INTRODUCTION:

Preterm infants are more likely to develop jaundice than full-term babies. The incidence of jaundice in newborns varies between 20 and 80% depending on gestational age and ethnicity. When jaundice is severe, it has the potential of causing brain damage (kernicterus) with long term neurodevelopmental impairment in survivors or death.¹Hyperbilirubinemia in the first 24 hrs often results in hemolytic diseases of the newborn erythroblastosis fetalis an abnormal rapid rate of RBC destruction.²The causes of neonatal jaundice are large or small for gestational age, prematurity, trisomy syndrome, use of oxytocin in labor, presence of bruising cephalo hematoma and a family history of neonatal jaundice.³Neonatal mortality has gradually increased as a percentage of total, child mortality.

This data are estimated by the survey registration system and national family health survey.⁴

The short post delivery hospital stay, delays in obtaining post discharge appointment, lack of post discharge appointment for mothers delivering in unorthodox settings, lack of knowledge of risk factors for development of significant hyperbilirubinaemia in mothers, increased frequency of breast feeding, lack of concern about high bilirubin levels in newborns among paediatric care providers and late recognition and/or commencement of effective therapy for NNJ are documented factors associated with occurrence of kernicterus.⁵The preparedness of expectant and actual mothers and their ability to detect NNJ early and present the affected babies promptly to appropriate health facility be evaluated by assessing their knowledge, attitude and practice with regard to NNJ.⁶

When the baby is born by caesarian section the milk secretion is slightly delayed and the mothers will also be in pain and in sedation, so the feeding is delayed, these babies are at higher risk for this condition. Mothers should be aware of initiating breastfeeding as early as possible, either she had caesarian section or had a normal delivery.⁷There is an estimated belief that the jaundice is nearly always a self-limited condition of newborns. This belief rather than awarness of jaundice causes late admission for medical care. So education of expectant parents about the fact that pathological jaundice can cause brain damage is essential.⁸The campaign identified key opportunities for parent and family engagement including education of expectant parents about the fact that jaundice can lead to brain damage, asking about a serum bilirubin testing prior to discharge, making and keeping the follow up appointment with a pediatrician within 48 hours after discharge etc.⁹ During 2015, an estimated 7.7 million children under five years of age died worldwide. This included 3.1 million neonatal deaths, 2.3 million post neonatal deaths and 2.3 million childhood deaths (age 1-4 years).¹⁰

OBJECTIVES OF THE STUDY:

1. To assess the pre-test and post -test knowledge score of primipara mothers regarding the management of neonatal jaundice as measured by the structured knowledge questionnaire

2. To evaluate the effectiveness of structured teaching programme in terms of gain in mean post test knowledge score regarding the management of neonatal jaundice among primipara mothers

3. To find out the association between the mean post-test knowledge score of primipara mothers regarding the management of neonatal jaundice with the selected socio demographic variables

HYPOTHESIS (tested at 0.05 level of significance):

H1- The mean post- test knowledge score of primipara mothers regarding the management of neonatal jaundice after structured teaching programme will be significantly higher than the mean pre-test Knowledge score.

H2- There will be significant association between the mean post-test knowledge score of primipara mothers with the selected socio demographic variables.

ASSUMPTION:

1. The primipara mothers have some knowledge regarding the management of neonatal jaundice

2. Structured teaching programme is an effective strategy for improving the knowledge regarding the management of neonatal jaundice among primipara mothers.

OPERATIONAL DEFINITIONS:

1. Evaluate:

In this study, evaluate refers to judge or determine the significant worth or quality of structured teaching programme on management of neonatal jaundice given to primipara mothers.

2. Effectiveness:

In this study effectiveness refers to the extend to which the structured teaching programme on the management of neonatal jaundice of neonates has produced desired effect among primipara mothers as measured by structured knowledge questionnaire.

3. Structured Teaching Programme:

In this study it refers to an organized teaching Programme designed for primipara mothers to provide information regarding causes, hazards and management of neonatal jaundice.

4. Knowledge:

Awareness gained by experience of fact of situation. In this study it refers to the subjects correct response to questions on management of neonatal jaundice by structured knowledge questionnaire and is expressed in terms of knowledge scores.

5. Management:

Refers to the act of treating and handling neonate with neonatal Jaundice by primipara mothers.

6. Primipara Mother:

It refers to a woman who has given birth to one infants capable of survival.

7. Jaundice:

Jaundice is the yellow discoloration of skin the and mucous membrane, due to accumulation of bilirubin in the serum.

8. Neonate:

It refers from birth to 28 days of the baby.

9. Hospital:

It is an institution care given to sick and injured at Gonda, UP

CRITERIA FOR SELECTION OF SAMPLE:

INCLUSION CRITERIA:

1 Primipara mothers in selected Hospitals of Gonda

2 Primi para mothers who are available and willing to participate in the study.

3 Primipara mothers who can read and write Hindi.

EXCLUSION CRITERIA:

1. Primipara mothers who are not willing to participate in the study

2. Primipara mothers who can not able to read and write Hindi.

DELIMITATION:

The study will be delimited to the

1. Primipara mothers of selected Hospitals at Gonda, UP

2. Study period 4-6 weeks.

RESEARCH DESIGN:

The research designs is the plan, structure and strategy of investigation of answering the research questions, is the overall plan or blue print the researcher selects to carry out the study. The research design selected for the present study is one group pre-test and post-test (pre experimental) design, in which pre-test is conducted followed by structured teaching programme and then conducting post-test for the same group after 7 days.

O1--------------X---------------O2

O₁- Pre test knowledge of primipara mothers regarding neonatal jaundice.

X- Structured teaching programme on management of neonatal jaundice.

O₂- Post test the knowledge of mothers regarding neonatal jaundice.

SETTING OF THE STUDY:

“Setting” refers to the area where the study was conducted. It is the physical location and condition in which data collection takes place in a study. This study was conducted in selected hospitals at Gonda.

The criteria for selection of the setting are the availability of subjects, feasibility of conducting the study.

TARGET POPULATION:

Population is a group whose member possesses specific attributes that a researcher is interested to study. Target population in the present study was primipara mothers of selected hospitals at Gonda.

SAMPLE AND SAMPLING TECHNIQUE:

Sample refers to a sub set of population, selected to participate in the research study. Sampling refers to the process of selecting a portion of population to represent the entire population. The sample of this study comprised of 60 primipara mothers of selected hospitals at Gonda. Simple random sampling technique method was used to draw the sample.

Simple random sampling proceeds on the brief that the researcher’s knowledge of population and its elements can be used to hand pick the cases to be included in the sample. It is also said that it is a type of probability sampling method in which the researcher selects the subjects, on the basis of personal judgment about which will be the most representative or productive for the study.

DEVELOPMENT OF THE STRUCTURED TEACHING PROGRAMME:

Structured teaching plan was developed based on Objectives, Review of Literature and consulting with experts. The steps adopted in the development of structured teaching programme were:

Development of Criteria Checklist to evaluate the structured teaching programme:

· Identification and Stating of Objectives in Behavioural Terms

· Selection of the Content

The content of neonatal jaundice was selected through literature search and in consultation with the guides.

SELECTION OF THE TOOL:

Self administered knowledge questionnaire to assess the knowledge of Primipara Mothers regarding management of neonatal jaundice.

DEVELOPMENT OF TOOL:

Self administered structured knowledge questionnaire to assess the knowledge of Primipara Mothers regarding Neonatal jaundice.

The following steps were carried out in preparing the tool.

1. Literature review.

2. Preparation of blue print.

3. Consultation with the guide, statistician, subject experts of Child Health nursing.

4. Establishment of validity and reliability.

DESCRIPTION OF THE TOOL:

In the present study the following tools were used.

Part-I: consisted of 7 items related to demographic data of the subjects such as age, religion, place of residency, family monthly income, previous education status and source of information and academic status in previous year.

Part-II: Structured knowledge questionnaire consisting of 30 items on knowledge regarding Management of Neonatal jaundice. It consist of

ASPECT-I: Knowledge regarding general information about Neonatal jaundice.

ASPECT -II:

Knowledge regarding clinical features of neonatal jaundice.

ASPECT -III:

Knowledge regarding management of neonatal jaundice.

Scoring of Items:

For knowledge questions each correct answer was given a score of ‘one’ and wrong answer a score of ‘zero.’

RELIABILITY OF THE TOOL:

Reliability of the research instrument is defined as the extent to which the instrument yields the same results on repeated measures. It is then concerned with consistency, accuracy, precision, stability, equivalence and homogeneity.

The tool is subjected to test for its reliability after the validation by experts. The structured knowledge questionnaire was administered to 06 samples. The reliability of the tool is computed by using simplified Split Half Karl Pearson’s correlation formula (Raw score method). The reliability co-efficient is found to be 0.87

METHOD OF DATA ANALYSIS:

Descriptive statistics:

1. Frequency and percentage distribution are used to analyze demographic data of Primipara Mothers.

2. Mean, percentage and standard deviation are used to assess the level of knowledge of primipara mothers.

Inferential statistics:

1. Paired ‘t’ test was used to assess the effectiveness of Structured teaching programme.

2. Chi square test was used to find association between post test knowledge score and demographic variables.

RESULTS AND ANALYSIS:

The analysis and interpretation of data of this study are based on data collected through self administred knowledge questionnaire for primipara mothers (N=60). The results were computed using descriptive and inferential statistics based on the following objectives

Presentation of the Data:

To begin with, the data was entered in a master sheet, for tabulation and statistical processing. In order to find the relationship the data was tabulated, analyzed and interpreted by using descriptive and inferential statistics. The data is presented under the following headings.

Section 1: Demographic characteristics of respondents under study.

Section 2: Overall and aspect wise knowledge scores of respondents

Section 3: Analysis of association between Demographic variables with post test

Knowledge scores

FINDINGS:

In the present study the frequency and percentage of demographic variable of participants revealed that majority (48.3%) were in age of 18years; (91.7) % were Hindu; (71.7) % of them resides in rural area; (50.0) % were had previous information about Neonatal jaundice; (60.0) % of participants’ had source of information from mass media; 50.0% of them 50,001-10,000 family monthly income; 46.7% were passed out their previous year with pass class.

1. The first objective of the study was to assess the knowledge among primipara mothers regarding neonatal jaundice:

The present study found that the mean percentage knowledge scores of the pre-test were maximum in the area of general information about neonatal jaundice (47.5%) and minimum in the area of management of neonatal jaundice (38.9%). The pre test knowledge of majority 73.3% (44) of the subjects regarding neonatal jaundice was inadequate, where as the post test level of knowledge of 68.3% (41) of subjects was adequate and 31.7% (19) of subjects was moderate.

Objective 2: To evaluate the effectiveness of structured teaching Programme by comparing the pre-test and post-test knowledge scores regarding management of Neonatal jaundice:

In the present study the mean percentage of post test knowledge scores (83.3%) of subjects were significantly higher than the mean percentage of pre-test score (40.4%) and the computed ‘t’ value (t₅₉₌34.61) was greater than the table value (t₅₉=1.96) at 0.05 level of significance.

The comparison between the pre-test and post-test scores showed that the pre-test level of majority of subjects regarding Neonatal Jaundice was inadequate 73.3%, and 26.7% was moderate. Where as the post test level of knowledge of 68.3% was adequate and 31.7% was moderate. These results can be compared with the results of

Objective 3: To find the association between post test knowledge scores of the primi para mothers with their selected demographic variable:

In the present study there was no significant association between the post test knowledge level of participants and the selected demographic variable except their place of residence, previous knowledge about neonatal jaundice and family monthly income. Calculated χ ² values were less than the table values for all the other demographic variables. But the calculated χ ² value for place of residence was (χ ² =4.34, P<0.05) more than the table value, the calculated χ ² value for previous knowledge about neonatal jaundice was (χ ² =6.24, P<0.05) more than the table value, the calculated χ ² value for family monthly income was(χ ² =6.55, P<0.05) more than the table value, Therefore it was concluded that there was a significant association between post test knowledge level and place of residence, previous knowledge about neonatal jaundice, family monthly income.

MAJOR FINDINGS OF THE STUDY:

Findings related to the subjects’ personal characteristics:

(1) Majority of respondents were age groups of 18 years

(2) Majority of the respondents 91.7% were Hindus.

(3) Majority of the respondents 71.7% resides in rural area.

(4) Majority of the respondents 50.0% were having monthly Family income 5001 to 10,000

(5) Majority of respondents 50.0% were had a previous information regarding Neoantal jaundice.

(6) Majority of respondents 60% were had previous information from mass media.

(7) Majority of respondents 46.7% passed out their previous year with pass class.

Findings related to effectiveness of structured teaching programme:

Using a structured knowledge questionnaire, knowledge level of 60 primipara mothers was assessed and findings reveal that

· The mean percentage knowledge scores of the pre-test were maximum in the area of general information about neonatal jaundice (47.5%) and minimum in the area of management of neonatal jaundice (38.9%). The mean percentage knowledge score of post-test was maximum in the area of management of neonatal jaundice (84.3%) and minimum in the area of general information about neonatal jaundice (77.5%).

· The pre test knowledge of majority 73.3% (44) of the subjects regarding neonatal jaundice was inadequate, where as the post test level of knowledge of 68.3% (41) of subjects was adequate and 31.7% (19) of subjects was moderate.

· Computed ‘t’ value (t₅₉=34.61) is greater than the table value (P<0.05), which represents the significant gain of knowledge through structured teaching programme. Hence the research hypothesis H₁ was accepted. Thus it suggests that the structured teaching programme has been effective in increasing the knowledge of primipara mothers regarding neonatal jaundice.

Findings related to association between post test levels of knowledge of primipara mothers with selected demographic variables.:

· Chi-square values were computed to find the association between post test levels of knowledge and selected demographic variables; Age, religion, place of residence, previous knowledge about neonatal jaundice, Source of information, family monthly income and academic status in previous year.

· Age- χ ²=0.12, P>0.05, (NS)

· Religion– χ ²=0.34, P>0.05, (NS)

· Place of residence - χ ²=4.34, P<0.05, (S)

· Previous knowledge about neonatal jaundice χ ²=6.24, P<0.05, (S)

· Source of information - χ ²=1.35, P>0.05, (NS)

· Family monthly income - χ ²= 6.55, P<0.05,(S)

· Academic status in previous year - χ ²=0.86, P>0.05, (NS)

(S=significant, NS= Non significant)

These findings indicated that except for “place of residence, previous knowledge about neonatal jaundice, family monthly income χ² values of all other demographic variables was less than the table value at 0.05 level of significance. Therefore the research hypothesis (H₂) is accepted. In the area of place of residence, previous knowledge about neonatal jaundice, family monthly income research hypothesis is accepted with at 0.05 level of significance respectively.

SUMMARY:

This chapter dealt with the discussion of the major findings of the present study and the comparison with the other studies in accordance with the objectives of the study and hypothesis, hence confirmed that STP was effective in increasing the knowledge of prmipara mothers on Neonatal jaundice.

CONCLUSION:

The aim of this study was to assess the knowledge of Primipara mothers on Neonatal jaundice as well as to provide information to them about Neonatal jaundice. The information was given with the aid of STP which included various aspects such as

· General information about Neonatal jaundice

· Clinical features of Neonatal jaundice.

· Management of Neonatal jaundice.

The following conclusions were drawn from the study.

· The knowledge of the Primipara mothers was not up to the mark before the introduction of STP.

· After the introduction of the STP, the post-test findings showed the significant increase in the knowledge of Primipara mothers on Neonatal jaundice.

· STP is proved to be one of the effective teaching strategies.

· STP can be kept for future reference when comparing with SIM.

· STP will be beneficial for mothers to understand about various clinical features of neonatal jaundice and to take precautionary measures if there is any future occurrence of neonatal jaundice.

LIMITATIONS:

1. The study was conducted over a small group of target population selected by simple random. Hence generalization is limited to the mothers of selected hospitals of Gonda. And sample size is limited to 60.

2. Extraneous variables like exposure to media, health personnel, peer contact or any other events occurred in the period between pre test and post test were beyond the investigators control as control group was not used; therefore there were possibilities of threats to internal validity.

3. Teaching plan was not based on learning needs of the subjects under the study but on the basis of the review of literature and investigators experience.

4. No attempts were made to do the follow up to check the retention of knowledge of mothers.

RECOMMENDATIONS:

On the basis of study findings, following recommendations have been made for further study.

1. The study can be a replicated on a large sample with a control group.

2. A comparative study may be conducted between urban and rural Primipara mothers to find out the effectiveness of STP regarding the same topic.

3. Similar study can be undertaken using other teaching strategies.

4. A similar study may be replicated with increased period of time provide for training programme and with still elaborative and in-depth content like a workshop.

SUMMARY:

The overall experience of conducting this study was satisfying one, as there was good co-operation from mothers and hospital authorities. The respondents were satisfied and happy with the information they received. The study was a new learning experience for the investigator. The study reveals that STP could be used as an effective teaching strategy.

INTERPRETATION:

The findings of the study showed that STP is an effective teaching strategy to increase the mothers’ knowledge on management of neonatal jaundice.

RESULTS:

The findings of the study proved that primipara mothers lacked knowledge on management of neonatal jaundice. The STP given by the investigator helped the mothers to improve their knowledge. The effectiveness of STP was tested in terms of gain in knowledge and the findings showed that it was statistically significant at 0.05 level of significance. The findings of the study proved that STP is an effective strategy in improving the knowledge of the mothers. All the subjects had a gain in knowledge compared to their pre-test knowledge scores.

On the whole, carrying out the present study was really an enriching experience to the investigator. It also helped a great deal to explore and improve the knowledge of the researcher and the respondents. The constant encouragement and guidance by the guide, co-operation and interest of respondents in the study contributed to the fruitful completion of the study.

REFERENCES:

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8. Manning Donnal, Todd Peter et al. “Prospective Surveillance study of severe hyperbilirubinema in the newborn in the UK and Ireland” Department of paediatrics, Arrowe pork hospital, October 2006.

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11. Abai, G., Henry, J., Lian, C.B., Bill, H. and Ratu, I. Improving the knowledge and practice on early detection of neonatal jaundice by nurses in Kuching District. International Journal of Public Health Research Special Issues, 5(4); pp.92-99, 2015.

Received on 12.11.2019 Modified on 30.11.2019

Int. J. of Advances in Nur. Management. 2020; 8(1):29-34.

DOI: 10.5958/2454-2652.2020.00009.8