INTRODUCTION:

The newborns arrival is one of the most fabulous moments of life for the parents and family. Principally the mother is the primary person to take responsibility to care for the precious gift the newborn in order to reduce the mortality and morbidity^.1

The high risk newborn babies face the highest risk of dying in their first month of life at an average global rate of 18 deaths per 1000 live births in 2017. The global issue of Neonatal Mortality Rate is approximately more than 3.3 million in the world. According to WHO, only five countries account for more than half of newborn deaths viz., India, Nigeria, Pakistan, China and Democratic Republic of Congo. The 98% of neonatal mortalities occur in developing regions, 28% in the least developed countries. In India, out of 26 million babies born, around 0.75 million newborns died every year; its highest for any country in the world. Among this 56 % occur mainly in Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Andhra Pradesh and Telangana.²

The transition of care from intensive care specialists ambulatory care providers begins at hospital discharge and is incomplete until the care of the infants is assumed by the primary care pediatricians. During the days or weeks between discharge and the initial outpatients visit, error may occur related to breakdowns in care coordination and communication.³

According to WHO reported that preterm with low birth weight (35%), birth asphyxia (20%), sepsis (15%), pneumonia (6%), congenital malformations (9%), and other causes includes diarrhea (5%) are major contributors to morbidity and mortality in survivors of newborns. So, the WHO stressed that the basic care like warmth, EBM, and prevention of infections are necessary to prevent neonatal mortality and morbidity. ⁶

Before discharge of newborns, instructions are given by nurses regarding bathing, feeding, and prevention of infections; but no video teaching cum demonstration is scheduled to impart knowledge to the mothers. So the investigator felt the need to conduct the study on knowledge and practice among the mothers on high risk newborn care by a video teaching method. This study aids to improve the knowledge, increase awareness, develops self-confidence of mothers and promotes to increase the health and survival of the newborns. This study also aims to achieve the India newborn Action plan target of single digit NMR by 2030.⁷

Video assisted teaching about the care of high risk babies may contribute to greater care, knowledge and maternal confidence. Hence the investigator personally felt that there is a need for the above study and statistics was inspired in the selection of the study. Thus it is essential to give a video assisted teaching program to mothers regarding high risk newborn care. So to improve the overall quality of life and to reduce the infant mortality rate video assisted teaching makes the mother conscious about the wellbeing of herself and her family.

Careful preparation for discharge and good follow-up after discharge may reduce these risks. It takes time for the family of a high-risk infant to prepare to care for their newborn in a home setting and to obtain the necessary support services and mobilize community resources. The survival of babies lies in the hands of the mother and caregivers, thus it’s important that mothers and caregivers know what type of care the newborn needs and that determines chances of survival, healthy growth and development for their newborn.

METHODOLOGY:

DESIGN:

Research design selected for the present study was post-test only control group design.

SAMPLE:

In this study, total sample size is 40 samples, Whereas 20 sample in experimental group and 20 sample in control group from a selected NICU of a tertiary care hospital, Bangalore.

SETTING:

The study was conducted in neonatal intensive care unit of SJMCH Bangalore which is a multispecialty hospital with 1357 beds. The NICU has bed strength of 30 beds and 8 ventilators. According to 2016 census of NICU – total admission-1174, The NICU of hospital receives an average of 70-78 babies per month and Neonatal follow-up clinic receives 90-100 babies per month for follow up at St. John's medical college hospital, Bangalore.

POPULATION:

In this study the population referred all the mothers whose babies got admitted to NICU of SJMCH and babies are ready for discharge.

DEVELOPMENT OF THE INSTRUMENT:

The tool was developed through an extensive review of literature on related studies, books, journal articles, internet search, opinion of the experts, discussion with guides and health care professionals.

DESCRIPTION OF THE TOOL:

Based on the objectives of the following instruments were developed to generate the data:

SECTION A: An interview schedule to collect the baseline variables

SECTION B: A structured questionnaire to assess the knowledge of mothers regarding post discharge care of high risk babies which consists of 20 questions. Each correct answer was given a score of one and wrong answer zero. Total score was 20. Interpretation is categorized into 3 levels: Poor knowledge =0-6, Average knowledge = 7-13, Good knowledge = 14-20.

SECTION C: A reported checklist to assess the reported practice of the mothers regarding post discharge care of high risk babies. The samples were asked to tick the option which they used to carry routinely. Total score was 10. The interpretation is categorized into 3 levels: Lack of practice=0-3, Average practice=4-7, Good practice= 8-10.

SECTION D: A video assisted teaching regarding post discharge care of high risk babies which will contain information on: Breast feeding, Kangaroo mother care, Body temperature

Development stimulation, Danger signs, Immunization, Hand hygiene and follow-up care.

METHOD:

The data was collected from 24/10/2017 to 27/11/2017. The formal permission was obtained from the authorities of a selected hospital, Bangalore. The samples were selected based on inclusion criteria. The purpose of the study was explained to the mothers. Informed consent was taken from both group, who were included in the study. Simple random computerized table sampling technique was used to recruit samples from NICU and KMC ward. Total of forty samples were selected based on inclusion and exclusion criteria. Whereas 20 samples in each group, For the control group the subjects were randomly selected from the NICU, KMC ward based on the inclusion and exclusion criteria, standard routines care was given, informed consent taken and baseline variables were collected using interview schedule. Knowledge and reported practices was assessed using structured knowledge questionnaire and reported practice with checklist. For the experimental group the subjects were selected and informed consent was taken from the mothers whose baby has got admitted in the NICU, KMC ward of SJMCH. On the day of discharge video assisted teaching was administered to the mothers and after 7days when they came for follow-up care assessed their knowledge and reported practice using structured knowledge questionnaire and practice checklist. On an average 1-3 samples participated daily. It took around 15-20 minutes to collect the data from one subject.

Section I: Description of Selected Baseline Variables of Mothers and High Risk Babies

Table 1a: frequency, percentage distribution according to the baseline variables of mothers N=40

S. no

Baseline Variables

Experimental group n=20

Control group n= 20

Chi-square

‘p’

Value

Mean

mean

Age

· 20 – 29

· 30 – 39

· 40 – 49

27.65

5.163

28.3

4.414

0.42

0.671NS

Occupation

· Professionals

· Homemakers

20%

80%

95%

0.342

Parity

1. Primi

2. Multi

55%

45%

85%

15%

4.286

0.038 S

Medical problem

1. No

2. Yes

75%

25%

70%

30%

0.125

0.725 NS

High Risk pregnancy

1. No

2. Yes

55%

45%

70%

30%

0.960

0.327 NS

Additional information

1. No

2. Yes

40%

60%

45%

55%

0.102

0.749

S= significant, NS= Non significant

Table 2: Frequency and percentage distribution according to birth weight, gestational age, gender, duration of illness and Diagnosis of babies. N=40

S. no

Baseline

Variables

Experimental group n=20

Control group n= 20

Chi-square

‘p’

Value

Mean

11.

Birth weight

2000-2500gm

1000-1999gm

<1000gm

2.00

0.77

1.97

087

0.109

0.914NS

12.

Gestational age

Preterm <37Wks

Full term 37- 40Wks

Post term >40Wks

50%

60%

40%

186.5

0.718NS

13.

Gender

Male

Female

55%

45%

55%

0.400

0.527NS

14.

Duration of illness

<=10 days

>10 days

35%

65%

20%

80%

1.129

0.288NS

15.

Diagnosis

LBW

ELBW

Preterm

RDS

Hyperbilirubunia

Hyponatremia

Hypoglycemia

Seizure

25%

15%

10%

15%

10%

20%

40%

10%

15%

NS=Non significant

Table 3: mean, range, SD and test of significance of knowledge some of mothers regarding post discharge care of high risk babies N=40

Group

Max score

Range

Mean

Mean %

Independent 'T' test

'p' value

Experimental group

Control group

11-18

5-15

15.95

11.00

80%

55%

1.85

2.79

-6.612

0.001

S= significant

The above figure 2(b) reveals that knowledge level of the mothers in relation to follow up care in experimental group and control group i.e. 70% in experimental group and 69.9% in control group. Control group had lesser score in relation to body temperature (27.5%).

Section 3: comparison of reported practice score of experimental group and control group.

Objectives: To compare the reported practice among mothers regarding the post discharge care of high risk babies between the study and control group.

The data from table-4 reveals that: The mean reported practice score in the control group is 6.15± 0.933 and in the experimental group is 8.35 ± 0.933. It was found to be statically significant at the level of <0.05. Hence H2 is accepted, there is a significant difference in the reported practice score in both group.

Figure 3(a): Level of reported practice in experimental group and control group.

The above figure reveals that 95% mothers had average practice in control group and 15% in average group. 85% of mothers had good practice in experimental group whereas 5% in control group.

Figure 3(b): Reported practice score in specific content areas

Area wise reported practice

Figure 3(b): Practice scores in specific content areas in experimental and control groups. The data above the figure represents the reported practice scores in both group was 95% in related to breast feeding and 80% in relation to kangaroo mother care in experimental group whereas 57% in control group, 97.50% practice in hand hygiene and 67.50% in body temperature, 84.90% in follow-up care whereas in control group it showed 82% in hand hygiene, 45% in body temperature and 49.90% in follow-up care.

Figure 3(c): Over all Knowledge and practice scores of experimental and control groups

Section 4: Correlation between Knowledge and Reported Practice

Objective: To determine the correlation between knowledge and reported practice regarding post discharge care of high risk babies in study and control group.

Table 5: Correlation between knowledge and reported practice

Variable

Mean

'r' value

'p' value

Experimental group

· Knowledge

· Practice

Control group

· Knowledge

· Practice

15.95

8.35

11.00

6.15

1.85

0.93

2.79

0.93

0.407

0.162

0.075

0.496

NS=Non significant

The data in table 5 depicts that there is no statically significant correlation between knowledge and reported practice scores, a negative correlation is observed in both experimental group and control group.

Section 5: association of knowledge with baseline variable of experimental group and control group.

Objective:

To determine the association of knowledge among mothers regarding post discharge care of high risk babies with baseline variable

Table 6: Mean, SD and test of significance for association of knowledge with age, parity and education N=40

S. no

Baseline

Variables

Experimental group n=20

Control groupn= 20

Mean

Test significant

'p' value

Mean

Test significant

'p' value

Age

· 20 – 29

· 30 – 39

· 40 – 49

28.3

4.414

0.253

0.635NS

27.65

0.365

0.113NS

Parity

· Primi

· Multi

15.76

1.954

11.36

10.56

3.107

2.45

0.635

0.534NS

Additional information

Ø Yes

Ø No

16.08

15.75

2.065

1.581

0.386

0.704NS

10.27

11.89

3.228

1.965

-1.313

0.206NS

Medical problem

Ø Yes

Ø No

16.67

15.64

1.033

2.061

1.144

0.268NS

11.60

10.80

1.817

3.075

0.545

0.593NS

High-risk pregnancy

Ø Yes

Ø No

15.83

16.00

1.169

2.112

-0.80

0.859NS

12.11

2.147

3.015

1.687

0.109NS

Gender

Ø Male

Ø Female

16.11

15.82

1.453

2.183

0.344

0.735NS

11.45

10.44

2.84

2.78

0.797

0.436NS

Duration of illness

>10 days

<=10days

16.0

1.932

0.135

0.570NS

10.85

11.29

2.85

2.87

0.365

0.328

0..114NS

NS=Non-significant.

Table 7: Mean SD and test of significance for association of practice with age, parity and year of education. N=40

S. no

Baseline

Variables

Experimental group n= 20

Control group n=20

Mean

Test of significant

'p' value

Mean

Test of significant

'p' value

Age

· 20 – 29

· 30 – 39

· 40 – 49

28.3

4.414

0.638

0.002S

27.65

5.16

0.536

0.015S

Parity

Ø Primi

Ø Multi

8.24

0.903

6.22

0.66

-0.305

0.76NS

S=Significant, NS=Non significant

Table 6 depicts that: There is no significant association between knowledge with additional information, medical problem and high risk pregnancy. There is no statically significant association between knowledge with support system, gender and duration of illness in both the groups of mothers at 0.05 level of significant.

Section 6: association of reported practice with baseline variable of experimental and control group.

Objective:

To determine the association of reported practice with selected baseline variable at the 0.05 level of significant.

Table 7: Depicts that there is a significant association between reported practice with age i.e. (0.002) in experimental group and 0.015 in control group and education in control group (0.008). There is a significance association between reported practices with education in control groups (0.003). Thus hypothesis 5 is accepted.

DISCUSSION:

The subjects in the present study constituted of 40 mothers, 20 in each experimental and control group. In the experimental group the mean age was 28.3±4.414 and in the control group was 27±5.163, the study finding showed that majority of them in both experimental group and control group were primi, i.e. in experimental group 85% and in control group 55% were primi-mothers. This shows a similarity with the study conducted in Manipal, India to assess the knowledge and practice of postnatal mothers on newborn care. The study revealed that out of most of the mothers 80% were in age group of 21-30 years, most of them were (53.3%) primi-para.¹²

In the present study most of mothers in both experimental group and control group had lesser percentage in medical problems and previous high risk pregnancy.80% in control group had support system and 55% in experimental group had support system. The finding of present study revealed that majority of babies in both groups had longer duration of illness i.e. 65% in control group and 80% in experimental group, and 25% of babies had a diagnosis with low birth weight in the control group and 40% of babies had preterm in experimental group.

A similar study was conducted in Vellore to check effectiveness of video assisted teaching on knowledge regarding essential newborn care among primi mothers. The finding revealed that in pre-test 80% had inadequate knowledge and 12% had moderate knowledge whereas in post-test 87% had adequate knowledge and 13% had moderate knowledge whereas none of them had inadequate knowledge. Whereas in present study control group were provided routine care thus their knowledge level was not found to be less as compared with others studies.

RECOMMENDATIONS:

On the basis of the finding of the study, the following recommendations put forward for further research: A similar study can be replicated on a large sample to generalize the findings.

· A study can be conducted by including additional demographic variables.

· A comparative study can be conducted on the use of information leaflet and video based information on common post discharge care of newborn.

· A similar study can be conducted to find out the effectiveness of PTP on post discharge of high risk babies among mothers in other hospitals.

CONFLICT OF INTEREST:

The authors declare that they have no conflict of interest.

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Received on 13.01.2020 Modified on 05.02.2020

Asian J. Nursing Education and Research. 2020; 10(2):210-216.

DOI: 10.5958/2349-2996.2020.00045.2