RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, …



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| |“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED PEDIATRIC |

| |EMERGENCIES AMONG MOTHERS OF UNDER FIVE CHILDERN IN SELECTED AREAS OF BAGALKOT.’’ |

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| |PROFORMA FOR REGISTRATION OF SUBJECT FOR |

| |DISSERTATION |

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| |MR. RAVI AJUR |

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| |SHRI. B.V.V.SANGHA’S |

| |SAJJALASHREE INSTITUTE OF NURSING SCIENCES, |

| |NAVANAGAR, BAGALKOT, KARNATAKA. |

| |2012 |

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

| |Name of the candidate and address | |

| |(in block letters) |MR.RAVI AJUR |

| | |I YEAR M. Sc. NURSING |

| | |SAJJALASHREE INSTITUTE OF |

| | |NURSING SCIENCES, BAGALKOT |

| |Name of the Institution |SAJJALASHREE INSTITUTE OF NURSING SCIENCES, BAGALKOT. |

| |Course of Study and Subject |M. Sc. NURSING |

| | |PAEDIATRIC NURSING |

| |Date of Admission to the course | 30/06/2012 |

| |Title of the Topic: |

| |“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED PEDIATRIC |

| |EMERGENCIES AMONG MOTHERS OF UNDER FIVE CHILDERN IN SELECTED AREAS OF BAGALKOT.’’ |

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| |6.Brief Resume of the Intended Work |

| |A child is generally a human between the stages of birth and puberty. Child generally refers to a minor, otherwise known as a |

| |person younger than the age of majority. Children are the future promise of the world .It is important that to raise a good future|

| |community for a good world. Children are high risk group to get accident and injuries. A proper first aid management in the |

| |right time will save the valuable life of our future generation. Every year a huge number of deaths are happening around the |

| |globe. Good knowledge of basic life support (BLS) and emergency management skills help to save the causalities.1 |

| |An emergency is a situation that possess an immediate risk to health, life property or environment have a already caused by loss |

| |of life, heath determinants, property damage. The emergency can be classified in to four sub divisions like, dangerous to life, |

| |heath, property, the environment. Paediatric emergencies is medicine is that branch of medicine concern with providing highly |

| |specialized acute health care to children of all ages and developmental levels which includes , Triage, stabilization ,diagnosis ,|

| |treatment and follow up care. Paediatric emergencies are the leading cause for the death in children under five years of age. The|

| |accidental trauma due to different causes influences in childhood mortality and morbidity. The children exhibit various |

| |behavioural characteristics that place them at risk to paediatric emergencies that are intense activity , Curiosity, mouthing of |

| |objects, traffic accidents and Suicidal attention in older children.2 |

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| |Public health emergencies resulting from major man-made crises and large scale natural disaster severely impact developing |

| |countries, causing unpredictable rates of indirect mortality and morbidity.Yong children sustain upper cervical spine |

| |injuries,drowning,snake bites, dental injuries .Snake bite is a global public health problem, with highest incidence in southeast |

| |Asia, it results from inadequate health services, difficulty transportation and consequent delay in antisnake venom |

| |administration are the main reasons for high mortality. The outcomes of snake bites depend on numerous factors, including the |

| |species of snake, area of the body bitten and the amount of venom injected.3 |

| |Paediatric emergencies are ,coma ,shock, upper and lower airway obstruction it includes croup , epiglotitis, foreign body |

| |aspiration, bronchiolitis , chest infection .cardiac emergencies includes , heart failure, supra- ventricular tachycardia. |

| |Infection includes meningitis, encephalitis, Kawasaki, hus, pertusis, endocarditis. Seizures include status epileptics, febrile |

| |fits, non- febrile fits, increased intra cranial pressure. In Renal includes hypertension, haematuria, nephrosis. Skin includes |

| |rash, purpura, peeling, cellulites. Pain includes lamping child, chest pain, abdominal pain, headache, backache, sickle cell. In |

| |environmental includes burns, smoke inhalation, drowning, poisoning, hypothermia, heat stress, fractures and road traffic |

| |accidents. Emergencies in babies include excessive crying, not feeding, cyanosis, apnoea, fitting, jaundice, diarrhoea, vomiting, |

| |fever and bleeding. Bites include snake bite, scorpion bite, human bite and stings.4 |

| |Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. It is a major cause of |

| |disability and death particularly in children .it is classified in to two types, cold water injury and warm water injury. Warm |

| |water drowning occurs at water temperature of 20’ Celsius. Cold water drowning occurs at water temperature of less than 20’ |

| |Celsius. Immediate threats include effects on the central nervous system and cardio vascular system. The degree of central nervous|

| |system and cardio vascular system injury depends on the severity and duration of hypoxia. 7% of deaths due to drowning in 2004 and|

| |average 388,000 deaths by Drowning, and 1 per 50,000 populations reported.4 |

| |Symptoms of drowning includes , Head low in water, head tilted back with mouth open, eyes glassy and empty, eyes open with fear |

| |evident on face, gasping, trying to swim, uncontrollable movements of arms and legs. Causes of drowning are Children drowned in |

| |baths, buckets, toilets, drums, tank and barrels. Deep water blackout. Shallow water blackout. Drowning can be prevented by having|

| |Lifeguards at pools, by keeping camera as safety measure at pools, by having the computers for detect drowning. by having |

| |telephone facilities at pool. While swimming the four rules should be maintained, always swim with a buddy, don’t dive unknown |

| |bodies of water, don’t push on others and be prepared for emergency.4 |

| |A snake bite is an injury caused by a bite from a snake often resulting in puncture wounds. Every year 10,000 people die from |

| |snake bites. Symptoms of snake bites includes, Overwhelming fear, Panic, Emotional instability, Nausea, Diarrhoea, Vertigo |

| |Fainting, Cold, Necrosis. First aid for Snake bites varies because different snakes have different types of venom and includes, |

| |protect the person and others from further bites |

| |Keep the person calm |

| |Call for help to arrange for transport to the nearest hospital emergency room |

| |Make sure to keep the bitten limb in a functional position and below the victims heart level |

| |Don’t give person anything to eat or drink |

| |Remove any items or clothing which may constrict the bitten limb |

| |Keep the person still as possible and don’t incise the bitten site.5 |

| |The fracture is medical condition in which a bone is cracked or broken .About 15% of all injuries in children are fracture |

| |injuries .Bone fractures in children are different than adult bone fractures because a child bones are still growing, also more |

| |consideration needs to be taken when a child fractures a bone since it will affect the child his or her growth. The fractures |

| |occur when the strong forces naturally applied on the bones.6 |

| |Types of fracture are Greenstick fracture, Torus or buckle fracture, Closed fracture ,Open fracture, Non –displaced fracture, |

| |Displaced fracture ,Hairline fracture, Single fracture ,Segmental fracture, Communicated fracture. Causative factors for fracture |

| |includes Fall , Osteoporosis ,Weakness ,Low immunity power. Symptoms of fracture are Tenderness, pain, obvious deformity, |

| |swelling, bruising, warmth, redness in fractured area and immobility. Children with generalized disorders such as renal disease, |

| |cystic fibrosis, growth hormone deficiency, age, sex, body built and child abuse are at risk for fracture.6 |

| |First aid for fracture includes , provide good ventilation, Immobilize the affected bone ,Provide splint ,Keep child on plane |

| |surface ,Prevent bleeding in affected site ,Don’t put pressure on affected site ,Advise them to drink water. , Maintain |

| |hygiene, Shift to hospital for further treatment.7 |

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| |6.1 Need for the Study |

| |“ If you want your children to keep their feet on the ground |

| |put some responsibility on their shoulder” |

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| |A child’s early years hold the clues to his future behaviour as an adult. Society stands to gain or lose, depending on the |

| |soundness of mother-baby attachment. La Leche League is committed to the belief that babies and mothers need to be together in |

| |the early years. We are convinced that a baby’s needs for his mother’s loving presence are as basic as his need for food.8 |

| |A baby must have a mother, a mother who is mature enough to attend to its needs and provide so-called object constancy for a |

| |minimum of three years... The mothering function is one of the most important of all human events but, unfortunately, one of the |

| |least appreciated or regarded by society.9 |

| |In the first three years of life every human being undergoes yet a second birth, in which he is born as a psychological being |

| |possessing selfhood and separate identity. The quality of self an infant achieves in those crucial three years will profoundly |

| |affect all of his subsequent existence.9 |

| |Many people have suggested that day and night care centres for children are an answer for women’s need to do more than child care.|

| |They propose that we channel millions of dollars and equal number of hours into organizing such places. But this is not the |

| |answer for the demands on the mother during this early infant adjustment period. One thing we have learned about children in the |

| |past few decades is that they do best in early infancy if they are principally cared for by their own mothers. Given a reasonably|

| |stable household and a level of economic stability where the children can receive all the emotional and physical benefits offered |

| |to the general population, mothers responding to their own children are still best.10 |

| |Paediatric emergencies are the leading causes of death in children under five years of age. The toddlers. Preschool and scholars |

| |with highest curiosity to explore, investigate and with the ability to run and play are more prone to |

| |gettinginjurieslikefalls,burns,cuts,bites.stings,poisoning,fracture,eyeinfection,hyperthermia,wounds,choking.Most of the |

| |paediatric emergencies occur in main location at home, road, school, play ground, hospital, and Anganwadi’s centres.10 |

| |Paediatric emergency is a medicine is that branch of medicine concern with providing highly specialized acute health care. Most |

| |common paediatric emergencies are fracture, drowning and snake bite .The incidence of snake bite is every year 10.000 people die |

| |from snake bite.7% of deaths recorded from drowning and 15% of fractures cases recorded in children. Average 388.000 deaths |

| |happened by Drowning.4 |

| |Parents are the primary care givers of the children. The mothers are the primary teachers and have the potential influence on the |

| |children .Thus mothers should have the knowledge regarding paediatric emergencies to react to situations occurred. Snakes bites |

| |reported during monsoon in preschool children accounted for almost half of the animal bites and stings.11 |

| |The study conducted a nationally representative study of 123,000 deaths from 6,671 randomly selected areas in 2001–03. Full-time, |

| |non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two |

| |of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication. A total of |

| |562 deaths were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) |

| |than females (41%), and peaked at ages 15–29 years (25%) and during the monsoon months of June to September. This proportion |

| |represents about 45,900 annual snakebite deaths nationally, and with the highest state rate in Andhra Pradesh. Annual snakebite |

| |deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500). Snakebite remains an |

| |underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from |

| |India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better|

| |distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India.12 |

| |Injuries comprise 13% of the burden of morbidity worldwide. Nearly 50 lakh people lost their lives due to injury as per the WHO |

| |estimates for 2002.Snake bites cause considerable morbidity worldwide. The highest burden exists in south Asia, Southern Asia & |

| |Sub – Saharan Africa. Annual incidence of snake bite in India is about 66 – 163 per 1, 00,000 population. Deaths from all types |

| |of injuries are projected to increase 1.47 .In any society ,59% of the mothers and children are living in total population |

| |.children are one third of our total population and today children are help in future for well lighten of the country. The care |

| |is needed for survival and development of children from infancy to child wood.12 |

| |A descriptive study was conducted at Bangalore to assess the knowledge of the mothers of the under fives regarding first aid |

| |during paediatric emergencies and to design an appropriate training programme to improve their knowledge on first aid .the |

| |assessment was repeated for the 56 subjects who attended a training programme on first aid and mean baseline knowledge score was |

| |2.34 which increased to 11.64 immediately following training. This increase was significant for the study and knowledge of the |

| |mothers increased compare to pre existing knowledge.13 |

| |The first five years are considered a critical period of life where the child learns to investigate and react |

| |with his surrounding and they move curious too much. Accidents are the largest single cause of death after the |

| |age of one year and are the most serious health problems facing the world today. Mothers knowledge and practice |

| |are relevant variables and are considered to be important factors in planning an educational programme for |

| |paediatric emergencies.11 |

| |A cross sectional study was conducted in Gujarat State, India on risk of domestic accidents among under five |

| |children. The objective of the study was to assess the domestic accidents among under five children so that |

| |suitable recommendations can be suggested for prevention of morbidity and mortality among them. Two stage sampling |

| |technique was used. The sample size was 600 families. Interview technique was used to collect the data from urban slum|

| |and middle income group. The study result was nearly two third of boys and 54.7% of girls were at higher to |

| |get exposure to electrical accidents, chemicals and fire. The children living in slum are at more risk to the |

| |accidents than the children in middle income group14. |

| |So the researcher felt to undertake the study in order to assess the knowledge of paediatric emergencies in children in view to |

| |improve and update their knowledge regarding some of the most common paediatric emergencies so that mothers can identify the |

| |paediatric emergencies in children at earliest and can follow better controlling measures and also it helps mothers to prevent |

| |paediatric emergencies in children. |

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| |6.2 Review of Literature |

| |“Literature Review is A Critical Summary Of Research On A Topic Of Interest, Often Prepared To Put A Research Problem In Context |

| |Or As The Basis For An Implementation Project.” |

| |- Polit and Hungler |

| |Review of Literature is a key step in research process. Nursing research may be considered as a continuing process in which |

| |knowledge gained from earlier studies is an integral part of research in general. In review of literature a researcher analyses |

| |existing knowledge before delving into a new study and when making judgement about application of new knowledge in nursing |

| |practice. The literature review is an extensive, systematic, and critical review of the most important published scholarly |

| |literature on a particular topic. |

| |A retrospective study conducted in SIRIRAJ Hospital Bangkok on treatment and outcome of drowning patients in paediatric unit. They|

| |reviewed records of 31 drowning patients, the result reveals that The average age of admitted patients was 4 years of age, 75% of |

| |patients were under five years age, The study concluded that poor outcome observed, prevention of drowning is most important, |

| |effective immediate resuscitation is crucial for the best outcome.15 |

| |A retrospective study was conducted with an objective to identify deaths due to drowning in water sumps over a period of 1 year in|

| |the deportment of Forensic medicine, MS Ramaiah medical college, Bangalore reveals that the following aspects as a total of 112 |

| |(100%) deaths were due to drowning of which 34 (30%) cases of drowning was in water sumps. The study revealed that 19 (55.90%) |

| |outnumbered the males and children in the age group of 0-10 (55.88%) accounted for majority of the cases, (73.3%) were mainly |

| |accidental in manners, (44.10%) had taken place between 12 noon to 6 pm and author concluded that this new source of water body |

| |has been a watery grave which is very unfortunate and supervision turns out to be the key contributors to these unfortunate |

| |preventable deaths.16 |

| |A prospective Study to identify the epidemiology of paediatric trauma in an urban scenario of India and compare results with |

| |studies from developed countries, and to formulate preventive measures to decrease such traumas. They selected cases Between |

| |January 2004 and 2005 inclusive, 500 paediatric, orthopaedic trauma patients. Information was recorded in a prescribed |

| |proforma.The children’s ages ranged from 0 to 16 years; 274 were males. Most fractures occurred in children aged 7 to 12 years and|

| |decreased in older children. The ratio of fractures in left versus right upper extremity was 2:1. In children aged 0 to 6 years, |

| |the most common injured site was the elbow, whereas in children aged 7 to 16 years it was the distal radius. In descending order, |

| |most injuries were sustained at home (47%), in school (21%), due to sports (17%), and due to vehicular accidents (13%).study |

| |concluded that An effective accident prevention proPaediatric trauma epidemiology in an urban scenario in India.17 |

| |A study was conducted to estimate national snake bite mortality rate in India. They selected 6,671 areas randomly in 2001–03. |

| |Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently |

| |coded by two of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication.|

| |The results revealed that a total of 562 deaths (0.47% of total deaths) due to snakebites. Snakebite deaths occurred mostly in |

| |rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15–29 years (25%) and during the monsoon|

| |months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) |

| |or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4/100,000; 99% CI |

| |4.8–6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar |

| |Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500).The study concluded that snakebite remains an underestimated cause of |

| |accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite |

| |totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of |

| |antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India.18 |

| |A study was conducted of the records of fifty-five children who were admitted to the Hospital for Sick Children in Toronto between|

| |1955 and 1975 with a diagnosis of Volkmann's contracture in fifty-eight limbs. Ten patients had been transferred to this hospital |

| |with established ischemia after Bryant's traction for a fractured femur; all had a very poor outcome. Thirteen other cases of |

| |Volkmann's contracture affecting the superficial posterior compartment had been treated with a fixed Thomas' splint and a Bradford|

| |frame after fractures of the femoral shaft. Supracondylar fractures of the elbow resulting in Volkmann's contracture frequently |

| |had both an arterial injury and a compartment syndrome. Most of the fifty-five children reviewed here had not had early |

| |appropriate treatment. For the past twenty-one years the frequency of Volkmann's contracture has not declined in spite of many |

| |published reports on the compartment syndrome, and the hazards of supracondylar fractures and of Bryant's traction.19 |

| |The study was conducted to describe the pattern of minor accidents in infants and their resulting injuries in U K. They collected |

| |data from 11466 parents using postal questionnaires. At 6 months of age, parents were asked to describe any accident since birth. |

| |The type of fall, distance fallen, resulting injury, and help sought were independently coded. Burns were similarly coded. Results|

| |revealed that 53% fell from beds or settees and 12% fell from arms or while being carried. Only 14% reported visible injury, of |

| |which 56% were bruises; 97% of injuries specified involved the head. Only 21 falls ( ................
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