Effectiveness of an Educational Program on mother’s Knowledge about Readiness for Discharge Care at Home for a Premature Baby in Intensive
Care Unit at Teaching Hospitals in Medical City Complex.
Seraj Hashim Alwan1 and Eqbal Ghanim Ali Ma'ala2
1BSN. Ministry of Health, Medical City Complex, Nursing Home Hospital, Iraq ,Email:
2 professor, University of Baghdad, College of Nursing, Pediatric Nursing Department, Baghdad City, Iraq. ,Email: eqbal_ghanim@conursing.uobaghdad.edu.iq
Abstract
A quasi experimental study design carried out through the period of 2020-2021 to evaluate the effectiveness of an educational program on mother’s knowledge toward discharge care plan. The study carried out in Welfare Teaching Hospital , Nursing Home Hospital and Baghdad Teaching Hospital in medical city complex in Baghdad city, Iraq, Thirty mothers in neonatal intensive care unit (NICU) were chosen by using of nonprobability sampling. The data were collected through two periods (pretest, and the posttest after the implementation of the educational program). The instrument reliable by using of equivalence reliability and valid by the panel of experts. The data analyzed by use of descriptive and inferential statistical data analysis.
The study findings indicated that the mothers sample at age (23-29) years, graduated of secondary school, housewives, urban resident, they had cesarean section delivery, they had days as a period of stay in the NICU, they had moderate level of socioeconomic status. Mothers had low level of knowledge at pretest mean score is (1.256), at posttest mean score is (1.887) at high level of knowledge. The study concluded that the educational program has an effectiveness in improve the mother’s knowledge toward discharge care plan of preterm baby. The study recommended Training session for the nurses about discharge care plan and improves the knowledge and practice of mothers to care of their premature babies at home.
Keywords: Mothers Knowledge, Readiness for Discharge Care , Premature Baby.
1. Introduction
The term "prematurity" refers to a birth a baby before the 37week of pregnancy.
Preterm babies, particularly those who were born prematurely, frequently have difficult medical issues that necessitate entered to (NICU). Development the body’s systems, particularly in this period, determine the sensitivity of the pre-term baby. The preterm infant sensitivity is dependent on, during this time, the body's systems, especially the nervous system, not well developed, which may result in irreversible damage at this age, (Aldirawi, Et al., 2019).
Premature babies and their families go on uncertain, high technological equipment, often terrifying via the journey a (NICU). When the time comes, to return Parents, it's time to go home can assess their ability to treated their child without assistance of the personnel. An integrated and well-prepared birth of healthy baby aides in ensuring smooth transport to home and secure and efficient post-birth treatment. Appointing and including parents in the high-risk pregnancy process gives them confidence in their abilities in order to look after their premature
A preterm infant requires close attention to the specific health problems after discharge from the NICU, as well as planning the multidisciplinary follow up that may be required. Thoughtful and thorough discharge planning may reduce the risk of morbidity, mortality and readmission, which are frequent in this group of patients, (Barkemeyer, 2015 ).
Preparing the family for the arrival of the prematurely born child at the neonate intensive care unit (NICU) is critical for ensuring the continuity of care for the newborn. For the success of this phase, it is recommended that parents participate in all stages of the process, beginning with planning and incorporating their suggestions into the care plan. It has been discovered that the strategies used to ensure the continuity of care when an assigned to the NICU and the hospital are insufficient, (Veronez, & Higarashi, 2016).
The program of education its help parents and newborn baby adjust to their new surroundings. Just a few studies have been done, however, to determine the basic needs of parents of premature babies and whether high-quality care for the first year of life will fulfill those needs. Medical education will strengthen a mother's understanding, ability to care for her child, and trust in herself, which will help her handle the stresses of caring for a fragile child at home, (Toral-López et al., 2016).
The preparation for the high involves a comprehensive assessment of the baby's preparation, family preparation, home plan preparation, and health-care resources for ambulatory patients. Successful high school preparation will lead to increased adversity tolerance, resilience, and improved infant growth and development, (Zimmerman, 2017).
2. Methodology
2.1. Design of the Study:
The study design is a quasi-experimental (One group), that study carried out from the period of September 2020 to March,2021 on mothers of neonates at neonatal intensive care units in teaching hospital in medical city complex, to evaluate the effectiveness of an educational program on their knowledge toward discharge care plan.
2.2. Ethical Considerations
Ethical approval was obtained from ethical committee of research in the Faculty of Nursing/University of Baghdad regarding confidentiality and anonymity of the participants. Also the mothers were fully acquainted of the current study and its aims and then a voluntary verbal consent was obtained in order to participate in the study.
2.3. Setting of the Study:
The study was carried out at NICU in welfare teaching hospitals, nursing home hospital and Baghdad teaching hospital in medical city complex.
2.4. Sample of the Study
The researchers sample includes (30) mothers of premature babies in NICU. They are selected by using non probability sampling (purposive sample).
2.5.1. Demographic Data and Socioeconomic Status
This part consists of (11) items which include: mothers (age, level of education, occupation, residence, asking about 1st pregnancy, number of pregnancy, number of born, have the babies been entered to newborn unit, causes of entered to NICU, type of delivery, period of child stay in NICU). This part related to assess the socioeconomic status by using of scale of Socioeconomic Status scale (SESS), (Ma’ala, 2001). This scale composed of group of items to detect the level of SESS.
2.5.2. Premature Demographic Characteristics
This part consists of (9) items which include: (age, twin, type of twin, period of gestational pregnancy, period of premature stay in the intensive care unit ( ICU ), cause of ICU of neonate admission, weight and then type of feeding).
2.5.3. Questionnaire about Mothers Knowledge toward Discharge Care Plan
This part is related to the questions that assess of the mothers knowledge for pre and post program. It is consisted of (55) items constructed for the purpose of an educational program.
2.6. Rating and Scoring of the Study Instrument:
The knowledge questionnaire have been scored and rated on two levels dichotomous scale correct answer and in correct answer, (2) points for the yes correct and (1) point for no as carried incorrect the no answer which assessed by cutoff point (0.33) due to scores (1 and 2) respectively. Scores of responses are categorized according to the following level of mothers´
knowledge:
(1-1.33) = low level of knowledge, (1.34-1.67) = moderate level of knowledge and (1.68-2.00) = high level of knowledge.
2.7. Data Collection Methods:
The process of gathering information was conducted from 20th December 2020 to February 11th 2021. The study and the objectives were explained to the study sample by the investigator, the mothers´ verbal consent has been taken and the answering of questions have been done by using interview. The investigator gathered the general information about mothers participated in the study, and conducted the pretest about mothers´ knowledge toward discharge care plan.
2.8. Statistical Data Analysis:
The statistical analysis of the data of the study is done by using Microsoft office excel 2010 and SPSS package ver. 20.
3. Discussion of the Results
Part (1): Discussion of the distribution of the mothers by their demographic characteristics The findings in the table (1) indicated that the age of mothers whom participate in the study between (23-29) years. This finding related small sample size and if the sample size is huge number may reflect result different from this finding and support the risk age for preterm labor is less than 17 and more than 35 years This result may be related to that most of Iraqi women married around the age of 18 – 30 years. Aldirawi et al., (2019) in their study (Mothers’
Knowledge of Health Caring for Premature Infants after Dis-charge from Neonatal Intensive Care Units in the Gaza Strip, Palestine) found that (46.7%) of mothers at age (20-30) years old.
AL-Mukhtar, & Abdulghani, (2020) in their study (Knowledge of Mothers regarding Premature Baby Care in Mosul city) found that the mean age of women was 26 years
Regarding to the mothers level of education the finding of the previous study indicated that most of mothers graduated of secondary school. Aldirawi et al., (2019) found that (50%) of mothers graduated of secondary school.
The present study related shows that are mother’s occupation were housewives. This finding related to the most of women have secondary school education and absent chance of work in Iraq. Aldirawi et al., (2019) found that (74.2%) of mothers were housewives. Regarding to the mother’s resident the finding of the present study indicated that most of mothers were living in urban area as resident.
While the mothers type of delivery indicated that most of mothers had cesarean section delivery. This finding related to that most of women prefer the cesarean section (C/S) delivery because it is less pain than the normal vaginal delivery (NVD (.
In related to the period of mother stay in the NICU with their premature baby the finding indicated that most of them stay days in the NICU,The definition of Nicu the premature baby may stay few hours , days and few weeks,(guidance care of preterm baby,2005). Most of the mother’s socio economic status in present studies the indicated that half they had moderate level of socioeconomic status. This finding related to that most of the Iraqi families come from moderate to poor socioeconomic status and absent of chance of work with the essentials human need for life. Aldirawi et al., (2019) found that (56.7%) of mothers had low level of income.
Part (2): discussion of distribution of premature demographic characteristics
Regarding to the finding of the present study the premature characteristics in the table (2), shows that age most of them at age days. The premature age at time of delivery shown, more than half of them were 33-37 weeks of gestation of pregnancy. This finding reflects that the sample of preterm baby stay in the hospital at the time of collections data also, the preterm baby delivery occur before 37 weeks of gestational age. AL-Mukhtar, & Abdulghani, (2020) found that 70% had Gestational age more than 37 weeks. The present study findings indicated that most of the premature admitted to NICU due to the breathing problems, one third of them had weight (1-1.5) & (1.5-2.5) kg and most of them feed by using Nasogastric tube (NG). The preterm baby more risk for many health problems and one of this problem is the respiratory system problem like respiratory distress syndrome (RDS) due to deficiency of surfactant substance.
Part (3): Discussion of Comparison between Two Periods (Pretest and Posttest) For Mothers Knowledge toward discharge care plan
According to the result of the present study which is related to the pretest and posttest of mother’s knowledge about discharge care plan of preterm baby, Indicated that mothers had poor level of knowledge about care of preterm baby after discharge from the NICU at the period of pretest. While, the finding in the posttest indicated that mothers had good level of knowledge about care of preterm baby after discharge from the NICU. Table (3) also, indicated there are highly significant difference between the mean score of mother’s knowledge at the pretest and posttest.
Table (3) represents the mean score of mothers knowledge about discharge care plan in the pretest which was (1.25) at low level. While in the posttest the mean score of mothers knowledge about discharge care plan was (1.887) at high level. This finding due to the effectiveness of the educational program session which might increases the mothers knowledge about discharge care plan of preterm baby. Khalesi et al., (2015) found that mothers had good level of knowledge about premature feeding, hand washing, vaccination, temperature measurement and maintenance, avoidance of baby kissing, being in crowded places and long trips in first days post baby discharge.
Aldirawi et al., (2019) found that the mean percentage of good knowledge of items related to breastfeeding was 54.2%, Infection prevention was 73.3%, vaccination was 60.2%, jaundice was 67.1%, temperature regulation was 50%, and umbilical cord care was 46%.
Furthermore, the mean overall percentage of mothers’ knowledge of health caring for premature infants after discharge from NICU was 58.4%.while, AL-Mukhtar, & Abdulghani, (2020) found
in their study that more than half of mothers had poor level of knowledge about premature baby care
Part (4) Difference between Mothers Knowledge at posttest and their age, education, occupation and socioeconomic status
The findings in table (4) revealed significant statistical difference between mothers knowledge at posttest and level of education and there are no significant statistical difference between mothers knowledge at posttest and their demographic characteristics like age, occupation and socioeconomic status.
4. Conclusion
The program has effectiveness on the mothers’ level of knowledge toward discharge care plan during the 2 period of test, the study group have low level of knowledge before implementation of an educational program and the level of knowledge ascend to high level at posttest. knowledge before and after implementation of the program. The program has effectiveness on the mothers’ level of toward discharge care plan during the 2 period of test.
5. Recommendations
Implementation of the educational program in medical city complex in Baghdad city about discharge care plan to improve the knowledge of mothers. Training session for the nurses might be necessity about discharge care plan. Follow up and evaluation of nurse’s knowledge toward applied discharge care plan is essential.
Table (1) Distribution of the mothers by their demographic characteristics
Variables Frequency Percent
Age
17-22 10 33.3
23-29 12 40
30-36 6 20.0
37-42 2 6.7
Level of education
Not read and write 3 10
Primary 5 16.7
Secondary 8 26.7
Preparatory 6 20
University 7 23.3
MSC 1 3.3
Occupation
Employee 7 23.3
Housewife 22 73.4
Other 1 3.3
Residence Rural 6 20
Urban 24 80
Socioeconomic status
Low 10 33.3
Moderate 15 50
High 5 16.7
Total 30 100
Table (2) distribution of neonate demographic (n=30)
Table (3) Distribution and difference mothers knowledge toward discharge care plan Levels of Assessment Through the "Mean of Score" Among the Period of the Program (Pretest & Posttest)
Period Level of Assessment Frequency Percent
P-value C.S.
Pre-test
Low (1-1.33) 24 80
.000(T) HS
Moderate (1.34-1.67) 6 20
High (1.68-2) - -
Total 30 100
𝐱 ± 𝐒. 𝐃
1.256±0.073
Posttest I
Low (1-1.33) - -
Moderate (1.34-1.67) - -
High (1.68-2) 30 100
Total 30 100
x ± S. D 1.887±0.075
𝐱 ∓ 𝐒. 𝐃.=Arithmetic Mean (𝐱 ) and Std. Dev. (S.D.) P < 0.05, HS: Highly Significant at P < 0.01, T: t-test
Variables Frequency Percent
Age Hours 3 10
Days 27 90
Age of pregnant
Less than 30 weeks 1 3.3
30-33 weeks 13 43.3
33-37 weeks 16 53.3
Period of neonate stay in intensive care unit
Hours 5 16.7
Days 24 80
Month 1 3.3
Cause of ICU of neonate admission
Breathing problem 20 66.7
Difficult feeding 2 6.7
Genetic defect 4 13.3
Jaundice 3 10
Others 1 3.3
Weight
Less than 1 kg 7 23.3
1-1.5 kg 10 33.3
1.5-2.5 kg 10 33.3
More than 2.5 kg 3 10
Type of feeding
Breast feeding 4 13.3
Bottle feeding 3 10.0
NG feeding 13 43.3
Mixed feeding 10 33.3
Table (4) difference between mothers Knowledge at posttest and age, education, occupation and socioeconomic status.
ANOVA Sum of
Squares df Mean
Square F Sig.
Age
Between Groups .010 3 .003 .733 .542
Within Groups .123 26 .005
Total .134 29
Education
Between Groups .058 5 .012 3.667 .013
Within Groups .076 24 .003
Total .134 29
Occupation
Between Groups .018 2 .009 2.114 .140
Within Groups .115 27 .004
Total .134 29
SES
Between Groups .008 2 .004 .851 .438
Within Groups .126 7 .005
Total .134 29
d.f=degree of freedom, F= fisher test, sig=significant, NS: Non Significant at P > 0.05, S: Significant at P
< 0.05, HS: Highly Significant at P < 0.01.
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