APPLICAION OF PENDERS MODEL INTEGRATED WITH INFECTION CONTROL MODEL IN HAND WSHING AMONG BREAST FED MOTHERS

APPLICAION OF PENDERS MODEL INTEGRATED WITH INFECTION CONTROL MODEL IN HAND WSHING AMONG BREAST FEED MOTHERS

GAFER IBN OUFF HSPITAL GE WARDININ2Rational:It has been observed that in community and hospital setting there is no compliance of hand washing among breast feed mothers, also there is major deficit in education program.

Rational con. It is known that hand washing is a most important hygienic preventive measures of infectious diseases such as diarrhea which lead to dehydration and malnutrition. Using Penders health promotion model and infection control model to direct correct behavior among breast feed mothers in hand washing, can lead to reduce mortality and morbidity among small children .

1/ Penders Health promotion model (PHPM):

Identifies cognitive perceptual factors in the individuals that are modified by situational, personal, interpersonal characteristic to result in participation in health promoting behavior in presence of acue to action.Acue = an example of how to behave.

Key words:

Key s Words Con.2/ Infection control model:Key s Words Con.Breast feeding mothers: Breast feeding mothers is the human female who feeds her infant or young child with breast milk directly from her breast (i.e., via lactation) rather than from a baby bottle or other container.()

Key s Words Con.1/Hand washing: Simplest and MOST effective way to stopspreading infectionsBreaks the chain of spreading infectionsfrom person to person Kills or stops the growth of manyorganisms Removes bacteria from the skin

Literature Review:

Previous Studies:1/ Relationship of Breast-feeding and Hand-washing with Dehydration in Infants with Diarrhea Due to Escherichia coli Authors: Khin Nwe Oo, War War Aung, Myat Thida, Maung Maung Toe, Hnin Hnin Lwin, Ei Ei Khin Immunology,Bacteriology, and Epidemiology Research Divisions, Department of Medical Research, Medical 1, Yangon Children Hospital, Yangon, Myanmar

Literature Review: con.. The study subjects included 100 infants with diarrhea, aged less than 4 months, admitted to the hospital from June 1997 to May 1998. Data on isolation of E. coli from rectal swab samples, types of feedings, hand-washing practices, and dehydration status were collected. In this study, most mothers washed their hands with water only after cleansing their children after defecation, and before and after feeding their children. The severity of dehydration was statistically significant in hand-washing practices when compared to washing with water only and washing with soap and waterLiterature Review: con.This study has shown the association between types of feedings and hand-washing practices with dehydration in infants with acute diarrhea due to E. coli. The results of the study suggest that there is a need for appropriate intervention programes to promote exclusive breast-feeding and hand-washing practices with soap and water after cleansing children after defecation, and before and after feeding children.

Literature Review: con.2/ Behavioral Determinants of Hand Hygiene Compliance in Intensive Care Unit:By David De Wandel, RN, Msc, Lea Maes, phD, sonia Labeau, RN, MNsc, CarineVereecken, phD, and stijn Blot, phDBackgroundObjectives: To identify and describe predictors and determinants of noncompliance with hand hygiene prescriptions in Intensive care unit nurses by means of a questionnaire.

Literature Review: con.Conclusions: Neither having good theoretical knowledge of Hand hygiene guidelines nor social influence or moral perceptions had any predictive value relative to hand hygiene Practice. Nurses reporting a poor self-efficacy or a poor attitude toward time-related barriers appear to be less compliant. (American Journal of Critical Care. 2010; 19:230-240)Infection Control Model(ICM.)OR (Model Infection Control Polices) A Model Infection Control Policy is a plan for action, written to a high standard and to guide those wishing to develop standardization of policy.Model policies can be used by all disciplines providing care, in order to meet the standards hoped of infection control to be achieved.Model Policies are available on Standard Infection Control Precautions and Transmission Based Precautions

Infection Control Model(ICM.): con.Standard Infection Control Precautions are the precautions necessary to reduce the risk of transmission of micro-organisms from both recognized and unrecognized sources of infection. Hand hygiene is considered the single most important Standard Infection Control Precautions activity and can help reduce the spread of healthcare associated infections(Model Infection Control Policies (Hand Hygiene), HPS ICT September 2009 Page 17 of 20)

WhyHand Washing is IMPORTANT2 Million patients develop infections yearly 90,000 die from their infection Many infections are transmitted on thehands of breast feed mothers.Hand Hygiene is part of infection control modelIt can reduce the transmission of infections to the mothers and their babies.

How to Hand Wash step by step images as apart of ICM.

Penders Health Promotion Model

The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was designed to be a complementary counterpart to models of health protection.

EVOLUTION OF PENDER THEORY

Philosophy:

She believes that the goal of nursing is to help people care for them selves and increasing a clients level of well being. Nurses should identify the cause of the problems before she look for solution. She defines health as a positive dynamic state not merely the absence of disease.

Philosophy: con.

She describes the multidimensional nature of persons as they interact within their environment to pursue health. Each individual is uniquely expressed by his/her own pattern of cognitive- perceptual and modifying factors

THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL PERSONAL FACTORSCategorized as biological, psychological and socio-cultural.

PERCEIVED BENEFITS OF ACTION

Anticipated positive out comes that will occur from health behavior.

THE MAJOR CONCEPTS con. PERCEIVED BARRIERS TO ACTIONAnticipated, imagined or real blocks and personal costs of understanding a given behaviourPERCEIVED SELF EFFICACY

Judgment of personal capability to organize and execute a health-promoting behavior.

THE MAJOR CONCEPTS con.ACTIVITY RELATED AFFECTSubjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behavior itselfINTERPERSONAL INFLUENCES Cognition concerning behaviours, beliefs, or attitudes of the others.

THE MAJOR CONCEPTS con. SITUATIONAL INFLUENCESPersonal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. COMMITMENT TO PLAN OF ACTIONThe concept of intention and identification of a planned strategy leads to implementation of health behaviour.

THE MAJOR CONCEPTS con. IMMEDIATE COMPETING DEMANDS AND PREFERENCES Competing demands are those alternative behavior over which individuals have low control because there are environmental contingencies such as work or family care responsibilities.

CONGITIVE PERCEPTUAL MODIFING FACTORS PARTICIPATION INFACTORS HEALTH PROMOT ION FACTOR health promotion modelImportance of healthPerceived control of healthPERCIEVED SELF-EFFICACY

DEFINTION OF HEALTH

PERCIEVED HEALTH STATUS

PERCIEVE BENEFIT OF BEHAVIOR

PERCIEVED BARRIER OF HEALTH-PROMOTIG BEHAVIORS

DEMOGRAPHIC CHARACTERISTIC

BIOLOGICAL CHARACTERISTIC

INTERPERSONAL INFLUENCES

SITUATIONAL FACTORS

BEHAVIORAL FACTORS

LIKELYHOOD OF ENGAGING IN HEALTH PROMOTING BEHAVIORS

CUES TO ACTION

Fitting of theory in practice & the gapAfter permission from Gaffer Ibnuoof administrator was gained, the group presentation interviewed the mothers of children age less than 6 month admitted with diarrhea.The data collected through interviewing mothers in gastro-enteritis ward &out patientThe questionnaire designed according to Pender health promotion model as follow:QUESTIONAIR GUIDED BY PENDERS HEALTH PROMOTION MODELResultQUESTIONSMODEL GUIDELess than 6 month20-----35 yearsLow economic work status =100%

Literate = 20%Low educational level =80%Low socioeconomic status-sub urban =100% CHILD AGE MOTHER AGEFATHER WORK

LEVEL OF EDUCATION,

RESIDENCE,PERSONAL FACTORSPersonal biological factors Personal socio-cultural factorsDecontamination =60%Prevention of disease=10%Cleanliness =30%WHAT DO YOU THINK THE BENEFIT OF HAND WASHING BEFORE BREAST FEED YOUR CHILD?PERCEIVED BENEFITS OF ACTION Financial =10%Busy =60%No barrier =30% WHAT IS THE DIFFICULTIES WILL FACE YOU WHEN WASHING YOUR HANDS BEFORE BREAST FEED YOUR CHILD?PERCEIVED BARRIERS TO ACTION Can manage =20%Can not manage=80%CAN YOU MANAGE THIS DIFICULTIES?PERCEIVED SELF EFFICACYNot always =60%Before every feed=40% HOW OFTEN WASH YOUR HANDS BEFORE BREAST FEED YOUR CHILD?ACTIVITY RELATED AFFECTExtended family=20%Single family =80%ARE YOU LIVE WITH EXTENDED FAMILY?INTERPERSONAL INFLUENCES Water only=20%Disinfectant soap and water=20%Normal soap and water=40%HOW YOU WASH YOUR HANDS BEFORE BREAST FEED YOUR CHILD?SITUATIONAL INFLUENCEScorrect technique =10%Incorrect technique =90%Awareness was provided to all mothers how wash their hands using infection control model guides

DESCRIBE THE WAY OF HAND WASHING BEFORE BREAST FEED YOUR CHILD.COMMITMENT TO PLAN OF ACTIONAll mothers reached how wash their hands using infection costal model guides32Result Discussion The questionnaire represented the inter relationship between cognitive-perceptual factors, modifying factors, & infection control factors that influencing the occurrence of health promoting behavior.The result shows that most of the mothers have low cognitive perceptual factor , that don't know how to implement proper & correct hand washing practice.Comment:This model lack an education programe which influence &enhance the cognitive perceptual factors which consider an important part in health promotion & ensure effective participation in health promotion factor.34Strength: simple , clear, & popular.Used as a tool for research.Highly applicable in adult , older adult, & young adult.

Limitation: Not applicable with children.Missing of standard guide lines applying in educational programs.

The group presenters suggested that if any one interested to implement this model, the strategies will be:SURVILLANCEOBJECTIVESAWARENESSHEALTH EDUCATION PROGRAME ACCORDING TO RESEARCHER VIEWMONITERINGEVALUATION