INTRODUCTION:

“My mother groaned, my father wept, into the dangerous worldI leapt.”

-William Blake

Birth weight is one of the most important factor for estimating the maturity of the newborn, evaluating intrauterine growth and development. In both, the developed and developing countries low birth weight is the most important factor that affects perinatal mortality, neonatal mortality, postnatal mortality, infant mortality and infant and Childhood morbidity.¹Neonatal period is the single-most hazardous period in the life. Never again life is the individual confronted with more dramatic challenges than during the transition from dependent intrauterine to existence to Independent post-natal life. Children are the wealth of any country. They are the most valuable asset for any society. They are the builders of the future of any nation. Traditionally birth weight has been regarded as a reliable indicator of fetal wellbeing and maternity. Since decades fetal weight is believed to be the greatest single factor determining the survival of the child.²

According to World Health Organization (WHO) “Low birth weight” newborn baby is be defined as babies with birth weight of less than 2500gm. The term “very low birth weight” refers to birth weight less than1500gm. “Extremely low birth weight” refers birth weight less than 1000gm, the term “micro preemie” refers when birth weight is below 500gm. The magnitude of low birth weight infants in developing countries is enormous. There are about total 22 million low birth weight infants in the world out of which India shows about 7-10 million. Low birth constitutes 30% of live births in India.³

Low birth weight babies are broadly of 2 clinical types. First are those born before37 weeks of gestation period (preterm). Because birth weight is a function of gestation, a preterm baby is expected to have less weight. Second category includes those babies who have intrauterine growth retardations. These babies are undernourished (or small) for a given gestation (dates) so they are also called “small for gestational age” (SGA) or “small for dates” (SFD) babies.⁴In general, risk factors in the mother that may contribute to low birth weight include young ages, multiple pregnancies, previous low birth weight infants, poor nutrition, heart disease or hypertension, drug addiction, alcohol abuse, and insufficient prenatal care. Environmental risk factors include smoking, lead exposure, and other types of air pollutions.⁵

Low birth weight, are also important indirect causes of neonatal deaths. Low birth weight contributes to 60% to 80% of all neonatal deaths. The global prevalence of low birth weight is 15.5%, which amounts to about 20 million low birth weight infants born each year, 96.5% of them in developing countries. Countries can reduce their neonatal and infant mortality rates by improving the care for the mother during pregnancy, childbirth and immediate care of low birth weight infants. Experience from developed and low and middle income countries has clearly shown that appropriate care of low birth weight infants, including their feeding,temperature maintenance, hygienic cord and skin care, and early detection and treatment of infections and complications including respiratory distress syndrome can substantially reduce mortality.⁶

NEED OF THE STUDY:

“We need to make a world in which fewer children are born, and in which we take better care of them.’’

-Max Born

The prevalence of low birth weight exists universally in all population. Low birth weight with high mortality and morbidity continuous to be a major public health problem in India. Low birth weight is one of the most serious challenges in maternal and child health in both developed and developing countries. Low birth weight newborn forms a pediatric priority because they have less chance of survival than babies weighing 2500 gm. Half of the prenatal and one third of infant mortality are due to the low birth weight. Low birth weight may lead to serious physical and mental handicap in those who survive.⁷Low birth weight is known to increase the risk for major disabilities such as cerebral palsy and mental retardation, anemia of prematurity, kernicterus, patent ductus arteriosus, respiratory distress, apnea, retinopathy, enterocolitis, but researchers now suspect that low birth weight may also contribute to minor difficulties in motor skills and in thinking, learning and memory.⁸Preterm birth is the leading cause of newborn deaths (babies in the first four weeks of life) and the second leading cause of death after pneumonia in children under five years.⁹Child trends data bank (2006) stated that babies who are have very low weight at birth (less than 1,500 grams), have a 24-percent chance of dying within their first year.¹⁰WHO (2011) published a data about Low birth weight which stated that 2.74% of the total deaths are due to low birth weight. Infants born at a low birth weight are also at increased risk of long-term disability and impaired development. Infants born weighing less than 2,500 grams are more likely to experience delayed motor and social development. Lower birth weight also increases a child’s likelihood of having a school-age learning disability, being enrolled in special education classes, having a lower IQ, and dropping out of high school. Risk for many of these outcomes increases substantially as birth weight decreases, with very low birth weight babies being most at risk.¹¹

National child survival and safe motherhood 1992 reported that nearly 50% of all infant deaths occur in the neonatal period and the common cause is low birth-weight.¹²Health and innovation in women’s and children’s health (2008) stated that low birth weight is the most common direct cause of newborn mortality. Low birth weight contributes to 60% to 80% of all neonatal deaths. The global prevalence of low birth weight is 15.5%, which amounts to about 20 million Low birth weight infants born each year, 96.5% of them in developing countries. Countries can reduce their neonatal and infant mortality rates by improving the care for the mother during pregnancy and childbirth and immediate care of low birth babies. Experience from developed and low and middle-income countries has clearly shown that appropriate care of low birth weight babies, including their feeding, temperature maintenance, hygienic cord and skin care, and early detection and treatment of infections and complications including respiratory distress syndrome can substantially reduce mortality.¹³

A study was conducted by RC Pereira (2014) in India to assess neonatal sepsis as a risk factor for neuro developmental changes in very low birth weight babies. Sample selected were 194 low birth weight infants. Findings of the study showed that approximately 44.3% of the infants had neonatal sepsis and 40.7% had abnormal neuromotor development at 12 months of corrected age. On the mental scale, 76 children presented abnormal cognitive development. Study concluded that neonates with neonatal Sepsis were 2.5 times more likely to develop changes in neuromotor development.¹⁴

A study was conducted by Rajwinder Kaur (2013) in India to assess the knowledge of staff nurses regarding care of low birth weight babies. Sample selected were 60 staff nurses. Study concluded that education had a vital role in improving the knowledge of staff nurses regarding care of low birth weight baby.¹⁵

A study was conducted by Nagwa A (2012) in Egypt to assess the knowledge and practice regarding the quality of nursing care immediately after birth. Sample selected were 50 staff nurses working in delivery room. Findings showed that nurses have an around average of knowledge and quality of practice regarding birth preparation, initiating attachment and breast feeding. Study concluded that staff nurses need to improve their knowledge and practice regarding care immediately after birth.¹⁶

A study was conducted by Poonam Sheoran (2011) in India to assess effectiveness of planned health education programme regarding risk factors and care of low birth weight babies in terms of knowledge and practice among staff nurses working in neonatal intensive care unit. Sample selected were 60 staff nurses working in neonatal intensive care unit. Findings revealed that there was a significant positive correlation between post test knowledge and practice scores of the staff nurses. Study concluded that planned health education programme on risk factors and care of low birth weight babies was found to be an effective strategy in enhancing the knowledge and practice of staff Nurses regarding the same.¹⁷

A review of article on gently caring and supporting the first few critical hours of life for the extremely low birth weight infant by CharshaDS (2008) in U.S suggested that caring for the extremely low birth weight infant in the first days of life is complex and challenging, yet rewarding. It is the experienced health care provider who will be best prepared to meet the needs of the fragile infant and their concerned/frightened parents. Understanding how to minimize stress and support body functions will help to care better for the infants in the first few days of life. Nursing plays an essential role in providing this minute-to-minute support. It is not always what health care providers do, but how they do it, that may matter the most.¹⁸

Investigator believes that by educating the staff nurses regarding immediate care of low birth weight babies will promote health and prevent complications

STATEMENT OF THE PROBLEM:

“Effect of planned teaching programme on knowledge of immediate care of low birth weight babies among staff nurses working in neonatal intensive care unit in selected hospitals of an urban area.”

OBJECTIVES OF THE STUDY:

1. To assess the knowledge level of staff nurses on immediate care of low birth weight babies before and after planned teaching programme.

2. To determine the effectiveness of planned teaching programme on the knowledge of staff nurses regarding immediate care of low birth weight babies.

ASSUMPTIONS:

1. Staff nurses may have some knowledge regarding immediate care of low birth weight babies.

2. Planned teaching may be helpful to the staff nurses for improving knowledge regarding immediate care of low birth weight babies.

HYPOTHESIS:

H0:-There is no significant difference between the pretest and post test knowledge scores of staff nurses regarding immediate care of low birth weight babies.

H1:-There is significant difference between the pretest and post test knowledge scores of staff nurses regarding immediate care of low birth weight babies.

LIMITATION:

1. The study is limited to staff nurses having less than 2 years of experience in neonatal intensive care unit.

2. The study is limited to staff nurses who are willing to participate.

3. The study is confined to one group pre-test and post test.

SCOPE OF THE STUDY:

This study will help to bring about a change in the knowledge regarding immediate care of low birth weight babies. As nurses play a major role in taking care of the health of the child, they will take necessary precaution to manage low birth weight child and prevent complications.

ETHICAL ASPECT:

1. Approval was obtained from ethical committee.

2. Approval was obtained from the institution head.

3. Informed consent from the samples was taken.

4. Samples have the right to participate or opt out at any given point of time

REVIEW OF LITERATURE:

The review of literature of the study is divided into 5 areas:-

1. Studies related to assessment of low birth weight baby:

A randomized trial study was conducted by Carlo WA, Kattwinkel J (2011) on mortality reduction by heart rate characteristic monitoring in very low birth weight neonates in America. Study was conducted on two-group, parallel, individually randomized controlled clinical trial of 3003 very low birth weight infants in 9 neonatal intensive care units. Findings showed that mortality rate was reduced in infants whose heart rate characteristic monitoring was displayed, from 10.2% to 8.1% and there was a trend toward increased days alive and ventilator free days. Study concluded that heart rate characteristic monitoring can reduce the mortality rate in very low birth weight.¹⁹

Lasker JN (2005) conducted a study to assess the risk factors for low birth weight deliveries in United States of America. The study stated that recognition of a higher than average incidence of low birth weight deliveries in areas of Eastern Pennsylvania led to an analysis of more than 5,500 deliveries in one of the region's hospital systems to investigate the predictors of low birth weight in that population. Results of multivariate analysis indicate key variables that contribute to low birth weight in particular, racial/ethnic background and specific medial problems during pregnancy, including preeclampsia, incompetent cervix, bleeding, low body mass index and lack of adequate weight gain.²⁰

A study was conducted by Diallo D (2003) to assess mortality rate of low birth weight newborns admitted to a neonatal care unit after transfer in India. Sample included 247 newborns weighing less than 2500 grams transferred to neonatal care unit. Findings showed that an ambulance was used for transport in only 10% of cases. The median time of admission after birth was 3 hours. Apgar score at 1st and 5th20minute were comparable between the newborns deceased and survivors. Study concluded that to reduce mortality associated with newborns transfer, there is a need for better organization of neonatal transport in under developed countries by promoting obstetricians and pediatrician’s collaboration and prevention of low birthweight.²¹

A qualitative study was conducted by Levison J, Nanthuru D, Chiudzu G (2014) to assess attitudes and knowledge on preterm birth in Malawi. The aims were to determine what is understood regarding normal length of gestation and how gestational age is estimated, to identify common language for preterm birth, and to assess what is understood as options for preterm birth management. Samples included six groups of community health workers. Study concluded that Qualitative research was useful in identifying gaps in knowledge in urban and rural Malawi, informing the development of educational materials and implementation of programs or trials ultimately aimed at reducing preterm birth. As a result of this qualitative work, implementation planning was focused on the gaps in knowledge, dissemination of knowledge, and practical solutions to barriers in known efficacious therapies.²²

2. Studies related to care of low birth weight baby:

A study was conducted by Parry M, Davies MW (2013) to assess low birth weight, term infant and the need for admission to special care nurseries in Australia. Sample selected were full term newborns born between 2000 and 2499 g. Study concluded that about half of the babies born with a birth weight of 2000-2499 g will require some intervention that will require them to be admitted to a special care nursery. However, about half would be able to avoid a special care nursery admission if they are well and admitted to the post-natal ward.²³

A study was conducted in by Vesel L, Manu A (2013) to assess promotion of skin-to-skin care for low birth weight babies in rural area of Ghana. The aim of the study was evaluate whether home visits intervention increased the adoption of skin to- skin care, in particular, among low birth weight<2.5 kg babies. Sample selected were 98 newborns. Study concluded that home visits intervention successfully promoted the uptake of skin to skin care in rural Ghana. Lessons learned can help shape skin to skin care promotion in efforts to increase adoption and save newbornlives.²⁴

A review of article by Turnbull V, Petty J (2013) to assess evidence-based thermal care of low birth weight neonates in London stated that parents should be involved in the care of, and decision making for, their newborn, and separations should be minimized. Their needs should be anticipated, respected and catered for in the neonatal unit. Open, clear, consistent information and communication should be maintained. Recommended facilities include accommodation and equipment for expressing breast milk, 24-hour visiting, psychological support services and22 maximized opportunities for parents to provide positive, gentle touch and skin-to-skin contact with their child during the admission.²⁵

A study was conducted by Kraybill EN in June (1998) in U.S to assess ethical issues in the care of extremely low birth weight infants by Kraybill EN in June 1998. Study examined the difficulties in making decisions about the medical treatment of infants who have uncertain viability because of extremely low birth weight. The advantages and disadvantages of three systematic approaches were reviewed. An approach called "provisional intensive care for all" which offered the most benefit and caused the least harm was introduced. With this approach, all live born infants would be presumed viable and would receive intensive care, at least initially. After further assessment of the infant, the parents would be informed as fully ²⁶

A study was conducted by Chaube SS, Higuchi M, Manandhar DS (2014) to assess the effectiveness of female community health volunteers in the detection and management of low-birth-weight in Nepal. Sample selected were 205 female health care workers. Study concluded that female community health volunteers are effective and skillful in managing low birth weight babies. Providing additional training to and increasing supervision of local female community health volunteers will increase the identification of high-risk neonates in resource-limited settings.²⁷

3. Studies related to maintenance of temperature:

A study was conducted by Manji KP (2003) to assess neonatal hypothermia on admission to a special care unit in Dar-es-Salaam, Tanzania. Aim of the study was to determine the prevalence and risk factors for hypothermia among neonates on admission to the Neonatal Care Unit. At admission all neonates were examined and axillary temperature recorded using a low-reading thermometer. Six-hourly temperature was taken in all infants. Those with a temperature below36.5 degrees C were recruited as cases and those with normal temperature served as controls. Study concluded that hypothermia on admission was found in 366 out of 1,632 babies (22.4%). In none of these was hypothermia recorded or reported as a reason for admission. 13% of the hypothermic neonates had severe hypothermia, with body Temperature below 32 degrees C on admission. Study concluded that hypothermia was significantly associated with deliveries from outside hospitals and with those who had operative or instrumental delivery in the same hospital. It was also associated with prematurity, low birth weight babies, time taken to transfer the baby and inadequate clothing after delivery.²⁸

A prospective study was conducted by Duman N, Utkutan S (2006) to determine the effects of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants promptly after birth admitted to the neonatal intensive careunit in Turkey.30 consecutively inborn infants weighing <1500 g were allocated to a wrap or non-wrap group within an incubator after admission to the neonatal intensive care unit. Axillary and incubator temperatures were taken on arrival at 1 and 2 hourly. Infants in the wrap group reached a normal axillary temperature faster than non-wrap infants and required lower incubator temperatures. Study concluded that polyethylene film wrapping effectively helps to correct hypothermia in very low birth weight infants admitted to the neonatal intensive care unit.²⁹

A retrospective study was conducted by Moreau JC, Kuakuvi N (2007) to assess the efficiency of kangaroo care on thermoregulation and weight gain of a, preterm newborn in Dakar. Sample selected were 56 preterm babies weighing below 2000 gms, after discharge from neonatal unit. Efficiency was appreciated on thermic curve evolution and daily weight gain. Findings showed mean gestational age was 33 weeks and mean birth weight, 1500 g. Mean temperature was satisfying during follow up and was stable around 37 +/- 0,5 degrees C. The results of this study pointed out on the efficacy of kangaroo method on thermoregulation, weight gain and survival of preterm babies.³⁰

A randomized control trial was undertaken by Srivastava S, Gupta A, Bhatnagar A (2014) to evaluate the effects of very early skin-to-skin contact (SSC), in preterm babies weighing 2500 g with their mothers, on success of breastfeeding and neonatal well-being in India. Findings showed that skin-to-skin contact contributed to better suckling competence. More babies in the skin-to-skin contact group were exclusively breastfed at first follow-up visit and at 6 weeks. Skin-to-skin contact led 30to higher maternal satisfaction rates, better temperature gain in immediate postpartum period, less weight loss was at discharge and at first follow-up and lesser morbidity than the study group. Results concluded that very early skin-to-skin contact is an effective intervention that improves baby's suckling competence, maternal satisfaction, breastfeeding rates and temperature control and weight patterns.³¹

An experimental study was conducted by Manani M, Jegatheesan P (2013) in India to eliminate admission hypothermia in preterm very low birth weight infants by standardization of delivery room management. The aim of the study was to increase preterm infants' admission temperatures to above 36°C by preventing heat loss in the immediate postnatal period. Samples selected was preterm infants born at less than 33 weeks' gestation with very low birth weight less than 1500 g were the sample. Findings showed that the rate of hypothermia was reduced from 44% in early 2006 to 0% by 2009.There was a slight increase to 6% in 2010. Subsequently, with further real-time feedback, the researcher was able to sustain 0% hypothermia through 2011. Study concluded that hypothermia can be reduced in very low-birth-weight infants using a standardized protocol, multidisciplinary team approach, and continuous feedback. Sustaining improvement is a challenge that requires real-time progress evaluation of outcomes and ongoing staff education.³²

4. Studies related to maintenance of nutrition:

A Comparative study was conducted by Rudgier M, Herrmann S (2008) in Australia to assess 2 hourly versus 3 hourly enteral feeding in extremely low birth weight infants, commencing after birth. Samples selected were 42 neonates in the 2 hourly feeding group and 32 infants in 3 hourly feeding group. Study charts were analyzed for all extremely low birth weight infants during a period of 2 years prior 31and after changing the feeding regime. Study concluded that weight gain and time until complete enteral nutrition are similar in 2 hourly and 3 hourly feeding regimes. Data suggested an advantage of 2 hourly feedings concerning the length of continuous positive airway pressure and phototherapy.³³

A prospective study was conducted by Almeida Hd, Venancio SI (2010) in Brazil to evaluate the impact of kangaroo care on exclusive breastfeeding in low birth weight newborns until 6 months of life. Samples included 43 newborns weighing < 2,000 g and staying in the neonatal unit for at least 7 days. Study concluded that Kangaroo care showed to be a facilitator of exclusive breastfeeding for low birth weight newborns until 6 months of life.³⁴

A retrospective study was conducted by Amendolia B, Fisher K (2014) in New Jersey to evaluate differences in feeding tolerance between infants maintained on continuous positive airway pressure and those receiving high-flow cannula with or without continuous positive airway pressure. Sample included 185 infants, 103 who received continuous positive airway pressure exclusively and 82 who received high flow cannula with or without continuous positive airway pressure. Findings showed that there was no statistical difference in time to full enteral feedings between the 2 groups. There was also no difference in time of initiation of oral feeding or days to 33 full oral feedings between 2 groups. The use of high-flow cannula was not associated with changes in feeding tolerance in premature infants. Study concluded that further studies are needed to investigate efficacy and potential advantages and disadvantages to the use of high-flow cannula in the very low-birth-weight infant population.³⁵

A review of article by Maas C, Poets CF, Franz AR (2014) Germany on how to avoid postnatal under nutrition of very low birth infants during neonatal intensive care stated that inadequate nutrient intakes in the first postnatal weeks play a crucial role in the etiology of postnatal growth restriction of very low birth weight infants. Efforts to improve early nutrition in these infants led to a significant reduction in postnatal growth failure. Initiation of enhanced parenteral nutrition immediately after birth and utilization of the large potential of early enteral nutrition seem pivotal. Nevertheless, it remains challenging to further reduce the initial drop in weight and head circumference and to improve body composition and linear growth.³⁶

A descriptive study was by Larios Del Toro YE, Larrosa-HaroA(2014) to describe the anthropometric indicators of growth and nutritional status in very low birth weight infants, hospitalized in a neonatal intensive care in Mexico. Samples included 114 very low birth weight infants, head, thigh, mid upper arm circumference, skin-fold measurements and weight/age, length/ age, and weight/length indices were obtained. Study concluded that weight/age in the very low birth weight infants could reflect growth, nutritional status and energy stored as fat, but in the very low birth weight infants, thigh circumference and mid arm circumference would be better indicators just of nutritional status.³⁷

A study was conducted by Zhongguo Dang (2014) to study the appropriate time of starting enteral nutrition and observe the effects of different enteral nutrition starting times on the digestive function, growth rate, and nosocomial infection rate in 34very low birth weight infants in China. Samples selected were very low birth weight babies admitted in neonatal intensive care unit. These infants were divided into three groups, ≤ 3days, 4-6 days and ≥ 7 days. Study concluded that the time of starting enteral nutrition has no impact on growth rate, but starting enteral nutrition early can promote the development of gastrointestinal function, increase milk intake, shorten the time to full enteral feeding, reduce the time of central venous catheterization, and significantly reduce nosocomial infection rate.³⁸

5. Studies related to prevention of infection:

A study was conducted by Wong HL, Lyon DJ (2004) in Hong Kong to assess the incidence of late onset (> 72 hours) infection and necrotizing enterocolitis in very low birth weight infants in two 36 month periods using two hand hygiene protocols, conventional hand washing, alcohol hand rub and gloves technique. Samples included were very low birth weight infants admitted to the neonatal 36intensive care unit. Findings showed that the introduction of the alcohol hand rub and glove technique protocol was associated with a 2.8-fold reduction in the incidence of late onset systemic infection, and also a significant decrease in the incidence of methicillin resistant staphylococcus aureus, septicemia and necrotizing enterocolitis in very low birth weight infants. This decrease in infection rate was maintained throughout the second 36 month period. Study concluded that alcohol hand rub and glove technique protocol was efficient is reducing the number of late onset infection and necrotizing enterocolitis.³⁹

A study was conducted by Torres Claveras S, DuplaArenaz M (2007) in Spain to analyze thrombocytopenia as an early marker of late onset neonatal candida sepsis and to determine whether there are significant differences in platelet count between neonates infected by different infectious agents. Samples included 42 neonates with late onset with positive blood culture in neonatal intensive care unit. The principal parameter examined was the incidence of thrombocytopenia according to the microorganisms causing the sepsis. Study concluded that the incidence of thrombocytopenia was significantly higher in candida sepsis than in bacterial sepsis. Thrombocytopenia is a highly specific marker of neonatal Candida sepsis.⁴⁰

A retrospective study was conducted by Terrin G, Passariello A (2009) in Italy to evaluate the efficacy and safety of minimal enteral feeding nutritional practice in feed intolerant very low birth weight infants. Sample selected were 102 newborns. During the study period, two feeding strategies were adopted: total parenteral nutrition group 1 and parenteral nutrition plus minimal enteral feeding group 2, for at least 24 hours. Primary outcome was the time to reach full enteral feeding; secondary outcomes were the occurrence of sepsis, the time to regain birth weight, the length of37 hospitalization, the occurrence of necrotizing enterocolitis. Study concluded that minimal enteral feeding in very low birth weight infants presenting feed intolerance reduces the time to reach full enteral feeding and the risk of sepsis. This feeding practice does not increase the risk of necrotizing enterocolitis and death.⁴¹

A study was conducted by Helwich E, Kordek A (2012) to investigate the incidence, cause, risk factors, etiologic agents and the outcomes of early onset infections in very low birth weight newborns in Polish neonatal intensive care units. Samples included were 910 newborns whose birth weight was less than 1500 gms. Findings showed that the frequency of early-onset septicemia was 7.0% and of early onset pneumonia 8.6%. The observed frequency of early onset septicemia did not differ from the one described in the literature, whereas the frequency of early onset pneumonia was higher. Study concluded that there is vertical transmission of the pathogens and a close relationship between the observed early onset infections with maternal environment.⁴²

A comparative study was conducted by Capretti MG, Sandri F (2008) in Italy to assess the impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants. Sample selected were staff nurses working in neonatal intensive care unit. Findings showed that in neonatal intensive care unit, the incidence of nosocomial infection in very low birth weight infants was significantly reduced after the introduction of a standardized hand washing protocol. In the researcher’s experience, a proper hand hygiene program can save approximately 10 nosocomial infection episodes/year, at a cost of $10,000 perepisode. Study concluded that improving hand hygiene practice is a cost-effective program in neonatal intensive care unit.⁴³

A retrospective study was conducted in by Korean J (2013) in Korea to assess the control of invasive candida infection in very low birth weight infants by reduction in the use of 3rd generation cephalosporin. Sample selected were 99 very low birth weight infants, who were admitted to the neonatal intensive care unit. Period I was defined as the period before the revision of management policies, comprised 57 infants, period II was defined as the period after the implementation of new management policies, comprised 42 infants. The new management policies entailed a reduction in antibiotic and histamine type 2 receptor blocker use, duration of central venous catheterization, and duration of endotracheal intubation. Study concluded that there was a significant overall decrease in the use of antibiotics including 3^rdgeneration cephalosporin and histamine type 2 receptor blockers, and a significantly lower incidence of invasive candida infections in period II as compared to period I.⁴⁴

RESEARCH METHODOLOGY:

RESEARCH APPROACH:

Research approach refers to the researcher‘s overall plan for obtaining answers to the research questions or for testing the hypothesis. The research design spells out the strategies that the researcher adopts to obtain information that is accurate, objective and interpretable. It is the set of flexible guideposts designed to keep the researcher in the right direction.⁴⁵Descriptive evaluatory research approach is a determination of scientific research methods and procedure to evaluate a programme. It is the determination of the results attained by some activity. The approach is made for assessing the effectiveness of social, economic or health programme implemented or for assessing the impact of developmental project. It mainly deals with quality and quantity. In the present study, the investigator intends and assesses the effectiveness of planned teaching based on the needs of staff nurses on immediate care of low birth weight babies. Hence a descriptive evaluatory research approach was considered to be appropriate and therefore accepted.

RESEARCH DESIGN:

The research design is a master plan specifying the methods and procedures for collecting and analyzing the needed information in a research study.⁴⁵The selection of research design depends upon the purpose of the study, research approach and variables to be studied. In this study, one group pretest post test was used which is referred as pre-experimental design. Planned teaching was prepared for staff nurses and its effectiveness seen in post test on knowledge regarding immediate care of low birth weight babies.

VARIABLES:

Independent Variable:

Independent Variable is a stimulus or activity that is manipulated or varied by the investigator to create an effect on the dependent variable⁴⁵. In this study, planned teaching regarding immediate care of low birth weight babies is the independent variable.

Dependent Variable:

Dependent variable is a response, behavior or outcome that the investigator wants to predict or explain.⁴⁵In this study knowledge of staff nurses regarding immediate care of low birth weight babies is the dependent variable.

SETTING OF THE STUDY:

The researcher chose one of the private hospitals. Patients from all over India come to this hospital to avail diagnostic facilities, treatment and for rehabilitation. The hospital is one of the largest of its kind and having well known educational institution including Child health Nursing. The hospital provides its services to all types of patients through its specialized and super specialized services. 44 The hospital is blessed with efficient, skilled and trained staff nurses who deliver their care to all patients equally. They work in wards, intensive care units, and various specialized departments and units in morning, evening and night shifts. They remain updated with the current trends in nursing through continuing education.

POPULATION:

In this study population was staff nurses having less than 2 years of experience in neonatal intensive care unit.

SAMPLE AND SAMPLING TECHNIQUE:

Sample consisted of staff nurses working in neonatal intensive care unit who met the inclusion criteria. Sampling technique used was non probability purposive sampling. The samples were selected according to the availability and pre-determined criteria.

TOOL PREPARATION:

The tool was developed by the researcher with reference of books, review of literature, under the guidance of research guide and experts and with personal experience of the researcher. The tool used for the study was structured questionnaire to assess the knowledge of staff nurses on immediate care of low birth weight babies

VALIDITY OF THE TOOL:

The validity of the tool was obtained by giving it to the expert in the field of study. A total of 11 experts: 8 from nursing faculty, 2 head of pediatric department, and 1 statistician validated the tool.

As per the suggestions of the experts, significant changes were made in the tool. The suggestion to reframe a few questions and options were incorporated and thus the content validity was established

RELIABILTY:

The reliability of the tool was tested on 10 staff nurses of the selected urban hospital. The reliability of the questionnaire was done using test retest method. The reliability was established using Pearson‘s correlation coefficient formula After calculation reliability score was obtained (r=0.97). Reliability coefficient ≥ 0.7 is considered satisfactory and reliable. Hence the tool used for the research study was considered reliable.

Fig. 1: Difference in pre test and post test overall knowledge mean score

Before calculating the‘t’ value Null hypothesis (H0) and alternate hypothesis (H1) was stated. The two tailed ‘t’ value for 0.05 level of significance is at 2.05 for degree of freedom of df = 29.

H01: There is no significant difference in knowledge among staff nurses before and after the planned teaching programme.

H1: There is a significant difference in knowledge among staff nurses before and after the planned teaching programme. The calculated t value was found to be 19.33 for knowledge. As the calculated value was statistically greater than the table ‘t’ value of 2.05 at 0.05 level of significance with the degrees of freedom 29 so null hypothesis (H0) was rejected.

CONCLUSION:

The data collected through the structured questionnaire was presented in frequency and percentage and depicted in charts for easy understanding. It is also evident that planned teaching programme regarding immediate care of low birth weight babies has improved the knowledge level of staff nurses significantly.

IMPLICATION OF THE STUDY:

Conducting research is a way of improving the existing knowledge in the field of nursing. The changes could be brought about through utilization of research and improvement in quality of care. The nurse as an important member of the health team is responsible for imparting this knowledge, hence she should be aware of the role in education through adequate and regular in service education.

Nursing Administration:

The findings of the study can be used by the nurse administrators to improve nursing care. The nurse administrators can participate in the formulation of policies and protocols pertaining to cardiopulmonary resuscitation. This will help to provide 88better care and decrease mortality, thereby strengthening the quality indicators of the institution.

Nursing Service:

This study highlighted the importance of imparting knowledge about immediate care of low birth weight babies among staff nurses working in neonatal care. Nursing services includes preventive, promotive, curative and rehabilitative services. Nurses have an important role in prevention and promotion of health in all age group of children. The findings of the study can help health care team members and care givers to develop positive attitude towards low birth weight babies. This study can be useful in preventing complications among low birth weight babies thus reducing their morbidity and mortality.

Nursing Education:

Nursing education plays a vital role in improving standards of nursing care. This study indicates that nurse educator can emphasize on knowledge regarding immediate care of low birth weight babies to staff nurses, students and other Health team members. The nurse educator can play a significant role by inculcating in nursing students the importance health education programme to staff nurses and other care givers regarding the same topic. Health education should be given prime importance in curriculum of all basic programs of nursing.

Nursing research:

The result of the study and tool used contributes to the body of knowledge of nursing. The suggestions and recommendations can be utilized by other researchers conducting study in the same field. Also future investigators can use the findings and methodology as a reference material.

RECOMMENDATIONS FOR FURTHER STUDY:

A comparative study can be conducted between planned teaching and other teaching methods such as video assisted strategy, self-instructional module etc.

The study can be done on large scale population thereby generalizing the finding.

CONCLUSION:

The finding of this study showed that staff nurses lacked adequate knowledge on immediate care of low birth weight babies. This has been improved after providing90 planned teaching on immediate care of low birth weight babies. This indicates that there is a need for planned structured education for staff nurses working in neonatal intensive care unit. Researcher had a good learning experience during the study. The timely suggestions and expert opinion of the guide helped the researcher to complete the study in time. The study allowed the researcher to interact with many nurses working in the neonatal intensive care unit and helped in better understanding of their problems regarding knowledge and practice.

REFERENCES:

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Received on 16.06.2016 Modified on 25.06.2016

Asian J. Nur. Edu. and Research.2017; 7(2): 209-218.

DOI: 10.5958/2349-2996.2017.00043.X

Sr. No.	Overall Knowledge mean				MD	SEMD	Calculated t value	p value
1	Pre-test		Post test		8.10	0.42	19.33	0.001
	M1	SD1	M2	SD2
	18.53	2.54	26.63	1.81

Mrs. Sneha Jose