1

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR

DISSERTATION

MR.RAMACHANDRA.V.KALE.

I YEAR M.Sc. NURSING

PAEDIATRIC NURSING

2012 – 2013

TULZA BHAVANI COLLEGE OF NURSING

NO.899/3, NEAR HAZRAT JUNEEDI DARGA,

GYANG BOWDI, BIJAPUR-586101

2

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE

KARNATAKA

1. NAME OF THE CANDIDATE AND ADDRESS

Mr.RAMACHANDRA. V. KALEI YEAR MSc NURSINGTULZA BHAVANI COLLEGE OFNURSING, BIJAPUR-586101

2. NAME OF THE INSTITUTE TULZA BHAVANI COLLEGE OF NURSING,No.899/3 NEAR HAZRAT JUNEEDI DARGA, GYANG BOWDI, BIJAPUR-586101

3. COURSE OF THE STUDY AND SUBJECT

I YEAR MSc NURSINGPAEDIATRIC NURSING

4. DATE OF ADMISSION TO THE COURSE

25/06/2012

5. TITLE OF THE STUDY “A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF NEONATAL EMERGENCY MANAGEMENT AMONG III YEAR GNM AND IV YEAR BSc NURSING STUDENTS IN SELECTED SCHOOLS AND COLLEGES AT BIJAPUR, WITH A VIEW TO DEVELOP INFORMATION BOOKLET”.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

3

6. BRIEF RESUME OF INTENDED WORK:

6.1 INTRODUCTION:

“Todays childrens tommorrows citizens”

The four basic needs of all babies at the time of birth, Warmth, Normal

Breathing, Mothers milk and Protection from these basic need indicate that a baby’s

survival is totally dependent upon its mother and other care givers. Therefore

it is important to provide proper care to all the neonates immediately after

birth.1

A baby's focus of vision is best at about 8 to 12 inches - just the

distance from the baby cradled in a mother's arms to her face.“The right to life

is a fundamental human right, implying not only the right to protection for life and

survival. Human rights are universal and must be applied without discrimination on

any grounds whats ever against arbitrary execution by the state.2

All newborns require essential newborn care to minimize the risk of illness

and maximize their growth and development. This care will also prevent many

newborn emergencies. For example, the umbilical cord may be the most common

source of neonatal sepsis and also of tetanus infection and good cord care can

dramatically reduce the risks of these serious conditions. Exclusive breast feeding

has a significant protective effect against infections. Early breast feeding and keeping

the baby close to the mother reduce the risk of hypothermia and hypoglycemia.3

An understanding of child care since it begin is essential for the nurse to gain

an appreciation of the trends leading to our present concepts and practices specific to

children. Some of todays philosophic beliefs can be attributed to evolving civilization.

Littel is known about life in prehistoric times, but child care is believed to have been

similer to that among cultural groups living today in areas hardly touched by

civilization .In such groups children usually are not valued for themselves but as

future adults. Health of children has been considered as the vital importance to all

societies because children are the resource of the future of humankind. Nursing care

of children is concerned for both the health of children and for the illness that affect

4

their growth and development. The increasing complexity of medical and nursing

science has created a need for special area of child care, i.e. pediatric nursing.4

The physical and mental well-being of an individual depends on the correct

management of events in the parinatal period. The morbidity and mortality rates in

new born infants are high. In India almost 7 out of 100 babies do not see their first

birthday and nearly 65%of these infant deaths occurs in the neonatal period. Death is

the time when something ends and birth is the time when something begins. The

neonatal emergencies are the leading cause of death in most of the developed and

developing countries. The young are often among the most vulnerable for

disadvantaged in society and thus their needs require special attention.5

The major causes for infant deaths are preterm birth, asphyxia, low birth

weight and sepsis. “We insist on transporting the sick baby in a special vehicle to

avoid infection, ICH receives at least 10 to 15 such babies every day. Specialised

intensive neonatal care units in government hospitals in Madurai and Tiruchi also

receive an equal number of such babies. Since June 29, 2011, when the State

government introduced its first neonatal ambulance, which is part of the Emergency

Management and Research Institute (EMRI) 108 fleet, around 930 babies less than 28

days old, and weighing less than 2 kg, have been transported for emergency care to

tertiary hospitals for treatment. While ICH accounts for 671 cases, the Chengalpet

Medical College Hospital's neonatal unit accounts for 259 babies. “Ninety percent of

the babies we transported were critical and would not have survived if they did not

have facilities like oxygen supply, warmers and a sterile atmosphere,” said Adeline

Dhivya Israel, an emergency physician at the EMRI 108 control room. With better

awareness about the need for cleanliness, death or complications due to sepsis are on

the decline. But birth asphyxia is a challenge, as it requires a team effort. “The first 24

hours are crucial. We are losing low birth weight babies. If a baby does not cry at

birth even though efforts are made to make it cry, then we generally ask that it be

referred to a neonatal care unit for observation and assess”.6

6.2. NEED FOR THE STUDY:

5

“Prevention is better than cure”

Need for the study means scientific method which refers to a body of

technique for investigation phenomena, acquiring new knowledge or collecting and

integrating previous knowledge to be termed scientific method of enquiry must be

based on gathering empirical and measurable evidence subject to specific principles

of reasoning. When the baby arrives, the days will be so much happier. However,

must also be prepared for bad situations. Newborn baby is very likely to face some of

the common health problems in her early days. Mother usually get overly worried and

panic finding their precious newborns sick.

Most maternal and neonatal deaths in developing countries happen at home,

beyond the reach of health facilities. India contributes about 1 million new born and

infant deaths to the global burden and its infant mortality is 43/1000 live births

globally ,in India its 53/1000 live births in Karnataka 45/1000 live births , a high rate

that has not declined much in the recent past. In Karnataka, major health indicators-

infant mortality rate (IMR) and maternal mortality rate (MMR) –show that state in

poor light. The Mysore city infant mortality rate is 29 per thousand.7

By immediate and exclusive breastfeeding, mothers can protect their

newborns from a wide variety of risks, including hypothermia, hypoglycemia and

infections. Infants who are breastfed also have improved chances for survival. The

review identified two priority interventions during labour and delivery: reducing

the risk of infection to mothers and newborns by keeping the birth attendant’s

hands and all contact with the newborn’s umbilical cord (especially cutting

instruments and ties) clean and resuscitating newborns who are not breathing

normally after birth. Having a skilled nurse present can save lives.8

Child mortality is a sensitive indicator of a country’s development.  In India,

the Infant Mortality Rate (IMR) (under one year) has shown a modest decline in

recent years. The average decline of IMR per year between the years 2004 to 2008 has

been about 1 per cent peryear. The IMR was 53/1,000 live births. Eight states

contribute to 75 per cent of infant mortality: Uttar Pradesh, Bihar, Madhya Pradesh,

Rajasthan, Andhra Pradesh, Orissa, Gujarat and Assam.  At the current rate of decline,

India will miss the XI plan goal of reduction in IMR and the Millennium development

6

Goal-4 on child survival respiratory infections (22 per cent) and diarrhea (13.8 per

cent). Malnutrition is an underlying cause responsible for about one third of all

deaths.9

According to World Population report, the World Population is seven

billion, the hungry people in the world is about 925 million. In developed countries it

is 19 million and in Asia it is 578 million. Children are the more visible victims of

undernutrtion. A survey by the World Health Organization -the number of

underweight pre-school children (0-5 years of age) is 40 %. Every 6 seconds a child

dies from malnutrition and related causes. Other deficiencies, such as lack of vitamin

A or zinc, account for 1 million.10

The current world population is 7 billions. Current population of India in

2011 is estimated to be 1.21 billion. Most growth retardation occurs by the age of

two, and most damage is irreversible. The prevalence under weight in rural areas 50

percent versus 38 percent in urban areas and higher among girls (48.9 percent) than

among boys (45.5 percent) .Current Population of Karnataka in 2011 is 6.1 crore. In

this state 37.6% of children are underweight 28.1% of the population is

undernourished and 5.5% of children who die under the age of 5 from hunger.11

Worldwide about 8 newborn babies die every minute. Every year more than 4

million babies die during first week of life due to inadequate care. Further reduction

of newborn mortality can be accomplished by improving the quality of care provided

to newborn babies. Globally, the average NMR has fallen by more than a quarter

over 20 year, (1990-2009) from 33.2 to 23.9 per 1,000 live births, or an average of

1.7% per year. Over 130 million babies are born every year, and more than 10

million infants die before their fifth birthday, almost 8 million before their first.10

During the past two decades, infant mortality rate has declined very slowly.

This is as a result of a very slowly declining neonatal mortality rate. There has been

relatively little change in neonatal mortality despite proven cost-effective solutions to

reduce neonatal mortality, such as promoting tetanus toxoid immunization, skilled

attendance during delivery, immediate and exclusive breastfeeding and clean cord

care. Two-thirds of all deaths that occur during the first year of life occur in the

7

neonatal period. More than half occur in the first 24 hours after birth an indication of

how hazardous this time is for an infant. Close observation of a newborn for

this indication of distress is essential during this period.12

Diarrhoea is a common but potentially serious illness in early childhood. A

child suffers, on an average with 10 to 15 episodes of diarrhoea in the first five years

of life. Of these, three to five occur in the first year of life. A child may loss almost as

much water and electrolytes from the body during an episode of diarrhoea as an adult,

since the length and surface area of intestinal mucosa of a child, from where the

diarrhoeal fluids are secreted, are fairly large.13

A study was conducted at Uttar Pradesh , Barabanki and Unnao, India to

assess the rates, timing and causes of neonatal deaths and the burden of still birth ;

there were 430 stillbirths reported, comprising 41% of all deaths in sample. Of the

618 live births, 32% deaths were on the day of birth, 50% occurred during the

first 3 days of life and 71% were during the first week. The primary causes of

death on the first day of life were birth asphyxia or injury (31%) and preterm birth

(26%). During days 1-6, the most frequent causes of death were preterm birth (30%)

and sepsis or pneumonia (25%). Half of all deaths caused by sepsis or pneumonia

occurred during the first week of life. The proportion of deaths attributed to sepsis

or pneumonia increased to 45% and 36% during days 7-13 and 14-27

respectively. The recommendation is provide to prevent 32% of deaths of neonatal.13

In the changing trends and changing attitude towards care of children, the

pediatric nurse has to face various challenges on the following aspects. Emergence of

medical speciality and super-speciality of pediatric care need specialized education

and training of pediatric nurse. Nurses required to be up to date in the field of

specialized care to be at per with their co-worker and team members especially

medical counterpart in intensive care, neonatalogy and in any special care system.

Increasing numbers of HIV infected innocent children create problems in pediatric

care and nursing practices which need for specialized approach. Increasing numbers

of psychological problems among children due to unhealthy competition, comparison,

single parent and family disruption call for special attention of pediatric nurse in child

care. Thus investigator felt to compare the knowledge of emergency neonatal

8

management in between GNM and BSc nursing students, So conducted a study on

comparative study to assess the knowledge and practice of neonatal emergency

management among IIIrd year GNM and IVth year BSc nursing students in selected

schools and colleges of Bijapur with a view to develop information booklet.

9

6.3 REVIEW OF LITERATURE:

The review of literature in a research report is a summery of current

knowledge about a particular problem and includes what is known and not known

about problem. Review of literature is one of the most important steps in research

process. The major goals of review of literature are to develop a strong knowledge

base to carry out research and non research schoolary activity.

A study was conducted to determine the most effective method of delivering

training to staff on the management of neonatal emergency management. The research

was conducted in District General Hospital in U.K delivering approximately 3500

women per year. The samples was 36 staff, including the junior and senior medical

and midwifery staff. There are three teaching method were employed. The team

knowledge and performance were assessed pre-training, post-training, and at three

months later. The study was revealed that all the team member improved their

performance and knowledge. Obstetrics is a high risk specially in which the

emergencies are to some extent, Training staff to manage emergencies is a

fundamental principles of risk management. The study was recommended that,

stimulation based training is an appropriate proactive approach to reducing errors and

risks in obstetrics, improving team work and communication giving the students a

multiplicity of transferable skill to improve their performance.14

A study was conducted in rural India on the effect of knowledge of

community health workers on essential newborn health care. Data collected from

302 anganwadi workers (AWWs) and 86 auxiliary nurse midwives (ANMs ) and

data from recently delivered women. Coverage of antenatal home visits and

newborn care practices were positively correlated with the knowledge level of

AWWs and ANMs. Initiation of breastfeeding in the first hour of life (odds

ratio 1.97; 95% confidence interval (CI): 1.55–2.49 for AWW, and odds ratio 1.62;

95% CI: 1.25–2.09 for ANM), clean cord care (odds ratio 2.03; 95% CI: 1.64–2.52

for AWW, and odds ratio 1.43; 95% CI: 1.17–1.75 for ANM) and thermal care

(odds ratio 2.16; 95% CI: 1.64–2.85 for AWW and odds ratio 1.88; 95% CI: 1.43–

2.48 for ANM) were students significantly recommended that higher among women

10

visited by AWWs or ANMs who had better knowledge compared with those

with poor knowledge.15

A study was conducted in rural Nepal, birth attendant hand washing was

related to a statistically significant lower mortality rate among neonates (adjusted

relative risk [RR] = 0.81; 95% confidence interval [CI], 0.66–0.99). Also in Nepal, a

study on hand washing at home births found the adjusted risk of newborn cord

infection was 27% (95% CI: 17–36) lower among infants where the birth

assistant washed her hands with soap before delivery. A 2009 review found

evidence that nosocomial infections can be reduced by 40% with adequate hand

hygiene. Clean birth kits that have been shown to reduce neonatal sepsis include a

clean, unused razor blade, a clean surface for the delivery, clean cord ties and a bar of

soap. Although the students recommended that clean birth kits were developed for

non-facility births, all settings for childbirth require excellent hygiene, and clean birth

kits brought to the facility by the mother may be a way to reduce neonatal sepsis.16

A cross - sectional survey was done, In Medak District using Simple

random sampling technique to assess the knowledge levels of Integrated

Management of Neonatal and Childhood Illness . Where a total of 36 round-

the-clock Primary Health Centers were functioning with 453 Auxiliary Nurse

Midwives and 43 Staff Nurses. The average score among all Health Care Providers

was 37.01% points. The trained Health Care Providers had an average score of

40.31 points and untrained Health Care Providers had scored 33.71 points. The

study found a significant difference in scores obtained by Integrated Management

of Neonatal and Childhood Illness untrained and trained Health Care Providers,

Students recommended that play a pivotal role in neonatal survival such as

identifying a neonate at risk, maintaining clean chain to prevent neonatal sepsis,

maintaining warm chain to prevent hypothermia and breast feeding.17

The study was conducted in health care facilities within two districts of

Gujarat. 70% of respondents said that standard infection control procedures were

followed, but a written procedure was only available in 5% of facilities. Alcohol

rubs were not used for hand cleaning and surgical gloves were reused in over 70%.

Only 15% of facilities reported that wiping of surfaces was done immediately after

each delivery in labour rooms. A few facilities had data on infections and

11

reported rates of 3% to 5%. By this study the researcher was felt that the need

of improved information systems, protocols and procedures, and for training and

research to improve the status. 18

A study was conducted in Philippines trained physicians observed 481

consecutive deliveries in 51 hospitals using a standardized tool to record practices

and timing of immediate newborn care procedures. Drying, weighing, eye care

and vitamin K injections were performed in more than 90% of newborns. Only

9.6% were allowed skin-to-skin contact. Interventions were inappropriately

sequenced, e.g. immediate cord clamping (median 12 sec), delayed drying (96.5%)

and early bathing (90.0%). While 68.2% were put to the breast, they were separated

two minutes later. Unnecessary suctioning was performed in 94.9%. Doctors trained

in neonatal resuscitation were 2.5 (1.1–5.7) times more likely to unnecessarily

suction vigorous newborns. 2% died and 5.7% developed sepsis ⁄ pneumonia the

researcher was found this minute-by-minute observational assessment revealed that

performance and timing of immediate newborn care interventions below WHO

standards and deprive newborns of basic protections against infection and death.

Hence the study was recommended that promote skin to skin contact and safe and

sterile methods using in delivery.19

A cross-sectional survey of nurses of secondary health care level in the

South-Western geopolitical zone of Nigeria, conducted between February and

March 2006. The participants were drawn from four hospitals using the random

sampling technique. A total of 179 nurses were interviewed. Overall, 78.8% of the

participants had adequate knowledge of Neonatal Resuscitation. Specifically, 95.5%

had adequate knowledge of evaluation. While 49.7% had adequate knowledge of

appropriate decisions and actions. 130 (72.6%), 162 (90.5%), 130 (72.6%) and 173

(96.6%) had adequate knowledge about provision of warmth, tactile stimulation,

airway clearance and ventilation, respectively. Who had previously worked in the

delivery room and special care baby unit had better knowledge of Neonatal

Resuscitation than those who had not & similarly, a significantly higher proportion

of participants who had recently attended an Neonatal Resuscitation training course

than who had no such training had adequate knowledge of Neonatal Resuscitation .

The introduction of routine and periodic Neonatal Resuscitation training programs

12

may improve the Neonatal Resuscitation skills of nurses, who often attend deliveries

in the developing world. This is essential for improved survival of newborn infants. 20

A study was conducted on Newborn Care Practices including Delivery

Practices, Immediate Care given after birth and Breast-feeding Practices in an

Urban slum of Delhi. They found out more than half of home deliveries 26,

(56.1%), are mostly conducted by dais 24, (91.3%) or relatives 4(8.7%) . Finger

was used to clean the air passage in most of the home deliveries . The study

was also suggested that there is an urgent need to reorient health care providers

and to educate on clean delivery practices and early neonatal care21 .

A cross sectional comparative study was conducted during June and July

in 2005 in Mardan district, Pakistan in hospital-based and community-based

deliveries to assess the essential Newborn emergency management Practices. Using

convenient sampling Information from 30 delivery cases was gathered ; half of the

cases were hospital-based and half at homes. The result showed that among hospital

deliveries 80% were conducted by Nurses , 20% by Skilled dais and non by

Doctor. Among these cleanliness was kept in 33%, cord care 100%. All the home

based deliveries were conducted by unskilled birth attendants. Among these :

cleanliness 16.6%, cord care 80% .In both of these groups eye care was 0% and

immunization was 100%.This study highlighted the deficiencies in the newborn

care. Both hospital practices and traditional ones neglected the basic principals

of newborn cleanliness, early breast feeding, eye care and cord care.22

A cohort observational study to evaluate the obstetrical emergency care

improves the neonatal outcomes. The samples are the term, cephalic presenting single

ton infant born at 1998 and 2003.The setting of the study was the south med hospital,

university of Bristol, UK. The method for the study was five minitues Apgar score

was reviewed. The study reveals that the five minitue Apgar score decreases from

86.4 to 44.6% and those with HIE decreased from 27.3 to 13.6% following the

introduction of the training courses in 2000.23

A study conducted to evaluate the effectiveness of a training program

for care providers in improving practice of essential newborn care in obstetric

units of 5 hospitals in Puttalam district, Sri Lanka. 4 days training program was

13

implemented for doctors, nurses and midwives. Outcome was measured by direct

observation, practices of essential newborn care at delivery in the labour room

on a subsample, interviewing mothers, immediate skin-to-skin contact and early

initiation of breast feeding. From health records, “undesirable health events’’ of the

newborns. Practices of cleanliness, thermal within one hour after birth was

constrained by inappropriate practices in private or maternity hospitals. The group

effect of maternity hospitals and the absence of individual maternal-related

factors that explain the outcome suggest that mothers have little or no autonomy

to breastfeed their babies within the first hour of life, and depend on the institutional

practices that prevail at the maternity hospitals. 33protection and neonatal assessment

improved significantly. Improved in skin-to-skin contact by 1.5 times, early initiation

in breast feeding by 2 times, undesirable health events declined from 32 to 21 /223

newborns.24

The researcher concluded that in all the neonatal assessments neonmatal

emergency management is the vital role of all the personnels, so this is most

important step in the development of a research project. It review of literature is the

systemic and critical review of the most important published schoolary literature on a

perticular topic. This helps the investigator to find what is investigations. Literature in

a research report is a summery of current knowledge about a particular already known

and what problems remain to be solved. Since effective research is based upon past

knowledge, this exercise provides useful hypothesis and suggestions for significant

problem and includes what is known and not known about the problem. The literature

is reviewed to summerise knowledge for use in practice or to provide a basis for

conducting a study. Review of literature section includes a description of the current

knowledge of a perticular problem, the gaps in this knowledge base and the

contribution of the study to development of knowledge in the area. Review of

literature is a key steps in research this knowledge base and the contribution oftudy to

development of knowledge in the question to identify what is known and what is

unknown about the topic. The major goals of review of literature are to develop a

strong knowledge base to carry out research and process, Review of literature is an

important step in the development of a research project. It involves systemic

identification, location, scrutiny and summery of written materials that contain

information on research problems.

14

6.4 STATEMENT OF PROBLEM:

“A Comparative study to assess the knowledge and practice of neonatal

emergency management among III year G.N.M. and IV year B.Sc. nursing

students in selected schools and colleges at Bijapur , with a view to develop

information booklet.”

6.5 OBJECTIVES OF THE STUDY:

1. To assess the knowledge and practice regarding emergency management.

2. To prepare and administer information booklet.

3. To find the association between knowledge scores with selected socio

demographic variables.

6.6 OPERATIONAL DEFINITIONS:

Comparative study: In this study, it reffers to the study, In which comparision of

knowledge between two groups.

Assess: In this study, it reffers to the total observation of the topic or person.

Knowledge: In this study , It refers to the correct response of students on topic to

aseliated through Self Administered Knowledge Questions (SAKQ).

Practice: In this study ,It refers to the performance of students according to the

prepared checklist regarding neonatal emergency management.

Neonatal: In this study, it reffers to, the baby From the birth to four weeks.

Emergency Management: In this study, it reffers Where the immediate care needed

and the solution is found.

Information Booklet: In this study, it reffers to, It is the teaching method/ tool

pepared by the researcher regarding neonatal emergency management.

15

G.N.M. Students: In this study, It refers to students who are learning and enrolled to

General Nursing Midwifery course.

B.Sc. Students: In this study, It refers to students who are learning and enrolled to

Bachelor of Science in Nursing course.

6.7 ASSUMPTIONS:

The assumptions of the study are,

1. Students have inadequate knowledge about neonatal emergency management.

2. Information booklet will improve the knowledge of students.

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA:

Data will be collected from the Nursing students regarding neonatal

emergency management in selected schools and colleges at Bijapur.

7.2 METHODS OF DATA COLLECTION:

7.2.1 RESEARCH DESIGN: Non Experimental comparative study design.

7.2.2 RESEARCH VARIABLES:

DEPENDENT VARIABLE: Knowledge of students regarding neonatal emergency

management.

INDEPENDENT VARIABLE: Information booklet.

EXTRANEOUSVARIABLES: Extraneous variables such as age, gender, religion,

occupation, income, family etc.

7.2.3 SETTING: Selected nursing schools and colleges at Bijapur.

7.2.4 POULATION: III year G.N.M. and IV year B.Sc. nursing students.

7.2.5 SAMPLE: III year G.N.M .and IV year B.Sc. nursing students.

7.2.6 SAMPLE SIZE: Sample size is 200.

16

7.2.7 CRITERIA FOR THE SAMPLE SELECTION:

INCLUSION CRITERIA: III year G.N.M. and IV year B.Sc. nursing Students at

the age group of 20 to 25 years.

EXCLUSION CRITERIA:

1) Students who are not available during data collection.

2) Students other than III year G.N.M. and IV year B.Sc. nursing.

3) Students who are bellow 20yrs of age and more than 25yrs of age.

7.2.8 SAMPLING TECHNIQUE: Purposive samplling technique.

7.2.9 TOOL FOR DATA COLLECTION:

SECTION A: Includes socio-demographic variables.

SECTION B: Self administered knowledge questionnaire on neonatal emergency

Management.

7.2.10 METHOD OF DATA COLLECTION: On first day pre test will be

conducted to assess the knowledge of III year G.N.M and IV year B.Sc. nursing

students regarding neonatal emergency management. On the same day informational

booklet will be distributed to improve their knowledge.

7.2.11 PLAN FOR DATA ANALYSIS: The collected data will be analyzed using

desciptive and Inferential Statestics.

DESCRIPTIVE STATISTICS: Frequency, percentage, mean, median and standard

deviation will be used.

INFERENTIAL STATISTICS: “t” test and chi-square test will be used.

7.3 Does the study requires any investigation or intervention to be conducted on patient or other human or animal?

Yes, there is an intervention as information booklet.

7.4 Has ethical clearance been obtained from your institution?

Yes, the ethical clearance will be obtained from the institution.

17

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18

12. State of the Art: Research Priorities for the Reduction of Perinatal

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9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE :

11. NAME AND DESIGNATION OF

11.1 GUIDE : Mr. Nagaraj G.J Associate Professor Department of Paediatric Nursing,

Tulza Bhavani College of Nursing, Bijapur

11.2 SIGNATURE :

11.3 CO-GUIDE (IF ANY) :

11.4 SIGNATURE :

11.5 HEAD OF THE DEPARTMENT : Mr. Nagaraj G.J Associate Professor

Department of Paediatric Nursing, Tulza Bhavani College of Nursing, Bijapur

11.6 SIGNATURE :

12. 12.1 REMARKS OF THE PRINCIPAL :

12.2 SIGNATURE :

21