INTRODUCTION:
During intrauterine life the fetal lungs are filled with fluid and they do not serve any ventilator purpose. Since the placenta supplies the oxygen to the fetus the blood flow through the lungs is markedly diminished due to constricted arterioles and right to left shunt through the ductus arterioeses during fetal life.1
During vaginal delivery the 1/3 rd of fetal lung fluid is removed and as chest is squeezed and lung fluid comes out through the nose and mouth. First few breaths of most newborn babies are extremely powerful expanding the alveoli and replacing the lung fluid with air. Infant who are apneic at birth those having weak respiratory efforts cannot achieve this function in order to ensure adequate expansion of lungs and clear the lung fluid. The initial ventilation requires at least two to three times the pressure needed for subsequent breaths.1
During the fetal life the lungs are immature soon after the birth the baby has to adopt the extra uterine life. Blood is oxygenated and is exchanged in the placenta and it is returned to fetus through umbilical vein. At the birth when the umbilical cord cut, the baby has to establish its own respiration. Hence some newborn need help in this transition.1
Effective resuscitation of newborn requires adequate training and preparation of staff involved in a lobour. As a poor cardio respiration adaptation at birth cannot be predicted in majority of the cases all staff involved in the care during labor should be skilled in resuscitation of the newborn.2
The period of newborn is very essential in the human life. Approximately 10% of the newborn require some assistance to begin breathing at birth and less than 1% requires extensive resuscitation measures. This is because we as a nurse are here to save newborn’s life as well as to help the newborn and infant mortality rate. Birth of healthy newborn baby is one of the finest gift of nature. More than 100 million babies are born annually worldwide. They have to make transition from fluid filled environment in which the placenta serves as the gas exchange for the organ of the fetus and to an air filled environment in which baby’s own cardiopulmonary system has to independently function within minutes of birth for survival.2
NEED FOR THE STUDY:
New born care is of immense important for proper development and healthy life of a baby. Neonatal resuscitation programme has been launched in INDIA since 1990.This programme provides a uniform systematic and action oriented approach to the resuscitation of the new born. Prospective evaluation of the resuscitation programme in teaching hospitals has revealed the use of rational resuscitation practices and a significant decline in asphyxia related death.3
Oxygen is important for every part of the human body. Without Oxygen the brain and other organs will die. During pregnancy the baby receive oxygen from mother through the placenta. After the baby is born, the baby starts to use his own lungs to receive the oxygen. For most of the babies this changes happens without any problems. But some babies need help to start or continue breathing. The skill of new born resuscitation gives that help.3
Birth asphyxia is important cause of preventable neonatal mortality and morbidly in developing countries. 26million births each year in India, 4-6% of neonates fail to establish spontaneous breathing at birth. These babies can be helped if, health care professional present at the time of birth are skilled in the art of neonatal resuscitation.4
Globally, the neonatal mortality rate is 5.1 million annual neonatal deaths. Of these, five million annual neonatal deaths (98% of the world's total) occur in developing countries. In other words, of 136 million babies born annually, around 10 million require assistance to breathe. Each year 814,000 neonatal deaths result from intra-partum related events in term babies and 1.03 million from complications of prematurity. Still no systematic assessment of mortality reduction or resuscitation has been done.11In that first golden minute it is urgent to get the baby to take first breath. When the umbilical cord is clamped shortly after delivery the baby stops getting blood and oxygen through the cord. Early resuscitation the most critical event in the prevention of sudden death of newborn. Resuscitation given at proper time helps in preventing birth asphyxia and its complication at birth community education should be focus more on the prevention of neonatal and maternal mortality rate.5
The current state of neonatal health in India is indeed dismal to state the least. Three neonates are dying every minute in India and every 4th baby born is low birth weight! India contributes 30% of the global burden of neonatal deaths. In India, the number is estimated to be about 1 million, highest for any country. Current neonatal mortality rate in India is 47/1000 live births accounting for almost two thirds of the infant deaths. Neonatal Mortality Rate (NMR) shows a wide variation in different states being the lowest in Kerala (11.5) with highest rates seen in Chhattisgarh (51.1), Jharkhand(48.6), Uttar Pradesh(47.6) and Madhya Pradesh(44.9). Surveys in Karnataka, depicts a neonatal mortality rate of 28.9.The World Health Organization (WHO) reports that between 4 and 9 million newborns have birth asphyxia, of whom an estimated 1.2 million die from birth asphyxia. Approximately 3.2 million stillbirths occur in the developing countries. Birth asphyxia results from events in the ante-partum (50%), intra-partum (40%), and post-partum (10%) periods.5
Neonatal resuscitation has the potential of altering the outcome of intra-partum and post-partum events. But, preventive strategies can be severely hampered by the lack of qualified health professionals. Neonatal resuscitation is an important starting-point in the scaled-up neonatal programs that are required to ensure that the world’s youngest citizens get the best possible start in life. Given the distribution of the burden of asphyxia, and the limitations of access, Nurses must be prepared to target preventive and management strategies in various settings. 6 As a nurse practitioners, this is very important role and responsibility to save newborn life by giving them a need base care. In the unit of neonatal intensive care and pediatric unit, the each nurse should have knowledge regarding newborn resuscitation and they should get the training, workshop and CNE to update their knowledge to perform as protocol.6 New born care is of immense important for proper development and healthy life of a baby. Neonatal resuscitation programme has been launched in INDIA since 1990.This programme provides a uniform systematic and action oriented approach to the resuscitation of the new born. Prospective evaluation of the resuscitation programme in teaching hospitals has revealed the use of rational resuscitation practices and a significant decline in asphyxia related death.6
STATEMENT OF THE PROBLEM:
“A Study to Assess the Knowledge and practice regarding Resuscitation of New Born among the staff nurses working in neonatal intensive care unit at selected hospitals of Belgaum city with a view to develop self instruction module”
OBJECTIVES OF THE STUDY:
1. To assess the level of knowledge of staff nurses regarding newborn resuscitation.
2. To assess the practice of staff nurses regarding neonatal resuscitation.
3. To develop self instructional module.
OPERATIONAL DEFINITIONS:
1. Assess:
It is organized, systemic and continues process of collecting data from the staff nurses related to knowledge regarding neonatal resuscitation
2. Knowledge:
It refers to appropriate response from the staff nurses about neonatal resuscitation through the items of structured knowledge questionnaires.
3. Practice:
It refers to the appropriate responses from the nurses regarding neonatal resuscitation through SIM.
4. Neonatal resuscitation:
It refers to intervention after the birth of the baby with bag and mask technique to help to breath and to maintain heart rate.
5. Neonate:
It refers to an infant the first 28 days after birth
6. Staff nurses:
Registered nurse and midwives who are working in NICU.
7. SIM:
It refers to an informational booklet prepared by the group and validated by experts regarding knowledge and practice of neonatal resuscitation.
8. Selected hospital:
K.L.E’s .Dr. Prabhakar. Kore Hospital and MRC Belgaum.
Assumptions
1. Staff nurses who are working in NICU have some knowledge regarding neonatal resuscitation.
2. Self instructional module regarding new born resuscitation will help the staff to improve their knowledge.
3. Self instructional module regarding new born resuscitation will help the staff to practice effectively.
Delimitation
This study is delaminated to the staff nurses working in the NICU of K.L.E’S .Dr.Prabhakar. Kore Hospital and MRC Belgaum
RESEARCH METHODOLOGY:
Research Approach:
A descriptive approach was adopted in this study.
Research Design:
A descriptive survey design was adopted to carry out the present study.
Research Setting:
The setting selected for the present study was NICU of KLE’S Dr. Prabhakar Kore Charitable Hospital Belgaum, Karnataka
Research Variable:
Knowledge and practice regarding neonatal resuscitation
Population:
In the present study population comprises of staff nurses who are working in NICU of KLE’S Dr. Prabhakar Kore charitable hospital Belgaum.
Sample and Sample Size:
The sample chosen for the present study were staff nurses who are working in NICU
and the sample size is considered for the study was 30 staff nurses
Sampling Technique: The sampling technique used for the study was purposive sampling which is a type of non-probability sampling.
Description of Tool:
A structured knowledge questionnaire on the neonatal resuscitation and observational check list on practice of neonatal resuscitation for nurses working in NICU of K.L.Es Dr. Prabhakar Kore Hospital and MRC Belgaum.
Description of the Tool
Tool consist of
Section A:
Structured knowledge questionnaire. This sections aims to assess the knowledge regarding neonatal resuscitation. 20 knowledge questionnaire
Section B:
Observational checklist consist of 20 Questions based on practice of neonatal resuscitation.
Section C:
Socio demographic data This section of tool consist of 05 items for obtaining information about the selected background factors of health care providers such as age, sex, qualification, source of information and work experience.
Method used for data collection:
Step I: The group obtained permission from respective authority and institute to conduct the study.
Step II: Formal permission obtained by KLEs Dr. Prabhakar Kore Hospital and MRC Belgaum.
Step III: The group introduced them self to the subjects.
Step IV: The group selected the subjects for the study.
Step V: The group distributed the research material (Questionnaires and SIM) .
Step VI: Data was tabulated and analyzed by using descriptive statistic.
a. Organizing of data on a master sheet.
b. Tabulation of data in terms of frequencies, percentage, mean, median, mode, standard deviation and range.
c. Classify the knowledge scores as follows:
ü 
Good score: (X+SD)
ü 
Average score: : (X +SD)
to(X-SD)
ü Poor score: : (X+SD)
RESULTS:
The major findings of the study were as follows:
1. Findings related to social demographic variables of staff nurses of NICU.
Majority of the Staff nurses were female, 30 (100%) and male 0 (0%).
· Majority of the Staff nurses belonged to the age group between25-30years that is15 (50%).
· Majority of (20) Staff nurses were GNM (66.66%).
· Majority of the staff nurses 16(53.33%) have 3-4 year work experience,where as 2 (6.66%) had more than 6 years work experience.
· Majority of the staff nurses 21(70%) got information through continuing nursing education where as 03(1%) staff nurses got information through mass media.
2. Findings related to the level of knowledge of staff nurses of NICU:
The majority of staff nurses 12 (40%) had average knowledge and the remaining 10(33.33%) and
08(26.66%) had good and poor knowledge score respectively regarding selected aspects of neonatal
Resuscitation
3. Findings related practice of staff nurses of NICU about neonatal resuscitation:
The majority of staff nurses 18 (60%) had average knowledge and the remaining 06(20%) and 06(20%) had good and poor knowledge score respectively regarding selected aspects of neonatal resuscitation
Graph 1: The pie graph represents frequency and percentage distribution of subjects according to gender
Graph 2: The bar graph diagram represents frequency and percentage distribution of subjects according to age in years
Graph 3: The Pie diagram represents frequency and percentage distribution of subjects according to educational status