INTRODUCTION:

Child care needs an effective strategy based on holistic approach as many children presents with overlapping sign and symptoms of disease and a single diagnosis can be difficult and may not be feasible or appropriate. Integrated Management of Neonatal and Childhood Illness is an integrated approach to child care which involves evidence based integrated syndromic approach to case management that includes rationale, effective and affordable use of drugs and diagnostic tools.¹

Children brought for medical treatment are often prompt to suffering from more than one morbid condition; therefore making a single diagnosis is impossible. These children require a combined therapy for successful treatment. Thus, there is a need for an integrated strategy that combines the treatment of major childhood illnesses, with involvement of parents in provision of home-based care, prevention of disease through immunization, improved nutrition, and breast feeding. This integrated strategy led to the formation of "The Integrated Management of Childhood Illness (IMCI)" in 1992 by UNICEF and WHO.¹

Child health programmes need to move beyond tackling single diseases in order to address the overall health and well being of the child. Improvements in child health are not necessarily dependent on the use of sophisticated and expensive technologies.

An understanding of child care is essential for nursing and medical students to gain an appreciation of trends leading to our present concepts and practices specific to children. Nurses can play an important role in improving the health status of children by careful and systematic assessment of common symptoms and well selected specific clinical signs which provides sufficient information to guide rational and effective actions.²

As IMNCI has become a growing need, the students of medical profession should also be addressed about all the newer concepts with the use of appropriate techniques. Thus IMNCI is also added in curriculum of all the medical students including nursing but still there is need to make the students more aware of this needed concept. Structured Teaching is a tool used by teachers and staff to organize student work and provide access to Content Curriculum. The "structure" consists of modifications in the environment, concrete and visual ways of presenting information, and proactive routines. It is individually designed around each student's strengths, skills, interests and needs.³

NEED:

Reduction of Infant and Child Mortality Rates and improving Child Survival has been an important goal of the National Programmes of India. Since 1977 to 1992, programmes like Universal Immunization, Oral Rehydration Therapy (ORT), control of diarrheal disease, acute respiratory infections, essential newborn care, promotion of breast feeding, complementary feeding, prevention of anaemia and vitamin A deficiency were implemented to address child mortality as vertical programmes.⁴

As a result of these programmes under facility based IMNCI, the Infant Mortality Rate (IMR) has come down significantly over the years from 114 in 1980 to 55 in 2007. It has however been seen that the IMR decline during the period 1980 to 1990 was 34 points (114 to 80), whereas the decline was only 12 points (80 to 68) during the period 1990 to 2000. However in the subsequent years i.e. in 7 years (2001-2007) the decline in IMR has been 13 points (68 – 55)revealing a very slow decline in the neonatal mortality rate.⁴

The planning Commission’s goals for the 10^th five year plan was to reduce IMR to the level of 45/1000 live births by 2007 and 28 by 2012.⁵These goals are even more ambitious than the Millennium Development Goals, to which India is a signatory.⁶But according to the data given in the above phrase these goals is still not achieved. So there is still a need to create more awareness regarding IMNCI.

WHO/UNICEF have developed this approach to tackle the major diseases of early childhood called the Integrated Management of Childhood Illnesses (IMCI). The integrated approach ensures that all relevant needs of the child are looked at and attended to during the contact of the child with the health workers.⁷As the health workers plays a major role in the proper implementation of this task among which nurses are one of the largest groups of professionals working in the health care system. Their presence in the health care system plays a very important role and helps in the speedy recovery from the illnesses. So the nursing students should be taken into consideration in the provision of this teaching programme and knowledge.

STATEMENT OF PROBLEM:

A study to assess the effectiveness of structured teaching programme on knowledge of Nursing students regarding Integrated Management of Neonatal And Childhood Illness (IMNCI) in selected colleges of Amritsar, Punjab.

OBJECTIVES OF THE STUDY:

1. To assess the pretest knowledge score of nursing students regarding Integrated Management of Neonatal and Childhood Illness.

2. To assess the post test knowledge score of Nursing students regarding Integrated Management of Neonatal and Childhood Illness.

3. To compare the pretest and post test knowledge score of Nursing students regarding Integrated Management of Neonatal and Childhood Illness.

4. To determine the association between change in knowledge score and selected demographic variables.

HYPOTHESIS:

1. H₀: There will be no significant difference between the pretest and post test knowledge score of nursing students.

2. H₁: There will be significant difference between the pretest and post test knowledge scores of nursing students.

Inclusion criteria:

1. Students who were willing to participate in the study.

2. Students who were studying in B.Sc.(N) 3^rd year

3. Students who were present at the time of data collection.

Exclusion criteria:

1. Students having prior exposure to knowledge regarding IMNCI

METHODOLOGY:

Research approach:

The research approach adopted for the present study was Quantitative research approach. This approach would help the investigator to evaluate the effectiveness of structured programme on the knowledge of nursing students regarding Integrated Management of Neonatal and Childhood Illness.

Research Design:

In the present study the investigator selected Pre-experimental one group pre test post test only design to assess the effectiveness of structured teaching programme on the knowledge of nursing students regarding Integrated management of neonatal and childhood illness. Keeping in view the objectives of the study, the investigator assessed the knowledge of groups prior to the intervention (pre-test). After the pre-test, intervention (structured teaching programme) was administered to the same group and was then again assessed (post-test).

Setting :

The study was conducted in selected nursing colleges of Amritsar city.

Variables:

Independent Variables: Structured teaching programme on IMNCI.

Dependent variable:

Knowledge of nursing students regarding IMNCI.

Socio-demographic variables:

Type of habitat, presence of any medical personnel in the family, educational qualification of the parents, percentage scored in B.Sc (N) 2^nd year .

Population:

In the present study the target population consists of B.Sc (N) 3^rd year students studying in selected Nursing colleges of Amritsar city.

Sample and Sampling Technique:

Those nursing students who were studying in B.Sc (N) 3^rd were selected as subjects. The sample size comprised of 100 nursing students. Convenience sampling technique was employed to collect data.

Data Collection instruments:

In this study data collection instruments was self structured knowledge questionnaire.

Description of tool:

Self Structured knowledge questionnaire which consists of socio demographic variables and knowledge questionnaire on Integrated management of neonatal and childhood illness.

Part A:

The first part of the tool consist of 4 items for obtaining information about the selected socio demographic background factors such as type of habitat, presence of any medical personnel in the family, educational qualification of the parents, percentage scored in B.Sc (N) 2^nd year .

Part B:

Structured questionnaire is to assess the knowledge of nursing students regarding Integrated management of neonatal and childhood illness. It consists of 30 items of multiple choice questions.

Total score is 30.

For right answer score = 1

For wrong answer score = 0

Content validity:

The initial draft was given to the thirteen experts. The experts were requested to validate the STP based on the criteria and to give suggestions on the adequacy and relevance of the content. Based on the experts’ opinion some of the content has been modified.

Ethical Consideration:

The written permission was sought from Principal S.G.R.D College of Nursing, Vallah, Amritsar.

Permission was obtained from the college Ethical Committee of SGRDIMSR.

Permission was obtained from the Principals’ of respected colleges.

Prior information and informed consent was obtained from each study subjects.

Anonymity and confidentiality of subjects was maintained.

Data collection procedure:

The data collection procedure was carried out in the month of December - January 2012-13. Structured knowledge questionnaire was distributed to those who were willing to participate in the study. On day 1^st after introducing and explaining the purpose of the study, pre test structured knowledge questionnaire was given to the respondents and knowledge regarding Integrated Management of Neonatal and Childhood Illness was assessed. STP of Integrated Management of Neonatal and Childhood Illness was conducted for a period of 60 minutes after pre test. On 7^th day, the investigator administered post-test and assessed their knowledge. No difficulty was faced by the investigator during the data collection process.

ANALYSIS AND INTERPRETATION:

Section A: Description of Socio-Demographic variables.:

In this section analysis of Socio-Demographic variables of the subjects is described in terms of type of habitat, presence of any medical personnel in the family, educational qualification of the mother, percentage scored in B.Sc (N) 2^nd year. The findings are presented in table 1

Table no. 1:

Depicts socio demographic characteristics of the study subjects and revealed that majority of the nursing students i.e. 56 (56%) belonged to Urban Habitat followed by 36 (36%) of nursing students belonged to Rural Habitat and least number of nursing students i.e. 12 (12%) belonged to the Semiurban Habitat.

The majority i.e 89% nursing students did not have any medical personnel in the family, followed by 11% of the nursing students had medical personnel in their family.

It is represented that the educational qualification of majority of the nursing students i.e 41% is secondary education followed by 27% are graduate and 23% are having higher secondary and 5% having informal education and least of 4% are post graduate.

It is depicted that Maximum of the nursing students i.e. 66% scored 60- 70% in B.Sc (N) 2^nd year and 33% of nursing students scored between 70- 80% and a few i.e 1% scored between 60- 50% and none of the nursing student had scored <80%.

Section B: Analysis of Pre Test Knowledge Score of nursing students.:

This section deals with the analysis of Pre Test Knowledge Score on knowledge of IMNCI among nursing students. The data regarding Pre Test Knowledge Score had been summarised using frequency and percentage and presented in table 2.

Table no. 2 Frequency and percentage distribution of Pre Test Knowledge Score of nursing students. N = 100

Level of Knowledge	Knowledge Score Pre Test		t- value
Level of Knowledge	(n)	(%)
Excellent	00	00%	42.228
Good	00	00%
Average Poor	57 43	57% 43%

Maximum score = 30

Minimum score = 0

Table no. 2 depicts that in pre test near half of nursing students i.e 43% had average knowledge and 57% had poor knowledge and no one falls in the category of good and excellent knowledge.

Section C: Analysis of Post Test Knowledge Score of nursing students.:

This section deals with the analysis of Post Test Knowledge Score on knowledge of IMNCI among nursing students. The data regarding Post Test Knowledge Score had been summarised using frequency and percentage and presented in table 3.

Table no.3 Frequency and percentage distribution of Post Test Knowledge Score of nursing students. N = 100

Level of Knowledge	Knowledge Score Pos Test		t- value
Level of Knowledge	(n)	(%)
Excellent	67	67%	42.228
Good	33	33%
Average Poor	0000	00%00%

Maximum score = 30

Minimum score = 0

Table no. 3:

depicts that in the post test it was observed that majority of nursing students i.e 67% had excellent knowledge and 33% of them had good knowledge.

From this score it can be clearly interpreted that post test score had gone up at the same time all the poor and average score had shifted to higher score of ‘good’ and ‘excellent’ as a result of structured teaching programme on IMNCI among nursing students.

Section D:

Comparison of Pre Test and Post Test Knowledge Score of nursingstudents to assess the effectiveness of structured teaching programme on knowledge regarding Integrated management of neonatal and childhood illness.

This section deals with the analysis of Pre Test and Post Test Knowledge Score to evaluate the effectiveness of structured teaching programme on knowledge of nursing students regarding Integrated management of neonatal and childhood illness. The data regarding Pre Test and Post Test Knowledge Score has been summarised using frequency and presented in table 4

Table no. 4 Mean Knowledge Score of nursing students. N= 100

	Mean Knowledge Score Pre Test and Post Test
	Frequency (n)	Mean	SD	Mean difference	t
Pre test	100	11.05	2.48
Post test	100	25.19	2.27	14.14	42.228**

٭* Significant at (p<0.001)

H₁ – There will be significant difference between the pre test and post test knowledge scores of the nursing students.

H₀– There will be no significant difference between the pre test and post test knowledge score of nursing students.

The data presented in the table no. 4 shows that the mean of the knowledge score of post test (25.19) was higher than pre test (11.05).

The ‘t’ value for total pre test and post test was 42.228. There was difference between Pre Test Knowledge Score and Post Test Knowledge Score. It means the knowledge score increased after structured teaching programme.

H₀rejected at t_cal42.228; p > 0.001 level of significance. This indicates that the difference between the pre test and post test mean was a true difference and had not occurred by chance. ThusH₁was accepted. So this proves that structured teaching programme is effective in increasing the knowledge of nursing students.

Section E:

Association of Change in Knowledge Score with selected Socio-Demographic variables.

This section deals with the association of change in Knowledge Score with selected Socio Demographic variables like type of habitat, presence of any medical personal in the family, educational qualification of the parents, percentage scored in B.Sc (n) 2^nd year. The findings are presented in tables 5.

Table no. 5 Association of Change in Knowledge Score with selected Socio-Demographic variables. N =100

SocioDemographic Variables	N	Change in Knowledge Score	SD	p value
		Type of habitat
Urban	32	13.00	3.09
Rural	56	14.70	3.26	0.064^*
Semiurban	12	14.58	3.92
		Presence of any medical personnel in the family
Yes	11	12.91	2.737	0.198^*
No	89	14.29	3.399
		Educational qualification of Parents
Informal education	5	14.00	5.148
Secondary education	41	14.39	3.820
Higher secondary education	23	14.65	2.948	0.227 ^*
Graduate	27	13.89	2.391
Post graduate	4	10.50	2.349
		Percentage scored in B.Sc. 2^nd year
>80%	-	-	-
70-80%	33	12.79	3.361	0.011 ^**
60-70%	66	14.85	3.163
50-60%	1	12.00	-

* = Non Significant

** = Significant

MAJOR FINDINGS:

Findings of the study depicts that Majority of nursing students belongs to rural habitat i.e 56% followed by urban habitat i.e 32%. Maximum change in the knowledge score was in the nursing students belonging to the rural habitat i.e 14.70 followed by semiurban i.e 14.58 and minimum change in knowledge score had occurred in nursing students belonging to urban habitat i.e 13.00.

Most of the nursing students i.e 89% does not had any medical personnel in the family. The change in Knowledge Score was more in nursing students who were not having any medical personnel in the family i.e 14.29 followed by those who were having any medical personnel in the family i.e 12.91.

Mothers of maximum of the nursing students i.e 41% had secondary education followed by graduates i.e 27%. The change in Knowledge Score in educational status was highest among nursing students whose mothers were having higher secondary education i.e 14.65 followed by nursing students whose mothers were having secondary education i.e 14.39 and mothers having informal education i.e 14.00. The change in knowledge score was 13.89 in nursing students whose mothers were graduate and the change in knowledge score was minimum in the nursing students whose mothers were post graduate i.e 10.50 respectively.

Majority of the nursing students i.e 66% had scored between 60-70% and 33 of the nursing students had scored 70-80% The change in knowledge score was highest in nursing students having 60-70% i.e 14.85 followed by nursing students having 70-80% i.e 12.79 and the change in knowledge score as least in nursing students who scored 50-60% i.e 12.00.

The findings of the study revealed that the mean knowledge score in pre test was 11.05 and had increased to 25.19 in post test after the structured teaching programme.

All the selected variables i.e. type of habitat, presence of any medical personal in the family, educational qualification of the mothers of the nursing students were not significant with the change in knowledge score except percentage scored in B.Sc (N) 2^nd year which was significant at p value 0.011.

SUMMARY:

This chapter dealt with analysis, interpretation and major findings of data collected from 100 nursing students. Bar diagrams were made to clarify the content of tables.

CONCLUSION:

The present study deals with assessing the effectiveness of structured teaching programme on knowledge of nursing students regarding Integrated management of neonatal and childhood illness. The study was conducted on 100 nursing students in selected nursing colleges of Amritsar, Punjab.

Structured knowledge questionnaire was used to collect the data. The data obtained was analysed in terms of objectives of the study using descriptive and inferential statistics. The data presented in the form of tables and figures.

Findings of the present study depicted that the mean pre test knowledge of nursing students was 11.05 and the mean post test knowledge of the nursing students was 25.19. The‘t’ value for total pre test and post test was 42.228. There was significant difference between pre test knowledge score and post test knowledge score. The mean change in pretest and post test was 14.14.

Which proves that structured teaching programme was highly effective in increasing the knowledge of nursing students.

Thus it was concluded that there was effectiveness of structured teaching programme on the knowledge of nursing students. regarding Integrated management of neonatal and childhood illness in selected nursing colleges of Amritsar, Punjab. Therefore such methods should be used to enhance the knowledge of nursing students regarding such important and recent topics like IMNCI.

LIMITATIONS:

This study was limited to the Nursing students studying in B.Sc. Nursing 3^rd year of selected colleges of Amritsar.

IMPLICATIONS:

The implications of the present study are discussed under following headings: Nursing practice, nursing education, nursing administration, nursing research.

Nursing Practice:

The nurse has a key role in health care delivery system. They are present at the time of delivery of care to the child and can play an important role in providing care as per IMNCI guidelines. By providing in service education programme to the staff nurses and student nurses can improve their practices in hospitals as well as community regarding Integrated Management of neonatal and childhood illness.

Nursing Education:

The present study emphasizes on the enhancements in the knowledge of the nursing students regarding Integrated management of neonatal and childhood illness. By educating health care professionals especially nurses and nursing students can remove misconceptions and improve their knowledge. They are in close contact with mother and the sick child during the delivery of care and so can counsel them regarding its importance. Furthermore the nurse educator should plan such structured teaching programmes and in-service education programme for nurses and other health care professionals at various levels to enable them to improve their knowledge and gain the skills in the provision of care as per the IMNCI guidelines. As it is also included in the curriculum of the nursing students but more emphasis is needed on the importance delivery of care as per IMNCI guidelines.

Nursing Administration:

The present study reveals that STP is an effective method to increase the knowledge of nursing students. Nurse administrator may use the study findings to improve the quality of care. The concept of extended role of nurse offers many opportunities for a nurse administrator to improve the quality of the life of health care professionals. Administrators should plan and organize such structured programmes and in-service education programme and workshops for health care personnels and encourage them to participate in these activities. The nurse administrator should make arrangements to see that sufficient manpower, money, and material, should be available for disseminating information.

Nursing Research:

Nursing research should be directed for exploring and updating the nursing personnels knowledge regarding Integrated management of neonatal and childhood illness. Nursing researches should be conducted to prepare various educational materials for staff nurses to improve knowledge regarding Integrated management of neonatal and childhood illness. Through the publication of research findings adequate knowledge and more positive attitude can be developed.

RECOMMENDATIONS:

1. The study can be repeated on large scale sample for better generalization of the findings.

2. A similar study can be conducted in assessing the knowledge of the staff nurses working in the hospitals.

3. A descriptive correlational study can be conducted between the government and private sectors on knowledge of Integrated management of neonatal and childhood illness.

4. True experimental study can be conducted to assess the knowledge of health personnels on knowledge of Integrated management of neonatal and childhood illness.

SUMMARY:

This chapter dealt with summary, conclusion, implications and recommendations based on the findings of the study.

REFERENCES:

1. W.H.O., Improving Child health, the integrated approach. Division of Child Health and Development; WHO: 1997. Rev.2. p2-7.

2. Joao Amaral. Effect of integrated management of childhood illness (IMNCI) on health worker performance in Northeast-Brazil. 2004Jan; 20 (2): p28-32. Available from:URL: http://www.scielosp.org/scielo.php?script=sci_arttextandpid.

3. Structured teaching. Available from :URL:http://www.cedarchapel.org/structuredteaching.html

4. National Rural Health Mission. Operational guidelines for the implementation of facility based IMNCI. Ministry of Health and Family Welfare of India: Cited 2012 feb 23. Available from :URL: http://nihfw.org/NCHRC.pdf

5. Bang AT et al. Home based neonatal care: summary and applications of the field trial in rural Gadchiroli. Journal of Prenatal paediatrics. India 2005; Cited 2012 feb 4; 25 (22): Available from: URL: http://www. ncbi. nlm. nih. gov/sites/entrez? cmd=search and db=pubmed and term=Bang%20AT%5Bau%5Danddispmax=50

6. Suresh K. Integrated Management of Neonatal and childhood illnesses: A package for hastening child survival and quality of life of children.1^st ed. New Delhi: 2008.

7. Operational guidelines for implementation of Integrated Management of Neonatal and childhood illnesses. WHO: Available from: URL: www. /imnci/ operational%20 plan%for20%for%20implementation.pdf.

Received on 12.06.2017 Modified on 02.07.2017

Asian J. Nursing Education and Research. 2018; 8(1): 15-21.

DOI: 10.5958/2349-2996.2018.00005.8

Socio-Demographic variables	Frequency (n)	Percentage (%)
1. Type of habitat
a) Urban	32	32
b) Rural	56	56
c) Semiurban	12	12
2. Presence of any medical personnel in the family
a) Yes	11	11
b) No	89	89
3. Educational qualification of the mother
a) Informal education	5	5
b) Secondary education	41	41
c) Higher secondary education d) Graduate e) Post graduate	23 27 4	23 27 4
4. Percentage scored in B.Sc. (N) 2^nd year
a) >80%	0	00
b) 70 – 80%	33	33
c) 60 – 70%	66	66
d) 50 – 60%	1	1