effectiveness of self instructional module (sim) on knowledge regarding the prevention of hiv/aids ...

8/13/2019 EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE REGARDING THE PREVENTION OF HIV/AIDS AMONG STUDENTS STUDYI

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

Mrs. DEEPTHI KAMATH

I YEAR M. Sc NURSING

CHILD HEALTH NURSING(200 !2 BATCH"

SRI SHANTHINI COLLEGE OF NURSING

#$$%B, PARVATHI NAGAR, OPP& SUB REGISTRAR OFFICE,

LAGGERE MAIN ROAD, LAGGERE,

BANGALORE ')00$


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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR

DISSERTATION.

). BRIEF RESUME OF THE INTENDED *ORK

01NAME OF THE

CANDIDATE

AND ADDRESS

Mrs. DEEPTHI KAMATH

s+YEAR M.SC NURSING,

SRI SHANTHINI COLLEGE OF NURSING

#$$%B,PARVATHI NAGAR, OPP&SUB

REGISTRAR OFFICE,LAGGERE MAIN ROAD,

LAGGERE, BANGALORE ')00$.

02NAME OF THE

INSTITUTION

SRI SHANTHINI COLLEGE OF NURSING ,

#$$%B,PARVATHI NAGAR,

OPP&SUB REGISTRAR OFFICE,LAGGERE

MAIN ROAD, LAGGERE,

BANGALORE ')00$.

03COURSE OF THE

STUDY AND

SUBJECT

MASTER DEGREE IN NURSING

CHILD HEALTH NURSING

04

DATE OF

ADMISSION TO

COURSE

0%0)%200

05TITLE OF THE

TOPIC

THE EFFECTIVENESS OF SELF

INSTRUCTIONAL MODULE FOR STAFF

NURSES REGARDING MANAGEMENT OF

PRETERM BABIES


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INTRODUCTION

Those who fear the Lord are always ready to serve him.

All expectant parents hope that their babies will be healthy. Most pregnancies last

around 40 weeks. Babies born between 3 and 42 weeks o! pregnancy are called !ull

ter". A preter" baby is one born be!ore 3 co"pleted weeks o! gestation. #ere

pre"ature or preter" re!ers to the inability o! the in!ant who is born be!ore the usual

gestation period to "ake and adoption to extra uterine existence in co"parison to

sur$i$al rate in "ature in!ants. %re"aturity along with low birth weight usually carry a

high rate o! "orbidity and "ortality unless opti"al care is gi$en to "aintain li!e.

&n &ndia' about ( to ) "illion *ow Birth +eight babies are born annually. ,ut o!

which about 10 to 12 - o! &ndian babies are born preter" as co"pared to 5 to -

incidence in the +est. he high incidence o! %reter" babies in our country is accounted

!or poor socio/econo"ic status' low "aternal weight' chronic and acute syste"ic

"aternal disease' ante partu" he"orrhage' cer$ical inco"petence' "aternal genital

coloniation and in!ections' cigarette s"oking during pregnancy' threatened abortion'

acute e"otional stress' physical exertion' sexual acti$ity' trau"a' bicornuate uterus'

"ultiple pregnancy and congenital "al!or"ations.2

%reter" in!ants born between 32 to 35 weeks gestation ha$e a )- sur$i$al rate

and co"prise )4- o! all preter" in!ants in the nited tates. hese in!ants "ay ha$e a

relati$ely benign hospital course and "ay be considered by so"e to be a healthy


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pre"ature in!ant. At the ti"e o! discharge !ro" the neonatal intensi$e care unit' in!ants

will be gaining weight' !eeding by "outh' and "aintaining te"perature ho"eostasis.

upport o! growth' !eeding choices' "anage"ent o! gastro esophageal re!lux'

de$elop"ental issues' "onitoring at ho"e and reco""ended special $accinations are

issues that pri"ary care nurse practitioners will !ace in caring !or preter" in!ants.

he birth o! a baby is a wonder!ul co"plex process. Most babies ad"itted to the

& ha$e low birth weight or ha$e a "edical condition that re6uires special care. here

are special needs o! preter" baby. %reter" babies lack the body !at necessary to "aintain

their body te"perature' e$en when swaddled with blankets. here!ore' incubators or

radiant war"ers are used to keep the babies war". &ncubators are "ade o! transparent

plastic' and they co"pletely surround an in!ant to keep hi" or her war"' decrease the

chance o! in!ection' li"it water loss. 7adiant war"ers are electrically war"ed beds open

to the air. hese are used when the "edical sta!! needs !re6uent access to the baby !or

care. he recent trend in care o! hypother"ia is 8angaroo Mother are. &t is one o! the

cheapest "ethod and e!!ecti$e "ethod to pre$ent hypother"ia.-

%re"ature babies ha$e special nutritional needs because they grow at a !aster rate

than !ull ter" babies and their digesti$e syste"s are i""ature. 9eontologists "easure

their weight in gra"s. Breast "ilk is an excellent source o! nutrition' but they are too

i""ature to !eed directly !ro" the breast or bottle until they are 32 /34 weeks gestational

age. here!ore they ha$e to be !ed on nasogastric !eeding. o"e preter" babies also

recei$e additional $ita"in supple"ents. he blood che"icals and "inerals such as blood

sugar' potassiu"' calciu"' phosphate and "agnesiu" are "onitored regularly and the

diet is ad:usted to keep these substances within a nor"al range.


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ta!! de$elop"ent progra""e is the key to 6uality nursing care that helps to

!acilitate the co"petence o! nurse in practice. ontinuing education pro$ides "eans by

which nurses can re"ain up to date with current de$elop"ents "aintain their co"petence

and "eet the standards o! nursing practice. he role o! pediatric nurse is also changing

due to ad$ances in science and technology and disco$eries in the !ield o! pediatrics to

sa$e the precious li!e and health o! neonate.)

he study is intended to identi!y learning needs o! sta!! nurses working in &'

on $arious aspects o! care o! preter" babies and to test the e!!ecti$eness o! sel!

instructional "odule.

). NEEDFOR THE STUDY

he +orld #ealth ,rganiation had set the targets o! #ealth !or all by the

year 2000. &n particular' i"pro$e"ents were sought in "aternity care pro$ision and a

reduction in perinatal "ortality rates. he incidence o! preter" labors has not reduced but

owing to i"pro$ed neonatal "anage"ent' increasing nu"ber o! s"all babies is

sur$i$ing.


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Babies born be!ore 3 co"pleted weeks o! pregnancy are called preter" or

pre"ature. All babies born preter" are at risk !or serious health proble"s' but those born

earliest are at greater risk o! "edical co"plications' long ter" disabilities death.

;ortunately' ad$ances in obstetrics and neonatology ha$e i"pro$ed the chances o!

sur$i$al !or e$en these s"allest babies.$

Babies born preter" !ace a greater risk !or serious health proble"s !or se$eral

reasons. he earlier a child is born' the less it will weigh' the less de$eloped the organs

will be' and "ore co"plications it is likely to !ace. hese babies "ay re6uire care in a

neonatal intensi$e care unit' which has specialied "edical sta!! and e6uip"ent that can

deal with "ultiple proble"s !aced by preter" in!ants.


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nature o! !eeding' it is necessary to ha$e a thorough understanding o! the de$elop"ental

nature !or this skill. &nter$ention strategies to pro"ote stability leading to success!ul

!eeding are also described.0

he preter" in!ant !aces "any challenges during the early stages o! li!e. %oor

control o! body te"perature is due to the large a"ount o! skin sur!ace in proportion to

body weight' the lack o! insulation o! subcutaneous !at' i""ature ner$ous syste" and

poor "uscular de$elop"ent. he latest trend o! care o! hypother"ia is kangaroo care.

Around )0- o! preter" in!ants de$elop hyperbilirunae"ia characteried by

:aundice. his condition is "ost co""only treated with phototherapy and exchange

trans!usion. .Although phototherapy appears to e!!ecti$ely treat preter" :aundice' aspects

o! its use re"ain contro$ersial and its apparent success is not e$idence based. 7esearch

"ust continue to !acilitate the de$elop"ent o! e!!ecti$e treat"ent and establish"ent o!

e$idence based guidelines.2

%atient care is seen as a tea" acti$ity and nurse will play an i"portant role.

tudies re$ealed that nurse did not ha$e ade6uate knowledge or desired skills in their

pro!essional !ield' and knowledge can be i"pro$ed by !or"al training progra""e. he

o$erload o! responsibilities auto"atically reduce the interest to ac6uire upto date

knowledge.

se o! a training progra" to enhance & nurses= cogniti$e abilities !or

assessing preter" in!ant beha$iors and o!!ering supporti$e inter$entions was conducted

in ri/er$ice >eneral #ospital' aiwan. he results support the hypothesis that nurses=

cogniti$e abilities were enhanced a!ter the training progra""e. ;urther' as the cogniti$e


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abilities are increased' it would be possible that nurse beha$iors in taking care o! these

preter" in!ants "ight change. -

he abo$e studies suggest that preter" babies are the "ost $ulnerable !or

ac6uiring in!ection and de$eloping co"plications. urses play an i"portant role in

planning inter$ention !or reduction o! "ortality and "orbidity a"ong preter" babies.

;urther' the studies show that nurses need to be updated on "anage"ent o! preter"

babies by training and other strategies to i"pro$e the 6uality o! care. he abo$e

"entioned studies also shows that the utiliation o! sel! learning "aterials were e!!ecti$e

in i"pro$ing the cogniti$e beha$ior o! nurses. #ence' the in$estigator !eels that there is a

need !or this study.

).2 REVIE* OF LITERATURE&

7e$iew o! literature is an essential step in the de$elop"ent o! a research

pro:ect. &t helps to de$elop an insight into the area o! in$estigation and directs the

researcher to de$elop a plan.

he re$iew o! literature is presented under the !ollowing headings/

(.2.1 *iterature related to pre$ention o! in!ection

(.2.2 *iterature related to pre$ention o! hypother"ia


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(.2.3 *iterature related to nutritional "anage"ent

(.2.4 *iterature related to "anage"ent o! :aundice

(.2.5 *iterature related to sel! instructional "odule

).2. LITERATURE RELATED TO PREVENTION OF

INFECTION&

As+1 NC 3+45 conducted a study on prophylactic oral anti!ungal agents to

pre$ent syste"ic andida in!ection in preter" in!ants. he study was conducted in &

o! hristchurch +o"en=s hospital' ew ?ealand. he study re$ealed that there is no

signi!icant e$idence to support the use o! prophylactic oral anti!ungal agents in preter"

in!ants. 7ando"ied controlled trials in current neonatal practice settings are needed in

order to deter"ine whether oral anti!ungal agents ha$e a role in pre$enting syste"ic

!ungal in!ections in preter" in!ants.

J61+7 D 3+45 conducted a study on i"pact o! unit based procedures on the

incidence o! nosoco"ial in!ections in neonatal intensi$e care unit. he study was

conducted to assess the e!!ects o! co""on procedures on the incidence o! nosoco"ial

in!ections. he procedures were $isitation' hand washing' nail care' skin and cord care'

"aintenance o! hubs in peripheral and central lines' gowning and isolation procedures'

use and "isuse o! antibiotics' and unit design and sta!!ing. he study re$ealed that

i"pro$ing hand hygiene@ care!ul use o! antibiotics' skin antisepsis' !ollow o! guidelines

in isolation' use o! "axi"u" sterile barriers' appropriate unit design and increasing

nursing hours can control in!ection.)


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*71+3'Tr4+ RC 3+45conducted a study on !eeding readiness in preter" in!antsF

the relationship between preter" beha$ioral state and !eeding readiness beha$iors and

e!!iciency during transition !ro" ga$age to oral !eeding. he data was collected as part o!

a larger study designed to co"pare the !re6uency o! ;eeding 7eadiness Beha$ior and

!eeding e!!iciency between control experi"ental groups. he data was collected !ro" 21

stable preter" in!ants. &n!ants were $ideotaped i""ediately prior to each o! the !irst three

oral !eedings' !ro" which in!ant beha$ioral state and !eeding readiness beha$iors were

assessed. he nu"ber o! !eeding readiness beha$iors was predicti$e o! !eeding e!!iciency

pE0.10C. he study re$ealed that !eeding e!!iciency "ay be predicted by the increased

nu"ber o! ;eeding 7eadiness Beha$iors i""ediately prior to !eeding./

McGr4+7 IM 3+45conducted a study on !eeding readiness in the preter" in!ant.

he study re$ealed that !inding ways to consistently prepare preter" in!ants and their

!a"ilies !or "ore ti"ely discharge "ust continue as a !ocus !or e$eryone in$ol$ed in the

care o! these in!ants in neonatal intensi$e care unit. uccess!ul bottle !eeding is

considered the "ost co"plex task o! in!ancy. ;ostering success!ul oral !eeding in preter"

in!ants re6uires consistently high le$els o! skilled nursing care' which "ust begin with

accurate assess"ent o! !eeding readiness and thought!ul progression to !ull oral !eeding.

his co"prehensi$e re$iew o! literature pro$ides an o$er$iew o! the state o! the science

related to !eeding readiness and progression in the preter" in!ant.20

).2.- LITERATURE RELATED TO MANAGEMENT OF

JAUNDICE&


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M3rc4+1 3+45 conducted a study on transcutaneous bilirubin "easure"ent BC

in preter" in!ants in eonatal centre in Brules' ;rance. A prospecti$e study was carried

out on 4 preter" in!ants in a neonatal intensi$e care unit. ;ro" birth' a transcutaneous

bilirubin "easure"ent using the Biliheck was "ade on the !orehead o! each newborn

e$ery ) hour and blood sa"pling !or deter"ination o! total seru" bilirubin BC was

co"bined with B. he "ean gestational age was 30 weeks and "ean birth weight was

141g. he "ean $alues obtained by B and B were respecti$ely 1(0.(G50"u"olD*

and 10.(G(1.4"u"olD*. A signi!icant correlation between B and B was !ound. he

B is reliable when its $alue is under the li"its !or phototherapy. &t was suggested that

with a $ery high incidence o! neonatal :aundice )-C in the cohort' a $alue o! B under

the li"its !or phototherapy has a good negati$e predicti$e $alue in preter" in!ants. 2

D3 C4r;4578 (///"conducted a study at orway hospital about intensi!ied

phototherapy using day light !luorescent la"ps. #e !ound out that narrow spectru" blue

light is superior to while light. ;i!ty in!ants sa"ple out o! which all o! the" were breast

!ed on de"and. eru" bilirubin le$els were deter"ined at 0' 12' and 24 hours. he

decre"ent in seru" bilirubin concentration was signi!icantly greater in in!ants

undergoing phototherapy with special blue la"ps co"pared to con$entional o$erhead

daylight la"ps pE0.001 both at 12 and 24 hourC.22

).2. LITERATURE RELATED TO SELF INSTRUCTIONAL

MODULE&


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1. o assess the knowledge o! sta!! nurses in "anage"ent o! preter" babies.

2. o assess the practice o! sta!! nurses in "anage"ent o! preter" babies.

3. o de$elop and ad"inister a sel! instructional "odule !or sta!! nurses in

"anage"ent o! preter" babies.

4. o e$aluate the e!!ecti$eness o! the sel! instructional "odule in "anage"ent o!

preter" babies.

5. o know the i"pact o! the de"ographic $ariables on the pre and post test results

on knowledge and practice aspects.

).- HYPOTHESIS

#1 here will be no signi!icant di!!erence between the pre test and post test

knowledge and practice scores regarding "anage"ent o! preter" babies a"ong

sta!! nurses.

#2 here will be no signi!icant i"pact o! selected de"ographic $ariables on post test

knowledge and practice scores regarding "anage"ent o! preter" babies a"ong

sta!! nurses.

). VARIABLES

INDEPENDENT VARIABLE

el! instructional "odule

DEPENDENT VARIABLE


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9ependent $ariables which includes age' sex' education' designation' inco"e'

general education' "arital status' work experience and in/ser$ice training.

).) OPERATIONAL DEFINITIONS&

EFFECTIVENESS&

&t re!ers to the extent to which the sel! instructional "odule has achie$ed the

desired e!!ect as assessed by gain in scores in post test.

SELF INSTRUCTIONAL MODULE&

&t re!ers to a sel! learning guide designed !or sta!! nurses on "anage"ent o!

preter" babies.

STAFF NURSES&

A trained registered nurse who is working in a &' who has co"pleted either

general nursing and "idwi!ery course or Bachelor o! cience in nursing post certi!icate

courseC or Basic B.c. ursingC course.

PRETERM BABIES&

&t re!ers to a li$e born baby whose gestation period is less than 3 weeks

regardless o! the birth weight.

HOSPITAL&


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&t re!ers to an institution which pro$ides care ' diagnosis and treat"ent o! the sick'

in:ured and those persons who need nursing and "edical care.

). ASSUMPTIONS

1. ta!! nurses working in eonatal &ntensi$e are nit possess so"e knowledge

regarding "anage"ent o! preter" babies.

2. ta!! nurses working in & "ight practice correct "ethod o! "anage"ent o!

preter" babies.

3. el! &nstructional Module will enhance the knowledge and practice o! sta!! nurses

regarding "anage"ent o! preter" babies with recent trends.

).$ DELIMITATIONS

he study is d li"ited to sta!! nurses in selected %ri$ate #ospitals.

. MATERIALS AND METHODS

. SOURCE OF DATA

he data will be collected !ro" sta!! nurses working in eonatal

&ntensi$e are nit o! selected pri$ate hospitals in bangalore.


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.2 METHOD OF COLLECTION OF DATA

.2. RESEARCH DESIGN

he research design will be adopted !or the study is 6uasi experi"ental with one

group pre test post test design.

.2.2 RESEARCH APPROACH

xperi"ental approach will be used to carry out the study.

.2. SETTING

he setting o! the study is eonatal &ntensi$e care unit o! selected %ri$ate

hospitals in bangalore.

.2.- POPULATION

he population o! present study consists o! sta!! nurses working in

eonatal &ntensi$e are nit o! selected pri$ate hospitals

.2. SAMPLE SIE

he proposed sa"ple sie o! the study is 50.

.2.) SAMPLING TECHNIUE

he sa"pling techni6ue adopted !or the study is non probability purposi$e

sa"pling techni6ue.

.2. SAMPLING CRITERIA


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INCLUSION CRITERIA

aC ta!! nurses who ha$e undergone

>eneral ursing and Midwi!ery ourse.

Bachelors 9egree in ursing.

bC %resently working in eonatal &ntensi$e are nit o! selected pri$ate hospitals.

cC hose who are present at the ti"e o! data collection.

dC hose who are willing to participate in the study.

ECLUSION CRITERIA

aC ta!! nurses who are not willing to participate in the study.

bC hose who are on lea$e at the ti"e o! data collection.

.2.$ DATA COLLECTION TOOL&

A structured 6uestionnaire and obser$ation checklist will be prepared to assess the

knowledge and practice respecti$ely o! the sta!! nurses regarding "anage"ent o! preter"

babies.

S3c+18 A& &t consists o! de"ographic characteristics o! sta!! nurses seeking in!or"ation

like age' sex' education' designation' inco"e' general education' "arital status' work

experience and in/ser$ice training.


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. DOES THE STUDY REUIRE ANY INVESTIGATIONS OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMAN OR ANIMALS

'Y3s'

.- HAS ETHICAL CLEARANCE BEEN OBTAINED

%er"ission will be obtained !ro"F

he research co""ittee o! ri hanthini ollege o! ursing.


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$. LIST OF REFERENCE&

1. *i"a >' attaneo A. o""on diagnoses in the &. e"ours ;oundation.

200 Mar@ 211CF 1/13.

2. ingh Meherban. are o! the newborn. ( th ed. ew 9elhiF agar %ublication@

2004. p. 21/230.

3. 8elly MM. %ri"ary care issues !or the healthy pre"ature in!ant. Iournal o!

%ediatric #ealth are 200( ep/,ct@ 205CF 23/.

4. +ong. ssentials o! pediatric nursing. thed. ew 9elhiF Mosby@ 2005. p. 23(/

23.

5. 8ada" ' Binoy ' 8anbur +' Mondkar IA' ;ernande A. ;easibility o!

kangaroo "other care in Mu"bai. &ndian I %ediatr. 2005 Ian@ 21CF 35/).

(. harpak ' ;igueroa de ?. %ri"er on pree"ies. Ann rop %aediatr. 2004 ep@

243CF 245/51.

. +elles/ystro" B' Bystro$a 8. pecial needs o! preter" in!ants. ngl I Med.

2000 ;eb 3@ 30)5CF 23/41.

). Best I+' 8ahn I


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12. Bell 7%' Mc>rath IM. March o! di"es birth de!ects !oundation. %reter" birth.

200@ 1/5.

13. #odges '

%ractice Bulletin 2002 ep@ u"ber 3).

1. onde/Agudelo A' 9ia/7ossello I*' Belia" IM. 8angaroo "other care. *atin

A"erican enter !or %erinatology and #u"an 9e$elop"ent' +#,' #ospital 9e

linicas' ochrane 9atabase yst. 7e$ 2003@ 2CF 90021.

1). har"a ' aigal 78' *al #. #yperbilirunae"ia in preter" in!ants. %ediatric

ursing 200( Iun@ 1)5CF 20/2.

1. >ailen 8%. el! instructional "odule. Manila. Module Bank. oncordia ollege.

1)2.

20. *iaw II. se o! a training progra" to enhance & nurses= cogniti$e abilities

!or assessing preter" in!ant beha$iors and o!!ering supporti$e inter$entions.

Iournal o! ursing 7esearch 2003 Iun@ 112CF )2/2.


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/. SIGNATURE OF THE STUDENT &

0. REMARKS OF THE GUIDE & he study will help the sta!! nurses to

i"pro$e their knowledge about the

"anage"ent o! preter" babies.

. NAME AND DESIGNATION OF

. GUIDE & Mrs.


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. HEAD OF THE DEPARTMENT : Mrs.

effectiveness of self instructional module (sim) on knowledge regarding the prevention of hiv/aids ...

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