Effectiveness of Nurse Led Educational Intervention on Knowledge regarding New-born Care among Hospitalized Primi-mothers

A. Priscillal Devakirubai¹, Firdaus Shaikh², Manisha Jukaria², Neethu Sukumaran²,

Sukmita Rai², Rajashree T. R.²

¹Professor and HOD, R&D Department, RV College of Nursing, Bangalore.

²Ward Sisters in Military Nursing Service.

*Corresponding Author E-mail: apriscillalde@gmail.com

ABSTRACT:

The care new-born receives in the initial weeks is the key to their successful outcome and the vital factor in the survival and future development of the new born. Rooming in promotes better emotional bonding between the mother and the baby and facilitate mothers’ involvement in baby care. The health and survival of the new-born baby depends upon the health status of the mother and her awareness, education and skills in mother craft thus she plays a pivotal role in the life of her infant. The objectives of the study were to assess the effect of Nurse Led Educational intervention on knowledge regarding new born care among hospitalized primi mothers and to associate the knowledge with selected demographic variables. Research approach and design – quantitative, pre-experimental design. Convenient sampling technique adopted and included 30 samples. Tool – self-administered questionnaire with 25 items prepared and used for collecting data. Data analysed and interpreted using descriptive and inferential statistics. Based on knowledge score subjects were divided into inadequate knowledge (<33.3%), satisfactory knowledge (33.4 – 66.6%) and adequate knowledge (66.7-100%) category. Among the study participants 60% of them belonged to 20-25 yrs of age category and of undergraduate qualification. Mean age of the group was 25.7 years. Fifty seven percentages (57%) of the participants were from nuclear family. Post-test knowledge was higher than the pre-test knowledge. In the pre-test 70% belonged to satisfactory knowledge category where as in post-test 76.6% were in adequate knowledge category. In both the pre-test and post-test no one in inadequate knowledge category. Knowledge on New born care was categorised into three components i.e. baby care, breast feeding and follow up care. In pre-test all three components score ranged from 59.72% to 63.7% and in the post test components score ranged from 89.4% to 91.6%. Knowledge in all three components showed maximum increase in the post test score. There was no association found between knowledge and selected socio demographic variables namely age of the mother, education of the mother and type of family. The present study concluded that majority (70%) of the mothers admitted in tertiary care hospital had satisfactory level (33.4 – 66.6%) in the pre-test and adequate knowledge (66.7-100%) in the post test on new born care which shows that Nurse Led Educational intervention had improved the knowledge of the hospitalized primi mothers.

KEYWORDS: Nurse Led Educational intervention, Knowledge on new-born care, Follow up care, Breast feeding, Hospitalized Primi-mothers.

INTRODUCTION AND NEED FOR THE STUDY:

The care newborn receives in the initial weeks is the key to their successful outcome and the vital factor in the survival and future development of the newborn.¹The baby must be provided basic care to ensure its survival and optimum growth and development.² Mother plays a key role in identifying minor deviations as she is constantly and closely watching her baby. A cross sectional interview among 170 mothers in Karachi, Pakistan revealed that antenatal care coverage was good, whereas the knowledge regarding new born care was poor which even recorded some of the harmful practices regarding new born care. Expressed that health education can improve the mothers’ knowledge regarding new born care practices.¹

A descriptive study carried out in South India during April – July 2009 among 100 postnatal mothers’ to assess the knowledge, attitude and practices of neonatal care. Knowledge of mothers was inadequate in areas of umbilical cord care (35%), thermal care (76%) and vaccine preventable Diseases. Result indicates that awareness and attitude of postnatal mothers towards neonatal care has lots of lacunae especially in those who belong to the lower socioeconomic status. There is need for education for antenatal mothers at primary care level.²A cross-sectional study among 200 postnatal mothers at Shahid Beheshti hospital, Kashan, identified that the knowledge of new born care among mothers was inadequate and also indicated the need for educational program on new born care.³

A cross-sectional study to assess the knowledge of new born care practices among 211 post natal mothers admitted in post natal ward at Dhaka medical college hospital. Result showed that half (51.7%) mothers had moderate level of knowledge and about a third (37%) had good level of knowledge and majority had poor to moderate knowledge.⁴

Assessment on knowledge and practices among 384 postnatal mothers on aspects of essential new-born care at Juba teaching hospital, South Sudan, showed existence of adequate knowledge towards breast feeding and knowledge gap in cord care, immunization, eye care and thermoregulation.⁵Maternal knowledge in selected components of newborn care i.e., thermoregulation, breastfeeding, immunization, cord care, eye care and danger signs in neonate among 380 postnatal mothers in Kenyatta National hospital, revealed that knowledge was inadequate among mothers regarding the eye care, care of low birth weight, thermoregulation, immunisation and danger signs in neonate.⁶

A study among 100 mothers expressed the need for an educational program coupled with effective health care delivery system to improve the level of knowledge on new born care.⁷Pre experimental study assessed the effectiveness of structured teaching programme (STP) on knowledge about postnatal care, among 60 postnatal mothers in tertiary care hospital Uttarakhand. The result showed that the STP was an effective method in enhancing the knowledge of postnatal care among postnatal mothers.⁸

A descriptive study assessing the knowledge on new born care in the selected civil maternity hospital, Belgaum, Karnataka among 50 primi mothers. The result showed that the mean knowledge value on new born care of primi mother was 67.2 and the primi mother had adequate knowledge.⁹Similardescriptive study assessing knowledge of mothers on neonatal care in the selected community areas of rural Bangalore among sample of 50 mothers. The result showed that majority had moderate knowledge on neonatal care and the mothers need a health education for practicing neonatal care.¹⁰

A correlational survey assessing knowledge and practice of postnatal mothers on new born care in a tertiary care hospital of Udupi district among a sample of 30 mothers. The study showed the need of an educational programme regarding new born care to the antenatal and postnatal mothers.¹¹

MATERIALS AND METHODS:

Research Design:

Quantitative pre-experimental design. Sampling Technique: non-probability convenient sampling.The number of samples - 30 hospitalized primi mothers. Setting: Tertiary care hospital, Bangalore.

Variables under study:

Independent Variable:

Nurse Led Educational Intervention on new born care.

Dependent variable:

Knowledge among hospitalizedPrimi- mothers.

Hypotheses:

H₁- There will be a significant difference in the pretest and post-test knowledge scores regarding new born care among hospitalized primi mothers.

H₂- There will be a significant association between pre-test knowledge scores and selected demographic characteristics.

Inclusion criteria: Primi Mothers who have completed 37 weeks Period of gestation, undergone full term normal delivery, instrumental delivery or elective LSCS, those who can read and write Hindi or English and willing to participate.

Exclusion Criteria- Primi Mothers who underwent emergency LSCS due to foetal distress and primi Mothers whose babies were admitted in NICU.

Tool: Consisted of two parts. Part I- Baseline Demographic details, Part II - Structured questionnaire regarding knowledge about new born care. Data Collection: Demographic baseline Performa consists of information regarding age, education, relation and type of family. Structured questionnaire regarding knowledge about new born care consisted of 25 multiple choice questions on the topics breastfeeding, skin care, thermoregulation, cord care, eye care, baby clothing, weight recording, immunization and follow up.The questionnaire was in English and Hindi. Tool validity and reliability was checked. Primi mothers were asked to answer the questions after introducing the purpose of the study. The consent form was distributed to the participants prior to data collection. The consent form assured the participants confidentiality. Institutional Ethical Committee permission was obtained for the conduct of the study.

Pilot study:

The investigators conducted the pilot study to assess the feasibility of the study appropriateness of the tool.

Table 1: Distribution as per Socio-Demographic Data N=30

Age (yrs)	Frequency (Percentage)
20-25	18 (60)	Mean Age 25.7
26-30	10 (33.34)
>30	02 (6.66)
Educational status
Secondary	6 (20)
UG	18 (60)
PG	6 (20)
Type of family
Nuclear	17 (56.66)
Joint	13 (43.34)

Inference- maximum participants were from 20-25 age group (60%) and >30 years were the minimum participants (6.66%). Maximum participants were under graduates (60%) and secondary education and post graduates were 20% each. Maximum participants belonged to nuclear family (57%).

Table 2: Distribution with respect to knowledge category regarding new born care N=30

Component	Inadequate Knowledge	Satisfactory Knowledge	Adequate knowledge
Pre Test	-	21 (70)	09 (30)
Post Test	-	07 (23.34)	23 (76.66)

Inference- maximum participants had adequate knowledge in the post-test (76.66%).

Table 3: Pre-test and Post-test Knowledge Score N=30

Group

Test

Mean

t value

P value

N=30

Pre test

14.73

±^2.59

t = 16.1430
df = 29

<0.0001

Post test

22.50

±1.94

Inference: There was a statistically significant increase in the knowledge score after the Nurse Led educational intervention as the p value was <0.0001.

Table 4: Pre-test and Post-test scores on knowledge aspects N=30

Aspects of Knowledge	Test	Mean	SD	t value	P value
Breast Feeding	Pre test	7.17	± 1.18	t =10.7727 df=29	<0.0001 S
Breast Feeding	Post test	10.73	± 0.83	t =10.7727 df=29	<0.0001 S
Baby Care	Pre test	5.73	± 0.94	t = 12.2858 df = 29	<0.0001 S
Baby Care	Post test	8.13	± 0.73	t = 12.2858 df = 29	<0.0001 S
Follow-up Care	Pre test	2.4	± 0.5	t = 11.8942 df = 29	<0.0001 S
Follow-up Care	Post test	3.67	± 0.61	t = 11.8942 df = 29	<0.0001 S

Inference: There was a statistically significant increase in the knowledge score after the Nurse Led educational intervention in all three knowledge aspects as the p value was <0.0001.

Table 5: Association between knowledge on newborn care and selected demographic variables N=30

Age (yrs)	Pre-test score	Frequency	Knowledge score	Chi square	P Value
20-25	263	18	281	0.0043, df =2	p >0.05 NS
25-30	149	10	159
>30	30	02	32
Education status
Secondary	84	06	90	0.0575, df=2	p >0.05 NS
UG	262	18	280
PG	96	06	102
Type of family
Nuclear	243	17	260	0.0278, df=2	p >0.05 NS
Joint	199	13	212	0.0278, df=2	p >0.05 NS

Inference: There was no significant association found between knowledge and selected socio-demographic variables such as age, educational status and type of family of the participants.

DISCUSSION:

In the present study the overall socio demographic characteristics of the participants revealed that 60% of the subjects were between the age group of 20-25 years among 30 samples, majority of them i.e.60% were undergraduates. A total of 57% of them belonged to nuclear family. After the Nurse Led educational intervention 76.66 % of them had adequate knowledge on new born care which was statistically significant as per p<0.0001.

Whereas a study conducted by at Karnataka 52% were in 20- 27 years in 100 primi mothers, 32% were undergraduate. 27% mothers belonged to nuclear family. Mothers with adequate knowledge about new born care were 27%.¹²Other study conducted among 196 samples out of which 31% were between 22-25 years of age. 44.5 % were undergraduates, 51.53% were from nuclear family. A total of 62.76% had adequate knowledge on new born care.¹³

Unlike the current study a cross sectional study done among the caesarean women to identify risk factors associated with breast feeding revealed they did not have any difficulty in the breast feeding the baby except for surgical wound pain.¹⁴ An interventional study done among the primi postnatal women revealed that there was a significant increase in the latch score(t=17.2, p<0.05), increased frequency of breast feeding and increased urine output evident through increased frequency of diaper change among the interventional group women in comparison with the routine group.¹⁵

Study concluded that breast feeding education has to be a part of routine teaching to all the antenatal women attending the clinic. As the study found that those who have adequate knowledge had favourable attitude towards breast feeding.Women had poor knowledge and unfavourable attitude towards breast feeding and also knowledge had significant correlation with the attitude among antenatal mothers (correlation coefficient r was 0.616 which was greater than the table value 0.139 at 0.05 level of significance.^{16, 17}

Study revealed initiation and maintenance of breast feeding was affected by breast crawl observed for three days. The effect was progressed on day two and three of birth.A review article explored the difficulties in breast feeding among the babies having tongue tie, so not only knowledge and attitude assessment but also these kind of factors to be assessed to know the effectiveness of breast feeding.^{18, 19}

Video teaching programme was effective in bringing change in the knowledge of Postnatal primi mothers as the mean pretest score and post test scores were 18.88 and 22.96. the attitude score was 7.023 that was greater than the table value and was significant at 0.05 level of significance.²⁰ Human milk banks are valuable in saving the lives of the babies. These banks help families by providing chance for them to chose a healthy life for their babies. Information on human milk banking is to be given to the receivers as much as possible by the health care workers.²¹

Nurses’ selected using simple random sampling technique underwent planned teaching module on BFHI. In the post test score 80% had high level of knowledge. There was significant difference between the pretest and posttest knowledge score.²²Another video teaching programme was effective in increasing the knowledge on breast feeding techniques among postnatal primi mothers as the mean pretest score and post test scores were 10.11 and 16.78 and the t value was higher than the table value and was significant at 0.05 level of significance.²³

CONCLUSION:

Nurses in their day to day practice need to discuss about new born care and importance with their clients and involve themselves in counselling mothers to bring about favourable attitude towards care of new born. Nurses need co-ordinate interactive discussions with primi-mothers and explain the myths and side-effects related to wrong practices in new born thus creating better awareness.

CONFLICT OF INTEREST:

The authors have no conflict of interest regarding this investigation.

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