Effectiveness
of Planned Teaching Programme (PTP) on Knowledge
Regarding Prevention of Neonatal Hypothermia among Postnatal Mothers
Mr. Shrishail.
B. Tambakad1*, Mrs. Sumitra. LA2
1Lecturer,
K.L.E. University’s Institute of Nursing Sciences, Belgaum, Karnataka.
2Professor,
K.L.E. University’s Institute of Nursing Sciences, Belgaum, Karnataka.
*Corresponding Author Email: sbtambakad@gmail.com
ABSTRACT:
A
study was conducted on 60 post-natal mothers admitted in post-natal ward of
KLE’S Dr. Prabhakar Kore
Charitable Hospital Belgaum. To evaluate the effectiveness of planned teaching programme on knowledge regarding prevention of neonatal
hypothermia post-natal mothers and to associate the knowledge of mothers with
selected socio-demographic variables.
Hypothermia
is one of the main causes of neonatal morbidity and mortality in developing
countries. Neonatal hypothermia is caused more by lack of knowledge than lack
of equipment and it is an important cause of neonatal death. Hypothermia is a
common alteration of thermoregulatory state of the neonates. Neonatal
hypothermia occurs when the body temperature drops between 36.5°C or 99.7°F in
the newborn infants. Thermal Protection of the newborn babies is considered as
one of important essential neonatal care.
The
subjects were selected by using non-probability purposive sampling technique.
Data collection was done through structured knowledge questionnaire. The study
was conducted by utilizing one group pre-test and post-test research design
with an evaluative approach. Data obtained was tabulated and analyzed in terms
of objectives of the study using descriptive and inferential statistics. The
study revealed that 60(100%) mothers had good knowledge and none to be found
average or poor knowledge. There was
significant gain in knowledge of post-natal mothers and is statistically
significant at P>0.05 level of significance. There was significant
association between age, religion, educational status, occupation and parity of
mother and pre-test knowledge scores.
KEYWORDS: Prevention
of neonatal hypothermia, Planned teaching programme,
Knowledge.
INTRODUCTION:
“Birth is not
only about making babies. Birth is about making mothers--strong, competent,
capable mothers who trust themselves and know their inner strength.”
Barbara Katz Rothman
The health of a Nation is the
wealth of the Nation. Today’s children are tomorrow’s adults. Birth is a major
challenge to the newborn to negotiate successfully from intrauterine to
extra-uterine life. Newborn baby is considered to be tiny and powerless,
completely dependent on others for life.
Within one minute of birth the normal
newborn adapts from a dependent foetal existence to
an independent one; capable of breathing and carrying on life process. Thus
these first hours are crucial because multiple organ systems are making the
transition from intrauterine to extra uterine functions1.
Warm is one of the basic needs of a newborn
baby. It is critical to the baby’s survival and well being. Unlike adults,
newborn babies are often not able to keep themselves warm especially if the
environmental temperature is low. This results in low body temperature. The
temperature of the newborn is the series of measures taken at birth and during
first day of life to ensure that the baby doesn’t become either too cold
(hypothermia) or too hot (hyperthermia) and maintains a normal body temperature
of 36.5 0C -37.50C (97.7 - 99.50F).2
Post-natal mothers play a vital role in
essential newborn care. She cares to her baby at physical, emotional and social
level. There are striking variations from place to place in the patterns of
care that newborn infant receives. It is as per their religion, community,
family, beliefs, customs and traditions which they follow. In extended and
joint families women are primary care takers, bearers and nurturers of next
generations as most of the practices are learnt by these young mothers from
their mothers or mother-in-laws.3
NEED FOR THE STUDY
“Children are wealth of tomorrow; take care
of them, if you wish to have strong India.”
Jawaharlal Nehru
Newborns constitute the foundation of a
nation and hence they are future pillars of our country. So it is every
citizen’s unique responsibility to take care of their needs and rights. Healthy
and strong babies are likely to evolve as physically and mentally strong adults
with enhanced quality of human resource development.4
The first 28 days of life are known as the
neonatal period. The child during this time is known as neonate. The children
in this age group are vulnerable and are liable to get various disease and
disabilities. The morbidity and mortality rates in newborn infant are high. It
is therefore very important comprehensive health care service to children to
promote their health.5
Hypothermia is one of the main causes of
neonatal morbidity and mortality in developing countries. Neonatal hypothermia
is caused more by lack of knowledge than lack of equipment and it is an
important cause of neonatal death. Hypothermia is a common alteration of
thermoregulatory state of the neonates. Neonatal hypothermia occurs when the
body temperature drops between 36.5°C or 99.7°F in the newborn infants. Thermal
Protection of the newborn babies is considered as one of important essential
neonatal care. The newborn looses heat by evaporation, particularly soon after
birth due to evaporation of amniotic fluid from skin surface, conduction (by
coming in contact with cold object, cloth, tray etc), convection (by air in
which cold air replaces warm air around baby, open windows, fans) and radiation
(due to colder solid objects in
vicinity). Hypothermia is considered as silent killer in neonates.6
Neonatal deaths in India
According to UNICEF
estimation statistics a quarter of world's neonatal deaths (1.2million) each year
take place in India. In India and other developing countries approximately
50%of infant’s death occurs in the neonatal period, 25% of neonatal deaths
occur within 24 hours of life and 20% neonatal deaths are due to hypothermic
complications.7
|
YEAR
|
2005
|
2008
|
2009
|
2010
|
|
Neonatal deaths in India (per1000
live births)
|
37
|
35
|
34
|
32
|
According to
National Rural Health Mission 2010-2011 statistics the neonatal mortality rate
is 44 in Madhya Pradesh, 42 in Uttar Pradesh, 40 in Rajasthan, Chhattisgarh
37,Assam and Haryana 33, Karnataka and Punjab 25, West Bengal 23, Maharashtra 22, Delhi 19, Tamil Nadu 16, and in Kerala 7/1000 live births respectively.
The various clinical signs of neonatal
hypothermia are skin temperature drops below 36.5°C, hands, feet, abdomen are
cold to touch, weak sucking ability,
weak cry and lethargy, bluish extremities, weight loss, slow heart rate at
irregular respiration. The various consequences of neonatal hypothermia are
hypoxia, hypoglycemia, respiratory distress, neonatal jaundice, metabolic
acidosis, sudden infant death syndrome, pulmonary haemorrhage
and impaired cardiac function.8
Prevention of
neonatal hypothermia by maintaining warmth at the time of birth in delivery
room, Immediate drying and wrapping, Skin-to-skin contact between mother and
neonate, appropriate clothing and covering the head properly, warmth during
transportation, warmth at neonatal care unit and warmth at home.9
STATEMENT OF THE
PROBLEM:
“A Study to evaluate the effectiveness of
Planned Teaching Programme (PTP) on knowledge
regarding prevention of neonatal hypothermia among postnatal mothers admitted
in postnatal ward of KLE’S Dr. Prabhakar Kore Charitable Hospital
Belgaum, Karnataka.”
OBJECTIVES OF THE
STUDY:
1)To assess the
knowledge regarding prevention of neonatal hypothermia among postnatal mothers.
2)To evaluate the
effectiveness of Planned Teaching Programme (PTP) on
the knowledge regarding prevention of neonatal hypothermia among postnatal
mothers.
3)To find out the
association between the pre-test knowledge scores and selected
socio-demographic variables.
OPERATIONAL
DEFINITIONS:
1)
Evaluate: It refers to the statistical
analysis on the knowledge of neonatal hypothermia.
2)
Effectiveness: It refers to determine the
extent to which the information in the Planned Teaching Programme
(PTP) has achieved the desired outcome by gain in knowledge scores.
3)
Planned Teaching Programme (PTP): It refers to the verbal material used for
teaching which will be prepared by researcher by using lecture-cum discussion
and A.V aids.
4)
Knowledge: It refers to the written
response of the postnatal mothers to the items in the questionnaire regarding
prevention of neonatal hypothermia.
5)
Prevention: In this study prevention refers
to the activities carried out by the mothers to prevent neonatal hypothermia
like early skin-to-skin contact, early initiation of breast feeding, mummifying etc.
6)
Neonate: It refers to babies within the
age group of 0 to 28 days after birth.
7)
Hypothermia: It refers to fall in body
temperature below 36.5°C and it is exhibited by poor sucking reflex, lethargy,
cold and clammy feet.
8)
Postnatal mothers: Mothers admitted in postnatal
ward of KLE’S Dr. Prabhakar Kore
Charitable hospital Belgaum, Karnataka.
Hypotheses:
H1: The mean post-test knowledge scores will
be higher than the mean pre-test knowledge scores at 0.05 level of
significance.
H2: There will be statistically significant
association between pre-test knowledge scores and selected demographic
variables at 0.05 level of significance.
Assumptions:
1)
Postnatal mothers may have some knowledge regarding prevention of neonatal
hypothermia.
2)
Planned Teaching Programme (PTP) may help to enhance
the knowledge of postnatal mothers regarding prevention of neonatal
hypothermia.
Delimitation:
The
study is delimited to mothers admitted in postnatal ward of KLE’S Dr. Prabhakar Kore charitable
hospital Belgaum, Karnataka.
Conceptual framework:
The Stufflebeams CIPP evaluation model [2003] for this
study identifies knowledge of mothers regarding neonatal hypothermia as
improvement in their child care.
Fig 1: Conceptual frame work
based on stuffle beams CIPP model of evaluation
RESEARCH METHODOLOGY:
Research Approach: An evaluative research
approach was adopted in this study.
Research Design: Pre-experimental one group pre-test and
post-test design was adopted to carry out the present study.
Research Setting: The setting selected for the
present study was post-natal ward of KLE’S Dr. Prabhakar
Kore Charitable Hospital Belgaum, Karnataka
Variables under
study: In the
present study the independent variable is Planned Teaching Programme
on prevention of neonatal hypothermia among postnatal mothers and gain in knowledge
score is the dependent variable.
Population: In the present study population comprises
of mothers admitted in postnatal ward of KLE’S Dr. Prabhakar
Kore charitable hospital Belgaum.
Sample and
Sample Size: The sample chosen for the present study were
mothers admitted in postnatal ward and the sample size is considered for the
study was 60 postnatal mothers.
Sampling
Technique: The sampling technique used for the study was
purposive sampling which is a type of non-probability sampling.
Description of
Tool:
The structured
knowledge questionnaire is used for sample selection.
Tool consists of 2
sections, namely
Section I: consists of 8 questions seeking the
demographic data of the mothers.
Section II: consists of part-I and part-II
Part-I
: 8 Items assessing the knowledge regarding
prevention of neonatal hypothermia among postnatal mothers.
Part-II (A): Knowledge questions of 11 items on
skin-to-skin contact.
Part-II (B): Knowledge questions of 14 items on bathing
and clothing
Part-II (C): Knowledge questions of 7 items on warm
chain.
The tool was found to have reliability of 0.78. The pilot study was done
on 10 post-natal mothers who are admitted in postnatal wards of Kasbekar Metagud Hospital in the
month of 17/01//2013. The final study
was conducted at Postnatal ward of K.L.E’S Dr. Prabhakar
Kore Charitable Hospital Belgaum on 01/03/2013 to
08/03/2013. Pre-test was conducted by administering structured knowledge
questionnaire and PTP with the help of power point presentation. Post test was
conducted after 7 days.
For the 40 items on knowledge of prevention
and management of neonatal hypothermia, a score of ‘1’ was awarded to correct
response, which a score of ‘(o)’ was awarded to an incorrect response. The data
obtained was analyzed in terms of
descriptive and inferential statistics.
RESULTS
The data obtained
was analyzed in terms of the objectives of the study using descriptive and
inferential statistics. Experts in the field of nursing and statistics directed
the development of data analysis plan which is as follows:
a. Organizing data on a master
sheet.
b. Tabulation of the data in terms
of frequencies, percentage, to describe the data.
Major Findings of the
study were:
1) Findings related to the socio-demographic variables of mothers:
In the present
study it was found that out of 60 mothers maximum number of 28(46.66%) belonged
to the age group of 21-25 years. Maximum mothers 46(76.66%) belonged to the
Hindu, Majority of mothers 24(40%) were belonged to secondary education,
Majority of mothers 45(75%) were house wives, Majority of mothers 42(70%)
belonged to nuclear family, Maximum mothers 40(66.66%) were belonged to rural,
Majority of mothers 26(43.33%) belonged to 6001 to 8000rs monthly income of
family, Majority of mothers 38(63.33%)
belonged to multiparity.
Graph 1: Cylindrical graph showing percentage
distribution of age
Graph 2: Pie graph showing percentage distribution of religion
Graph 3: Column graph showing percentage
distribution of educational status of mother
Graph 4: Pie graph showing percentage distribution of
Occupation of mother
Graph 5: Column graph showing percentage distribution of
type of family
Graph 6: Line graph showing percentage distribution of
residence
Graph 7: Cone graph
showing percentage distribution of monthly income of family
Graph 8: Doughnut graph showing
percentage distribution of parity
2) Findings related to pretest and post test knowledge scores of
mothers and assessment of effectiveness of Planned Teaching Programme:
Graph 9: Column graph showing distribution
of Pretest and Post test knowledge scores of mothers
Pretest knowledge
scores of mothers: Based on the analysis of pretest knowledge scores it has
been found that 11(18.33%) had good knowledge, 39(65%) had average knowledge
and 10(16.66%) had poor knowledge. Post test knowledge scores of mothers: Based
on the analysis of post-test knowledge scores it has been found tha all the mothers 60(100%) had good knowledge score, and
none to be found average or poor knowledge.
3) Findings related to effectiveness of Planned Teaching Programme on knowledge regarding prevention of neonatal
hypothermia among post-natal mothers:
Graph 10: Column
graph showing Mean difference, Standard
error difference and paired ‘t’ value
The
mean post-test knowledge score (36.6) was higher than the mean pretest
knowledge score (17.9). The post test
knowledge score of mothers regarding prevention of neonatal hypothermia was
significantly higher at 0.05 level of significance and knowledge score of paired
‘t’ test calculated value (32.73) was
higher than paired ‘t’ test table value
(1.96) at 0.05 level of significance. i.e Highly
significant. Hence the planned teaching programme was
found to be effective in improving the knowledge of mothers regarding
prevention of neonatal hypothermia. The knowledge score of pre-test was found
to be mean 17.9 with standard deviation 3.98
and mean score was 44.79%.
The
overall knowledge score of post test was found to be mean score 36.6 , a mean
percent was 100% with standard deviation 1.48. From the result of the study it
was concluded that the Planned Teaching Programme was
effective.
4) Findings related to association between pretest knowledge scores
and socio-demographic variables of mothers.
The
association between pretest knowledge scores and socio-demographic variables
was computed by using chi-square (χ2). There was significant association between
age, religion, educational status of mother, occupation and parity of mother
and pretest knowledge scores of mothers. Hence H2 is accepted.
5) Findings
related to Assessment of Planned Teaching Programme
Table 1
n=60
|
Area of
analysis
|
Mean
|
Median
|
Mode
|
Standard
deviation
|
Range (H-L)
|
Paired ‘t’ value
|
|
Pretest
|
17.9
|
18
|
18
|
3.98
|
17
|
32.73*
|
|
Post test
|
36.6
|
37
|
38
|
1.48
|
6
|
|
Difference
|
18.7
|
19
|
20
|
2.5
|
11
|
*(P<0.05)
The Table 1
revealed that in the pretest mean was 17.9, standard deviation 3.98, whereas in
post test mean was 36.6 and standard deviation was 1.48.
Graph11: Cylindrical graph showing Mean,
Median, Mode and standard deviation
The mean post-test
knowledge score (36.6) was higher than the mean pretest knowledge score (17.9).
calculated paired ‘t’ value (t=32.73) is greater than tabulated ‘t’ value (t=1.96) at 0.05 level of
significance. i.e Highly significant. Hence the
planned teaching programme was found to be effective
in improving the knowledge of mothers regarding prevention of neonatal
hypothermia.
The knowledge
score of pre-test was found to be mean 17.9 with standard deviation 3.98 and mean score was 44.79%.
The overall
knowledge score of post test was found to be mean score 36.6, a mean percent
was 100% with standard deviation 1.48. From the result of the study it was
concluded that the Planned Teaching Programme was
effective.
CONCLUSION:
Based on the findings of the study the
following conclusions were drawn:
1) Over all pre-test knowledge
scores of mothers regarding prevention of neonatal hypothermia was low, which
suggested that there is need for planned teaching programme.
2) Post –test results shown that
there is significant improvement in the level of knowledge. It can be concluded
that Planned Teaching Programme was effective method
of teaching the mothers to improve their knowledge regarding prevention of
neonatal hypothermia.
NURSING
IMPLICATIONS:
The
findings of this study have implication for nursing practice, nursing
education, nursing administration and nursing research.
1. Implication in Nursing practice
The
mothers have a vital role in providing care to their child. Health promotion is
one of the role of a nurse has to play, hence its accountability has to be
stressed. Nurses should put their efforts to increase the knowledge. The
empowered mothers can influence the community at large and it is an essential
step towards better neonatal care and helps to reduce neonatal morbidity and
mortality.
2. Nursing education
The
nurse educators can conduct mini-workshops on prevention of neonatal
hypothermia to uplift the knowledge of people. The power point presentation
could be utilized by the midwifery teachers and students during their clinical
posting to provide health education to NICU and postnatal mothers.
3. Nursing administration
Nurse
administrators are the backbone of providing effective nursing care. They
should make provision for nurses for regular in-service education programme on different aspects of neonatal hypothermia and
its management can be introduced to update the knowledge and skills of
practicing midwives. The nurse administrators can provide booklets, pamphlets,
posters in every units of child health and maternity blocks and OPDs to create
awareness in mothers.
4. Nursing research
There
is a need for extended and intensive nursing research in the area of upgrading
knowledge and skills of mothers regarding prevention of neonatal hypothermia.
Nurses
play a key role in providing health care to patients, they can conduct projects
and research studies in the hospital. Researcher can use the methodology as a
reference material. It provides avenue for further studies in this area.
LIMITATIONS:
1) The study was confined to a small size of
sample selected by non- probability, purposive sampling do not give a
representative sample.
2) The study was delimited to mothers admitted
in postnatal ward of KLE’S Dr. Prabhakar Kore Charitable Hospital Belgaum, Karnataka.
3) Incidental teaching by the senior nurses,
doctors could not be controlled in between pre-test and post-test data
collection.
RECOMMENDATIONS:
1) A similar study can be undertaken with a
large sample to generalize the findings.
2) A comparative study can be conducted on
knowledge and confidence of post natal mothers to know the effectiveness of
planned teaching programme.
3) A self instructional module (SIM) can be
developed based on the learning needs of the mothers.
4) An observational study can be done on
knowledge, attitudes and practices of postnatal mothers regarding prevention of
neonatal hypothermia.
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