INTRODUCTION:

Assessment of high quality new born care is the right of the new born everywhere. Babies have the right to breathe normally, prevention of infection, and should protected from the injuries. New born care includes essential new born care and routine care.

Essential new born care involves the immediate care provided at the time of the birth. Routine care involves the other basic care provided to the new born after 24 hours of delivery.

Neonate means new born child. Neonate is an infant less than 4 weeks old. The word neonate comes from the word “neonates”, ‘neo’ means new and ‘nat’ means born. The arrival of the new born or neonate, begins a highly vulnerable period during, which many physiological and psychological adjustments to life outside the uterus must be 3 made. Majority of the deaths occurs during this period. New born care consists need of resuscitation, complete physical examination, administrations of vaccines and prophylactic medicines, adequate nutrition, sleep, and hygiene of the new born.¹

After the delivery of the baby there may be amniotic fluid and mucous in the air passage. The potential problems of aspiration of these secretions can be avoided by suctioning. The doctor and nurses gently clears the mucus from the mouth, nose and throat through suction bulb or mucus sucker. After that the new born able to take breathing after that. The umbilical cord is clamped and cord cutting should be done between two clamps. For the prevention of hypothermia skin to skin contact should be maintained between mother and baby. The child should be wrapped in to warm blanket. In some cases the new born needs special attention provides information on how well your heart works, identifies problems and allows for procedures to open blocked arteries.

Cutting the umbilical cord The third package of WHO for the new born care is delayed cord clamping. The umbilical cord should be clamped at least after one minute of the delivery or when the cord pulsation stops. Because of the delayed cord clamping the new born continue receiving fetal blood from the placenta after the delivery. The benefits of the DCC is increased in haemoglobin concentration and reduced rate of anaemia. The stump of the cord should be observed for the 3 openings of the blood vessels, one vein and two arteries. It should be daily cleaned. Daily observation of the umbilical site for any type of discharge, redness or inflammation is necessary. If any deviation found, it should be reported to the paediatrician.

The doctor should be examine the new born for any type of abnormalities. The doctor does the full physical examination of the new born baby. Apgar score was checked after one minute and five minutes of the delivery. The low apgar score indicates the child need assistance in breathing and circulation. If the baby is stable then the nurse should check the height, weight, head and chest circumference.¹

Maintain the new born’s body temperature is critical. As soon as possible, the new-born is wrapped in lightweight clothing and the head should be covered to reduce the loss of body heat. A few drops of an antibiotic, i.e. erythromycin, tetracycline, or silver nitrate or povidone iodine, are applied to the eyes to prevent infection from any harmful organisms that the new born may have had contact with during delivery.

After the normal delivery, the parents should be encouraged to hold their baby. It improves the bonding between the parents and the new born. So, the parents can bond nicely with their baby even when they are not spending the first hours together.

Skin to skin contact is very necessary for prevention of hypothermia, for the establishment of breast-feeding practices. The child should be provided exclusive breast feeding for 6 months.

The mother and new born usually recover together in the delivery room. The mother and the baby should remain together in one room to establish the bonding between child and parents.

Early initiation of breast feeding (EIB) should be provided within the first hour after the delivery. Breast feeding is the most universally recommended way of providing an infant with nourishment. There is an evidence that the exclusive breast feeding for 6 months is a cheap and effective way to reduce all types of infection related mortality. After the delivery yellowish fluid was secreted called colostrum, it provides development of the intestinal mucosal and immunological protections.³

Breast feeding has so many advantages. It stimulates oxytocin hormone which helps the mother’s womb heal. And it also promotes the milk supplies. After the baby transported to the ward, he or she should be wrapped in a pre-warm cloth to maintain the temperature of the new born. The new born’s liver is not enough mature. So there was a low level of vitamin K in the new born. So, the nurses should be given vitamin K injection to prevent bleeding.

After the 6 hours of the birth of the baby, the baby is allowed for the bathing. But the nurses should not wash out the whitish cheese like structure which covers the new born. It is called as vernixcaseosa. It helps the new born for the prevention of infection. The hair like structure found on baby’s body is called as lanugo. These should be examined by the nurses.

There is a good evidence that the good essential new born care practices reduces the risk of mortality. Health service contacts (notably associated with antenatal care and the hospital admission for childbirth) are important opportunities to influence these practices. In some settings, community health workers (CHWs) can serve as important channels to influence adoption of these practices among pregnant women.

Within 1 hour of birth, intramuscular vitamin K should be administered. Prophylaxis with erythromycin ointment to both eyes and injection of hepatitis B vaccine are recommendations, while the baby has skin-to-skin with the mother.

Breastfeeding: Early skin-to-skin contact and breastfeeding initiation are key to successful breastfeeding. Skin-to-skin contact improves the transition of the newborn, increases the production of maternal milk and makes breastfeeding more effective. Effective sucking and latching should be established in the first 48 hours. If there is a weight loss of over 7% associated with a poor suckling reflex or feeding, supplementation with formula is an option. The volume of feedings can be increased each day during the first week starting at 3 to 17 cc/kg/day on day one to 140-170cc/kg/day on day 7.

Vitamin D supplementation should initiate within 2 months in breastfed only infants. Daily requirements are 400 IU/day. Infants fed with formula and breast milk that consume less than 32 ounces per day of formula should also be supplemented with vitamin D as well.³

Skin Care: It is important to note that full-term newborn infant’s skin is covered by vernix caseosa which protects the epidermis in the uterus from water damage due to its high lipid content and hydrophobic properties. It is recommended to keep it in contact with the skin for at least 6 hours after birth.

Bathing: Until the umbilical stump falls, bathing should be done with a sponge to keep the cord dry and is not required frequently. Soaps usually contain surfactants to remove dirt, and this can damage subcutaneous lipid and cause irritation.

Diaper care: Diaper care is the ultimate goal to reduce excessive skin moisture. Skin cleansing should be with soft nonwoven wipes, water, and emollient cleansers; these wipes should be free of alcohol and fragrance.

Urine and stool: Newborns pass first meconium within 24 to 48 hours after birth. Meconium is a black and sticky substance and is the first stool passed by the infant. The stools progressively change to a characteristic seedy, mustard yellow or green stool with an increase in mother’s milk consumption. Infants have a gastro-colic reflex which makes them pass stools with almost every feeding. If meconium passage delays more than 48 hours, the infant should undergo evaluation for pathologies like imperforate anus or Hirschsprung disease. Urine usually is passed in the first 24 hours of life. It is important to remember that it is easy to miss urine when it is mixed with stools or is not witnessed or documented at the time of birth. If true anuria is suspected, the physical exam should be repeated to evaluate genitals and abdomen for any missed abnormalities. If there are valid concerns about voiding, catheterization and ultrasound along with a urology consultation should take place. The parents should receive counsel that vaginal discharge is normal at birth due to maternal hormones and that they might see the presence of urate crystals that look like brick dust, which can be confused with blood. The discharge should happen after voiding and passing stools.

Hyperbilirubinemia is common in newborns, and most infants have some visible jaundice in the first week after birth. Jaundice during the first 24 hours of life is pathologic and requires investigation. Jaundice may be due to an immature uridine diphosphate glucuronyltransferase enzyme in the liver, elevated hemoglobin levels in newborns and increased destruction of RBCs. Bilirubin screening is done before hospital discharge either transcutaneous or measuring serum levels.

Umbilical cord: The umbilical cord is susceptible to bacterial colonization and can serve as a port of entry for bacteria into the systemic circulation. Dry cord care is the preferred method as per the World Health Organization. The umbilical cord should be kept exposed to the air, and if covered, it should be loosely covered with a clean garment. If contaminated at any point with stool or urine, it should be washed with soap and sterile water and dried. The umbilical stump usually falls off naturally in 10 to 14 days.

Safety: From the moment of birth, parents should be given education and guidance about sleep position, shaken baby syndrome, smoking around the baby, the effect on siblings and pets. Babies should be put to sleep on their back in a crib with the goal of decreasing sudden infant death syndrome (SIDS), with fitted sheets, no blankets or stuffed animals, and no co-bedding.

NEED FOR THE STUDY:

The neonatal period—the first 28 days of life—carries the highest risk of mortality per day than any other period during the childhood. The daily risk of mortality in the first 4 weeks of life is ~30-fold advanced than the post-neonatal period, that is, from 1 month to 59 months of age. Still, new born health didn't admit the commensurable attention it merited until during the once decade. This has redounded in a slow decline in neonatal mortality rate (NMR) in utmost countries including India, and has hampered their achieving the Millennium Development thing- 4(MDG 4) by time 2015.⁵

An unacceptable number of babies around the world die in the first week of life with the highest number dying within the first 24 hours of birth. Many of these deaths occur to babies born too early and too small, or with infections, or to babies asphyxiated around the time of delivery. Studies have shown that numerous new born lives can be saved by the use of simple low technological interventions.⁶

Quality of care is decreasingly honoured internationally as a critical aspect of the untreated motherly and new born health docket, substantially with respect to care around labour and delivery and in the immediate postnatal period. It's honored that high content alone isn't enough to reduce mortality. To reduce motherly and neonatal mortality mainly and move towards elimination of preventable causes of motherly and new born death, increased content should be accompanied by advanced quality throughout the continuum of care.⁷

The WHO Multicounty Survey on Maternal and New born Health, with data on more than 300 000 women attending 359 health care facilities in 29 countries, showed a poor correlation between coverage of “essential interventions” (e.g. the proportion of the population who had received an indicated intervention, such as women with eclampsia who received magnesium sulphate) and maternal mortality in health facilities. Studies also show that high-quality care requires appropriate use of the available infrastructure, staff and commodities to ensure effective case management. High-quality care requires appropriate use of evidence-based clinical practices and nonclinical interventions, strengthened health infrastructure and optimum skills and a positive attitude of health providers.⁷

The quality of care frame, norms of care and quality measures may be used to guide the medication of public norms of care and measures for perfecting, assessing and covering the quality of care handed to maters and new borns in health installations. The frame can also be used as a base for quality enhancement strategies and conditioning and for incorporating quality into being public programmes.

The current birth rate of India in 2022 is 17.163 births per 1000 people. The birth rate of India in 2021 was 17.377 births per 1000 people. The birth rate of India in 2020 was 17.592 births per 1000 people. The death rate of India in 2020 was 7.3 per 1000 people. The birth rate of Gujarat in 2018 is 19.7 births per 1000 people. The death rate of Gujarat in 2018 is 5.9 deaths per 1000 people.

Hence the investigator planned to conduct a study to assess the knowledge of Standard safety protocol guidelines for newborn care in Newborn and Pediatric units unit. This made me undertake this study to assess the effectiveness of PTP on knowledge regarding Standard safety protocol guidelines for newborn care. among staff nurses at selected hospital.

OBJECTIVES OF THE STUDY:

· To assess the level of knowledge regarding Standard safety protocol guidelines for newborn care among staff nurses working in Selected hospital.

· To assess the effectiveness of Planned Teaching Programme on knowledge regarding Standard safety protocol guidelines for newborn care among staff nurses.

· To find out association between the selected demographic variables and their post test level of knowledge score regarding Standard safety protocol guidelines for newborn care among staff nurses.

HYPOTHESES:

· H1: The mean post test knowledge scores of staff nurses will be significantly higher than the mean pretest knowledge scores regarding Standard safety protocol guidelines for newborn care

· H2: There will be significant the association between selected demographic variables and their post test level of knowledge score regarding Standard safety protocol guidelines for newborn care among staff nurses working selected hospital.

MATERIAL AND METHODOLOGY:

Research approach:

Quantitative research approach.

Research design:

Pre experimental one group pre test post test design

Setting of the Study:

Setting is the physical location and condition in which data collection takes place. The study was conducted in selected Hospital at Rajkot.

Population:

Target population: Staff nurses working in selected hospital.

Accessible population: Staff nurses working in new born and pediatric unit of selected hospital at Rajkot

Sample:

The sample of the study comprised the staff nurses working in new born and pediatric unit in selected hospital at Rajkot.

Sample Size:

Staff nurses who fulfilled the sample selection criteria. 30 samples

Sampling technique:

Sampling technique used by the investigator was non probability convenience sampling technique

Data Analysis Plan: The collected data was analyzed using both descriptive and inferential statistics.

Major finding of the study: Major study findings includes

Findings related to demographic variables of the study:

1. The majority of 21 (70%) sample’s age is between 22-24 years

2. The majority of 20 (67%) samples are Female.

3. The majority of 11 (36%) samples are having education of GNM.

4. The majority of 20 (66%) samples are working in medical and Surgical ward.

5. The majority of 12 (40%) samples are having 0-1 years of work experience.

CONCLUSION:

The main conclusion from this present study is that most of the staff nurses working in cardiac unit had inadequate and moderate level of knowledge in pre-test and they improved to moderate and adequate level of knowledge in post-test. This shows that need to understand the purpose of the PTP on knowledge regarding Standard safety protocol guidelines for newborn care in improving patients care and safety of critically ill patients among staff nurses working in cardiac units and it will improve the practice of infection control measures to improve quality care of nurse.

REFERENCE:

1. Btbasavanthappa. Child Health Nursing. Jaypee The Health Science Publication, New Delhi; 1st Edition; Page no 263-289

2. Manoj Yadav. Child Health Nursing. Pee Vee Publication; 4th Edition; Pageno 308-312

3. Paruldatta. Textbookof Paediatric Nuursing. Jaypee Publication. 3rd Edition; Page no-64-90

4. https://www.ncbi.nlm.nih.gov/books/NBK539900/#_article-28666_s6_

5. https://www.msdmanuals.com/en-in/home/children-s-health-issues/care-of-newborns-and-infants/initial-care-of-the-newborn

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5144119/

7. https://cdn.who.int/media/docs/default-source/mca-documents/qoc/quality-of-care/standards-for-improving-quality-of-maternal-and-new born-care-in-health-facilities.pdf

Received on 12.08.2024 Revised on 11.09.2024

Accepted on 07.10.2024 Published on 30.11.2024

Available online on December 31, 2024

A and V Pub Int. J. of Nursing and Med. Res. 2024; 3(4):165-169.

DOI: 10.52711/ijnmr.2024.38