DISSERTATION ON

DISSERTATION ON

“A STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE

REGARDING CARE OF NEWBORN DURING PHOTOTHERAPY

AMONG II YEAR DGNM STUDENTS AT INSTITUTE OF CHILD

HEALTH AND HOSPITAL FOR CHILDREN, EGMORE ,

CHENNAI-08”

M.Sc (NURSING) DEGREE EXAMINATION

BRANCH- II CHILD HEALTH NURSING

COLLEGE OF NURSING

MADRAS MEDICAL COLLEGE, CHENNAI-600 003

A dissertation submitted to

THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY,

CHENNAI- 600 032

In partial fulfillment of the requirement for the award of the degree of

MASTER OF SCIENCE IN NURSING

OCTOBER - 2019





HEALTH AND HOSPITAL FOR CHILDREN , EGMORE ,

CHENNAI-08”

Examination : M.Sc (Nursing) Degree Examination

Examination Month and Year : October-2019

Branch & Course : II – CHILD HEALTH NURSING

Register Number : 301716254

Institution : COLLEGE OF NURSING,

MADRAS MEDICAL COLLEGE,

CHENNAI – 600 003.

Sd: __________________ Sd: ________________

Internal Examiner External Examiner

Date: ____________ Date: ____________

THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY,

CHENNAI – 600 032.

CERTIFICATE

This is to certify that this dissertation titled, “A STUDY TO ASSESS

THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING CARE OF

NEWBORN DURING PHOTOTHERAPY AMONG II YEAR

DGNM STUDENTS AT INSTITUTE OF CHILD HEALTH AND

HOSPITAL FOR CHILDREN, EGMORE , CHENNAI-08” is a

bonafide work done by Mrs.R.REVATHY, M.Sc Nursing-II Year Student,

College of Nursing, Madras Medical College, Chennai-03 submitted to The

Tamil Nadu Dr.M.G.R. Medical University, Chennai-32 in partial fulfillment

of the university rules and regulations towards the award of the degree of

MASTER OF SCIENCE IN NURSING, BRANCH-II CHILD HEALTH

NURSING, under our guidance and supervision during academic year from

2017-2019.

Mrs.A.Thahira Begum, M.Sc (N)., MBA., M.Phil., Dr.R.Jayanthi, M.D.,F.R.C.P.(Glasg).,

Principal, Dean,

College of Nursing, Madras Medical College,

Madras Medical College, Chennai – 03.

Chennai – 03.





HEALTH AND HOSPITAL FOR CHILDREN, EGMORE,

CHENNAI-08”.

Approved by dissertation committee on: 24.07.18

CLINICAL SPECIALITY GUIDE

Mr. A. Senthil kumaran, M.Sc (N)., Lecturer in Child Health Nursing,

College of Nursing,

Madras Medical College,

Chennai- 03.

HEAD OF THE DEPARTMENT

Mrs. A. Thahira Begum, M.Sc (N)., MBA., M.Phil.,

Principal,

College of Nursing,


Chennai – 03.

DEAN

Dr. R. Jayanthi, M.D., FRCP(Glasg).,

Dean,


Chennai-03.

A dissertation submitted to

THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY,

CHENNAI- 600 032

In partial fulfilment of the requirement for the award of the degree of

MASTER OF SCIENCE IN NURSING

OCTOBER – 2019

CERTIFICATE OF PLAGIARISM

This is to certify that the dissertation work titled, “A STUDY TO ASSESS

THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON

KNOWLEDGE REGARDING CARE OF NEWBORN DURING

PHOTOTHERAPY AMONG II YEAR DGNM STUDENTS AT INSTITUTE

OF CHILD HEALTH AND HOSPITAL FOR CHILDREN, EGMORE,

CHENNAI-08”of the candidate R.REVATHY, for the partial fulfilment of M.Sc.

Nursing programme in the branch of Child Health Nursing has been verified for

plagiarism through relevant plagiarism checker. We found that the uploaded thesis

file from introduction to conclusion pages and rewrite shows % of plagiarism(

% uniqueness) in this dissertation.

CLINICAL SPECIALITY GUIDE/ SUPERVISOR

Mr.A.Senthil Kumaran, M.Sc (N).,

Lecturer in Child Health Nursing,

College of Nursing,


Chennai-03.

PRINCIPAL

Mrs A.Thahira Begum, M.Sc (N)., MBA., M.Phil.,

Principal,

College of Nursing,


Chennai-03.

ACKNOWLEDGEMENT

Gratitude calls never expressed in words but this only to deep perceptions,

which make words to flow from one‟s inner heart.

First of all, I praise God Almighty, merciful and passionate, for providing me

this opportunity and granting me the capability to complete this study successfully .I

lift up my heart in gratitude to God Almighty, I feel the hand of God on me, leading

me through thick and thin heights of knowledge. It is he who granted me the grace

and the physical and mental strength behind all my efforts.

This dissertation appears in its current form due to the assistance and guidance

of many professionals and non professionals. The investigator is whole heartedly

indebted to her research advisors for their comprehensive assistance in various forms.

I express my genuine gratitude to the Institutional Ethics Committee of Madras

Medical College for giving me an opportunity to conduct this study.

I wish to express my sincere thanks to Dr.R.Jayanthi, M.D., F.R.C.P (Glasg).,

Dean. Madras Medical College, Chennai-03 for providing necessary facilities and

extending support to conduct this study.

I render my deep sense of sincere thanks to Dr.K.Jayachandran,M.D., D.C.H,

Director and Superintendent ,Institute of Child Health and Hospital for

Children,Egmore,Chennai-08,for permitting me to conduct this study at Institute of

Child Health and Hospital for Children and also, for their valuable suggestions and

guidance for this study.

I am grateful to., Head of the Department of Neonatology, Institute of Child

Health and Hospital for Children, Egmore, Chennai-08 for giving me the permission

to conduct the study among the DGNM students regarding care of newborn during

phototherapy, Institute of Child Health and Hospital for Children,Egmore,Chennai-08

for sharing her experience in providing ideas and guide me to complete this study in

useful manner.

At the very outset, I express my whole hearted gratitude to my esteemed guide

Mrs.A.Thahira Begum, M.Sc (N)., MBA., M.Phil., Principal, College of Nursing,

Madras Medical College, for her academic and professional excellence, treasured

guidance, highly instructive research mentorship, valuable suggestions, prudent

guidance, moral support and patience that has moulded me to conquer the spirit of

knowledge for sculpturing my manuscript into thesis.

I am highly indebted to Dr. R. Shankar Shanmugam, M.Sc. (N), MBA,

Ph.D., Reader, H.O.D – Department of Nursing Research, College of Nursing,

Madras Medical College, for his great support, warm encouragement, constant

guidance, thought provoking suggestions, brain storming ideas, timely insightful

decision, correction of the thesis with constant motivation and willingness to help all

the time for the fruitful outcome of this study.

I would like to express my deepest sense of gratitude to Mrs.Seetharaman

Vijayalakshmi, M.Sc.(N).,MBA., Reader, H.O.D-Child Health Nursing, College

of Nursing, Madras Medical College, for her highly instructive research mentorship,

her hard work, efforts, interest and sincerity to mould this study in a successful way.

Her easy approachability and understanding nature inspired me to laid strong

foundation in research. It is very essential to mention her wisdom and helping nature

made my research study a lively and everlasting one.

I am grateful to Mr. K. Kannan, M.Sc. (N), Nursing Tutor, Department of

Nursing Research, College of Nursing, Madras Medical College, for his valuable

guidance, suggestions, motivation, timely help and support throughout the completion

of this study.

I would like to express my deep and sincere gratitude to our respected

Dr.G.Mala, M.Sc. (N), Nursing Tutor, College of Nursing, Madras Medical

College, Chennai-03 for the approval of the study.

I am thankful to all the faculty of College of Nursing, Madras Medical College,

for their timely advice, encouragement and support.

It‟s my duty to convey my thanks to all experts, Dr.G.K.Jaikaran,MD.,

Associate Professor of Paediatric, Institute of Child Health and Hospital for Children

Egmore, Chennai, Dr.S.Madhialagan,MD., Associate Professor of Paediatric,

Institute of Child Health and Hospital for Children Egmore, Chennai,

Mrs.R.Dhanalakshmi,.M.Sc (N)., H.O.D-Child Health Nursing, Billroth College Of

Nursing, Chennai. Mrs.Nesa SathyaSatchi,.M.Sc (N)., H.O.D-Child Health Nursing,

Apollo College of Nursing, Chennai. Who validated the research tool and guided me

with valuable suggestions and corrections, constructive judgments while validating

the tool.

I owe my deepest sense of gratitude to Dr.A.Vengatesan, M.Sc., Ph.D., former

DDME (Statistics) for his suggestion and guidance in statistical analysis.

I thank Mr.S.Ravi, M.L.I.S, Librarian, College of Nursing, Madras Medical

College for his co-operation and assistance which built the sound knowledge for this

study.

I owe my great sense of gratitude to Mr.Jas Ahamed Aslam, Shajee

computers and Mr.Ramesh, B.A., MSM Xerox for their enthusiastic help and

sincere effort in typing the manuscript with valuable computer skills and also bringing

this study into a printed form.

I thank Mrs.P.Malliga.M.A. B.Ed., Headmistress, Govt.Girls Hr Sec

School, Chennai, for editing and providing certificate of English editing.

I have much pleasure of expressing my cordial appreciation and thanks to all

the students who participated in the study with interest and cooperation.

I am grateful to thank my life partner Mr.Thamodharan, for his whole

consent, encouragement, support, endless effort and love otherwise this work would

not be successfully completed.

I would be a lapse on my part if i fail to thank my daughter

Baby.T.Shamritha for her love, patience and cooperation throughout my study.

Words are beyond expressions for meticulous effort of my parent

Mr.A.Rajasekaran and Mrs.R.Bhuvaneshwari for their loving support,

encouragement, earnest prayer, which enabled me to complete the study.

I immensely extend my gratitude to thank my lovable sister Mrs.R.Gayathri,

B.E for her encouragement, constant support and timely help to finish this study

successfully.

I thank my mother in law Mrs.K.Saroja for her graceful support and all my

family members for their encouragement towards the successful completion of my

study.

I take this opportunity to thank all my Colleagues, Friends, Teaching and Non

Teaching Staff Members, Librarian and Office Staff Members of Madras Medical

College –College of Nursing for their cooperation and help rendered.

I extend my heartfelt gratitude to those who have contributed directly or

indirectly for the successful completion of this dissertation.

I thank the one above all of us, omnipresent God, for answering my prayers for

giving me strength to plod on each and every phase of my life.

ABSTRACT

Phototherapy is one of the important procedures in New born care setting.

In most infants with physiological jaundice, bilirubin levels do not rise to a

point that requires treatment. Effective treatments to decrease serum bilirubin

levels with severe jaundice include phototherapy. It is a vital procedure to save

the life of many newborns, when performed at correct time. It needs special

skills and techniques to do this procedure. The students should be specially

trained to assist the procedures tactfully. Students need to have adequate

knowledge regarding care of newborn during phototherapy in order to identify

and prevent fatal complications in neonates.

TITLE: “A study to assess the effectiveness of structured teaching

programme on knowledge regarding care of newborn during phototherapy

among II year DGNM students at ICH, Egmore , chennai-08”

OBJECTIVES: To assess the pretest knowledge of II year DGNM students

regarding care of newborn during phototherapy. To assess the post test

knowledge of II year DGNM students regarding care of newborn during

phototherapy. To compare the pre test and post test knowledge of II year

DGNM students regarding care of newborn during phototherapy. To

compare the pre test and post test knowledge of II year DGNM students

regarding care of newborn during phototherapy. To find the association

between the post-test knowledge scores of students with selected

demographic variables.

METHODS AND MATERIALS: This study was conducted with 90 samples

(students) in quantitative approach, pre experimental one group pretest posttest

design, sampling selection was done by convenient sampling technique.pre

existing knowledge was assessed by using semi structured questionnaires after

the pre test, structured teaching programme was given regarding care of

newborn during phototherapy among students after 7 days post test was

conducted by using same tool.

RESULTS: The results shows that students were gained 33.63% score on

knowledge in post test compare to pre test after structured teaching programme

and the mean difference were 3.81 by using McNamara‟s chi-square test which

is statistically significant.

CONCLUSION: Hence the structured teaching program was instructionally

effective, appropriate and feasible. It would help and guide the students to

provide care to the newborn during phototherapy.

INDEX

Chapter

No

Content Page

No.

I

INTRODUCTION 1

1.1 Background of the study 4

1.2 Need for the Study 6

1.3 Statement of the Problem 8

1.4 Objectives of the Study 9

1.5 Operational Definition 9

1.6 Assumption 10

1.7 Hypothesis 11

1.8 Limitation 12

1.9 Conceptual Framework 12

II

REVIEW OF LITERATURE 14

2.1 Review of Literature 14

III

RESEARCH METHODOLOGY 24

3.1 Research Approach 24

3.2 Study Design 24

3.3 Duration of the Study 24

3.4 Study Setting 24

3.5 Study Population 25

3.6 Sample 25

3.7 Sample Size 25

3.8 Sample Criterion

3.8.1 Inclusion Criteria

3.8.2 Exclusion Criteria

25

3.9 Sampling Technique 26

3.10 Research Variables 26

3.11 Development and Description of the Tool 26

3.11.1 Development of the Tool 26

Chapter.

No

Content

Pg.No

III

3.11.2 Description of the Tool 26

3.12 Content validity 27

3.13 Reliability of the Tool 27

3.14 Protection of Human Subjects 27

3.15 Pilot Study 28

IV ANALYSIS AND INTERPRETATION OF DATA 30

V DISCUSSION 52

VI SUMMARY,IMPLICATION,LIMITATION,

RECOMMENDATION & CONCLUSION

59

6.1 Summary of the Study 59

6.2 Findings of the Study 59

6.3 Implication of the Study 62

6.4 Limitation 64

6.5 Recommendation 64

6.6 Conclusion 65

REFERENCES 66

APPENDICES 71

LIST OF TABLES

Table

No

Title

Page

No

1.1 Statistics of Neonatal Jaundice at Institute of

Child Health and Hospital for Children, Egmore,

Chennai for the Year 2014 – 2018

5

3.1 Scoring Interpretation of knowledge score 27

4.1 Description of demographic variables of students 32

4.2 Pretest Percentage of Knowledge on Care of

Newborn during Phototherapy among Nursing

students

40

4.3 Pre test level of knowledge 41

4.4 Post test Percentage of Knowledge on Care of

Newborn during Phototherapy among Nursing

students

42

4.5 Post test level of knowledge 43

4.6 Comparison of Pre test And Post test Level of

Knowledge Score

44

4.7 Comparison of Pretest and Post test Knowledge

Score

45

4.8 Each Domain wise Pretest and Post-test

Percentage of Knowledge

46

4.9 Effectiveness of Structured teaching programme 47

4.10 Association between post test level of knowledge

and demographic variables

49

4.11 Association between students knowledge gain 52

score and their demographic variables

LIST OF FIGURES

Figure

No

Description

1.1 Mortality statistics of Neonatal Jaundice

1.2 Role of Paediatric Nurse

2.1 Conceptual framework based on Modified Kings Goal Attainment

Theory

3.1 Schematic representation of the Research Methodology

4.1 Cylindrical diagram shows distribution of sample age group

4.2 Pie diagram showing distribution of sample according to medium of

instruction in higher secondary

4.3 Bar diagram shows distribution of sample according to type of family

4.4 Bar diagram shows distribution of sample according to mother

education status

4.5 Bar diagram shows distribution of sample according to father education

status

4.6 Cylindrical diagram shows distribution of sample according to father

occupation

4.7 Cylindrical diagram shows distribution of sample according to monthly

income

4.8 Doughnut diagram shows distribution of sample according to posted in

NICU

4.9 Pie diagram shows distribution of sample according to previous

exposure on care of newborn during phototherapy.

4.10 Pre test level of knowledge score

4.11 Post test level of knowledge score

4.12 Percentage of Pre test and Post test level of knowledge

4.13 plot compares the student‟s pre test and post test knowledge score

4.14 Pretest and Post test Percentage of Knowledge Score

4.15 Multiple bar diagram shows association between the posttest level of

knowledge score and medium of instruction in higher secondary


knowledge score and NICU posting.


knowledge score and exposure on care of newborn during phototherapy

LIST OF APPENDICES

Appendix

No

Annexure

1. Certificate approval by Institutional Ethics Committee

2. Certificate of content validity by Experts

3. Letter seeking permission to conduct the study

4. Study tools (English)

Section A- Socio Demographic data of students

Section B- knowledge about care of newborn during

phototherapy

5. Structured teaching programme on care of newborn during

phototherapy

6. Informed consent form

7. Certificate for English editing

8. Photos

LIST OF ABBREVATION

ABBREVATION

EXPANSION

DF Degree of Freedom

ICH Institute of Child Health and Hospital for

Children

NS Non Significance

P Significance

SD Standard Deviation

STP Structured Teaching Programme

CHAPTER-I Introduction

CHAPTER-1

INTRODUCTION

A new baby is like the beginning of all things- wonder, hope and a dream

of possibilities.

–EdaJ.Le.Shan.

Jaundice is the accumulation of bilirubin in blood, bilirubin is

formed by breakdown of red blood cells and it is naturally removed by liver

and excreted in stool and urine. When the bilirubin is produced faster, then it

cannot be removed, it leads to increase in bilirubin level. Physiological

jaundice of the term newborn usually appears after 30 hrs. Peak level of serum

bilirubin (a maximum of 12mg/dl) is reached on the 4th

or 5th

day and icterus

disappears by 7 to 14 days. In premature babies maximum bilirubin level

reaches 12 to 15mg/dl on 5th

to 7th

day and icterus disappears by 14 days to a

month.

Jaundice appears in first days of life, it is common in newborns about

50-75% during this period, all babies have high plasmatic bilirubin than

compared with normal adults. It develops between 72 – 96 hours after birth and

usually disappears by one to two weeks after birth. In full term newborns the

level of bilirubin increases for few days, reaches high and then decreases by the

end of first week of life. In case of premature babies, it may require more time

to resolve as normal elimination mechanism mature.

Hyperbilirubinemia refers to high serum concentration in bilirubin,

treatment is according to the increase in level of bilirubin. The most commonly

used treatment for newborn jaundice is phototherapy.

Neonatal hyperbilirubinemia is a common problem in newborn and

manifest clinically as jaundice. Nearly 25-50% of all newborns and a much

higher percentage of premature babies develop hyperbilirubinemia. About 3%

of all hospital-born babies in India develop significant jaundice levels more

than 15 mg/dl.

Since the early 1970‟s, phototherapy is mainly used to treat jaundice.

Phototherapy is one of the non-invasive methods to reduce the bilirubin level

by exposing the baby skin to blue or cool white light. Light converts the

bilirubin to non – toxic water soluble compound, they are excreted in urine and

stool. Baby should be undressed expect diaper, to protect gonads. In order to

prevent chilling, an external means of maintaining normal body temperature

must be used.

The vital signs are taken at least every 4 hours to monitor the infant

temperature. Eyes are covered to prevent damage in the retina. Baby is kept

under phototherapy light at a distance of 45cm, baby position should be

changed every 2 hours or each feed for maximum exposure. Phototherapy is

stopped, bilirubin return to safe value as per protocol. Proper nursing care

should be given to the newborn during phototherapy to enhance the

effectiveness and to minimize the complication greenish stool, skin rashes and

electrolyte imbalance.

It has emerged as the most widely used tool for treating unconjugated

pathologic hyperbilirubinemia. Bilirubin absorbs light maximally at 420-490

nanometers. It gets oxidized to biliverdin with light source of this range and is

excreted in bile or to lesser extent in urine. Technique of phototherapy is now

generally opined that blue light is superior to white light although simple

sunlight is useful. Fluorescent tubes are remarkable as a potent source of blue

light. These tubes can be mounted with reflectors in frames.Baby is placed at a

distance of 18 inches below the lights. 24 -48 hours exposure is long enough to

bring down Serum bilirubin level to a safe limit. Serum bilirubin estimation is

done at intervals of 12 hours. If it is less than 11 gm/dl on two consecutive

sittings 24 hours apart, termination of phototherapy is indicated.

Phototherapy is a simple, effective, inexpensive and acceptable

procedure for the neonate in reduction of bilirubin. During phototherapy the

bilirubin molecules in the peripheral tissues are activated to biliverdin by the

absorption of light photons. Phototherapy is used to prevent the concentration

of unconjugated bilirubin in the blood from reaching the levels where neuro-

toxicity may occur. High intensity light photo chemically converts fat soluble

unconjugated bilirubin in to water soluble bilirubin that can be excreted in bile

and urine. Accurate charting is another important nursing responsibility it

includes times that phototherapy is started and stopped, proper shielding of the

eyes, types of fluorescent lamps number of lamps , distance between surface

of lamps and infant , use of phototherapy in combination with incubator or

open bassinet , photometer measurement of light intensity, occurrence of side-

effects.

Neonatal hyperbilirubinemia is the most common cause for hospital re-

admission in the first weeks of life. Bilirubin induced complication can be

prevented by instituting a neonatal jaundice protocol to identify infants at risk

for significant hyperbilirubinemia, by ensuring adequate parental education

and preparedness, and by implementing a good neonatal tracking system for

follow-up care. Hyperbirubinemia is easily treated with phototherapy, which

can be administered at home in selected infants.

Nurses play a important role in caring the newborn during

phototherapy. Nurses are the ones with the newborn for 24 hours in NICU. So,

I felt that, there is need to provide knowledge regarding care of newborn during

phototherapy among future nurses and decided to administer structured

teaching programme on care of newborn during phototherapy.

1.1 BACKGROUND OF THE STUDY

Neonatal jaundice is a transitional phenomenon affects the newborn

with consequences in first week of life.

GLOBAL STATISTICS

World Health Organization reveals the source of incidence as

hyperbilirubinemia in 50 to 60,000 neonates reported. 2% has total serum

bilirubin level over 20 mg/dl; the total serum bilirubin level in normal range

is 0.3 to 1 mg/dl. 0.15% had levels over 25mg/dl and 0.01% had over

30mg/dl.

The global burden of disease (GBD) 2016, reported that health of the

children younger than 5 years suggests that prevention of neonatal jaundice

is important in the first week of life mainly countries with highest neonatal

mortality.

Fig:1.1 MORTALITY RATE OF NEONATAL JAUNDICE

NATIONAL STATISTICS

Each year in India over 1 million newborn‟s die before they

complete their first month of life, accounting for 30% of the world‟s

neonatal death due to complication of hyperbilirubinemia. Neonatal

mortality rate is higher in rural areas. Orissa has the highest neonatal

mortality rate of 61 per 1000 live births.

INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR

CHILDREN, EGMORE, CHENNAI-08

Table: 1.1 STATISTICS OF NEONATAL JAUNDICE

YEAR STATISTICS

2014 703

2015 550

2016 641

2017 520

2018 632

TOTAL CENSUS OF NEONATAL JAUNDICE IN THE YEAR

OF 2018

There is a need for creation of awareness about the care of baby in

phototherapy for future nurses. Nurses are caring the neonates during

phototherapy. So, knowledge is essential to prevent the complication and

improve the neonate‟s health status during phototherapy.

1.2 NEED FOR THE STUDY

Hyperbilirubinemia is a common cause for brain death and

encephalopathy in newborns. Over 9% of healthy term infants develop

hyperbilirubinemia with serum bilirubin levels above 15 mg/dl.

Jaundice in newborn is quite commonly affects nearly 70% of term and

80% of preterm neonates during first week of life.

A study was conducted in Postgraduate Institute of Medical

education and Research in 2012 shown that in India about 3% of all hospital

born babies develop significant jaundice with serum bilirubin level more

than 15mg/dl.

As per the National Neonatal Prenatal Database report 5% of all

neonates in India develop significant jaundice with total serum bilirubin

>15mg/dl.

The mild jaundice which appears in 30-50% of normal newborns is

usually self-limited. But in uncontrolled cases, serum indirect reacting

bilirubin concentration exceeding physiologic levels may results in acute or

chronic bilirubin encephalopathy with seizure and cerebral palsy with

hearing loss in surviving infants.

Phototherapy has been found to be effective in treating

hyperbilirubinemia in hemolytic as well as in non-hemolytic settings. It has

dramatically reduced the need for exchange transfusion. Phototherapy is the

noninvasive widely used modality for treatment of neonatal indirect

hyperbilirubinemia as it is effective and relatively safe.

On 1st Feb 2009 at Patiala, five infants including two girls were

burnt alive while five others were critically injured in a fire that broke out

due to an electric short circuit at the Government Rajindra Hospital. This

tragic accident shouldn‟t happen again, for that continuous monitoring and

nursing care is very essential in the intensive care units.

Lawrence Slater from the University of California conducted a study on

effectiveness of phototherapy on 25 term infants and showed the

hyperbilirubinemia reduced among infants after the phototherapy.

Tatil and Innet in Turkey conducted a study on effectiveness of

phototherapy on neonatal hyperbilirubinemia on 33 full term neonates with

physiological jaundice. Phototherapy was given with 6 fluorescent lamps

producing radiation with wavelength 480-520 nm with 12 microwatt/cm/nm,

total serum bilirubin checked at 24 hrs and 48hrs of phototherapy which

showed a decline in total serum bilirubin level, indicating the effectiveness

of phototherapy in treating neonatal hyperbilirubinemia. The above study

focused on the importance of phototherapy for the neonates with

hyperbilirubinemia. But certain side effects may arise in babies on

phototherapy. So we, the nurses should be careful while caring of newborns

during phototherapy.

Based on this model, as a paediatric nurse can empower and educate the

students regarding phototherapy. Paediatric nurse plays a major role in

health care settings. Nurse educator should emphasis the nursing student for

providing adequate care to the newborn in the intensive care setting. It is the

evidence based core competencies that prioritize the knowledge, skill and

attitude needed to begin practice as a professional nurse in a paediatric

intensive care setting.

Nurse educator plays a major role in importing knowledge to the nursing

students based on the role of paediatric nurse such as:

Primary care giver

Health educator

Manager

Team co ordinator and collaborator

Recreationist

Child care advocate

Nurse consultant

Fig 1.2 ROLE OF PAEDIATRIC NURSE

Nurse researcher has selected this study because neonatal

hyperbilirubinemia is one of the major health problems across the world.

With proper knowledge regarding care of newborn during phototherapy, the

complication of child can be prevented by some extent. This motivated the

investigator to undertake a study on knowledge regarding care of newborn

during phototherapy among nursing students.

1.3 STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of structured teaching programme

on knowledge regarding care of newborn during phototherapy among II year

DGNM students at ICH, Egmore , chennai-08”

• Social Worker• Nurse Counselor

• Health educator• Primary Care Giver

Team Co Ordinator

and Collaborator

Manager

RecreationistChild Care Advocate

NURSE

RESEARCHER

NURSE

CONSULTANT

1.4 OBJECTIVES

The objectives of the study are to

1) To assess the pretest knowledge of II year DGNM students regarding

care of newborn during phototherapy.

2) To assess the post test knowledge of II year DGNM students regarding


3) To compare the pre test and post test knowledge of II year DGNM

students regarding care of newborn during phototherapy.

4) To find the association between the post-test knowledge scores of

students with their selected demographic variables.

1.5 OPERATIONAL DEFINITION

Assess:

It refers to knowledge of the students about care of newborn during

phototherapy among II year DGNM students.

Effectiveness:

It refers to the significant increase in the level of knowledge of students

regarding care of newborn during phototherapy which will be measured

from the response of pre-test and post-test.

Structured teaching programme:

It refers to systematically planned teaching strategy for students posted in

pediatric wards prepared by investigator for duration of 1 hour on care of

newborn during phototherapy which includes definition, indication, mechanism

of action, care of newborn on phototherapy complications expected due to

phototherapy by using power point presentation and issued booklet regarding


Knowledge:

It refers to the level of understanding of student‟s knowledge regarding care

of new born during phototherapy among II year DGNM students in ICH,

Chennai.

Care of newborn:

Care of newborn refers to baby under phototherapy receive eye care,

skincare, fluid requirement, maintenance of body temperature, care of

genitals, assessing dehydration, breast feeding and prevention of

complication.

Phototherapy

Phototherapy is one of the non-invasive methods to reduce the bilirubin level

by exposing the baby skin to blue or cool white light. Light converts the

bilirubin to non toxic water soluble compound, they are excreted in urine and

stool. Baby is kept under phototherapy light at a distance of 45cm.proper

nursing care should be given to the newborn during phototherapy to enhance

the effectiveness and to minimize the complication as greenish stool, skin

rashes and electrolyte imbalance.

Nursing Students

Students undergoing DGNM II Year training programme, posted at ICH,

Chennai.

1.6 RESEARCH HYPOTHESIS

The following hypothesis will be tested

H1-There will be significant difference between pretest and post-test level of

knowledge score regarding care of newborn during phototherapy.

H2-There will be a significant association between posttest level of

knowledge and selected socio demographic variables

1.7 ASSUMPTIONS:

Students may have varying level of knowledge regarding care of

newborn during phototherapy.

Structured teaching programme may help to improve the knowledge of

students regarding care of newborn during phototherapy.

1.8 LIMITATIONS

The study is limited to Diploma Nursing students.

The study is limited to 90 samples.

The study is limited up to 4 weeks of period.

1.9 CONCEPTUAL FRAMEWORK

The investigator has adopted Imogene king‟s goal attainment

theory (2011) based upon personal and interpersonal systems including

perception, action, interaction and transaction. The investigator adopted this

basic theory for conceptual framework, which is aimed to find out the

effectiveness of structured teaching programme on level of knowledge

regarding care of newborn during phototherapy among II year DGNM students.

This involves interaction between the researcher and the students.

There are 6 major components:

PERCEPTION

It refers to student‟s representation of reality. It is non observable but it

can be interfered. Hence the investigator has the perception for the assessment

of demographic variables and pre test assessment about the level of knowledge

regarding care of newborn during phototherapy among II year DGNM students

at ICH, Egmore , chennai-08”

JUDGEMENT

The investigator found that student has inadequate knowledge regarding care of

newborn during phototherapy thus decided to give education to students, to

improve their knowledge about phototherapy.

ACTION

Action refers to the matter, energy and information that enter into the system

through its boundary. Action involves preparation of structured teaching

programme on care of newborn during phototherapy.

REACTION

The investigator‟s reaction is to set goal which is increasing the knowledge

regarding care of newborn during phototherapy.

INTERACTION

Interaction refers to the processing where the system transforms the energy

matter.

Interaction involves in introducing the structured teaching programme through

lecture method by using AV aids such as PowerPoint and information booklet


TRANSACTION

It refers to the matter, energy and information in the environment that are in an

altered state.

Transaction is the awareness among students regarding care of newborn during

phototherapy by care of eyes, skin care, and maintenance of temperature, breast

feeding and duration of exposure.

FEED BACK

It refers to the environment response to the stimuli.

Feed back is the evaluation of teaching programme by using the same semi

structured questionnaires.

Figure 2.3 CONCEPTUAL FRAMEWORK

peper Post - test

PRE - TEST ACTION INTERACTION TRANSACTION

Assessment of

learning needs

about care of

newborn during

phototherapy

among selected

demographic

variables such as

age, occupation,

income, previous

exposure in NICU

and knowledge

regarding care of

newborn during

phototherapy

Preparation of

articles for

structured

teaching

programme on

care of newborn

during

phototherapy

Introducing

structured teaching

programme

through lecture

method by using

AV aids such as

power point and

information booklet

POST - TEST

Adequate

knowledge on care

of newborn during

phototherapy

Moderate

knowledge on care

of newborn during

phototherapy

Inadequate

knowledge on care

of newborn during

phototherapy

FEED BACK

KING‟S GOAL ATTAINMENT THEORY (2011)

CHAPTER-II

REVIEW OF

LITERATURE

CHAPTER II

REVIEW OF LITERATURE

Review of literature involves the systematic identification location,

scrutiny and survey of the written materials that contain information of

research problem.

Literature review refers to activities involved in identifying and

developing a comprehensive picture of the state of knowledge on the topic.

Related literature both research and non research was explored to

broaden the understanding and gained an insight into selected problem under

study.

2.1 REVIEW OF LITERATURE:

In this study the literature reviewed is presented under the following headings:

2.1.1. Incidence and Effectiveness of phototherapy

2.1.2. Knowledge regarding phototherapy

2.1.3. Management and complication of phototherapy

2.1.1. STUDIES RELATED TO INCIDENCE AND

EFFECTIVENESS OF PHOTOTHERAPY

Abdelazeem.KS et al. (2016) were carried out a study to

assess the effectiveness of intensive phototherapy in comparison with

conventional phototherapy in reducing the need for exchange transfusion and

the duration of phototherapy for management of neonatal hyperbilirubinemia in

Neonatal Unit of Assiut University Children Hospital. The prospective study

was conducted from March 2016 to February 2017 and comprised neonates

with indirect hyperbilirubinaemia near the level of ECT who were admitted to

the Neonatal Unit. The study concludes that use of intensive phototherapy in

the treatment of indirect pathological hyperbilirubinaemia is very effective in

lowering total serum Bilirubin when its level is within 2-3 mg/dl (34-50

UMol/l) of the exchange transfusion level and it has succeeded in reducing the

frequency of exchange transfusion with its hazards and serious complications.

Saravanan.S et al. (2016) were carried out a cross sectional study

on incidence of phototherapy induced hypocalcaemia in full term normal

newborn. Samples of 198 full term jaundiced neonates were selected for the

study (113 females and 85 males) receiving phototherapy. Neonates were

completely examined, plasma and calcium level determined before and after 48

hours of phototherapy,7-15% newborn receiving phototherapy develop

hypocalcemia. As a result of the study significant decrease in serum calcium

was observed (p<0.03).the researcher concluded that phototherapy lowers

serum calcium level in term infants.

Arnold.G et al. (2014) was conducted a comparative study on

effectiveness of three LED phototherapy machine, single and double sided for

treating neonatal jaundice in low resource setting at Da Nang Hospital for

women and children Vietnam. The study population was restricted to infants

born weighing > 1500gm with diagnosed as jaundice. As a result, double sided

machine showed 54% increased in reduction of TSB, 16% reduction of length

of stay. The study confirms that increasing surface area exposure during

phototherapy and substantly decreases the duration of treatment and length of

stay in NICU.

Carolyn.G et al. (2013) carried out a descriptive study on Incidence

and risk factors for neonatal jaundice among newborns in southern Nepal.

Samples of 18,985 newborns/infants born in salahi district were selected for the

study using cluster randomized sampling, by naked eye examination jaundice

level was assessed.teh study result shows there is significant association

between difficulty feeding and increased risk factors for neonatal jaundice

(p<0.001). This study confirmed the several known risk factors for jaundice in

neonates includes birth weight, difficulty feeding and primiparity.

Thomas.B et al. (2016) were conducted a case control study on

jaundiced noted in first 24hours after birth in managed organization at northern

California Kaiser permanent medical care program.631 samples were selected

for the study by randomly selected sample. Notations of jaundice in the

medical record, timing and results of bilirubin testing ,use of phototherapy and

development of bilirubin levels of 25mg/dl or higher.teh study concludes that

jaundice noted in the medical record in the first 24hours after birth was

uncommon and often clinically significant.

Usatin.D et al. (2010) was conducted a retrospective cohort study to

assess the effect of neonatal jaundice and phototherapy on the frequency of the

first year of outpatient visits at KPMCP university of California. Group 1 never

had a documented TSB level > 12mg/dl, group 2 had a TSB level >17 and <23

mg/dl as outpatient between 48hours and 7 days of age and did not receive

phototherapy inpatient phototherapy, group 3 met criteria of group 2.the result

concludes that neonatal jaundice and inpatient phototherapy are associated with

only small increase in first year outpatient visit rates or infrequent contribution

to vulnerable child syndrome in this population.

Bertini.G et al. (2007) was conducted a study in Italy to evaluate

whether high intensity gall nitride light emitting diode (LED) phototherapy

influences trans epidermal water loss (TEWL) and cerebral hemodynamic in

preterm neonates in comparison with conventional phototherapy. Thirty-one

preterm infants were randomized for conventional (n=14) and for LED (n=17)

phototherapy. All infants were studied using a Tewameter TM 210 and cerebral

Doppler ultrasound immediately before phototherapy (time0), 30 min (time1),

1-6 (time 2), and 12-24 hours (Tim 3) after the start of phototherapy and 6-12 h

after discontinuing phototherapy (time4). The study showed that LPT doesn‟t

induce significant changes in TEWL, in peak systolic, and diastolic and mean

cerebral blood flow velocity (CBFV) and in the resistance index (RI) CPT

shows significant increase of TEWL which disappeared at time 4 when

phototherapy had stopped. This study showed that LPT, emitting light within

450-470nm spectrum for optimal bilirubin degradation can be preferable to

CPT for the therapy of hyperbilirubinemia in preterm infants.

Dgokomuljanto.S et al. (2006) study was conducted in Malaysia to

determine the addition of low-cost reflecting curtains to a standard

photography unit could increase effectiveness of phototherapy for neonatal

jaundice. 97 term newborns with uncomplicated neonatal jaundice was taken.

Phototherapy with white curtains hanging from the sides of the phototherapy

unit (study group, n = 50) was compared with single phototherapy without

curtains (control group, n = 47). Total serum bilirubin was measured after 4hr

phototherapy. The mean decrease in total serum bilirubin levels was

significantly (P<0.001) higher in study group (27.62 (25.24) M mol/l) than the

control group (4.04 (24.27) M mol/l).The duration of phototherapy was

significantly shorter in the study group (12h) than the control group. No

difference in adverse events such as hyperthermia or hypothermia weight loss,

rash, loose stools or feeding intolerance. This study showed that hanging white

curtains around phototherapy unit significantly increases efficacy of

phototherapy in the treatment of Neonatal jaundice.

2.1.2 STUDIES RELATED TO KNOWLEDGE REGARDING CARE OF

NEWBORN DURING PHOTOTHERAPY

Rajashri. B et al. (2018) conducted a quasi experimental study to

assess the effectiveness of structured teaching programme on knowledge and

practice regarding phototherapy application among student nurses in Krishna

hospital.50 students were selected for the study by purposive sampling

technique, a structured questionnaire was administered. The study findings are

pre test mean value (13.3) post test mean value (22.7) and no association

between pre test knowledge and demographic variables. Study concludes that

significant gain in knowledge score after STP to nursing students.

SM Hossain et al. (2017) conducted a cross sectional study on

knowledge regarding neonatal jaundice management among mother in a

tertiary level hospital of Dhaka city, samples of 150 mothers were selected for

the study using non – randomized purposive sampling technique .a structured

knowledge questionnaire was used to collect the data from the mothers. The

study major finding was 7.3% had excellent level knowledge regarding

neonatal jaundice, where as 40.0% had satisfactory knowledge and 34% had

poor knowledge regarding neonatal jaundice. Hence awareness should be

created among the mothers.

Adopa P et al. (2017) were conducted a case control study on

knowledge level and determinants of neonatal jaundice at Effutu Municipality

of Ghana.150 neonates were selecsted for the study 100 neonates with clinical

evident jaundice and 50 neonates without jaundice, a structured questionnaire

were used to collect demographic variables and clinical history. The study

findings are majority (54%) of neonates develop jaundice within 1-3 days,

neonatal birth weight associated with neonatal jaundice (p<0.05), prolonged

duration of labor associated with neonatal jaundice (p=0.025).

Chandrasekhar.M et al. (2017) was conducted a descriptive study to

assess the knowledge regarding neonatal jaundice and its management among

staff nurses at Mysuru.60 staff nurses were selected for the study by non-

probability convenient sampling technique. The data were collected by

structured knowledge questionnaire. The knowledge score of staff nurse ranged

from 6-28%band mean value 19.3 with (SD=4) 19.5.The research findings has

shown that nurses with more year of experience and area of working have

significant association in management of neonatal jaundice.

Ahmed.SM et al. (2017) conducted a pre experimental study on

assessment of nurse‟s knowledge and practice about neonatal

hyperbilirubinemia working in district hospitals at Minia Governorate.41 staff

nurses were selected by convenient sampling technique. Data collected by self

structured questionnaire, as a result there is a correlation between the years of

experience in NICU and year of experience in other department have high

significant p value <0.01 and training is significant p value <0.05.based on the

findings of the pretest study, majority of the nurses were competent regarding

practices related to hyperbilirubinemia.

Ghada.M et al. (2016) were conducted a quasi experimental study to

examine the effect of a designed nursing care protocol on clinical outcomes for

neonates with hyperbilirubinemia at neonatal intensive care units in Shebin El-

Kom Teaching Hospital and El Gamea El Sharea for neonates. Sample consist

of 37 nurses two work in NICU and a convenient sample (120) neonates were

selected. Instruments: three tools were used: nurses' knowledge structured

questionnaire, Nurses' practices observational checklist and Neonatal

assessment sheet. It showed significant improvement in nurses' knowledge and

practices after implementation of educational program regarding neonatal

hyperbilirubinemia. Study concluded that, implementation of the designed

nursing care protocol improved nurses' knowledge and practices regarding care

of neonates with hyperbilirubinemia on posttest than on pre test. Also, it

improved clinical outcomes of neonates with hyperbilirubinemia.

Neghabadi.FP et al. (2015).carried out a descriptive study on

auditing phototherapy related nursing care in neonatal general and ICU units

affiliated to shabid benesthi university of medical science ,Iran.120

phototherapy related nursing care delivery episodes were selected and sampling

were observed by using checklist.The checklist based on current standards. The

accordance of phototherapy related nursing care services with the current

standards in study setting was moderate (58.7%) and co-relation co-efficient is

(0.78).the study concludes that lack of knowledge about importance and

outcome of accurate phototherapy related nursing care services.

Sinmayee Kumari Devi et al. (2015) was conducted a study to

assess the Effectiveness of Video Assisted Teaching Module (VATM) on

Knowledge Regarding Care of Newborn Baby under Photo Therapy among

Female Health Workers. A quasi experimental study with pre and post test

without control group design was undertaken on 30 female health workers of

Capital Hospital, Bhubaneswar, Odisha selected by purposive sampling

technique. The data collected by multiple choice close ended questionnaire and

analyzed by using descriptive and inferential statistics. The study findings that

there is a significant difference between pre and post test knowledge was found

(t=25.48, p≤0.05). No significant association was found between post test

knowledge and demographic variable.

Rahman.J et al. (2015) conducted a pre experimental study to assess the

effectiveness of self instructional module on phototherapy knowledge and

practice among staff nurses of selected hospital, Kolkata.30 staff nurses were

selected for the study by purposive sampling technique. Data collected by

structured questionnaire. The study concludes that post test score (19.5)

knowledge,(16.8) practice is higher than pre test score. Hence the self

instructional module was effective method of importing staff nurse knowledge

and practice.

Orimadegum A.E et al. (2015) conducted a cross sectional survey of

knowledge and practice related neonatal jaundice in Ibadan,Nigeria.227

primary health workers were selected for the study, by using semi structured

questionnaire knowledge and practice was assessed. As a result of the study is

that 80.2% had poor knowledge and 46.4% engaged in wrong practices (CI =

1.03, 4.79).The researcher concludes that they need to organize regular training

programme were emphasized.

Soheila Rabiyeepoor et al. (2014) conducted a descriptive analytical

study to assess knowledge and attitude of postnatal mothers on Neonatal

jaundice in Motahari hospital.200 mothers were selected for the study by

purposive sampling technique. Data were collected by structured knowledge

questionnaire. The knowledge score was 6.65 (SD= 3.5) and attitude score was

25.9 (SD=4.48).the researcher conclude that knowledge and score was

correlated with the past experience of neonatal jaundice. An educational

programme is needed for the mothers to increase their knowledge about

neonatal jaundice.

Shrestha.S (2008) conducted a descriptive and explorative study on

knowledge and practice of nursing personnel regarding the care of neonates

under phototherapy at Paropakar Shree Rajyalaxmi Devi Hospital,

Kathmandu.50 samples were selected for the study by purposive sampling

technique .data were collected by semi structured questionnaire. The study

reveals that 56% of respondents are highly knowledgeable and 44% of

respondents are with average knowledge regarding care of baby in

phototherapy.

Ogunfowora.O et al. (2006) was carried out a pre experimental study

in Olabisi Onabanjo University in Nigeria to assess the knowledge and practice

of community health workers regarding neonatal jaundice and its

management.66 community health workers were participated and they were

interviewed by means of self administered questionnaire. The study concludes

that only 54.5% had adequate knowledge of effective treatment namely

phototherapy and exchange transfusion. Researcher recommended regular

training and workshop for the community health workers.

2.1.3 STUDIES RELATED TO MANAGEMENT AND COMPLICATION

OF PHOTOTHERAPY

Sridhar N.L et al. (2018) were conducted a study on calcium

concerns in neonates undergoing phototherapy. Study group included 50

neonates with term and late pre term neonates (35-37 weeks) receiving

phototherapy for neonatal jaundice were included in the study. At the end of

phototherapy in study group, a significant fall in calcium levels in 64% of term

and 76% of late preterm neonates was observed, but almost all expect one

remained asymptomatic.teh efficacy of phototherapy in the prevention of

treatment of hyperbilirubinemia in newborn and infants well established. The

researcher concludes that duration of phototherapy may influence the severity

of hypocalcaemia.

Venktamurthy M et al. (2016) was conducted a prospective

comparative study on effect of phototherapy on platelet count in neonatal

hyperbilirubinemia in tertiary care hospital at Karnataka. Samples of 100

neonates were selected for the study with neonates receiving phototherapy.

Before starting phototherapy platelet count was checked at 0 hours and

discontinuation of phototherapy (second sample).the first sample was

considered as control group. The study concludes that mean platelet count

(2.23 +/- 0.28 lakh) by phototherapy and (1.82 +/- 0.01 lakh) after

phototherapy. There was a decline in platelet count after phototherapy, it was

not statistically expect for low birth weight babies.

Mashal Khan et al. (2016) a cross sectional study conducted at

neonatal intensive care unit, National Institute of Child Health, Karachi. A total

of 123 term neonates with jaundice of either gender managed by phototherapy

were enrolled in the study. Duration of phototherapy was recorded. A sample

of 3ml of blood was sent to the laboratory for the serum calcium level before

initiating phototherapy and after 24 hours of phototherapy. All the data were

recorded in the proforma.Data was analyzed using SPSS version‟s value <0.05

was taken as significant. The study concludes that frequency of hypocalcaemia

is significant in the jaundiced neonates treated with phototherapy.

Olusanya B.O et al. (2009) a study was conducted in Nigeria to

establish the incidence, correlates and hearing screaming outcomes of infants

with severe neonatal jaundice. A hearing screaming was done in 5269 infants

of them 48.7% Neonatal jaundice of whom 5.5% received phototherapy and

1.9% had an exchange blood transfusion. All but two infants with severe

neonatal jaundice were exclusively breast fed. Of those who failed the hearing

test, 17.3% were treated with phototherapy and 11.3% had an exchange blood

transfusion. At least 8.9% of infants requiring phototherapy and 17.3% of those

requiring exchange blood transfusions were at risk of sensor neural hearing

loss. This study showed that severe neonatal jaundice is a significant condition

associates with modifiable risk factors in this population. Policy initiatives for

prevention, early detection followed by appropriate and timely intervention

were urgently needed to reduce the disease burden.

Mehta.S et al. (2006) was conducted a randomized control trial study

to evaluate the effectiveness of fluid supplementation in decreasing the rate of

exchange transfusion and the duration of phototherapy in term neonates with

severe no hemolytic hyperbilirubinemia, seventy four term neonates with

severe non hemolytic hyperbilirubinemia (total serum bilirubin>18mg/d to

<25mg/dl) The subjects were randomized to an extra fluid group (intravenous

fluid supplementation for 8 hours and oral supplementations for the duration of

phototherapy n=37) or a control group had (n=37). At inclusion 54 infants

(73%) had high serum osmolality, including 28 (75%) in the extra fluid group

28 (75%) in the extra fluid group and 26 (70%) in the control group. The

duration of phototherapy was also shorter in extra fluid group (5+/-18 hours

versus 73+/-31 hours). This study shows that fluid supplementation in term

neonates presenting with severe hyperbilirubinemia decrease the rate of

exchange transfusion and duration of phototherapy.

Shinwell E.S et al. (2004) study was conducted in Israel to find the

effect of position changing on bilirubin levels during phototherapy. Thirty term

infants were enrolled in the study (turned -14, supine position –16). The

blanching time was found to be approximately 150 minutes. Transcutaneous

bilirubinometer was used to determine the time required to clear the skin of

bilirubin in term infants. This study showed that infants in the supine group

showed a significantly larger drop in serum total bilirubin concentration and

required a shorter duration of phototherapy than the turned group.

CHAPTER-III

RESEARCH

METHODOLOGY

CHAPTER – III

METHODOLOGY

This chapter deals with the methodology to assess the effectiveness of

structured teaching programme on knowledge regarding care of newborn

during phototherapy among II year DGNM students at Institute of Child Health

and Hospital for Children, Egmore, Chennai-08”.

3.1 RESEARCH APPROACH

Quantitative research approach

3.2 STUDY DESIGN

Pre experimental one group pre test post test design

The research design adopted for the study is pre experimental (one group pre

test post test ) with manipulation and no randomization and no control group.

E O 1 X O2

KEY:

E – Pre experimental group

O1 – Pre assessment (Pre test)

X – Nursing intervention (Structured teaching programme)

O2 – Post assessment (Post test)

3.3 DURATION OF THE STUDY

4 weeks

3.4 STUDY SETTING

The study was conducted at the Institute of Child Health and Hospital for

Children, Egmore, Chennai-08.The Department was started in 1948, at

Government General Hospital and then upgraded in 1957 for public service. It

is an 867 bedded hospital with tertiary care centre, referral, nodal centre for

IMNCI and also the research centre. This hospital is renowned for its

excellence in medical experts, nursing care and quality diagnostic services

specifically for newborn and children. Institute of Child Health and Hospital

for Children has Departments like IMNCI, SICU, NICU and other specialities

which are rendering comprehensive care to children at and around Chennai and

for neighboring states like Andhra Pradesh etc. The rationale for selecting this

area is its feasibility and availability of adequate samples.

3.5 STUDY POPULATION

3.5.1. Target population: Students who are posted in Institute of Child Health

and Hospital for Children, during the time of study

3.5.2. Accessible population: The population available during the study time

at Institute of Child Health and Hospital for Children.

3.6 SAMPLE:

The sample comprises of II year DGNM students.

3.7 SAMPLE SIZE:

90 students who met with the inclusion criteria

3.8 SAMPLE CRITERIA

3.8.1. INCLUSION CRITERIA:

Students of II year DGNM posted in ICH.

Students of II year DGNM who are available at the time of data

collection.

Students who are willing to participate.

3.8.2. EXCLUSION CRITERIA:

Students who are studying other paramedical courses.

Students who are studying B.Sc.(N),M.Sc.(N),P.B.B.Sc(N)

3.9. SAMPLING TECHNIQUE

Sampling procedure is Non-probability convenient sampling technique

3.10. RESEARCH VARIABLES:

3.10.1. Independent variable:

The Structured teaching module on knowledge regarding care of newborn

during phototherapy

3.10.2. Dependent variable:

The knowledge of the students regarding care of newborn during

phototherapy.

3.11. DEVELOPMENT AND DESCRIPTION OF TOOLS:

3.11.1. DEVELOPMENT OF TOOLS

Structured questionnaire was developed after in-depth review of literature;

obtained opinion and content validity from medical, nursing and statistical

experts. Construction and pretesting of tool was done during pilot study and

direct assessment of students was performed during data collection.

3.11.2. DESCRIPTION OF TOOLS

SECTION I: Comprises a demographic variable of students which includes

age, medium of study, family income, education, previous exposure on

phototherapy.

SECTION II: Consists of 40 multiple choice questions to assess the

effectiveness of structured teaching programme on knowledge regarding care

of newborn during phototherapy and it has following subsection like

knowledge aspects of general information about phototherapy, nursing care of

newborn during phototherapy and side effects of phototherapy.

3.11.3. SCORING PROCEDURE:

Section A : The demographic variables were coded to assess the subject it for

statistical analysis.

Section B: The semi structured knowledge questionnaire, each correct answer

was given a score of „one‟ and the wrong answer was given a score of „zero‟

Table 3.1. INTERPRETATION OF KNOWLEDGE SCORE

SCORE INTERPRETATION

>75% Adequate knowledge

51-75% Moderate knowledge

<50% Inadequate knowledge

3.12. CONTENT VALIDITY

Content validity of the tool was obtained from 2 Medical expert and 2 Nursing

experts in the field of Child health nursing. They suggested certain

modification in the tool. The expert‟s suggestions were incorporated in the tool.

Then the tool was finalized and used for the main study.

3.13. RELIABILITY OF THE TOOL

Reliability of the tool was determined by test retest method. There was a

significant co-relation between the test and retest knowledge score according to

Karl Pearson‟s correlation coefficient the value is 0.08.This score indicates

high co relation. Hence the tool was found to be reliable to conduct the main

study.

3.14. PROTECTION OF HUMAN SUBJECTS

Obtained approval from the Institutional Ethical Committee, Madras

Medical College, Director of Institute of Child Health and Hospital for

Children, Egmore, Chennai-08 and all respondents were carefully informed

about the purpose of the study. The students were explained about the purpose

and need of the study. They were assured that their details and answers will be

used only for research purpose and kept confidentially. Written permission was

obtained from the participants before conducting the study.

3.15. PILOT STUDY:

In order to test the feasibility, relevance of the study, a pilot study was

conducted with 10 students. Convenient sampling technique was used. Before

and after structured teaching program pre and post test was conducted. Those

data were analyzed to find out the suitability of the study. The results of the

pilot study showed that there was a positive correlation between the knowledge

of the students with care of newborn during phototherapy and the investigator

found that the study was feasible.

3.16. DATA COLLECTION PROCEDURE

The study was conducted in Institute of Child Health and Hospital for

Children, after obtaining permission from the Director and Head of the

Department of NICU in Institute of Child Health and Hospital for Children,

Chennai-08. Before the data collection, the researcher introduced herself,

explained the purpose of the study to the DGNM II year students regarding

care of newborn during phototherapy. The confidential was assured and

consent was obtained from the participants. Then the students were interviewed

and educated using structured teaching module. Five to ten participants were

selected everyday and assured that at anytime they can withdraw from the

study. The period of study extended for four weeks and the data was collected

from Monday to Saturday between to 8am to 4pm. Using convenient sampling

technique, 90 samples were collected who fulfilled their selection criteria.

Pre test was conducted for 25 minutes; the structured teaching

programme was implemented on the same day for 45 minutes using

PowerPoint presentation and information booklets, which was prepared by the

researcher after consulting with the specialists. The students participated with

interest and were alert and enthusiastic. Certain points were repeated for better

understanding and doubts were cleared and given a self instructional module to

each student regarding care of newborn during phototherapy.

After seven days of interval the post test was administered to the same sample

for 25 minutes regarding the knowledge regarding care of newborn during

phototherapy, using the same questionnaire, and evaluated the effectiveness of

structured teaching programme on care of newborn during phototherapy

3.17. DATA ENTRY AND ANALYSIS

Demographic variables in categories were given in frequencies with their

percentages.

Knowledge score were given in mean and standard deviation.

Quantitative knowledge score in pre test and post-test were compared using

student‟s paired t-test.

Associations between knowledge gain score with demographic variables are

assessed using one way ANOVA F-test and t-test.

Diagram, with regression estimate were used to represent the data.

FIGURE-3.1: SCHEMATIC REPRESENTATION OF THE

RESEARCH METHODOLOGY

RESEARCH DESIGN

Pre experimental one group pre test and post test

design

STUDY SETTINGS

Institute of Child Health and Hospital for Children,

Egmore, Chennai-08

TARGET POPULATION

DGNM II Year students

SAMPLING TECHNIQUE

Convenient sampling technique

SAMPLE SIZE

90

DESCRIPTION OF THE INSTRUMENT

Semi structured questionnaire

DATA ANALYSIS

Descriptive and Inferential statistics

FINDINGS AND CONCLUSION

CHAPTER-IV

DATA ANALYSIS AND

INTERPRETATION

CHAPTER – IV

DATA ANALYSIS AND INTERPRETATION

This chapter presents the analysis and interpretation of data collected

from 90 subjects using a structured questionnaire to assess the knowledge


The data was analysed according to the objectives and hypothesis formulated

for purpose of the study using descriptive and inferential statistics.

Analysis is the process of organizing and synthesizing the data in such a way

that research questions can be answered and hypotheses tested. The purpose of

analysis is to reduce the data into an intelligible and interpretable form, so that

the relation of research problem can be studied and tested.

ORGANIZATION OF DATA

Section A: Description of frequency and percentage distribution of


Section B: Assessment of pre test knowledge among nursing students with care

of newborn during phototherapy.

Section C: Assessment of post test knowledge among nursing students with


Section D: Comparison of pre test and post test knowledge among nursing

students with care of newborn during phototherapy and effectiveness of

structured teaching programme.

Section E: Association between the post test knowledge among nursing

students with care of newborn during phototherapy with demographic

variables.

STATISTICAL ANALYSIS

Demographic variables in categories were given in frequencies with their

percentages.

Knowledge score were given in mean and standard deviation.

Quantitative knowledge score in pre test and post test were compared using

student‟s paired t-test.

Qualitative level of knowledge in pre test and post test were compared using

Stuart-Maxwell test /extended McNemar test

Association between demographic variables and knowledge score were

analysed using Pearson chi-square test

Simple bar diagram, multiple bar diagram, Pie diagram, Doughnut diagram and

Box plot were used to represent the data.

P<0.05 was considered statistically significant. All statistical test are two tailed

test.

SECTION A: DESCRIPTION OF DEMOGRAPHIC VARIABLES

OF STUDY PARTICIPANTS.

Table-4.1: Reveals distribution of demographic variables of nursing

students with care of newborn during phototherapy.

Demographic variables No. of students %

Age of the student

18-21 years

86

95.56%

21-25 years 4 4.44%

25-30 years 0 0.00%

Medium of instruction

in higher secondary

English

31

34.44%

Tamil

59 55.56%

Type of family

Nuclear

63

70.00%

Joint

20

22.22%

Extended

7 7.78%

Mothers education

Illiterate

16

17.78%

Primary 25 27.78%

Secondary education 9 10.00%

High school 25 27.78%

Higher secondary 12 13.33%

Graduate 3 3.33%

Fathers education

Illiterate

16

17.78%

Primary 24 26.67%

Secondary education 9 10.00%

High school 20 22.22%

Higher secondary 18 20.00%

Graduate 3 3.33%

Father‟s Occupation

Unemployed

9

10.00%

Unskilled worker 14 15.56%

Semiskilled worker 5 5.56%

Skilled worker 17 18.89%

Clerk, shop owner 40 44.44%

Semi profession 2 2.22%

Profession 3 3.33%

Monthly income of

the family

Below Rs. 2,091

26

28.89%

Rs .2,092 – Rs .6,213 21 23.33%

Rs .6214 – Rs .10,356 23 25.56%

Rs .10,357 – Rs

.15,535 12 13.34%

Rs .15,536 – Rs

.20,714 4 4.44%

Rs.20,715 –Rs. 41,429 2 2.22%

>Rs. 41,430 2 2.22%

Have you been posted

in NICU?

Yes

15

16.67%

No 75 83.33%

Do you have

exposure on care of

newborn during

phototherapy?

Yes

28

31.11%

No 62 68.89%

Data presented in table-4.1 shows the following:

Age: Maximum 95.56% of the students belongs to age group of 18 – 21 years,

4.44% of the students belongs to age group of 25 – 31 years.

Medium of instruction: 65.56% of the student‟s medium of instruction in

higher secondary is Tamil and 34.44% of the student‟s medium of instruction

in higher secondary is English.

Type of family system: 70% of the students were nuclear family, 22.22% of

students were joint family and 7.78% of students were extended family.

Mother education: 27.78% of the student mothers had primary and high

school education, 17.78% of the student mother is illiterate, 13.33% of the

student mother had higher education, 10% of the student‟s mothers had

secondary education and 3.33% of the student‟s mothers become graduates.

Father education: 26.67% of the student father had primary, 22.22% of the

student‟s father had high school education, 20% of the student father is higher

secondary, 17.78% of the student father become illiterate, 10% of the student‟s

fathers had secondary education and 3.33% of the student‟s fathers become

graduates.

Father occupation: 44.44% of the fathers were clerk, shop owner, 18.89% of

the fathers were skilled worker, 15.56% of the fathers were unskilled worker,

10% of the fathers were unemployed, 5.56% of the fathers were semi skilled

worker, 3.33% of the fathers were profession and 2.22% of the fathers were

semi profession.

Family income: 28.89% of subjects have family income of about (< Rs.2,091),

25.56% of subjects have family income of about (Rs.6214- Rs.10,356), 23.33%

of subjects have family income of about (Rs.2,092- Rs.6,213), 13.34% of

subjects have family income of about (Rs.10,357- Rs.15,535), 4.44% of

subjects have family income of about (Rs.15,536- Rs.20,714), 2.22% of

subjects have family income of about (Rs.20,715- Rs.41,429) and (>

Rs.41,430).

Posted in NICU: 83% of the students have not been posted in the NICU and

17% of the students have been posted in the NICU.

Previous exposure: 69% of the students not had exposure on care of newborn

during phototherapy and 31% of the students had exposure on care of newborn


Figure- 4.1: Cylindrical diagram shows distribution of sample age group

Figure-4.2: Pie diagram showing distribution of sample according to medium

of instruction in higher secondary.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18-21 years 21-25 years 25-30 years

95.56%

4.44%0.00%

% o

f st

ud

ents

AGE DISTRIBUTION

English

34.44%

Tamil

65.56%

MEDIUM OF INSTRUCTION IN HIGHER

SECONDARY

Figure-4.3: Bar diagram shows distribution of sample according to type of

family

Figure- 4.4: Bar diagram shows distribution of sample according to mother

education status

0%

10%

20%

30%

40%

50%

60%

70%

80%

Nuclear Joint Extended

70.00%

22.22%

7.78%% of

stu

den

ts

TYPE OF FAMILY SYSTEM

0%

5%

10%

15%

20%

25%

30%

35%

40%

Illiterate Primary Secondary

education

High school Higher

secondary

Graduate

17.78%

27.78%

10.00%

27.78%

13.33%

3.33%

% o

f s

tud

ents

MOTHER EDUCATION STATUS

Figure -4.5: Bar diagram shows distribution of sample according to father

education status

Figure -4.6: Cylindrical diagram shows distribution of sample according to

father occupation

0%

5%

10%

15%

20%

25%

30%

35%

40%

Illiterate Primary Secondary

education

High school Higher

secondary

Graduate

17.78%

26.67%

10.00%

22.22%20.00%

3.33%

% of

stu

den

ts

FATHER EDUCATION

-10%

0%

10%

20%

30%

40%

50%

60%

10.00%

15.56%

5.56%

18.89%

44.44%

2.22% 3.33%% of

stu

den

ts

FATHER OCCUPATION

Figure -4.7: Cylindrical diagram shows distribution of sample according to

monthly income

Figure-4. 8: Doughnut diagram shows distribution of sample according to

posted in NICU

0%

5%

10%

15%

20%

25%

30%

35%

40%

Below Rs.

2,091

Rs .2,092 –

Rs .6,213

Rs .6214 –

Rs .10,356

Rs .10,357 –

Rs .15,535

Rs .15,536 –

Rs .20,714

Rs.20,715 –

Rs. 41,429

>Rs. 41,430

28.89%

23.33%25.56%

13.34%

4.44%2.22% 2.22%

% o

f s

tud

ents

MONTHLY INCOME OF THE FAMILY

Yes

17%

No

83%

POSTED IN NICU

Figure-4.9: Pie diagram shows distribution of sample according to previous

exposure on care of newborn during phototherapy.

Yes

31%

No

69%

PREVIOUS EXPOSURE ON CARE OF

NEWBORM

DURING PHOTOTHERAPY

SECTION B: ASSESSMENT OF PRE TEST KNOWLEDGE AMONG

NURSING STUDENTS WITH CARE OF NEWBORN DURING

PHOTOTHERAPY.

Table-4.2: Pretest Percentage of Knowledge n Care of Newborn during

Phototherapy

Table-4.2: shows each domain wise pre-test percentage of knowledge of II year

DGNM students regarding care of newborn during phototherapy. They are

having maximum knowledge in General information (58.67%) and minimum

knowledge score in adverse effects of phototherapy (38.29%). Overall

knowledge score is 44.83%.

Knowledge on

No. of

questions

Min –

Max

Score

Knowledge score

Mean

SD

% of

mean

score

General information 3 0 -3 1.76 .78 58.67%

Indications of phototherapy 2 0 – 2 .90 .74 45.00%

Types of jaundice 2 0 – 2 .90 .60 45.00%

Diagnostic evaluation 2 0 – 2 1.17 .72 58.50%

Phototherapy 2 0 – 2 1.16 .67 58.00%

Mechanism of action of phototherapy 4 0 – 4 2.16 .98 54.00%

Nursing care of newborn during

phototherapy

18 0 – 18 7.22 2.04 40.11%

Adverse effects of phototherapy

7 0 – 7 2.68 1.23 38.29%

TOTAL

40 0 -40 17.93 3.21 44.83%

Table-4.3: Pretest Level of Knowledge

Level of knowledge No. of Students %

Inadequate knowledge 71 78.88%

Moderate knowledge 19 21.12%

Adequate knowledge 0 0.00%

Total 90 100%

Table No-4.3 Shows the level of pre-test percentage of knowledge of II year

DGNM students regarding care of newborn during phototherapy.78.88% of

students are having inadequate level of knowledge score, 21.12% of them

having moderate level of knowledge score and none of them are having

adequate level of knowledge score.

Figure-4.10: Pre Test Level of Knowledge Score

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Inadequate Moderate Adequate

78.88%

21.12%

0.00%

% o

f st

ud

ents

PRETEST LEVEL OF KNOWLEDGE SCORE

SECTION C: ASSESSMENT OF POST TEST KNOWLEDGE AMONG

NURSING STUDENTS WITH CARE OF NEWBORN DURING

PHOTOTHERAPY.

Table-4.4: Posttest Percentage of Knowledge on Care of Newborn during

Phototherapy

Table-4.4: shows each domain wise post-test percentage of knowledge of II

year DGNM students regarding care of newborn during phototherapy. They are

having maximum knowledge in General Information (90.67%) and minimum

knowledge score in Diagnostic Evaluation (81.50%). Overall knowledge

score is 84.15%.

Domains

No. of

questions

Min –

Max

score

Knowledge score

Mean SD % of

mean

score

General Information 3 0 -3 2.72 .45 90.67%

Indications Of Phototherapy 2 0 - 2 1.67 .47 83.50%

Types Of Jaundice 2 0 - 2 1.64 .48 82.00%

Diagnostic Evaluation 2 0 - 2 1.63 .48 81.50%

Phototherapy 2 0 - 2 1.70 .46 85.00%

Mechanism Of Action Of

Phototherapy

4 0 - 4 3.37 .84 84.25%

Nursing Care Of Newborn During

Phototherapy

18 0 - 18 14.92 2.40 82.89%

Adverse Effects Of Phototherapy 7 0 - 7 6.00 .92 85.71%

TOTAL 40 0 -40 33.66 3.81 84.15%

Table-4.5: Post test Level of Knowledge

Table No-4.5: shows the level of post-test percentage of knowledge of II year

DGNM students regarding care of newborn during phototherapy. None of the

students are having inadequate level of knowledge score, 17.78% of them

having moderate level of knowledge score and 82.22% of them are having


Level of knowledge No. of students %

Inadequate knowledge 0 0.00%

Moderate knowledge 16 17.78%

Adequate knowledge 74 82.22%

Total 90 100.00%

Figure-4.11: Post Test Level of Knowledge Score

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


0.00%

17.78%

82.22%

% o

f s

tud

ents

POSTTEST LEVEL OF KNOWLEDGE SCORE

SECTION D: COMPARISON OF PRETEST AND POSTTEST LEVEL

OF KNOWLEDGE SCORE AMONG II YEAR DGNM STUDENTS


Table-4.6: Comparison of Pre test And Post test Level of Knowledge Score

Level of knowledge

Pretest

Post test Extended

McNemar‟s

test n % n %

Inadequate

knowledge

71 78.88% 0 0.00% 2=81.23

P=0.001***(S)

Moderate

knowledge

19 21.12% 16 17.78%

Adequate

knowledge

0 0.00% 74 82.22%

Total 90 10.00% 90 100.00%

***very high significant at p<0.001 level

Table no 7 shows the pre-test and post test level of knowledge among students

Before STP, 78.88% of the students are having inadequate level of knowledge

score, 21.12% of them having moderate level of knowledge score and none of

them are having adequate level of knowledge score.

After STP, none of the students are having inadequate level of knowledge

score, 17.78% of them having moderate level of knowledge score and 82.22%

of them are having adequate level of knowledge score.

Level of knowledge gain score between pre-test and post-test was calculated

using Extended McNemar‟s chi-square test.

Figure-4.12: Percentage of Pre test and Post test level of knowledge

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pretest Posttest

78.88%

0.00%

21.12%17.78%

0.00%

82.22%

% o

f s

tud

ents

PRETEST AND POSTTEST LEVEL OF KNOWLEDGE SCORE

Inadequate

Moderate

Adequate

Table-4.7: Comparison of Pretest and Post test Knowledge Score

*** Very high significant at P≤0.001 DF= Degrees of Freedom

Knowledge on Pretest Post test Mean

Difference

Student‟s paired

t-test Mean SD Mean SD

1 General

Information 1.76 .78 2.72 .45 0.96

t=13.21P=0.001 ***

DF= 89 , Significant

2 Indications of

Phototherapy .90 .74 1.67 .47 0.77

t=7.75 P=0.001 ***


3 Types of

Jaundice .90 .60 1.64 .48 0.74

t=9.90 P=0.001 ***


4 Diagnostic

Evaluation 1.17 .72 1.63 .48 0.46

t=5.46P=0.001 ***


5 Phototherapy 1.16 .67 1.70 .46 0.54

t=6.38P=0.001 ***


6 Mechanism of

Action of

Phototherapy

2.16 .98 3.37 .84 1.21

t=9.26P=0.001 ***


7 Nursing Care of

Newborn During

Phototherapy

7.22 2.04 14.92 2.40 7.7

t=22.80P=0.001 ***


8 Adverse Effects

of Phototherapy 2.68 1.23 6.00 .92 3.32

t=20.24P=0.001 ***


Total knowledge

score 17.93 3.21 33.66 3.81

15.73

t=31.12P=0.001 ***


Table no-4.7 shows the comparison of Pre test and post test knowledge score


Knowledge regarding

General information: In pretest students are having 1.76 score and in posttest

they are having 2.72 score, so the difference is 0.96. This difference is large

and statistically significant difference.

Indications of phototherapy: In pretest students are having 0.90 score and in

posttest they are having 1.67 score, so the difference is 0.77. This difference is

large and statistically significant difference.

Types of jaundice: In pretest students are having 0.90 score and in posttest



Diagnostic evaluation: In pretest students are having 1.17 score and in posttest



Phototherapy: In pretest students are having 1.16 score and in posttest they are

having 1.70 score, so the difference is 0.54. This difference is large and

statistically significant difference.

Mechanism of Action of Phototherapy: In pre test students are having 2.16

score and in post test they are having 3.37 score, so the difference is 1.21. This

difference is large and statistically significant difference.

Nursing Care of Newborn During Phototherapy: In pretest students are

having 7.22 score and in post test they are having 14.92 score, so the difference

is 7.70. This difference is large and statistically significant difference.

Adverse Effects of Phototherapy: In pre test students are having 2.68 score

and in post test they are having 6.00 score, so the difference is 3.32. This


Total: In pre test students are having 17.93 score and in post test they are



On an average, students are improved their knowledge from 17.93 to

33.63 after the administration of structured teaching programme. Or we can

say, in pre test they are able to answer only 18 questions before administration

of STP, after administration of STP they are able to answer upto33 questions.

Due to STP they are able to answer 15 more questions correctly. This

difference is statistically significant. Statistical significance was calculated by

using student‟s paired „t‟test.

Figure -4.13: Box plot compares the student’s pre test and post test knowledge scor

Table-4.8: Each Domain wise Pretest and Post-test Percentage of

Knowledge

Table no-4.8: shows each domain wise knowledge gain score regarding care of

newborn during phototherapy among II year DGNM students at ICH, Egmore,

chennai-08. In pretest students are having 44.83% of knowledge score and in

posttest they are having 84.15%. So they gained 39.32% after structured

teaching programme

Domains

Pretest

Knowledge

Posttest

Knowledge

% of

Knowledge

Gain

General Information 58.67% 90.67% 32.00%

Indications Of Phototherapy 45.00% 83.50% 38.50%

Types Of Jaundice 45.00% 82.00% 37.00%

Diagnostic Evaluation 58.50% 81.50% 23.00%

Phototherapy 58.00% 85.00% 27.00%

Mechanism of Action of

Phototherapy 54.00% 84.25% 30.25%

Nursing Care of Newborn

During Phototherapy 40.11% 82.89% 42.78%

Adverse Effects of Phototherapy 38.29% 85.71% 47.42%

Overall 44.83% 84.15% 39.32%

Figure-4.14: Pretest and Post test Percentage of Knowledge Score

0%

20%

40%

60%

80%

100%

58.67%

45.00% 45.00%

58.50% 58.00%54.00%

40.11% 38.29%

90.67%83.50% 82.00% 81.50%

85.00% 84.25% 82.89% 85.71%

% o

f s

tud

ents

PRETEST AND POSTTEST PERCENTAGE OF KNOWLEDGE SCORE

Pretest

Posttest

Table no-4.9: EFFECTIVENESS AND GENERALIZATION OF

STRUCTERED TEACHING PROGRAMME

Max

score

Mean score Mean Difference of

knowledge gain score

with 95% Confidence

interval

Percentage of

knowledge gain score

with 95% Confidence

interval

Pretest 40 17.93 15.72(14.71 – 16.72) 39.30 %( 36.78% –

41.80%) Posttest 40 33.66

Table no-4.9:shows the effectiveness of structured teaching programme on

knowledge regarding care of newborn during phototherapy among II year

DGNM students at ICH, Egmore , chennai-08

On an average, in posttest after having STP, students are gained 39.30% more

knowledge score than pretest score.

Differences and generalization of knowledge gain score between pretest and

posttest score was calculated using and mean difference with 95% CI and

proportion with 95% CI.

SECTION E: ASSOCIATION BETWEEN STUDENTS POSTTEST

LEVEL OF KNOWLEDGE AND THEIR DEMOGRAPHIC

VARIABLES

Table-4.10: shows association between posttest level of knowledge and

demographic variables

Demographic variables

Posttest level of knowledge score n Chi square

test Inadequate Moderate Adequate

N % n n % n n %

Age of the

student

18-21 years

0

0.00%

14

16.28%

72

83.72%

86

2=2.97

P=0.08(NS) 21-25 years 0 0.00% 2 50.00% 2 50.00% 4

25-30 years 0 0.00% 0 0.00% 0 0.00% 0

Medium of

instruction in

higher

secondary

English

0

0.00%

2

6.45%

29

93.55%

31

2=4.45

P=0.04*(S)

Tamil 0 0.00% 14 23.72% 45 76.28% 59

Type of family

Nuclear 0 0.00% 8 12.69% 55 87.31% 63 2=8.60

P=0.01**(S) Joint 0 0.00% 4 20.00% 16 80.00% 20

Extended

0 0.00% 4 57.14% 3 42.86% 7

Students

education

Illiterate 0 0.00% 2 12.50% 14 87.50% 16 2=4.01

P=0.55 (NS) Primary 0 0.00% 7 28.00% 18 72.00% 25

Secondary

education 0 0.00% 1 11.11% 8 88.89% 9

High school 0 0.00% 3 12.00% 22 88.00% 25

Higher

secondary 0 0.00% 3 25.00% 9 75.00% 12

Graduate 0 0.00% 0 0.00% 3 100.00% 3

Fathers

education

Illiterate 0 0.00% 1 6.25% 15 93.75% 16 2=6.20

P=0.29 (NS) Primary 0 0.00% 6 25.00% 18 75.00% 24

Secondary

education 0 0.00% 0 0.00% 9 100.00% 9

High school 0 0.00% 4 20.00% 16 80.00% 20

Higher

secondary 0 0.00% 5 27.78% 13 72.22% 18

Graduate 0 0.00% 0 0.00% 3 100.00% 3

Father‟s

Occupation

Unemployed

0 0.00% 2 22.22% 7 77.78% 9

2=6.20

P=0.28 (NS)

Unskilled

worker 0 0.00% 2 14.29% 12 85.71% 14

Semiskilled

worker 0 0.00% 2 40.00% 3 60.00% 5

Skilled worker 0 0.00% 1 5.88% 16 94.12% 17

Clerk, shop

owner 0 0.00% 7 17.50% 33 82.50% 40

Semi

profession 0 0.00% 0 0.00% 2 100.00% 2

Profession 0 0.00% 2 66.67% 1 33.33% 3

Monthly

income of the

family

Below Rs.

2,091 0 0.00% 3 11.54% 23 88.46% 26

2=8.91

P=0.18 (NS)

Rs .2,092 – Rs

.6,213 0 0.00% 4 19.05% 17 80.95% 21

Rs .6214 – Rs

.10,356 0 0.00% 3 13.04% 20 86.96% 23

Rs .10,357 –

Rs .15,535 0 0.00% 3 25.00% 9 75.00% 12

Rs .15,536 –

Rs .20,714 0 0.00% 1 25.00% 3 75.00% 4

Rs.20,715 –

Rs. 41,429 0 0.00% 1 50.00% 1 50.00% 2

>Rs. 41,430 0 0.00% 1 50.00% 1 50.00% 2

Have you been

posted in

NICU?

Yes 0 0.00% 0 0.00% 15 100.00% 15 2=6.55

P=0.01**

(S)

No 0 0.00% 16 21.33% 49 78.67% 75

Do you have

exposure on

care of

newborn

during

phototherapy?

Yes 0 0.00% 1 3.57% 27 96.43% 28 2=5.61

P=0.02* (S) No

0 0.00% 15 24.19% 47 75.81% 62

NS=not significant S= Significant P> 0.05 not significant *P≤0.05 significant

**P≤0.01 highly significant

Table no 10: shows the association between posttest level of knowledge and

their demographic variables.

English medium students, Nuclear family students, NICU posted students and

having exposure on care of newborn during phototherapy students are gained

more knowledge than others.

Statistical significance was calculated using chi square test.

Table -4.11: ASSOCIATION BETWEEN STUDENTS KNOWLEDGE

GAIN SCORE AND THEIR DEMOGRAPHIC VARIABLES

Demographic variables

knowledge gain score n Oneway

ANOVA

F-test/t-

test

Pretest Posttest

Gain

score=post-pre

n % n

n

% N

n

%

Age of the

student

18-21 years

17.79

3.14

32.73

3.78

14.94

4.78

86

t=1.23

P=0.22(NS) 21-25 years 21.00 3.74 33.00 4.55 12.00 2.00 4

25-30 years 0.00 0.00 0.00 0.00 0.00 0.00 0

Medium of

instruction in

higher

secondary

English

18.15

3.52

34.84

3.86

16.69

5.59

31

t=2.04

P=0.05*(S) Tamil

17.84 3.10 32.32 3.82 14.48 4.46 59

Type of

family

Nuclear

17.70

3.25

34.77

3.83

17.07

4.99

63

=3.47

P=0.04*(S) Joint 19.70 2.54 34.25 3.80 14.55 3.99 20

Extended 15.00 1.63 27.59 4.15 12.59 4.23 7

Mothers

education

Illiterate

17.50

3.74

34.31

3.68

16.81

5.21

16

F=0.92

P=0.47

(NS)

Primary 18.84 3.59 33.48 4.35 14.64 5.11 25

Secondary

education 17.00 2.45 32.44 2.46 15.44 3.47 9

High school 17.92 2.84 34.40 3.99 16.48 4.70 25

Higher

secondary 16.75 2.60 32.83 3.64 16.08 4.72 12

Graduate 20.33 2.89 32.33 2.08 12.00 4.00 3

Fathers

education

Illiterate

17.75

3.09

36.13

3.28

18.38

4.72

16

F=6.00

P=0.27

(NS)

Primary 18.29 3.10 31.87 3.63 13.58 4.48 24

Secondary

education 15.78 3.31 35.22 2.22 19.44 3.68 9

High school 18.35 3.34 33.70 3.80 15.35 4.97 20

Higher

secondary 18.17 3.28 33.22 4.19 15.06 4.18 18

Graduate 18.33 3.21 32.33 2.08 14.00 2.00 3

Father‟s

Occupation

Unemployed 17.33 4.18 33.22 4.06 15.89 5.18 9

F=0.48

P=0.82

(NS)

Unskilled

worker 17.71 2.58 33.21 3.51 15.50 4.78 14

Semiskilled

worker 19.40 1.34 33.20 5.26 13.80 5.02 5

Skilled

worker 18.76 3.77 34.76 3.49 16.00 5.34 17

Clerk, shop

owner 17.55 3.21 33.78 3.91 16.23 4.77 40

Semi

profession 20.50 2.12 34.00 1.41 13.50 .71 2

Profession 17.00 1.00 29.67 3.06 12.67 2.89 3

Monthly

income of the

family

Below Rs.

2,091 17.69 2.57 34.73 3.35 17.04 4.24 26

F=1.24

Rs .2,092 –

Rs .6,213 18.14 3.68 33.57 3.60 15.43 4.73 21

Rs .6214 –

Rs .10,356 17.87 3.58 34.00 4.09 16.13 5.19 23

Rs .10,357 –

Rs .15,535 18.50 3.99 32.58 3.50 14.08 4.64 12

P=0.29

(NS)

Rs .15,536 –

Rs .20,714 17.75 1.71 32.00 4.55 14.25 5.38 4

Rs.20,715 –

Rs. 41,429 16.00 .00 32.00 7.07 16.00 7.07 2

>Rs. 41,430 18.50 .71 28.00 2.83 9.50 3.54 2

Have you

been posted

in NICU?

Yes 17.27 2.63 35.07 3.33 17.80 3.85 15 t=2.38

P=0.02*

(S)

No 18.07 3.31 32.66 3.88 14.59 4.91 75

Do you have

exposure on

care of

newborn

during

phototherapy?

Yes 17.89 3.62 34.83 3.71 16.94 4.53 28 t=2.24

P=0.03*

(S)

No

17.95 3.04 32.44 3.87 14.49 4.94 62

NS=not significant S= Significant P> 0.05 not significant *P≤0.05 significant

**P≤0.01 highly significant

Table no12: shows the association between post-test level of knowledge and

their demographic variables.

English medium students, Nuclear family students, NICU posted students and

having exposure on care of newborn during phototherapy students are gained

more knowledge than others.

Statistical significance was calculated using chi square test.

Figure-4.15:shows association between the posttest level of knowledge score

and medium of instruction in higher secondary

Figure-4.16:shows association between posttest level of knowledge score and

type of family system

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

English Tamil

0.00% 0.00%6.45%

23.72%

93.55%

76.28%

% o

f s

tud

ents

ASSOCIATION BETWEEN POSTTEST LEVEL OF

KNOWLEDGE SCORE AND MEDIUM OF INSTRUCTION IN

HIGHER SECONDARY

Inadequate

Moderate

Adequate

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Nuclear Joint Extended

0.00% 0.00% 0.00%

12.69%20.00%

57.14%

87.31%80.00%

42.86%

% of

stu

den

ts

ASSOCIATION BETWEEN POSTTEST LEVEL OF

KNOWLEDGE SCORE AND TYPE OF FAMILY SYSTEM

Inadequate

Moderate

Adequate


and NICU posting.


and exposure on care of newborn during phototherapy

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


0.00% 0.00%

100.00%

0.00%

21.33%

78.67%

% o

f st

ud

ents

ASSOCIATION BETWEEN STUDENTS POSTTEST

LEVEL OF KNOWLEDGE SCORE AND NICU

POSTING

Yes

No

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

0.0

0%

0.0

0%

3.5

7%

24

.19

%

96

.43

%

75

.81

%

% o

f st

ud

ents

ASSOCIATION BETWEEN POSTTEST LEVEL OF KNOWLEDGE

SCORE AND EXPOSURE ON CARE OF NEWBORN DURING

PHOTOTHERAPY

Inadequate

Moderate

Adequate

CHAPTER-V

DISCUSSION

CHAPTER-V

DISCUSSION

This chapter deals with the discussion of the results of data analyzed

based on the objectives of the study and hypotheses of the study. The purpose

of the study was designed to evaluate the effectiveness of structured teaching

programme on knowledge regarding care of newborn during phototherapy

among II year DGNM students at Institute of Child Health and Hospital for

Children, Egmore, Chennai. Non– probability convenient sampling technique

was used. The students selected for the study was 90.

The students were interviewed and educated using structured teaching

module. Five to ten participants were selected every day. Pre test was

conducted and the structured teaching programme was implemented on the

same day for 45 minutes using PowerPoint presentation and information

booklets. Post test was conducted by the researcher after seven days of interval


FINDINGS BASED ON SOCIO DEMOGRAPHIC VARIABLES

95.56% were in the age group of 18 - 21 years.

65.56% of student‟s medium of instruction is English.

70% of students belong to Nuclear family.

27.78% of the student mothers had primary and high school education.

26.67% of the student father had primary education.

28.89% students were in the income group of less than Rs.2, 091.

83% of the students not posted in NICU.

69% of the students not had exposure on care of newborn during

phototherapy.

5.1. FINDINGS BASED ON OBJECTIVES

OBJECTIVE-1: To assess the pre test knowledge on care of newborn

during phototherapy among II year DGNM students.

During pre-test score of knowledge regarding care of newborn during

phototherapy of II year DGNM students. They were having maximum

knowledge in General information (58.67%) and minimum knowledge score

in adverse effects of phototherapy (38.29%). Overall knowledge score is

44.83%.

Pre-test level of knowledge score regarding care of newborn during

phototherapy among II year DGNM students before administration of

structured teaching programme are 78.88% of students are having inadequate

level of knowledge score, 21.12% of them having moderate level of knowledge

score and none of them are having adequate level of knowledge score.

The result of the present study findings was also similar to the study

conducted by Rajashri vaishali. B et al. (2018) in which they aimed to assess

the knowledge regarding phototherapy among nursing students in Krishna

hospital at Karad, reported that majority (12%) students had poor knowledge

and 2% had good knowledge.SM.Hossain et al. (2017) conducted a study to

assess knowledge regarding neonatal jaundice among mothers in Dhaka city,

the which revealed that majority (40%) mothers had poor knowledge and

(34%) had satisfactory knowledge.Orimadegum A.E et al. (2015) carried out

a study to assess the knowledge of neonatal jaundice among health care

workers at Nigeria, the study concluded that 80% health workers were having

poor knowledge and 20% had moderate knowledge.

In General, it was observed that the nursing students are having

inadequate knowledge regarding phototherapy, which suggests that there is a

need for special attention on imparting knowledge on phototherapy to the

nursing students.

OBJECTIVE -2: To assess the post test knowledge on care of newborn

during phototherapy among II year DGNM students.

During post-test score of knowledge regarding care of newborn during

phototherapy among II year DGNM students. They were having maximum

knowledge in General Information (90.67%) and minimum knowledge score

in Diagnostic Evaluation (81.50%). Overall knowledge score is 84.15%

among nursing students.

Post test level of knowledge score regarding care of newborn during

phototherapy among II year DGNM students after administration of structured

teaching programme. In general none of the students are having inadequate

level of knowledge score, 17.78% of them having moderate level of knowledge

score and 82.22% of them are having adequate level of knowledge score.

The above study findings were supported by study conducted to assess

the knowledge regarding care of neonates under phototherapy among nursing

personnel at Kathmandu by Shreshtha (2008) ,the study findings reported

that 56% of nurses are highly knowledgeable and 44% of nurses are with

average knowledge.Ogunfowora.O (2006),carried out a study to assess the

knowledge regarding phototherapy among community health workers in

Nigeria, the researcher reported that majority (64.5%) community health

workers are having adequate knowledge regarding phototherapy and its

management. Jahanara Rahman (2015),were carried out a study to assess the

knowledge regarding Phototherapy among Staff Nurses of a Selected Hospital,

Kolkata, West Bengal, the study findings reveals that majority (66.5%) staff

nurses were having adequate knowledge regarding phototherapy.

The study findings suggest that STP is found to be effective in

improving the knowledge of the students. It is also evident that STP is effective

in empowering students with adequate knowledge and helps them in providing

quality care by preventing complications among newborn during phototherapy.

OBJECTIVE 3: To compare the pre test and post test knowledge of II

year DGNM students regarding care of newborn during phototherapy.

Knowledge regarding

General information: In pretest students are having 1.76 score and in posttest



Indications of phototherapy: In pretest students are having 0.90 score and in


large and statistically significant difference.






















Knowledge score, on an average, students are improved their

knowledge from 17.93 to 33.63 after the administration of structured teaching

programme. Or we can say, in pre test they are able to answer only 18

questions before administration of STP, after administration of STP they are

able to answer upto33 questions. Due to STP they are able to answer 15 more

questions correctly. This difference is statistically significant. Statistical

significance was calculated by using student‟s paired „t‟test.

Pretest percentage of knowledge score is 44.83% among nursing students

is 78.88% of students are having inadequate level of knowledge score, 21.12%

of them having moderate level of knowledge score and none of them are

having adequate level of knowledge score.

Post test level of knowledge score is 84.15% among nursing students.

Mainly none of the students are having inadequate level of knowledge score,

17.78% of them having moderate level of knowledge score and 82.22% of

them are having adequate level of knowledge score.

The results of the present study are in consistent with following studies.

Tejas pandya, et al. (2015), were conducted a study to assess the

knowledge regarding phototherapy among Nursing students in Gujarat the

researcher found that post test score (85.7%) is higher than the pre test score

(51.8%) ,the researcher proved that planned teaching program is effective to

improve the knowledge of the students. Rahman. J et al. (2015) were

conducted a study to assess the knowledge of staff nurses regarding

phototherapy in selected hospitals at Kolkata, the study findings reveals that

post test score (19.5) of staff nurses is higher than the pre test score. Sinmayee

et al. (2015), the study results indicated that there is a significant difference

between pre and post test knowledge score among female health workers.

Hence video assisted teaching module is effective in improving their

knowledge.

It is believed that self instructional module was effective method of

improving the knowledge of nursing students regarding care of newborn during

phototherapy.

Effectiveness of structured teaching programme in general

information students gained 90%,indication students gained 83%,types of

jaundice students gained 82%,diagnostic evaluation students gained

81%,phototherapy gained 85%,nursing care of newborn during

phototherapy students gained 83% and in adverse effects students gained

85% after intervention. This shows effectiveness of structured teaching

programme intervention.

The analysis revealed that there was significant difference in the level of

knowledge who received structured teaching programme. Hence hypothesis H1

stated that there is significant difference between the mean pre test and post test

knowledge regarding care of newborn during phototherapy among II year

DGNM students who received the structure teaching programme.

OBJECTIVE-4: To find the association between the post-test knowledge

scores of students with their selected demographic variables.

The association between knowledge gain score and their


English medium, Nuclear family, NICU posted and having exposure on care of

newborn during phototherapy students are gained more knowledge score than

others. Statistical significance was calculated using one way analysis of

variance F-test and student independent t-test.

H2 There is a significant association between the post test knowledge score

of students with their selected demographic variables.

The study findings were showed that there is significant association

between NICU posted and previous exposure may influence the care of


The results of the present study were supported by following studies.

Egube BA, et al. (2013) were conducted a study to assess

Knowledge, attitude, and practice of Neonatal jaundice and its management

among mothers attending antenatal clinic at University of Benin Teaching

Hospital, Nigeria. The study showed that 14.1% of respondents had previous

experience with NNJ. There was also an association between previous

knowledge of the respondents on NNJ and level of knowledge among the

respondents.Ahmed SM et al. (2017) conducted a study to assess the

knowledge regarding neonatal jaundice among staff nurses in Minia, the

researcher concludes that years of experience in NICU has highly significant in

management of neonatal hyperbilirubinemia.Chandrasekar. M et al. (2017)

carried out a study to assess the knowledge regarding neonatal jaundice among

staff nurses in Mysuru.The research findings has shown that nurses with more

year of experience and area of working have association in management of

neonatal jaundice.

The analysis revealed that there was significant association between

demographic variables such as English medium, nuclear family, NICU posted

and having exposure on care of newborn during phototherapy 2=6.55

P=0.01** .

The analysis revealed that there was significant association between the

knowledge regarding care of newborn during phototherapy among students

with selected demographic variables. Hence H2 was accepted.

The present study results highlight the effectiveness of STP on care of

newborn during phototherapy among II year DGNM students. It is also evident

that STP is effective in empowering students with adequate knowledge and

helps them in providing quality care by preventing complications among


CHAPTER-VI

SUMMARY, IMPLICATION,

RECOMMENDATION,

LIMITATION AND

CONCLUSION

CHAPTER-VI

SUMMARY, IMPLICATION, RECOMMENDATION,

LIMITATION AND CONCLUSION

6.1 SUMMARY OF THE STUDY

Investigator undertook the study to assess the effectiveness of

structured teaching programme on knowledge regarding care of newborn

during phototherapy among II year DGNM students at the Institute of Child

Health and Hospital for children, Egmore, Chennai-08.

The conceptual framework of the study was based on the Modified

Imogene King‟s Goal Attainment Theory (2011).A pre experimental one group

pre test and post test design was used. The independent variable was the

structured teaching programme and the dependent variable was the knowledge

of the students regarding care of newborn during phototherapy.

The study period was 4 weeks from 2.2.19 to 4.3.19.Totally 90

students were selected as samples using convenient sampling technique. The

data was collected using semi structured questionnaire. Structured teaching

program and information booklet was given. The reliability of the tool was

tested by test retest method. The data analysis and interpretation were done by

using descriptive and inferential statistics.

6.2 MAJOR FINDINGS OF THE STUDY

6.2.1 Findings based on the demographic variables of the student‟s

95.56% were in the age group of 18 - 21 years.

65.56% of student‟s medium of instruction is English.

70% of students belong to Nuclear family.

27.78% of the student mothers had primary and high school education.

26.67% of the student father had primary education.

28.89% students were in the income group of less than Rs.2, 091.

83% of the students not posted in NICU.

69% of the students not had exposure on care of newborn during

phototherapy.

6.2.2 Findings based on knowledge of the students before and after

structured teaching programme:

In the pre test They are having maximum knowledge in General

information (58.67%) and minimum knowledge in adverse effects of

phototherapy (38.29%). Overall knowledge is 44.83%. Mainly 78.88%

of students are having inadequate level of knowledge, 21.12% of them

having moderate level of knowledge and none of them are having

adequate level of knowledge.

In post test They are having maximum knowledge in General

Information (90.67%) and minimum knowledge score in Diagnostic

Evaluation (81.50%). Overall knowledge score is 84.15%. Mainly

none of the students are having inadequate level of knowledge, 17.78%

are having moderate level of knowledge score and 82.22% are having


6.2.3 Findings based on comparison of pre test and post test mean

knowledge score

Knowledge regarding

General information: In pretest, students are having 1.76 score and in

posttest, they are having 2.72 score. So the difference is 0.96. This difference is

large and statistically significant.

Indications of phototherapy: In pretest, students are having 0.90 score and in


large and statistically significant.






















Significance of difference between pre test and post test score was

calculated by using student‟s paired „t‟test.

6.2.4 Findings based on effectiveness of structured teaching programme on

care of newborn during phototherapy among students.

In post-test, the majority of the students of about (82.22%) were having

adequate level of knowledge, (17.78%) were and none of the students having

inadequate knowledge. The overall knowledge regarding phototherapy in post

test 84.15 with standard deviation of 3.81.the improvement score of mean

value was 15.73 and „t‟ test value was 31.12 which were statistically

significant.

6.2.5 Findings based on association between post test knowledge and


Association between demographic variables and post test level of

knowledge represents as, students from score. English medium (16.69), has

Nuclear family (17.07),exposure to NICU (17.8) and having exposure on care

of newborn during phototherapy (16.94).statistical significance was calculated

using Chi square test.

6.3 IMPLICATIONS OF THE STUDY

The findings of present study may be helpful for such future studies. In

this context the findings of the study has valuable implications in different

areas of nursing practice, nursing administration, nursing education and nursing

research.

6.3.1. NURSING EDUCATION

The Nurse educator can use the structured teaching module to teach the

students about care of the newborn baby under phototherapy.

The finding will help the nursing faculty to give more importance for

planning and organizing programme to improve the knowledge of

students, so that they can practice in the clinical area.

In- service educational training programs about neonatal

hyperbilirubinemia can be conducted for neonatal nurses in neonatal

intensive care units.

A standardized neonatal care protocols for neonatal hyperbilirubinemia

should be integrated into paediatric nursing curriculum.

Educational training programs for nurses should include following areas

as aseptic techniques, caring of incubator, assessing vital signs,

assessing color of newborn by Kramer's rule, measuring bilirubin level,

plotting total serum bilirubin and deciding with physician the proper

management of neonatal hyperbilirubinemia.

The nursing students should be made aware of their responsibility in the


6.3.2. NURSING PRACTICE

This study is conducted among nursing students to assess the level of

knowledge regarding the care of newborn during phototherapy. This

study can be utilized for educating and practicing the students and help

others and give the knowledge about the phototherapy.

Ongoing in-service education programs should be designed and

implemented at neonatal intensive care units to improve nurses'

knowledge and practices on the basis of nurse's actual needs.

A standardized clinical nursing protocols and guidelines about neonatal

hyperbilirubinemia should be available in each neonatal intensive care

unit.

New staff nursing members who provide care for newborns with

hyperbilirubinemia in neonatal intensive care units should be well

oriented with each standardized international nursing care protocols to

ensure competent nursing care.

6.3.3. NURSING ADMINISTRATION

With technological advances and ever growing challenges of nursing,

the nurse administrators have responsibility to provide the nurses with

substantive educational opportunities.

Nursing administrator should provide necessary facilities and

opportunities for nursing students and staff.

In each hospital, there should be specialized units for developing

nurse‟s knowledge and practices (training unit) based on nurses needs

for practices.

The hospital administrative authority should develop up-dated

neonatology care policies and procedures for nurses and should be

annually reviewed and approved by the quality assurance committee.

Provide adequate medical and nursing supervision, guidance and

regular feed back to nurses concerning their knowledge, attitude and

performance.

Strict policies should be developed to ensure nurses adherence to

infection control rules such as hand washing and wearing gloves.

Library and internet access for all medical and nursing staff should be

established at hospitals settings and should contain the most recent

publications related to neonatal hyperbilirubinemia.

Advanced booklets and electronic media regarding clinical protocols

for neonatal hyperbilirubinemia should be available at each neonatal

intensive care unit.

6.3.4. NURSING RESEARCH

The findings can be utilized as evidence based practice in clinical

practice beneficial for paediatric nursing students and staffs.

A large scale study can be done for replication to standardize the video

assisted teaching module on care of newborn baby under phototherapy.

There is growing need for furnishing nursing research in all the areas of

care. The nurse researcher especially beginners need to enhance their

quest for knowledge. The nurse researcher may effectively use result of

available student and recommended on the importance of application of

phototherapy.

6.4. LIMITATION OF THE STUDY

This study is limited to students posted in Institute of Child Health and

Hospital for Children, Egmore.

The study is limited up to 4 weeks of period

The samples are the Students of II year DGNM.

6.5. RECOMMENDATION

On the basis of the study the following recommendations have been made for

further study:

This study could be replicated on a larger sample.

The study could be conducted in different settings to find out the

effectiveness of STP.

A study could be replicated with a control group.

A comparative study can be conducted among nursing staff and female

health workers regarding care of newborn during phototherapy.

6.6. CONCLUSION

Nurses must have holistic knowledge regarding care of newborn during

phototherapy. Nurses play a vital role in caring the newborn in NICU.The

present study had been supported by a series of other studies which confirmed

that the knowledge on care of newborn during phototherapy is important to

prevent the child from complication. Data analysis and result revealed that the

structured teaching programme on care of newborn during phototherapy was an

effective method for providing adequate knowledge to the student.

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Arch Pediatric Adolesc Med.2002:156:1244-1250.

Usatin D, Lijestrand.P, Kuzniewicz M et al. to assess the effect of

neonatal jaundice and phototherapy on the frequency of the first year of

outpatient visits:NIH public access :2010 april:125(4):729-734.

Venktamurthy M, BalajiM.D,Reddy .K, study on effect of phototherapy

on platelet count in neonatal hyperbilirubinemia in tertiary care hospital

at Karnataka, International Journal of Contemporary Paediatrics.2016

Feb;3(1):253-255.

Viswanatha J, Desai A.B., Achars Textbook of Pediatrics 3rd

ed.

Hyderabad, Orient Longman 1995.

NET REFERENCE:

1. www.pubmed.com

2. www.google.com

3. www.medscape.com

4. www.wikipedia.com

5. www.rasp.edu.an/indexhtm

http://www.pubmed.com/

http://www.google.com/

http://www.medscape.com/

http://www.wikipedia.com/

http://www.rasp.edu.an/indexhtm

APPENDICES

SECTION-A

DEMOGRAPHIC DATA

INSTRUCTIONS: The respondents are expected to answer the following

questions by placing the (a) against the response which you feel appropriate

1. Age of the student

a) 18-21 years

b) 21-25 years

c) 25-30 years

2. Medium of instruction in higher secondary

a) English

b) Tamil

3. Type of family

a) Nuclear

b) Joint

c) Extended

4. Mothers education

a) Illiterate

b) Primary education

c) Secondary education

d) High school

e) Higher secondary

f) Graduate

5. Fathers education

a) Illiterate

b) Primary education

c) Secondary education

d) High school

e) Higher secondary

f) Graduate

6. Father‟s Occupation

a) Unemployed

b) Unskilled worker

c) Semiskilled worker

d) Skilled worker

e) Clerk, shop owner, farmer

f) Semi profession

g) Profession

7. Monthly income of the family

a) Below Rs. 2,091

b) Rs .2,092 – Rs .6,213

c) Rs .6214 – Rs .10,356

d) Rs .10,357 – Rs .15,535

e) Rs .15,536 – Rs .20,714

f) Rs.20,715 –Rs. 41,429

g) Rs. 41,430

8. Have you been posted in NICU?

a) Yes

b) No

9. Do you have exposure on care of newborn during phototherapy?

a) Yes

b) No

SECTION-B

INSTRUCTIONS: The respondents are expected to answer the following

questions by placing the (a) appropriate alphabet which you feel correct.

GENERAL INFORMATION

1. The meaning of phototherapy

a) Light therapy

b) Heliotherapy

c) Polarised light

2. The father of phototherapy

a) Louis Pasteur

b) Prof.Niels Ryberg Finsen

c) Prof.Pavlou

3. The meaning of neonatal jaundice

a) Occurs at birth

b) Occurs at any time

c) Occurs 3 or 4 days after birth in about 50% of newborns

INDICATIONS OF PHOTOTHERAPY

4. Indication for phototherapy in term baby, if the bilirubin level

a) > 17mg/dl

b) > 5mg/dl

c) > 8mg/dl

5. Phototherapy is used

a) To treat hyperbilirubinemia

b) To maintain body temperature

c) To prevent dehydration

TYPES OF JAUNDICE

6. Jaundice occurs within 48hrs after birth is called

a) Physiological jaundice

b) Pathological jaundice

c) Neonatal jaundice

7. Physiological jaundice resolves spontaneously

a) Within 2 to 4 days after birth

b) Within 8 to 10 days after birth

c) Within 10 to 14 days after birth

DIAGNOSTIC EVALUATION

8. Kramer‟s rule is used

a) To identify level of jaundice

b) To identify level of electrolytes

c) To identify level of SPO2

9. The instrument used to identify the level of jaundice

a) Icterometer

b) Transcutaneous Bilirubinometer

c) Photo probe

PHOTOTHERAPY

10. The most effective light for phototherapy

a) Fluorescent light

b) White light

c) Blue green light

11. The initiation of phototherapy is for babies

a) Less than 32 weeks of gestation

b) Less than 28 weeks of gestation

c) Less than 36 weeks of gestation

MECHANISM OF ACTION OF PHOTOTHERAPY

12. Normal total serum bilirubin level of baby

a) 0.3 – 1.0 mg/dl

b) 2mg/dl

c) 5mg/dl

13. During phototherapy, light waves converts the bilirubin

a) Lumirubin

b) Z-isomer

c) Photo voltaic

14. Mechanism of phototherapy

a) Photo oxidation effect

b) Photo voltaic effect

c) Photo energy effect

15. Elimination of bilirubin products is through

a) Urine

b) Faeces

c) Sweat

NURSING CARE OF NEWBORN DURING PHOTOTHERAPY

16. Purpose of changing position during phototherapy

a) To make the baby comfortable

b) For light to reach all the areas of the body

c) To maintain skin integrity

17. Size of the eye pad used for phototherapy

a) Size N 720

b) Size N 722

c) Size N 721

18. An important observation during phototherapy is to assess

a) Heart rate

b) Skin color

c) Conjunctiva

19. Ideal room temperature for administering phototherapy

a) 20-240c

b) 32-360c

c) 25-280c

20. The distance between phototherapy light and baby

a) 20-30cms

b) 30-45cms

c) 46-50cms

21. One of the reason to check rebound bilirubin level

a) Pigmentation of skin

b) Incase of physiological jaundice

c) Early use of phototherapy

22. Duration of phototherapy per day

a) 18 hours

b) 24 hours

c) 12 hours

23. The eye pads should be removed

a) Every 4th

hourly

b) Every 8th

hourly

c) Every 12th

hourly

24. Phototherapy light should be changed

a) Every 6 months

b) Every 3 months

c) Every 9 months

25. The number of times breast feeding can be promoted during

phototherapy

a) Every 1 hour

b) Every 4 hours

c) Every 2-3 hours

26. Purpose of covering the eyes of the newborn with eye pads

a) To prevent retinal damage

b) To prevent photo sensitivity

c) To prevent optic nerve damage

27. Daily fluid requirement of baby receiving phototherapy

a) 5 – 10 ml/kg/day

b) 10 – 15 ml/kg/day

c) 20 – 25 ml/kg/day

28. Incase of ABO incompatibility

a) Expose maximum area of skin

b) Expose minimum area of skin

c) Expose only the chest/back

29. Adverse effect of phototherapy

a) Insensible water loss

b) Extra cellular water

c) Intra cellular water

30. The amount of fluid loss for the baby

a) 25 – 50 ml/kg

b) 50-75 ml/kg

c) 75 – 100ml/kg

31. Expansion for NJCF

a) Neonatal Jaundice Condition Form

b) Neonatal Jaundice Control Form

c) Neonatal Jaundice Care Form

32. The purpose of covering genital of male baby during phototherapy

a) To prevent infertility

b) To prevent malignancy

c) To prevent hypertrophy

33. The formula to calculate insensible water loss

a) IWL= Fluid intake - Urine output + Weight gain (or) Weight loss

b) IWL= Fluid intake+ Urine output - Weight gain (or) Weight loss

c) IWL= Fluid intake+ Urine output + Weight gain

ADVERSE EFFECTS OF PHOTOTHERAPY

34. The term bronze baby syndrome denotes

a) Yellow pigmentation of skin

b) Dark grey brown pigmentation of skin

c) Bluish discoloration of skin

35. The expected colour of stool during phototherapy

a) Yellowish

b) Greenish

c) Brownish

36. Transistent skin rashes appears

a) Within 1 – 7 days

b) Within 2 – 5 days

c) Within 8 – 10 days

37. Complication of hyperbilirubinemia

a) Encephalopathy

b) Chronic kidney disease

c) Electrolyte disturbance

38. Expansion for BIND

a) Bilirubin Induced Neurologic Dysfunction

b) Bilirubin Increased Neonatal Disorder

c) Bilirubin Induced Nerve Disorder

39. Precaution measures to be taken before collecting the blood sample

a) Check the temperature

b) Turn off lights

c) Check baby condition

40. Complication of acute bilirubin encephalopathy

a) Cerebral palsy and hearing impairment

b) Seizure and blindness

c) Respiratory distress and sepsis

Key answers:

1. (a)

2. (b)

3. (c)

4. (a)

5. (a)

6. (b)

7. (b)

8. (a)

9. (b)

10. (c)

11. (b)

12. (a)

13. (a)

14. (a)

15. (a)

16. (b)

17. (a)

18. (b)

19. (c)

20. (b)

21. (c)

22. (a)

23. (a)

24. (b)

25. (c)

26. (a)

27. (c)

28. (a)

29. (a)

30. (a)

31. (b)

32. (a)

33. (a)

34. (b)

35. (b)

36. (a)

37. (a)

38. (a)

39. (b)

40. (a)

COLLEGE OF NURSING MADRAS MEDICAL COLLEGE, CHENNAI-03

STRUCTURED TEACHING PROGRAM ON

CARE OF NEWBORN DURING PHOTOTHERAPY

TOPIC : CARE OF NEWBORN DURING PHOTOTHERAPY

GROUP : DGNM II YEAR STUDENTS

PLACE OF TEACHING : NEONATAL INTENSIVE CARE UNIT

DURATION : 45 MINUTES

METHOD OF TEACHING : LECTURE CUM DISCUSSION

MEDIUM OF TEACHING : ENGLISH

TEACHING AIDS : POWERPOINT AND INFORMATION BOOKLET

RESEARCH GUIDE : MRS.S.VIJAYALAKSHMI, M.Sc (N)., READER

HOD-CHILD HEALTH NURSING, COLLEGE OF NURSING,

MADRAS MEDICAL COLLEGE, CHENNAI-03.

NAME OF THE INVESTIGATOR : R.REVATHY, M.Sc (N) II YEAR

CHILD HEALTH NURSING

CENTRAL OBJECTIVE:

At the end of the class the student will be able to acquire knowledge and understanding regarding care of newborn

during phototherapy and to develop desirable skill and attitude to practice this in all health care settings.

CONTRIBUTORY OBJECTIVE

At the end of the class, students will be able to

1. define the term neonatal hyperbilirubinemia

2. mention the causes of hyperbilirubinemia

3. describe about the diagnostic measures of neonatal jaundice

4. define the term phototherapy

5. enlist the purposes of phototherapy

6. list out the indications of phototherapy

7. specify the types of phototherapy

8. discuss the mechanism of action of phototherapy

9. explain about the care and observation during phototherapy

S.NO

TIME

SPECIFIC

OBJECTIVES

CONTENT TEACHERS

ACTIVITY

LEARNERS

ACTIVITY

AV

AIDS

EVALUATI

ON

1 min

Introduction to

the topic

INTRODUCTION:

Phototherapy is the important procedures in New born care

setting. About 1 out of 2 of term and 8 out of 10 of preterm

babies develop jaundice, which generally appears 2 to 4 days

after birth, and resolves spontaneously after 7-14 days. In

most infants with physiological jaundice bilirubin levels do

not rise to a point that requires treatment. Effective treatments

to decrease serum bilirubin levels with severe jaundice

include phototherapy. It is a vital one to save the life of many

new born when perform at correct time. It needs special skills

and techniques to do the procedures. The students should be

specially trained, to assist the procedures tactfully.

Explaining

Listening

Power

point

S.No

1.

2.

Time

2 min

3 min

Specific

objectives

define the term

neonatal hyper -

bilirubinemia

mention the

causes of hyper-

bilirubinemia

Content

DEFINITION OF NEONATAL

HYPERBILIRUBINEMIA.

It is the elevation of the bilirubin level in the newborn's

blood, which results in yellowish staining of the skin and

whites of the newborn's eyes (sclera) by pigment of bile

(bilirubin). In newborn babies, a degree of jaundice is normal.

CAUSES OF HYPERBILIRUBINEMIA

Physiological Jaundice:

Occurs in 60% of term and 80% of preterm infants.

The newborn has a high level of hemoglobin combined with a

short red cell life leading to a high rate of haemolysis whilst

the body mass bilirubin production is more than double in the

neonate. Jaundice usually occurs at 2-3 days of life and has

resolved by 7-14 days of life. 3 weeks in preterm infant.

Breastfeeding Jaundice:

Occurs in 10% of newborns when the infant does not

Teachers

activity

Explaining

Explaining

Learners

activity

Listening

Listening

Av aids

Power

point

Power

point

Evaluation

What is

neonatal

hyperbilirub

inemia?

What are

the causes

of

hyperbilirub

inemia?

S.No

Time

Specific

objectives

Content

drink enough breast milk and is similar to physiological

jaundice but is more pronounced.

Breast-Milk Jaundice:

This occurs in 1-2% of breast fed babies and is caused

by a substance that is produced in the breast milk. Jaundice

starts at 3-5 days of age and can last 3-12 weeks (occasionally

up to 16 weeks).

ABO Blood Group Incompatibility and Rhesus

Incompatibility (Haemolysis):

These can occur if the mother produces antibodies that

destroy the newborn‟s red cells, resulting in haemolysis of the

infant‟s blood. This leads to a sudden buildup of bilirubin in

the infant‟s circulation during the first 24hrs of life

Other Pathological Causes:

Sepsis, endocrine /metabolic disorders, bile duct

obstruction, G6PD deficiency.

Teachers

activity

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Learners

activity

Listening

Av aids

Power

point

Evaluation

S.No

3.

Time

4 min

Specific

objectives

describe about

the diagnostic

measures of

neonatal jaundice

Content

DIAGNOSIS OF JAUNDICE:

A serum bilirubin level will be used in conjunction with

signs and symptoms of jaundice. The serum bilirubin level

along with the gestational age and postnatal age will be

plotted on the „Treatment Threshold Graph‟. This will be

plotted by the neonatal/medical team.

It is necessary to proceed more cautiously if the serum is

above certain levels (i.e. conjugated bilirubin level greater

than 25micromol /litre) due to the potential consequences of

serious potentially. Irreversible liver disease. Pale stools / dark

urine also indicate conjugated hyperbilinaemia.

Kramer‟s rule:

Estimating the level of jaundice by simply observing the

baby‟s skin color, one can utilize cephalocaudal progression

of jaundice.

kramers divided the infant in to 5 zones, the ranges associated

with progression to the zones as follows:

Teachers

activity

Explaining

Learners

activity

Listening

Av aids

Power

point

Evaluation

What are

the

diagnostic

measures of

neonatal

jaundice?

Zone 1 2 3 4 5

SBR

UMol/L

100 150 200 250 >250

BLANCHING:

Blanching the skin of tip of nose, sternum, abdomen, palms

and soles with digital pressure. In accordance with kramer‟s

guidelines a rough estimate of the bilirubin level can be made

as follows

Area of body Level of bilirubin

Face 5mg/dl

Chest/upper abdomen 10mg/dl

Lower abdomen and thighs 12mg/dl

Arms and lower legs 15mg/dl

Palms and soles >15mg/dl

explaining

listening

Power

point

ICTEROMETER:

This is non invasive method which is more accurate and less

subjective. The tool used is a transparent plastic with 5 graded

yellow stripes of different shades corresponding to the serum

bilirubin level. It is pressed against the tip of the nose. The

color of the skin is matched with yellow stripes to obtain the

bilirubin level.

Transcutaneous bilirubinometer:

The photo probe is pressed against the skin of fore head or

sternum. When pressure is applied to the photo probe a xenon

tube generates a strobe light. This light passes through a fibre

optic filament penetrates the blanched skin and enters the

subcutaneous tissue. The intensity of the yellow color in this

light, after correcting for the haemoglobin, is measured and

instantly displayed in arbitrary unit.

Explaining

Listening

Power

point

4.

5.

6.

1 min

2 min

2 min

define the term

phototherapy

enlist the

purposes of

phototherapy

list out the

indications of

phototherapy

DEFINITION OF PHOTOTHERAPY:

A treatment for jaundice where the exposure to

ultravioletlight source converts unconjugated bilirubin

molecules into water soluble isomers that can be excreted by

the usual pathways. Blue-green light is most effective for

phototherapy as it both penetrates the skin and is aborted by

bilirubin to have the photochemical effect.

PURPOSES:

To bring down the serum bilirubin level

Treatment of Hyperbilirubinemia.

The phototherapy will help the liver to process

bilirubin, bringing your baby‟s level down to normal

INDICATIONS OF PHOTOTHERAPY:

Elevated serum bilirubin levels:

Explaining

Listening

Power

point

What is

phototherapy

What is the

purpose of

phototherapy

What is the

indication of

phototherapy

7.

3 min

specify the types

of phototherapy

Healthy term babies >17mg/dl

Preterm babies (weighting more than 1500g:>8mg/dl)

Preterm babies (weighting less than 1500g >5 mg/dl).

Severely bruising.

TYPES OF PHOTOTHERAPY:

Continuous phototherapy

Conventional phototherapy

Intensive phototherapy

Continuous phototherapy:

It is better than intermittent phototherapy. Phototherapy

should be interrupted in a newborn only during breast feeding

and nappy changes.

Conventional phototherapy:

If jaundice is non- haemolytic or rate of rise of jaundice is

slow, then one can use either conventional or fiber optic

phototherapy.

Intensive phototherapy:

In case of haemolytic or rapidly rising bilirubin or when a

Explaining

Listening

Power

point

What are the

types of

phototherapy

?

8.

7 min

discuss the

mechanism of

action of

phototherapy

conventional until is not effective, use of intensive

phototherapy is needed. This can be achieved by placing the

infant in the bili blanket and using additional overhead

phototherapy implies irradiance in the blue green spectrum

have the wavelength of approximately 425-490nm delivered

to infants surface area as possible.

MECHANISM OF ACTION:

Bilirubin is a naturally occuring molecule of the red blood

cells. It is released into blood stream .when the red blood cells

break down. This is normal and occurs often. Our livers

breakdown the bilirubin and it is excreted.

Phototherapy (light treatment) is the process of using light

to eliminate bilirubin in the blood. Your baby‟s skin and blood

absorbs these light waves. These light waves are absorbed by

your baby‟s skin and blood and change bilirubin into

products, which can pass through their system.Wavelength of

420-448nm, oxidised the bilirubin to biliverdin,a soluble

product that does not contribute to kernicterus.

Explaining

Listening

Power

Point

What is the

mechanism

of action of

phototherapy

?

The light waves convert the bilirubin to water soluble

nontoxic forms which are then easily excreted. Some

bilirubin, are present in the interstitial spaces and superficial

capillaries of the skin, subcutaneous tissues. During

phototherapy, these molecules are exposed to light. The

photons of energy are absorbed by the pigment, bilirubin. This

leads to a sequence of photochemical reactions:

1.CONFIGURATIONAL ISOMERIZATION:

Z-isomer E-isomer

Reversible as it reaches bile duct

Constitute 25% of TSB after 8-12hrs.

Excreted slowly from body.

2.STRUCTURAL ISOMERIZATION:

Bilirubin lumirubin

This reaction is directly proportional to the dose of

phototherapy. Converts 2-6% of TSB, which is excreted

Explaining

Listening

Power

point

9.

20

min

explain about the

care and

observation

during

phototherapy

rapidly from Body.

3. PHOTO OXIDATION:

Forms photo products that are excreted in the urine

CARE AND OBSERVATION DURING

PHOTOTHERAPY

1.GENERAL INSTRUCTION

Recognize the possible need for phototherapy based on

risk factors and blood testing. This will assist in the

prompt and timely detection and treatment of jaundice.

Perform a physical assessment of the infant to assess

for the presence of jaundice.

The infant should be stripped down to perform an

accurate assessment.

Where possible perform assessment in bright, natural

daylight. Artificial light can make it more difficult to

accurately assess for jaundice.

Jaundice can be detected by blanching the skin with

digital pressure.

The baby should be observed; the gums and sclera of

Explaining

Listening

Power

point

How will

you care the

baby during

phototherapy

?

the eyes should be observed. Also press lightly on the

skin and observe „branched skin‟ for jaundice.

A serum bilirubin level is taken on all infants within 2

hours, where jaundice is observed.

Check blood glucose also.

Level must be determined prior to commencing

phototherapy as prophylactic phototherapy before

jaundice is ineffective.

2.EXPLANATION AND REASSURANCE TO PARENTS

The decision to commence phototherapy is made by

the neonatologist.

Explain the need for phototherapy and the functions of

the equipment to the parents as clinically indicated.

Reassure them that their baby can be removed from

the incubator for feeding.

Provide written information if appropriate.

3.ASSESSMENT SHOULD BE DONE BEFORE

PHOTOTHERAPY:

GA of the baby

Weight of the baby

Postnatal age

Explaining

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point

Types of jaundice

The level of jaundice

4.OBSERVATIONS

Neonates must be weighed on admission to the nursery

and then 2nd daily and documented as per protocol

weight-length-head circumference on the Neonatal

Weight Chart.

Monitor the infant‟s temperature more frequently

when commencing phototherapy and once stabilised,

record at least 4th hourly.

Preterm / unwell infants receiving phototherapy should

have temperature, pulse, respiration rate and oxygen

saturation monitored and documented 1- 4th hourly on

the appropriate observation chart.

The date and time phototherapy is commenced /

discontinued, the type of phototherapy device (s) and

the dose of phototherapy should be documented on the

Neonatal Jaundice Control Form.

5.ADMINISTERING PHOTOTHERAPY:

Make sure room temperature is optimum 25-280c

Remove all clothes of baby except diaper.

Explaining

Listening

Power

point

Cover the eyes with eye patches.

Place naked baby under the lights

- In a cot or bassinet:weight >2kg or

- In an incubator or radiant warmer: weight <2kg

Keep baby at a distance of 30-45cm from light sources

Ensure optimum breastfeeding.

6.POSITION:

The phototherapy lamp should be positioned a

minimum: 30-45 cm .There should be a 3cms distance

between light and incubator.

This is the optimum distance to allow effective use of

the phototherapy unit.

One or more units may be used at one time. The lamp

should be positioned to allow for the coverage of the

greatest surface area of the infant‟s body.

Nurse infant supine or prone if indicated with

maximum skin exposure to the phototherapy lights.

Change infant‟s position after care if appropriate. To

ensure effective phototherapy treatment is applied to

maximum area of skin.

Reposition the infant regularly during phototherapy.

Explaining

Listening

Power

point

7.MAINTAINING TEMPERATURE

The infant will be nursed in an incubator or radiant

warmer with only a nappy in place.

The incubator should be dressed with white linen.

The infant‟s temperature should be monitored and

recorded at least 4 hourly or more frequently as

clinically indicated.

Monitor and record incubator temperature hourly.

To ensure infant does not become cold stressed,

hypothermic or hyperthermia due to removal of

clothing or exposure to phototherapy lights.

8.DURATION OF PHOTOTHERAPY

The infant may be removed from the lights for

feeding, diaper changes and other general care but

should receive phototherapy for 18 hours every day.

Explaining

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point

9.BREAST FEEDING

Provide the mother who is breast feeding with the

necessary support and advice to allow her to continue

breastfeeding or to express milk if required.Frequent

feeding may help to break down the bilirubin if the

cause of the jaundice is due to breast milk or

breastfeeding.

The infant may need to be breastfed 8-12 times a day.

The newborn stomach has a capacity of 30mls

approximately. It can also promote bonding.

Feed the baby every 2-3 hours because phototherapy

causes the baby to lose fluid from the skin and have

loose stools. This may cause dehydration.

10.SKIN CARE

A more rapid response to treatment can be achieved by

exposing larger surface areas to the phototherapy light.

For infants with a rapidly rising serum bilirubin level,

for example ABO incompatibility, the maximum area

of skin should be exposed. This may require use of

Explaining

Listening

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point

double phototherapy and removal of the nappy.

Keep the infant clean and dry.

Cleanse skin thoroughly and change nappies when

soiled.

The registered nurse/ enrolled nurse should be

proactive with early use of barrier creams if stools are

loose and green.

Infants nursed in nappies or where the buttocks are not

directly exposed to the phototherapy may have zinc

and castor oil applied to areas of skin excoriation.

Oils and creams are not routinely applied to

phototherapy exposed skin however if LED

phototherapy is used, emollients and creams may be

used with caution (LED technology uses “cold light”).

Clean only with water. Do not apply oils or creams to

the exposed skin.

Observe the skin for rashes, dryness and excoriation.

11.RESPIRATORY MONITORING

Infants must be weighed on admission to the nursery

and 2nd

daily as per the protocol.

All infants in newborn care receiving phototherapy

Explaining

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point

should have a temperature, pulse, respiration rate

documented 4th

hourly.

12.EYE CARE:

There has been some speculation about an association

between neonatal phototherapy and retinopathy of

prematurity (ROP).

Eye shields (opaque) must be placed over the infant‟s

eyes at all times during phototherapy. As a prophylaxis

and to protect against retinal damage that can occur

due to irradiance from phototherapy light.

Eye pads are required for the infants comfort if

overhead white or blue fluorescent lights are used:

Size N 720(micro)<1500gm

Size N 721(small) 1500-2500gm

Size N 722(Large)>2500gm.

Ensure the eye patches are not applied too tight, as

they may apply undue pressure to the infant's delicate

eye.

Ensure the infant‟s eyes are closed when positioning

the eye shields. To prevent corneal abrasions.

Eye care should be performed 4th

hourly and eye cares

attended with normal saline and assess eyes for

drainage, oedema and evidence of infection Allow

visual stimulation at this time.

Ensure the phototherapy unit is switched off, before

removing the eye shields.

To protect against retinal damage that can occur due to

irradiance from phototherapy light .

Check baby at least every hour and see that the eye

Shields remain in place. The eye shields should not press

against the eyes.

13.FLUID REQUIREMENTS:

The requirements for fluids and electrolytes of the

newborn infant are unique. At birth, there is an excess of

extra-cellular water (ECW), and this decreases over the first

few days after birth. Furthermore, ECW at birth and

insensible water loss decrease as birth weight and gestational

age increase.

Several days after birth, fluid and electrolyte

requirements increase as the infant starts to grow. Therefore,

appropriate management of fluids and electrolytes in preterm

Explaining

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point

infants must take into consideration the birth weight,

gestational age and age after birth. Fluid and electrolyte

requirements are also influenced by a variety of medical

conditions that affect preterm infants.

INSENSIBLE WATER LOSS (IWL) is greatest in the

smallest and least mature infants due to high surface area to

body mass ratio and to immature, water-permeable skin.

Estimated IWL in the first few days of life are:

Phototherapy can increase IWL by 25-50%. IWL may

exceed urinary output in smaller infants but, unlike urine

output, IWL cannot be measured directly. However, IWL

must be estimated in order to plan appropriate fluid

management.

IWL can be estimated by: IWL = Fluid intake - Urine

output + weight loss (or – weight gain)

(E.g., 24-hour totals = Intake 90 mL, urine output 60 mL, and

weight loss 55 g. Therefore, IWL = 90 - 60 + 55 = 85 mL).

Monitor the infant‟s intake and output closely.

explaining

listening

Power

point

Weigh nappies to monitor output.

Maintain strict fluid balance chart.

Daily urinalysis for specific gravity or the infant may

experience poor feeding due to lethargy caused by

hyperbilirubinaemia and may require enteral feeding

for a short period.

To ensure adequate nutrition / calorie intake to

maintain enzyme activity for degeneration of bilirubin.

Phototherapy increases insensible water loss by 30

50% and poor hydration also slows bilirubin excretion.

The fluid intake may need to be increased 20ml/kg

14.MONITRING SERUM BILIRUBIN:

Obtain 6-24 hourly serum bilirubin level as determined

by age and clinical condition of the infant as clinically

indicated, following commencing phototherapy. To

monitor and evaluate the effectiveness of treatment.

NICE recommend 6 hourly testing for first 24 hours

until SBR below treatment threshold or stable / falling.

Turn off lights prior to obtaining sample. Conjugated

and unconjugated bilirubin are photo oxidized when

exposed to white or ultraviolet lights and haemolysis

Explaining

Listening

Power

point

.

can give false lower results.

WHEN TO STOP PHOTOTHERAPY

TERM BABIES:

Day <3 stop at the discretion of the consultant as the

jaundice like to be pathological.

Day > 4 : stop phototherapy for term infants with

physiological jaundice.

PRE MATUTRE BABIES:

Stop at the discretion of the consultant.

REBOUND BILIRUBIN LEVELS:

It is unnecessary to keep a baby in hospital for a

rebound bilirubin level.

If a baby does not appear visibly jaundiced 48hours

after stopping phototherapy then they do not require a

repeat bilirubin level.

Term babies who are re admitted for phototherapy

explaining

listening

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point

(usually between day 3-6) for physiological jaundice

do not require a routine rebound level after lights are

stopped.

Reasons to check a rebound bilirubin 24hours after

stopping phototherapy may include:

a) < 37 weeks gestation

b) Bruising

c) Early use of phototherapy (started <72 hours of

age)

Consider using trancutaneous bilirubinometer to assess the

need for further bilirubin levels to prevent unnecessary blood

tests.

YPAREHTOTOHP FO STCEFFE EDIS

emordnys ybab eznorB

it is the dark grey – brown pigmentation of skin

mucous both upper and lower limb after receiving

phototherapy for neonatal jaundice.no treatment is

required for bronze baby syndrome as the

pigmentation slowly disappears after stopping

phototherapy.

Explaining

Listening

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point

Greenish

era stnemevom lewob ybab,yparehtotohp gniruD

dna lamron si siht.roloc hsineerg a dna esool semitemos

.spots tnemtaert nehw pots dluohs

sehsar niks tnetsisnarT

Multiple white or yellow skin rash characterised by

erythematous of the skin that can develop in infants

after initiation of phototherapy.

Poor feeding – Infants with jaundice are often sleepy

and do not wake for feeds. Assess infant attachment

and suck and hydration on admission. Use of

expressed breast milk via bottle or intra gastric tube

may be necessary for some infants.

Temperature instability – can occur in infants under

radiant warmers or in closed care systems – monitor

closely. Now less likely to occur with the LED

phototherapy systems.

Loose stools and peri-anal excoriation – due to

transient lactose intolerance • Increased insensible

water loss – this can be managed by increasing the

daily fluid requirements if required. This is assessed

explaining

listening

Power

point

on a case by case basis.

Maternal-infant separation – otherwise well late

preterm / term infants should be managed on the

postnatal ward when appropriate and safe to do so.

hyperthermia-

Increasing metabolic rate

Dehydration

Electrolyte disturbance.

explaining

listening

Power

point

SUMMARY

So far, we discussed about the definition of phototherapy, Phototherapy is the light treatment for newborn jaundice. Newborn

jaundice is excess bilirubin in your newborn‟s blood, About the Mechanism of actions naturally occurring molecule of the red blood

cells, nursing care given to newborn in phototherapy These light waves are absorbed by your baby‟s skin and blood change bilirubin into

products, which can pass through their system, Wavelength of 420-448nm, oxidized the bilirubin, a soluble product that does not

contribute to kernicterus. Check your baby‟s blood pressure, heart rate, breathing rate, advantages of phototherapy are preventing the

needs for more invasive treatment and the serious complications, which can occur if excessive levels of bilirubin, phototherapy is a safe.

Effective method of treatment and temperature. These vital signs give healthcare providers information about your baby‟s condition.

RECAPTULIZATION:

1. What is the neonatal hyperbilirubinemia?

2. What are the causes of hyperbilirubinemia?

3. What are the diagnostic measures of neonatal jaundice?

4. What is phototherapy?

5. What is the purpose of phototherapy?

6. What is the indication of phototherapy?

7. What are the types of phototherapy?

8. What is the mechanism of action of action of phototherapy?

9. How will you care the newborn during phototherapy?

BIBLIOGRAPHY

1. Achar‟s (2003). TEXT BOOK OF PEDIATRICS (3rded,). New Delhi: orient Longman publishers.

2. Dorothy R. Marlow, Barbara A. Redding (2002). TEXT BOOK OF PEDIATRIC NURSING (6thed,). New Delhi. Saunders

publishers.

3. Ghai o. piyushguptha, Paul V.K (2004) ESSENTIAL PEDIATRICS (6TH ED,). New Delhi. GBS Publishers and distributors.

4. Marilyn J. Huckleberry (2005). WONG‟S ESSENTIAL OF PEDIATRIC NURSING (7thed,). New Delhi. Reed Elsevier India

private limited.

5. Parul dutta (2009) PEDIATRIC NURSING (2nded,). New Delhi. Brothers‟ medical publishers (P) LTD.

6. Suraj Gupte (2009). THE SHORT TEXT OF PEDIATRICS (11thed,). New Delhi. Reed Elsevier India private limited.

7. Tambulwadkar R.S. (1999). PEDIATRIC NURSING (2nded,) Bombay: Vora medical publishers

COLLEGE OF NURSING

MADRAS MEDICAL COLLEGE, CHENNAI

Information booklet ON CARE OF

NEWBORN DURING PHOTOTHERAPY

INTRODUCTION

Phototherapy is the important procedures

in New born care setting. About 1 out of 2

of term and 8 out of 10 of preterm babies

develop jaundice, which generally appears

2 to 4 days after birth, and resolves

spontaneously after 7-14 days.

Effective treatments to decrease serum

bilirubin levels with severe jaundice

include phototherapy. It is a vital one to

save the life of many new born when

perform at correct time. It needs special

skills and techniques to do the procedures.

The students should be specially trained to

assist the procedures tactfully.

HISTORY OF PHOTOTHERAPY

It was in the 19th

century that the use of

artificial light sources for phototherapy

happened.

Prof.nielsRybergFinsen is known as the

father of phototherapy.

He was the Nobel prize winner in

physiology and medicine in 1903,for his

remarkable work, since many works in the

pathway of phototherapy have been done.

NEONATAL

HYPERBILIRIUBINEMIA

It is the elevation of the bilirubin level in

the newborn‟s blood, which results in

yellowish staining of the skin and eyes

(sclera) by pigment of bile (bilirubin).

CAUSE OF HYPERBILIRUBINEMIA

Physiological Jaundice: Jaundice usually

occurs at 2-3 days of life and has resolved

by 7-14 days of life. 3 weeks in preterm

infant.

Breast-Milk Jaundice: This occurs in 1-

2% of breast fed babies and is caused by a

substance that is produced in the breast

milk. Enzyme activity in the infant‟s liver,

slows the breakdown and secretion of

bilirubin. Jaundice starts at 3-5 days of

age and can last 3-12 weeks.

ABO Blood Group Incompatibility and

Rhesus Incompatibility (Haemolysis):

These can occur if the mother produces

antibodies that destroy the newborn‟s red

cells, resulting in haemolysis of the

infant‟s blood. This leads to a sudden

build-up of bilirubin in the infant‟s

circulation during the first 24hrs of life.

DIAGNOSIS OF JAUNDICE: The

serum bilirubin level along with the

gestational age and postnatal age will be

plotted on the „Treatment Threshold

Graph”

KRAMER‟S RULE: Estimating the level

of jaundice by simply observing the baby‟s

skin color, one can utilize cephalocaudal

progression of jaundice

Zone 1 2 3 4 5

SBR

UMol/

L

100 150 200 250 >250

BLANCHING: Blanching the skin of tip

of nose, sternum, abdomen, palms and

soles with digital pressure.

ICTEROMETER:

This is non invasive method which is more

accurate and less subjective. The tool used

is a transparent plastic with 5 graded

yellow stripes of different shades

corresponding to the serum bilirubin level.

It is pressed against the tip of the nose. The

color of the skin is matched with yellow

stripes to obtain the bilirubin level.

TRANSCUTANEOUS

BILIRUBINOMETER:

The photo probe is pressed against the skin

of fore head or sternum. When pressure is

applied to the photo probe a xenon tube

generates a strobe light. This light passes

through a fiber optic filament penetrates

the blanched skin and enters the

subcutaneous tissue. The intensity of the

yellow color in this light, after correcting

for the haemoglobin, is measured and

instantly displayed in arbitrary unit.

Area of body Level of bilirubin

Face 5mg/dl

Chest/upper

abdomen

10mg/dl

Lower abdomen and

thighs

12mg/dl

Arms and lower legs 15mg/dl

Palms and soles >15mg/dl

DEFINITION OF PHOTOTHERAPY

A treatment for jaundice where the

exposure to ultravioletlight source converts

unconjugated bilirubin molecules into

water soluble isomers that can be excreted

by the usual pathways.Blue-green light is

most effective for phototherapy as it both

penetrates the skin and is aborted by

bilirubin to have the photochemical effect.

PURPOSES

To bring down the serum bilirubin

level

Treatment of Hyperbilirubinemia.

The phototherapy will help the

liver to process bilirubin, bringing

your baby‟s level down to normal.

INDICATION OF PHOTOTHERAPY

Elevated serum bilirubin levels:

Healthy term babies >17mg/dl

Preterm babies (weighting more

than 1500g:>8mg/dl)

Preterm babies (weighting less than

1500g >5 mg/dl).

Severely bruising

TYPES OF PHOTOTHERAPY

Continuous phototherapy: Phototherapy

should be interrupted in a newborn only

during breast feeding and nappy changes.

Conventional phototherapy: If jaundice

is non- haemolytic or rate of rise of

jaundice is slow, then one can use either

conventional or fiber optic phototherapy.

Intensive phototherapy: In case of

haemolytic or rapidly rising bilirubin or

when a conventional until is not effective,

use of intensive phototherapy is needed.

DIFFERENT LIGHTS USED IN

PHOTOTHERAPY

1. Micro-lite – white halogen

lightsThese should be positioned above

the infant and can deliver 10 to 30 µ

W/cm2/nm. They deliver light via a quartz

halogen bulb and have a tendency to

become quite hot so should not be

positioned closer to the infant than the

manufacturers recommendations of 52cm.

2.Fluoro-lite-2 blue and 2 white

fluorescent lights

Blue light is the most effective light for

reducing the bilirubin.

3. Ohmedabiliblanket -blue

halogen light This uses a halogen bulb directed into a

Fiberoptic mat. There is a filter that

removes the ultraviolet and infrared

components and the eventual light is a

blue-green colour.

4.Biliblankets: are not to be used on

infants less than 28 weeks gestation or

infants with broken or reduced skin

integrity.

5. MedelaBilibed – blue

fluorescent light A blue fluorescent tube is fitted into a

plastic crib with a stretched plastic cover

over the top for the baby to lie on. The

baby is dressed in the Bilicombibaby suit

and nursed on the soft plastic cover.

MECHANISM OF ACTION

Phototherapy (light treatment) is the

process of using light to eliminate bilirubin

in the blood. Your baby‟s skin and blood

absorbs these light waves. These light

waves are absorbed by your baby‟s skin

and blood and change bilirubin into

products, which can pass through their

system.

Wavelength of 420-448nm, oxidised the

bilirubin to biliverdin,a soluble product

that does not contribute to kernicterus. The

light waves convert the bilirubin to water

soluble nontoxic forms which are then

easily excreted.

During phototherapy, these molecules are

exposed to light.

The photons of energy are absorbed by the

pigment, bilirubin. This leads to a

sequence of photochemical reactions:

1. ConfigurationalIsomerisation:

Z-isomer E-isomer

Reversible as it reaches bile duct

Constitute 25% of TSB after 8-

12hrs.

Excreted slowly from body

.

2. Structural Isomerisation:

Bilirubin lumirubin

This reaction is directly

proportional to the dose of

phototherapy.

Converts 2-6% of TSB,which is

excreted rapidly from Body.

3. Photo Oxidation:

Forms photo products that are excreted

in the urine

CARE AND OBSERVATION OF

NEWBORN DURING

PHOTOTHERAPY

1. GENERAL INSTRUCTION

Recognize the possible need for

phototherapy based on risk factors and

blood testing. .

Perform a physical assessment of the

infant to assess for the presence of

jaundice.

Where possible perform assessment in

bright, natural daylight. Artificial light

can make it more difficult to accurately

assess for jaundice.

Jaundice can be detected by blanching

the skin with digital pressure.

The baby should be observed; the

gums and sclera of the eyes should be

observed.

A serum bilirubin level is taken on all

infants within 2 hours, where jaundice

is observed.

Check blood glucose also.

Level must be determined prior to

commencing phototherapy as

prophylactic phototherapy before

jaundice is ineffective.

2. EXPLANATION AND

REASSURANCE TO PARENTS

The decision to commence

phototherapy is made by the

neonatologist.

Explain the need for phototherapy to

the parents as clinically indicated.

Reassure them that their baby can be

removed from the incubator for

feeding.

Provide written information if

appropriate.

The nurse is encouraged to use

clinical judgement to facilitate a

break from phototherapy of up to 30

minutes for feeding / bonding).

Explain to the parents, type of

jaundice, the infant is being treated,

what precautions will be taken and

thatthe lights being used do not

contain ultraviolet light.

3. ASSESSMENT SHOULD BE DONE

BEFORE PHOTOTHERAPY:

GA of the baby

Weight of the baby

Postnatal age

Types of jaundice

The level of jaundice

4. OBSERVATIONS

Neonates must be weighed on

admission to the nursery and then 2nd

daily and documented on theNeonatal

Weight Chart.

Monitor the infant‟s temperature more

frequently when commencing

phototherapy and once stabilised,

record at least 4th hourly.

All infants managed with overhead

phototherapy or with eye protection in

place, need a saturationmonitor .

The date and time phototherapy is

commenced / discontinued, the type of

phototherapy device (s) and the dose of

phototherapy should be documented on

the Neonatal Jaundice Control

Form.

5. ADMINISTER PHOTOTHERAPY:

Make sure room temperature is

optimum 25-280c

Remove all clothes of baby except

diaper.

Cover the eyes with eye patches.

Place naked baby under the lights

- In a cot or bassinet:weight>2kg

or

- In an incubator or radiant

warmer: weight <2kg

Keep baby at a distance of 30-45cm

from light sources

Ensure optimum breastfeeding.

6. POSITION:

The phototherapy lamp should be

positioned a minimum: 30-45 cm

This is the optimum distance to allow

effective use of the phototherapy unit.

One or more units may be used at one

time. The lamp should be positioned to

allow for the coverage of the greatest

surface area of the infant‟s body.

Nurse infant supine or prone if

indicated with maximum skin exposure

to the phototherapy lights.

Reposition the infant regularly during

phototherapy.

7. MAINTAINING TEMPERATURE

The infant will be nursed in an

incubator or radiant warmer with only

a nappy in place.

The incubator should be dressed with

white linen.

To ensure maximum exposure of the

infant to phototherapy. A „neutral

thermal environment‟ can be achieved.

The infant‟s temperature should be

monitored and recorded at least 4

hourly.

Observe skin temperature by “warm to

touch” method.

Monitor and record incubator

temperature hourly.

If baby is hypothermic, discontinue

phototherapy and keep baby exposed

under fan. When temperature reaches

normal, restart phototherapy.

8. DURATION OF PHOTOTHERAPY

The infant may be removed from the

lights for feeding, diaper changes and

other general care but should receive

phototherapy for 18 hours every day.

If Fiberoptic blanket is used, it should

be kept next to baby‟s skin at all times.

It is not necessary to cover the eyes if

blanket alone is used.

9. BREAST FEEDING

The infant may need to be breastfed 8-

12 times a day.

The newborn stomach has a capacity of

30mls approximately. It can also

promote bonding.

Feed the baby every 2-3 hours

because phototherapy causes the baby

to lose fluid from the skin have loose

stools. This may cause dehydration.

10. SKIN CARE

A more rapid response to treatment can

be achieved by exposing larger surface

areas to the phototherapy light. For

infants with a rapidly rising serum

bilirubin level, for example ABO

incompatibility, the maximum area

of skin should be exposed.

Keep the infant clean and dry.

Cleanse skin thoroughly and change

nappies when soiled.

Infants nursed in nappies or where the

buttocks are not directly exposed to the

phototherapy may have zinc and castor

oil applied to areas of skin excoriation.

For infants less than 27 weeks, the

topical emollient when applied

sparingly may be used while the infant

is receiving phototherapy.

Clean only with water. Do not apply

oils or creams to the exposed skin.

Observe the skin for rashes, dryness

and excoriation.

11. RESPIRATORY MONITORING

Infants must be weighed on admission

to the nursery and 2nd

daily as per the

protocol.

Infants under the blue fluorescent

lights need atleast saturation

monitoring as it is difficult to assess

the infants color under these lights.

12.EYE CARE:

There has been some association

between neonatal phototherapy and

retinopathy of prematurity (ROP).

For infant comfort, eye protection

(phototherapy masks) must be used for

all babies nursed under overhead

phototherapy.

When on home phototherapy the infant

does not require eye protection.

Eye shields (opaque) must be placed

over the infant‟s eyes at all times

during phototherapy.As a prophylaxis

and to protect against retinal damage

Eye pads are required for the infants

comfort if overhead white or blue

fluorescent lights are used:

Size N 720(micro)<1500gm

Size N 721(small) 1500-2500gm

Size N 722(Large)>2500gm.

Ensure they do not slip or too tight.

Ensure the infant‟s eyes are closed

when positioning the eye shields. To

prevent corneal abrasions.

Eye care should be performed

4th

hourly and eye cares attended with

normal saline and assess eyes for

drainage, oedema and evidence of

infection.

Ensure the phototherapy unit is

switched off, before removing the eye

shields. .

Check baby at least every hour and see

that the eye Shields remain in place.

13. FLUID REQUIREMENTS:

The requirements for fluids and

electrolytes of the newborn infant are

unique. At birth, there is an excess of

extra-cellular water (ECW), and this

decreases over the first few days after

birth

INSENSIBLE WATER LOSS (IWL) is

greatest in the smallest and least

Mature infants due to high surface area

to body mass ratio and to immature,

water-permeable skin. Estimated IWL

in the first few days of life are:

IWL can be estimated by: IWL = Fluid

intake - Urine output + weight loss (or –

weight gain)

(E.g., 24-hour totals = Intake 90 mL, urine

output 60 mL, and weight loss 55 g.

Therefore, IWL = 90 - 60 + 55 = 85 mL).

14.MONITRING SERUM BILIRUBIN:

Obtain 6-24 hourly serum bilirubin

level as determined by age and clinical

condition of the infant.

To monitor and evaluate the

effectiveness of treatment. NICE

recommend 6 hourly testing for first 24

hours until SBR below treatment

threshold or stable / falling.

Turn off lights prior to obtaining

sample. Conjugate and unconjugated

bilirubin is photo oxidized when

exposed to white or ultraviolet lights

and haemolysis can give false lower

results.

REBOUND BILIRUBIN LEVELS:

It is unnecessary to keep a baby in

hospital for a rebound bilirubin level.

If a baby does not appear visibly

jaundiced 48hours after stopping

phototherapy then they do not require a

repeat bilirubin level.

Term babies who are re admitted for

phototherapy (usually between day 3-

6) for physiological jaundice do not

require a routine rebound level after

lights are stopped.

BODY WEIGHT IN INCUBATOR

<1,000

1,000-1,500

1,500-2,000

>2,000

75-100

50

25-50

25-50

Reasons to check a rebound bilirubin

24hours after stopping phototherapy

may include:

d) < 37 weeks gestation

e) Bruising

f) Early use of phototherapy

(started <72 hours of age)

COMPLICATION OF

YPAREHTOTOHP

emordnys ybab eznorB

Greenish stool

Transistent skin rashes

Poor feeding

Temperature instability

Loose stools and peri-anal

excoriation

Maternal-infant separation

hyperthermia-

Increasing metabolic rate

Dehydration

Electrolyte disturbance

GUIDED BY:

Mrs.SeetharamanVijayalakshmi, M.Sc (N).,MBA.,

Reader in Child Health Nursing,

College of Nursing,


Chennai – 03.

Dr. R. Shankar Shanmugam, M.Sc (N), MBA., Ph.D.,

Reader in Nursing Research,

College of Nursing,


Chennai – 03.

STUDENT INVESTIGATOR:

Mrs .R. Revathy,

M.Sc (N) II year student,

Department ofChild Health Nursing,

College of Nursing,


Chennai – 03.

INFORMED CONSENT

TITLE: “A study to assess the Effectiveness of structured teaching programme on

knowledge regarding care of newborn during phototherapy among II year DGNM

students at Institute of Child Health and hospital for children, Egmore, Chennai-

08”.

Sample no:

Name of participant:

Name of the principal investigator: R.REVATHY

Name of the Institution : Institute of Child Health and hospital for

children, Egmore, Chennai-08

Whether the participants consent was asked: yes/no

[If the answer to the above question is yes, write the following phrase: you agree

with the manner in which consent was asked from you and given by you. You

agree to take part in this study].

[If answer to the above question is no, give reason(s):

Name and signature or thumb impression of the participant legal representative.

Name ------------------------------ Signature---------------------------

Date--------------------

Name and signature of the investigator or his representative obtaining consent:

Name ------------------------------- Signature--------------------------

Date------------------

INFORMATION TO PARTICIPANTS

TITLE OF THE STUDY :“A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON

KNOWLEDGE REGARDING CARE OF NEWBORN DURING

PHOTOTHERAPY AMONG II YEAR DGNM STUDENTS AT

INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN,

EGMORE, CHENNAI-08”.

Investigator : REVATHY .R

Name of the Participant :

Date :

Age/sex :

You are invited to take part in this study. The information in this document is

meant to help you decide whether or not to take part. Please feel free to ask if

you have any queries or concerns.

You are being asked to Cooperative in this study being conducted in Institute

of Child Health and Hospital for Children, Egmore, Chennai-08.

What is the Purpose of the Research (explain briefly)

` This research is conducted to evaluate to,“ A study to assess the Effectiveness

of structured teaching programme on knowledge regarding care of newborn during

phototherapy among II year DGNM students at Institute of Child Health and

hospital for children, Egmore, Chennai-08”.

We have obtained permission from the Institutional Ethics Committee.

Study Procedures

Study will be conducted after approval of ethics committee

A written formal permission will be obtained from authorities of

Institute of Child Health and Hospital for Children to conduct study.

The purpose of study will be explained to the participants.

The investigator will obtain informed consent.

The investigator will assess the knowledge regarding care of newborn


Possible benefits to other people

The result of the research may provide benefits and also empathetic care

to them by investigator.

Confidentiality of the information obtained from you

You have the right to confidentiality regarding the privacy of your

personal details. The information from this study, if published in scientific

journals or presented at scientific meetings, will not reveal your identity.

How will your decision not to participate in the study affect you?

Your decisions not to participate in this research study will not affect

your activity of daily living, medical care or your relationship with investigator

or the institution.

Can you decide to stop participating in the study once you start?

The participation in this research is purely voluntary and you have the

right to withdraw from this study at any time during course of the study

without giving any reasons.

Your Privacy in the research will be maintained throughout study. In the

event of any publications or presentation resulting from the research, no

personally identifiable information will be shared.

Signature of Investigator: Signature of Participants:

Date: Date:

DISSERTATION ON

Documents

Transcript of DISSERTATION ON