“ A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON INITIATION OF BREAST FEEDING BY

BREAST CRAWL METHOD AMONG STUDENT NURSES OF SELECTED

NURSING INSTITUTES IN GOGAK TALUK WITH A VIEW TO

PREPARE INFORMATION BOOKLET”.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Ms. SUNITA ANNA PATIL

SHRI. J.G.CO-OPERATIVE HOSPITAL SOCIETY’S COLLEGE OF

NURSING, GHATAPRABHA.KARNATAKA

2011

1

1 NAME OF THE CANDIDATE AND ADDRESS

Ms. SUNITA ANNA PATIL.

M. Sc. [NURSING] Ist YEAR.

PAEDIATRIC NURSING

SHRI. J.G.CO-OPERATIVE HOSPITAL

SOCIETY’S COLLEGE OF NURSING,

GHATAPRABHA.KARNATAKA.

2 NAME OF THE INSTITUTION SHRI. J.G.CO-OPERATIVE HOSPITAL SOCIETY’S COLLEGE OF NURSING, GHATAPRABHA.KARNATAKA

3 COURSE OF STUDY AND SUBJECT

M. Sc. [NURSING] Ist YEAR.

PAEDIATRIC NURSING.

4 DATE OF ADMISSION TO THE COURSE

1/11/2010

5 TITLE OF THE TOPIC: “ A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON INITIATION OF BREAST FEEDING BY

BREAST CRAWL METHOD AMONG STUDENT NURSES OF SELECTED

NURSING INSTITUTE OF GOGAK TALUK WITH A VIEW TO PREPARE

INFORMATION BOOKLET”.

2

6BRIEF RESUME OF THE INTENDED STUDY

INTRODUCTION:-

Mother’s milk is a divine gift for a baby. Breast milk is only the food for the baby

which is natural, physiological way of feeding. Breast feeding could save the lives of

1.3million children a year. Breast milk provides the exact combination of nutrients that a

developing infant needs. Improved breast feeding alone could save the lives of more than

3500children every day, more than any other preventive intervention. (Declaration, 2005by

IYFC). Increasing optimal breast feeding could save an estimated 1.5 million infant lives

annually. Up to 55%of infant deaths from diarrheal disease and acute respiratory tract

infection may result from inappropriate feeding practices. Optimal feeding for sustained

child health and growth includes initiation of breast feeding within first hour of life,

exclusive breast feeding for 6 month, timely complementary feeding with appropriate foods,

and continued breast feeding for 2 years and beyond.1

Breast feeding has several advantages to mother, baby and society. It saves the life of

baby, provides initial immunization, prevents diarrhea, provide complete and perfect

nutrition, maximizes a child’s physical and intellectual potential support, food security,

bonds mother and child, helps birth spacing, and saves money. It has most useful, naturally

available, clean and safe food. As it has various advantages it should initiate early after the

birth of baby.1

“Breast feeding the 1st hour-saves one million babies”.

World Breast Feeding Week 2007

The first hour after birth has a major influence on the survival, future health, and

wellbeing of a newly born infant. The basic needs of a baby at birth are warmth, normal

breathing, mother’s milk and protection from infection. Early initiation of breast feeding

serves as the starting point for a continuum of care for mother and newborn that can have

long lasting effects on health and development.6

3

UNICEF, WHO and WABA, along with the scientific community strongly

recommend initiating breast feeding within half hour of birth. Evidence showed that early

initiation can prevent 22% of deaths among babies between one million countries. Globally

over 1 million new born infants could be saved each year by initiating the breast feed in the

first hour of life. In developing countries alone, early initiation of breastfeeding could save

as many as 1.45million lives each year by reducing deaths mainly due to diarrheal disorders

and lower respiratory tract infection in children.2

Every newborn, when placed on the mother’s abdomen soon after birth, has the ability

to find mother’s breast all on her/his own and to decide when to take the first breast feed.

This is called the “Breast Crawl”. It was first described in 1987 at Karolinska institute in

Sweden.3

The description of breast crawl, complied from the article as follows, ‘Immediately

after birth the child was dried and laid on mother’s chest. In the control group a regular

behavioral sequence, previously not described in the literature was observed. After 15

minutes of comparative inactivity, spontaneous sucking and rooting movements occurred

reaching maximum intensity at 45 minutes. The first hand to mouth movement was

observed at 34 minutes after birth and at 55 minutes the infant spontaneously found the

nipple and started to suckle. These findings suggest that an organized feeding behavior

develops in a predictable way during the first hours of life, initially expressed only as

spontaneous sucking and rooting movements, soon followed by hand to mouth activity

together with more intense sucking and rooting activity, and culminating in sucking to the

breast.3

Many studies with different aims were published subsequently in relation to the ‘breast

crawl’ study the effect of other hindering factors biological mechanisms for homing in on

the nipple Advantages of the breast crawl. Klaus reviewed many of these studies and gave a

beautiful description of the breast crawl. This inspired them to include the breast crawl in

our ‘Lactation Management’ curriculum and to prepare this documentary. The credit for

using the word ‘breast crawl’ as a noun for the first time should be given to Klaus (1998).

All previous studies have used it as a verb’. The starting position for the’ Breast crawl’ has

been specified by veranda t al. (1994.1996) i.e. nose in the midline of the mother’s chest,

4

eyes at the level of the nipples.3

Babies completing the ‘Breast crawl’ with spontaneous attachment is instinctive and

almost a rule with very few requiring assistance. The Breast crawl is associated with a

variety of sensory,central,motoral and neuro-endocrine components, all directly or

indirectly helping the baby to move and facilitate her survival in the new world. The

promotion of early imitation of breast feeding has great potential: 16% of neonatal deaths

could be saved if all infants were breastfeed from day 1 and 22% if breastfeeding were

started within the first hour after birth .All these advantages will obviously be maximally

tapped with Breast crawl. In 2006, authorities of the WHO/ UNICEF and baby-friendly

hospital initiative added an optional component to the baby-friendly assessment tools,

which examines mother-friendly care. Each country will determine whether it will integrate

this module as it updates assessment criteria and tool to the new standards. Implementing

‘Ten steeps of mother friendly care’ will facilitate successful initiation (Breast crawl).

Hence, every maternity service should consider implementing these steps.3

Education is as old as the human race. It is a great conservative and transmitting force.

It helps in maintaining and enriching cultural heritage. Education is the art of developing

and cultivating the various powers of mind, physical, mental and moral. However, it should

be remember that nothing can be drawn, unless something is put in beforehand. To achieve

this goal the teacher/instructor should use the different methods of teaching. 4

Every teacher must devise his own method. Good teaching method can result only

from orderly arranging of procedure in teaching arrangement of subject matter and must

link up the teacher and pupils into an organic relationship with constant mutual interaction.

Planned teaching programme would create an interest of pupils to acquire new knowledge.

Breast crawl being a new knowledge the student nurse must possess this which would be

beneficial to the field of nursing. Application of this new knowledge will help to achieve

the millennium development goal. With this view in mind this study was undertaken.

5

6.1 NEED FOR THE STUDY:

“A people without the knowledge of their past history, origin and culture is like a tree

without roots.”

Marcus Gravy

It is said that,” destiny of the nation is built in the four walls of classroom”. Today’s

student is tomorrow’s future. As changes occur every day in nursing field, the task of the

nurse is changing, and this will in turn affect the learning needs of student’s of nursing.

Learning may be defined as, “the mental activity by means of which knowledge, skills,

attitudes, appreciation, and ideals are acquired, resulting in the modification of behavior.

This modification comes through knowledge and experience; it involves no addiction or

subtractions of knowledge, and experience as such, but rather implies something new which

has not existed for the individual before”.4

As a nursing student’s they are acquainted with the daily routines of labour room, such as

separation of the infant and mother for measuring and wrapping procedure, suctioning of

the baby, giving inj. Vit.K, bathing the baby, this routine delays the initiation of breast

feeding. If the students have gain the knowledge of advantages of early initiation of breast

feeding and method of initiation by breast crawl they will implement it as routine which has

the major influence on the survival, future health and wellbeing of a newborn infant. From

which the care of infant will start towards the healthy and intellectual development.5

UNICEF, WHO, WABA, BPNI strongly recommended initiate breast feeding with in

half hour of birth. Early initiation can prevent 22% of all deaths below 1month in

developing countries. This is due to the several advantages it affects to the mother and baby.

Such as, Prevent hypothermia, due to skin-to-skin contact with mother, baby achieves

effective feeding skill faster so chances of long term breast feeding success increases, baby

gets early protection from infections from colostrum as the first feed, early feeding prevents

hypoglycemia and helps in better maintenance of other biochemical parameters, it may have

a role in boosting development of the baby’s nervous system, it leads to better mother-infant

bonding. Maternal advantage of early initiation are better uterine contractions due to

6

oxytocin surge, leading to faster expulsion of the placenta, reduction in maternal blood loss

and thus prevention of anemia.

All the above advantages of early initiation are best achieved by Breast Crawl then by

initiating feeding by other methods. Breast crawl offers proper acclimatization from the

intrauterine to extra uterine environment it is an innate and instinctive process with other

mammalians; so why not in human beings?5

The breast crawl was described 20 years ago. The discovery, in spite of its

tremendous potential, has failed to reach the beneficiaries (i.e. mothers and infants) at large.

The scientific community the medical fraternity, health managers, breastfeeding advocates

and international health organizations have missed out on a powerful ‘change’ agent for

early initiation and hence short and long term breastfeeding success .even in those places

where health professionals are well informed and keen to initiate breast feeding within an

hour of birth, awareness of breast crawl is lacking.2

The body of scientific evidence is strong enough to recommend ‘Breast crawl’ as the

method for initiating breastfeeding. However, there has been no such widespread

recommendation. In fact, no particular method for initiation of breast feeding has been

recommended by the BFHI documents. The purpose of this study is to strongly recommend

evidence based workable method in form of the breast crawl for initiation of breast feeding.

The lessons from the breast crawl, like skin to skin contact and the newborn’s spectrum of

abilities would com handly in this period. Some of the mothers whom we have seen

initiation breastfeeding by the breast crawl, continued to use the ‘crawling in position

advantageously, so as to establish successful breastfeeding. Through ‘Kangaroo Mother

Care’ was invented to care for low birth weight babies, Klaus visualized a unification of this

concept with the breast crawl, in this extended initiation period , for normal full term

newborns.2

In the current scenario, the prevalent rate of under-nutrition in young children is high

46% in India, according to third national family health survey. This coupled with high

morbidity and mortality lead to full need in India for the identification of an evidence based

workable method which is easily replicable and cost effective.2 For a bright talented

generation we have to start the provision of health services from womb to tomb. Here lies

7

the importance of breast crawl.

Every newborn, when placed on her mother’s abdomen soon after birth, has the ability

to find her mother’s breast all on her own and to decide when to take the first breast feed.

This is called the “Breast Crawl.” 2 Klaus reviewed many of the studies and gave a

beautiful description of breast crawl. Thus breast crawl is included in the lactation

management curriculum. In India government of Maharashtra, Nutrition mission, I C D S,

B P N I jointly with UNICEF have initiated an ambitious programme to train GOVT/NGO

functionaries in the basis of I Y C F. Dr. Karthikeya Bhagat of Grace Maternity home

Mumbai-have first experimented breast crawl and continued as a method on

recommendation from care of high risk neonate. 3

During our clinical experience most of them believe that newborn need help to begin

breast feeding. But the study by Klaus and others revealed this was not true. As the student

nurses, who are the future professionals lack knowledge on breast crawl and its importance

in initiation of breast feeding, it is necessary to teach them regarding this as a part of new

knowledge.

During the clinical posting the investigator noticed the lack of knowledge regarding

the initiation of breast feeding by breast crawl method and previously conducted

educational programmes were effective in enhancing the knowledge of staff nurses

regarding the initiation of breast feeding by breast crawl method thus the investigator felt

the need to conduct this study to assess the knowledge of student nurses and evaluate the

effectiveness of planned teaching programme on initiation of breast feeding by breast crawl.

8

6.2 REVIEW OF LITERATURE:

Review of literature is a systematic identification, location, selection and

summary of written material that contains information on research problems. Literature

review is based on the extensive survey of books, journals, and international nursing

indices. It provides basis for future investigations, justifies the needs for study, and relates

the findings from one study to other with a hope to establish a comprehensive study of

scientific knowledge in a professional discipline from which valid and pertinent theories

may be developed.

Two recentenly published studies conducted in Ghana and southern Nepal on the

impact of early initiation of breast feeding on neonatal mortality evaluated the relationship

between the timing of initiation of breast feeding and neonatal death between day 2and 28

by community based observation study. The study sample was 10,947 breast feeding infants

and 22,838breast feeding infants in southern Nepal. The authors of the Ghana study

estimated that 16% of neonatal deaths could have been prevented if all newborn had been

breast feed starting from day 1 and 22% if breast feed within the first hour of life. Initiation

of breast feed after the first 24 hour was associated with a 2.4 fold increased risk of

mortality in Ghana and 1.4 fold increase risk in Nepal when compared to initiation before

24 hours.6

The author of the Nepal study estimated that initiation of breast feeding within 1 st

hour of birth could have prevented 19% of neonatal deaths. These studies conclude that,

initiation of breast feeding within the first hour can help to prevent neonatal deaths caused

by infections such as sepsis, pneumonia and diarrhoea and also prevent additional

hypothermia related deaths, especially in preterm and low birth weight infants in developing

countries. These studies further recommended that, research is needed on how to encourage

women to participate early and exclusive breast feeding, how to reach women in different

settings. Identifying the optimal type, content, and duration of communication programme

to increase the early initiation and care for mother and baby.6

A prospective coherent study was conducted to investigate influence of skin

to skin contact after birth on breast feeding by breast crawl method in Poland. It was

analyzed in a group of 1250 three year old polish children. The practice significantly

9

increased the mean exclusive breast feeding duration by 0.4 month and overall breast

feeding by 1.4 month. The effect of skin to skin contact after birth was also observed. The

infant kept with the mother at least 30 minutes were 1-2 month longer exclusively breast

feed and 1.7 month later weaned than those who had shorter contact. Multivariate linear

regression analysis showed that mother infant contact after birth was significant.7

To examine the rate and duration of breastfeeding among recent Ethiopian 93

Ethiopian born mothers of children aged 2 months to 5 years living in northern Israel was

studied by using a structured questionnaire interview. Results revealed that 92% of the

children born in Ethiopia were exclusively breastfed as compared to 76.3% of the Israeli

born children, in whom the rate of mixed feeding was 18.3%. Although the duration of

breastfeeding of the youngest child was significantly shorter than that of the firstborn (20.1

vs. 24.8 months), it remains much longer than the average duration for native Israeli

mothers. No association was seen between breastfeeding rates or duration and the years

since immigration, work outside the home or exposure to formula. The women's attitude

towards breastfeeding was positive despite the lack of specific knowledge concerning breast

milk and importance of breast crawl method. Study concluded that Breastfeeding patterns

among Ethiopian women have changed since their immigration to Israel.8

A clinic-based and community-related intervention trial was carried out to assess the

knowledge regarding the ‘Ten steps to successful breast feeding’, among the maternity

professionals of ten hospitals in Lower Bavaria as a model region with below average

breast-feeding rates. A singular assessment of the advanced training programme was

undertaken concerning an increase of knowledge and the practicability in clinical everyday

life by participants; improvements of the maternity wards were assessed via structural

interviews with maternity ward staff before and after intervention. Results revealed that

approximately 85% (n=378) of the staff of the 10 maternity clinics attended the training

course. The survey after the training programme (response rate 83%) indicated that more

than 80% of the participants stated to have learned something new and to be able to use the

knowledge acquired for their own practice. Results of the clinic interviews showed a

transfer of training contents into clinical work routines. Improvements at interview date

were shown best for bonding (all 10 maternity clinics), for additional feeding (8 maternity

clinics) as well as for 24-h rooming-in and mother counselling (7 maternal clinics each).

Study concluded that training of maternity ward professionals accounts for baby-friendly

conditions in maternity clinics. Most willingness for improvements was shown by maternity

10

ward staff particularly for bonding between the hospitals were observed for the promotion

of infant formulas before and after the intervention.9

In Bangladesh a study was conducted to assess the Breastfeeding in infancy:

identifying the program-relevant issues. Quantitative data were collected through visits to

households (n = 356) in rural Chittagong and urban slums in Dhaka, and qualitative data

from sub-samples by applying semi-structured in-depth interviews (n = 42), focus group

discussions (n = 28), and opportunistic observations (n = 21). Trials of Improved Practices

(TIPs) (n = 26). Results revealed that the biggest gaps were found to be in putting baby to

the breast within the first hour of birth (76% gap), feeding colostrums and not giving other

fluids, foods or substances within the first three days (54% gap), and exclusive

breastfeeding from birth through 180 days (90% gap). Lack of knowledge about dangers of

delaying initiation beyond the first hour and giving other fluids, foods or substances, and

the common perception of "insufficient milk" were main reasons given by mothers for these

practices. Health workers had talked to only 8% of mothers about infant feeding during

antenatal and immunization visits, and to 34% of mothers during sick child visits. The

major providers of infant feeding information were grandmothers (28%). Study concluded

that the findings showed that huge gaps continue to exist in breastfeeding behaviours,

mostly due to lack of awareness as to why the recommended breastfeeding practices are

beneficial, the risks of not practicing them, as well as how to practice them. Health workers'

interactions for promoting and supporting optimal breastfeeding are extremely low.

Counselling techniques should be used to reinforce specific, priority messages by health

facility staff and community-based workers at all contact points with mothers of young

infants.10

A study was conducted to assess the breastfeeding (BF) duration predicts later

psychosocial development (PD) in a large low socioeconomic status (SES) sample in the

Philippines. The sample consists of 2,752 children aged 1-3 years who were measured in

2004 as part of the Philippine government's Early Childhood Development Project.

Duration of any BF was the primary independent variable in regression models predicting a

cumulative index of PD that has been shown previously to predict school readiness. Results

revealed that in this sample, mothers who breastfed their children for longer tended to have

lower educational attainment and to come from lower income households. Despite this, BF

duration was a positive predictor of future PD measured in late childhood, but only after

adjustment for SES and related confounders. Study concluded that breast feeding could

provide lasting economic and social benefits and underscore the importance of continuing

11

current public health efforts to promote BF in the Philippines and across the globe.11

A study was conducted to assess the effectiveness of hospital-based interventions to

improve the rates of exclusive breast feeding at four to six months in infants in low- and

low-middle-income countries UK. Databases to identify randomized controlled trials of

hospital-based interventions to improve the rate of exclusive breast feeding in low- and low-

middle-income countries. Findings revealed that four studies, from four different countries,

were included in the final review. Although they evaluated slightly different interventions,

all showed a significant improvement in the rate of exclusive breast feeding with a pooled

odds ratio of 5.90 (95% confidence interval 1.81-18.6) on random effects meta-analysis.

Study concluded that hospital-based interventions in low- and low-middle-income countries

can substantially increase the rates of exclusive breast feeding and are therefore a viable

option.12

Maternity Experience Survey targeting women aged >or= 15 years who had singleton

live births between February 2006 - May 2006 in the Canadian provinces and November

2005 - February 2006 in the territories. A study was conducted to examine the prevalence

and predictors of 6-month exclusive breastfeeding among Canadian women. Sample size in

this study was 5,615 weighted to represent 66,810 Canadian women. While ever

breastfeeding was 90.3%, the 6-month exclusive breastfeeding rate was 13.8%. Based on

the regression model, having higher years of education, residing in the Northern territories

and Western provinces, living with a partner, having had previous pregnancies, having

lower pre-pregnancy body mass index and giving birth at older age were associated with

increased likelihood of 6-month exclusive breastfeeding. Moreover, smoking during

pregnancy, Caesarean birth, infant’s admission to the intensive care unit and maternal

employment status before 6 months of infant’s age was negatively associated with exclusive

breastfeeding. Mothers choosing to deliver at home were more likely to remain exclusively

breastfeeding for 6 months (Odds Ratio: 5.29, 95% Confidence Interval: 2.95-9.46). Study

concluded that the 6-month exclusive breastfeeding rate is low in Canada.13

The 4th step for successful breast feeding given by BFHI is,

“Help mothers initiate breastfeeding within a half-hour of birth.”

Mothers in the maternity ward who have had normal vaginal deliveries should confirm that

within a half-hour of birth they were given their babies to hold with skin contact, for at least

30 minutes, and offered help by a staff member to initiate breastfeeding...At least 50% of

mothers who have had caesarean deliveries should confirm that within a half hour of being

able to respond, they were given their babies to hold with skin contact. (The Global Criteria

12

for the WHO/UNICEF Baby Friendly Hospital Initiative, 1992).

The literature search conducted to identify published studies relating to each of the

steps and the ten steps and the effect on breast feeding on their implementation inside health

facilities. Observations of 10 newborns(1987) and by of 38 newborns(1990) have shown

that non-sedated infants follow a predictable pattern of prefeeding behavior when held on

the mother’s chest immediately after birth, but timing varies widely. Movements started

after 12 to 44 minutes, and were followed by spontaneous suckling with good attachment at

27 to 71 minutes. Widström observed that sucking movements reached a peak at 45 minutes

which thereafter declined and were absent by two to two and a half hours after birth. After

caesarean section, initiation of breastfeeding may be delayed. The condition of the mother

or infant sometimes makes delay unavoidable, but it should not be necessary as a routine.

After caesarean section with local anesthesia, breastfeeding can often be initiated

immediately. With general anaesthesia, breastfeeding can be initiated within a few hours, as

soon as the mother regains consciousness (Gonzales, 1990).

Several randomized and quasi-experimental studies have examined the influence of

early postnatal contact on the initiation or continuation of breastfeeding and in some cases

on other aspects of mother-infant interaction. Righard & Alade (1990) studied the effect of

early contact on early suckling. They compared two groups of infants assigned (the decision

being made by the midwife and mother) to a ‘contact’ or ‘separation’ group immediately

after birth. The contact group (38 infants) had immediate contact from birth for at least one

hour. Twenty-four of them were suckling correctly after a mean of 49 minutes. The

separation group (34 infants) started contact immediately after birth, were separated at 20

minutes and returned 20 minutes later. Only 7 of them suckled effectively, the difference

being significant (P<0.001).

40 primiparae in Sweden were studied by observation method to study the effect of

“extra contact’. Mothers were randomly assigned to a control group and an intervention

group which had “extra contact” (15-20 min suckling and skin-to-skin contact during the

first hour after delivery). At 3 months, 58% of mothers in the extra contact group were still

breastfeeding compared with 26% in the control group (P<0.05). Extra contact mothers

spent more time kissing and looking en face at their infants, while their infants smiled more

and cried less.

A meta-analysis of these studies concluded that early contact had a positive effect on

the duration of breast-feeding at 2 to 3 months (P<0.05). However, it is cautions that “the

effect of size across studies was heterogeneous” and some studies included other

13

interventions (breastfeeding guidance, presence of the father during early contact), which

might contribute independently to improve breastfeeding.

These reviews study also conclude that, there is good evidence in principle for step 4

which relates to early contact, through the optimal timing of a newborn’s first breast feeding

is probably not as restricted as the original wording at the step suggests. The most important

part of the procedure is for the baby to have skin-to skin contact with the mother from

immediately after delivery until he or she spontaneously shows readiness to feed. This

usually occurs within an hour of birth though it may be any time in the first 2 hours, or later

if the mother received pethidine.14

6.3 STATEMENT OF THE PROBLEM:

14

“ A Study To Assess The Effectiveness Of Planned Teaching Programme On

Initiation Of Breast Feeding By Breast Crawl Method Among Student Nurses Of

Selected Nursing Institutes Of Gogak Taluk With A View To Prepare Information

Booklet”.

6.4 OBJECTIVES OF THE STUDY

1) To assess the knowledge of student nurses regarding initiation of breast feeding by

breast crawl method.

2) To administer and to evaluate the effectiveness of planned teaching programme on

knowledge of student nurses regarding initiation of breast feeding by breast crawl method.

3) To find out the corelation between the pre-test and post- test knowledge scores of student

nurses.

6.5 OPERATIONAL DEFINITIONS:

1) ASSESS;- In this study, assess refers to statistical measurement of Knowledge of

student nurses regarding initiation of breast feeding by breast crawl method by structured

questionnaire .

2) EFFECTIVENESS; -In this study, effectiveness refers to significant gain in between

pre –test and post- test knowledge scores after the administration of planned teaching

programme.

3) PLANNED TEACHING PROGRAMME; - In this study, planned teaching

programme refers to the systematic plan of teaching and learning process between the

subjects and investigator using various teaching methods on initiation of breast feeding by

breast crawl method.

4)KNOWLEDGE; - In this study knowledge refers to correct response of student nurses to

15

the knowledge items in the structured questionnaire regarding initiation of breast feeding by

breast crawl.

5) BREAST FEEDING; - In this study breast feeding refers to feeding a normally born

infant with breast milk directly on mother’s breast.

6)BREAST CRAWL: - In this study breast crawl refers to an ability of a new born baby to

find the mother’s breast all on its own when placed on the mother’s abdomen soon after

birth and to decide when to take the first breastfeed.

7) STUDENT NURSES; - In this study student nurses refers to the students who are

studying in the selected nursing institutes of Gogak taluk.

6.6 ASSUMPTIONS:

The study assume that;

1) The student nurses have no knowledge regarding initiation of breast feeding by breast

crawl method.

2) The planned teaching programme will enhance the student nurses knowledge regarding

initiation of breast feeding by breast crawl method.

6.7 HYPOTHESIS:

H0: There will be no significant difference between the pre-test and post-test knowledge of

student nurses on initiation of breast feeding by breast crawl method.

H1:There will be significant difference between the pre-test and post-test knowledge of

student nurses on initiation of breast feeding by breast crawl.

6.8 DELIMITATIONS:

16

The study is limited to student nurses studying in selected nursing institutes in Gokak

Taluk.

7) MATERIAL AND METHODS OF THE STUDY:

7.1 Sources of data:

The data will be collected from the student nurses studying in selected nursing institutes in

Gokak Taluk

7.1.1 Research design:

Quasi-experimental approach with one group pre-test and post-test design.

7.1.2. Research setting:

The study will be conducted at selected nursing institutes in Gokak Taluk

7.1.3 Population:

The population will be student nurses studying in selected nursing institutes in Gogak taluk.

7.2 METHODS OF DATA COLLECTION:

7.2.1 Sampling technique:

Purposive sampling technique will be used to select the Student nurses for Study.

7.2.2 Sample size:

In this study, the sample size will be 100 student nurses who are studding in selected

nursing institutes in Gogak taluk.

17

7.2.3 Duration of Study

4-6 weeks

7.2.4 Inclusion criteria for sampling :-

The study includes the student nurses who are,

1) Willing to participate in the study.

2) Who are studding in III and IV year B.S.C nursing, III year diploma student.

3) Available at the time of study.

7.2.5 Exclusion Criteria:

The study excludes the student nurses who are,

1) Not willing to participate in the study.

2) Absent at the time of planned teaching programme.

7.2.6 Variables:

Variables included in the present study are

Dependent variable: - Knowledge regarding initiation of breast feeding by breast

crawl method.

Independent variable: - Planned Teaching Programme regarding initiation of

breast feeding by breast crawl method.

18

7.2.7 Data collection instruments:

A structured closed ended questionnaire on knowledge regarding initiation of breast feeding

by breast crawl method will be used to collect data. It comprises two parts

Part 1: Consists of items related to demographic characteristics of student nurses.

Part 2: Consists of items seeking knowledge regarding initiation of breast feeding

by breast crawl method.

7.2.8 Data collection method:

Prior permission will be obtained from the concerned authorities. After explaining the

purposes of the study to the participants, a pre-test will be conducted by using structured

closed ended questionnaire to assess the existing knowledge regarding initiation of breast

feeding by breast crawl method among student nurses. Then planned teaching programme

will be administered, and post test will be conducted with the same questionnaire.

7.2.9 Plan for data analysis:

Descriptive and inferential statistics will be used to analyze the data.

1)Descriptive Statistics;- Data obtained from the sample will be organized and

summarized with the help of descriptive statistics like mean, frequency and percentage

distribution and standard deviation.

2)Inferential statistics;- The significance of difference between the pre-test and post test

knowledge scores of student nurses will be found by using paired ‘t’ test and association

between the knowledge of student nurses regarding initiation of breast feeding by breast

crawl method with selected demographic variables will be done with the help of chi-square

test.

7.3, Does the study require any investigation or intervention to be conducted on

19

patients or other human or animals?

Yes.

7.4 Whether the ethical clearance has been obtained from your institution in case of

7.3? --------- Yes.

Formal permission from;

1) Ethical clearance committee of Shri. J.G.Co-Operative Hospital Society’s College Of

Nursing, Ghataprabha, Karnataka.

2) Principal, Shri. J.G.Co-Operative Hospital Society’s College Of Nursing, Ghataprabha

Karnataka.

3) Principals, of Selected nursing institutes in Gogak taluk

4) Consent will be obtained from the participants.

Bibliography

20

1) Dr R.K.Anand. Guide to child care feeding the newborn and infants. Breast feeding

some basic facts. (www.Unicef.com)(cited 2oo5) Available from htpp://www.World

breastfeeding Week.org.

2) Prashant Gangal. Breast Crawl. Initiation of breast feeding by Breast Crawl.

1sted.UNICEF Maharashtra: Mumbai: 2007.Available from www.breast crawl.org.

3) Marshall Klaus. Mother and infant: Early Emotional Ties. Pediatrics 1998; 102;

1244.2007 Mar1.Available

from:http://www.pediatrics.org/cgi/content/full/1021515E1/1244

4) ) BT Basavanthappa. Nursing education. New Delhi: Jaypee brothers publishers;

2004 . p.279.

5) P Chaturvedi. Breast Crawl. JMGIMS. Savagram: 2008:13(2):9-14.

6) Impact of early initiation of exclusive breast feeding on newborn death. A&T

technical Brief Issue 2010 Jan 1. Available from http://www.Allive and Thrive.org

7) Kostra Michael, I Boltruszko, J Mazur. Skin to skin contact after birth as a factor

determining breast feeding duration.2006. Available from URL.http:/www.ncbi.nml.

8) Rubin L, Nir-lnbar S, Rishpon S. Breastfeeding patterns among Ethiopian

immigrant mothers. Israel: 2005-2006.

9) Meyer N, Spiegel H, Hendrowarsito L, Eschweiler U, Fromm H. Breast-Feeding

Training Programme as Intervention Approach at the Hospital Level. 2010 Dec 15.

10) Hider R, Rushed S, Sanghvi TG, Hassan N. Breastfeeding in infancy: identifying

the program-relevant issues in Bangladesh. 2010 Nov 30; 21(5):

11) Duazo P, Avila J, Kuzawa CW. Breastfeeding and later psychosocial development

in the Philippines. 2010 Nov: 22(6):725-30.

12) Hall J. Effective community-based interventions to improve exclusive breast

feeding at four to six months in low- and low-middle-income countries. 2010 May

21

13.

13) Al-Sahib B, Lanes A, Feldman M, Tamim H. Prevalence and predictors of 6-month

exclusive breastfeeding among Canadian women.2010 Apr 8: 10-20.

14) Dr Constanza Vallenas, Felicity Savallenas. Evidence for the ten steps to successful

breast feeding. WHO/CHD/98.9. Available from: www.breast crawl.org/pdf.

22

9. SIGNATURE OF CANDIDATE

10. REMARKS OF THE GUIDE This study is feasible and I forward it for

acceptance.

11 NAME AND DESIGNATION OF

11.1 GUIDE

PROF.S.M.SATRALKAR.

PROFESSOR & HOD,

DEPT.OF PAEDIATRIC NURSING,

SHRI. J.G.CO-OPERATIVE HOSPITAL

SOCIETYS COLLEGE OF NURSING,

GHATAPRABHA.KARNATAKA.

11.2 SIGNATURE

11.3 CO- GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE

DEPARTMENT

PROF.S.M.SATRALKAR.

PROFESSOR & HOD,

DEPT.OF PAEDIATRIC NURSING,

SHRI. J.G.CO-OPERATIVE HOSPITAL

SOCIETYS COLLEGE OF NURSING,

GHATAPRABHA.KARNATAKA.

11.6 SIGNATURE

12 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL: The topic is discussed

with the members of the research committee and is finalized. He is permitted to conduct

the study.

12.2 SIGNATURE:

23