CHAPTER 1

INTRODUCTION

BACKGROUND OF THE STUDY-

One of the most awe-inspiring and emotional events that can occur one’s life

time is the birth of an infant. The neonate’s arrival after the anticipation and

preparation for nine months causes a flurry of excitement for the parents and also for

the other family members. But if the neonate is not the healthy robust infant who was

expected, it creates a problem.1 The birth of a healthy newborn is one of the finest

gifts of nature.

The birth process takes only few hours but it is the most hazardous period of

life since it is associated with the largest number of deaths as compared to any other

phase of life. The first one minute after birth which is regarded asthe “golden minute”

the baby should be breathing well. The failure of the new born to establish and sustain

respirationat one minute of life results to the condition known as birth asphyxia.2

The birth process is the most hazardous period of life and there are maximum

numbers of deaths in this period as compared to deaths in all other phases of life. 3 The

term newborn refers to the infant in the first minutes of hrs following birth in contrast

the neonatal period is defined as the first 28 days of life .4 The transition from foetus to

neonate commonly called birth, is one of the most profound changes that human will

ever undergone.

During this transition fetus ceases to received blood, oxygen and nutrient

from the maternal circulation and most derive those thing from the outside the world.5

Most of the neonates are born naturally and normal. Although it is normal, during the

process of birth, the baby has to face many physiological and Environmental

changes.6 The birth is a challenging transition from the intrauterine to extra uterine
life. Majority of babies handle this transition well. 90% of newborn babies do not

need any medical intervention for survival but 5-10% of newborn needresuscitation. 7

The neonatal period (birth to 28th day of life) is the most vulnerable and high-risk

time in life because of the highest mortality and morbidity incidence in human life

during this period.8

Worldwide each year, 5 million neonatal die. Birth asphyxia is responsible for

20% these death. In India 4-6% fails to experience spontaneous breathing at birth and

suffer from asphyxia. Timely and appropriate management of asphyxiated babies at

birth can save them and provide a better quality of life amongst survivors, without any

neurological sequelae.9 Neonatal Asphyxia accounts for 20.9% of neonatal deaths.

Although the majority of newly born infants (90%) do not require intervention to

breathe during transition from intrauterine to extra uterine life.10

Approximately 10% of the newborns require some assistance to begin

breathing at birth, and about 1%required extensive resuscitative measures. 11Heart rate

should remain the primary vital sign by which to judge the need for and efficacy of

resuscitation Babies who require ongoing resuscitation or respiratory support or both,

the goal should be to use pulse oximetry.12

Globally, about one quarter of all neonatal deaths are caused by birth asphyxia. In this

document, birth asphyxia is defined simply as the failure to initiate and sustain

breathing at birth. Effective resuscitation at birth can prevent a large proportion of this

deaths.13

According to WHO reports of 2016, Close to 700, 000 neonatal deaths were

attributed to asphyxia. However, the majority of thedeaths due to asphyxia could be

prevented by adequate resuscitation practice which would thenlead to a decline in the

overall neonatal mortality.14Out Of the 25 million babies born every year in India,
3.5% babies experience asphyxia at birth. Every 3rd newborn (NB) dying in the

World is an Indian.3 lakh Indian NBs die every year in India during their 1st h of life,

most of them just because they did not get their first breath in time.

Birth asphyxia is responsible for 19% of NB deaths in India. 15 Birth asphyxia

accounts for about 23% of the approximately 4 million neonatal deaths that occur

each year worldwide.

In contrast, at least 90% of newly born babies make the transition from

intrauterine to extra uterine life without difficulty. They require little to no assistance

initiating spontaneous and regular respirations.16

Neonatal resuscitation means to revive or restore life to a baby from the state

of asphyxia. The aim of neonatal resuscitation program is to teach the steps necessary

to ventilate a newborn baby that is not breath properly and protect the life of baby.

Ninety percent of newly born babies make the transition from intrauterine to extra

uterine life without difficulty. They require little or no assistance to begin

spontaneous and regular respirations.17

Newborn resuscitation is defined as the set of interventions at the time of birth

to support the establishment of breathing and circulation. The goals of neonatal

resuscitation are to prevent the morbidity and mortality associated with hypoxic-

ischemic tissue (brain, heart and kidney) injury and also to re-establish adequate

spontaneous respiration and cardiac output.18

Neonatal resuscitation also known as newborn resuscitation is

an emergency procedure focused on supporting the approximately

10%of newbornchildren who do not readily begin breathing, putting them at risk of

irreversible organ injury and death. Through positive airway pressure, and in severe
cases chest compressions, medical personnel can often stimulate neonates to begin

breathing on their own, with attendant normalization of heart rate.19

With the goal of preventing these deaths, the American Academy of

Paediatrics (AAP) and its global partners created the Helping Babies Breathe (HBB)

program, which teaches newborn resuscitation techniques to birth attendants in low-

resource setting.20Neonatal resuscitation (NR) is a means to restore life to a baby from

the state of asphyxia. It is a single intervention of birth asphyxia. 21Resuscitation of a

neonate is more challenging than that of an adult or even older infant or child.22

Basic newborn resuscitation refers to airway clearing (suctioning if required),

head positioning, and positive pressure ventilation with bag and masks.23NR is an

essential component of maternal and child health services and is an inexpensive

intervention by which many newborn lives can be saved. The quality of NR and initial

stabilization of newborn during first few minutes of birth has a significant effect on

neonatal morbidity and mortality especially in high risk newborns like premature and

low birth weight babies.24

Need of the study-

Birth of a baby is a special movement of joy demanding rapid physiological

adjustments. Most babies go through the transition successfully as a matter of routine

but 10% of these may vary in need for degrees of assistance and opportunity lost to

provide needed assistance at this time would be a crucial impediment for saving these

babies.

Birth asphyxia and prematurity is the leading cause of neonatal mortality.

According to UNITADE NATION, approximately every year 140 million are born

worldwide out of that 2.5 million newborn died in just there first month of life, about

a third of there on the first day of life, among those children most died from
preventable cause such as birth asphyxia, prematurity and complication during

delivery and infection.

According to UNICEF, In India 7 lakh neonate deaths occur every year

horrifying rate of neonatal deaths every 2 neonatal death every minutes.

Approximately 7000 newborn death occur every day with about one third dying on

the day of birth and close to 3 quarter dying within the 1 st week of life.India accounts

for nearly 0.9 million newborn deaths per year i.e. 30% of global neonatal deaths.

Two major causes of these deaths are birth asphyxia and sepsis.

One effective measure to prevent these deaths is to have skilled birth

attendants in neonatal resuscitation A nationwide training programme on neonatal

resuscitation in China decreased intrapartum related deaths from 7.5 to 3.4 per 10,

0001 .1 Moreover, several trials have shown that basic neonatal resuscitation training

decreases neonatal deaths up to 20% in low-resource settings2.

Among more than 130 million births per year globally, approximately ten

percent of newborns require some form of intervention immediately at birth. It is

estimated that 25% of approximately 4 million neonatal deaths worldwide are

secondary to birth asphyxia.Evidence around the world also show that the risk of

death increases by 16% for every 30 s delay in initiating ventilation up to six minutes

and every 6% for every minute of delay of applied bag and mask ventilation.

A study conducted in Tamale showed that 98% of the participants in the study

had insufficient knowledge about newborn resuscitation. In term of experience, 55%

of participants in their study were not experience in performing neonatal resuscitation.

Research statement
 A comparative study to assess the effectiveness of conventional method of teaching

versus video assisted teaching on level of knowledge regarding newborn resuscitation

among under graduate student nurses in selected college,Lucknow, Uttar Pradesh.

Objective of the study

1. To assess the level of knowledge score among under graduate student nurses

regarding newborn resuscitation.

2. To compare the effectiveness of conventional method and video assisted teaching

method regarding newborn resuscitation.

3. To find the association between pre test knowledge score regarding newborn

resuscitation among under graduate student nurses with their selected demographic

variables.

Operational definition-

Assess-it refers to an activity to measurement of knowledge of graduate nursing

student regarding newborn resuscitation by using appropriate tools which is

developed by the investigator.

Effectiveness- the term refers to an outcome after the intervention of video teaching

programmed in term of knowledge gain among the under graduate nurses regarding

newborn resuscitation measured by knowledge questionnaire.

Knowledge- it refers to a fact and awareness about the information regarding

newborn resuscitation among graduate nurses.

Video teaching-it refers to a systematic organized content matter regarding newborn

resuscitation presented through video.

Newborn resuscitation- it refers to a procedure for initiating breathing in the

newborn.
Under graduate student nurses- an institute that provide the knowledge and skills of

degree and diploma in general nursing and midwifery course.

Variables: Variables of the study

Dependent variables-were level of knowledge among under graduate student nurses

measured by structured knowledge questionnaire regarding newborn resuscitation.

Independent variables- under the study were conventional method and video

assisted teaching method on newborn resuscitation.

Hypothesis-

All hypothesis were tested at p<0.05 level of significant.

H0- there will be no significant difference in the mean scores of video assisted

teaching method and traditional method.

H1: the mean scores of video assisted method would be higher than that of

conventional method at p<0.05.

H2: There would be significant association between knowledge on neonatal

resuscitation among under graduate student nurses with two group and their selected

demographic variables.

CONCEPTUAL FRAMEWORK
 Conceptual framework of the present study was based on general system theory

which describes input, process, output and feedback by Ludwig von bertalanffy. According to

this theory, a system is a group of elements that interact with one and another in order to

achieve the goal. An individual is a system and receives input from the environment. This

input when processed provides an output. All living system is open in which there is a

continual exchange of matter, energy and information. The cyclical in nature and continuous

to be so as long these four parts keep interacting. If there is change in any parts, there will be

changes in all the parts. Feedback is one from in which the system or the environment

provides information.

The conceptual frame work of the present study was based on bertalanffy’s general system

model (1978). This consists of the components like-

 Input

 Throughput (process)

 Output

 Feedback

In this present study, the under graduate student nurses considered as an open system

because they received the information from the environment. The study used this input to

increase knowledge regarding newborn resuscitation.

INPUT:-Input is the information, knowledge, attitude or energy that enters the system. In the

present study, input refers to under graduate student nurse’s demographic variables like age,

gender, religion, marital status, family income, type of residence and previous knowledge

regarding newborn resuscitation. These factors were taken into consideration in input for pre

test evaluation of effectiveness in bringing out the changes in knowledge regarding newborn

resuscitation.
PROCESS- refers to tasks and the formal and informal system components. Here, in this

study investigator prepare and provide intervention (conventional method and video assisted

teaching programme) to group N1& group N2 regarding newborn resuscitation.

OUTPUT-refers to the energy, matters or knowledge disposed off by the system as a result of

the process. In the present study, output refers to the differences in knowledge score. The

comparison between the conventional method and video assisted teaching method regarding

newborn resuscitation among under graduate student nurses. knowledge score will give

evidence to the significant difference in knowledge score that which method is more

effective.

FEEDBACK- feedback is a process that enables a system to regulate itself. It provides

information about the system output and its feedback as input and its feedback as input and

process. In the present study, conventional method is more effective than video assisted

teaching method.