Knowledge and Attitude among Nursing Personnel

Regarding Kangaroo Mother Care in

TUTH

By

Urmila Prajapati

A Research Report Submitted In Partial Fulfillment of the

Requirement for the Bachelor Degree of Hospital Nursing

In

Tribhuvan University

Institute of Medicine

Maharajgunj Nursing campus

Maharajgunj, Kathmandu

Nepal

June, 2009

APPROVAL SHEET

Research on “Knowledge and attitude among nursing personnel regarding

Kangaroo mother care in TUTH” is my bonafided work submitted for approval as

the partial fulfillment of the requirement of the Bachelor of Nursing with major in

Hospital Nursing from Maharajgunj nursing Campus, Institute of Medicine,

Tribhuvan University.

……………………………….…Urmila prajapati

B.N. 2nd year

August 22, 2009

………………………………………Ms. Mandira Onta, Associate Professor

Research Advisor

T.U., IOM

Maharajgunj Nursing Campus

Kathmandu, Nepal

Date:…………………………………

ACKNOWLEDGEMENT

This study has been completed with suggestion, support, guidance and contributions

of various individuals and institutions.

First of all I want to express my sincere gratitude to TU, IOM, and Nursing Campus

Maharajgung for providing me with the opportunity to do this study as the partial

fulfillment of Post Basic Bachelor in Nursing Programme. I would like to express my

sincere thanks to the campus chief Mrs Tara Pokharel, Assistant campus chief Mrs

Raj Devi Adhikari and BN second year co-ordinator Mrs Nira Pandy for providing

necessary advice, making necessary arrangements for data collection and precious

direction and guidance.

At the same time, I would like to extent my sincere thanks to the research teacher

Professor Dr Sarala Shrestha and Ms Milan Lopchan, Associate professor for

equipping with theoretical aspect of research and for valuable comments and

suggestions.

The researcher is extremely grateful to Mrs Mandira Onta, Associate Professor,

Research advisor, Maharahgunj Nursing Campus, for her guidance, precious time,

valuable suggestions and constructive criticism during the course of the study. She

always ensured that the researcher ought to go through the study systematically and it

is due to her efforts that the researcher was able to complete this study methodically

in time. The researcher always remains indebted for her valuable suggestion and help.

I also feel deeply indebted to the Medical Director and Matron of the TUTH for their

respective permission and supports to conduct this research work. I would like to

acknowledge the ward in charge of labor room, neonate ward maternity ward female

surgical ward and pediatric ward for providing permission to their staff in

participating research work.

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My special thanks go to all the respondents for their kind co-operation to complete my

research study even in busy time, without their support, this research will not appear

in real repot.

In the same way, I like to express my thanks to all staff of Library, Nursing Campus

Maharajgunj, the Liberian of Nepal Health Research Council and special thanks to Dr

Lila sundar Shrestha, MD Resident, Pediatric for helping me in searching necessary

literature for this study.

I would like to express my heartfelt gratitude to my parents for economic and

continuous support during the study. I am indebted to all other members of my home.

I wish to express my gratitude to my all colleagues who helped me directly or

indirectly during the period of completion of this study.

A last but not least I would like to extend heartly thanks Mr Raghu Prajapati continue

cooperation and support in computer formatting and processing throughout the study.

Urmila Prajapati

4

ABSTRACT

Low birth weight is an important cause of neonatal mortality in Nepal. Kangaroo

mother care is a universally available a simple inexpensive and biologically sound

method of care for LBW infant. An approach used in the case of the both preterm and

LBW babies based on continuous skin to skin contact with the mother design to

encourage breast feeding and provide continuous warmth. It is evidence based

standard of practice.

The objective of the study is to explore the existing knowledge and attitude of nursing

personnel regarding KMC.

The research design was descriptive exploratory. Adopting non probability purposive

sampling technique, 50 nurses were taken as respondents from labor room, neonate

ward, maternity ward, female surgical ward and pediatric ward where neonate are

expose. The self structured questionnaire was a combination of open and closed ended

question for exploring knowledge and Likert’s scale for attitude.

The result showed that respondent had the mean score of knowledge was 20.84 and

mean score of attitude was 41.14. The respondent with Bachelor in nursing obtained

higher knowledge score (55.81%) and attitude score (82.58%) than PCL nursing and

ANM. The respondents with practice of KMC obtained the knowledge score

(51.27%) and attitude score (84.7%) which is higher than the respondents without

practice of KMC. As regarding to working area the highest knowledge score (60.46%)

and attitude score (86%) was done by neonate ward. The respondents with training

obtained higher knowledge score (51.16%) and attitudes score (84%) than the

respondents without training. The increase the knowledge scores high the attitude

score and vise versa.

In conclusion to increase knowledge and attitude of KMC, nurses need educational

offerings highlighting the knowledge and skills needed to provide KMC safely and

effectively. In service education, training regarding KMC is necessary for staffs who

are working in concerned ward because these educational offerings should also

emphasize the value of KMC to infants and parents. Increased knowledge on KMC in

nurses lead to increase routine practice of this beneficial intervention. In addition,

knowledgeable nurses need to develop evidence-based policies and procedures that

will lead to successful KMC.

6

CONTENTS

LIST OF TABLES

LIST OF FIGURE

8

ABBREVIATION

IMR Infant mortality rate

NMR Neonatal Mortality rate

LBW Low birth weight

KMC Kangaroo mother care

UMN United Mission of Nepal

MDG Millennium Development Goal

PCL Proficiency Certificate Level

TUTH Tribhuwan University Teaching Hospital

WHO World Health Organization

DHS Demographic Health Statistic

SGA Small for gestational age

KMCTH Kathmandu Medical Collage Teaching Hospital

PMR Perinatal Mortality Rate

NICU Neonatal Intensive Care Unit

9

CHAPTER I

INTRODUCTION

1.1 Background

Every year globally, an estimates 4 million babies die before they reach the age of one

month. Deaths are far more likely to occur early in the neonatal period. This has been

neatly summarized as the ‘two third rule’ which stated that approximately two third of

all death in the first year of life occurs in first month of life. Of these deaths

approximately two third occur in the 1st week of life. Of these deaths, approximately

two third occurs in the first day of life. Neonatal mortality account for almost 40% of

all under five deaths and for nearly 60% of infant death. (SCF, 2004)

It is estimated that in Nepal nearly 50,000 children under one year of age die every 12

months. 2/3rd of them die with in 28 days of age, resulting in over 30,000 neonatal

deaths per year. Among those dying within the neonatal period, 20,000 (2/3 rd) die in

1st week of life. Nearly the same numbers of babies are stillborn. More than 16,000 of

those dying within the 1st week of life, die within 24 hours. As things stand, this

means that three to four newborns are dying every hours in Nepal. (SSMP, 2004)

Research from around the world has identified the main causes of newborn deaths.

LBW is an important contributing factor in many neonatal deaths. Direct causes of

neonatal deaths are birth asphyxia and injuries 29%, infections (tetanus, sepsis,

pneumonia, diarrhea) 32%, complication of prematurity 24%, congenital anomalies

10%, others 5%. (SCF,2001)

In Nepal infant and neonatal mortality and morbidity is very high: IMR as 48/1000

live birth, NMR as 33/1000 live births, and PMR as 47.4/1000 live births and still

births. (DHS, 2006)

There has been remarkable decline in infant mortality rates in Nepal over the past 15

years from 113 in 1987 to 64 in 2001. However this has not been matched by a similar

fall in neonatal mortality which has decrease from 45.2 in 1987 to 38.6 in

2001.consequently neonatal mortality has risen from 40% to 60% as a proportion of

infant mortality. Further significant reduction in infant and child mortality rate will

largely be dependent on reducing neonatal mortality rate.

There are no population based studies that describe the pattern of the direct causes of

neonatal death available for Nepal. Hospital based data suggest that the major direct

causes of neonatal death in Nepal are: birth asphyxia, infection, prematurity,/ LBW,

hypothermia.Although the exact prevalence of prematurity/LBW in Nepal is not

known data from community programme estimate LBW prevalence 21%, and hospital

based studies estimate about 27%. In addition to globally it is estimated that LBW

underlying factor in 60- 80% of neonatal death, making the management of LBW

babies an urgent concern to reduce NMR. (DHS, 2006)

Low birth weight is an important cause of neonatal mortality in Nepal. So it is a

significant problem in Nepal. Kangaroo mother care is one of the components in

integrated neonatal package for achieving millennium development goal.

Kangaroo mother care is a universally available a simple inexpensive and biologically

sound method of care for LBW infant. An approach used in the case of the both

preterm and LBW babies based on continuous skin to skin contact with the mother

design to encourage breast feeding and provide continuous warmth. It is evidence

based standard of practice. (SCF, 2004)

The term KMC has been derived from the marsupial care provided by animal

kangaroo to their young babies by keeping them in their pouch. In translate in Nepali,

it means Nawajat Sishulai Mayako Angalo.

2

Since 1978, Dr Rey and Martinez in Bogata, Colambia have developing KMC as an

alternative to traditional care of using incubators for the care of LBW to keep babies

warm as there were not enough incubator in hospital. They found that this method

was better than incubator care as it promoted breast feeding in addition to keeping the

babies warm. Since then this method of caring LBW babies has been discussed widely

and used to many countries.

UMN hospital at Tansen, Palpa is the first hospital to report using KMC in managing

LBW in 1996. In august 2006 with core finding Access project initiated KMC

services at health care facilities to complement community level KMC for LBW

neonate in Kanchanpur. Now the KMC is established in Paropakar Maternity and

Woman’s Hospital Thapathali. Kathmandu Medical collage teaching hospital and

Nepal Medical Collage, Atterkhel start using KMC since over 2 years. KMC has been

started recently in some hospital and communities as well.

Hypothermia is the major cause of morbidity and mortality in preterm, LBW infants.

Hypothermia is due more to lack of knowledge than lack of equipment.

LBW infant used nearly half their energy intake maintaining body temperature. So

provision of warmth and prevention of heat loss can significantly improve survival

rate which is only given by KMC because KMC helps to transmit temperature from

mother to baby through conduction method.

The use of air heated incubators has been the standard method providing a stable,

individualized thermal environment for the newborn infant at risk. The availability of

incubators and radiant warmers in industrialized countries has made neonatal

hypothermia uncommon, except in infants transported over long distance. In

developing countries however hypothermia still poses a significant threat to the

survival of LBW infants. These include maintaining incubator air, temperature, air

flow and relative humidity within a narrow range in order to provide a thermoneutral

environment. This level of regulation requires sophisticated modern equipment,

3

neonatal intensive care unit, highly skill professional and constant electricity supply.

The cost of such infrastructure is often prohibitive in developing countries which is

very expensive in relation to KMC.

KMC was developed to cope with the overcrowding, recurrent nosocomal infections

and scarcity of resources in hospital caring the LBW infants and was first reported in

the world literature in 1985. LBW occupy most neonatal care beds and spend longest

time in nursery, consuming large amount of hospital resources.

1.2 Statement of the problem

Knowledge and attitude among nursing personnel regarding kangaroo Mother Care

1.3 Rational of the study

LBW is common cause of neonatal mortality.

LBW baby occupy most neonatal care bed and spend longest time in nursery

consuming large amount of hospital service in high cost.

KMC has many benefits such as promote exclusive breast feeding, thermal

control, less morbidity (prevention of infection, apnea attack), prepare for

early discharge, maternal child stronger bonding increase confidence and deep

satisfaction to mother, caring her fragile baby with competently

Incubator care is not available all over the country and it is high economically

and technically. It is only available in the tertiary level of hospital like our

country. KMC takes part of incubator.

Nurses need to have more competent to use incubator but application of KMC

is very simple and biological sound.

Positive attitude of health personnel only can acceptability in this technique

that’s why researcher wants to study this topic.

Most of the nurses are directly associated in the care of mother and children.

They have great role to reduce neonatal mortality rate. So to reduce neonatal

4

mortality rate, they should have knowledge of KMC, important component of

the integrated neonatal package, to achieve MDG because in MDG NMR

should be reduced up to 15/1000 live births. (DHS, 2006)

1.4 Objectives

1.4.1 General objectives

To explore the existing knowledge and attitude of nursing personnel regarding KMC.

1.4.2 Specific objectives

1. To identify he knowledge of nurses regarding KMC

2. To find out the attitude of nurses regarding KMC.

1.5 Variables

1.5.1 Independent variables

Educational background

Working experience

Training in neonatal care

Practical experience in KMC

1.5.2 Dependent variables

Knowledge and attitude of nursing personnel regarding KMC

1.6 Operational definition

1. Neonate: newborn baby age of within 28 days

2. Low birth weight: birth weight less than 2500gm

3. Premature: baby delivers before 37 weeks.

4. Kangaroo mother care: skin to skin contact of baby in between the mother

breast

5. Nursing personnel: those nurse who have successfully completed PCL

nursing, bachelor and master in nursing, recognized from universities and

working in he ward.

5

6. Knowledge: education, intelligence and cognition about KMC and its

application.

7. Attitude: way of thinking or behaving related to KMC

8. Female surgical ward: Most bed of this ward is also occupied by postnatal

mother when maternity ward is overcrowded.

1.7 Research question

1. What is knowledge of nursing personnel regarding to kangaroo mother

care?

2. What is attitude of nursing personnel regarding to kangaroo mother

care?

1.8 Delimitation of study

The followings delimitation will be set for this study:

The study will be limited to nurses who are working on neonate exposure ward: labor

room, neonatal ward, maternity ward, female surgical ward, pediatric ward.

The respondent will be fifty people.

Total time of this study will be 7 weeks.

1.9 Significance of study

This study will provide baseline knowledge about knowledge and attitude of

nursing personnel regarding KMC in hospital setting.

It helps to plan for training and awareness from in service unit of nursing.

This study will help to make draft training manual to policy maker

Arrange in-service education so that in future KMC will use in hospital and

decrease the pressure in neonatal ward.

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1.10 Conceptual framework

Improve the practice of KMC

Improve health of

neonate

Decrease the neonatal

mortality rate

KnowledgeEducation

Working experience with neonate

Training

Attitude

Practical experience of KMC

7

CHAPTER II

LITERATURE REVIEW

Literature review is essential step. Literature related to the research problem and

reviewed to gain insight to problem. This chapter represents a review of related

literature both from research as well as non research area of report, article, documents,

journal and book.

Area of literature review

Introduction to low birth weight.

Knowledge related to kangaroo mother care

Literature related to independent variable

Summary of the literature.

2.1 Introduction to low birth weight

Birth weight is the first weight of the fetus or newborn obtained after birth. For live

births, birth weight should preferably be measured within the first hour of life, before

significant postnatal weight loss has occurred. (WHO & UNICEF, 2004)

Low birth weight has been defined by the World Health Organization (WHO) as

weight at birth of less than 2,500 grams (5.5 pounds). This practical cut-off

international comparison is based on epidemiologic observations that infants

weighing less than 2,500 are approximately 20 times more likely to die than heavier

babies. More common in developing than developed countries, a birth weight below

2,500 g contributes to a range of poor health outcomes. (WHO & UNICEF, 2004)

Low birth weight thus defines a heterogeneous group of infants: some are born early,

some are born growth restricted, and others are born both early and growth restricted.

Very low birth weight is less than 1,500 g (up to and including 1,499 g).

8

Extremely low birth weight is less than 1,000 g (up to and including 999 g).

(WHO & UNICEF, 2004)

Neonate less than 2500gm at the birth are termed as LBW. LBW infants are broadly

of two clinical types. First are those who are born before 37 weeks (preterm), because

birth weight is function of gestation age, a preterm baby is expected to have less in

weight. Second category of LBW infants includes those babies who have intrauterine

growth retardation. These babies are undernourished for a given gestation. They are,

therefore called small for gestational age. (Ghai,2000)

2.1.2 Causes

There are numerous and complex causes of a LBW. There is no single direct cause

but it happens more frequently to certain mothers eg pre-esclampsia, eclampsia,

severe anemia, poor nutrition, multiple pregnancyor in case of certain fetal problems

eg early rupture of membrane, chromosomal disorder, chronic fetal infectionor

placental condition eg placental insufficiency.(SCF, 2004)

Many factors affect the duration of gestation and of fetal growth, and thus, the birth

weight. They relate to the infant, the mother or the physical environment and play an

important role in determining the infant birth weight and future health. For example

same gestational age, girl weight less than boys, twins weight less than singleton,

women of short stature, living in high altitude and young women have smaller baby,

birth weight also affect mother diet from birth to pregnancy, life style, exposure to

disease drugs and socio economic condition of mother. (WHO & UNICEF, 2004)

2.1.3 Problems of LBW

The problems of LBW are breathing problems, low body temperature, low body

sugar, feeding problems, infections, jaundice and bleeding problems. (SCF, 2004)

9

Low birth-weight is closely associated with fetal and neonatal mortality and

morbidity, inhibited growth and cognitive development, and chronic disease later in

life. The shorter the gestation, the smaller the baby and the higher the risk of death,

morbidity and disability. It has been shown that the mortality range can vary 100-fold

across the spectrum of birth weight and rises continuously with decreasing weight.

Low birth weight due to restricted fetal growth affects the person throughout life and

is associated with poor growth in childhood and a higher incidence of adult diseases,

such as type 2 diabetes, hypertension and cardiovascular disease. (WHO & UNICEF,

2004)

2.1.4 Incidence of LBW

In the world, LBW is 15.5% where the number of live birth (1000) is 132,882. among

them in more developed country 7.0%, less developed country 16.5% and least

develop country 18.6%. in Asia 18.3%.(WHO & UNICEF, 2004)

As UNICEF/WHO estimates of incidence of LBW in 2000, in Nepal 21% is LBW

infants, number of LBW infants are 169/ 1000 and % of birth not weight is not

available (DHS, 2001)

In TUTH, a total of 1040 babies were born out of 3968 deliveries during this study

(shrwan 2063 – 32nd Asar 2064). The perinatal mortality for the same period was

20.44 per thousand births and NMR was 8.8 /1000 live birth. 11.19% of newborn

require admission to neonatal nursery for various problem during this period.

Neonatal sepsis( 54.38%),respiratory morbidities(19.55%) perinatal asphyxia with/

out (6.90%) neonatal hyperbilurubinmia (7.40%) need of supportive care by virtue of

LBW, both PT and SGA babies (5.80%).1.79% of babies has major congenital

malformations or recognized syndromes and another 1.3% of new born had isolated

congenital cardiac abnormalities.

10

The most common indication for admission to the unit were neonatal sepsis, birth

asphyxia and respiratory morbidities. LBW and SGA are among the important group

of neonate requiring nursery support. Respiratory morbidity and LBW are highlight

the need to upgrade existing nursery facilities n this hospital.(Sharma, Shrestha and

Shrestha, 2008)

2.2 Knowledge related to Kangaroo mother care

2.2.1 Kangaroo mother care

Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother.

It is a powerful, easy-to-use method to promote the health and well-being of infants

born preterm as well as full-term. Its key features are early, continuous and prolonged

skin-to-skin contact between the mother and the baby,exclusive breastfeeding

(ideally),it is initiated in hospital and can be continued at home, small babies can be

discharged early, mothers at home require adequate support and follow-up, effective

method that avoids the agitation routinely experienced in a busy ward with preterm

infants.(WHO,2003)

Kangaroo mother care is becoming an integral part of the care of low birth weight

infants worldwide. It provides economic savings to families and health care facilities

and many physiologic and psychobehavioral benefits to mothers and infants, the most

important of which is the promotion of successful breastfeeding.( Kirsten et al ,2001)

A universally available and biologically sound method of care for all newborns, but in

particular for premature babies, with three components: Skin-to-skin contact,

exclusive breast feeding, support to the mother and infant. (www.

Kangaroomothercare.com)

2.2.2 The two components of KMC are:

Skin-to-skin contact: 

Early, continuous and prolonged skin-to-skin contact between the mother and

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her baby is the basic component of KMC. The infant is placed on her mother's

chest between the breasts.

Exclusive breastfeeding: 

The baby on KMC is breastfed exclusively. Skin-to-skin contact promotes

lactation and facilitates the feeding interaction. (Kmci network manual)

2.2.3 Types of KMC

Continuous KMC: When KMC is practiced ideally for 24 hrs except cleaning diaper

or some personal activities of mother.

Partial or intermittent KMC: for certain period of a day or night, it will be applied to a

mother with c-section, sick mother or those who are not able to do KMC continuously

due to other domestic work. KMC that last less than one hour should be avoided

because frequent handling may be stressful for the baby. (kmci network manual)

2.2.4 Benefits of KMC

Breastfeeding: Studies have revealed that KMC results in increased breastfeeding

rates as well as increased duration of breastfeeding. Even when initiated late and for a

limited time during day and night, KMC has been shown to exert a beneficial effect

on breastfeeding.

Thermal control: Prolonged skin-to-skin contact between the mother and her preterm/

LBW infant provides effective thermal control with a reduced risk of hypothermia.

For stable babies, KMC is at least equivalent to conventional care with incubators in

terms of safety and thermal protection.

Early discharge: Studies have shown that KMC cared LBW infants could be

discharged from the hospital earlier than the conventionally managed babies. The

babies gained more weight on KMC than on conventional care.

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Less morbidity: Babies receiving KMC have more regular breathing and less

predisposition to apnea. KMC protects against nosocomial infections. Even after

discharge from the hospital, the morbidity amongst babies managed by KMC is less.

KMC is associated with reduced incidence of severe illness including pneumonia

during infancy.

Other effects: KMC helps both infants and parents. Mothers are less stressed during

kangaroo care as compared with a baby kept in incubator. Mothers prefer skin-to-skin

contact to conventional care. They report a stronger bonding with the baby, increased

confidence, and a deep satisfaction that they were able to do something special for

their babies. Fathers felt more relaxed, comfortable and better bonded while providing

kangaroo care. (kmci network manual)

2.2.5 Advantages of KMC

Kangaroo Mother Care is the low cost, humane technique for caring low birth weight

babies by direct skin to contact with the mother. Baby had weight gain average

30gm/pay in short duration of hospital 9 day. 100% baby an exclusive breast feeding

and KMC is acceptable to mother. Other advantage of this technique are low cost,

promote exclusive breast feeding practice and increases mother confidence in

handling small baby and build good mother and infant bonding.(Subedi et al )

KMC managed babies had better weight gain, earlier hospital discharge and, more

impressively, higher exclusive breast-feeding rates. KMC is an excellent adjunct to

the routine preterm care in a nursery. (Ramanathan et al,2001)

Low birth weight or prematurity results in the separation of infants from their mothers

immediately after birth because of the need for intensive care. These infants are

placed in an isolated environment in the incubator or under radiant warmer. This

isolation and separation reduces the opportunity for parents to interact with their

infants, which in turn, may lead to stressful interactions between mother and infant. In

KMC mother is more often the main care taker of baby. Mother is significantly more

13

involved in care taking activities like bathing, diapering, sleeping with their babies

and spend more time beyond care taking. So KMC facilitate mother baby attachment

in LBW infants.( Gathwala et al, 2008)

Most babies are home delivered and the home care of LBW is a challenge. KMC is

effective and safe in stable preterm infants and as effective on traditional care with

incubators. KMC because of its simplicity may have a place in home care of LBW

babies. (Gupta et al, 2007)

2.2.6 Kangaroo positioning

• The baby should be placed between the mother's breasts in an upright position.

• The head should be turned to one side and in a slightly extended position. This

slightly extended head position keeps the airway open and allows eye to eye contact

between the mother and her baby.

• The hips should be flexed and abducted in a "frog" position; the arms should also be

flexed.

• Baby's abdomen should be at the level of the mother's epigastrium. Mother's

breathing stimulates the baby, thus reducing the occurrence of apnea.

• Support the baby in bottom with a sling/binder.( Kmci network manual)

2.2.7 Time of initiation

KMC can be started as soon as the baby is stable. Babies with severe illnesses or

requiring special treatment should be managed according to the unit protocol. Short

KMC sessions can be initiated during recovery with ongoing medical treatment (IV

fluids, oxygen therapy). KMC can be provided while the baby is being fed via

orogastric tube or on oxygen therapy.(Kmci network manual)

2.2.8 When should KMC be discontinued?

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When the mother and baby are comfortable, KMC is continued for as long as

possible, at the institution & then at home. Often this is desirable until the baby's

gestation reaches term or the weight is around 2500 g. She starts wriggling to show

that she is uncomfortable, pulls her limbs out, cries and fusses every time the mother

tries to put her back skin to skin. This is the time to wean the baby from KMC.

Mothers can provide skin to skin contact occasionally after giving the baby a bath and

during cold nights(Kmci network manual)

The term kangaroo mother care ( KMC ) is derived from practical similarities to

marsupial care-giving, i.e., the premature infant is kept warm in the maternal pouch

and close to the breasts for unlimited feeding. It is a gentle and effective method that

avoid agitation routinely experienced in a busy ward with preterm infants. An

important main stay of kangaroo mother care is breastfeeding encouragement.

Preterm babies exposed to skin to skin contact showed a better mental development

and better results in motor tests. It also improves thermal care. All stable LBW babies

are candidate for KMC. Often this is desirable, until the baby’s gestation reaches term

or the weight is around 2500 g.(Thukral et al, 2008)

2.2.9 Discharge criteria for KMC

Discharge means letting the mother and baby go home. Their own environment,

however, could be very different from the KMC unit at facility, where they were

surrounded by supportive staff. Usually, a KMC baby can be discharged from the

hospital when the following criteria are met:

the baby is general health is good and there is no concurrent disease such as

apnea or infection;

he is feeding well, and is exclusively or predominantly breastfed;

he is gaining weight (at least 15g/kg/day for at least three consecutive days);

15

his temperature is stable in the KMC position (within the normal range for at

least three consecutive days)

the mother is confident in caring for the baby and is able to come regularly for

follow-up visits.(WHO,2003)

2.2.10 Physiologic effect in KMC

KMC is the practice of holding a premature infant naked except for a diaper and hat,

against the mother’s and father’s chest. Maternal kangaroo care and paternal kangaroo

care show similar physiologic effects, no adverse effect on energy expenditure.. Thus

both paternal and maternal kangaroo care should be promoted. (Bauer et al,1996)

Heart rate variability, especially the parasympathetic component, was high when the

infant was fussy in the open crib, indicating increased autonomic nervous system

activity. With kangaroo care, the infant fell asleep, and both sympathetic and

parasympathetic components of heart rate variability decreased. The wide fluctuations

in the parasympathetic component of heart rate variability suggest immaturity of the

sympathovagal response. Overall, kangaroo care produced changes in heart rate

variability that illustrate decreasing stress.( McCain et al , 2005)

For stable preterm infants weighing less than 1500 gm and less than 1 week of age,

1hour of skin-to-skin care is not a cold stress compared with care in a thermoneutral

incubator. (Bauer et al, 1997)

Heel stick is the most common painful procedure for preterm infants in neonatal

intensive care units. Resultant pain causes adverse physiological effects in major

organ systems. Infants experienced better balance in response in KMC than Incubator

care condition as shown by more autonomic stability during heel stick. KMC may be

helpful in mediating physiologic response to painful procedures in preterm infants.

(Cong X et al, 2009)

2.2.11 KMC in twins

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Twins can be simultaneously held in KMC without temperature or physiologic

compromise. Right and left breast temperatures differ. Infant temperatures remained

warm and increased during KC while staying within neutral thermal zone. The

temperatures of each twin in a pair were different as they lay on their respective

breast. (. Ludington-Hoe et al, 2006)

One Infant’s vital signs exceeded acceptable clinical limits during shared KC; vital

signs returned to normal range once Infant was returned to the incubator. Another

baby’s vital signs approximated clinically acceptable ranges throughout the session.

Breast temperatures did not differ. Individuality mandates vigilant assessment of

infant responses to shared KC. (Jarrell et al, 2009)

2.3 Literature related to independent variable

2.3.1 Literature related to training, education and experience,

KMC does not require any more staff than conventional care. Existing staff should

have training in the breast feeding and adequate training in all aspect of KMC.eg

when and how to initiate, how to position the baby between and during feed,

alternative feeding method during breast feeding is impossible, taking appropriate

action when problem is detected, deciding in discharge and ability to encourage and

support family.(WHO, 2003)

A national survey was conducted to assess practice, knowledge, barriers, and

perceptions regarding Kangaroo Care in USA. 82% of the respondents reported

practicing KC in their NICUs. Nurses were knowledgeable about KMC. Respondents

from NICUs in which KC is practiced were more positive in their perceptions than

respondents from NICUs that do not practice KC. The findings suggest that in order

to overcome barriers to the practice of KC, nurses need educational offerings

highlighting the knowledge and skills needed to provide KC safely and effectively.

(Engler et al, 2002)

17

2.3.2 Feasibility and acceptability of KMC

Hypothermia is the common problems in the newborns particularly among the LBW

babies. It is one of the major causes of morbidity and mortality among LBW babies.

KMC is the cost effective method of maintaining temperature of newborns especially

LBW without using costly equipment. KMC was easily accepted in hospital. Al the

mother except one were happy to carry out KMC. It is a simple method of keeping

babies warm. It can be applied easily at home hence its great importance in caring

LBW babies at home where most of the babies are born in Nepal.(Manandhar et al,

2006)

KMC was acceptable to mothers and staff. An important advantage of KMC over

previous conventional care is cost--US$20 vs US$66 per bed/day. This study confirms

that KMC for stabilized LBW in hospital is feasible, acceptable and cheap and in

hospitals with limited resources is an appropriate alternative to conventional incubator

care.( Lima et al, 2000)

2.4 Summary of literature review

Birth weight is the first weight of the fetus or newborn obtained after birth. Birth

weight less than 2500gm is termed as LBW. Low birth weight thus defines a

heterogeneous group of infants: some are born early, some are born growth restricted,

and others are born both early and growth restricted. There are numerous and complex

causes for the birth of LBW. There is no single direct cause but it happens more

frequently to certain mother, fetal and placental conditions. LBW have different

problems during the time of neonate and late adult. It is one of the important causes of

neonatal morbidity and mortality.

Kangaroo mother care is a non conventional method for caring for preterm and/ or

LBW newborns after initial stabilization. Its primary features are uninterrupted use of

adult body heat (skin to skin contact) to maintain the newborn’s temperature and

exclusive breast feeding.

The benefit of KMC is both for baby and mother such as exclusive breast feeding,

thermal control, early discharge, early weight gain, less morbidity, stronger maternal

18

child bonding. KMC can be initiated as soon as birth of baby or stable. At the time of

KMC baby should be kept in “frog” position in between the mother breast.

The criteria for discharge is appropriate weight gain, temperature maintained, well

feeding and mother gain confidence.

For starting KMC unit all the staff should be trained but not need extra staff in

nursery. As research show, staffs that are exposed to neonate have more knowledge.

Different physiological changes are present during KMC and conventional care in

term of heart rate, temperature regulation, low stress, oxygen saturation and relieve

pain also in painful procedure.

KMC can be provided in twin baby as sharing KMC. KMC is acceptable method both

mother and staff because of its benefit. It is feasible in develop and developing

country where the resources are limited. So it is integral part of caring LBW in the

nursery.

19

CHAPTER III

RESEARCH METHODOLOGY

This chapter deals with the research design and procedure was used in this study. It

contain the research design, study area, population and sample, sampling technique,

instrument, ethical consideration and stastical tools were used for data analysis.

3.1 Research design

A small scale descriptive study of explorative nature was used to assess the

knowledge and attitude of nurses regarding KMC.

3.1 Study area

This study was carried out in labor room, neonatal ward, maternity ward, female

surgical ward and pediatric ward where neonatal are exposed, in TUTH.

3.2 Study sample/ Sample size

Fifty nursing personnel working in TU Teaching Hospital.

3.3 Sampling method

Non probability purposive sampling technique was used in the study because of

because of availability and accessibility of the sample.

3.4 Inclusion criteria

Nurses with ANM, PCL nursing, bachelor in nursing, master in nursing.

Nurses working in labor room, neonatal ward, maternity ward, female surgical

ward and pediatric ward where neonatal are exposed, in TUTH

3.5 Exclusion criteria

Nursing personnel who have not willing to participate in this study.

3.6 Data collection instrument

Structure self report questionnaire technique was used for data collection. Both open

ended and close ended question was mentioned in questionnaire.

The questionnaire consist of

a. Socio-demographic information

b. Knowledge based question

c. Likert’s scale for attitude

3.7 Pre test of questionnaire

The questionnaire was tested on 10% of responded in Intermediate neonatal care unit

of Kanti Children Hospital. Necessary modification was done in the basis of result.

3.8 Validity and Reliability

3.8.1 Validity

The validity of instrument was mentioned by consulting with the advisor

and colleges for their valuable comments and suggestions.

Necessary modification was done in the instrument after consulting with

expert, advisor and colleague as appropriate for its validity.

3.8.2 Reliability

Reliability of the instrument will be mentioned by pre testing the

instrument in same setting in Kanti Children Hospital but responded, who

participate in pre testing, will exclude in study.

Feedback was taken and necessary modification was done on

questionnaire to get desire information.

3.9 Data collection procedure

The researcher took formal permission from the director and matron of TU

Teaching Hospital. Verbal consent was obtained from each respondent. Each

respondent was explained about the objectives of the study. English version

questionnaire was distributed all respondents for collecting data.

3.10 Data processing and analysis

After completion of data collection, data was checked for their completion and

accuracy categorized according to research objectives and analyzed using

different stastical method as appropriate: scoring, mean score and percentage

score of knowledge and attitude and presented in table, bar graph and piechart.

3.11 Ethical consideration

The objectives were explained to the respondents.

Verbal permission was taken from respondents.

Privacy and confidentiality and anonymity of all respondents was

maintained.

Human right and justice was maintained.

Information was used only for study purpose.

It was requested to the respondents to answer the question separately and

independently.

3.12 Measure to reduce bias

To reduce bias proper care was taken during research activities. The questionnaire

was distributed to all respondents with clear instruction by the researcher herself

and the questionnaire was collected on the same day.

CHAPTER IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with descriptive analysis and interpretation of data obtained from

50 nursing personnel of labor room, neonatal ward, maternity ward, female surgical

ward and pediatric ward in TUTH regarding knowledge and attitude of Kangaroo

Mother Care. The collected data have been analyzed considering the research

questions and objectives of the study, through numerical order. The results were

presented in different tables, bar diagram and pie charts. For the data analysis, simple

statistical method of analysis was adopted in this study. The data have been taken

from primary source.

Analysis and Interpretation of the data has been organized in the following three

ways:

Part I : Socio-demographic characteristics of the respondents.

Part II : Knowledge regarding Kangaroo Mother Care

Part III : Attitude regarding Kangaroo Mother Care

Part I: Socio-demographic characteristics of the respondents

It includes age group, educational level, work area, work experience, position training

and name of the training of respondents.

TABLE: 1

Distribution of respondents according to socio demographic information

n=50

Characteristics Frequency Percentage

Age group

20-25 33 66

26-30 5 10

31-35 2 4

36-40 4 8

above 40yrs 6 12

Educational level

ANM 1 2

PCL 41 82

Bachelor 8 16Master 0 0

Working area

Labor room 9 18

Neonate 10 20Maternity 10 20Female Surgical Ward

13 26

Pediatric 8 16

Work experience

1month-1yr 19 38

1-2yr 9 18

2-3yr 3 6

3-4yr 3 6

4-5yrs 3 6Above 5 yrs 13 26

Designation

Staff nurse 37 74

Senior staff nurse 0 0

Sister 13 26

TrainingYes 5 10

No 45 90

If yes, name of training

Essential new born care

3 60

KMC 1 20Saving new born 1 20

The above table shows that most of the respondents were from the age group 22-25

which were accounted for 33 (66%) and least age group is 31-35 which were

accounted for 2 (4%).

Majority of respondent had educational level of PCL in nursing that is 41 (82%) and

1 (2%) out of 50 is ANM.

Most of the respondents were participate from female surgical ward 13 (26%)

followed by neonate ward 10 (20%), maternity ward 10 (20%), labor room 9 (18%),

and pediatric ward 8 (16%).

Majority of respondents had work experience 1momth – 1year 19 (38%) and followed

by above 5 yrs 13 (26%), 1-2yrs 9 (18%), 2-3yrs 3 (6%), 3-4yrs 3 (6%), and 4-5yrs 3

(6%).

Most of respondents had position of staff nurse which is account for 37 (74%), and

position of sister is 13 (26%).

Regarding training only 5 (10%) respondent had taken, and out of five , 3 (60%) had

essential newborn care, 1 (20%) had saving new born and other1 (20%) had taken

Kangaroo Mother Care which shows majority of respondents 45 (90%) were deprived

of specific training.

Part II: Knowledge related to Kangaroo mother care

TABLE: 2

Respondents Knowledge regarding birth weight with 2400gm n = 50

SN Responses Frequency Percentage1 Normal weight 3 62 Low birth weight 45 903 Very LBW 1 23 Extremely LBW 1 2

  Total 50 100

The above table depicts that majority of respondents 45 (90%) answered the baby

birth weight with 2500gm represent LBW, 1 (2%) respondent answered very LBW

and another 1 respondent (2%) answered extremely LBW.

TABLE: 3

Respondents Knowledge on survival Chance of LBW

n=50

SN Responses Frequency Percentage1 Same for other newborn 5 102 Better than average baby 2 4

3Lower than babies with birth weight 2500gm

42 84

4 Little lower than very LBW 1 2Total 50 100

The above table shows maximum of respondents 42 (84%) had a knowledge of baby

with low birth weight have lower chance of survival than baby with birth weight

2500gm , 5 (10%) had same for other newborn, 2 (4%) had better than average baby

and 1 (2%) respondent had little lower than very LBW.

TABLE: 4

Respondents Knowledgon Common problem of LBW

n=50

SN *Responses Frequency Percentage1 Hypothermia 43 862 Hypoglycemia 10 203 Infection 6 12

4Respiratory distress

6 12

*Multiple responses answer

Table 4 shows that majority of respondents 43 (86%) had knowledge of hypothermia

and followed by hypoglycemia 10 (20%), infection 6 (12%) and respiratory distress 6

(12%).

No30%

yes70%

yes

No

FIGURE: 1

Distribution of respondents in care of LBW (n=50)

Figure 1 show that majority of respondents 35 (70%) had cared LBW and 15(30%)

respondents had not cared LBW.

16%

30%

34%

24%

0

2

4

6

8

10

12

14

16

18

No

. of R

espo

nd

ents

Incubator

Radiant Warmmer

Kangaroo mother care

Wrapping with cloth

FIGURE: 2

Distribution of respondents knowledge of keeping warm to the baby (n = 50)

Figure 2 shows that majority of respondents17 (34%) used Kangaroo mother care in

practice for keeping warm to LBW and 15 (30%) used radiant warmer, 12 (24%) used

wrapping cloth and only 8 (16%) used incubator.

TABLE: 5

Respondents Knowledge on care of LBW after birth

n=50

SN Responses Frequency Percentage

1Bath soon after birth to prevent infection

1 2

2prolong skin to skin contact with mother

48 96

3 Antibiotic by injection 1 2

4Small amount of sugar water in 1st day of life

0 0

  Total 50 100

Table 5 present that most of respondents 48 (96%) had knowledge on care of LBW

after birth is prolong skin to skin contact with mother after delivery , 1 (2%)answered

bath soon after birth to prevent infection, 1 (2%) answered antibiotic by injection

TABLE: 6

Distribution of respondent on official media about KMC

n=50

SN Responses Frequency Percentage1 Yes 44 882 No 6 12

Total 50 100if yes name of media* (n=44)

1 Book 34 77.272 Practice of KMC 5 11.363  Nursing conference 6 13.634 Magazine 1 2.275 Neonatal unit 3 6.816 Training 2 4.547 Internet 1 2.27*Multiple responses answer

Table 6 present that majority of respondents 44 (88%) had heard about Kangaroo

mother care and 4 (12%) had not heard about kangaroo mother care. Among of them

most respondents 34 (77.27%) had known about kangaroo mother care from book and

only 1 (2.27%) heard from magazine and another 1 (2.27%) from internet.

All the respondents 50 (100%) had knowledge on meaning of Kangaroo mother care

TABLE: 7Respondents Knowledge on initiation of Kangaroo mother Care

  n=50

SN Responses Frequency Percentage

1 Start soon after birth 43 86

2 after one hour of birth 3 6

3 after 24 hours of birth 4 8

4when the neonate is unstable

0 0

  Total 50 100

Table 7 shows that majority of respondents 43 (86%) had knowledge of kangaroo

mother care have to start soon after birth followed by 4 (8%) after 24 hours of birth, 3

(6%) after one hour of birth and none of them response when the neonate is unstable.

18%

6%

64%

36%

0

5

10

15

20

25

30

35

40

No

. of R

es

po

nd

en

ts

Socks/gloves

A long sleeved shirt

A cap to cover head

Napkin

FIGURE: 3

Respondent knowledge on clothing of baby for KMC (n = 50)

Figure 3 shows that majority of respondents 32 (64%) answered the baby should wear

a cap to cover the head, 18 (36%) napkin, 9 (18%) a long sleeve shirt and only 3 (6%)

answered a long sleeved shirt.

TABLE: 8Respondent knowledge on type of position to maintain KMC

  n=50

SN Respondents Frequency Percentage1 Lateral position 2 42 Frog position 15 303 Prone position 9 184 comfort position 4 85 upright position 5 106 not known 15 30

  Total 50 100

Table 8 present that 15 (30%) respondent had knowledge of position of baby during

kangaroo mother care and followed by 15 (30%) did not know about position, 9

(18%) prone position, 5 (10%) upright position, 4(8%) any comfort position and 2

(4%) lateral position.

TABLE: 9

Respondents knowledge on monitoring during Kangaroo mother care

n=50

SN *Respondents Frequency Percentage1 Temperature 36 72

2 Breathing and well being

10 20

3 Feeding 5 104 Weighing 6 12

*Multiple response answers

Table 9 shows that most of the respondents 36 (72%) had knowledge of monitoring

temperature during kangaroo mother care, 10 (20%) had knowledge of breathing and

well being, 6 (12%) had monitoring weight and 5 (10%) answered feeding is also

important.

TABLE: 10

Respondents Knowledge: Kangaroo mother care while mother is sleeping

  n=50

SN Responses Frequency Percentage1 Yes 31 622 No 19 38  Total 50 100  If yes, how (n =31)  1 15 degree head high 1 3.22

2 Semi recumbent position

5 16.12

3 Supine position 3 9.67

4Other member can help to continue

2 6.45

5 With comfort position 1 3.226 Lateral position 2 6.457 KMC Chair 1 3.228 Not known 16 51.62

  Total 31 100

Table 11 replicates that 31 (62%) respondent have the knowledge of kangaroo mother

care can continue while mother is sleeping and 19 (38%) not. But among them16

(51.61%) do not know the position of mother, 5 (16.12%) semi recumbent position, 3

(9.67%) have supine position, 2 ( 6.45%) have baby taken by other members to

continue KMC, 2 (6.45%) have lateral position1 (3.22%) have with comfort position,

and 1 ( 3.22%) KMC chair. Only 1 (3.22%) have knowledge of 15o head high during

sleeping.

TABLE: 11

Respondents Knowledge: Temperature in KMC room

 n=50

SN Description Frequency Percentage

1 25oC 18 36

2 24oC 6 12

3 28oC 26 52

4 22oC 0 0  Total 50 100

Table 11 presents that 26 (52%) respondents answered that temperature in KMC room

need 28oC and fallowed 25oC by 18 (36%) and 24oC by 6 (12%) and none answered

22oC.

TABLE: 12

Respondents Knowledge: Eligible criteria of mother for kangaroo mother care

(n=50)

SN *Responses Frequency Percentage1 Willingness of mother 39 782 Healthy mother 19 383 Support from family 18 36

4 Not supporting community

0 0

*Multiple response answer

Table 12 reveals that 39 (78%) respondents had knowledge of willingness of mother

is criteria for kangaroo mother care and followed healthy mother by 19 (38%),

support from family by 18 (36%).

22%

98%

28%

6%

36%

74%

4%

0

5

10

15

20

25

30

35

40

45

50

No

. of R

espo

nd

ents

Exclusive breast feding

Prevention of Hypothermia

Infection prevention

Prevention of Hypoglycemia

Weight gain

mother child bonding

secure

FIGURE: 4Knowledge of respondent: Benefit of KMC for baby (n= 50)

Figure 4 represents that 49 (98%) respondent have knowledge about prevention of

hypothermia, 37 (74%) have mother child bonding, 18 (36%) have weight gain, 14

(28%) have infection prevention, 11 (22%) have exclusive breast feeding, 3 (6%)

have prevention of hypoglycemia and 2 (4%) have secure of baby as benefit for the

baby.

90%

8%

34%

14%

32%

0

5

10

15

20

25

30

35

40

45

Maternal childbonding

Early discharge Confidence Cost reduce Maintain lactation

FIGURE: 5

Knowledge of respondent: Benefit of KMC for mother

Figure 6 shows that 45 (90%) respondents have knowledge about maternal child

bonding, 17 (34%) have confidence of mother, 16 (32%) have maintain lactation, 7

(14%) have cost reduce and only 4 (8%) have early discharge as benefit for the

mother.

TABLE: 13

Respondents Knowledge: Problems associated with Kangaroo mother care

n=50

SN *Items Frequency Percentage

1 Tiring of mother 29 58

2 Strong belief in high technology 10 20

N=50

3 Cultural barrier 19 38

4Non compliance of mother and health staff

19 38

*Multiple response answer

Table 13 shows 29 (58%) respondents response tiring of mother as problem

associated with kangaroo mother care, 19 (38%) response cultural barrier, 19 (38%)

response non compliance of mother and health staff and 10 (20%) response strong

belief in high technology.

TABLE: 14

Respondents Knowledge: Criteria for discharge in Kangaroo mother care

n=50

SN *Descriptions Frequency Percentage

1 Appropriate weight gain

29 58

2 Feeding well 18 36

3 Temperature maintain

24 48

4 Confident of mother 28 56

*Multiple response answer

Figure 14 shows that 29 (58%) respondents have a knowledge of appropriate weight

gain, 28 (56%) have a confident of mother, 24 (48%) have a temperature maintain and

18 (36%) have a feeding well as a criteria for discharge in kangaroo mother care.

TABLE: 15

Respondents Knowledge: Discontinue of Kangaroo mother Care

n=50

SN *Items Frequency Percentage

1 When baby reaches at 2500gm 22 44

2When baby doesn’t tolerate KMC

6 12

3When mother has no desire to continue KMC

7 14

4When mother is sick or unstable to provide KMC

27 54

*Multiple response answer

Figure 15 shows that 27 (54%) respondents have a knowledge of mother is sick or

unstable to provide KMC, 22 (44%) have a baby reaches at 2500gm, 7 (14%) have a

mother has no desire to continue KMC and 6 (12%) have a baby doesn’t tolerate

KMC, as a condition for discontinuing KMC.

TABLE: 16

Distribution of respondent according to total knowledge score about Kangaroo

mother care (n= 5)

SNTotal

knowledge score

No of respondents percentage

1 11-15 7 142 16-20 21 423 21-25 13 264 26-30 4 85 31-35 5 10

  Total 50 100

The above table shows that the total knowledge score in between 16-20 is highest that

is account for 21 (42%) of respondents and the lowest in between 26-30 that is

account for 4 (8%) of respondents

Part III: Scoring of the Likert’s scale for attitude of nurses regarding Kangaroo

mother care

There were 10 item used to asses the nurses’ attitude toward kangaroo mother care.

The items were based on Likert’s scale in which there were 5 categories of agreement

and disagreement. An approximately equal number of positively and negatively

worded statements were chosen to avoid bias.

During analysis, the respondent’s response of strongly agree and agree was kept as

positive response and disagree and strongly disagree response was kept as negative

response. Score 5 is awarded for strongly agree response in positive statement and

strongly disagree response for negative statement and score 1 is awarded vice versa.

The highest attitude score was 50 and lowest score is 10. A high score consistently

reflects positive attitude and low score reflects negative attitude.

FIGURE: 6

Scoring of the attitude by Likert’s scale (n= 50)

0

1

2

3

4

5

6

7

8

30 35 40 45 50

Series1

Figure 5 shows that the highest score is 49, scored by two respondents and lowest

score is 33 scored by only one respondent.

Knowledge scored according to independent variables

Total knowledge score of respondents was 43 and attitude score was 50. but

knowledge score and attitude score was affected by independent variables.

TABLE: 17

Relationship between independent and dependent variable

Independent variable    Dependent

variable      Knowledge Attitude

   Mean score Percentage

Mean score Percentage

Educational backgroundBachelor in nursing (n=8 ) 24 55.81 40 80PCL nursing (n = 41) 20.07 46.67 41.29 82.58ANM (n=1) 22 51.16 41 82   Practice  With practice of KMC (n = 17) 22.05 51.27 42.35 84.7Non practice of KMC(n = 33) 20.21 47 40.51 81.02   Working experienceLabor room (n = 9) 21 48.83 40.9 81.8Neonate ( n =10) 26 60.46 43 86Maternity (n= 10) 18 41.86 41 82Female surgical ward (n = 13 ) 20 46.51 41 82Pediatric ward (n = 8) 19 44.18 41 82   Training  With training (n = 5 ) 22 51.16 42 84Without training (n = 45) 20.71 48.16 41.02 82.04

The above table shows that the respondents with Bachelor in nursing scored in

knowledge is 24 (55.81%) which is higher than PCL in nursing but the attitude score

is more in PCL in nursing 41.29 (82.58%). The score of knowledge respondents with

practice of KMC had done 22.05 (51.27%) and attitude of score had done

42.35(84.7%) which is higher than respondents with non practice of KMC. The

respondents working in the neonate had the highest score in knowledge 26 (60.46%)

and attitude 43 (86%). The respondents who had the training scored in knowledge 22

(51.16%) and in attitude 42 (84%) which was higher than respondents who had not

training.

CHAPTER V

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

This chapter is concerned with the summary of the finding of the study. It contain

discussion along with the comparison of the finding with literature review,

recommendation, implication of the finding of the study, difficulties faced during the

study and plan of dissemination.

5.1 summary of the finding

All the obtained data were tabulated and interpreted on the basis of purposes and

objectives of the study and are stated below

5.1.1 Socio – demographic characteristics of the respondents

Among the respondents, majority of respondents were the age groups of 22-25yrs

33 (66%), and the least were from the age groups 31-35yrs 2 (4%).

Regarding the educational level majority of respondents are PCL in nursing 41

(82%), followed by Bachelor of nursing 8 (16%) and ANM 1 (2%), none were

master degree.

Most of the respondents were from the working area female surgical ward 13

(26%), and least from the working area maternity ward 10 (20%) and neonate

ward 10 (20%).

As for the working experience majority of respondents have the experience of

1month – 1 yrs 19 (38%) and followed by 2-3 yrs, 3-4 yrs and 4-5yrs 3 (6%).

Majority of respondents were in the position of staff nurse 37 (74%) and left were

in the position of sister 13 (26%).

As regarding to the training, majority respondents 45 (90%) did not have any

training about kangaroo mother care and new born care. Only 5 (10%) had

training, among them 3 had essential newborn care, 1 had kangaroo mother care

and other 1 had saving newborns.

5.1.2 Finding related to knowledge of respondents regarding Kangaroo mother

care

The result disclosure that 45 (90%)respondent have the knowledge of baby born with

birth weight 2400gm is LBW fallowed by normal weight 3 (6%), very LBW 1 (2%)

and extremely LBW 1 (2%).

Majority of respondent 42 (84%) had knowledge of survival chance of LBW is lower

than babies with birth weight less than 2500gm, 5 (10%) had same for the other

newborn, 2 (4%) had better than average newborn and 1 (2%) had little lower than

very LBW.

Majority of the respondents 43 (86%) identified hypothermia as the common problem

of neonate, and 10 (20%) identified hypoglycemia, 6 (12%) identified both infection

and respiratory distress as common problem of neonate.

Majority of respondent 35 (70%) had cared the LBW baby and left 15 (30%) had not

cared. Among them most 17 (34%) used kangaroo mother care, 15 (30%) used radiant

warmer 12 (24%) used wrapping cloth and only 8 (16%) used incubator to provide

warm to LBW.

Regarding care of LBW baby, majority respondent 48 (96%) had knowledge of care

of LBW prolong skin to skin contact, only few respondent 1 (2%) had LBW bath soon

after birth to prevent infection and other 1 (2%) had antibiotic by injection.

The great part of the respondent 44 (88%) had heard about KMC and left 6 (12%) had

not heard. Among them most 34 (77.27%) had heard from book, practice of KMC 5

(11.36%), nursing conference 6 (13.63%), magazine 1 (2.27%), neonate unit 3

(6.81%), training 2 (4.54%) and internet 1 (2.27%).

Further more findings revealed that all the respondents 50 (100%) had knowledge of

meaning of Kangaroo mother care.

Most of respondents 43 (86%) had answered Kangaroo mother care should be started

soon after birth, 4 (8%) after 24 hour of birth, 3 (6%) after one hour of birth.

The finding shows that majority of respondents 32 (64%) had answered baby should

wear a cap cover to head, 18 (36%) napkin, 9 (18%) socks/gloves, and 3 (6%) a long

sleeved shirt.

Majority of respondents 15 (30%) had knowledge of frog position of baby and other

15 (30%) had known about position.

The finding disclosure that most of respondents 36 (72%) had knowledge to monitor

temperature, 10 (20%) breathing and well being, 6 (12%) weight and 5 (10%) feeding.

Majority of respondents 31 (62%) had knowledge of mother continue KMC while

mother is sleeping and 19 (38%) had not. Among them only 1 (3.22%) answered 15

degree head high and 5 (16.12%) answered semi recumbent position.

Regarding the knowledge of room temperature in KMC room 26 (52%) had answered

28oC, 18 (36%) answered 25oC, and 6 (12%) answered 24oC.

Regarding the eligible criteria, 39 (78%) had knowledge of willingness of mother, 19

(38%) had healthy mother, and 18 (36%) had support from family.

Regarding the benefit of KMC to the baby majority of respondent 49 (98%) had

prevention of hypothermia, 18 (36%) weight gain, 37 (74%) knowledge of maternal

child bonding, 14 (28%) infection prevention, 11 (22%) excusive breast feeding, 3

(6%) prevention of hypoglycemia and only 1 (2%) security of baby.

Regarding the benefit of KMC to mother majority of respondents 45 (90%) had

knowledge of maternal child bonding, 17 (34%) confidence, 16 (32%) maintain

lactation, 7 (14%) cost reduce and 4 (8%) early discharge.

The finding revealed that majority of respondent 29 (58%) had answered tiring of

mother, 19 (38%) cultural barrier, 19 (38%) non compliance of mother and health

staff and 10 (20%) strong belief in high technology.

Regarding the criteria for discharge in KMC 29 (58%) had knowledge of weight gain,

28 (56%) confident of mother, 24 (48%) temperature maintain, 18 (36%) feeding

well.

Regarding the condition of discontinue of KMC 27 (54%) respondent had knowledge

of when the mother is unstable to provide KMC, 22 (44%) when baby reaches at

2500gm,7 (14%) when mother has no desire to continue KMC and 6 (12%) when

baby doesn’t tolerate KMC.

Majority of respondent 21 (42%) scored total knowledge score 16-20, least

respondents 4 (8%) scored 26- 30. The highest knowledge score 31- 35 was scored by

5 (10%) of respondents and the lowest knowledge score 11-15 was scored by 5 (10%)

of respondents.

5.1.3 Finding related to attitude of respondents regarding Kangaroo mother care

The scoring of attitude of respondents was done by Likert’s scale. The total score of

Likert’s scale was 50. The highest score 49 was scored by two respondents and the

lowest score 33 was scored by one respondent. Majority of respondents 7(14%)

scored 43 and 38. The least 1 (2%) scored 48 and 33 score.

5.1.4 Finding according to independent and dependent variable

The total score of knowledge is 43 and total score of attitude is 50. But the total score

was affected by independent variables. The summary of score was mean score.

Regarding to the educational level bachelor of nursing scored 24 (55.81%) in

knowledge and 40 (80%) in attitude which is higher than PCL in nursing and

ANM.

As far to the practice of KMC, respondents with practice of KMC scored

22.05 (51.27%) in knowledge and 42.35 (84.7%) in attitude which is higher

than respondents with non practice of KMC.

Regarding the working experience, respondent from the neonate ward scored

the highest 26 (60.46%) in knowledge and 43 (86%) in attitude.

Respondent with training score 22 (51.16%) in knowledge and 51.16 (42.84%)

which is higher than respondent without training.

5.2 Discussion

The result disclosure that 90% respondent have the knowledge of baby born with birth

weight 2400gm is LBW. This details is supported by WHO & UNICEF (2004)

Majority of respondent (84%) had knowledge of survival chance of LBW is lower

than babies with birth weight less than 2500gm because different problems, breathing

problems, low body temperature, low body sugar, feeding problems, infections,

jaundice and bleeding problems, are arises in LBW baby. This details is also

supported by SNL (2004)

Majority of the respondents (86%) identified hypothermia as the common problem of

neonate, and 20% identified hypoglycemia, 12% identified both infection and

respiratory distress as common problem of neonate. Hypothermia is the major cause

of neonatal death which is correct.

Majority of respondent 35 (70%) had cared the LBW baby and remaining 15 (30%)

had not cared. Only 8 (16%) used incubator to provide warm to LBW. The staffs who

were working in the neonatal ward giving this answer which is highly cost and need

specific technical knowledge and skill. This data is contradicted with SNL report.

The finding further more revealed that majority respondent 48 (96%) have knowledge

of care LBW soon after birth was prolong skin to skin contact. Majority respondent

had heard about KMC from different media, most from book 44 (88%). Because of

the curriculum of PCL 3rd year had included the topic of KMC, so the all respondent

(100%) had knowledge of meaning of Kangaroo mother care.

This study shows that 43 (86%) respondent had knowledge of KMC should be started

soon after birth this finding of data was contradict with the kmci_network manual

because it was stated as soon as baby is stable. But when exactly to initiate KMC

depends on the condition of mother as well as baby.

This study reveals that 32 (64%) respondents answered to wear napkin, cap to cover

head and 9 (18%) respondents answered to wear socks/ gloves. This finding is

supported by SNL (2004)

Since most of respondent were not practicing KMC, only 15 (30 %) respondent had

known the position of baby, frog position. This data was supported by WHO (2003).

Only the 1(3.22%) respondent had explained 15 degree head high from horizontal and

5(16.12%) explain semi recumbent. These are correct answer. 2 (6.45%) respondents

explained other member can help to continue KMC while mother is sleeping. Bauer et

al (1996) stated that Maternal kangaroo care and paternal kangaroo care show similar

physiologic effects, no adverse effect on energy expenditure. Thus both paternal and

maternal kangaroo care should be promoted. This finding is supported this data.

Most of respondent 49 (98%) had knowledge on the benefit of KMC to the baby is

prevention of hypothermia. This data is supported by Cattaneo et al (1998) he had

stated that hypothermia is significantly less common in KMC.

Most of respondents 45 (90%) had answered the benefit of KMC is maternal child

bonding. Colonna et al (1990) concluded that KMC method favored the development

of early mother infant relationship which is very important for long term well being of

the child. Gathwala et al (2008) concluded that Mother is significantly more involved

in care taking activities like bathing, diapering, sleeping with their babies and spend

more time beyond care taking. So KMC facilitate mother baby attachment in LBW

infants. This data is supported by these findings.

As regarding to weight gain, 18 (36%) respondents had answered the benefit of KMC

is weight gain. This data is also supported by subedi et al, she had suggested that baby

had weight gain average 30gm/ day in short duration of hospital 9 day and 100%

baby are in exclusive breast feeding. This finding also support the finding of this

study which is 16 (16%) respondents had answered the benefit of KMC is maintain

lactation.

4 (8%) respondents had answered the benefit of KMC is early discharge this data is

also supported by Ramanathan et al (2001), he had stated that in randomized control

study the duration of hospital stays are 27.2+/-7 Vs 34.6 +/- days in KMC and control

group respectively.

Regarding to the cost reduce, 7 (14%) respondents answered the benefit of KMC is

cost reduce Lima et al (2000) stated an important advantage of KMC over previous

conventional care is cost reduce-US$20 vs US$66 per bed/day in KMC and control

group respectively. This finding is also supported the finding of this study.

The finding revealed that majority of respondent (58%) had said tiring of mother,

(38%) cultural barrier, (38%) non compliance of mother and health staff and (20%)

strong belief in high technology. But in contrast to those responses Ramanathan et al

(2001) stated that in their study mothers did not report any feelings of discomfort

about holding the infant in Kangaroo position. As was learned out of questionnaire

and conversation with the parents, Kangaroo Care was socially acceptable for the

mothers. Mothers expressed high levels of satisfaction.

Regarding the criteria for discharge in KMC (58%) had knowledge of weight gain,

(56%) confident of mother, (48%) temperature maintain, (46%) feeding well. These

all criteria to be maintained for discharge as mention to WHO (2003)

Regarding the condition of discontinue of KMC 54% respondent had knowledge of

when the mother is unstable to provide KMC, (44%) baby reaches at 2500gm, (14%)

mother has no desire to continue KMC and (12%) baby doesn’t tolerate KMC.

Thukral et al sated that all stable LBW babies are candidate for KMC. Often this is

desirable, until the baby’s gestation reaches term or the weight is around 2500 g, these

responses are consistent.

The scoring of attitude of respondents was done by Likert’s scaleThe highest score 49

was scored by two respondents and the lowest score 33 was scored by one respondent.

Majority of respondents (7 respondents) scored 43 and 38. The least (1 respondent)

scored 48 and 33 score. Ramanathan et al (2001) stated that Staff nurses In NICU

fully supported KMC and endorsed this method as a part of routine neonatal care.

These score are also consistent to this study.

Regarding to the educational level bachelor of nursing scored 24 (55.81%) in

knowledge and 40 (80%) in attitude which is higher than PCL in nursing and ANM.

As far to the practice, respondents with practice of KMC scored 22.05 (51.27%) in

knowledge and 42.35 (84.7%) in attitude which is higher than respondents with non

practice KMC. Regarding the working experience, respondent from the neonate ward

scored the highest 26 (60.46%) in knowledge and 43 (86%) in attitude. Respondent

with training score 22 (51.16%) in knowledge and 51.16 (42.84%) which is higher

than respondent without training. Similar study was conducted in USA. Engler et al,

(2002) stated that 82% of the respondents reported practicing KC in their NICUs.

Nurses were knowledgeable about KMC. Respondents from NICUs in which KC is

practiced were more positive in their perceptions than respondents from NICUs that

do not practice KC. These findings are supported to this study.

5.3 Conclusion

The study was conducted to explore knowledge and attitude among nursing personnel

regarding Kangaroo mother care in TUTH. Data were taken from 50 nursing

personnel from the labour room, neonate ward, maternity ward, female surgical ward

and pediatric ward.

Based on the study report it is concluded that most of the respondents are in the age

group of 20- 25 yrs and PCL nursing in educational level. Most of the respondents are

from the working area of female surgical ward, work experience 1month -1 yrs in the

position of staff nurse. Majority respondents did not have any training regarding

Kangaroo mother care and new born care.

The result of the study shows that the score of knowledge and attitude is higher in the

nurses with bachelor degree in nursing than PCL and ANM. The knowledge and

attitude score of nurses with practice of KMC had higher than nurses without practice

KMC. As regarding to the working area the highest knowledge and attitude score was

from neonatal unit where KMC also practice. The nurses who had training had higher

score in knowledge and attitude than without training. The nurses who had higher

knowledge score had the higher attitude score or positive attitude in the Kangaroo

mother care.

The findings suggest that in order to increase knowledge and attitude of KMC, nurses

need educational offerings highlighting the knowledge and skills needed to provide

KMC safely and effectively. These educational offerings should also emphasize the

value of KMC to infants and parents. Increased knowledge on KMC in nurses lead to

increase routine use of this beneficial intervention. In addition, knowledgeable nurses

need to develop evidence-based policies and procedures that will lead to successful

KMC.

5.4 Implication of the study

Despite the limitation of this study the finding of the study have fallowing

implication.

For the future researcher

The study will be source of reference or baseline to future researcher of

Kangaroo mother care and other related studies.

This study will be helpful in order to conduct a research in large scale.

For concern authorities and policy maker

This study will be helpful to provide information about existing knowledge of

nursing personnel on Kangaroo mother care to concern authorities to some

extent.

The finding of the study will be beneficial to policy maker, NGOs and INGOs

to organize in service education and training package on Kangaroo mother

care for nursing personnel and other health personnel.

For the respondents

There seemed serious knowledge deficit in some area on Kangaroo mother

care. This study will help the respondent to realize their weakness and

encourage them toward self directed learning.

5.5 Recommendation

Recommendation for further study

A similar kind of study can be conducted in a large scale to draw

generalization.

Comparative study on this topic can be done taking sample from different

hospitals.

Recommendation for concerned person

Proper supervision and evaluation should be done at the nursing personnel

In service education/ refresher courses should be provided on a regular basis to

the nursing personnel regarding importance of KMC.

5.6 Strength of the study

This study tried to explore the present knowledge of Kangaroo mother care.

This study can be helpful while the educational programme and training for

nurses who are exposure to neonate in hospital or in community.

The researcher herself collected all the data to bring uniformity to the study

and reduce the risk of misleading finding.

The researcher has gained confidence from the study to do large scale research

and will be carried out further research in future.

The researcher got good co- operation and suggestion from her advisor.

The researcher gained detailed knowledge about Kangaroo mother care.

5.7 Limitation of the study

The study was limited up to 50 samples. The study was done in 5 different

wards of TU teaching hospital.

It was conducted on labor room, neonate ward, maternity ward, female

surgical ward and pediatric ward. Among these wards, female surgical ward

and pediatric ward is less concerned with neonate.

The researcher didn’t get time to observe nurses attitude during practice

period.

5.8 Difficulties faced by the researcher during study period

The researcher felt difficulties to find out adequate and appropriate literature

on knowledge of nursing personnel regarding Kangaroo mother care.

Due to the flow of patient and limited number of working staff, respondents

were very busy. So the researcher felt difficulties to collect information in

time.

Due to the time constraints, the researcher had a limit the study to self

administered questionnaire.

5.9 Plan for dissemination:

The investigator intends to disseminate the findings of the study through submission

of written report to following organization/ institution and person

1. Library of Maharajgunj Nursing Campus

2. Research advisor.

The investigator also plans to prepare the abstract of the study report and publish it in

health of nursing journal foe wider dissimination.

BIBLIOGRAPHY

1. Bauer, J., Sontheimer, D., Fischer, C. & Linderkam, O. (1996). Metabolic rate

and energy balance in very low birth weight infants during kangaroo holding

by their mothers and fathers. The journal of padiatric. 129(4), 608-611.

2. Cong, X., Ludington-Hoe, S.M., McCain, G. & Fu, P. (2009). Kangaroo Care

modifies preterm infant heart rate variability in response to heel stick pain:

Early Human Development. www.healthintermetwork.org

3. Dimenna, L. (2006). Consideration for implementation of a neonatal Kangaroo

care protocol. Neonatal Netw. 25 (6), 405-12 www.pubmed.org

4. Engler et al. (2002, May- June). Kangaroo Care: national survey of practice,

knowledge, barriers, and perception. MCN American Journal Maternal Child

Nursing. 27 (3), 146-53. www.pubmed.org

5. Gathwala, G., Singh, B. & Balhara, B. (2008). KMC Facilitate Mother Baby

Attachment in Low Birth Weight Infants. Indian Journal of pediatric. 75 (1),

43-47.

6. Ghai, O.P., Gupta, p.& Paul, V.K. (2000). Ghai Essential Pediatric (5th ed.)

Interprint

7. Ghimire, C. (2006). Knowledge and practice of nurses on prevention of

neonatal hypothermia. Unpublished dissertation, TU, IOM, Nursing Campus

Maharajgung

8. Gupta,M., Jora, R. & Bhatia,R. (2007). Kangaroo Mother Care in LBW

Infants A western Rajasthan Experience. Indian Journal of Pediatric. 74(8),

747-749. www.medind.nic.in

9. Jarrell, J.R., Ludington-Hoe, S.M., & Abouelfettoh, A. (2009). Kangaroo care

with twins: a case study in which one infant did not respond as expected.

Neonatal Netw. 28 (3) 157-63. www.healthinternetwork.org

10. kmci network manual. www.Kmcindia.org,

11. Lima, G., Quintero-Romero,S., Cattaneo, A.(2000). Feasibility, acceptability

and cost of kangaroo mother care in Recife, Brazil. Ann Trop Paediatric.20

(1), 22-26. www.pubmed.gov

12. Ludington- Hoe, S.M., Lewis, T., Cong, X. & Anderson, L. (2006). Breast-

Infant Temperature with Twins during Shared Kangaroo Care. Journal of

Obsteric Gynecol Neonatal Nursing. 35 ( 2), 223- 231

www.healthinternetwork.org

13. Ludington-Hoe et al. (2000).Kangaroo Care Compared to Incubators in

Maintaining Body Warmth in Preterm Infants Biological Research For

Nursing, 2 (1), 60-73. SAGE, Downloaded from http://brn.sagepub.com at

HINARI on April 1, 2000.

14. MaCain, G.C., Ludington-Hoe, S.M., Swinth, J.Y., & Hadeed, A.J. (2005).

Heart rate variability response of a preterm infant to kangaroo care. Journal of

Obesteric Gynaecol Neonatal Nursing. 34(6), 689-94.

15.Manandhar, D.S. (2008, 11-12 Jan). Establishing Kangaroo Mother Care

Service. Souvenir 6 th conference of perinatal society of Nepal . Kathmandu

16. Manandhar, S, Joshi, S., Bjracharya, B.L. & Manandhar, D.S. (2007).

Kangaroo mother Care at KMCTH. Journal of Nepal Pediatric Society. 26 (1),

46-48.

17. National Neonatal health strategy . (2004, January). Family health division,

Ministry of Health.

18. Ramanathan, K.,Paul, V.K., Deorari, A.K., Taneja, U.,&George, G.( 2001).

Kangaroo Mother Care in Very Low Birth Weight Infants. Indian Journal of

Pediatric. 68 (11), 1019-1023.

19. Save the children. (2004). Care of the Newborns, Reference Manual

20. Subba, R. (2007). Knowledge and practice regarding care of low birth weight

babies among postnatal mother. Unpublished dissertation, TU, IOM, Nursing

Campus MaharajgungSubedi,

21. K., Aryal, D.J., & Gurbacharya, S.M. (n.d.) Kangaroo Mother Care for Low

Birth Weight Babies: A Pospective Observational Study. Journal of Nepal

Pediatric Society. 29 (1)

22. Thukral, A., Chawla, D. Agarwal, R. Deorari, A.K.& Paul, V.K.(2008)

Kangaroo Mother Care-an Alternative to Conventional Care. Indian Journal of

Pediatric. 75 (5), 497-503.

23. WHO. (1997). Thermal protection of newborn: Practical guide. Maternal and

newborn health/ safe motherhood unit, Geneva.

24. WHO. (2003).Kangaroo Mother Care Practical Guide. Department of

Reproductive Health and Research, Geneva.

25. www.kangaroomothercare.com

26. WHO & UNICEF. (2004). Low Birth Weight, country, regional and global

estimate. www.who.int.

27. Subba, R. (2007). Knowledge and practice regarding care of low birth weight

babies among postnatal mother. Unpublished dissertation, TU, IOM, Nursing

Campus Maharajgung

APPENDIX I

WORK PLAN for RESEARCH PRACTICUM

From 2066/3/7 to 2066/4/23

S.No. Activities

Month Asad Shrawn

Week 1st 2nd 3rd 4th 5th 6th 7th

Date 7 14 21 28 4 11 18

1. Literature Review

2.Proposal writing and tool development.

3.Pre-testing and Data collection

4.Data analysis and interpretation

5.Provisional Report writing

6. Final Report writing

7.Report presentation and dissemination

NOTE:Topic was presented on the period of study block.

TRIBHUVAN UNIVERSITY

MAHARAJGUNJ NURSING CAMPUS

MAHARAJGUNJ, KATHMANDU

Topic: Knowledge and attitude among nursing personnel regarding Kangaroo mother

care in TUTH

Objective: To explore the existing knowledge and attitude of nursing personnel

regarding KMC

Direction: I am Urmila Prajapati, BN student of Maharajgunj Nursing Campus

fulfilling of research practicum, go head to do research. These questions are only for

the research purpose. Confidentiality and anonymity will be maintained throughout

data collection

SAMPLE NO: - DATE :-

PART – I

SOCIO-DEMOGRAPHIC INFORMATION

1) Age group in years

a) 20-25yrs b) 26-30yrs c) 31-35yrs

d) 36-40yrs e) above 40yrs

2) Educational level

a) ANM b) PCL c) Bachelor d) Master

3) Where do you work?

a) Labor room b) neonatal ward c) Maternity ward

d) Female surgical ward e) Pediatric ward

4) How much experience have you had in your ward?

a) 1month- 1year b) 1-2 yrs c) 2-3 yrs

d) 3- 4 yrs e) 4-5 yrs f) 5 yrs above

5) Your present position

a) Staff nurse b) senior staff nurse c) Sister

6) Have you had any training/ in service education related to new born care or

kangaroo mother care?

a) Yes b) No

6.1) If yes, Name the training …………………….

PART II

Questionnaire related to knowledge of kangaroo mother care

1) The baby born with weight 2400gm is

a. Normal weight for term baby

b. Low birth weight

c. Very LBW

d. Extremely low birth weight

2) Is LBW has equal chance of survival?

a. About the same for other newborn

b. Better than average newborn

c. Lower than babies with a birth weight of 2500gm

d. A little lower than those babies who are very LBW

3) Which is the common problem of LBW?

a. Hypothermia

b. Hypoglycemia

c. Infection

d. Respiratory distress

4) Did you care LBW baby?

a. Yes b. No

4.1) If yes, which method do you use to provide warm to baby?

a. Incubator

b. Radiant warmer

c. Kangaroo mother care

d. Wrapping with cloth

5) A typical LBW baby will benefit most from

a. Bath soon after birth to prevent infection

b. Prolong skin to skin contact with the mother

c. Antibiotic by injection

d. A small amount of sugar water in 1st day of life.

6) Have you ever heard about KMC?

a) Yes b) No

6.1) if yes, name media ……………………

7) What do you mean by KMC?

a. To keep in a warm room

b. Skin to skin contact of the newborn baby to the mother client

c. To be wrapped in the cloth

d. To keep in warm incubator

8) When is KMC initiated?

a. Start soon after birth

b. After one hour of birth

c. After 24 hours of birth

d. When the neonate is unstable

9) During the preparation of KMC, which cloth should be worn by baby?

a. Socks/ Gloves

b. A long sleeved shirt

c. A cap to cover head

d. Napkin.

10) What position should be maintained for baby during KMC?

……………………….

11) During KMC, what should be monitored?

a. Temperature

b. Breathing & well being

c. Feeding

d. Weight

12) Can KMC continue while mother is sleeping?

a. Yes b. No

12.1) If yes, how…………………………

13) AT least, how much temperature should be maintained in KMC room?

a. 25o C

b. 24o C

c. 28oC

d. 22oC

14) What kind of eligible criteria should mother have for KMC?

a. Willingness of mother

b. Healthy mother

c. Support from family

d. Not supporting community

15) Do you think KMC benefit for baby?

a. yes b. No

15.1) If yes, list out the benefit ………………………..

…………………………

…………………………

……………………………

16) Do you think KMC benefit for mother?

a. Yes b. No

16.1) If yes, list out the benefit ………………………….

…………………………….

………………………………

……………………………….

17) What are the problems associated with KMC?

a. Tiring of the mother

b. Strong belief in high technology

c. Cultural barrier

d. Non compliance of mother and health staff

18) What are the criteria for the discharge?

a. Appropriate weight gain

b. Feeding well

c. Temperature maintain

d. Confident of mother to take care baby

19) When should be discontinue KMC?

a. The baby reaches at 2500gm

b. The baby doesn’t tolerate KMC

c. The mother has no desire to continue KMC

d. The mother is sick or unstable to provide KMC

Part III

Likert’s scale for attitude regarding Kangaroo mother care

Please put the tick mark (√ ) in appropriate option according to your opinion

after reading the statement carefully.

A – Agree

SA – Strongly Agree

U – Uncertain (can not decide)

D – Disagree

SD – Strongly Disagree

SN statement SA A U D SD

1 KMC is useful method of care of LBW

2 KMC increase the workload in ward

3 KMC supervision hampers care to other

neonate in ward

4 Mothers are happy with this method of care

6 KMC increase milk output in the mother.

7 It is worthwhile putting effort in KMC.

8 KMC promote the bonding

9 KMC helps for exclusive breast feeding

10 It is necessary to maintain privacy in KMC

11 Policy of hospital is necessary for KMC

Thanks for your cooperation and giving your

valuable time

CONSENT FORM

Study Title: Knowledge and Attitude among nursing personnel regarding Kangaroo

Mother Care in TUTH

Researcher: Urmila Prajapati, Bachelor of Nursing, Second Year

Ms. Urmila Prajapati is, a student of Bachelor of Nursing in Maharajgung Nursing

Campus, studying the Knowledge and Attitude among nursing personnel regarding

kangaroo mother care in TUTH. Although this study may or may not be benefit you

directly, it explore the knowledge and attitude of nurses and help to make draft for

training package.

This study and procedure have been approved by the research guide of Maharajgung

Nursing Campus. This procedure involves no foreseeable risk or harms you. The

procedure include completing a socio-demographic data sheet, self administer

questionnaire for knowledge related to kangaroo mother care and Likert’s scale for

attitude. Participation in this study will take approximately 20 minutes. You are free

to ask any question about study.

Your participation in this study is voluntary, you are no under obligation to

participate. You have right to withdraw at any time.

The study data will be coded so it will not be linked to your name. your identity will

not be revealed while the study is being conducted or when the study is reported. All

the study data will be collected by Ms Urmila Prajapati, store in secure place and not

share with any other person without your permission.

I have read this consent form and voluntarily consent to participate in this study.

…………………………………

Subject’s signature

Date

I have explained this study to above subject and have sought her understanding for

informed consent.

………………………………….

Researcher’s signature

Date

PICTURES