Effectiveness of Nursing Intervention on Knowledge and Practice of Feeding Among Caregivers of Cerebral Palsy Children.

Amirtha Lourdu Mary. I.

College of Nursing, Sri Ramakrishna Institute of Paramedical sciences, Siddhapudur, Coimbatore-44

E-mail:

ABSTRACT:

Introduction

Feeding and eating are important activities that allow individuals to maintain adequate growth in the children with cerebral palsy. They are at risk because of oral, pharyngeal or esophageal dysphagia. oral motor dysfunction (OMD), communication difficulties that may deteriorate their health status. Focusing on the nutritional aspects may help them to maintain their health status. So the investigator was interested to conduct a research study to bring awareness among care-givers.

Material and methods:

A quasi experimental non equivalent control group design was adopted for this study. There were 30 caregivers, 15 in each control and experimental groups were selected. Through non probability purposive sampling technique the samples were selected and assessed by means of a structured questionnaire and observation check list. Health education cum demonstration on feeding practice of cerebral palsy children was given to the experimental group. The data was analyzed by means of descriptive and inferential statistics.

Results and findings:

The care-givers of CP children had moderately adequate knowledge and feeding practice during the pre-test. The experimental group gained more knowledge score than the control group of caregivers in the post-test. This is proved by‘t’ test (n = 30) = 16.22 (p<0.01). The health education and demonstration on feeding practices was found to be effective and the care-givers improved their feeding practice and reduced their feeding difficulties and problems to their children.

Conclusion:

Research hypothesis stated was accepted. It was concluded that there is a need to improve the knowledge and practice of feeding the cerebral palsy children among the care-givers.

KEY WORDS: Care-giver, Cerebral palsy children, feeding practices, health education.

INTRODUCTION:

Feeding problems are very common in children with cerebral palsy as 30 to 80 percent of disabled individuals feed with difficulty. The incidence of malnutrition in individuals with cerebral palsy is a combination of factors, which directly or indirectly result in reduced food and nutrient intake. Feeding problems are usually complicated by the lack of awareness of parents about disease and the incidence of malnutrition in individuals with cerebral palsy.

The main reasons for lack of awareness in parents were illiteracy, misconception about disease and associated complications of cerebral palsy. (Motion, Northstone, 2002).

Objectives:

1. Assess the care givers existing knowledge on feeding of cerebral palsy children among experimental and control group.

2. Assess the practice of feeding of cerebral palsy children among caregivers of both experimental and control groups.

3. Assess the care givers knowledge on feeding of cerebral palsy children after nursing intervention in the experimental group.

4. Compare the knowledge scores of both experimental and control groups of caregivers on feeding of cerebral palsy children.

5. Find out the effectiveness of nursing intervention on feeding practices of cerebral palsy children among caregivers in experimental group.

6. Associate the selected demographic characteristics of caregivers and cerebral palsy child with their knowledge on feeding practice in both groups.

Hypothesis :-

H_{1 -} There is a significant improvement in knowledge on feeding among caregivers who received nursing intervention, than those who did not receive nursing intervention.

Methodology

Research design:

Quasi experimental non equivalent control group design without use of randomization.

Variables under the Study:

Individual teaching cum demonstration on feeding is independent variable. Caregiver’s knowledge and practice on feeding of cerebral palsy children are dependent variables.

Setting:

The study was conducted at Amrit centre for special needs, Mettupalayam road, Coimbatore, and Ashirwad The Coimbatore spastic trust, R.S. Puram, Coimbatore.

Population:

All care givers of cerebral palsy children with feeding difficulty.

Sample size:

The sample size for the study consists of 30 cerebral palsy children and their caregivers. Among them, 15 from Amrit center was assigned to experimental group and 15 from Ashirwaad center was assigned to control group.

Sampling technique:

Non probability Purposive sampling technique was adopted for the present study.

Criteria for sample selection:

Inclusion criteria:

1. Caregivers who are involved in feeding of cerebral palsy children.

2. Child age ranging from 6 – 12 years who are having cerebral palsy

Exclusion criteria:

1. Cerebral palsy children who have medical problems.

2. Children with associated facial anomaly. e.g. cleft lip and palate.

3. Care givers who have already participated in similar kind of study.

Development and Description of the tool for data collection:

The tool was developed by the researcher.

Teaching Module:

A planned individual teaching module prepared regarding feeding of cerebral palsy children which includes causes for cerebral palsy, feeding problems, type of food, quantity, quality, and consistency of food, duration and frequency of feed, management of feeding difficulties like position, chewing, drooling, choking, utensils used for feeding, and hygienic practices.

Description of tool:

Section A: Demographic profile of the care giver and cerebral palsy child.

Section B: Questionnaire on assessing the knowledge on feeding.

Section C: Observation checklist to assess the feeding practice.

Section A:

Caregiver’s demographic profile include type of marriage, number of children, family type, family history of cerebral palsy, and source of information. Child’s demography includes age of the child, sex, weight and birth order of the affected child.

Section B:

Structured questionnaire consisting of 30 closed ended questions with multiple choice answers on various aspects on feeding of cerebral palsy child. Each right answer was assigned the score of one and wrong answer zero. The maximum score possible was 30 and the minimum score was zero. Higher the score greater the knowledge on feeding of cerebral palsy children.

Section C:

Observational checklist to evaluate the feeding practice of caregivers. The checklist contains position of the child during feeding, food item, frequency of feeding, consistency of food, duration of the feeding, and care of the child after feeding, hygienic practices, management of feeding problems and feeding difficulties.

Plan for data analysis:

The obtained data from the subjects were computed with appropriate descriptive and inferential statistical analysis to test the hypothesis and to achieve the set objectives. To compare the effectiveness of nursing intervention,‘t’ test was used. 'Chi' square was used to assess the association between selected demographic variables with the knowledge scores of the caregivers in both groups.

RESULTS:

In Experimental group regarding the type of marriage, all 15 caregivers (100%) got non consanguineous marriage. Majority of caregivers (86.67%) two children and only 2 care givers (13.33%) have only one child. Considering family type 6 care givers (40%) are in joint family and care givers (60%) are in nuclear family.

Table 1: Comparison of pre test knowledge scores of care givers on experimental group and control group.

Group	Mean	Standard deviation	Independent 't' value
Experimental Pre test	13.20	1.42	1.45 (NS)
Control Pre test	14.53	1.28

NS-Not significant

In the above table 1 the ’t’ value 1.45 for the mean difference in the pretest knowledge scores of care givers between experimental and control group is not significant. Hence, the homogeneity is maintained in the knowledge score of the care givers between experimental and control group.

Table 2: Comparison of post test knowledge scores of care givers between experimental and control groups.

Group	Mean	Standard deviation	Independent 't' value
Experimental post test	24	1.73	16.22**
Control post test	14.6	1.5

** - p < 0.01

In the above table 2 the’t’ value 16.22 for the mean difference in the post test knowledge score of the care giver on feeding practice of the control and experimental group is significant (P<0.01).

The mean post test knowledge scores of the care givers in the experimental and control group on feeding practice of cerebral palsy children were 24 and 14.6 respectively of reveals that the nursing intervention is effective in enhancing the knowledge of the care giver on feeding practice. Hence the proposed alternative H₁ hypothesis is accepted

Table 3: Distribution of experimental and control groups of care givers on feeding practice of cerebral palsy children N = 15

S. No.	Particulars	Control group				Experimental group
		Pre Observation.		Post observation		Pre-observation		Post-observation
		N	%	N	%	N	%	N	%
1.	Position Sitting Upright Semi sitting Sitting leaning forward Lying	2 7 6 -	13.33 46.67 40.00 -	2 6 7 -	13.33 40.00 46.67 -	3 8 4 -	20.00 53.33 26.67 -	13 - 2 -	86.67 - 13.33 -
2.	Food items Pulses and cereals Pulses and meat Pulses, cereals, meat, vegetables and fruits	11 - 4	73.33 - 26	10 - 5	66.67 - 33.33	10 - 5	66.67 - 33.33	2 - 13	13.33 - 86.67
3.	Frequency of feeding Four times Five times Six times Three times	3 3 - 9	20.00 20.00 - 60.00	3 3 - 9	20.00 20.00 - 60.00	4 3 - 8	26.67 20.00 - 53.33	- 14 - 1	- 93.33 - 6.67
4.	Consistency of food items Liquid Semi solid Solid Normal	- 7 - 8	- 46.67 - 53.33	- 8 - 7	- 53.33 - 46.67	- 8 - 7	- 53.33 - 46.67	- 12 - 3	- 80.00 - 20.00
5.	Duration of feeding 10 minutes 10 - 15 minutes 20 minutes More than 30 minutes	- 5 8 2	- 33.33 53.33 13.33	- 6 7 2	- 40.00 46.67 13.33	- 6 7 2	- 40.00 46.67 13.33	- 1 2 12	- 6.67 13.33 80.00
6.	After care of the child Repositioning Burping Cleaning the mouth Cleaning the utensils	7 4 11 12	46.67 26.67 73.33 80	6 5 12 11	40.00 33.33 80.00 73.33	8 3 10 10	53.33 20.00 66.67 66.67	14 13 15 15	93.33 86.67 100.00 100.00
7.	Hygienic practices Hand washing Nail clean Utensil washing	10 8 7	66.67 53.33 46.67	10 8 7	66.67 53.33 46.67	10 8 7	66.67 53.33 46.67	15 13 13	100.00 86.67 86.67
8.	Feeding difficulty Chewing Swallowing Regurgitation Drooling	2 6 1 5	13.33 40.00 6.67 33.33	2 6 1 5	13.33 40.00 6.67 33.33	2 5 2 6	13.33 33.33 13.33 40.00	- 2 - 2	- 13.33 - 13.33
9.	Feeding problems Apnoea Aspiration Coughing and chocking Cyanosis and tachypnea	- 4 4 -	- 26.67 26.67 -	- 4 4 -	- 26.67 26.67 -	- 3 4 -	- 20.00 26.67 -	- - 1 -	- - 6.67 -

The table (3) represents the observation scores among control and experimental group of caregivers on feeding practice of cerebral palsy children. With regard to position of the child during feeding shows that 86.67% were followed sitting upright position, the same 86.67% of children were taking pulses, cereals, meat, vegetables and fruits in their food, 93.33% were taking food 5 times a day, and 80% of children were taking normal food.

Out of 15 children, 12(80%) were taking food for more than 30 minutes, All the children cleaned mouth and utensils, all followed hygienic practices like hand washing, swallowing difficulty and drooling faced by 13.33% of children, and other feeding problems like coughing and choking experienced by 6.67% of children.

DISCUSSION:
Comparison of pre test knowledge scores of control and experimental group of caregivers on feeding of cerebral palsy children reveal that there is no significant difference of knowledge among both groups on feeding of cerebral palsy children. Hence, the homogeneity is maintained. Comparison of post test knowledge score of care givers of both control and experimental group on feeding of cerebral palsy children, the‘t’ value of 16.22 is statistically significant at 0.01 level. The interventional group who received health education cum demonstration was scored more than control group of caregivers. The effectiveness of Health education was documented.

Distribution of caregivers of control and experimental groups according to the pre and post test scores of observation checklist revealed that though the observations are not statistically proved, still there is lot of improvements in areas of feeding practice and reduction in problems during feeding.

Considering the position during pretest 20% were followed upright position during feeding their child, after intervention 86.67% were maintained upright in post test of the experimental group.In after care of the child, repositioning was followed by 53.33% of caregivers in the pre test. In the post test 93.33% were followed. After feeding 20% only done burping to their children in pre test. In the post test 86.67% had done the burping in experimental group. In reduction of feeding difficulty, 33.33% had swallowing difficulty in prestest, it was reduced as 13.33% in post test. During pre test 13.33% were got regurgition in pretest, In the post test it was nil. And drooling also reduced in some extend in the experimental group. Among feeding problems, 20% of aspiration in pretest was reduced as nil in post test of experimental group. And experience of coughing and choking reduced from 26.67% to 6.67% in post test.

Recommendations:

· A similar study can be conducted with large sample.

· A study can be done by using different instruction technology.

· A comparative study can be conducted to assess the feeding problem and care needed between cerebral palsy children and children affected with other disabilities.

· A study can be conducted as a long term study on nutritional status and growth of cerebral palsy children.

Limitations:

· The researcher could not generalize the study findings as the sample size was small.

· Observation of feeding practice of cerebral palsy children could not be done in their home setup.

REFERENCES:

1. Florence Yossem.,(1998). Clinical Management of feeding disorder.(1^st ed.). Newton: Butterworth-Heinemann.

2. Nancie R Finnie. (1997). Handling the Young child with Cerebral Palsy at Home. (3^rd ed.). Johannesburg: Butter worth Heinemann.

3. Aota, (2007). Specialized Knowledge and Skills in Feeding, Eating, and Swallowing for Occupational Therapy Practice. The American Journal of Occupational Therapy, Vol: 61, 686-697.

4. Fung EB, Samson and Samson-Fang L, (2002). Feeding Dysfunction is Associated with Poor Growth and Health Status in Children with Cerebral Palsy. Journal of American Dietetic Association. Vol: 83, 47-53.

5. Gangil A (2001). Feeding difficulties in Children with Cerebral Palsy to assess the parental awarenesss. Available from www.indianpediatrics.net/aug2001/aug 839-846.htm

6. Larnert G and Ekberg O (1995). Positioning improves the oral and pharyngeal Swallowing function in children with cerebral palsy. Acta Paediatr 84, 689-692.

7. Veness C, Reilly S. (2008). Meal time Interaction Patterns Between Young Children with Cerebral Palsy and their Mothers: Characteristics and relationship to feeding impairment. Available from www/ feeding.in / cpchild.

Received on 30.08.2011 Modified on 12.09.2011

Accepted on 09.11.2011 © A&V Publication all right reserved

Asian J. Nur. Edu. and Research 1(4): Oct-Dec. 2011; Page 109-112