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ASSESSMENT OF NEONATAL CARE PRACTICES OF NURSES IN SELECTED TERTIARY INSTITUTIONS

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CHAPTER ONE

INTRODUCTION

Background to the Study

Neonatal period comprises the first 28days of life. During this period, newborns are non verbal very vulnerable, and unable to actively participate in the patient identification process which increases the likelihood of neonatal morbidity and mortality.(National Association of Neonatal Nurses (NANN), 2014). Globally neonatal mortality rate fell by 40% between 1990 and 2013- from 33 to 20 deaths per 1,000 live births. Over the same period the number of newborn babies who died within the first 28days of life declined from 4.7million to 2.8million. (United Nations  Children’s Fund,(UNICEF),2014),

 

About half of under-five deaths occur in only five countries: China, Democratic Republic of the Congo, India, Nigeria and Pakistan. India (21%) and Nigeria (13%) together account for more than a third of all under-five deaths. Sub-Saharan Africa has the highest neonatal mortality rate (32 deaths per 1,000 live births in 2012) and accounts for 38 percent of global neonatal deaths. World Health Organization, (WHO), (2014), stated that children in Sub-Saharan Africa are over than 15 times more likely to die before the age of five than children in developed regions. Sub-Saharan Africa is among the regions showing the least progress in reducing the neonatal mortality rate. About 5.9 million babies are born in Nigeria every year, and nearly one million children die before the age of five years. One quarter of all under-five deaths are newborn: 241,000 babies each year, (Federal Ministry of Health, 2011).

 

About 5.9 million babies are born in Nigeria every year, and nearly one million children die before the age of five years, (WHO, in Toqan & Iman  2011). Federal Ministry of Health (2011) states that  Nigeria has achieved only an average of 1.2% reduction in under-five mortality since 1990 some effort has been made to reduce deaths after the first month of life (the neonatal period) although, there has been no measurable progress in reducing neonatal deaths over the past decade.

The questions or challenges are: how can these deaths be reduced? , what can be done towards achieving this? And who are directly involved? When can this be? Which health professionals are directly involved toward reducing the number of deaths of newborn in Nigeria? Prevention is the key to reducing these deaths. It starts with having stipulated standards which are built into a System or Institution in form of structure, process or outcome standards.  If measures are put in place and standards are set and adhered to, a lot can be achieved. Maintaining and improving patient care requires active involvement of everyone in health care system, in other to meet the needs of evaluating health care in its totality as well as to identify whether effective and appropriate care has been provided.

 

Standard is the major component of neonatal health care and it demands participation from nurses rendering care. According to Jemilugba (2011), standards are the yardsticks of measuring and evaluating the quality of education and performance of the practitioners in the health care delivery system. They are derived from core values which include respect for dignity of persons, integrity in service, compassion, tolerance, intellectual and psychomotor competencies and accountability. There is need for measuring the degree of skill, with which technique or procedure was carried out, the degree of client participation or the nature of interaction between nurse and client as a means of ensuring that good quality care is rendered. This is of upmost importance especially in neonatal units, considering the vulnerable nature of neonatal patients. For instance NANN (2014) noted that   errors in neonatal intensive  care unit (NICU) are common, especially  medication error, ranging from 13 to 91 medication errors per 100 NICU admissions, and to experience more harm when a medication error does occur. American Nurses Association (ANA), identified a number of other standards, including ethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resource utilization, and environmental health. All of these standards help to define what professional nursing is, and these are the standards to which the nurse is held accountable, (Witt, 2011).

 

Thus, professional nurses and midwives have a duty to adhere to principles of integrity, demonstrate respect for the profession, for colleagues, for clients and for the society as a whole. To ensure that the above is achieved, the Nursing and Midwifery Council of Nigeria (N&MCN) as a regulatory body has the responsibility to set acceptable standards and also to ensure compliance either by the professional nurse/midwives as well as the training institutions responsible for preparing these professionals.

 

In Nigeria, Jemilugba (2011) observed that standard of nursing practice is gradually falling from what it used to be in the past. Also documented evidence has shown that medication errors occur among health care providers including nurses. Simpson, Lynch, Grant and Alroomi (2004), carried a study on medication management and observed a total of 105 errors from their study, 4 serious, 45 potentially serious, and 56 minor. Out of the errors, most (75%) were reported by the clinical pharmacist, but all four serious errors were reported by medical or nursing staff involved in the error. Parenteral medicines were involved in 63 errors (60%), oral medicines in 41 errors (39%), and topical medicines in one error

 

If nursing practice is poor, ineffective and inefficient, then quality health care cannot be achieved in Nigeria. This is no doubt related to about nearly one million children that die before the age of five years in Nigeria. The study aims to assess Neonatal care practices of Nurses in selected Institutions in South-East, Nigeria.

 

Statement of the Problem

The burden of neonatal mortality in ill-equipped tertiary centers in Nigeria is enormous. Out of about 5.9million babies that are born in Nigeria annually, nearly one million children die before the age of five years. And one quarter of these deaths that are about 241,000 occur during neonatal period, (Federal Ministry of Health, 2011).  Nigeria is ranked third in the World Health Organization’s statistics of neonatal death after India and China, (UNICEF, 2014). The neonatal nurses’ practices need to be observed in order to find out whether they are performing correctly or not. The questions or challenges are: how can these deaths be reduced? What can be done towards achieving this? When can this be? Which health professionals are directly involved toward reducing the number of deaths of newborn in Nigeria.

 

There has been no measurable progress in reducing neonatal deaths-over past decade, despite the fact that nurses in NICU are rendering their services, the data above still shows increase in neonatal mortality. This increase inversely necessitate that the neonatal nurses practices be observed in order to find out whether they are performing correctly or not. This is very crucial if they are to attend adequately to the needs of this very vulnerable group of client. Federal Ministry of Health, (2011)  reported that attempts to improve standards  in neonatal care in Nigeria has been short-lived as there are a lot of deficiencies in the way care is rendered as well as unavailability of skilled personnel.

 

The area of concern then is; how adequate is the care in NICU. Does it mean that guideline is not maintained that we are having increase in neonatal mortality. In Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, the researcher observed from the record of newborn register that statistics showed that a large number of newborns, 771 in the year 2012 and 946 in 2013 were admitted in the neonatal unit. This showed that neonates and their parents attend the hospital yet from researchers’ observation those neonates and their parents were burdened by the neonates health condition as their needs were not adequately met, as they stay long in the hospital and seem depressed as observed by the researcher since year 2013 she started visiting the unit.

 

Based on the foregoing, and on the fact that no work on this to the best of the researcher’s knowledge has been done in the area of study, the researcher wants to fill the gap in knowledge.

 

Purpose of the Study

 

The purpose of the study is to assess Neonatal care practices of nurses in selected teaching Hospital in South-Eastern, Nigeria.

Objectives of the Study are to:        

  1. Determine nursing care practices of neonates among nurses in newborn units.
  2. Determine medication management practices among nurses in newborn units
  3. Ascertain infection prevention practices among nurses in newborn units.
  4. Determine family education practices among nurses in neonatal units.
  5. Ascertain practice evaluation practices among nurses in

 

Research Questions

  1. How do nurses in selected hospitals render nursing care practices to neonates?
  2. What are the medication management practices among nurses in selected hospitals like?
  3. What are their infection prevention practices?
  4. What are their family education practices?
  5. How are practices of neonatal nurses evaluated?

 

Research Hypotheses

  1. There is no significant difference between neonatal nurse’s year of work experience and their care practices of neonates.
  2. There is no significant difference between nurse’s qualification and their care practices of neonates.

 

Scope of the Study

This study is delimited to all nurses working in neonatal units of Nnamdi Azikiwe University Teaching Hospital, University of Nigeria Teaching Hospital, Enugu (UNTH) and Enugu State University Teaching Hospital, (ESUTH) in South-East Nigeria. The variables of interest are: nursing care of neonates, medication management, infection prevention, family education and practice evaluation.

 

Significance of the Study

The findings from this study will help to reveal areas of gap in nursing care of neonates, medication management, infection prevention, family education.  Findings from the study will be of use to health policy makers in the locality to develop policies that will favour adherence to adequate care if findings are put to use. This will be possible when areas of deficiencies are identified. With back-up policies nurses and health workers will be motivated to adhere according to stated guidelines for care. Neonates who are at the receiving end stand to benefit, so that errors are reduced.  Prevention of errors and the likely harms in the NICU will go a long way in reducing neonatal mortality rate in Nigeria. In addition, findings of the work will add to existing body of knowledge in the field of study. Other researchers who may wish to replicate this or similar topic in another locality will find the work useful.

 

Operational Definition of Terms

Neonates: Babies within 28 days of life who are ill and hospitalized.

Neonatal Care practices: As regards to the study, these are practices/activities routinely carried out to ensure neonates recovery and survival when they are ill and hospitalized. These activities/practices include: Nursing care, Medication management, Infection prevention, family education and practice evaluation.

Nursing Care practices-This will entail the different activities engaged by nurses for recovery of neonates. This may be in form of;

  1. Assessment: Which according to the study entails collecting comprehensive data based on neonate’s health and family? Prioritizing collected data and documenting relevant ones. If the nurses do not document relevant data, the practice is not adequate.
  2. Diagnosis-This entails using collected data to derive diagnosis. The diagnosis is refined and revised regularly.

iii.     Planning-This encompasses line of actions for a particular neonate. The plan is to be implemented in a safe and realistic manner. Planning will be measured when they are individualized and implemented in a safe and realistic manner.

Medication Management: These constitute the activities engaged by the nurse so that neonate’s drugs are administered properly. The activities includes, swabbing the top of vial with alcohol or alcohol containing disinfectant when drawing medication vaccines, not leaving the needle sticking into multi-drug vials for multiple patient usages and availability of comprehensive neonatal unit formulary.

Medication practices will be measured by adoption of the following;

  • Top of the vial is always swabbed with alcohol or alcohol containing disinfectant.
  • Needle is never left sticking into multi-dose vials for multiple patient usages
  • Comprehensive unit formulary is available in the unit.

 

Infection prevention practices-This will be measured by the adoption of the following practices:

  • Hand washing before and after contact with individual patients or the immediate environment and source of water to be from sink.           
  • Hand hygiene includes keeping finger nails short and not using artificial nails or nail extenders.
  • Abiding by the written policy for general hygiene and cleaning of surfaces, walls and general equipment.

 

Family education practices: These are practices employed by nurses to ensure that parents of the neonates are empowered as regards the health needs of their neonates. In this study, this includes:

  • Assessing the family’s ability and willingness to learn.
  • Teaching topics that relates to neonates and safe use of medical equipment.

Collaborating with health professionals to provide e

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