The best way to deal with the cord area is to just 'leave ...



PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

| |NAME OF THE CANDIDATE AND |MRS. USHA YADHAV |

|1 |ADDRESS |I YEAR M.Sc. NURSING, (2008-09) |

| | |THE KARNATAKA COLLEGE OF NURSING, No. 12 KOGILU MAIN ROAD, |

| | |YELAHANKA, BANGALORE – 64 |

|2 |NAME OF THE INSTITUTION |THE KARNATAKA COLLEGE OF NURSING, No. 12 KOGILU MAIN ROAD, |

| | |YELAHANKA, BANGALORE – 64 |

|3 |COURSE OF STUDY AND SUBJECT |M.Sc. NURSING |

| | |(PAEDIATRIC NURSING) |

|4 |DATE OF ADMISSION TO THE COURSE |1 JULY 2008 |

INTRODUCTION:

“The best way to deal with the cord area is to just 'leave it alone'! As the old saying goes…let the cord dry by itself.”

Neonate is birth to 28 days baby. Prevention is better than the cure. The umbilical cord of neonate is at high risk for infection. So immediate hygienic care should be provided by nursing staff to prevent the infection and complications.

The umbilical (um-BIL-i-kal) cord connects your baby to the placenta. The placenta is an organ that supplies your baby with nutrition and blood while you are pregnant. When your baby is born, your baby no longer needs the placenta or umbilical cord. When your baby is born, your baby's caregiver will cut the umbilical cord. A small part of the umbilical cord (stump) will stay on your baby for a short period of time. The stump will usually fall off in 6 to 8 days after birth. This area will usually completely heal within 2 weeks. Do not worry if your baby's stump falls off sooner or takes longer than 6 to 8 days. The stump may be blue because of a dye your baby's caregiver put on it to prevent infection.

The method of management of the umbilical cord has been widely debated in the past and the preferred methods of cord care including dry care have varied greatly. There is a considerable body of opinion, in the use of antibiotics and antiseptics solutions in cord care as they interfere with the body’s own natural healing processes. On the other hand there is the view that an antiseptic will help specially in an environment where principles of

cleanliness are neglected during childbirth and immediate newborn period. Traditional practices of applying powders, pastes, dung and oil to the cord stump are still prevalent in many parts of India and necessitate effective and clear communication about the method of cord care.

“Umbilical Cord Care - For the Newborn Baby is must and necessary for the Neonates”

Umbilical cord care Full term baby the cord area should be kept clean and dry, but it doesn't need washing with soap. If you are bathing your newborn then do bath your baby in plain water - nothing added. If you are top n tailing your baby you only need to wipe the umbilical cord area if it becomes soiled. This can be done with cotton wool and plain water. After bathing your baby, dab the cord area dry with a clean soft towel. There is no need to apply creams, moisturizers or powder to the cord area. After putting on your baby's nappy, just fold the front down a little so it doesn't interfere or rub on the 'cord stump'. That's it, plain and simple.

In Premature baby umbilical cord care it is delicate procedure ,which should be taken

enough With premature or sick babies, the risk of infection to the cord area may be higher.

So your midwife or care provider may suggest the use of an antiseptic cream or powder. If

not then the cord care will be the same as above for a full term, healthy baby.

NEED FOR THE STUDY:

Bennet et al (1996) stress that the greatest risk fir umbilical sump contamination with bacteria including C.tetani is in the first three days and the risk decreases as umbilical wound heals and stump separates.

Umbilical cord care - The basics

Baby's umbilical cord needs to dry out and fall off naturally. Do not be tempted to pull at it, or rub it, even if it looks like its only attached by a small thread of tissue. Occasionally the cord will not fully dry out on its own, it may form a pink scar tissue, and may leak a yellowish colored fluid. This is known as a granuloma. Sometimes your doctor may need to cauterize this tissue, but more than likely it will go away on its own.

Care of the cord:

The baby's stump should be kept clean and dry until it falls off. If it is not kept clean this area can become infected. Always follow your baby's caregiver's instructions on how to clean the stump and area around it. We should clean your baby's stump every time you give your baby a bath. We should sponge bathe your baby instead of tub bathing until the stump falls off. Gently wash the stump and around it with soap and water on a sponge or cloth. Gently dry the area when you are done with the sponge bath. Be sure the area is completely dry. Some caregivers may suggest using alcohol and a cotton swab to clean your baby's umbilical cord. Other caregivers may suggest letting the cord air-dry instead of using alcohol. Ask your caregiver how you should care for your baby's umbilical cord. Do not put any medicine on or around the stump unless your child's caregiver says it is okay. When you put a new diaper on, keep the front of the diaper folded below the cord. This will prevent wetness and the diaper from rubbing on the stump. When the stump is starting to fall off, you may see a few drops of blood on the diaper. You may also see some drops of blood around the stump. Do not worry. This is normal; we should watch for signs of infection and call your child's caregiver if you notice any of the following: Pus (yellow or green discharge) or red skin around the base of the stump. The cord has a bad smell to it even after you clean it. Once the cord falls off, no special care of the area (belly button) is needed. Cord care, just as any other clinical procedure, gradually becomes an established practice and nurses and other health care providers develop routine actions which become habits and traditions. It is difficult to unlearn these established practices even when evidence suggests that they are unnecessary or harmful, These are the evidences which stimulated the investigator to do the study on the effectiveness of dry cord care of umbilical cord.

Observations made in many hospitals revealed that most health personnel still continue to practice the cord care followed in earlier days and are not aware of the latest concept of dry cord care. This means that evidence based information has not been communicated to them or that hospital procedures are based on scientific evidence. The present study is to gather fresh information about cord care so that evidence can be used for daily practice. The study concluded that the dry cord care is very effective than the medicated cord care.

A critical review of literature revealed that this question has not been adequately answered. It also revealed that there is a dearth of literature related to exploration of the effectiveness of medicated cord care with that of dry cord care on neonates. In developed countries, researchers have addressed this problem to some extent but in India very few published literature could be retrieved. Hence this study is an attempt to assess the effectiveness of medicated cord care with that of dry cord care on neonates to provide the qualitative advance nursing practice.

REVIEW OF LITERATURE:

Literature reviews can serve number of important function in the research process and they also play a critical role for nurses seeking to develop an evidence based practice.

01. General information related to umbilical cord care and importance of Dry cord care.

02. Related studies.

General information related to umbilical cord care and importance of Dry cord care

Manigheh Nourian in his study on Comparison of the effect of Alcohol 70% versus dry cord care on cord bacterial colonization and cord separation time among newborns has identified that, Umbilical Cord bacterial colonization and cord separation time among newborns whose cords were treated with Alcohol 70% versus dry cord care. In conclusion the study reports with the decreased with the absence of infection that the, bacterial colonization was lesser in dry cord care group than in the medicated cord care, thus the author suggest that the dry cord care is better and thus prevent the sepsis

Experts from WHO reproductive health library conducted a study on care of Topical umbilical cord care at birth recommended by WHO suggests that reduction of infection rate is lesser in dry cord than in placebo or antiseptic solution.

Mariam Claeson et al. (2000) Umbilical cord infections are one of the leading causes of neonatal deaths globally. Neonatal cord infections continue to be an important cause of neonatal morbidity and mortality in developing countries. In India, according to 1995 census, out of 29412 cases 337 (1.1% newborns developed umbilical sepsis - Report of National Neonatology forum). Cord care is thus an important issue that needs to be studies. Peripheral care providers need to get the right message so that the method recommended is effective, simple and low cost. If cord separation and healing are delayed and happens when some antimicrobials are used, the cost of neonatal care may unnecessarily increase with some medications. Thus, the variety of cord care regimen also raises the issue of cost effectiveness associated with unnecessary routines.

Benneth. J. et al. (1996) did a comparative study to find the effectiveness of the medicated cord care that of dry cord care. The findings are the cord care practice to be followed needs to take into consideration the time factor of cord fall, the drying process, rate of infection, cost effectiveness and the work load of nurse midwives as well as concern of patents in order to maintain the optimal health of the child.

Barclay, L., et al, (1997), comparisons were made on the condition of umbilical cord on local reactions and general manifestations among neonates under dry cord care and medicated cord care. The findings show that the method of cord care could significantly affect the healing process as also demonstrated by several earlier studies.

A study conducted among 40 newborns in a selected hospital in New Delhi to know the effectiveness of medicated cord care with that of dry cord care. It was proven that the neonates received dry cord care had their fallen on the 4th day whereas only two neonates among medicated cord care group.

Jeyam, S and Pandit. (1998), the umbilical cord care is very important in the neonatal stage because stump is portal of entry for infection. There are so many controversies in the umbilical cord care. The antiseptics which are applied to cure the umbilical cord may create some local reactions to the neonate. But the dry cord care makes the stump dry out and fall earlier.

Macia, Y. et al. (1999). The use of antibiotics and antiseptic solutions in cord care as they interfere with the body’s own natural healing processes. On the other hand there is the view that an antiseptic will help specially in an environment where principles of cleanliness are neglected during childbirth and immediate newborn period. The study conducted among 100 newborns in selected hospital in Mumbai resulted the dry cord care is very effective.

5. TITLE OF THE TOPIC:

A Comparative Study To Assess The Effectiveness Of Medicated Cord Care With That Of Dry Cord Care On Neonates who are available in the post natal ward at Selected Hospital (s) In Bangalore.

6.3 OBJECTIVES OF THE STUDY:

1.To assess and compare the condition of umbilical cord in terms of local reactions and general manifestations among medicated cord care and dry cord care groups of neonates.

2.To assess and compare the drying process of umbilical cord on neonates with medicated cord care and dry cord care group of neonates.

3.To determine the association of medicated cord care on neonates with their selected demographic variables viz, age, gender, religion, birth-order, type of delivery and socio economic status.

4.To determine the association of dry cord care on neonates with their selected demographic variables viz, age, gender, religion, birth-order, type of delivery and socio economic status.

CONCEPTUAL/THEORETICAL FRAME WORK:

Lydia Hall’s theory of core, care, cure has been modified and applies to this study. The core of this concept is that the need for effective nursing care will decreases the need for medical care management.

OPERATIONAL DEFINITIONS:

01. EFFECTIVENESS:

It refers to the skills in producing a desired or intended result. In this study effectiveness refers to the type of care which is given for the umbilical cord either by medicated cord care or dry cord care.

02. NEONATES:

It refers to a period from birth to 28 days (Ist week of life is known as early neonatal period and late neonatal period extends from 7th to 28th days of age) of life is called neonatal period and the infant in this period is termed as neonates.

03. MEDICATED CORD CARE:

It refers to method of cleaning the umbilical cord with alcohol swabs and application of antibiotics .eg, Gentamycin.(Garamycin),Oxacillin (Bactocill, Clindamycin (Cleocin) ,Metronidazole (Flagyl)and Betadine.

04. DRY CORD CARE:

It refers to method of cleaning the umbilical cord with dry swabs.

05. POSTNATAL WARD:

It refers to the place, where the mothers will be transferred after the delivery.

ASSUMPTIONS

1. Dry cord care and will reduced the risk of umbilical sepsis

2. Dry cord care enhances early fall of umbilical care

3 .It is simple and cost effective

HYPOTHESIS:

H1 = There will be a significant association between the mean medicated cord care scores of neonates and their selected demographic variables via, age, gender, religion, birth-order, type of delivery and socio economic status.

H2 = There will be a significant association between the mean dry cord care scores of neonates and their selected demographic variables via, age, gender, religion, birth-order, type of delivery, and socio economic status.

7.0 MATERIALS AND METHOD

7.1 The neonates born is a selected hospitals at Bangalore

7.2 Method of data collection:

Experimental method

7.2.1. Research Approach:-

Research approach in this study is evaluative in Nature.

7.2.2. Research Design:

Research Design is the blue print for conducting a study. It‘s an overall plan for collecting of analyzing data including specifications for enhancing the internal external validity of study .The present is comparative study.

7.2.3. Research setting:-

The setting for the study is the postnatal ward at the selected hospital in Bangalore.

7.2.4. Population:

The population for the study is a neonate who haven delivered by a normal delivery, available in the postnatal ward at selected hospital at Bangalore

7.2.5. Sample size:

30 neonates.

7.2.6. Sampling technique:

Covenant sampling technique.

7.2.7. Sampling criteria

(A) Inclusion criteria:

(1) Parents of neonates who are willing to participate in the study.

(2) Neonates who are available during the data collection period in the postnatal ward at selected hospital.

(3) Neonates should be healthy.

(4) Neonates should be face then neonates.

(B) Exclusion criteria:

(1) Parent of neonates who are not willing to participate in the study.

(2)Neonates who have be delivered by cohesion selection.

7.2.8. Development of Description of the tool:

It consists of a structured observational checklist

A structured observational checklist was developed board an the information gathered from the literature reviewed

Section A:-

To assess demographic data such as age religion birthday type of delivery social economic status.

Section B:-

Structured observation checklist used to assess the effectiveness of the medicated

Cord with that the of day cord care.

7.2.9 Data collection procedure of analysis:-

Formal permission will be obtained from respective authorities Investigator will be selecting the sample form a selected hospital by using convenient sampling techniques after obtaining the informed consent from the parts of mention the investigator will use the structured observation checklist which consist of 15 observation to asses the effectiveness of medicated cord care with that day cord care among the group of neonates

Plan for data analysis

Descriptive analysis:-

The medicated cord care and dry cord care will be analyzed using descriptive statistics percentage and frequency distribution, mean median standard deviation and paired T test.

Inferential statistics:

The correlation co-efficient will be compared to describe the co- relation between medicated and cord care and dry core care association between the medicated and cord care and dry core care with there selected democracy data will be analysis using chi-square test.

PROJECTED OUTCOMES:

After the study the investigator will evaluate the effectiveness of the dry core of the among the groups neonates which can be used by the Nurses in practice in the postnatal ward at hospital in Bangalore

7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly.

No

7.4 Has ethical clearance been obtained from the concerned authority of hospital conducting the study?

Yes.

01. Confidentially and anonymity of the subjects will be maintained.

02. Consent will be obtained from the parents of the neonates before conducting the study.

03. Clearance from the institutional authority will be obtained.

BIBLIOGRAPHY:

01 Barclay, L., et al. (1994). A comparative study of Neonates umbilical cord management. Australian Journal of Advanced Nursing, March – May,pp- 34-40.

02. Benneth, J.et al., (1996). Bundling, a newly identified risk factor for neonatal tetanus: implications for global Control. International Journal of Epidemiology,pp- 870-884

03. Bennett,J., et al. Topical antimicrobials applied to the umbilical cord stump: A new intervention against neonatal tetanus. International Journal of Epidemiology, December ,pp-904-908.

04. Dore, S. et al. (1998). Alcohol versus natural drying for new born cord care.

Journal of Obstetric Gynecology and neonatal Nursing, December, pp-621-627.

05. Fatemeh Allaii ,Journal of perinatology –umbilical cord care in

preterm infants influence cord bacteria colonization

05. Haroldo Capurro. Routine topical umbilical cord care at birth, The WHO

Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006.

06. Linda B. et al. Textbook for Midwives. 11th edition. ELBS by British Government:

pp-. 456-457

07. Mariam Claeson et al. (2000) Reducing child mortality in India in the New Millennium. Bulletin of the World Health Organization. Vol 78 pp- 1192

08.Macia, Y. et al. (1999),Usage of antibiotics and antiseptic solutions in cord care, Midwifery journal vol 28 pp-192-193

09. Nourian M, Allaii F, Heidari A. Comparison of the effect of Alcohol 70% versus

dry cord care on cord bacterial colonization & cord separation time among newborns.

Pak J Med Sci 2009;25(1)pp-103-107

10. Jeyam, S and Pandit, Umbilical cord care Management ,Nursing Times,

April 2008 edition, pp 34-36

Websites:

1..org

2. Google. Com

3.

04. Thomas Reuters

9.0 SIGNATURE OF THE CANDIDATE:

10.0 REMARKS OF THE GUIDE: Recommended and forwarded

11.0 NAME AND DESIGNATION OF GUIDE : Mrs.Rajeshwari M.Sc. (N)

11.2 SIGNATURE :

11.3 CO- GUIDE (If any) :

11.4 SIGNATURE :

11.5 HEAD OF THE PAEDIATRIC NURSING DEPARTMENT:

11.6 SIGNATURE :

12.1 REMARKS OF THE PRINCIPAL: Recommended and forwarded

12.2 SIGNATURE:

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