Rajiv Gandhi University of Health Sciences Karnataka



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |MISS LINCY THOMAS |

| | |GOUTHAM COLLEGE OF NURSING |

| | |MANJUNATHANAGAR |

| | |WEST OF CHORD ROAD |

| | |RAJAJINAGAR |

| | |BANGALORE-560010 |

|2. |NAME OF THE INSTITUTION |GOUTHAM COLLEGE OF NURSING |

| | |MANJUNATHANAGAR |

| | |WEST OF CHORD ROAD |

| | |RAJAJINAGAR |

| | |BANGALORE-560010 |

|3. |COURSE OF THE STUDY |M.Sc NURSING 1ST YEAR |

| | |PAEDIATRIC NURSING. |

|4. |DATE OF ADMISSION TO COURSE |16-06-2010 |

|5. |TITLE OF THE TOPIC |A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE |

| | |REGARDING KNOWLEDGE ON NEONATAL SEPSIS AMONG MOTHERS OF NEONATES IN |

| | |SELECTED HOSPITALS AT BANGALORE. |

|6 |BRIEF RESUME OF THE INTENDED WORK |

|6.1 |NEED FOR STUDY: |

| |The birth of an infant is one of the most emotional events that can occur in one’s life time. After 9 months of anticipation and |

| |preparation, the neonate arrives with a flurry of excitement .But the transition from the intra uterine to extra uterine life is |

| |critical event in life.1 |

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| |Neonatal sepsis or neonatrum is a clinical syndrome resulting from systemic infection and bacteremia in the first month of life. |

| |Neonates have limited ability to localize infections which makes them to susceptible to septicemia. Overwhelming infections of |

| |the lungs and meninges is common and later can be devastating with permanent neurological sequelae.2 |

| |Neonatal sepsis is the single most important cause of neonatal death in hospital as well as community. The onset of symptoms occur|

| |within 72hour of life.3 |

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| |According to WHO 2009, more than one third of the estimated 4 million neonatal deaths around the world each year are caused by |

| |severe infections and quarter around 1 million death are due to neonatal sepsis or pneumonia. The incidence of neonatal sepsis |

| |varies from 1-4 per 1000 live births in developed countries and 10-50 per 1000live births in developing countries.4,5 |

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| |India is the most home to the highest number of newborn deaths in the worldwide, of which 52% are due to infections.6 As per |

| |National Neonatal Perinatal Database (NNPD) 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live births.7 |

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| |A study was conducted to determine the predictors of mortality outcome in neonates with sepsis admitted to neonatal care unit. |

| |Over 6 months 120 neonates were studied, sepsis was confirmed by clinical and laboratory measures. Early onset sepsis was detected |

| |in 35 neonates while late onset sepsis was detected in 85 neonates. However the mortality rate was higher in early onset of sepsis.|

| |Higher mortality was associated with positive blood culture for pseudomonas aeruginosa and staphylococcus aureus where all |

| |neonates, died.8 |

| |A study was conducted on practice variation in suspected neonatal sepsis. In this they examined all term infants admitting ICD-9 |

| |code for suspected neonatal sepsis. infants had to be asymptomatic by 24 hours of life with no significant respiratory signs. A |

| |total of 170 infants treated for 4-6 days. The study find out that treatment of neonates with suspected neonatal sepsis appears to |

| |be influenced by considerations other than maternal risk factors or the infant’s clinical condition beyond the first day of life. |

| |There appears to be great deal of practice variation among neonatologists confronted by patients with suspected sepsis.9 |

| |A prospective cross sectional study was conducted regarding predictors of positive blood culture and deaths among neonates with |

| |suspected neonatal sepsis in tertiary hospital. The study involving 300 neonates admitted in neonatal unit. Standard data |

| |collection data form was used to collect all demographic data and clinical characteristics of newborn. Positive blood cultures was |

| |found in57 and 92 among neonates with early and late neonatal sepsis. Mortality and morbidity on neonatal sepsis is high at their |

| |setting and significantly contributed by positive blood culture and multi resistant gram negative bacteria.10 |

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| |A study was conducted about etiology and antimicrobial resistance of neonatal sepsis in intensive care unit at a tertiary care |

| |centre in eastern India. Blood culture report of positive sepsis were reviewed and demographic data of the babies was collected. |

| |The incidence of culture proven neonatal sepsis among inborn babies was 14.8/1000 live births. The proportion of the culture |

| |positive sepsis for out born babies admitted in NICU was 8.3%. The etiology of early and late onset of sepsis is similar.11 |

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| |In this view of above studies, and from the investigator experience it is found that neonatal sepsis very common in India. If it is|

| |not treated in the beginning it will lead to severe conditions like meningitis, pneumonia etc. Thus the researcher is interested in|

| |imparting the knowledge to mothers of neonates. The researcher felt that, there is a need to study in this area and to change the |

| |parental practices through educational intervention. |

|6.2 |REVIEW OF LITERATURE |

| |Review of literature is a comprehensive, in depth, systematic scanning and critical review of selected literature to find out how |

| |it can be useful to present study. It includes scholarly publication, unpublished scholarly print materials, audio visual materials|

| |and personal communication.12 |

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| |The extensive and systematic review of literature and it is organized according to the following headings. |

| |Studies Related to Neonatal Sepsis. |

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| |Studies Related to Knowledge of Neonatal Sepsis among Mothers. |

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| |Studies Related to Effectiveness of Self Instructional Module. |

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|6.2.1 |Studies Related to Neonatal Sepsis. |

| |A case control study was conducted on risk factors and prevention of early onset neonatal sepsis. Early onset disease occurred in |

| |188 infants i.e,3.5cases per 1000live births. Group B streptococcal sepsis 1.4 cases per 1000 live births. An obstetric risk |

|6.2.2 |factors, preterm delivery, intrapartum fever or membrane rupture more than 18 hours was found in 49% of cases and 79% of other |

| |sepsis. Intrapartum antibiotic prophylaxis had an efficacy of 68.2% against any early onset sepsis. Ampicillin resistance was|

| |evident in 69% of E.coli infections, where as 41% of ampicillin resistant E.coli infections were fatal.13 |

|6.2.3 | |

| |A study was conducted on neonatal sepsis to evaluate local pattern of pathogens and the risk factors for sepsis using case control |

| |analysis. 61cases of neonatal septicemia identified by blood culture. The incidence of neonatal septicemia was 4.9 per 1000 live |

|6.2.1 |births. Among inborn infants birth weight specific, sepsis rate ranged from 2 per 1000liveborns. Among infants with birth weight |

| |≥2500gm,to 150 per 1000liveborns, in those weighing ≤ 1500gm. Significantly associated with septicemia were fatal distress, low |

| |apgar score and requirement for mechanical ventilation and umbilical catheterization. Staphylococci were the major gram positive |

| |isolate occurring in both early and late onset septicemia.14 |

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| |A study was conducted on early onset of neonatal sepsis among 1743 live births. A total of 69 episodes of sepsis occurred in 65 |

| |neonates with an incidence of 37.2 per 1000 live births. The early onset sepsis was 20.7 per 1000 live births and it constituted |

| |55.4% of overall sepsis, and it is associated with maternal risk factor.15 |

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| |A study was conducted on evaluation procalcitonin (PCT) |

| |for diagnosis of neonatal sepsis of vertical transmission. PCT was measured in 827 blood samples collected from 317 neonates. 169 |

| |asymptomatic newborns and 148 symptomatic newborn were studied. In asymptomatic neonates PCT values at 12-24hour were significantly|

| |higher than at birth and at 36-48 hour of life. Neonates with confirmed vertical sepsis showed significantly higher PCT values than|

| |those with clinical sepsis.PCT threshold for the diagnosis of sepsis were 0.55ng/ml at birth; 4.7ng/ml in 12- 24 hour of life and |

| |1.7ng/ml within 36-48 hour of life. Concluded that serum PCT was moderately useful for the detection of sepsis of vertical |

| |transmission.16 |

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| |Studies Related to Knowledge of Mothers Regarding Neonatal Sepsis |

| |A study was conducted on household practices that affect the neonatal health from the perspective of care givers and to identify |

| |the signs in neonates that leading to illness and health seeking behavior. The participants were mothers, grandmothers, |

| |grandfathers. In this study they find out that many house hold practices that will adversely affect the neonatal health. Among 200 |

| |care givers 70.5% reported home deliveries, more than half of the care givers recognized danger signs in neonates, 79% of the care |

| |givers had seen a sick neonate in the family. The finding of the study showed that, inadequate knowledge of care givers regarding |

| |neonatal care and health.17 |

| |A study was conducted regarding knowledge of mothers on neonatal infections and newborn care. Study sample was 101 mothers. They |

| |assessed the knowledge of mothers before and after the module using a standardized interview tool. Women’s knowledge of neonatal |

| |care increased by 10% immediately after post test. The study concluded that, education to mothers increases parental knowledge of |

| |newborn care and newborn infections and it could reduce high mortality rates.18 |

| | |

| |A study was conducted to evaluate the effectiveness of home based management of neonatal sepsis. Neonates in 39 villages are |

| |monitored trained village health workers. They find out that home based management of neonates with suspected sepsis is acceptable |

| |to most parents, safe, effective in reducing sepsis case fatality by nearly 60%.19 |

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| |A study was conducted on social and behavioral aspect of mother’s health behavior and neonatal health and risk factors analysis of |

| |neonatal sepsis. The study sample was 24 mothers.12 mothers with neonatal sepsis infants and others are normal. The result of the |

| |study indicate that two group of mothers share a relatively Similar socio economic status and knowledge of health and hygiene. The |

| |mothers with lack of knowledge and their local view of illness seemed to embody questionable newborn care and breast feeding.20 |

| |Studies related to effectiveness of Self Instructional Module |

| |A quasi experimental study was conducted on evaluation of an osteoporosis prevention education program among young adults in |

| |Shandong university. The study result shows or revealed that statistically significant increases in the reported follow up for each|

| |out come. Osteoporosis knowledge test scores, osteoporosis health brief scores, and osteoporosis self efficacy scores, for those in|

| |the intervention group compared with those in the control group. On the satisfaction score, most participants in the intervention |

| |group rated the nurse’s performance in the educational program positively.21 |

| |A study was conducted to evaluate the effectiveness of self instructional module on child labour among mothers. The study sample |

| |was 40. The result of study shows that self instructional module was found to be effective in terms of increasing the cognitive |

| |behavior and developing more favorable attitude towards child labour. This that self instructional module was an effective method|

| |of imparting information to the mothers on child labour.22 |

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|6.2.2 | |

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|6.2.3 | |

| |STATEMENT OF THE PROBLEM |

| |“A study to assess the effectiveness of self instructional module regarding knowledge on neonatal sepsis among mothers of neonates |

| |in selected hospitals at Bangalore”. |

|6.3 |OBJECTIVES OF THE STUDY |

| |To assess the existing knowledge regarding neonatal sepsis among mothers of neonates. |

| |To evaluate the effectiveness of self instructional module regarding neonatal sepsis among mothers of neonates. |

| |To find out the association between the knowledge scores with selected demographic variables. |

|6.4 |OPERATIONAL DEFINITION |

| |Assess: Refers to judge the importance of neonatal sepsis among mothers of neonates. |

| |Effectiveness: Refers to significant increase in the level of knowledge of the mothers of neonates on neonatal sepsis which are |

| |measured between pre test and post test. |

| |Self Instructional Module: Refers to systematic and organized content matter prepared by researcher and validated by experts. It |

| |contains information regarding neonatal sepsis, which will be provided to the subjects for self reading and gaining information. |

| |Neonatal sepsis: Refers to clinical syndrome resulting from systemic infection and bacteraemia in the first month of life. |

| |Mothers of neonates: Refers to mothers who have baby under the age of 28days and who are hospitalized. |

|6.5 |HYPOTHESIS |

| |H1: There will be a significant difference between pre and post test knowledge score regarding neonatal sepsis among mothers of |

| |neonates after administering self instructional module at 0.05 level |

| |H2: There will be a significant association between knowledge scores with selected demographic variables at 0.05 level |

|6.6 |DELIMITATIONS |

| |The study is delimited to mothers of neonates. |

| |The study is delimited to knowledge aspect. |

|7 |MATERIALS AND METHODS |

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|7.1 |SOURCES OF DATA |Mothers of neonates in selected hospitals at Bangalore |

|7.2 |METHODS OF COLLECTION OF DATA |

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|7.2.1 |SAMPLING CRITERIA | |

| |INCLUSION CRITERIA |Mothers of neonates who are in hospital. |

| | |Mothers of neonates who can read and write Kannada. |

| |EXCLUSION CRITERIA |Mothers of neonates who are not willing to participate in the study. |

| | |Mothers of neonates who have undergone educational program earlier for |

| | |the same topic |

|7.2.2 |RESEARCH DESIGN |Pre experimental design (one group pre test and post test design) |

|7.2.3 |VARIABLES UNDER | |

| |THE STUDY | |

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| |INDEPENDENT VARIABLE | |

| | |Self instructional module on neonatal sepsis. |

| |DEPENDENT VARIABLE | |

| | |Knowledge among mothers of neonates |

| |ATTRIBUTE VARIABLE | |

| | |Age, education, socio economic status, occupation, nutritional status. |

| | |Number of children |

|7.2.4 |SETTING OF THE STUDY |The study will be conducted in selected hospitals at Bangalore. |

|7.2.5 |SAMPLE TECHNIQUE |The sampling technique adopted for the study is non randomized purposive |

| | |sampling technique |

|7.2.6 |SAMPLE SIZE |The proposed sample size of the study is 40 |

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|7.2.7 |TOOLS OF RESEARCH |Section A: |

| | |A structured questionnaires to assess the demographic variables among |

| | |mothers of neonates. |

| | |Section B: |

| | |Structured self administered questionnaire will be developed by the |

| | |investigator to assess the knowledge among mothers of neonates regarding|

| | |neonatal sepsis |

|7.2.8 |COLLECTION OF DATA | 1. A prior formal permission will obtained from concerned |

| | |authorities for conducting study. |

| | |2. The purpose of the study will be explained. |

| | |3. On the first day the investigator will administer the structured |

| | |self administered questionnaires to the mothers of neonates to assess pre|

| | |test knowledge on neonatal sepsis. |

| | |4. On the same day self instructional module on neonatal sepsis will be |

| | |given to the mothers of neonates. |

| | |5. Post test knowledge will be assessed by using the same questionnaire |

| | |after 7 days. |

| | |6. The proposed study duration is |

| | |30 days. |

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|7.2.9 |METHODS OF DATA ANALYSIS |Appropriate statistical method will be used. The plan of data analysis |

| |AND PRESENTATION |will be as follows: |

| | |1. Organize the data in a master sheet or computer. |

| | |2. Assessing the knowledge among mothers of neonates will be interpreted|

| | |by descriptive statistics such as mean, standard deviation. |

| | |3. Effectiveness of self instructional module will be analyzed by |

| | |‘t’test. |

| | |4. Association of knowledge scores with selected demographic variables |

| | |will be analyzed by Chi Square(Ӽ2)23. |

|7.3 |DOES THE STUDY REQUIRE ANY INVESTIGATION OR INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO PLEASE |

| |DESCRIBE BRIEFLY |

| |Yes, the study requires administration of structured questions and self instructional module to the mothers of neonates in selected|

| |hospitals at Bangalore. |

|7.4 |HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3? |

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| |Yes, informed consent will be obtained from the institution authorities and subject. Privacy, confidentiality, and anonymity will |

| |be guarded. Scientific objectivity of the study will be maintained with honesty and impartially. |

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|8 |LIST OF REFERENCE |

| |1. Marlow R. Dorothy, Redding A. Barbara. Text book of pediatric nursing.6th edition .published by Elseveir.2008.346-347. |

| |2. Acharya text book of paediatrics.published by universities press. 4th edition. 2009. 213-215. |

| |3. Ajay kumar .Piyush Gupta: pediatric nursing. 2004.58-59. |

| |4. Stoll BJ. Kleigman RM.The fetus and neonatal infant. In Behrman RE. Jenson HB. Nelson’s text book of pediatrics. WB Saunders |

| |CO.17th edition. 2004.552, 623-639. |

| |5. Khalid N. Neonatal infections.In. Mclntosh N.Helms P. Smyth R.Text book of pediatrics. Churchil livingstone.6th edition. 2003. |

| |336-343. |

| |6. State of India’s Newborns(2005). National Neonatology forum and save children/USA.Washington DC.NNF and save the |

| |children/USA2004. |

| |7. Dr. Shalini Tripthi. Neonatal Sepsis- Past , Present, Future.Internet J Med Update.2010.July.5(2). 45-54. |

| |8. Duha sabeeh. Jumah and Mea’d Kadhum Hassan. Predictors of mortality outcomes in Neonatal Sepsis. The Medical Journal of Basrah |

| |University.2007. 25(1).11-18. |

| |9. Alan R Spitzer. Sharon Kirkhy. Michel Kornhauser. Practice variation in selected neonatal sepsis. |

| |10. Neema kayange. Erasmus kamugisha. Predictors of positive blood culture and deaths among neonates.BMC pediatrics. |

| |. |

| |11. R.viswanathan. P. Das. S. Das. Etiology and antimicrobial resistance of neonatal sepsis at tertiary care center: Indian journal|

| |of pediatrics. October 2010. |

| |12. C. V. Nirmala.Research Methodology in nursing. Jaypee brothers publication.34-35. |

| |13. Schuchat A.Zywicki S S.Risk factors and opportunities for prevention of Neonatal Sepsis. PENS study group. |

| |14. Dawodu A. Al Umran K.A case control study of Neonatal Sepsis. Journal of trophical pediatrics. January 2005. (72). 23-26. |

| |15. Chacko Betty. Sohi Inderpreet.Early Onset of Neonatal Sepsis. Indian journal of pediatrics. January 2005 (72). 23-26. |

| |16. Jose B Lopez and Gil D Coto Cotallo. BMC pediatrics. Evaluation of pediatrics for diagnosis of neonatal sepsis of vertical |

| |transmission.26 February 2007. |

| |17. NLM. Medline citation. Household practices that affect the Neonatal health. |

| |18. Mahtab.S. Bamji.impact of women health and nutrition and mothers knowledge and health related practices.indian journal of |

| |perinatology. 5th August 2010.5-6. |

| |19. M. Vishnuvardan Rao. Effectivaness of home based management of Neonatal Sepsis. |

| |20. Abada Teresa SJ .Thesis on Social Behavioral Aspect of Mothers Health Behavior and Neonatal health and Risk Factors for |

| |Analysis of Neonatal Sepsis.2004.10-11. |

| |21. Chan Fai Moon, Kwong suet wing, Zang li-yu aan yuk po. Evaluation of osteoporosis prevention education program for young |

| |adults. Journal of advance nursing. 2007. January3(57).270-285. |

| |22.MS. N. Ramanjamma. the effectiveness of self instructional module on causes , hazards, and prevention of child labour among |

| |mothers. Dept.of pediatric nursing. Goutham college of nursing:2007. |

| |23. Saundar Rao P S S . Richard J.Introduction to Biostatistics and Research Methods.Prentice Hall of India. 4th edition.2006. |

| |94-96. |

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