`RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES …



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE.

ANNEXURE: II

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

| | | |

|1. |Name of the candidate and address |MS. LEEMA JOSEPH |

| | |FIRST YEAR M.SC. NURSING, |

| | |SHREE DEVI COLLEGE OF NURSING, |

| | |MAINA TOWERS, BALLALBAGH, |

| | |MANGALORE – 575 003. |

| | | |

|2. |Name of the Institution |SHREE DEVI COLLEGE OF NURSING, |

| | |MAINA TOWERS, |

| | |BALLALBAGH, |

| | |MANGALORE – 575 003. |

| | | |

|3. |Course of study and subject |M.SC. NURSING, PAEDIATRIC NURSING |

| | | |

|4. |Date of admission to the course |20.02.2009 |

| | |

|5. |Title of the study: |

| |A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON GROWTH MONITORING OF CHILDREN USING INNOVATIVE PEDIATRIC GROWTH CHART |

| |AMONG THE THIRD YEAR GENERAL NURSING AND MIDWIFERY STUDENTS IN A SELECTED INSTITUTE AT MANGALORE. |

| | |

|6 |BRIEF RESUME OF THE INTENDED WORK |

| |Introduction |

| |The children’s growth and development is dependent upon their nutritional status. A well balanced and sufficient nutritional intake is most |

| |essential for children to promote optimal growth and development, to protect and maintain health, to prevent nutritional deficiency and various |

| |illnesses and to reserve for starvation and dietary stress. Dietary factors regulate growth at all stages of development and their effects are |

| |exerted in numerous and complex ways1 |

| |Growth charts are the essential components of the paediatric tool kit. Anthropometric measurements are commonly used for assessing growth and |

| |nutritional status of the children. The innovative paediatric growth chart includes weight for age, height for age, and weight for height, the |

| |head-circumference, mid-arm circumference, triceps and sub-scapular skin fold and milestones were also included. Observed values are compared |

| |with standards to determine whether the child is growing normally2. |

| |6.1 Need for the study |

| |Growth and development in a child is definite and predictable patterns which are continuous, orderly and progressive, and these patterns are |

| |universal and basic to all human being, but each human being accomplishes these in a manner and time unique to that individual3. |

| |Growth monitoring is the regular recording of a child's weight, coupled with some specified remedial actions if the weight is abnormal in some |

| |way. It focuses health interventions on at-risk children, promoting community development, and providing information for nutrition surveillance |

| |and programme management. Growth monitoring is a screening tool to diagnose nutritional, chronic systemic and endocrine disease at early stage. |

| |Monitoring the growth of a child requires taking the various measurements at regular intervals, approximately at the time of the day, and |

| |screening how they grow3 |

| |The WHO report on innovative paediatric growth chart provides technical improvement in the infant chart. The old charts were based on a small |

| |sample of children but the revised charts are based on five recent ethnically diverse, national samples. The old charts were largely based on |

| |bottle- fed infants; the revised new growth chart reference is based on breast feeding. The old chart had a disjunction when making the |

| |transition from length (measured in recumbent) in the infants sample to height (measured in standing) for older children in the national |

| |samples. The revised innovative paediatric growth chart is for all ethnic groups. It include three new features: 1) the age range has been |

| |extended up to 20th birth day: 2) the back of the charts for children ages 2 to 20 years shows the body mass index (BMI), a measurement of |

| |obesity; and 3) although the clinicians generally use the chart that have the 5th and 95th percentile lines, chart shows the 3rd and 97th |

| |percentiles (for cases at the extremes of growth). It is important to use the back of the charts to monitor not only the growth of the head but |

| |also to identify the children who are becoming fat or thin. The chart shows the 85th percentile line as representing “at risk of over weight” |

| |and the 95th as “over weight”. Other measurements include head circumference, mid-arm circumference, triceps and sub-scapular skin folds. In |

| |addition, six key motor milestones were measured, linking motor development to the physical growth4. |

| |An exploratory study on the perceptions of growth monitoring and promotion among international panels of 19 District Medical Officers were |

| |conducted and reported that the growth chart has been proposed as an educational tool to make the child’s growth visible to both health workers |

| |and care givers and to enhance communication between them. The aim of this qualitative research was to explore the perceptions and difficulties |

| |of an international panel of District Medical Officers regarding growth monitoring and promotion (GMP). In-depth interview conducted and data |

| |were collected. A discrepancy between intended purpose and practice of GMP was detected at two levels. First, lack of participation of care |

| |givers & second, the Medical Officers expressed a restrictive interpretation of the concept of growth monitoring. This two fold discrepancy |

| |between the intention of international policy planners and practice of local programme implementers could be a crucial factor affecting the |

| |performance of GMP. They suggest to put more emphasis on social communication of health works and involvement of caregivers in the growth |

| |monitoring and promotion programme5 |

| |The new WHO Child Growth Standards confirm that children born anywhere in the world and given the optimum start in life have the potential to |

| |develop within the same range of height and weight. Naturally there are individual differences among children, but across large populations, |

| |regionally and globally, the average growth is remarkably similar. Growth charts are tools that contribute to form an overall clinical |

| |impression for the child being measured. The growth monitoring charts have the grids scaled to metric units (kg, cm), with English units (lb, |

| |inch) as the secondary scale. The growth monitoring charts are available for boys and for girls.6. |

| |An experimental study was conducted among the primary health workers to assess the knowledge and the technical quality of measuring and |

| |recording the weights of children, interpreting their growth trend, and providing education to mothers. The supervisors used lot quality |

| |assurance sampling to assess the measurements for growth monitoring. Supervisors sampled 10 households in each of 12 health areas they reported |

| |that the community health workers (CHW) need to improve their knowledge in monitoring children with the innovative growth monitoring chart. They|

| |concluded that about 90% of the CHW are poorly functioning with the growth monitoring chart and health promotion. They need to improve their |

| |knowledge and skills in using the innovative growth charts7. |

| |The researcher during her experience found that the nursing students are lacking in their knowledge on innovative paediatric growth monitoring |

| |chart. Nurses are often responsible for measuring the growth in children, so it is essential to understand the revised growth charts. Since |

| |several important differences exists between the previous and the revised charts with significant implications on monitoring the growth of the |

| |children. Hence educating the nursing students on innovative paediatric growth monitoring chart will improve their knowledge regarding WHO |

| |growth standards and help them in their professional practice. |

| |6.2 REVIEW OF LITERATURE: |

| |A longitudinal study was conducted in Canada among the 84 infants from birth to 18 months of age and aim of their study was to illustrate how |

| |the growth curve used to assess growth influences the interpretation of weight gain and the age of onset of higher gains during infancy. Infant |

| |feeding pattern was recorded monthly; weight and height of 73 infants were measured at 8 different ages. Weight, height, weight for height, and |

| |BMI were compared with the CDC 2000 growth curves and WHO growth standard. They reported that using the WHO growth standard, an increase in body|

| |weight occurred between 6 and 9 months of age infants, associated with a change from breast feeding to formula feeding and introduction of solid|

| |foods. When compared with the WHO standards, breastfed infants followed the standards, but formula-fed infants deviated with higher weight for |

| |age. When compared with the CDC charts, breastfed infants showed an apparent decline in weight for age beginning at 6 months. And they concluded|

| |that the growth curve is important in interpreting infant growth and identifying the onset of the excess weight gain. Hence they revealed that |

| |the identification of the prevalence and age of onset of early excess weight gains among Canadian infants have best achieved by using WHO growth|

| |standards8 |

| |A cross-sectional study was conducted in India among 19834 school children from North, South, East, West and Central zone were selected to |

| |produce contemporary growth curve for children from 5-18 years for height, weight and BMI. All sites used similar measuring equipments, which |

| |were calibrated daily. Standing height was measured using a portable stadiometer. Weight was measured using portable electronic weighing scale. |

| |The subject aged 18 were excluded. The data were analysed using the LMS method. They reported that, median height at 18 years was |

| |0.6 cm greater for boys but unchanged for girls, while the 97th height percentile had increased by 1.7 cm for boys and 2 cm for girls. Boys and |

| |girls were heavier and taller at almost all ages and they were taller at a younger age. The difference between the zones were not significant (P|

| |value: boys height 0.755, boys weight 0.722, BMI 0.48, P value: girls height 0.95, girls weight 0.14, BMI 0.11). They concluded that the |

| |assessment of innovative growth chart by anthropometric methods like weight, height and BMI are crucial in child care to assess the nutritional |

| |status, the assessment of physical growth and identification of growth failure. The findings revealed that growth monitoring help the health |

| |personals and policy makers to diagnose under nutrition, over weight, obesity and other growth related conditions9 |

| |The Standing Committee on Nutrition of the United Nations System (SCN) reported on the long- awaited WHO Child Growth Standards as the |

| |innovative pediatric growth chart enhances the monitoring of the growth of children including the head-circumference, mid-arm circumference, |

| |triceps and sub-scapular skin fold and milestones were also included. The standard of this chart establishes the guidelines for the healthy |

| |growth and development of all infants and young children. They also provided support for good general mother and child care practices such as |

| |immunization, starting exclusive breast feeding for the six months of life, they also recommended the introduction of adequate complementary |

| |foods while breast feeding is continued to two years and beyond, and adequate pre-and post-natal care for the mothers. This growth standards |

| |will be widely used as a tool in public health, public nutrition, medicine and by governmental and health organizations for monitoring the |

| |well-being of the children and for detecting the children or populations not growing properly or who are under or over weight , requiring the |

| |specific health and malnutrition responses10 |

| |A cross-sectional study was conducted in US among the age group of birth to 20 years of age group children, to present a clinical version of the|

| |2000 Centers for Disease Control and Prevention (CDC) innovative growth charts and to compare them with the previous version, the 1977 National |

| |Centers for health statistics (NCHS) growth chart. They reported that the growth represents a cross-section of children who live in US; |

| |breastfed infants are represented on the basis of their distribution in the US population. The CDC 2000 innovative growth charts are more |

| |closely match the national distribution of birth weights than NCHS growth chart. They concluded that the CDC 2000 growth charts are recommended |

| |for use in the US for routine monitoring of growth in infants, children, and adolescents11. |

| |A prospective study on 14-day audit of 491 charts of children seen in the emergency department (ED) or admitted to a ward was performed to |

| |determine the frequency of documentation of height/length, weight, head circumference, BMI or weight for height and presence of growth charts a |

| |tertiary care paediatric hospital in Nova Scotia. They reported that growth parameters, aside from weight, were infrequently documented in the |

| |medical record. Height / length were documented in no ED charts and in 42% of ward charts. BMI or weight for height were almost never found, and|

| |growth charts were present in only 23% of ward charts, one clinic chart and one ED chart. They conclude that the rates of documentation of |

| |growth parameters in the hospital setting were unacceptably low. Implementation of the use of the CDC 2000 growth charts will require not only |

| |education regarding BMI but also steps to encourage more regular measurement of height and use of growth charts in all areas of the hospital12 |

| |6.3 Statement of the problem |

| |A study to evaluate the effectiveness of planned teaching programme on growth monitoring of children using innovative paediatric growth chart |

| |among the third year general nursing and midwifery students in a selected institute at Mangalore. |

| |6.4 Objectives of the study |

| |To assess pre-test knowledge score among the third year GNM students on growth monitoring of children using innovative paediatric growth chart |

| |measured by structured knowledge questionnaire. |

| |2. To develop planned teaching programme on growth monitoring of children using innovative paediatric growth chart. |

| |To evaluate the effectiveness of planned teaching programme on growth monitoring of children using innovative paediatric growth chart. |

| |To find out association between pre-test knowledge score of third year GNM students and selected demographic variables. |

| | |

| |6.5 Operational definitions |

| |Effectiveness: It refers to the extent to which the planned teaching programme has achieved the desired objective that means improvement of |

| |knowledge scores among students on growth monitoring of children using innovative paediatric growth chart. |

| |Planned teaching programme: It refers to a teaching programme conducted by the investigator based on growth monitoring of children using |

| |innovative paediatric growth chart. |

| |Innovative paediatric growth chart: It refers to the graphical representation of growth and development of children from 0-20 years of age, |

| |which was developed by WHO. It mainly includes the monitoring of growth in children by checking the head-circumference, mid-arm circumference, |

| |triceps, sub-scapular skin fold and milestones. |

| |Growth monitoring of children: It refers to the screening tool used for monitoring the periodical growth of the children. |

| |Third year GNM students: It refers to the students who are studying in III year, general nursing and midwifery course in a selected institute. |

| |6.6 Assumptions |

| |The study assumes that: |

| |Third year GNM students will have some knowledge regarding innovative paediatric growth chart. |

| |2. The PTP will enhance third year GNM student’s knowledge on growth monitoring of children using innovative paediatric growth chart. |

| |6.7 Delimitations |

| |The study is delimited to |

| |- the third year GNM students in a selected institute. |

| |- students who are willing to participate in the study. |

| |6.8 Hypothesis |

| |H1: The mean post test knowledge score of third year GNM students on growth monitoring of children using innovative paediatric growth charts |

| |will be significantly higher than that of their mean pre-test knowledge score at 0.05 level of significance. |

| |H2: There will be significant association between levels of knowledge and selected demographic variable at 0.05 level of significance. |

| | |

| |MATERIAL AND METHODS |

| |7.1 Sources of data |

|7 |Data will be collected from the third year GNM students in a selected institute at Mangalore. |

| |7.1.1 Research design |

| |Pre-experimental one group pre-test post test design will be adopted for this study. |

| |7.1.2 Setting |

| |This study will be conducted in a selected institute at Mangalore. |

| |7.1.3 Population |

| |The population of this study consist of third year GNM students in a selected institute at Mangalore. |

| |7.2 Method of data collection |

| |7.2.1 Sampling procedure |

| |The sample for the present study is purposive sampling technique. |

| |7.2.2 Sample size |

| |In this study the sample size will be 40, third year GNM, students in a selected institute at Mangalore. |

| |7.2.3 Inclusion criteria |

| |Students who are |

| |- willing to participate in the study. |

| |- available at the time of data collection. |

| |7.2.4 Exclusion criteria |

| |The students |

| |- who are already exposed to teaching programme on growth monitoring of children using innovative paediatric growth chart. |

| |-who are not willing to participate in the study. |

| | |

| |7.2.5 Instruments intended to be used |

| | |

| |The tool consists of demographic performa and a structured knowledge questionnaire, to assess the knowledge of third year GNM students on growth|

| |monitoring of children using the innovative paediatric growth chart. |

| |7.2.6 Data collection method |

| |Prior to the data collection written permission will be obtained from the selected institute authority concerned for conducting the study |

| |subjects. The data will be collected from 40 third year GNM students after obtaining the consent. The procedure will be explained to them and |

| |confidentiality will be assured. Pre-test will be conducted using structured knowledge questionnaire and a planned teaching programme will be |

| |provided to the students on the same day and post test will be conducted by using the same knowledge questionnaire on the seventh day. |

| |7.2.7 Data analysis plan |

| | |

| |The plan of data analysis is |

| |All data will be tested at 0.05 level of significance. |

| |Demographic data will be analyzed using frequency, percentage and graph. |

| |Paired‘t’ test will be used to find the promotion of knowledge through PTP. |

| |Association between pre-test knowledge scores and selected demographic variable will be found using chi- square test. |

| |7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? |

| |Yes, a planned teaching programme for third year GNM students regarding the growth monitoring of children using innovative paediatric growth |

| |chart will be conducted. |

| |7.4 Has ethical clearance been obtained from your institution in case of 7.3? |

| |Yes. Ethical clearance will be obtained from concerned authority |

| | |

| | |

| | |

| |BIBLIOGRAPHY |

| |Whaley And Wong’s Essentials of Paediatric Nursing. 7th ed. Philadelphia: Elsevier Reed; 2005. |

| |Park K. Parks text book of preventive and social medicine. 17th ed. Jabalpur: Jaypee Brothers Publications; 2002. |

| |Marlow DR, Redding BA. Textbook of Paediatric Nursing. 6th ed. Philadelphia: W. B. Saunders Company; 2001. |

| |Peter Dawson. Normal growth and revised growth charts. Paediatrics in Review.2002; 23 (7): 255-6. |

| |Roberfroid D, Lefevre P, Hoeree T, Kolsteren P. Perceptions of Growth Monitoring and Promotion among an International Panel of District Medical |

| |Officers. 2000. [1screen] Available from URL: http//wwwdroerfroid@itg.be |

| |WHO Library Cataloging .WHO Child Growth Standards.2006. [1,2,305,306screen] Available From URL: |

| |Valadez JJ, BrownLD, Vargas W, Moreley D. Using lot quality assurance sampling to assess measurements for growth monitoring in a developing |

| |country’s primary health care system. Journal of Health, Population and Nutrition. 2005; 23(3): 207-14. |

| |Evellen van CD, Margaret S. Growth-curve standards and the Assessment of early excess weight gain in infancy. Paediatrics 2009; 123(1): 102-7. |

| |Khailkar VV, Khadilkar AV, Cole TJ, Sayyad MG. Cross sectional growth curve for height, weight and body mass index for affluent Indian children,|

| |2007. Indian paediatrics 2009; 46(17):477-9. |

| |SCN Endorses the new WHO growth standards for infants and young children.[2 screen] Available from URL: |

| |Ogden CL, Kuczmarski, Flegal KM, Zuguo Mei, Shumeri Guo, Rong Wei. et.al. Centers for disease control and prevention 2000 growth charts for the |

| |United States: Improvements to the 1977 National Centers for Health Statistics Version. Paediatrics 2006; 14(3):187-8. |

| |Cloe TJ, Paul AA, Whitehead RG. 14-day audit of growth charts of children using in the emergency department (ED). Taylor & Francis health |

| |sciences. 2002; 91(6): 1296-1300. |

| | |

|9. |Signature of the candidate |

| | |

|10. |Remarks of the guide |

| | |

|11. |Name and designation of (in block letters) |

| | |

| |11.1 Guide | Ms. PRIYA VADHANA, |

| | |ASSOCIATE PROFESSOR, |

| | |HOD, CHILD HEALTH NURSING, |

| | |SHREE DEVI COLLEGE OF NURSING, |

| | |BALLALBAGH, MANGALORE. |

| |11.2 Signature | |

| |11.3 Co-guide | |

| |11.4 Signature | |

| |11.5 Head of the department |Ms. PRIYA VADHANA, |

| | |ASSOCIATE PROFESSOR, |

| | |CHILD HEALTH NURSING, |

| | |SHREE DEVI COLLEGE OF NURSING, |

| | |BALLALBAGH, MANGALORE. |

| |11.6 Signature | |

| |12.1 Remarks of Chairman and principal | |

| | | |

| | | |

| |12.2 Signature | |

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