RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON MOTHERS OF UNDER 5 CHILDREN

REGARDING KNOWLEDGE, ATTITUDE AND PRACTICE ON THE

IMPORTANCE

OF PLAY NEEDS DURING HOSPITALIZATION

IN SELECTED HOSPITALS

IN KOLAR

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

KRISHNA HANDA

A.E.& C.S. PAVAN COLLEGE OF NURSING,

KOLAR.

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE- KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

KRISHNA HANDA

W/O SUDHIR KOHLI # 505/6, SHANTI NAGAR,NEAR RADHA BALIBH MANDIR,CIVIL LINE MOGA-142001PUNJAB.

2. NAME OF INSTITUTION PAVAN COLLEGE OF NURSING , KOLAR

3. COURSE OF STUDY AND TRHE SUBJECT

M.Sc. Ist YEAR PEDIATRICS

4. DATE OF ADMISSION TO COURSE 31-05-2007

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5. TITLE OF THE TOPIC:“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME ON MOTHERS OF UNDER 5 CHILDREN REGARDING

KNOWLEDGE, ATTITUDE AND PRACTICE ON THEIMPORTANCEOF

IN SELECTED HOSPITALSIN KOLAR.”

INTRODUCTION

“Shape the future of life,

Healthy environment for children

The children of today,

Are the adult of tomorrow.

They deserve to inherit

a safer, fairer and healthy world.

There is no task more important

than providing healthful environment”2.

By

Gro Harlem Brundt land. Director general WHO (2003)

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Play is the key centre of a healthy child’s life. Play provides the

opportunities to be free, creative and expressive. In play children expand their

understanding of themselves and others, their ability to communicate with peers and

adults. Play is the business of the childhood, allowing your child free rein to experiment

with the world around him and the emotional world inside him, says Linda Acredolo

professor of Psychology at the university of California. In play children expand their

understanding of themselves and others, their knowledge of physical world and their

ability to communicate with peers and adults. Play is crusial for your child social,

emotional, physical, cognitive growth.

Children under five years of age constitute the 15-20% of total

population. Morbidity rate among them is 35-65% of children population. In the history

of health services of many developing countries their social and health needs were

realized rather later. Now ministry of health in India has focuses attention to provide

better health services to this group because “A healthy child is a sure future” is one of

the themes of WHO. To make the child healthy quality child care is needed. One of the

important parts of child’s development is play.

It is often seems that all children do is play. They play until they are five

or six, then they go off to school and start to learn. They play until they are big enough

to really begins to do things. Play helps children to relax which makes parents to relax4.

“Play is a child’s work and this is not a trivial pursuit”, says Alfored Adler. Play is

synonyms with being a child and it is the universal language of children. Hospitalization

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to any child is very unpleasant and traumatic experience. The child undergoes break

from his normal routine due to illness but also separated from his peer group and

friends3.

Essential child care needs play therapy should be included with medical

therapy in hospitals. Mothers should be enhanced to provide play needs during

hospitalization to lessen the emotions.

6.1 NEED FOR STUDY

Health care of children has been markedly changed in developed

countries. There is a change in the view of children from, “miniature adults”, to “unique

individuals” with special needs and qualities.

The child care has prime importance, as the mortality and morbidity are

higher in this group. In India the mortality rate under five is 105 per 1000, while in

Japan it is 6 per 1000.(W.H.O.2003) This can be reduced by demonstration, health

education and guidance to the parents and creating awareness and making changes

towards the health care branches.

Play is a very important component of children’s life. It is the most

essential activities for the physical emotional and social development to the child.

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It has special importance in the hospital to help sick children to continue to grow and

develop, to preserve their sense of wholeness to understand hospital procedures, and to

act out emotions. The separation of the family during hospitalization cause an anxiety in

the young children and may disturb parent child relationship.

Beryl Julliet Sam(2007). Assistant Professor Child health nursing department

Coimbatore, Tamil Nadu conducted case study to assess the knowledge attitude and

practice of the parents and nursing personnel regarding importance of play needs in

hospitalized children. He assessed that 86.11% of nursing personnel had adequate

knowledge, 13.89% had moderate knowledge. But 94.44% of them shows favorable

attitude towards the importance of play during hospitalization6

There are now ample research to demonstrate that hospitalization has

considerable potential to cause long lasting emotional damage(Vernon,1966 Douglas,

1975; Thomason 1986). A child most often looks dull anxious, afraid or angry. Mothers

feel that their children become passive after the admission to the hospital7.

Bradshaw’s and Silva,1980,Thomson and Standford (1981), says we know the

experience of being in hospital is , itself , a major stress for children which is additional

to the stress of illness. More over he is subjected to lot of interventions which are

directed to the promotion of his health but aggravate his pain and sufferings8.

Singer. J , (2000) conducted a case study on a play therapy on Massachusettrs General

Hospital, Boston. They found that parents have knowledge of play for children. 74.98%

of the parents knew the importance of play for their child, but only 28.53% parents have

favorable attitude to provide during hospitalization to the children9.

Keyes, Marianne, NewZealand (1991) says in their studies-that all children do play.

Play is vital to life, it is child’s life. During hospitalization child exploring and elevate

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the crisis of hospitalization by play. Play also helps in speedy recovery. The recovery

rate is more in children who got play therapy during their hospitalization. Hospitalized

children require more than recreational play because illness and hospitalization

constitute crisis in child’s life. These situations are fraught with over whelming stresses.

Children need to play out their fear, angers and anxieties as a means of coping with

these stresses. Play also helps temporarily to divert their mind from pain and loneliness.

Mothers play a major role in providing play to children because child feels secure and

confident in mother’s lap.

Dr. Harish chellani, Professor from Safdarjung hospital Delhi (2007) spoke on the

concept, Integrated Management of Neo-natal and Childhood illness at training course

organized by TNAI with collaboration of Common Wealth Secretarial London, he

stressed that the health services should include play therapy with cure therapy for

children1.

Haiat H, Bar-Mor G, Shochat M,(1991) Dina Academic school of Nursing says that

the world of a child is a world of play even in the hospital. Hospitalization to any child

is very unpleasant and traumatic experience. The child’s familiar routine are interpreted,

they are surrounded strange and often frightening people, equipment, sounds, smells.

Opportunity for play and exploration is severely curtailed or non existent10.

` After investigation the research studies , review of literature regarding

importance of play in child’s life the investigator found the need for study.

6.2 REVIEW OF LIERATURE

The review of literature is a key step research process. It is defined as a

broad comprehensive in depth, systematic and critical review of scholarly publications,

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unpublished scholarly print materials, audiovisual materials and personal

communications.

Review of literature is an essential activity of scientific research project; help

to familiarize with the practical issue related to the problem and enable the researcher to

avoid unintentional duplication of studies.

Knowing the importance of play in childs life during hospitalization the

investigator has review the available literature in the following-

Review of literature related to importance of play for children under five

Review of literature related to curtail of play and its effect on under five

children during hospitalization.

Review of literature related to attitude and practice of mothers regarding

play needs during hospitalization.

A. REVIEW OF LITERATURE RELATED TO IMPORTANCE OF PLAY FOR CHILDREN UNDER FIVE

Dorthy R.Marlow says that the play helps the children to form concept, classification,

and contrast and compare relationship among objects, cause effect relationship. Concept

of time, object characteristics and problem solving.

Garvey (1984) conducted a study regarding toys and plays and expressed his ideas that

play and play toys develop the ability to represent experience symbolically. They

expressed their ideas and feelings about the social world around. King, 1986 said that

children learn during play to negotiate offensive alternatives and need for defense11.

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Piaget (1962), Bergen (1988) states through their study that children expand their

understandings of themselves and others, their knowledge of physical world and their

ability to communicate with peers and adults. At 9 month infants learn that a ball rolls

away, a rattle make noise. At 12 months objects bring forth more specific and

differentiated actions. By the age of 4 or 5, child’s ideas about the social word initiate

most pretend play. In Toddler, there is growing awareness. They share, communicate,

expresses anger or joy through play.

Caldwell,B.,(1977)conducted a case study on children under five in kinder garden at

Lucasa. He found that children under five shows their aggression and hostility through

play either throwing toys or snatching toys form other children. He conducted the study

on 20 children age 3-5 years, by giving them only one Barbie doll. 12 out 20 eagerly get

up to get, snatching and pushing each other for toy, but five remained sitting

silently ,three out of twenty not shown any interest, but they remain silent and looking

towards the others. It shows that toys attract the children. They enjoy as a fun for them14.

B. Review of literature related to curtail of play and its effect on under five

children during hospitalization.

Keys, Marianne, (1991) conducted a case study in New Zealand and concluded that

children requiring extensive hospitalization to understand cope with their illness,

treatment and hospital experiences. He conducted a study on three children who have to

stay long time in the hospital for recurrent surgery. The children who participate in play

programmes have three to five years of age. One is 4 years old female who had

congenital problem who requires repeated surgery, the second a boy who need

correction of oesophageal atresia and the third is five years old boy who had congenital

cardiac anomalies. After 11 month, the author evaluated the result. The four years girl

who has attended play therapy during her hospitalization regularly shows speedy

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recovery and healthy growth than the others two who have not attended the play

therapy. This shows that play during hospitalization helps to cure faster than the others15.

A report published by American Academy of Pediatrics (9.10.06) the importance of

play in promoting healthy child development and maintaining strong parent- child

bonds-Mother play an important role because the child feels more secure and confident

in the presence of mother. Play brings you closer to your child. It helps them to become

more independent. They more able to work problems out, to develop their own

concentration and imaginations7.

Vernon, (1966), Doglas, (1975) Quinton and Rutter, (1976), Golden, (1983) and

Thomson, (1986) did research on role of play in assisting children requiring extensive

hospitalization in Auckland Children’s Hospital. They say that we know that the

experience of being in hospital is itself a major stress for children which are additional

to stress of the illness. Children respond to this stress in varies ways according their age,

personality emotional state and their previous experience in hospital, and the attitude to

those caring for them. Play is the best alternative to cope with stresses16.

Barker (1974), Beuf (1979), Simons, Bradshaw and Silva(1980), Thomson and

Standford (1981) says that it is not surprising that developmental regression is common

and the emotional withdrawl may be adapted as a way of shutting out experiences with

which the child is ill equipped to cope. Play therapy helps them to communicate with

them and cope with emotional hazards17.

Bergan D (1988) states in his study that play is an important part of the care we provide

to the children which allow them acknowledge and deal with their illness and treatment

through play. They keep children occupied, they help them to cope with pain, anxiety

and fear, to make friends to regain skills they have last as a result of their illness and

learn new skills

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C. REVIEW OF LITERATURE RELATED TO ATTITUDE AND PRACTICE

OF MOTHERS REGARDING PLAY NEEDS DURING

HOSPITALIZATION.

Rev Esc Enfern USP (1999Dec), 33(4):364-9. “Playing in hospital: addition to

nursing care”. Playing is one of the essential activities for physical, emotional and

social development to a child. The empiric data collection realized through the

participant observation of 11 children. They identified that the act to play has

repercussions into the child, nurse and hospital; to the child it is not obstruct the

development, helps it in the understanding about what is occurring with itself. They

discharge tension, fear, anxiety and frustration, promote satisfaction, funny and

spontaneity and allow it transforms experiences that should support inactive in active

discharge. To the nurse it is tool of intervention and way of communication. More

necessary is to initiate the play. Mother can play a vital role in it18.

Dorthy R.Marlow, says, the presence of an adult in the play of toddler facilitates

release of aggression, while helping expression impulses by under control. Guidance

should not inhibit self directed activity. It is important for adults to provide material

which children can explore and adopt in the play.

ERIC # Journal Articles: Reports- Evaluation, “Use of Art of Play therapy in

oncology”. Two play therapies applied by parents for darkness phobia in young children

are compared. 27 children between the ages of 4-6 years were recruited from 27 schools.

The participants were randomly assigned to three experimental conditions bibliotherapy

and games, emotive performance and no treatment. The treatments were applied at home

by parents who were trained previously and it last for 5 weeks and took place in three 20

minutes alternate weekly session. Both therapy shows significant result. The study

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shows that art and play has great effect on children under five. They can cope up with

their problems easily through play they become more understandable and confident19.

Calwell 1997) said that adults should identify play which has led to problems for

particular children. They should check materials, equipment for safety. Adult should

make children aware of any hidden risk in physical challenges they set for themselves.

According to PMID:1340875 a child’s play is recognized as a useful tool for nurses in

the diagnostic process of making judgments about a hospitalized child’s compliance

with medical procedures, adjustments to the hospitals, environment, degree of pain, and

level of psychosocial functioning. However, the bases that is required to effectively help

a pediatric patient “play” in a therapeutic mode appears to be extremely limited for most

nurses and is rarely addressed in a substantive manner in nursing education. Educational

programs must be willing to incorporate a “developmentally appropriate, culturally

sensitive, and family-centered approach” using clinical experiences and professional

role modes in their nursing curricula. The end product should be nurses who are

competent in a much wider range of learn to play. They can take the help of mothers.

Nursing Clin North Am 1984 Jun,say that play for most hospitalized children centers

around self and stressful situations as perceived by the child and is restricted in terms of

what the environment and physical limitations so the child present. Play can be a tool to

understand and intervene with pediatric patients. Collaboration with nurses who are

clinical specialists, early childhood educators, and others who have expert knowledge of

children and play equipment is useful to plan purposeful play programs or programs or

play sessions for the special need of hospitalized children. Such collaboration will insure

that play will be carried out in consistent growth promoting manner. For some children,

hospitalization is an challenging experience that promotes a sense of competence. For

other children, hospitalization is an experience that results in a negative outcome.

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An American Association Nursing care of children and families, (2000) describes

that, “hospital play is an important part of medical care” 20. Play can really make a

difference-

o Create an environment where stress and anxiety are reduced.

o Help the child to regain confidence and self esteem.

o Provide an outlet for feelings for anger and frustration.

o Help the child understand the treatment and illness through play.

o Aids in assessment and diagnosis.

o Speed recovery.

o Advance physical development.

o Promoted social skills.

o Build imagination.

STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE KNOWLEDGE, ATTITUDE AND PRACTICE AMONG MOTHERS OF UNDER FIVE CHILDREN ON THE IMPORTANCE OF PLAY NEEDS DURING HOSPITALIZATION IN SELECTED HOSPITALS IN KOLAR”.

6.3 OBJECTIVE:

1. To assess the knowledge, attitude and practice among mothers of under five

children regarding importance of play needs during hospitalization.

2. To evaluate the effectiveness of planned teaching programme regarding the

importance of play needs for under five children.

3. To find out the association between knowledge, attitude and practice with

certain demographic variables.

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OPERATIONAL DEFINITION:

1. KNOWLEDGE

In this study knowledge refers to the awareness among mothers of under five children

regarding importance of play needs during hospitalization.

2. UNDER FIVE CHILDREN

In this study under child means a child who is less than five years of age.

3. Mothers

In this study a mother means a mother who has child less than five years of age

4. Play needs

In this study importance of play need means creative activities which divert their

attention and helps in speedy recovery.

5. Practice

In this study practice refers to doing or fulfilling the play needs of children during

hospitalization.

6. Attitude

In this study attitude refers to mother’s tendency to provide play needs to under five

children during hospitalization.

6.4 HYPOTHESIS:

There will be significant difference in pre and post test knowledge score of the mothers

of under five children regarding importance of play needs to children during their

hospitalization.

6.5 ASSUMPTIONS:

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Mothers of under five children have some knowledge regarding importance of

play needs for children under five.

The knowledge will differ according to the background of the subject.

There is a significant association between the knowledge of mothers of under

five with selected variables.

VARIABLES:

Independent variable: Planned teaching program

Dependent variable: Mother’s knowledge.

Attribute variable : Age, sex ,education, income, occupucation and type of family

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

Mothers of under five children in selected hospitals in Kolar.

7.2 METHODS OF DATA COLLECTION

7.2.1 Research design

Descriptive evaluative design.

7.2.2 Setting of the study

Selected hospitals in Kolar.

7.2.3 Population

Mothers of under five children in hospital.

7.2.4 Sample size (total)

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100

7.2.5. Sample technique

Purposive sampling technique will be used to select sampling

7.2.6 SAMPLING CRITERIA :

Inclusion criteria:

The study includes mother who are having under five children admitted in the

selected hospitals of Kolar.

Mother who are willing to participate in the study regarding the importance of

play needs during hospitalization.

Exclusion Criteria:

.The study excludes mothers who,do not having under five children admitted in

the selected hospitals of Kolar.

.Mothers who, are not Willing to participate in the study.

7.2.7 TOOLS:

A structured questionnaire will be used to study the knowledge, attitude and practice

among mothers of under five children.

Tools of data collection

Structured questionnaires consisting of section A and B.

Section-A

Demographic Data

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It consists of variables like age, education, income, occupation and type of family.

Section-B

Knowledge, attitude and practice questions regarding the importance play needs of

hospitalized children under five.

7.2.8 METHOD OF DATA COLLECTION

By using pre test before giving planned teaching to mothers of under five

children who are hospitalized, will be assessed and administered planned teaching

program then post assessment will be done after seven days.

7.2.9. DATA ANALYSIS AND INTERPRETATION

Descriptive and inferential statistics procedures such as frequencies, percentages,

mean, median, standard deviation and chi-square will be used for data analysis and

interpretation will be presented in the form of tables, graphs and diagrams.

7.3 DOES THE STUDY REQUIRES ANY INVESTIGATIONS OR INTERVENTION TO BE

CONDUCTED FROM PATIENTS OR OTHER ANIMALS IF SO DESCRIBE BRIEFLY

The study is conducted on mothers of under five children in Selected hospitals in Kolar.

Since it is evaluatory study does not require any intervention.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM CONCERNED AUTHORITIES?

The purpose of the study will be explained to the mothers of under five children, prior

to the study permission will be obtained from the concerned authorities to conduct the

study and also from research committee of Pavan College of Nursing, Kolar.

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1) Park K, Text Book of Preventive and Social medicine, Bhanot Publications, 2005, pp-391-398.

2) Juliet Sam, Importence of play for hospitalized children, Nursing Journal of India,Oct,2007, pp 24.

3) From net. http;//www.health care and management.com/20030615/rural/Shtme

4) Hall.D.(2000), Social and psychological care before and during hospitalization,

(25),721-732, England, Abstract from Pubmed.

5) Roe.W.A.,Worchel.F.,Samner and Daniel CA.,(1989) Journal of Pediatric psychology 14 (4), The psychological impact of play on hospitalized children, Dec., 1617-27 Abstract from Yahoo.

6) Singer J., (2000), what is play therapy?, Kid bower, Abstract from Yahoo.

7) Wong D, (1999), Whaley and Wong’s Nursing care of Infants and Children, C.V.,Moshyco., It. Loues, ed – 6, 1171.

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8) Waechter,(1985), Nursing care of children, J.B.Lippincott.Co., Philadelphia, ed-10, 87-8.

9) Thompson, R.H., (1988) from questions to answer: approaches to studying play in health care settings, child health care, 16(3), 186-94, abstaract from pubmed.

10) ERIC clearing house on Elementary and early childhood education, Urbana, III abstract from Yahoo.

11) Fernie, David, The nature of children’s play, ERIC digest., Edition 307967-88.

12) Achar, Text book for pediatrics, 3rd edition, 1999. pp-110-115.

13) Phipps R, CSSM and family welfare, Ist edition, 1992, pp32.

14) Haiat H, Bar.Mor G., Shochat M, The world of the child: a world of play even in hospital., J. Pediatr Nars 2003, June, 18(3) 209-14. Abstract from pubmed.

15) Gottlieb SE, Pornov S., The role of play in a pediatric bone marrow transplantation unit.,

16) IGNOU, Pediatric Nursing unique press Pvt, Ltd., Ist- 37 sector 4 No.Ida.2001.

17) Tambulwadkar R.S., Pediatric Nursing 2nd edition, Bombay, Vora Medical Publishers.

18) Marlow R.Dorothy, The text book of Pediatric Nursing, 6th edition, New Dehli. Elsevier a division of reed Elsevier India Private Limited.

19) Info change India news 2000: Survival and Health Care.

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