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Essential Newborn Care Implementation

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    Chapter 1 THE PROBLEM AND ITS SCOPE Introduction Newborn care is the most essential procedure in the delivery room, it is a procedure or a proper way of handling the baby and implementing the proper way for the newborn. A newborn baby can acquire complications if the procedure was incorrectly performed.

    The Intrapartum/Newborn Practices assessment tools were developed through a collaboration between the Philippine General Hospital and World Health Organization (WHO) with Department of Health (DOH) (Sala, 2011). The Essential newborn care protocol is a step-by-step guide for health workers and medical practitioners issued by the Department of Health for implementation under Administrative order 2009-0025 (Sala, 2011).

    The Department of Health embarked on Essential Newborn Care , a new program to address neonatal deaths in the country. Under the umbrella of the Unang Yakap Campaign, Essential Newborn Care  is an evidenced based strategic intervention aimed at improving newborn care and helping neonatal mortality ( KATHARINA, 2010). The Essential Newborn Care package is a four-step newborn care  time-bound intervention undertaken to lessen newborn death.

    First is Immediate and thorough drying to stimulate breathing after delivery of the baby; and provision of appropriate thermal care through mother and newborn skin-to skin contact maintaining a delivery room temperature of 25-28 degrees centigrade and wrapping the newborn with clean dry cloth; properly timed clamping and cutting of the umbilical cord, (1-3 minutes or until cord pulsation stops);non-separation of the newborn and mother for early breast-feeding for the immediate latching on and initiation of breastfeeding within first hour after birth (KATHARINA, 2010).

    A study conducted at the University of Alabama at Birmingham (UAB) Division of Neonatology shows that training birth attendants in essential newborn-care techniques reduced stillbirths by more than 30 percent and potentially could save as many as 1 million lives worldwide each year (Carlo 2011). Another study by U. S. researchers looked at the effectiveness of a newborn care program developed by the World Health Organization (WHO), and found that it reduced by more than one-third the number of newborn stillbirths in six countries where it was tried (Berman 2010).

    Berman (2010) states that the effectiveness birth techniques, among 120,000 births revealed the rate of stillbirths dropped from 23 per 1,000 deliveries and 16 stillborn babies per 1,000 births. World Health Organization(WHO) (2012) states that Philippine research has also documented that these evidence-based newborn care interventions are not practiced sufficiently. It is on this premises that the current study was conducted to determine the essential newborn care emplementation among delivery/operating room nurses at Adventist Medical Center, Tibanga, Iligan City.

    Theoretical Framework The study made use of the Social Learning Theory by Albert Bandura(1977) and the Human Care by Jean Watson(2003). Albert Bandura’s (1977) Social Learning theory is a learning theory based on the ideas that people learn by watching what others do, and that human thought processes are central to understanding personality. The social learning theory of Bandura emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others.

    Bandura (1977) states: “Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behavior is learned observationally through modeling: from observing others one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action. ” Social learning theory explains human behavior in terms of continuous reciprocal interaction between cognitive, behavioral, an environmental influences.

    The component processes underlying observational learning are: (1) Attention, including modeled events (distinctiveness, affective valence, complexity, prevalence, functional value) and observer characteristics (sensory capacities, arousal level, perceptual set, past reinforcement), (2) Retention, including symbolic coding, cognitive organization, symbolic rehearsal, motor rehearsal), (3) Motor Reproduction, including physical capabilities, self-observation of reproduction, accuracy of feedback, and (4) Motivation, including external, vicarious and self-reinforcement.

    Because it encompasses attention, memory and motivation, social learning theory spans both cognitive and behavioral frameworks (Kendra Cherry, 2012). This study is also anchored on the theory of human care by Jean Watson (2003) , as cited by kozier (2008) that the practice of caring is central to nursing: it is unifying focus for practice.

    Watson outlines the 10 following factors which she reffered to as carative factors like forming a humanistic-altruistic system of values; instilling faith and hope; cultivating sensitivity to one’s self and others; developing a helping- trust relationship; promoting and accepting the expression of positive and negative feelings; systematically using the scientific problem-solving method for dcision making; promoting interpersonal teaching-learning, providing a supportive, protective, or corrective mental, physical, socio-cultural, and spiritual evironment; assisting with the gratification of human needs and; allowing for existential-phenomenological forces Watson’s theory of human caring has received worldwide recognition and is a major force in rendering nursing as a caring-healing model. Conceptual Framework Essential Newborn Care (ENC) represents the highest standard for safe and quality care for birthing mothers and healthy newborns in the 48 hours of the intrapartum period and up to a week of life of the newborn.

    Its adoption helps reduce maternal and newborn morbidity and deaths. It supports the national commitment to the United Nations millennium Development Goals (MDG) 4 by the year 2015 (DOH, 2012). This study composed of independent variables which might influence on the dependent variables of the study. The first box is the Independent Variables identified includes the personal profile of the respondents such as age, gender, years of hospital experience, employment status and the Essential Newborn Care (ENC) Training. The dependent variable focuses on the Essential Newborn Care such as drying newborn, skin to skin contact, followed by the Properly Timed Cord Clamping and Initiation of Breastfeeding.

    Drying is for protecting from cold stress and hypothermia, immediate and thorough drying stimulates breathing. It should be the immediate first action for all newborns, regardless of gestational age or birth weight (DOH , 2012). Skin to skin contact is generally perceived to be an intervention for provision of warmth and bonding between newborn and mother. less well appreciated are its conbtributions to immunoprotection of the newborn and to the protection hypoglycemia (DOH, 2012). Properly timed cord clamping has traditionalluy been the standard in the country. Properly timed cord clamping increases the infant’s blood volume and iron reserves, and reduces the incidence of iron-deficiency anemia in infancy (DOH, 2012).

    Initiation of breastfeedingmay reduce neonatal mortality by decreasing the ingestion of infectious pathogens. Early breast milk also provides many immunocompetent fctors, including immunoglobulins (antibodies) and lymphocytes (white blood cells) that may stimulate humoral or cell-mediated immune systems (DOH, 2012). Figure 1 shows the interplay between the dependent and independent variables. INDEPENDENT VARIABLES DEPENDENT VARIABLE PERSONAL PROFILE: * Age * Gender * Years of hospital experience * Employment Status * Essential Newborn Care (ENC) training ESSENTIAL NEWBORN CARE IMPLEMENTATION on: * Drying newborn * Skin to skin contact Properly timed cord clamping * Initiation of breastfeeding Figure 1. Schematic Diagram Showing the interplay between the Relationship of the Independent and Dependent Variables Statement of the Problem This study sought to determine the Essential Newborn Care Implementation at Adventist Medical Center (AMC), Tibanga, Iligan City. Specifically, it aims to answer the following questions: 1. What is the personal profile of the respondents in terms of: 1. 1. Age ; 1. 2. Gender; 1. 3. Years of Hospital Experiences; 1. 4. Employment Status; 1. 5. Essential Newborn Care training; 2. What is the Essential Newborn Care(ENC) implementation among the respondents? 3.

    Is there a significant relationship between the respondents ENC implementation and their personal profile in terms of age, gender, years of hospital experience, employment status and essential newborn care training? Hypothesis The null hypothesis was tested at 0. 05 level of significance: Ho1: There is no significant relationship between the respondents personal profile and their ENC implementation status. Significance of the Study Essential Newborn Care must ensure the quality of needs and to spread the use the protocol to prevent at least half of newborn deaths without additional cost to both families and hospital. It is time to rapidly reduce neonatal mortality (DOH,2012).

    The result of this study woud be beneficial to: Clientele: The study will be benificial to both mother and newborn to improve health, enhance recovery and prevent complications. Nursing Service: The result of the study will give them information on the implementation status of the Essential Newborn Care (ENC) among OR/DR Staff in the hospital. Nursing Education: The findings of the study will strengthen the implementation of the ENC procedure by the Clinical Instructor during skills enhancement, lectures and as well as during clinical exposure in the hospital among the students. This will help the students to be better equipt on tthe Essential newborn Care(ENC) Practice.

    Future Researchers: The findings of the study will serve as basis for similar and other related studies in this particular area. Scope and Delimitation This study consists of 10 registered nurses who assisted the OB-Gyne Doctors during the essential Newborn Care Implementation at the delivery room regardless of their age, gender, years of hopital experience, employment status, ENC training at Adventist Medical Center, Tibanga, Iligan City. The study was conducted from February to March 2013. Definition of Terms The following terms are defined operationally for better understanding of the study: Age. This refers to the length of time that a person has existed. In this study, the age will range from 21years old and above. Gender.

    This refers whether the respondents is male or female. Years of Hospital Experience. This refers to the time in which the respondents works in the delivery room. Employment Status. This refers to the respondent working either as a regular, contractual or reliever in the hospital. Essential Newborn Care (ENC) training. This refers to the  ENC training received by nurses as well as the doctors either from the CHO or DOH for hospital implementation. Immediate and thorough drying of the newborn. This refers to keeping the Newborn warm with blanket within 30 seconds to one minute while on the abdomen of the mother. Early skin-to-skin contact between mother and newborn.

    This refers to early skin-to-skin contact between mother and newborn after immediate and thorough drying of the newborn. Proper cord clamping. This refers proper clamping and cutting of the cord between 1 to 3 minutes. Non-separation of the newborn from the mother for early breastfeeding. This refers to unhurried breastfeeding of the newborn after proper cord clamping and cutting. Chapter 2 REVIEW OF RELATED LITERATURE AND STUDIES Related Literature This chapter discusses the review of related literature and studies for better understanding of the study conducted. The Philippines is one of 42 nations that account for 90 percent of global under-five mortality.

    Neonatal and post-neonatal deaths declined the slowest over the past 20 years with the reduction of only 9 percent and 7 percent, respectively, from 1988 to 2003. An estimated 82,000 Filipino children die annually before their 5th birthday. More than one-third (37 percent) of these children are newborns less than 28 days old. These newborns die mostly of preventable causes such as asphyxia (lack of oxygen to the brain) or sepsis (severe infection). The highest number of newborn deaths occur in the first two days of life. Factors and conditions surrounding labor, delivery, and the immediate postpartum period have been seen as reasons. Department of Health has emphasized the need to strengthen health services of children throughout the stages.

    The neonatal period has been identified as one of the most crucial phase in the survival and development of the child (DOH, 2009). The Millennium Development Goal (MDG) 4, aims for a reduction in under-five mortality by two-thirds by 2015. Childhood death rates in the Philippines have shown a downward trend, but the decline dangerously slowed down in the past 10 years because the neonatal mortality rate has remained almost unchanged. Adminstration Order (AO) outlines specific policies and principles for health care providers with regard the prescribed systematic implementation of interventions that address health risks known to lead to preventable neonatal deaths. This AO is consistent with AO no. 008-0029 on Implementing Health Reforms for Rapid Reduction of Maternal and Newborn Mortality and supports all DOH initiatives and programs for newborn and child health (DOH, 2009). Department of Health (DOH) Secretary Francisco Duque III convened recently at Hotel Sofitel to discuss the state of newborn care system in the country. Joining Secretary Duque were executives from key health institutions in the country such as officials from health maintenance companies as well as doctors,’ nurses,’ and midwives’ associations. The occasion also formalized the launch of the Essential Newborn Care (ENC) protocol endorsed by the World Health Organization, which offers an evidence-based strategic intervention aimed at improving newborn care and helping curb neonatal mortality (Duque, 2012).

    The guidelines are categorized into to the time bound and non-time bound and unnecessary procedures. Time bound procedures should be routinely performed first which is immediate drying, skin to skin contact followed by clamping of the cord after 1-3 minutes, non-separation of the newborn from the mother and breastfeeding initiation. Non-time bound interventions include immunizations, eye care, Vitamin K administration, weighing and washing while unnecessary procedures include routine suctioning, routine separation of newborn for observation, administration of prelacteals like glucose water or formula (The News Today, 2009). This are the step by step interventions such as: Immediate drying it is Use to clean, dry cloth, thoroughly dry the aby, wiping the face, eyes, head, front and back, arms and legs; Uninterrupted skin-to-skin contact- Aside from the warmth and immediate bonding between mother and child, it has been found that early skin-to-skin contact contributes to a host of medical benefits such as the overall success of breastfeeding/colostrums feeding, stimulation of the mucosa—associated lymphoid tissue system, and colonization with maternal skin flora that can protect the newborn from sepsis and other infectious disease and hypoglycemia; Proper cord clamping and cutting- Waiting for up three minutes or until the pulsations stop is found to reduce to chances of anemia in full term and pre-term babies. Evidence also shows that delaying cord clamping has no significant impact on the mother; Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in- the earlier the baby breastfeeds, the lesser the risk of death.

    Keeping the baby latched on to the mother will not only benefit the baby (see skin-to-skin contact) but will also prevent doing unnecessary procedures like putting the newborn on a cold surface for examination (thereby exposing the baby to hypothermia), administering glucose water or formula and foot printing (which increases risk of contamination from ink pads) and washing (the WHO standard is to delay washing up to 6 hours; the vernix protects the newborn from infection) (WHO, 2012). According to health center directors, who coordinated the health districts, health posts were not exposed to the The Promotion and Essential Obstetric and Neonatal Care strategy (ProCONE) strategy through this document, but instead through meetings and in an informal verbal manner from the coordinators or professional nurses of the centers to auxiliary nurses of health posts. The auxiliary nurses of health posts became part of quality improvement teams of the health centers. In health center meetings, the use of medical records and the monthly measurement of indicators were explained to personnel (EINC Bulliten, 2011). Related Studies

    Noting an alarming stagnation in the country’s neonatal mortality, rate, subsequent studies have documented a marked lack in the practice of newborn care interventions in the biggest health facilities in the country (World Health Organization, 2011). An observational study of consecutive deliveries using a standardized assessment tool to document minute-by-minute newborn care done in the first hour of life was undertaken in 51 hospitals in 9 regions of the country in 2008. The study found that philippine hospital practices prevented newborns from benefitting from their mother’s natural protection in the first hour of life. Further, the performance and timing of evidenced-based interventions in immediate newborn care (WHO, 2012).

    In these hospitals, their practices prevented Philippine newborns from benefiting from their mothers’ natural protection in the first hour of life and almost none in the study newborns benefited from the natural transfusion from delayed cord clamping. It should be known that any unnecessary delay and restriction on immediate thorough drying, early and sustained skin-to-skin contact, early latching, rooming in and full breastfeeding, compromised the newborns’ chance for maintenance of warmth and survival beyond the newborn period. Further, these interventions can be integral to hospital infection control practices as they directly reduce risk of neonatal sepsis ( EINC Bulletin, 2011).

    Only 3% of the study newborns were dried prior to or with cord cutting and only 1 of 26 with difficult breathing was dried first. Hypothermia can lead to infection, coagulation defects, acidosis, delayed fetal to newborn circulatory adjustment, hyaline membrane disease and brain hemorrhage. Unnecessary delays and resrictions on immediate and sustained skin-to-skin contact, early latching on, rooming in and full breastfeeding compromised the newborns chance for maintenance of warmth and sustained breastfeeding. These earliest interventions contribute to hospital infection control as they directly reduce risk of neonatal sepsis. Almost no newborn benefited from the natural transfusion through non-immediate cord clamping.

    A Cochrane systematic review of 7 Randomized Controlled Trials(RCTs) showed that among infants less than 37 weeks of gestation, non-immediate cord clamping is asspciated with fewer transfusions due to anemia or low blood pressure and fewer intraventricular hemorrhages. Full-term neonates also benefit by having lower incidence of anemia (WHO, 2012). Only 61. 3% of newborns was inititated to breastfeeding within the first hour. However, newborns were given a median of only about two minutes to get colostrumn, their immunization. Furthermore, they were being forced to breastfeed at a median of 10 mins, long before the typical newborn would be ready. More than 80% was exposed to hypothermia during washing. The WHO recommends that initial bathing should be six hours after birth or longer.

    The vernix was washed off at a median of 8 minutes thereby removing a protective barrier to bacteria such as E. coli and Group B Strep. Furthermore, washing removes the crawling reflex. Virtually all healthy newborns were suctioned unnecessarily, 80% more than once- a practice WHO discourages (WHO, 2012). Accordingly, of all the changes implemented by health posts, 13% (251) were replicas (identical or similar) of the changes implemented in the demonstration phase and 87% (1699) were new changes. The intervention replicated by most health posts (52%) was training in norms, procedures and/or clinical records of care for infants and young children.

    The second change most frequently replicated by health posts (48%) was home visits to increase the coverage of care for postpartum women. It is possible that home visits were also implemented in the case of neonates. Most new changes implemented by health posts related to content of care and information, and education and communication (IEC) activities. IEC activities were important to increase the coverage of care (Feria, 2011). The study concludes that the expansion of the Basic strategy from health centers to health posts in San Marcos was informal and not based on proven and documented “change packages. ” The study recommends future spread activities make more deliberate use of existing documentation.

    However, the supposition that increased and more systematic use of best practices documentation leads to better implementation and more improvement in indicators could be the subject of another study. Further, the methodology used in collecting data for this study did not allow for a thorough understanding of the process of reception, adaptation and integration of “best practices” into the daily activities of health units. A complementary case study could gain a better understanding of these processes (EINC Bulletin, 2011). Chapter 3 RESEARCH METHODOLOGY This chapter presents the research design, research locale, sampling design, respondents of the study, research instruments, scoring of the instruments, data gathering procedures, and statitical tools. Research Design

    This study utilize the descriptive type of research design, to determine the personal profile of the resspondents such as age, gender, years of hospital experience, employment status and there implementation status on the essential newborn care. It further looks into whether their is a significant relationship between the respondents profile and their on essential newborn care implementation. Research Locale This study was conducted at Adventist Medical Center – Iligan City formerly known as Mindanao Sanitarium and Hospital, located at Barangay San Miguel, Iligan City. It is an accredited ISO tertiary hospital with 130 bed capacity. It offers the following services: out-patient department, Radiology, Hemodialysis, Intensive Care,medical, surgical, ob-gyne, pediatric, Dental, Optical services. Respondent of the Study

    The respondents of the study consist of all the 10 registered nurses assisting the Pediatrician in the delivery of the newborn regardless of age, gender, years of hospital experience, employment status and there implementation on the essential newborn care. Sampling Technique A purposive sampling technique was used in choosing all the respondents of the study. Accoring to Polit and Beck (2004) purposive sampling, the target population of aggregate cases which we would like to make generalization. Research Instrument This study made use of 9 item questionaire which consist two parts. Part one includes the respondents personal profile such as age, gender, years of hospital experience, employment status and essential newborn care training.

    Part two includes 4 items on Essential Newborn Care implementation taken from Essential Newborn Care Unang Yakap Bulliten (2012) such as the Immediate and thorough drying for 30 seconds to one minute warms the newborn and stimulates breathing, early skin to skin-to-skin contact between mother and newborn and delayed washing for at least six hours to prevents hypothermia, infection and hypoglycemia, properly-timed cord clamping and cutting prevents anemia and protects against brain hemorrhage in premature newborns. Properly timed cord-clamping means waiting for the cord pulsations to stop (between 1-3 minutes), non-separation of newborn and mother for early breastfeeding. Scoring of the Instrument

    Essential Newborn Care implementation in the hospital and the questionnaire was scored by the respondents using this methods and it vary according to its parts. The first part was to observe the respondents through checking the corresponding box that aligns the entry of each category. The second part of the questionnaire was answered through ticking the number that corresponds to its answer. These numbers contain a specific description that identifies their level of knowledge. These are the descriptive rating scale or perception scale which was used and given below: Fully implemented= 100% Implemented= 75% Partially implemented= 50% Not implemented= 0% Data Gathering Procedure

    This study followed a step- by-step process to ensure that the data gathering procedure adheres according to the guidelines concerned and involved. The processes are depicted below: First, a letter or approval was made by the researchers was noted by the thesis adviser. Second, this letter of approval was addressed to the thesis adviser, research coordinator, dean of nursing, vice president of academic affairs and to the vice president for nursing services of the hospital. All signature affixed was also reflected on the letter for the respondents. Third, after the signatories was gathered. The implementation process on the designated date was conducted.

    Fourth, during the data gathering process, a courtesy call was made to the vice president for nursing services of Adventist Medical Center accompanied with using the checklist for self-evaluation of the essential newborn care implementation among the nurses assisting the newborn. Fifth, after the data gathering procedure, tabulation and tallying of data was performed and this was subjected for analysis and interpretation using the defined and appropriate statistical tools. Statistical Tools The data gather was summarized, interpreted and analyzed using the following statistical techniques: 1. Frequency Count and Percentages These tools is used to determine the personal profile of the respondents. Formula: F/N x 100 Where: F- Frequency of Respondents N- Total number of Respondents 00 constant used to convert the decimal number to percent. 2. Weighted Mean This test was used to determine the respondents Essential Newborn Care Implementation. Formula: xw=i=1nkixin Where: xw=weighted mean xi=actual score ki=weight attached n=number of observation 3. Chi-square test This test was utilized for the significant relationship between personal profile and their Esential Newborn Care implementation. Formula: x? =?? (Oij – Eij) Eij Where: Oij= observed pregnancy Eij= expected pregnancy V= (c-i)(r-1) Critical region is x? > x? a = 0. 05 Chapter 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA This chapter presents the results, analysis and discussions of the data gathered.

    The discussion is divided into three parts, which are the following: Part 1 presents the respondents’ profile in terms of age, gender, and years of hospital experience, employment status and essential newborn care training. Part 2 presents the Essential Newborn Care (ENC) implementation among the respondents. And lastly, Part 3 presents the significant differences in the respondents’ response, and then they are grouped according to their personal profile. Part I. Profile of the Respondents Table 1 Distribution of Respondents in Terms of Age Age (in years)| Frequency| Percentage (%)| 22-24| 4| 40| 25-27| 3| 30| 28-above| 3| 30| Total | 10| 100. 0| Table 1 presents the distribution of respondents in terms of age.

    Result shows that 40% of the total respondents have age of 22-24 years, 3 or 30% have age ranges 25-27 years, and 3 or 30% falls within 28 years of age or more. This depicts that 4 or more out of every 10 respondents are 22-24 years of age. It reveals that 40% of the respondents are 22-24 years of age because mostly of them are newly registered nurse or newly pass the nursing licensure exam and they need skills and exposure. Table 2 Distribution of Respondents in Terms of Gender Gender| Frequency| Percentage (%)| Male| 0| 0| Female| 10| 100| Total | 38| 100. 0| Table 2 presents the distribution of respondents in terms of gender. Result shows that majority of the respondents are female. This indicates that out of 10 respondents are all female in the study.

    Nursing is traditionally thought of as a female profession, since woman are the one who care for the child and give the needs of the child and nurses are caregivers and usually act as partners in the health care team. Table 3 Distribution of Respondents in Terms of Years of Hospital Experience Years | Frequency| Percentage (%)| 11mos. -2| 7| 70| 3-4| 3| 30| Total | 10| 100. 0| Table 3 presents the distribution of respondents in terms of years of hospital experience. Result figures out majority of the respondents had11mos. -2 years of experience which consists 7 or 70% of them, and only 3 or 30% of the respondents are 3-4 years of hospital experience. This describes that 7 of the respondents in the study have 11months-. 2 years of hospital experience. Since that our respondents are newly graduated or pass the licensure exam.

    Most of the respondents had 11months – 2 years of experience. Table 4 Distribution of Respondents in Terms of Employment Status Employment Status| Frequency| Percentage (%)| contractual| 5| 50| reliever| 4| 40| regular| 1| 10| Total | 10| 100. 0| Table 4 presents the distribution of respondents in terms of their employment status. Result verifies that most of the respondents are contractual nurse (which comprises 5 or 50% of them), 4 or 40% are reliever nurse, and only 1 or 10% is regular nurse. This depicts that 5 out of every 10 respondents are contractual because of the needs of a newly registered nurses to have an experience in the hospital. Table 5

    Distribution of Respondents in Terms of Essential Newborn Care Training Essential Newborn Care Training| Frequency| Percentage (%)| yes| 10| 10| no| 0| 0| Total | 10| 100. 0| Table 5 presents the distribution in terms of Essential Newborn Care Training. Result displays that majority of the respondents are already of the new protocol of 4 steps of EssentialNewborn Care. This indicates that all respondents are trained on Essential Newborn Care by the DOH/CHO and are expected to implement of the Essential Newborn Care program. Part II. Essential Newborn Care Implementation Table 6 Distribution of Respondents’ to Essential Newborn Care Implementation DELIVERY ROOM NURSES/STAFF| Weight Mean| Description| 1.

    Immediate and thorough drying for 30 seconds to one minute warms the newborn and stimulates breathing. | 100%| Full implemented| 2. Early to skin-to-skin contact between mother and newborn and delayed washing for at least six hours prevents hypothermia, infection and hypoglycemia. | 100%| Fully implemented| 3. Properly timed cord-clamping means waiting for the cord pulsations to stop (between 1-3 minutes)| 75%| Implemented| 4. Non-separation of newborn and mother for early breastfeeding| 100%| Fully implemented| Overall Weighted Mean| 93. 75%| Fully implemented| Table 6 presents the distribution of respondents to Essential Newborn Care Implementation.

    Results reveals that Immediate and thorough drying for 30 seconds to one minute warms the newborn and stimulates breathing, Early skin-to-skin contact between mother and newborn and the delayed washing for atleast six hours prevens hypothermia, infection and hypoglycemia and the Non-separation of the newborn and mother for early breastfeeding was fully implemented by the nurses at Adventist Medical Center-Iligan City. This verifies that the respondents has the positive believe that essential newborn care implementation is beneficial to the mother and the baby. In contrast, proper timed cord-clamping while waiting for the cord pulsation to stop is implemented. Part III. Relationship Between Respondent’s Essential Newborn Care Implementation and their Profile Table 7

    Relationships between Respondent’s Essential Newborn Care implementation and their Age Age (in years)| Essential Newborn Care Implementation| Total| x2-value/ p-value| remark| | Fully implemented| implemented| Partially implemented| Not implemented| | 0. 782/0. 676| Not signifi-cant| 22-24| 1| 3| 0| 0| 4| | | 25-27| 0| 3| 0| 0| 3| | | 28-above| 1| 2| 0| 0| 3| | | Total| 2| 8| 0| 0| 10| | | Table 8 Relationships between Respondents’ Essential Newborn Care Implementation and their Years of Hospital Experience Years of hospital experience| Essential Newborn Care Implementation| Total| x2-value/ p-value| remark| | Fully implemented| implemented| Partially implemented| Not implemented| | 3. 416/0. 332| Not signifi-cant| 11mos. -2yrs| 2| 5| 0| 0| 7| | | 3-4yrs| 0| 3| 0| 0| 3| | | Total| 2| 8| 0| 0| 10| | | Table 9

    Relationships between Respondents’ Essential Newborn Care Implementation and their Employment Status Employment status| Essential Newborn Care Implementation| Total| x2-value/ p-value| remark| | Fully implemented| Imple-mented| Partially implemented| Not implemented| | 0. 505/0. 777| Not signifi-cant| regular| 1| 0| 0| 0| 1| | | contractual| 1| 4| 0| 0| 5| | | reliever| 0| 4| 0| 0| 4| | | Total| 2| 8| 0| 0| 10| | | Table 7 presents the relationship between respondents’ Implementation on Essential Newborn Care and their age profile using Likelihood Chi-square test analysis. Result demonstrates that there is no significant relationship between respondents’ perception on Essential Newborn Care and their age, since the p-value of 0. 676 (with an X2-value=0. 782) exceeded at the 0. 05 level of significance.

    This suggests that the age classification of the respondents is independent how on they perceive the importance of essential newborn care. This implies regardless of the respondents’ age, it does not influence in the Essential Newborn Care implementation in the hospital as long as they recognize the importance of the program both to the mother and newborn. De Jesus (2012) Age classification of a nurse is not the basis on how they implement the Essential Newborn Care, as long as they have the skill to percieve the importance of Essential Newborn Care. Table 8 presents the relationship between respondents’ perceptions on Essential Newborn Care and their years of hospital experience profile using Likelihood Chi-square test analysis.

    Result demonstrates that there is no significant relationship between respondents’ perception on Essential Newborn Care and their years of hospital experience since the p-value of 0. 332 (with an X2-value=3. 416) exceeded at the 0. 05 level of significance. This suggests that the years of hospital experience classification of the respondents is independent how on they perceive the importance of essential newborn care. This implies that regardless of the respondents’ years of hospital experience, is not hindrance in their Essential Newborn Care implementation. Petri P. M (2012) A neonatal nurse should be a Registered Nurse (RN) with a four-year Bachelor of Science in Nursing Degree (BSN) regardless of their hospital experience as long as they know the importance of Essential Newborn Care.

    Table 9 presents the relationship between respondents’ perceptions on Essential Newborn Care and their Employment status profile using Likelihood Chi-square test analysis. Result demonstrates that there is no significant relationship between respondents’ perception on Essential Newborn Care and their Employment status, since the p-value of 0. 777 (with an X2-value=0. 505) exceeded at the 0. 05 level of significance. This suggests that the employment status classification of the respondents is independent how on they perceive the importance of essential newborn care. Thus, the null hypothesis which states that there is no significant relationship between the respondents ENC implementation status and their employment status was accepted. Black R. 2011) A graduate of Bachelor of Science in Nursing Degree and a Registered Nurse can take care of a newborn as long as they have the knowledge and skills in Essential Newborn Care that was being Implemented by the World Health Organization to decrease the mortality rate of newborn. Chapter 5 SUMMARY, FINDINGS, CONCLUSIONS AND RECOMMENDATIONS This chapter presents the summary, findings, conclusions and recommendations of the study. Summary This study deals on the essential newborn care protocol and aimed to determine if they implemented the new steps or checklist on the essential newborn care among delivery room nurses at Adventist Medical Center, Tibanga, Iligan City. The study employed a descriptive-correlational approached. It utilized a self-evaluation method using researcher-made questionnaire in the form of checklist.

    Using the purposive sampling, the researchers distributed copies of questionnaire to ten (10) Delivery room nurses who care the newborn after birth. The data collection process lasted for almost 3 weeks or exactly 20 days, from February 24 to march 15, 2013. This study utilizes the descriptive type of research design, to determine the personal profile of the respondents. It further looks into whether there is a significant relationship between the respondents profile and their implementation status on essential newborn care. The obtained data were analyzed and interpreted using the Percentage and Frequency Distribution, Weighted Mean and the Chi-Squared Test. Findings Based on the result presented in the preceding chapter, the following findings of the study are listed below: 1.

    Majority of the total number of respondents were aged 22-24 years (4, 40%), all were notably female (10, 100%), more of them were 11mos. -2 years of hospital experience (7, 70%); most of them are contractual nurse (which comprises 5 or 50% of them). 2. With the average mean score of 93. 75%, it implies that the respondents rated fully implemented on all indicators of essential newborn care implementation. 3. There is no significant relationship between personal profile and essential newborn care implementation, in terms of age (p-value=0. 676), Years of Hospital Experience (p-value=0. 332) and Employment Status (p-value=0. 777) since the p-value of each variable exceed at the 0. 05 level of significance. Conclusions

    Based on the results and findings derived from the study, the following conclusions are formulated below: Majority of the total number of respondents were aged 22-24 years (4, 40%), all were notably female (10, 100%), more of them were 11mos. -2 years of hospital experience (7, 70%); most of them are contractual nurse (which comprises 5 or 50% of them). It is verified that the age, gender, and years of hospital experience, employment status and essential newborn care training of the respondents did not significantly associated to the different factors observed under study, since that young women are very active and alert in their profession. With the average mean score of 93. 5%, it implies that the respondents rated fully implemented on all indicators of essential newborn care implementation. This implies that the respondents view essential newborn care more positively and they implemented actively. And there is no significant relationship between age, years of hospital experience, employment status and essential newborn care, in terms of age (p-value=0. 676), Years of Hospital Experience (p-value=0. 332) and Employment Status (p-value=0. 777) since the p-value of each variable exceed at the 0. 05 level of significance. The factors given under consideration did not influence the performance of the respondents as the data per seen. Recommendations

    Based on the conclusions given, the following recommendations are given below: Respondents. Essential Newborn Care provides quality outcome to the clients thereby preventing unnecessary newborn complication. If followed whole heartedly it will enhance quality of services to clients. Nursing Education. Students majoring in health-related courses, particularly nursing students should be future role models and advocates for essential newborn care. Thus they must be highly educated and more trained with regards to essential newborn care. Nursing Practice. Further studies should be conducted on this particular topic. BIBLIOGRAPHY A. BOOKS Kozier, Barbara, et al. (2004).

    Fundamental of Nursing Concepts, Process and Practice. 7th ed. Philippines: Pearson Education South Asia PTE Ltd. Littleton, L. and Engeboetson J. (2002). Maternal, Neonatal and Women’s Health Nursing, Thomson Asian Edition. Singapore: Thomson Asia Pte Ltd. Pillitteri, A. (2007). Maternal and Child Health Nursing: Care of Childbearing and Childrearing Family. 5th ed. Philippines: Lippincott Williams and Wilkins. B. MAGAZINES/JOURNAL DOH, 2009. AO no. 2008-0029 on Implementing Health Reforms for Rapid Reduction of Maternal and Newborn Mortality from http:// www. thewip. net/contributors/2007/07/breastfeeding_rates_decline_ac. html C. ELECTRONIC SOURCES Scott, B, R. 2008) Review of Literature on Strategies to Support Breastfeeding from www. health. sa. gov. au/… /Review-of-Breast Feeding- Literature-%20final. pdf D. DICTIONARY BMA Illustrated Medical Dictionary 2nd edition. Dorling Kindersley Publishers Ltd. APPENDIX A LETTER TO THE VICE PRESIDENT FOR NURSING SERVICES Shirley M. Bacus, RN, MAN, MPH Vice President for Nursing Services Adventist Medical Center Tibanga, Iligan City Madam, Greetings! We,the third year nursing students of Mindanao Sanitarium and Hospital College is presently working on a study entitled “ESSENTIAL NEWBORN CARE IMPLEMENTATION”, in partial fulfillment of the requirements for the degree Bachelor of Science in Nursing.

    In this connection, we are asking from your good office to please allow us to conduct our study among the nurses at the delivery room in the hospital. The data that will be gathered will be of great help for the accomplishment of this study. Please be assured that all data will be handled with utmost confidentiality. We are hoping that you will grant our humble request. Respectfully yours, Cristine Joy B. Molina Toni Rose Z. Ojeda Mae Kenneth B. Pranza Noted by:| Approved by:| MA. ALMIRA P. NEBRES, MAN, RNThesis Adviser| ROSELYN S. PACARDO, MAN, MM, RN,RMDean, College of Nursing| | | MERLIN M. ESPINOSA, DM, MAN , RN| MATILDE N. BENITO, Ed. D| Research Coordinator| Vice President for academic Affairs| QUESTIONNAIRE Dear respondents: Greetings!

    We are third nursing students of Mindanao Sanitarium and Hospital College is presently working on a study entitled “ESSENTIAL NEWBORN CARE IMPLEMENTATION”, in partial fulfilment of the requirement for the degree of Bachelor of Science in Nursing. In relation to this, may we ask you to please answer the attached questionnaire completely. Please be assured that all data will be handled with utmost confidentiality. Thank you for your cooperation. More power and God bless! Part I. Personal Profile Instructions. Please check (? ) the box next to your corresponding answer. Age: 22-24 25-2728 and above Gender: Female Male Years of Hospital Experience: 11mos. -2yrs 3-4 yrs Employment Status: contractual reliever regular Essential Newborn Care Training: yesno Part II Essential Newborn Care Implementation

    Instruction: Please check that applied by the respondents. Rating: 1. Fully Implemented 2. implemented 2. Partially implemented 4. Not implemented DELIVERY ROOM NURSES / STAFF| RESPONSES| | FULLY IMPLEMENTED1| IMPLEMENTED2| PARTIALLY IMPLEMENTED3| NOTIMPLEMENTED4| 1. Immediate and thorough drying for 30 seconds to one minute warms the newborn and stimulates breathing. | | | | | 2. Early skin to skin-to-skin contact between mother and newborn and delayed washing for at least six hours prevents hypothermia, infection and hypoglycemia. | | | | | 3. Properly timed cord-clamping means waiting for the cord pulsations to stop (between 1-3 minutes)| | | | | 4.

    Non-separation of newborn and mother for early breastfeeding| | | | | CURRICULUM VITAE Personal Information Name: Cristine Joy B. Molina Nick-name:“Joy” Gender:Female Status:Single Home Address:Poblacion, Salvador LanaodelNorte Religion: Roman Catholic Date of Birth: November 03, 1992 Place of Birth:Poblacion, Salvador LDN Parents: Father:Carlito B. Molina Mother:Rosario B. Molina Siblings: Cristita B. Molina-Macatol Bebelitha Molina- Cabrera Rosalito B. Molina Rosecar B. Molina Marie Rose B. Molina- Generalao Ruel B. Molina Educational Attainment:third year nursing student College:Mindanao Sanitarium and Hospital College Barangay San Miguel,Iligan City

    Secondary:Salvador National High School Salvador Lanao Del Norte Elementary:Salvador Central Elementary School Salvador Lanao Del Norte CURRICULUM VITAE Personal Information Name: Toni Rose Z. Ojeda Nick-name:Oshin Gender:Female Status:Single Home Address:Celdran Village, Bacayo Iligan City Religion: Roman Catholic Date of Birth: August 21, 1992 Place of Birth:Iligan City, Lanao del Norte Parents: Father:Alvin Escano Ojeda Mother:Sheila Zalsos Ojeda Siblings: Trisha Rose Z. Ojeda Educational Attainment:Third Year College College:Mindanao Sanitarium and Hospital College Barangay San Miguel Iligan City Secondary:Iligan City National Highschool Roxas Ave. Mahayahay Iligan CIty

    Elementary:Iligan City Sped Center Roxas Ave. Mahayahay Iligan City CURRICULUM VITAE Personal Information Name: Mae Kenneth B. Pranza Nick-name:Mae Gender:Female Status:Single Home Address:Pitogo, Zamboangga Del Sur Religion: Seventh – day Adventist Date of Birth: November 25, 1993 Place of Birth:Pitogo, ZDS Parents: Father:Celestino Flores Pranza Mother:Arlene Bulay Pranza Siblings: Mhara B. Pranza Marcel B. Pranza Educational Attainment:Third Year College College:Mindanao Sanitarium and Hospital College Barangay San Miguel Iligan City Secondary:Paulino Dari National Highschool Sugbay Dos, Pitogo ZDS Elementary:Pitogo Central Elementary School Pitogo, ZDS

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