RESEARCH STUDY ON KANGAROO MOTHER CARE

“A STUDY TO ASSESS THE KNOWLEDGE GAIN WITH VIDEO ASSISTED TEACHING ON KANGAROO MOTHER CARE AMONG B.SC NURSING III YEAR STUDENTS AT NIMS COLLEGE OF NURSING HYDERABAD”

By

MS.G.R.NEELIMARANI

Dissertation submitted to NIMS Deemed University,

Nizam’s Institute of Medical Sciences, Hyderabad

In partial fulfillment of the requirements for the degree of

Master of Science in Nursing

In Obstetrics & Gynaecological Nursing

Under the guidance of

Mrs. T. Sudha

Department of Obstetrics and Gynaecological Nursing

NIMS, College of Nursing

Hyderabad, October – 2009

INTRODUCTION

Mrs. Kangaroo, is it true

You are hiding someone new

In the pocket part of you?

There must be someone new and growing

                                It’s little ears have started showing.                                     In talking to the kangaroo,

Its opinion would be

To care “for your child as

My mother cared for me.”

In order to be stable,

When you are able,

“Care for your child the way

My mother cared for me.”

Close to her heart –

Warmth, gentle beating,

Love unfleeting.

Research shows it’s so,

This Kangaroo Care.

No matter what the species,

It’s a mother’s care.

Kangaroo care is a technique of direct skin - to - skin contact between mothers (or fathers) and their premature infants. It has shown to improve the mothers psychological state, strengthen mother and infant bonding and stimulate maternal lactation.

          Dr. Nils Bergman, Medical Superintendent of Mowbray Maternity Hospital in Cape Town, South Africa, has been researching KMC for twelve years. He believes restoring the original model of the infant-mother early care rather than our present incubator, bottle and feeding formula model can result in happier and healthier babies.

          Inferring from mammalian animal behavior, believe that there is much wrong with our present way of treating the newborn. On recent findings in neuro-endocrinology. Bergman explains that it is the newborn infant itself which begins and directs the attachment process that is aided by skin contact with the mother. The mother responds to her infant’s “attachment program” and mother and infant set up a mutually stimulating system to which both respond by altering hormonal outputs. As an example, Bergman says that if the newborn is placed on the mother’s chest, within one hour, the baby will pull itself to the breast, find the nipple and begin nursing.

          One of the problems with our present attitude of unnecessarily separating mother from infant is that the newborn exhibits the protest-despair response as soon as it is removed from her. This sorrowful and despairing wailing is the survival mechanism of an infant in pain trying to bring its mother back. Sadly, if this doesn’t work, and the mother doesn’t appear, the baby becomes too tired to cry any more. It gives up in despair, and to conserve energy for survival. I believe that it is not only an automated reflex as the baby consciously wants to be with its mother. Many of us in primal therapy have discovered this truth.

NEED FOR STUDY

          The skin-to-skin contact of the mother and child allows for a needed emotional closeness of both as well as allowing the production of essential bonding hormones. I wonder if the bonding which occurs between mother and child is the result of being loved or because of hormones? Perhaps one cannot exist without the other!

              Although women of many cultures have carried their infants against their breasts for centuries, KMC as described above was rediscovered in Bogota, Colombia in the 1970s in response to shortages of people power and other resources in hospitals there. Drs Rey and Martinez developed KMC as a method of ambulatory care for low birth weight infants in their hospital where there had been high morbidity and mortality among these infants due to overcrowding and sepsis. As soon as the infants are stable and the mothers trained in the KMC method, the infants are sent home, irrespective of weight or gestational age, carried between their mothers' breasts at all times and fed only mothers' milk. They are followed Up at a special KMC clinic. The dramatic improvement in the outcome of the Bogota patients prompted investigation from the WHO, UNlCEF and soon North American. European and other health services around the world were putting KMC into practice in addition to, and in some instances instead of, their conventional methods of LBW infant care. As per the current scenes 30 million pre term babies are born world wide. Numerous studies have show KMC to be a safe and effective method of caring for these infants.

                The educational offerings highlighting the knowledge and skills needed to provide kangaroo care safely and effectively enable the student nurses to overcome barriers to the practice of kangaroo care. In addition knowledgeable practitioners need for develop evidence based procedures that will lead to successful kangaroo care which can minimize the infant mortality rate to certain extant.

PROBLEM STATEMENT:

 “A study to assess the knowledge gain with video assisted teaching on kangaroo mother care among B.Sc nursing III year students at NIMS College of nursing Hyderabad”

THE OBJECTIVES OF THE STUDY:

1.     To assess the level of knowledge of B.Sc nursing students on kangaroo mother care.

2.     To develop video assisted teaching on kangaroo mother care.

3.     To analyze the effectiveness of video assisted teaching by giving post test.

4.     To analyze significant difference between pre test and post test score with‘t’ test.

5.     To find the association between post test knowledge scores and selected variable.

VARIABLES

INDEPENDENT VARIABLES :

                   In the present study, the independent variable is video assisted teaching on kangaroo mother care.

DEPENDENT VARIABLES :

                   The dependent variable in the present study is knowledge gain by B.Sc Nursing students.

OPERTATIONAL DEFINATIONS OF TERMS

Knowledge:-

Refers to the level of understanding of  B.Sc nursing III year students regarding kangaroo mother care as measured by their correct responses to knowledge items of questionnaire.

Video assisted teaching:-

          Set of teaching prepared by investigator regarding meaning, purpose, position, equipment, procedure and complications of kangaroo mother care by the help of video.

B.Sc nursing III year students:

         The students who have opted to study the graduate programme in nursing which will be of 4 years duration.

B.Sc nursing III year students studying in NIMS college of nursing Hyderabad will be selected

Kangaroo mother care:

Kangaroo care seeks to provide restored closeness of the newborn with mother and/or father by placing the infant in direct skin-to-skin contact with one of them. This ensures physiological and psychological warmth and bonding. The kangaroo position provides ready access to nourishment. The mother's body responds to the needs of the infant directly, helping regulate temperature more smoothly than an incubator, her milk adjusts to the nutritional and immunological needs of her fragile infant, and the baby sleeps more soundly

ASSUMPTIONS

      It is assumed that

-       B.Sc nursing III year students participating in the study will have some knowledge regarding kangaroo mother care.

-       The video assisted teaching programme prepared by the investigator will be appropriate to improve B.Sc nursing III year students knowledge on kangaroo mother care.

-       Tool prepared will be appropriate to collect data regarding kangaroo mother care.

-       The B.Sc nursing III year students who are studying at NIMS College of Nursing Hyderabad will participate willingly in the study.

HYPOTHESIS:

On the basis of objectives and review of literature,  the following research hypothesis have been formulated

H1– There will be significant association between knowledge of B.Sc nursing III year students on kangaroo mother care with selected variables.

H2 – There will be significant difference between pre test and post test knowledge scores.

NULL HYPOTHESIS:

H01- There will be no association between knowledge of B.Sc nursing III year students on kangaroo mother care with selected variables.

H02 – There will be no significant difference between pre test and post test knowledge scores.

ABSTRACT

MAJOR FINDINGS, CONCLUSIONS, LIMITATIONS, IMPLICATIONS AND RECOMMENDATIONS

A Pre experimental approach with single group pre test and post test was under taken to assess the “knowledge gain on kangaroo mother care with the help of video assisted teaching programme among B.Sc nursing III year students at NIMS College Of Nursing, Panjagutta, Hyderabad”.

OBJECTIVES OF THE STUDY

Ø To assess the knowledge of B.Sc nursing III year students regarding kangaroo mother care during labor.

Ø To develop and administer video assisted teaching programme.

Ø To analyze the knowledge gain of video assisted teaching programme by giving post test.

Ø To analyze the significance difference between pre test and post test.

Ø To see the association between pre test scores knowledge and selected variables.

      The investigator planned the study in effective manner by review the related literature and recommendations of the previous studies, which helps in formation of conceptual frame work and methodology for the study and to plan the analysis of the data in effective and efficient way.

      The investigator plan or form the conceptual frame work, adopted for this study, is based on Dorothy john. Which consist of an Open system, the energy, matter or information move into and out of them.  All living systems like people, family, community etc., are Open systems.  An Open system consists of input, through put, process and output.  According to the theorist, the information, matter and energy, which the system receives from the environment, is considered the input.  The system uses, organizes and transforms the Input such proves is called the Throughput.  Through this Throughput, the system releases the information, energy and matter as output into the environment.  The output that retains to the system is called the ‘ feed back ‘.

          In this study, the investigator considers the system as the NIMS College Of Nursing  and BSc nursing III year students as the sub-system.  The whole area or community is considered as an open system.  This processes input, through put, output and feed back.

A pre experimental design with single group pre test and post test research approach adopted for this study? Systematic random sampling technique is used and sample size was 30 B.Sc nursing III year students who are studying at NIMS College Of Nursing, Panjagutta, Hyderabad.

       The questionnaire prepared by the investigator after thorough literature review, consultation with guide and subject experts. The tool used for data collection was structured questionnaire in which section-I consist of demographic variables, section-I consist of knowledge assessment on kangaroo mother care.                    

         The validation of the tool was done by subject experts. The reliability of the tool was done by test and retest method and found to be reliable and feasible.

         After getting permission from the College authority, the investigator conduct pilot study on 10 B.Sc nursing III year students who are studying at KAMINENI College Of Nursing, Hyderabad and the results revealed that it is feasible to proceed further with the  actual study. The actual study was done on 30 B.Sc nursing III year students who are studying at NIMS College Of Nursing, Panjagutta, Hyderabad.

       Researcher planned VIDEO ASSISTED TEACHING programme on kangaroo mother care, pre test was conducted on the first data and implemented the video assisted teaching programme on kangaroo mother care on subsequent days. The sample subjects were actively participated in video assisted teaching programme. Post test was conducted after 5^th day of video assisted teaching programme. Depending upon the objectives of the study the data was collected, analyzed and interpreted. Descriptive and inferential statistics was used for data analysis and interpretation. The major findings of the study are summarized as follows.

Findings related to sample characteristics:

·        Majority of  B.Sc nursing III year students 23 (76.6%) belong to the age group of 19 – 20 years, and the rest 7 (23.3%) students belongs to the age group of 21 – 22 years

·        Majority of  B.Sc nursing III year students18 (60 %) were female students and, 14(60 %) were male students in the study.

·        Majority of  B.SC Nursing III year students 14(46.6%) were from Hindu religion, 04 (13.3%) were from Muslim religion, 12 (40 %) were from Christian religion, there is no sample from Other category.

·        Majority of  B.SC Nursing III year students 29(96.6%) belongs to nuclear families, and 01 (3.3%) belongs to joint family.

·        Majority of  B.SC Nursing III year students 16(53.3%) were having the family income of above R      s10,000/month, 09 (30%) were having the family income of Rs 9999 – Rs 7000/month, 04 (13.3 %) were having the family income of Rs 6999-Rs4000/month only 01 (3.3%) had the family income of below Rs 4000/ month.

·        Majority of B.SC Nursing III year students 13(43.3%) were having Television as source  of  information, 11 (36.6%)were having news paper as source  of  information the family income of 9999 – 7000/month, 03 (10 %) were having internet access as source  of  information the family income of 6999 – 4000/month, only 03 (10%) were having magazines as source  of  information .

·        Majority of B.SC Nursing III year students 24 ( 80%) have not received teaching about KMC earlier ,and only 06( 20% )  had received teaching on KMC

Findings related to pre test and post test scores of knowledge and association between selected variables and knowledge level scores of B.Sc nursing III year students.

·        There is association between knowledge scores of B.Sc nursing III year students with selected demographic variable like ever received teaching regarding kangaroo mother care, Hence, the research hypothesis is accepted and null hypothesis rejected for these variable.

·        Total score and item wise analysis on kangaroo mother care among B.Sc nursing III year students are found to be improved (35.22) with pre test and post test scores, hence, null hypothesis is rejected and research hypothesis accepted.

·        Comparison of pre test and post test knowledge scores of B.Sc nursing III year students, with pre test scores the students at below average level is about 70% and at average level is about 30%. In post test the students at  average level is about 36.66% and above average level is about 63.33%.

·        Effectiveness of  video  assisted teaching on kangaroo mother care shows, an improvement of knowledge scores with pre test and post test by using paired ‘t’ test. The ‘t’ value is 9.6429 at 29 degrees of freedom, it shows highly positive. Hence research hypothesis (H2) is accepted and null hypothesis rejected. (H02).

CONCLUSION

·        Significant difference in pre test and post test knowledge scores of  B.Sc nursing III year students on kangaroo mother care.

·        The association between  knowledge scores of  B.Sc nursing III year students with selected demographic variables

·        Effectiveness of video assisted teaching  on kangaroo mother cares show highly significance, it shows video assisted teaching was more effective.

IMPLICATIONS OF THE STUDY

The results obtained from the study helped the researcher to drive certain implications for nursing practice, nursing administration and nursing education.

Implication for nursing practice:

Most of B.Sc nursing III year students are not aware of kangaroo mother care because of ignorance and not utilization. Use of kangaroo mother care is very important in clinical practice as it is very helpful for the low birth weight babies, pre term babies and full term babies also in helping them to maintain the normal body temperature, pulse, respirations, and gaining body weight by exclusive breast feeding, and also helps in good bonding between the mother and the baby. 

As India is a developing country where in many places the availability of incubators and warmers are not seen so this method of caring can be used as an substitute for conventional way of caring the babies which needs very less equipment and less costly way of caring with little knowledge.

Nursing administration:

As in the present scenario where there is there is lack of man power and money in developing countries. It is very much needed that in NICU or other wards 1:1 ratio is needed for caring the newborns but it is not maintained and the administrators are finding it difficult to manage the situation and over burdening the staff.

So in order to solve this easily mothers Can be made as a part of care givers where they can be thought how to take care of their babies through kangaroo mother care and the 1:1 ratio can be maintained in hospitals and even early discharge with good knowledge of mother on caring can minimize the hospital expenses.  The number of care givers (staff) need not be raised the present staff can be trained in giving good supervision when mothers are caring for their babies.

Nursing education:

Today’s nursing students will be tomorrow’s full fledged nurses who will be practicing at bed side. So it is recommended to the nursing education department that implementation of video assisted teaching in their curriculum will bring good results in their learning and improve their skills and knowledge in many aspects.

As pertaining to kangaroo care it is the simple and best way of caring their babies by mother and family members it should be thought to nursing students so that they can practice that in the clinical set up and teach many mothers as they come across. This aspect should be included in their syllabus and emphasis is to be given on this topic.

Nursing research:

·        The professional and student nurses can conduct studies on kangaroo mother care.

·        The study will be a motivation for other researchers to conduct similar study or larger population with different variables.

·        Disseminate findings through conference, seminars and publications in professional, national and international journals.

·        The study will be a reference for research scholars.

LIMITATIONS OF THE STUDY

·        The study findings were applicable only to the B.Sc nursing III year students who were studying at NIMS College Of Nursing, Panjagutta, Hyderabad.

RECOMMENDATIONS:

·        A similar study can be conducted on larger population

·        A Similar study can be conducted on sample with different demographic variables

·         A Comparative study can be conducted to assess the practices of   staff nurses on KMC in various hospitals.

·        A comparative study can be conducted assessing the effectiveness of structured teaching programme and video assisted teaching programme.

·        The descriptive study can be conducted to know the attitude of mothers on kangaroo mother care.

·        A Similar study can be conducted on low birth weight babies and see the effect of kangaroo mother care

·        A comparative study can be conducted on two groups of new born babies to see the effectiveness of kangaroo care.

·        An experimental study can be conducted on new born babies to assess the weight gain, temperature maintenance by kangaroo mother care.