Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.
PROFROMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION

1 Name of the candidate and Mr.JOMON MATHEW,


Istyear M. Sc. Nursing Student,
Address
Shanti Dhama College of Nursing,
Sunkadakatte, Magadi Main Road,
Bangalore.

2 Name of the Institution Shanti Dhama College of Nursing,


Sunkadakatte,
Magadi Main Road, Bangalore.

3 Course of study and Subject I year M. Sc. Nursing


Child Health Nursing

4 Date of Admission 27/10/2011

5 Title of the Topic “A STUDY TO ASSESS THE


EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE(SIM) ON
KNOWLEDGE REGARDING KANGAROO
MOTHER CARE (KMC) AMONG III rd YEAR
B.Sc. NURSING STUDENTS IN
SELECTED COLLEGES, BANGALORE.”
6 Brief Resume of the intended work
INTRODUCTION
New born care techniques are advancing in day-to-day life. In spite

ofthose advancement in new-born care, a simple, low cost and effective method,

i.e, Kangaroo Mother Care has been evolved in last few decades. Kangaroo care

is a technique of direct skin - to - skin contact between mothers (or fathers) and

their premature infants. It has shown to improve the mother’s psychological

state, strengthen mother and infant bonding and stimulate maternal lactation.

          Dr. Nils Bergman, Medical Superintendent of Mowbray Maternity

Hospital in Cape Town, South Africa, has been researching KMC for twelve

years. He believes restoring the original model of the infant-mother early care

rather than our present incubator, bottle and feeding formula model can result in

happier and healthier babies.1

          Inferring from mammalian animal behaviour, believe that there is much

wrong with our present way of treating the new-born. On recent findings in

neuro-endocrinology. Bergman explains that it is the new-born infant itself

which begins and directs the attachment process that is aided by skin contact

with the mother. The mother responds to her infant’s “attachment program” and

mother and infant set up a mutually stimulating system to which both respond by

altering hormonal outputs. As an example, Bergman says that if the new-born is

placed on the mother’s chest, within one hour, the baby will pull itself to the

breast, find the nipple and begin nursing.

          A recent research conducted by Dr. Joy Lawn of ‘Save the Children’ 

which revealed the most effective intervention to reduce newborn and child

deaths globally.  The most fascinating finding arising from Dr Lawn’s study was

the suggestion that up to half of these deaths could be prevented if Kangaroo


Mother Care was readily available for preterm babies.2

6.1 Need for the study


Kangaroo mother care is a type of care for pre-term by their parents

that provides early skin-to skin contact between the baby and the parents.

Low birth weight is one of the major health problems throughout the world. All

such neonates can benefit from an effective and efficient human care model

–“Kangaroo Mother Care”. Kangaroo Mother Care is important because it

reduces pain and infections, shortens hospitalization, favorsbreast-feeding: in

comparison to neonates treated conventionally. This method results in an earlier

and better cognitive and motordevelopment3.

Worldwide more than 20 million babies are born each year with low

birth weight. This represents 15.5% all births. Of these low birth weight babies,

95.6% are born in developing countries. The World Health Organization defines

low birth weight baby at birth less than 2500grams. Of these babies,

approximately one third die before stabilization or first twelve hours. Low birth

weight and very low birth weight babies require intensive neonatal nursing and

care from often limited resources at a vast expense4.

As India is a developing country, where in many places the availability

of incubators and warmers are not seen. Hence Kangaroo mother care(KMC)

method of caring can be used as a substitute for conventional way of caring the

babies, which needs very less equipment and less costly way of caring with little

knowledge.

Newborn care has greatly benefited from major technical advances in the

last four decades, showing substantial improvements in the mortality and

morbidity of the high-risk neonate. In addition, there has been a heightened


awareness of the psychological and emotional burden encountered by the parents

of the premature neonate. From birth, primary care for the infant is transferred

from the mother to the professional caregivers of the neonatal unit5.

Today’s nursing students will be tomorrow’s full-fledged nurses

who will be practicing at bed side.The educational offerings highlighting the

knowledge and skills needed to provide kangaroo care safely and effectively

enable the student nurses to overcome barriers to the practice of kangaroo care.

In addition knowledgeable practitioners need for develop evidence based

procedures that will lead to successful kangaroo care which can minimize the

infant mortality rate to certain extant.

6.2 Review of Literature:


Review of literature is an essential step in the development of a
research project. It helps to develop an insight into the area of investigation and
directs the researcher to develop a plan.

The review of literature is presented under the following headings-


6.2.1 Literature related to Kangaroo mother Care (KMC).
6.2.2Literature related to Knowledge and attitudes of nursing staff& mothers
towards KMC
6.2.3 Literature related to effectiveness of self -instructional module

6.2.1 Literature related to KMC:


A descriptive study conducted on Kangaroo Mother Care(KMC)

for Low Birth Weight infants; a randomized controlled trail, in a teaching

institution with a tertiary level of neonatal intensive care unit(NICU) in Western

India over a period of 9 months, among 206 neonates with birth weight <2000g.

The subjects were randomized into two groups, the interventional group(KMC-

103) received Kangaroo mother care and the controlled group(CMC-103)


received conventional care. The results shown that, the KMC babies h better

average weight gain per day(KMC: 23.99g vs CMC: 15.58g, P< 0.0001) This

study shows Kangaroo mother care improves growth and reduces morbidities in

low birth weight infants. It is simple, acceptable to mothers and can be continued

at home6.

A descriptive study conducted on Effect of Kangaroo Mother Care

on physical growth, breastfeeding and its acceptability. The aim of this study was

to determine whether the implementation of Kangaroo Mother Care (KMC) to

low birth weight infants would improve physical growth, breastfeeding and its

acceptability. A randomized controlled trial was performed over 16 months in

which 110 neonates were randomized into a KMC group and a control group

using a random number table. Weight, length and occipito-frontal circumference

(OFC) were measured weekly for three months. The acceptability of KMC by

mothers and nursing staff was assessed on day 7 after the start of KMC using a

questionnaire incorporating the Likert scale. Breastfeeding rates were calculated

based on history at end of three months. The exclusive breast-feeding rate at end

of three months was 88% in the KMC group compared to 72% in the control

group (P < 0.05).The result shown that, KMC improved physical growth,

breastfeeding rates and was well accepted by both mothers and nursing staff7.

A descriptive study conducted on Kangaroo Mother Care. The

review examined 15 studies in eight low- and middle-income countries,

including three randomized controlled trials, and found a 51 percent reduction in

newborn mortality when stabilized babies weighing less than four pounds (2,000

gm) received warmth and breast milk through continuous skin-to-skin contact on

the chest of their mothers. The findings suggest that up to half a million newborn
deaths due to preterm birth complications could be prevented each year if

Kangaroo Mother Care were available for all preterm babies, particularly in low-

income countries, where newborn mortality rates are highest. The results show

that, 'Kangaroo Mother Care' Reduces Newborn Deaths More than 50 percent8.

A descriptive study conducted on Kangaroo-Mother Care:

scientific evidence and impact on breastfeeding. The analysis of randomized

trials showed that Kangaroo mother care consists in a protection factor to

breastfeeding at discharge (relative risk 0.41, 95% confidence interval 0.25 to

0.68). The method was always associated with the following reduced risks:

nosocomial infection at 41 weeks' corrected gestational age (relative risk 0.49,

95% confidence interval 0.25 to 0.93), severe illness (relative risk 0.30, 95%

confidence interval 0.14 to 0.67), lower respiratory tract disease at 6 months

(relative risk 0.37, 95% confidence interval 0.15 to 0.89) and better gain of

weight per day (weighted mean difference 3.6 g/day, 95% confidence interval

0.8 to 6.4). Psychomotor development at 12 months' corrected age was similar in

the two groups. The study concludes the Kangaroo mother care appears to reduce

severe infant morbidity without any serious deleterious effect reported9.

A descriptive study conducted on Kangaroo mother care and the

bonding hypothesis. The randomized controlled trial was conducted on a set of

488 infants weighing <2001 g, with 246 in the KMC group and 242 in the

traditional care (TC) group. Two series of outcomes are assessed as

manifestations of a mother's attachment behavior. The first is the mother's

feelings and perceptions of her premature birth experience, including her sense

of competence, feelings of worry and stress, and perception of social support.

The second outcome is derived from observations of the mother and child's
responsiveness to each other during breastfeeding at 41 weeks of gestational age.

The studyshow that, a change in the mothers' perception of her child, attributable

to the skin-to-skin contact in the kangaroo-carrying position. These results

suggest that KMC should be promoted actively and that mothers should be

encouraged to use it as soon as possible during the intensive care period up to the

40 weeks of gestational age. Thus, KMC should be viewed as a means of

humanizing the process of early new-born care10.

A descriptive study conducted on Cerebral oxygenation responses

during kangaroo care in low birth weight infants. The objective of this study was

to evaluate the response of cerebral hemodynamics during Kangaroo care(KC)

in low birth weight infants. Near infrared spectroscopy measured regional

cerebral oxygenation (rSO2), heart rate (HR), respiration rate (RR) measured by

electrocardiogram, and percentages of oxygen saturation (SpO2) measured by

pulse oxymetry was monitored in 16 preterm infants (< 1600 g) in three sessions:

before, during, and after KC. The study reports that, KC intervention appears to

have influence on cerebral hemodynamics as well as cardiorespiratory

parameters. The study concludes of rSO2 and HR might be associated with quiet

sleep states. The results of this study may indicate the contribution of KC

intervention to the activation of central nervous system and brain function11.

A descriptive study conducted on Use of “Kangaroo Care” to

Alleviate the Intensity of Vaccination Painin Newborns. This study was a

randomized case-control clinical trial. Subjects were 60 healthy full term

newborns delivered in a general Hospital, in Iran, from March to July 2006. They

were randomly assigned to case and control groups. The case group received 30

minutes skin to skin contact, whereas infants in the control group were put,
wrapped in a blanket, aside the mothers. Behavioral changes of newborns were

evaluated and observed 2 minutes before, during, and 3 minutes after the

intervention. All procedures were filmed. The finding show, Mean pain intensity

during the intervention v was significantly lower in the case group(P<0.006).

Mean pain intensity 3 minutes after intervention was also significantly lower in

the case group (P<0.021). Mean duration of crying was significantly lower in

case group as well (P<0.001).The study concludes that, Kangaroo care may be

used to decrease pain intensity in newborns undergoing painful procedures.

According to the results of this study KMC decreased pain severity in neonates

of the case group during the intervention and 3 minutes afterwards12.

6.2.2 Literature related to Knowledge and attitudes of nursing staff and

mothers towards KMC

A descriptive study conducted on Knowledge and attitudes of

nursing staff and mothers towards kangaroo mother care in the eastern sub-

district of Cape Town, R.S.A. A multi-stage sample of 30 kangaroo care mothers

admitted to the Helderberg District Hospital (HDH); six nurses from the HDH;

and nine nurses from the seven antenatal clinics that the mothers attended. The

respondents were interviewed using a pretested questionnaire. The result shown

that, Most of the mothers lacked prior knowledge of KMC, and were only

informed about it when they were admitted to the KMC ward. All of the nursing

staff who were engaged in KMC (n = 15) had a positive attitude towards

Kangaroo mother care13.

6.2.3 Literature related toSelf -Instructional Module

Valsa (2010) conducted a study to evaluate the effectiveness of


a Self Instructional Module for staff nurses prepared on phototherapy for

neonatal jaundice. The sample consisted of 50 Staff nurses from various

hospitals in Mangalore. One group pre-test post-test design was used. The mean

post-test knowledge scores were higher than pre test scores indicating the

effectiveness of self -instructional module14.

Gracemol GS (2009) conducted a study on effectiveness of

SIM on pregnancy related highrisk conduction among antenatal mothers in

selected maternity hospital in Mangalore. The sample comprised of 50 antenatal

mothers selected by using purposive sampling technique. One group pre-test

post-test design was adopted. The findings revealed that the SIM was very

effective (p<0.05). The mean post test score (56%) was higher than the mean

pre-test score (87%)15.

6.3.Statement of Problem;
A STUDY TO ASSESS THE EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE(SIM) ON KNOWLEDGE REGARDING
KANGAROO MOTHER CARE(KMC) AMONG IIIrd YEAR B.Sc. NURSING
STUDENTS IN SELECTED COLLEGES, BANGALORE.

6.4 Objectives of the Study:


1. To Assess the existing knowledge ofB.Sc. nursing IIIrd year students regarding

Kangaroo Mother Care(KMC) in terms of pre-test knowledge score.

2. To assess the effectiveness of SIM on B.Sc. nursing IIIrd year students

regarding Kangaroo Mother Care(KMC) in terms of post-test knowledge scores.

3. To find out the association between knowledgeof B.Sc. nursing III year

studentswith selected demographic variables.

6.5 Variables
Independent Variables: Self -Instructional Module.
Dependent Variable :Knowledge of B.Sc. nursing III year students

6.6 .Operational Definitions


Assessment:It refers to measurement of knowledge of III year B.Sc. nursing

students.

Effectiveness: It means producing the intended result, In the present study it

refers to knowledge gained by B.Sc. nursing III year students through SIM.

Self-Instructional Module: Self prepared, systematically developed booklet for

teaching program regarding Kangaroo mother care.

Knowledge: Refers to the level of understanding of B.Sc. nursing III year

studentsregarding Kangaroo Mother Care(KMC) by their correct responses to

knowledge items of questionnaire

Kangaroo Mother Care: Kangaroo mother Care is a type of care for preterm

infants by their parents that provide early skin-to-skin contact between the baby

the parents, which promotes exclusive breastfeeding and ensures physiological

and psychological warmth and bonding.

B.Sc. NursingIII year students: The students who have opted to study the

graduate program in nursing which will be of 4year duration.

B.Sc. nursing III year students studying in nursing in selected college of

nursing, Bangalore will be selected.

6.7. Assumptions:The study assumes that ,


1. The B.Sc. nursing III year students participating in the study will have

some knowledge regarding Kangaroo Mother Care.

2. Self-Instructional Module prepared by the investigator will be appropriate

to improve knowledge of B.Sc. nursing IIIrd students on Kangaroo Mother Care.


6.8. Hypothesis;
H1 :- There will be significant association between knowledge of B.Sc. nursing

III year students on Kangaroo Mother Care with selected variables.

H2:- There will be significant difference between pre-test and post-test

knowledge scores.
7. MATERIALS & METHODS:
7.1:SOURCE OF DATA: Data will be collected by using structured

questionnaire to B.Sc. nursing III year students in selected college of

nursing, Bangalore.

7.2:Method of Collection of data: Structured Knowledge Questionnaire

7.2. 1. Research Design :Pre experimental study design will be

selected

7.2. 2.Research Approach :Evaluative approach.


7.2.3.Research Setting :The study will be conducted in selected

Nursing Colleges, Bangalore.

7.2. 4.Population :The students ofB.Sc Nursing IIIrd year.

7.2. 5. Sample size : 50 B.Sc.NursingIIIrd year students from

SelectedNursingColleges, Bangalore.

7.2. 6.Sampling Technique;


Purposive sampling technique will be adopted for the study.

7.2.7 Sampling Criteria:


Inclusion Criteria:-
1. Students who are willing to participate in the study.

2. Students who are available at the time of data collection.

Exclusion criteria:-
1. Students who are appeared seminar regarding KMC
7.2.8.Data collection Tools ;
A structured knowledge questionnaire will be used to assess the

knowledge of students regarding K.M.C.

The tools consists of two sections:

Section – A

Section – B

Section – A:-
Consists of demographic variables such as age, sex, religion, family income,

educational qualification etc.

Section – B:-
Knowledge questionnaire on Kangaroo Mother Care.

7.2.9 Collection of Data


The data is collected by using structured knowledge questionnaire. An

informed written consent will be obtained from the subject, after explaining

the purpose of the study.

7.2.10.Data Analysis Method:


Data will be Analyzed by applying Descriptive and Inferential Statistics.

Descriptive-Mean Standard Deviation and Mean Percentage will be used to

describe the variables.

Inferential Statistics- Chi-squaretest will be used to find out the association

between the dependent and independent variable. Analyzed data will be

presented in the form of tables and graphs.

7.3.Doesthe study require any investigation or interventions to be


conducted on patients or other humans or animals? If so please
describe briefly.
YES
7. 4 Has Ethical clearance has been obtained from your institute.
Permission to conduct the present study will be obtained from;

1 :- Ethical Committee, selected College of Nursing, Bangalore.

2 :- The Principal, selected College of Nursing, Bangalore.


8 LIST OF REFERENCE
1. Dr.Nils Bergman. Kangaroo Mother Care: Restoring the Original

Paradigm for Infant Care and Breastfeeding. Spring 2005 IPA

Newsletter. Available from URL:

http://www.primals.org/articles/torngren06.html

2. Dr Joy Lawn. Save the Children.International Journal of Epidemiology,

2010 [cited on 2010 Mar 28]. Available from URL:

http://blog.babesinarms.com.au/2010/04/

3. Bulfone G, Elisa N,Tenore A. Kangaroo mother care and conventional

care.ProfessioniInfermieristiche , 2002; 64(2):75-82. Available from

URL: http://www.mendeley.com/research-papers/

4. Blackwell K,Cattaneo A. What is the evidence for kangaroo mother care

of the very low birth weight baby? International child health review

collaboration [Online] 2007 [cited 2007 May 13]; Available from

URL:www.ichrc.org

5. Curran RL, Genesoni L,CeballosHA, Tallandini MA. A kangaroo

mother care research study: a work in progress. Infant 2008; 4(5): 163-

65. Available from: URL: http://www.neonatal-

nursing.co.uk/pdf/inf_023_mer.pdf

6. RaoSPN, Rekha U,Nanavathi R. Kangaroo mother care for LBW

infants: a randomized controlled trail. Indian Pediatrics 2008 Jan 17;

45: 17-23. Available from URL:

http://www.indianpediatrics.net/jan2008/jan-17-23.htm
7. Gathwala G, Singh B, Singh J. Effect of kangaroo mother care on

physical growth, breast feeding and its acceptability.Epub[Online] 2010

[cited 2010 Jul 28] Available from URL:

http://td.rsmjournals.com/content/40/4/199.abstract

8. Westport, Conn. New research shows kangaroo mother care reduces

newborn deaths more than 50 percent [Online] 2010 [cited 2010 Mar

30] Available from:

http://www.prweb.com/releases/Kangaroo_Mother_Care/Save_the_Chil

dren/prweb3803284.htm

9. Pediatr J. Kangaroo-mother care: scientific evidence and impact on

breastfeeding . PubMed [serial online] 2004 Nov ;80(5) : 173-

180.Available from: URL:

http://www.ncbi.nlm.nih.gov/pubmed/15583768

10. Tessier R, Cristo M, Velez S, Giron M, de Calume ZF, Ruiz JG et al.

Kangaroo mother care and bonding hypothesis. Pediatrics 1998

Aug;102(2): e17. Available from:

URL:http://pediatrics.aappublications.org/content/102/2/e17

11. Begum EA, Bonno M,Ohtani N, Yamashita S,Tanaka S, Yamamoto H

et al.Cerebral oxygenation responses during kangaroo care in low birth

weight infants. BMC Pediatr 2008[cited 2008Nov 7]; 8: 51. Available

from: URL:http://www.biomedcentral.com/1471-2431/8/51

12. Saeidi R, Asnaashari Z, Amirnejad M, Esmaeili H,Robatsangi MR. Use

of “Kangaroo Care” to alleviate the intensity of vaccination pain in

newborns. Iran J Pediatr 2011 Mar; 21 (1): 99-102. Available from:

URL: http://www.bioline.org.br/pdf?pe11017
13. Solomon N, Rosant C. Knowledge and attitudes of nursing staff and

mothers towards kangaroo mother care in the eastern sub-district of

Cape Town. S Afr J ClinNutr 2012;25(1) :33-39. Available from: URL:

http://www.ajol.info/index.php/sajcn/article/viewFile/75033/65617
9 Signature of the Candidate

10 Remarks of the Guide

11 Name & Designation of


(In Block Letters)

11.1 Guide

11.2 Signature

11.3 Co-Guide (If any)

11.4 Signature

11.5 Head of the Department

11.6 Signature

12 12.1 Remarks of the Chairman


and the

Principal

12.2 Signature

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