https://doi.org/10.33698/NRF0315-Kiran Batra, Mamta
Abstract: Kangaroo mother care (KMC) is the care given to new born immediately after the birth in which skin to skin contact is provided to improve the growth of low birth weight babies (LBW) along with other benefits. This study was conducted in two hospitals of Mohali, Punjab to assess the effectiveness of structured teaching protocol (STP) on knowledge related to Kangaroo mother care (KMC) among staff nurses. 40 nurses from both the hospitals were enrolled in the study through convenient purposive sampling. Data was collected using self structured questionnaire on knowledge regarding KMC. A pretest was carried out to assess the pre-interventional knowledge. Followed this STP on KMC was introduced among subjects. After 10 days of STP introduction again post test knowledge was assessed. Data analysis was carried out there after. Results showed that about 3/4th of the total sample were within age group 20-30 years. Majority (95%) of them were female nurses, 18% of the staff nurses had attended seminar on KMC in the past. The results showed the significant increase in the post test knowledge score of the nurses. All the nurses had achieved excellent level of knowledge after implementation of STP on KMC. The structured teaching protocol was found to be quite effective in increasing the knowledge of the staff nurses regarding KMC. Hence more and more awareness and training programmes should be conducted so that this method can be implemented throughout the country and a healthy, happy generation can be developed.
Keywords:Knowledge, Structured teaching protocol (STP), Kangaroo mother care (KMC)
Correspondence at :Mrs Mamta Nursing Tutor M.Sc Nursing (Community Health Nursing) College of Nursing,All India Institute of Medical Sciences, Jodhpur, Rajasthan
Introduction:Nature’s most precious gift to a woman is her baby and every woman look forward to have a healthy normal baby. Low birth weight in infants is a global and alarming problem and it is the most significant factor contributing to neonatal morbidity and mortality. WHO estimates that each year about 20 million infants of low birth weight (LBW) are born world wide of which 95% of them are in developing countries. In India alone the incidence of LBW newborns is 32.8%. Still large numbers of deliveries are being conducted by untrained people especially in rural areas and urban slums. Therefore, the care of such infants becomes a burden for health and society everywhere.1-3 The LBW babies are cared using incubators, radiant warmer and KMC etc. The recent concept of Kangaroo Mother Care (KMC) or the skin to skin care is an economical, acceptable and practical way for maintaining temperature of the LBW neonates. It has the added advantage of providing adequate nutrition through frequent breast feeds. KMC improves growth and reduces morbidities in LBW infants. It is simple, acceptable to mothers and can be continued at home also. 4 Studies have shown that KMC has many advantages over the conventional incubator care and it improves the health of the new born. KMC is a scientifically sound, effective and efficient alternative to neonatal care unit in many settings. It satisfies all five senses of the baby such as touch (skin to skin contact), Hearing (listens to mother’s voice and heart beat), Taste (sucks on breast), Vision (eye contact with mother), and Olfactory (smells mother’s odour). It is the method of holding an infant with skin to skin contact, prone and upright on the chest of the parents. It fosters their health and well being of baby by promoting effective thermal control, breast feeding, infection control and bonding.1,5-9 Nurses play an important role in neonatal care at health care facilities from being skilled attendants at birth. Nurse’s contribution to new born care at district and sub district facilities is even more critical because of shortage of physicians. They are interface with community and the family in regard to the promotion of healthy new born care practices. On the whole Nurses form the backbone of new born care. As India is a developing country and Kangaroo mother Care is an important practice to reduce neonatal mortality and morbidity, staff nurses being the fore-runner of care providers play a vital role in the practice and implementation of Kangaroo Care. This made the investigator to conduct a study to assess the effectiveness of STP on knowledge of staff nurses in the use of Kangaroo mother care.
Objective:To evaluate the effectiveness of structured teaching protocol regarding KMC among the staff nurses.
Materials and Methods:A pre experimental research design was adopted to conduct the study among staff nurses of two selected hospitals of Mohali, Punjab. Total of 40 nurses from these two hospitals were enrolled through convenient purposive sampling technique. A written permission to conduct the study was taken from the Nursing superintendent of both the hospitals.Data was collected by questionnaire. The content validity of tool was established by taking opinion from nursing experts. Further the tool was pilot tested on 4 nurses of one of the selected hospital to check its feasibility and reliability. Reliability of the tool was checked through spearmen’s brown prophecy formula (0.91). This tool consisted of 2 parts:A part: Socio demographic section which collected information related to age,gender, education, working area, working experience, monthly income etc. B part: Knowledge questionnaire comprising 30 questions regarding KMC. Total score was 30 Score 0-10 falls within poor category, 11- 20 within good category and 21-30 within excellent category. A structured teaching protocol on KMC was prepared and validated by experts in the field of nursing. It consisted of introduction, definition, types, procedure, advantages and equipments required for KMC. This protocol was developed after doing extensive literature review and by taking opinion of experts.During data collection, on first day pretest was conducted on the sample. Knowledge questionnaire was administered to each subject. On an average 30 minutes were given to fill the questionnaire on KMC. On second day of pretest structured teaching protocol was administered to all the 40 nurses through lecture cum discussion with use of Charts, pamphlets, posters. The topics covered under teaching protocol included introduction, definition, types, procedure, advantages and equipments required for KMC. The total time taken for delivering structured teaching protocol on KMC was 30 minutes. After 10 days of introduction of STP among staff nurses again Knowledge questionnaire on KMC was administered to them to assess the post test knowledge. The data collected was coded and entered in to master sheet. Descriptive (Frequency, %, mean, S.D.) and inferential statistics (t test) were used for data analysis.
Results:Socio demographic details:
Majority:(75%) of the nurses were within age group of 20-30 years. Most (95%) of them were females. As per the educational qualification is concerned majority (87.5%) of them had done GNM. All of them had worked in MCH units and only 30% of them had >2 years of experience of working in MCH units. Income wise nearly 80% of them had their income in between Rs 5000-10000/- per month whereas only 17.5% had their monthly income more than Rs. 20000/-. Only 7 of the total sample had attended any seminar on KMC in the past.
Knowledge on KMC : As per theknowledge on KMC is concerned comparison of pre test and post test knowledge score showed the increase in knowledge of staff nurses. In pre test about 67.5 % of staff nurses had good knowledge regarding KMC where as in the post test all the nurses acquired excellent level of knowledge (Table 1).
Table 1: Frequency distribution of staff nurses as per levels of pretest and posttest knowledge score
(N=40)
| Level of knowledge scores | Pretest n (%) | Posttest n (%) |
| Poor (0-10) | 13 (32.5) | 0 (0.0) |
| Good (11-20) | 27 (67.5) | 0 (0.0) |
| Excellent (21-30) | 0 (0.0) | 40 (100.0) |
The overall mean knowledge score in a pre test was 20.52 whereas it had been increased to 29.54 in the post test . The statistical paired’t’ test indicated that enhancement in the mean knowledge scores is highly significant (t value=4.77, p level=0.005). (Table 2)
Table 2: Comparison of mean, mean % and t value of pretest and posttest knowledge
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scores of staff nurses on KMC N=40
*** significant at 0.005 p level
Item wise % difference in terms of knowledge on KMC: Item wise % difference of correct response on KMC in terms of knowledge showed that most of the nurses had given right answer for all the items in thempost test. Maximum knowledge gain has been seen for statements related to equipment required during KMC, placement of binder and hypothermia in low birth weight babies as revealed by % difference of 92.5%. (Table 3)
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Table 3: Item wise % difference in terms of knowledge on KMC N=40
However even after the implementation of STP on KMC, knowledge was still lacking on some of the aspects such as Temperature maintenance during KMC, Danger signs & Transportation of stabilized babies as all subjects could not answer correctly in the post test. (Table 3)
Discussion :Kangaroo Mother Care (KMC) or the skin to skin care is an economical, acceptable and practical way for maintaining the growth and development of neonates especially the LBW babies. Nurses are the prime care givers who work in different settings such as hospitals, intensive care units, community areas. They should have the sufficient knowledge and skills to provide KMC in different areas to the needy. With this view the present study was carried out to evaluate the effectiveness of structured teaching protocol on KMC among staff nurses.The findings of the present study revealed that the most of the nurses were young females and had >5 years of experience as a professional nurse. All of them had earlier worked in MCH units. The results of current study highlighted the effectiveness of structured teaching protocol. It helped professional nurses to increase their knowledge on Kangaroo mother care. The overall mean knowledge score in a pre-test was 39.1% whereas it had been increased to 94.5% in the post test. These findings are supported by a study conducted by Kanya M et al in Chandigarh which reported the increased acceptance and level of knowledge among nursing personnel after 2 weeks training on KMC.8 One of the another study conducted by S Sindhu in Bangalore also reported increase of nursing professional’s posttest mean knowledge score upto 82.6% from 39.1% in pretest. 10 The current study reported the highly significant difference in pre test and post-test knowledge scores at p <0.05 level. These results are consistent with the study conducted by S Sindhu in Bangalore where enhancement in the mean knowledge was found to be significant at 0.05 level.10 Another study conducted by Neelimarani in Hyderabad among B.Sc Nursing students also reported significant difference in post test knowledge score (t=9.64, p value< 0.05).11 Item wise % difference of correct response on KMC in terms of knowledge depicted that most of the nurses had given right answer for all the items in the post test. Similar results are reported in a study conducted by Samya et al where the majority of subjects had given correct response for all the statements in post test. 12 The overall findings of the study clearly showed that the STP on KMC was significantly effective in improving the knowledge of staff nurses. Nurses being forerunners in providing the neonatal care must be sufficiently equipped with the knowledge regarding KMC. Thus more and more training programmes should be carried out and hands on practice sessions should be taken to implement this cheap, effective method of newborn care.
References
- Kumar Introduction of community based skin-to skin care in rural Uttarpradesh, India. Journal of Perinatology 2007; 26(10):597-604.
- UNICEF partners with Neonatology Forum for Newborn Survival Revolution in www.unicef.org/india/health. Accessed on 23- 10-08
- Gabriel R P, Nathalie C, Luis G Kangaroo mother care an example to follow from developing countries. Available at: http://: www.google.bmj.bmjjournals.com/cgi/content/full/329/7475/1179. Accessed on 12-10-12.
- Aravind Essential care of low birth weight neonates. Journal of the Indian academy of paediatrics 2008 January 17; 45(1):13-14.
- Bergh A M, Manu R, Davy K, Rooyen E V, Asare G Q et Translating research findings into practice – the implementation of kangaroo mother care in Ghana. Implement Sci 2012; 7: 75.
- Ludington-Hoe S M, Morgan K, Abouelfettoh A clinical guideline for implementation of kangaroo care with premature infants of 30 or more weeks’ postmenstrual age. Adv Neonatal Care.2008; 8(3 Suppl):S3–S23.
- Conde A A, Belizán J M, Diaz R Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2011; Art. No.: CD002771 ( I s s u e 3 ) d o i : 10.1002/14651858.CD002771.pub2.
- M, Narang A, Kumar K, Pradeep et al. Workshop on Neocon XX!V NNF. Annual convention at Chandigarh: 28 Oct 2004
- Suman Rao, Rekha Udani, Ruchi Kangaroo mother care for low birth weight infants: A randomized controlled trail. Journal of Indian paediatrics 2008 January 17; 45 (1): 17-22.
- Sindhu A study to evaluate the effectiveness of self instructional module for staff nurses regarding management of preterm babies in selected government and private hospitals in Bangalore. Available at http://www.rguhs.ac.in/cdc/onlinecdc/uploads/123456789/1452 accessed on 14-10-12
- Neelimarani A study to assess the knowledge gain with video assisted teaching on KMC among B.Sc Nursing III year students at NIMS college of Nursing, Hydearbad. Available a t h t t p : / / n u r s i n g r e s e a r c h s t u d i e s . blogspot.in/2010/10/research-study-on- kangaroo-mother-care.html accessed on 9-10- 2013
- Samya El-N, Josephin L, Howida Impact of Neonatal Nurses’ Guidelines on Improving Their Knowledge, Attitude and Practice Toward Kangaroo Mother’s Care. Journal of Natural Sciences Research 2013; 3(7): 175-186