“EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME (STP) ON KNOWLEDGE REGARDING

BILIBLANKET PHOTOTHERAPY AMONG STAFF NURSES IN

SELECTED PEDIATRIC HOSPITALS AT BIJAPUR”.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

MR. JAKKAPPA.BASARAGI

CHILD HEALTH NURSING

FIRST YEAR M.Sc NURSING

YEAR 2012 -2014

BLDEA’S SHRI B M PATIL

INSTITUTE OF NURSING SCIENCES

SOLAPUR ROAD, BIJAPUR - 586103

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS

MR. JAKKAPPA.BASARAGI.

I YEAR M. Sc. NURSING

BLDEA’S SHRI B.M.PATIL INSTITUTE

OF NURSING SCIENCES, BIJAPUR-586103

2 NAME OF THE

INSTITUTION

BLDEA’S SHRI B.M.PATIL INSTITUTE OF

NURSING SCIENCES, BIJAPUR -586103

3 COURSE OF THE STUDY

AND SUBJECT I YEAR M. Sc. NURSING

CHILD HEALTH NURSING

4 DATE OF ADMISSION TO

THE COURSE

27.07.2012

5 TITLE OF THE STUDY

“EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP)

ON KNOWLEDGE REGARDING BILIBLANKET PHOTOTHERAPY AMONG

STAFF NURSES IN SELECTED PEDIATRIC HOSPITALS AT BIJAPUR.”

2

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“Our children are our most precious resources”

The birth of an infant is one of the most awe inspiring and

emotional events that can occur once in life time. After nine months of anticipation

and preparation the neonates arrives aimed a flurry of excitement. But most often the

enjoyment of parents and the bonding with new born will be disturbed due to certain

common neonatal disorders. One such common health problem is neonatal jaundice.

The word jaundice is derived from the French word Jaune which means Yellow.

Clinical jaundice manifests as yellowish discoloration of the skin of the face when

the serum bilirubin level exceeds 5mg/dl. As the degree of jaundice increases, there

is a cephalocaudal progression of the yellowishness of the skin. When the trunk of

the baby is distinctly yellow stained, the serum bilirubin levels is likely to range

between 10 to 15mg/dl. The yellow staining of the palms and soles indicates that

serum bilirubin level has exceeded 15mg/dl.1

Neonatal jaundice affects 60%of full term infants and 80% of preterm

infants, bilirubin level greater than 5mg/dl in the first week of life and about 6% of

term babies will have bilirubin levels exceeding 15mg/dl. Neonatal jaundice is a

yellowing of the skin and other tissues of a newborn infant with a bilirubin level of

more than 5mg/dl.2

A biliblanket is a portable soft flexible pad woven of fiber optic pad placed

with disposable cover and exposed emitting lights in 400 to 500 nanometer range for

therapeutic blue violet range. Biliblanket is trade mark of general electric’s datex –

ohmeda subsidiary. It is an obvious combination of bilirubin and blanket. Others

names used are home phototherapy system, bilirubin blanket or phototherapy

blanket or fiber optic phototherapy. It can be used in the home situation and hospital

setup also. It is available in standard size mat, large fiber optic mat and double fiber

optic mat.3

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6.2 NEED FOR THE STUDY

More than 40% of the population of our country falls in the age spectrum

covered by paediatrics. Infants (0-1 years) constitute 2.82% of the total population in

India.4 The WHO reveals that the incidence of hyperbilirubinemia is 50 to 60

thousands neonates among these 2% has total serum bilirubin levels over 20mg/dl,

the total serum bilirubin level in normal range is0.3 to 1mg/dl.0.15%had levels over

25 mg/dl and 0.01% has over 30mg/dl5.Three methods of treatment modalities are

used to reduce the level of conjugated Bilirubin. They are phototherapy,

pharmacological therapy and exchange transfusion. The phototherapy is best in

moderate case where the bilirubin raises above 12mg/dl. In pharmacological

therapy, Phenobarbital induces hepatic microsomal Enzymes and increases bilirubin

conjugation and excretion. Exchange transfusion is used to prevent kernictreus and

replace 85 % of circulating red blood cells and reduces bilirubin level by 50%.6

There are two types of biliblanket phototherapy one is ohmeda system, it

consists of standard size fiber optic biliblanket with a halogen lamp and attached

fiber optic cable containing 2400 optic fibers. The ends spread out in a flat mat

emission of blue green light. Intensity of light ranges from 15mw/cm2 –

35mw/cm2.The second one is health dyne wallaby system, this devices has long flat

florescent panel attracted to the main unit by short connector3.

A study was conducted to evaluate the efficacy of fiber-optic phototherapy

using the standard Ohmeda Biliblanket, a large version, double standard Biliblanket,

and conventional phototherapy using daylight fluorescent lamps in full-term, healthy

infants with nonhemolytic hyperbilirubinemia.Among171 infants full-term, healthy

infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 micro

mol/L or 222 micro mol/L at <48 hours of age) were allocated randomly to one of

four modes of phototherapy: standard fiber-optic mat (Ohmeda Biliblanket), a large

version, double standard Biliblanket, and conventional phototherapy. Bilirubin

levels were monitored every 12 hours. Exposure was stopped when bilirubin levels

were less than 185 micro mol/L, the minimum duration being 24 hours. 42 were

exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy,

42 to double-fiber-optic phototherapy, and 44 to conventional phototherapy. The

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result shown that the efficacy of double-fiber-optic phototherapy and conventional

phototherapy was similar and significantly better than that of the large fiber-optic

mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall

decline rate. The large mat was slightly better than the standard-size mat with regard

to 24-hour decline rate and overall decline rate, but this difference was not

significant. Failure of phototherapy occurred only in the large fiber-optic mat group

(3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other

two groups, but differences not statistically significant. The nursing personnel were

more comfortable with single fiber-optic phototherapy, which caused no initial

disturbance to the swaddled infants as did conventional phototherapy, but found

double-fiber-optic phototherapy difficult to use. The researchers concluded that for

efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of

our conventional phototherapy, the light dose of the standard mats needs to be

doubled.7

To compare with other phototherapy it has a advantages. It helps the

mother and baby bonding , mother can nurse, swaddle and hold the baby ,skin

temperature will not raised , no need for eyes pad, a greater flexibility of use may be

used in a incubator , radiant warmer , bassinet or at home diaper can be worn , baby

can be clothed , it can be Used for 24 hours a day.3

A study has been conducted to compare the use of standard overhead

fluorescent phototherapy units with the biliblanket a woven fibreoptic pad which

delivers high intensity light with no ultraviolet or infrared irradiation in the

treatment of jaundice in preterm infants. Infants between 800g to 2500 g, were

included in the study with strict criteria for commencing and ceasing phototherapy.

Serum bilirubin levels were followed at 12-24 h intervals until 24 h after cessation

of phototherapy. Infants were allocated at random to receive either conventional

phototherapy or the biliblanket. There were 24 infants in the conventional group and

20 in the biliblanket group. Mean duration of phototherapy was compared and was

44 h for the conventional group versus 42 h for the biliblanket group. The researcher

has concluded that the biliblanket is as effective as conventional phototherapy and

was well accepted by nursing staff and parents.8

The biliblanket phototherapy is one of the advanced technology for

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treatment of the jaundice. In Indian context, the use of Biliblanket phototherapy is

very minimal in paediatric health set up. Health professionals in general, nurses in

particular may not have adequate knowledge regarding this procedure. Hence the

researcher is interested to conduct a study on the effectiveness of structured teaching

program on knowledge regarding Biliblanket phototherapy among staff nurses.

6.3 REVIEW OF LITERATURE

A Study was conducted To compare the effectiveness of various

phototherapy systems in lowering serum bilirubin levels among 140 preterm infants.

Eligible infants were randomly assigned to four study groups: conventional, fiber

optic Wallaby, fiber optic Biliblanket, and combined phototherapy. Efficacy was

assessed by comparing highest serum bilirubin levels, duration of treatment, and

number of infants requiring exchange transfusion. Result shows that fiber optic

phototherapy, both Wallaby and Biliblanket, had the same effectiveness of

conventional phototherapy. The best results have been obtained using combined

phototherapy, which allowed to reach lower serum bilirubin levels, a shorter

duration of treatment and a significant reduction of exchange transfusions. The

researcher concluded that combined phototherapy should be the method of choice in

treating hyperbilirubinemia in very preterm infants.9

The study was conducted to evaluate the efficacy of fibreoptic

phototherapy. In the management of newborn infants with hyperbilirubinaemia.with

sample size of thirty-one subjects were identified of which 24 met inclusion criteria.

They evaluated the efficacy of fibreoptic phototherapy in a number of different

clinical situations and patient populations. Result shown that combination of

fibreoptic and conventional phototherapy was more effective than conventional

phototherapy alone .Researcher concluded that fibreoptic phototherapy has a place

in the management of neonatal hyperbilirubinemia. It is probably a safe alternative

to conventional phototherapy in term infants with physiological jaundice.10

A study was done to compare special blue compact fluorescent lamp (CFL)

phototherapy with special blue standard-length tube lights. Sample size of study was

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293 consecutive babies with gestation more than 34 weeks who received photo-

therapy, 100 babies, who satisfied the eligibility criteria, were enrolled and

randomized. There were 50 babies in each group. The results of the study shown that

baseline characteristics, causes of jaundice, hemolysis, baseline TSB and irradiance

were similar in both groups. Mean duration of phototherapy (P = 0.98) was similar

in both groups. Kaplan-Meier analysis of phototherapy duration showed no

difference in the survival curves of the two groups (P = 0.6). Auxiliary temperature

was similar in both groups and no baby has dehydrated. The study concluded that

CFL phototherapy has no superiority over STL phototherapy in terms of efficacy

and adverse effects on the neonate and effects on nursing staff darted.11

A study was conducted on treatment of neonatal hyperbilirubinemia, with

aim of, focusing on practical aspects that are relevant to paediatricians and

neonatologists. The study findings suggest that jaundice is very common among

infants during the first days of life. Several factors such as maternal and neonatal

history have to be considered before implementing treatment. Significant advances

have been made in the past few years concerning the treatment of jaundiced

newborn infants. The conclusion of the study shown that nowadays, the in-depth

knowledge about the mechanism of action of phototherapy, the development of

intensified phototherapy units and the use of drugs to reduce bilirubin formation,

have contributed to significantly decrease the need for exchange transfusion.12

A study was conducted to compare of double phototherapy (conventional

plus biliblanket) versus conventional single phototherapy in the management of

neonatal hyperbilirubinemia. The sample size of study was 90 ,with divided in to

two groups.45 new born in each groups, those who got conventional single

phototherapy were taken in group one and babies who got double phototherapy were

taken in group two. Each group was again divided in to three subgroups according to

their birth weight (NBW, LBW&VLBW).The result shows that decrement rate of

serum bilirubin per day was 2.4+-1.20 mg/dl in NBW babies with the use of

conventional single phototherapy compared to 4.97±1.05 mg/dl with the use of

double phototheraphy.In LBW babies, decrement rate of serum bilirubin per day was

2.45±1.9mg/dl with conventional single phototherapy but 4.99±0.59mg/dl with

double phototherapy. In VLBW babies decrement rate of serum bilirubin per day

7

was 2.49±0.59 mg/dl with conventional single phototherapy but with double

phototherapy this decrement rate was5.21±1.13mg/dl per day. Double

phototheraphy.In was more effective than conventional single therapy all three

groups of babies however the rate of fall of bilirubin was higher in VLBW group.

This study concluded that decrement rate of serum bilirubin more than two folds

with double phototherapy (conventional plus biliblanket) compared with single

phototherapy.13

6.4 STATEMENT OF PROBLEM

“Effectiveness Of Structured Teaching Programme (STP)On Knowledge

Regarding Biliblanket Phototherapy Among Staff Nurses In Selected Paediatric

Hospitals At Bijapur”.

6.5 OBJECTIVES:

1. To assess the knowledge regarding Biliblanket phototherapy among staff

nurses as measured by structured knowledge questionnaire.

2. To evaluate the effectiveness of structured teaching programme (STP) on

knowledge regarding Biliblanket phototherapy.

3. To find out the association between pre-test knowledge score with selected

demographic variables.

6.6 OPERATIONAL DEFINITION

Effectiveness: - In this study effectiveness means improving knowledge

regarding Biliblanket phototherapy among staff nurses by structured teaching

programme which may results from differences between pre and post test

knowledge score.

Structured teaching programme :- In the present study it refers to

systematically planned teaching programme designed to provide information

regarding biliblanket phototherapy

Knowledge: - It refers to the ability of the staff nurses in giving correct

responses to the questions asked as measured by structured knowledge

questionnaire about biliblanket Phototherapy.

Biliblanket phototherapy: - A biliblanket is a portable soft flexible pad

8

woven of fiber optic pad placed with disposable cover and exposed emitting

lights in 400-500 nm.range for therapeutic blue violet rays.

Staff nurses :- In this present study staff nurses refers to those who are

providing professional nursing care in paediatric hospitals with minimum

qualification of general nursing ,B.Sc Nursing , PBBSc Nursing

6.7 ASSUMPTIONS

The study assumes that:

1. Staff nurses may have inadequate knowledge regarding biliblanket

phototherapy.

2. Structured teaching programme will improve the knowledge regarding

Biliblanket phototherapy among staff nurses.

6.8 HYPOTHESES

The following hypotheses will be tested at 0.05 level of significance.

H1. There will be significance difference between pre test and post test

knowledge Score.

H2: There will be significant association between pre test knowledge score and

selected demographic variables

6.9 DELIMITATION

1. No effort will be made to assess the perception or practice of nurses

regarding care of child with Biliblanket phototherapy

2 .The area or setting for the study is delimited to staff nurses of selected

paediatric hospitals, at Bijapur

3. Study period is limited to 4 to 6weeks

4, No effort will be made to assess the effectiveness of biliblanket phototherapy

on reduction of neonatal jaundice

MATERIALS AND METHOD.

7.1 SOURCE OF DATA

The data will be collected from the staff nurses in selected pediatric hospitals.

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7. 7.1.1 RESEARCH DESIGN

Pre experimental design (One group pre test-post test design)

7.1.2 RESEARCH APROACH

Evaluative research approach will be used for this study.

7.1.3 SETTING

The study will be conducted in selected paediatric hospitals, at Bijapur.

7.1.4 POPULATION

The population for the present study comprises of staff nurses from paediatric

Hospitals at Bijapur.

VARIABLES

Independent variable : Structured teaching programme

Dependent variable : Knowledge of staff nurses regarding

Biliblanket phototherapy.

Demographic variables : Age, Gender, Educational status, Year of

experience, Economic status etc.

7.2 METHOD OF DATA COLLECTION

7.2.1 SAMPLING PROCEDURE

Non probability sampling procedure

Sampling technique

Convenient sampling technique

7.2.2 SAMPLE SIZE

In this study the sample size will be 40 staff nurses from selected

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Paediatric hospitals.

7.2.3 INCLUSION CRITERIA

1. Staff Nurses who have minimum qualification of GNM, B.Sc Nursing,

PBBSc Nursing and registered to KNC.

2. Staff Nurses who are willing to participate.

7.2.4 EXCLUSION CRITERIA

1. Staff Nurses who are not available during data collection.

2. ANM, nurse aides

7.2.5 INSTRUMENTS INTENDED TO BE USED

Proforma for collecting data regarding demographic variables

Structured knowledge questionnaire to assess the knowledge regarding

Biliblanket phototherapy.

7.2.6. DATA COLLECTION METHOD

Prior to data collection, permission will be obtained from concerned authority

After obtaining the permission the following steps will be taken by the

Investigator. The researcher introduces himself and explains the purposes of

the study to the subject.

Administration of pre-test on knowledge regarding biliblanket phototherapy.

Introduce the structured teaching programme.

Administration of post test on knowledge regarding biliblanket phototherapy

after one week.

7.2.7 DATA ANALYSIS PLAN

The data would be analyzed by using descriptive (mean, median, frequency,

range, percentage) and inferential statistics (paired t- test, Chi-square test) on

the basis of objectives and the hypotheses

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7.2.8 DURATION OF STUDY

Study period is 4-6 weeks.

7.3 DOES THE STUDY REQUIRE ANY INTERVENATION TO BE

CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL?

Yes ,Structured teaching programme will be administered to staff nurses

regarding Biliblanket phototherapy

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

INSTITUTION IN CASE OF 7.3?

Yes, Ethical clearance is obtained from the institutional ethical committee.

LIST OF REFERENCES

1. Gupta R. Neonatal surgical jaundice revised 4th ed .Delhi: Jaypee; 2005.

2. Mary Fran Hazinski. Nursing care of the critically ill child. Princeton.1st ed.

Mosby publication; 1984.

3. Suseela.T. biliblanket phototherapy. Nightingale Nursing Times. 2012

12

8 march; 7(12):40-42.

4. Whaley and Wong. Essentials of paediatric nursing. 7th ed. St Louis: Mosby

publication; 2004.

5. Robertson. Text book of Neonatology. 2nd ed. Tokyo: Churchill living stone;

1992.

6. Ghai O.P, Piyush Gupta. V.K.Paul.Essential peaditrics.6th ed. Delhi : CBS

publication; 2005.173.

7. Tan K L. Efficacy of bidirectional fiber-optic phototherapy for neonatal

hyperbilirubinemia;1997 may; 99(5): 13.

8. Costello SA , Nyikal J, Yu VY. McCloud P. Biliblanket phototherapy system

versus conventional phototherapy: a randomized controlled trial in preterm

infant’s. J Paediatric Child Health;1995 Feb; 31(1): 13.

9. Romagnoli C . Zecca E. Papacci P. Vento G. Girlando P. Latella C.et all.

Which phototherapy system is most effective in lowering serum bilirubin in

very preterm infants;2006 May; 21 (2): 204-09.

10. Mills.J.F.Tudehope .Fiberoptic Photo therapy for neonatal jaundice.2011

Aug; 78 (8) : 996-08.

11.Sarin M Dutta. S Narang A. Randomized controlled trial of compact

fluorescent lamp versus standard phototherapy for the treatment of neonatal

Hyperbilirubinemia;2006 Jul; 43 (7 ): 583-90.

12. Manoel de Carvalho. Treatment of neonatal hyperbilirubinemia. Journal de

Pediatria;2001;7(1):71.

13. Chiranjib Baura,et all. compare of double phototherapy (conventional plus

biliblanket)versus conventional single phototherapy in the management of

Neonatal hyperbilirubinemia.Jcmcta.2007;18(2):21-25.

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