn to initiate

breathing within one minute of birth.

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Staff nurses: In this study, staff nurses refers to those who have completed a nursing

course conducted by a registered university or board, registered as nurse midwives and

working in labour room, gynecology operation theatre and maternity wards.

6.6 ASSUMPTIONS

1. Birth asphyxia is one of the primary causes of early neonatal mortality.

2. Staff nurses can manage birth asphyxia by improving their knowledge &

skill in neonatal resuscitation.

3. Staff nurses possess some knowledge regarding neonatal resuscitation of

newborns developing birth asphyxia.

4. Structured video teaching programme is an accepted strategy to improve

the knowledge.

5. Staff nurses have a need to acquire information regarding the neonatal

resuscitation of newborns developing birth asphyxia.

6.7 HYPOTHESES

1. H1: There will be a significant difference between pre test knowledge score and

post test knowledge scores of staff nurse working in SVS Hospital,

Mahabubnagar, regarding the neonatal resuscitation of newborns developing birth

asphyxia.

2. H2: There will be a significant association in the knowledge levels of staff nurse

working in SVS Hospital, Mahabubnagar, regarding the neonatal resuscitation of

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newborns developing birth asphyxia, with selected demographic variables such as

nursing education status (BSc or GNM), years of experience, clinical area of

experience etc.

6.8 REVIW OF LITERATURE

A randomized, controlled trial was conducted by Opiyo et al.(2008), on health

workers receiving early training on newborn resuscitation (n = 28) or late training (the

control group, n = 55) in Pumwani Maternity Hospital in Nairobi, Kenya. The aim of the

study was to test resuscitation training on practices by randomly assigning labour ward

and theatre staff to either early or late training, considering the health worker as a unit of

clustering. Data were collected on 97 and 115 resuscitation episodes over 7 weeks after

early training in the intervention and control groups respectively. The results showed that

the trained providers demonstrated a higher proportion of adequate initial resuscitation

steps compared to the control group (trained 66% vs control 27%; risk ratio 2.45, [95%

CI 1.75–3.42], p<0.001, adjusted for clustering). The study concludes that

implementation of a simple one day newborn resuscitation training can be followed by

significant, short-term improvement in health workers' practices.

An evaluative study was conducted by Deorarai et al on the impact of a neonatal

resuscitation programme on staff nurses in fourteen Indian teaching hospitals. The

purpose of the study was to evaluate the impact of a training programme for a rational

approach to neonatal resuscitation. The results showed that there was a statistically

significant reduction in the use of chest compression and medications ( p < 0.001) and an

increase in the use of bag mask ventilation and asphyxia related deaths declined

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significantly (p <0.01). The researchers concluded that the study reflected a more rational

approach to neonatal resuscitation with more effective and appropriate use of bag and

mask ventilation leading to less need for chest compressions and resuscitation drugs.

A randomized, controlled trial study was conducted on immediate effect of

training of nurses on newborn care at birth and implications for management of asphyxia

by Ayesha Sania et.al on 26 nurses of obstetric unit in a tertiary-level sub-urban hospital

in central Bangladesh during November 2005–January 2006. The objective of the study

was to assess the immediate newborn care practices pertaining to recognition and

management of birth asphyxia in delivery room prior to, and following, training of nurses

of delivery room. The results showed that before the training, only 5 babies were assessed

to identify the need for resuscitation, whereas 17 babies were assessed during the post-

training period. The study concluded that a wide gap existed between the evidence-based

standard of immediate newborn care and the actual practices. Need-based training of staff

in delivery rooms is needed for timely recognition and management of asphyxiated births

in hospital deliveries.

A multicentric trial study was conducted by Ramji S et. al on resuscitation of

asphyxiated newborn infants with 21% or 100% Oxygen: Follow-Up at 18 to 24 Months.

The aim of the study was to follow-up children who had been resuscitated at birth with

either 21% or 100% oxygen (O2). 410 infants for whom resuscitation was performed with

either 21% or 100% O2 were selected as samples for the study. A follow-up between ages

18 and 24 months was performed. A simple questionnaire was filled out and neurologic

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assessment was performed in addition to measuring anthropometric data. The results

showed that there were no significant differences in weight, height, or head

circumference between the 2 groups. The researchers concludes that there were no

significant differences in somatic growth or neurologic handicap at an age of 18 to 24

months in infants resuscitated with either 21% or 100% O2 at birth.

A multicentric quasi randomized control trial was conducted by J A Dawson

et.al, (2006), on oxygen saturation and heart rate during delivery room resuscitation of

infants <30 weeks’ gestation with air or 100% oxygen. The aim of the study was to

describe changes in preductal oxygen saturation (Spo2) and heart rate (HR) in the first 10

min after birth in very preterm infants initially resuscitated with 100% oxygen (OX100) or

air (OX21). There were 20 infants in the OX100 group and 106 in the OX21 group. The

results showed that in the OX100 group, Spo2 had risen to a median of 84% after 2 min and

94% by 5 min. In the OX21 group, median Spo2 was 31% at 2 min and 54% at 5 min.The

study concludes that most very preterm infants received supplemental oxygen if air was

used for the initial resuscitation.

A prospective descriptive observational study was conducted by Ersdal HL et. al

among 5845 newborns born in a rural hospital in Tanzania. The aim of the study was to

assess the effectiveness of early initiation of basic resuscitation interventions including

face mask ventilation in reducing birth asphyxia related mortality in low-income

countries. The results were the risk for death or prolonged admission increases 16% for

every 30s delay in initiating resuscitation up to six minutes (p=0.045) and 6% for every

minute of applied resuscitation (p=0.001). The researchers concluded that infants who

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required resuscitation were more likely to die particularly when ventilation was delayed

or prolonged.

A monocentric randomized controlled trial was conducted by Vento M et al,

(2001), in Spain comparing the use of air versus 100% oxygen for the resuscitation of 40

term infants with clinical and biochemical evidence of asphyxia. The results showed that

the time to establish regular respirations was significantly less in the room air group

(p<0.05). They concluded that there were no apparent disadvantages to resuscitation with

room air and potentially significant advantages.

A comparative study was conducted to assess the functionality and acceptability

of selected neonatal resuscitation devices in Durban, South Africa (2008) on 34 health

workers. The goal of this study was to reduce neonatal mortality and childhood disability

in South Africa by ensuring that health care providers have access to affordable, high-

quality neonatal resuscitation devices and have appropriate skills in neonatal

resuscitation. This study used a participatory methodology to engage users and potential

users within the health system in the evaluation of the functionality and acceptability of a

select group of resuscitators. Participants recorded their observations about individual

devices using a structured 5-point Likert-type scale instrument The study concluded that

the Laerdal device was universally evaluated as superior, and most of the participants

chose the Besmed resuscitator as their second choice. The researchers recommended that

comprehensive neonatal resuscitation training is essential for all new staff and for all staff

when a new resuscitator is introduced.

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A retrospective study was conducted in neonatal unit of National Institute of

Child Health (NICH) from 1st January to 31st August, 2001. The objective of the study

was to look for risk factors leading to birth asphyxia in new borns admitted in a tertiary

care unit. Patients and Methody Records of 235 new borns admitted with birth asphyxia

during this period were analyzed. The results showed majority (71%) of mothers were

booked and had antenatal care, similarly most (88%) of the babies were born at term and

75.3% were delivered in maternity homes or hospitals. Caesarian sections were

performed in 14% cases and rest was all vaginal deliveries. The study concluded that

birth asphyxia occurring in such a high number of booked cases delivered at term with

good weight, reflects the poor perinatal services offered in those maternity homes or

hospitals. It recommended that trained personnel and neonatal resuscitation equipment

should be made mandatory in all maternity homes/hospitals.

A comparative study was done by Abhay T B et. al on effectiveness of two types of

birth attendants and of resuscitating with mouth-to-mouth, tube mask or bag-mask in

management of birth asphyxia in home deliveries in Rural Gadchiroli. Trained birth

attendants used mouth-to-mouth resuscitation in the baseline year (1993-1995).

Additional village health workers only observed in 1995-1996. In the intervention years

(1996-2003) they used tube-mask and bag-mask. The incidence case fatality (CF) &

asphyxia specific mortality rate (ASMR) were compared. The results of the study showed

decrease in incidence of mild birth asphyxia by 60% from 14% in the observation year to

6% in the intervention year (P< 0.0001). The incidence of severe asphyxia did not change

significantly.

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A meta-analysis was conducted on neonatal resuscitation and immediate

newborn assessment and stimulation for the prevention of neonatal death of 3 studies of

neonatal resuscitation studies examining the effect of resuscitation training on

intrapartum-related neonatal deaths .The results showed that immediate newborn

assessment and stimulation would reduce both intrapartum-related and preterm deaths by

10%, facility-based resuscitation would prevent a further 10% of preterm deaths, and

community-based resuscitation would prevent further 20% of intrapartum-related and 5%

of preterm deaths. The study concluded that neonatal resuscitation training in facilities

reduces term intrapartum-related deaths.

7.0 MATERIALS AND METHODS

Research methodology involves the systematic process, which the investigator

starts from the initial identification of the problems to its final conclusion. It is a science

of study how research is done scientifically. It is a backbone of the study. So

methodology is a significant part of an investigator under which the investigator is able to

project conclusion of the research undertaken.

This chapter includes description of research approach, research design, study

setting, sampling technique, development and description of the tool, data collection

technique and plan for data analysis.

7.1 Research Approach

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Research Approach is a systemic, objective method of discovery with empirical

evidence and rigorous control. Research Approach spells out the basic strengths that the

researcher adopts to develop information that is accurate and interpretable. The control is

achieved by holding conditions constant and varying only the phenomenon under study.

Evaluative research was considered as an appropriate approach for the present study.

Quasi – experimental research design is used for the present study.

7.2 Source of data / Subjects

Staff nurses working in labour room, gynecology operation theatre and

maternity wards in SVS Hospital, Mahabubnagar, AP.

7.3 Population

Population selected for the study is working staff nurses working in SVS

Hospital, Mahabubnagar, AP.

7.4 Sample

Sample size of 20 staff nurses that are randomly grouped as 10 experimental

group and 10 control group working in SVS hospital, Mahabubnagar, A.P.

7.5 Sampling technique

In this study the researcher will use convenient sampling technique.

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7.6 Method of data collection

A structured Questionnaire with Interview method consists of two parts namely

section A& B. Section –A represents the demographic data, Section –B represents the

knowledge on neonatal resuscitation of newborns developing birth asphyxia. A structured

questionnaire consists 30 questions will be given to the subjects. After obtaining the

consent and prior permission from the subjects and significant others, data will be

collected back immediately from the subjects after making sure about their completion.

7.7 Does the study require any investigation or interventions to conducted on

patients or other humans or animals? If so, please describe briefly.

Yes, the study will be conducted on staff nurses working in SVS hospital,

Mahabubnagar, AP.

7.8 Has ethical clearance being obtained from your institution in case of 7.7?

Yes, ethical approval has obtained from the ethical committee.

7.9 Plan for data analysis

The data obtained will be analyzed in terms of objectives of descriptive and

inferential statistics.

8.0 List of references

1. Lawn J.E,Haws R.A,Darmsatdt L.G.Reducing one million child deaths from birth

asphyxia.Biomed Central Ltd.2007;22(4):314-317

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2. WHO (2005) The world health report: 2005: make every mother and child count

3. Department of Reproductive health and Research. Basic new born resuscitation; a

practical guide.WHO.Geneva;1997

4. www.pubmed.com .

5. www.google.com.

6. Sophie Berglund, Mikael Norman, Charlotta Grunewald, Neonatal resuscitation

after severe asphyxia – a critical evaluation of 177 Swedish cases.Acta Paediatrica.

2008 June; 97(6): 714–719.

7. N Opiyo, Newton .O, Fred.W, Fridah.G, Grey.F .Effect of newborn resuscitation

training on health worker practices. PLoS Clinical trials.2008 Oct; 16 (10): 1886-97.

8. Deorari AK, Paul VK, Singh M, Vidasagar D. Impact of education and training on

neonatal resuscitation practices in 14 teaching hospitals in India. Annals of Tropical

Paediatrics: International Child Health. March 30, 20122001; 21 (1): 29-33

9. Ramji S, Rasaily R, Mishra PK, Narang A, Jayan S, Kapoor AN, Kambo I, Mathur

A, Saxena BN. Resuscitation of asphyxiated newborns with 21% or 100% oxygen at

birth: a multicentric trial. Indian Pediatr. 2003 Jun;40(6):507-9

10. Dawson JA, Yam CH, Schmölzer GM, Morley CJ, Davis PG. Heart rate changes

during resuscitation of newly born infants <30 weeks gestation: an observational

study.Arch Dis Child Fetal Neonatal Ed. 2011 Mar;96(2):F102-7.

11. Ersdal HL, Mduma E, Svensen E, Perlman JM. Early initiation of basic resuscitation

interventions including face mask ventilation may reduce birth asphyxia related

mortality. Journal of Paediatr Child Health 2002 Jan;38: 241–245

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12. Vento M, Asensi M, Sastre J, Carcia-Sala F, Pallardo F, Vina J. Resuscitation with

room air instead of 100% oxygen prevents oxidative stress in moderately asphyxiated

term neonates. Pediatrics. April 2001;107(4):642-647

13. Elwyn C, ElIzebeth M.M, Linda L.W,WalderA.L . Effect of WHO Newborn care

training on neonatal mortality by education. Ambulatory Pediatrics.2006

September;8(5)

14. O’Hare B.A, Nakakeeto M,Southhall D.P.A study to determine if nurses trained in

basic neonatal resuscitation would impact the outcome of neonates delivered in

Kampala.Tropical pediatrics Advance 2006 June; 52(2):376-379.

15. Raina N, Kumar V. Management of birth asphyxia by traditional birth attendants.

World Health Forum. 1989;10(2):243-6

16. Abhay T.B,Rani A.B,Sanjay B.BHanimi M.R, Management of birth asphyxia in

home deliveries in rural Gadchiroli.Journal of tropical pediatrics Advance.2006June

25 (2): 130 – 41

17. Linn S, Theresa A.S, Meta analysis on neonatal resuscitation and immediate

newborn assessment and stimulation for the prevention of neonatal death

Midwifery.2004 March;20(1):51-60

18. Rose marie nieswiadong. Foundation of nursing research. 2nded appketion and

lange; Norwalk 9us).2008 Aug; 100(8):625-9.

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9.0 Signature of the Candidate :

10.0 Remarks of Guide :

11.0 Name and Designation Of

11.1 Guide :

11.2 Signature :

11.3 Head of the department :

.

11.4 Signature :

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12.1 Remarks of the Chairman and Principal:

12.2 Signature of the principal :

Principal

S.V.S. College of Nursing

Mahabubangar.

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