A Quasi Experimental Study to Assess the Effect of Self Instructional Module on Knowledge of Staff Nurses regarding Baby Friendly Hospital Initiative Policy at selected Hospitals of Jalandhar, Punjab

 

Ms. Kalpna Bhatia¹, Ms. J. Sobiya²

¹M Sc. Nursing Student, S.G.L. Nursing College, Semi, Jalandhar

 

ABSTRACT:

The Baby Friendly Hospital Initiative policy aimed to improve hospital-based breastfeeding rates through the implementation of the Ten Steps to Successful Breastfeeding. In India many hospitals still are lagging behind in implementing the policy due to insufficient staff, excessive tasks performed by nurses, lack of continuity in the health team work and insufficient knowledge of the staffs regarding the policy and find no time to educate mothers regarding the policy. The  main objective of the study is to assess the pre-test knowledge level of staff nurses regarding Baby Friendly Hospital Initiative Policy in control and experimental group, to assess the post-test knowledge level of staff nurses regarding Baby Friendly Hospital Initiative Policy in control and experimental group, to compare the pre-test and post-test knowledge level of staff nurses regarding Baby Friendly Hospital Initiative Policy in control and experimental group and to determine the association between knowledge of staff nurses with their selected socio-demographic variables. The study was conducted on 60 samples selected by purposive sampling technique. Pre-test of both groups were taken, which was followed by Self Instructional Module for the experimental group. Post-test was taken one week after the Self Instructional Module in both groups. Descriptive and Inferential statistics were used in data analysis. The knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy was inadequate in pre test and whereas the knowledge was improved during the post test. Self instructional module was effective in improving the knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy. In control group there was no significant (tcal 0.67 less than ttab 2.05 at <0.05) difference between pre-test (12.50±2.29) and post-test (12.67±2.19) knowledge regarding Baby Friendly Hospital Initiative Policy. Whereas In experimental group there was significant (tcal 15.447 more than ttab 2.05 at <0.05) difference between pre-test (13.80±2.75) and post-test (21.67±2.32) knowledge of staff nurses working in obstetric and paediatric ward. Hence the research hypothesis was accepted and null hypothesis was rejected. The study concluded that self instructional module had significant impact on improving the knowledge regarding Baby Friendly Hospital Initiative Policy.

 

 

 

INTRODUCTION:

Nurses are the back bone of the health care delivery system. They are committed to care for all persons across life cycle. Being a primary health care delivery personnel he/she can teach the mothers about breast feeding, its importance, benefits. Nurses, working in NICU, PICU and Newborn ward should know the importance of breast milk. But this concept is still not very familiar in Indian hospitals. It is the duty of nurses to give education to the mothers about  of breast feeding. Therefore it is necessary for the nurses to have adequate knowledge regarding the breast feeding¹.

 

Breast feeding is a natural way of feeding the infant with the milk directly from the mother’s breast. It is a living fluid and contains exactly the right amount of nutrients required by a baby, in the right proportions, to ensure that the baby gets the perfect balanced meal. The benefits of breast milk are incalculable and incomparable. It’s a complete mixture of nutrients & antibodies. Varying composition of breast milk keeps pace with the infant’s individual growth and changing nutritional needs. It prevents many gastro-intestinal disorders in infants, reduces the risk of breast, ovarian, cervical, and endometrial cancers in mothers².

 

With this background, world alliance for breastfeeding promotion started the program appropriately baby friendly hospital initiative to promote, protect, and encourage exclusive breastfeeding in all hospitals. The initiative encourages health professionals to promote, protect, and support breastfeeding as the optimal method of infant nutrition and enables families to make an informed choice about infant feeding³.

 

Lack of knowledge regarding exclusive breast-feeding among the mothers is a major cause of their children sufferings. Mostly infection during the infancy due to lack of immunity. This leads to high infant mortality rates in India. The investigator felt the need for the study to create awareness in nurses about the BFHI policy implication in their practices. So, the nurses can guide the mothers for exclusive breast feed to their infants.

 

NEED OF THE STUDY:

Breast-feeding is the normal method of infant feeding, but many people choose to feed their newborn babies on infant formula. While babies grow & develop with their method of feeding, there is evidence of disadvantages for infants that are not breast-fed³.

 

A study was conducted regarding Optimizing Breastfeeding in the Newborn. The results show that the ‘Ten steps to successful breastfeeding’ and the Baby Friendly Hospital Initiative are effective measures to increase breastfeeding initiation, duration, and exclusivity. A recent national survey reveals that significant health care workers are not providing evidence based recommendations for breastfeeding guidance and support⁵.

 

Investigators personal experience from day to day staff’s practices in hospitals, though nurses play a pivotal role in supporting and motivating mothers regarding breastfeeding, many hospitals in India still are lagging behind in implementing the policy either due to insufficient staff, excessive tasks performed by nurses, lack of continuity in the health team work, out-of-context guidelines, lack of commitment with the proposal, lack of continuing education program of the staff regarding the policy. They find no time to educate mothers regarding the policy. Hence it was required to timely evaluate knowledge and to bring about positive attitude in the staffs regarding the implementation of ten steps of Baby Friendly Hospital Initiative policy in their hospitals and thus contribute in the reduction of infant mortality and morbidity.

 

REVIEW OF LITERATURE:

Lynette Carmen Daniels, Debra Jackson, L Jacob (2011), conducted a cross-sectional descriptive study to assess nursing staff knowledge, attitudes and practices regarding the Baby-Friendly Hospital Initiative. Total 45 nursing staff nurses were interviewed. A total of 56.6% of the staff could define rooming-in, 47.2% could define the components of the BFHI, and 52.8% could name three baby-friendly care practices and routines. 89% of the nursing staff were able to demonstrate correct positioning of the baby for breastfeeding, and 91.1% could demonstrate the correct attachment of the baby to the breast. Only 8.9% of the nursing staff were able to adequately demonstrate the correct hand milk-expressing technique, 35.6% knew about the correct management of painful nipples and 22.2% knew how to manage engorgement. Only 40% could adequately describe the safe preparation of infant formula. The majority of the nurses had a positive attitude toward BFHI principles and practices⁶.

 

Puoane T (2006), carried out a study to assess the effect of BFHI training on knowledge, attitudes and support practices of nurses with regards to exclusive breastfeeding. . A total of 298 nurses in maternal and child health care units were interviewed, of these 113 (37.1%) had participated in the BFHI training workshop. Significantly higher proportions of the BFHI trained nurses had the correct knowledge regarding the causes and management of common breastfeeding problems. The overall knowledge scores of the BFHI trained nurses were significantly higher than that of the untrained. The findings show that nurses who had participated in the BFHI training workshop were significantly more knowledgeable about some aspects of exclusive breastfeeding; they had more positive attitudes and were more likely to employ correct practices for the promotion of exclusive breastfeeding⁷.

 

Okolo and Ogbonna (2002), conducted a randomized cross sectional study to assess knowledge of health workers toward BFHI. The staff interviewed had no BFHI training. The study found a lack of awareness of some major recommended BFHI practices that promote and sustain breastfeeding. 21% of staff were aware of the need for initiating breastfeeding, 36.8 % were aware of breastfeeding support groups. Only 5.22 % could demonstrate correct positioning and attachment, while 19.2 % of staff believed that babies less than six months of age should be given water⁸.

 

MATERIALS AND METHODS:

The Quantitative research approach and Quasi Experimental research design (Non randomized control group design) was adopted in the present study to assess the Effect of Self Instructional Module on Knowledge of Staff Nurses Regarding Baby Friendly Hospital Initiative Policy at Selected Hospitals of Jalandhar (Punjab). The conceptual framework used for present study was based on Imogene King’s Theory of Goal Attainment.

 

The research design used for the present study was Quasi Experimental research design (Non randomized control group design. The study was conducted at selected hospitals of Jalandhar, Ankur kids superspeciality hospital  Jalandhar, Sigma hospital Jalandhar, Civil hospital Jalandhar, Doaba Hospital Jalandhar, Punjab. The target population was the staff nurses working in obstetric and paediatric ward of selected  hospitals of Jalandhar, Punjab. Sample size was 60 nurses working in obstetric and paediatric ward of selected  hospitals of Jalandhar, Punjab. There were 30 in control group and 30 in experimental group. Purposive sampling technique was used to select the sample.

 

DEVELOPMENT OF TOOLS:

Part A:

This tool includes socio demographic data of the subjects.

 

Part B:

This section consisted Self structured  knowledge questionnaire regarding Baby Friendly Hospital Initiative Policy

 

Criterion Measure for level of Knowledge

Sr. No.	Level of knowledge	Score
1.	Good	(19-28)
2.	Average	(10-18)
3.	Low	(0-9)

Maximum score =28

Minimum score =0

 

ETHICAL CONSIDERATIONS:

1.       Written permission was taken from the institutional ethical committee.

2.       Written permission was taken from medical director of selected hospital.

 

 

 

3.       Informed consent was taken from each subject prior data collection.

4.       Confidentiality and anonymity of responses was assured and maintained throughout study.

 

RESULTS AND INTERPRETATION:

Table 1 Frequency and Percentage distribution of the demographic characteristics among the subjects. N=60

		Control         Group                                                                                         n=30	Experimental Group n=30
Sociodemographicvariables		N        %	N     %
Age (in years)	21-25 26-30 31-35 Above 35	20       67 5        16 2         7 3        10	21    72 1      0.3 3      10 5      17
Professional qualification	GNM   Post Basic-B.Sc. Nursing B.Sc. Nursing	16       52 7         24   7        24	6      20 6      20   18    60
Total work experience (in years)	0-2 2-4 4-6 Above 6	23      77 3        10 0          0 4         13	19      63 2          7 3        10 6        20
Experience in Obstetric and Paediatric ward (in years)	0-2 2-3 3-4 Above 4	23       77 3         10 0           0 4          13	23      77 0          0 0          0 7         23
Sector of Working	Private Sector   Government Sector	15       50 15       50	30      100 0            0
Area of working	Obstetric ward     Paediatric ward	15       50 15       50	15      50 15      50

 

Table 2: Frequency and percentage distribution of pre test knowledge level of staff nurses regarding Baby Friendly Hospital Initiative Policy in control and experimental group.

Level of knowledge
Level             Score
Control                         Experimental                                                      Group                           Group
n=30                              n=30
Pretest                           Pretest                                                                             n                %               n                  %
Good	(19-28)	0	0	0	0
Average	(10-18)	27	90%	28	93.3%
Low	(0-9)	3	10%	2	6.7%

Maximum=28

Minimum =0

 

Table 2: depicts in control group majority 27(90%) of staff nurses had average knowledge and minority 3(10%) of staff nurses had low knowledge regarding Baby Friendly Hospital Initiative Policy. In experimental group majority 28(93.3%) of staff nurses had average knowledge and minority 2(6.7%) of had low knowledge regarding. None staff nurses from control and experiment group had good knowledge.

 

Table 3: Frequency and percentage distribution of post test knowledge level of staff nurses regarding Baby Friendly Hospital Initiative Policy in control and experimental group.

Level of knowledge
Level             Score
Control                   Experimental                                                    group                      group
n=30                        n=30
Posttest                   Posttest                                                                      n               %             n                %
Good	(19-28)	0	0	28	93.3%
Average	(10-18)	29	96.7%	2	6.7%
Low	(0-9)	1	3.3%	0	0

Maximum=28

Minimum =0

 

Table 3: depicts  in control group majority 29(96.7%) of staff nurses had average knowledge regarding Baby Friendly Hospital Initiative Policy and minority 1(3.3%) of staff nurses had low knowledge. In experimental group majority 28(93.3%) of staff nurses had good knowledge and minority 2(6.7%) of staff nurses had average knowledge and none of the staff nurse had low knowledge.

 

Table 4: Comparison of pre-test and post-test knowledge level of staff nurses regarding Baby Friendly Hospital Initiative Policy in control and experimental group

Groups	Control group			Experimental group
	n	Mean	SD	n	Mean	SD	‘t’
Pretest	30	12.50	2.29	30	13.80	2.75	0.67NS
Post test	30	12.67	2.19	30	21.67	2.32	15.447*
df=29         t=0.482				df=29                t=16.596*

Significant at p<0.05 level

NS = Non Significant

 

Table 4: Depicts in control group there was no significant (t_cal 0.67 less than t_tab 2.05 at <0.05) difference between pre-test (12.50±2.29) and post-test (12.67±2.19) knowledge regarding Baby Friendly Hospital Initiative Policy. Whereas In experimental group there was significant (t_cal 15.447 more than t_tab 2.05 at <0.05) difference between pre-test(13.80±2.75) and post-test (21.67±2.32) knowledge of staff nurses working in obstetric and paediatric ward. Hence the research hypothesis was accepted and null hypothesis was rejected.

Table 5: Association of Post test Knowledge scores of with  selected socio-demographic variables in Experimental Group.             n=60

Variables	Opts	N	good	average	Low	Chi test	df	Table value
a) Total work experience (in years)	0-2 2-4 4-6 Above 6	19 2 3 6	19 2 3 4	0 0 0 2	0 0 0 0	8.545	3	7.815*
b) Experience in Obstetric and Paediatric ward (in years)	0-2 2-3 3-4 Above 4	23 0 0 7	23 0 0 5	0 0 0 2	0 0 0 0	7.033	1	3.841*

 

a) According to total work experience, the majority of 19 staff nurses were having 0-2 years of total work experience. The calculated value of chi test (8.545) is more than the table value (7.815), hence it is concluded that the association between the total work experience  and knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy in experimental group is significant.

 

b) According to experience in obstetric and paediatric ward, the majority of 23 staff nurses were having 0-2 years of experience in obstetric and paediatric ward. The calculated value of chi test (7.033) is more than the table value (3.841), hence it is concluded that the association between the experience in obstetric and paediatric ward and knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy in experimental group is significant.

 

DISCUSSION:

The findings of the study showed that in control group 27(90%) staff nurses had average knowledge and 3(10)% staff nurses had low knowledge. In experimental group 28(93.3)% staff nurses had average knowledge and 2(6.7)% had low knowledge regarding Baby Friendly Hospital Initiative Policy.The findings of the study was supported by Lynette Carmen Daniels (2011) in Cape Town, was used to assess the knowledge, attitudes and practices of staff nurses regarding the Baby Friendly Hospital Initiative Policy. 45 staff nurses were interviewed in this study. Results of the study showed that in pre test knowledge score, 47.2% staff nurses had moderate knowledge, 52.8% staff nurses had in adequate knowledge and no staff nurse had adequate knowledge regarding Baby Friendly Hospital Initiative Policy.

 

The findings of the study showed that in control group 29(96.7)% staff nurses had average knowledge and 1(3.3)% staff nurses had low knowledge. In experimental group 28(93.3)% staff nurses had good knowledge and 2(6.7)% staff nurses had average knowledge.The findings of the study was supported by Lynette Carmen Daniels (2011) in Cape Town, was used to assess the knowledge of staff nurses regarding the Baby Friendly Hospital Initiative Policy. 45 staff nurses were interviewed in this study. Results of the study showed that in post test knowledge score, 68.3% staff nurses had adequate knowledge, 31.7staff nurses had moderate  knowledge .

 

The findings of the study showed that the comparison of pre-test and post-test knowledge level in control and experimental group. In control group there  was no significant (t_cal 0.67 less than t_tab 2.05 at <0.05) difference between pre-test (12.50±2.29) and post-test (12.67±2.19) knowledge.Whereas In experimental group there was significant (t_cal 15.447 more than t_tab 2.05 at <0.05) difference between pre-test(13.80±2.75) and post-test (21.67±2.32) knowledge.The findings of the study was supported by Lynette Carmen Daniels (2011) in Cape Town, was used to assess the knowledge of staff nurses regarding the Baby Friendly Hospital Initiative Policy. 45 staff nurses were interviewed in this study. Results of the study showed that in pre test and post test knowledge score was 13.05 and in post test it was 24.07 which show that after teaching programme knowledge regarding Baby Friendly Hospital Initiative Policy among staff nurses has increased.

 

The findings of study showed that according to total work experience, the calculated value of chi test (8.545) is more than the table value (7.815), hence it is concluded that the association between the total work experience  and knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy in experimental group is significant. This reveals that total work experience of staff nurse has an impact on knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy.According to experience in obstetric and paediatric ward, the calculated value of chi test (7.033) is more than the table value (3.841), hence it is concluded that the association between the experience in obstetric and paediatric ward and knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy in control group is significant.This reveals that experience in obstetric and paediatric ward of staff nurse has an impact on knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy.

 

CONCLUSION:

The finding of the study indicated a that the knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy was inadequate in pre test and whereas the knowledge was improved during the post test. Self instructional module was effective in improving the knowledge of staff nurses regarding Baby Friendly Hospital Initiative Policy. There is significant difference between pre test and post test scores were demonstrated by using “t” test. The analysis of the knowledge  score in the pre test and post test of experimental group revealed that the mean pre test knowledge score was 13.80, where as post test knowledge score was 21.67. The mean difference 7.87 shows the effectiveness of Self Instructional Module regarding Baby Friendly Hospital Initiative Policy.

 

 

REFERENCES:

1.        Hands A. Safe storage of expressed breast milk in the home. MIDIRS Midwifery Digest. Apr 2003,13(9): P 378-85.

2.        Dutta P. Pediatric Nursing. 2^nd ed. New Delhi: Jaypee publishers; p. 24,25, 51.

3.        RamanTSR, Parimala.V, Iyengar A. Baby friendly hospital initiative experiences from a service hospital   Medical Journal Armed Forces India(serial online) 2001 Jan; 57(1):23-5.

4.        Marlow. R Dorothy textbook of pediatric nursing, 6^th ed. Elsevier publication 2013, p: 273, 274.

5.        Cramton R, Zain-Ul-Abideen M, Whalen B, Optimizing successful breastfeeding in the newborn. Curr Opin Peditr serialonline 2009Jun.; 21(3):38696, Available from: URL:http://www.Pubmed.com.

6.        Lynette Carmen Daniels, Debra Jackson, L Jacobs. Knowledge, attitudes and practices of nursing staff regarding the Baby-Friendly Hospital Initiative in non-accredited obstetric units in Cape Town Vol 24, No 1 (2011).

7.        Puoane T, Sanders D, Ashworth A, Ngumbela M,” Training nurses to save lives of malnourished children” Curationis. 2006 Mar;29(1):73-8.

8.        Okolo, S.N., Ogbonna, C. (2001). Knowledge, attitudes and practice of health workers in Keffi local government hospitals regarding Baby Friendly Hospital Initiative practices, European Journal of Clinical Nutrition, 56: 438 – 441.

 

 

 

 

Received on 12.09.2019          Modified on 16.10.2019

Accepted on 12.11.2019     © A&V Publications all right reserved