Rajiv Gandhi University of Health Sciences, Bengaluru

Karnataka

SYNOPSIS PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

Mrs. RAJBALA R. DAMOR

I Year M Sc Nursing
Obstetrics and Gynaecological nursing
Year 2012-2013

BRITE COLLEGE OF NURSING

BENGALURU-560091

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 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE-I
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. NAME OF THE CANDIDATE Mrs. RAJBALA R. DAMOR.

& ADDRESS 1st YEAR M.Sc. ( NURSING ),

BRITE COLLEGE OF NURSING ,
#69, BWSSB COLONY,
CHIKKAGOLLARAHATTI, MAGADI MAIN
ROAD,VISHWANEEDAM POST,
BENGALURU – 500 091.

2. NAME OF THE INSTITUTION BRITE COLLEGE OF NURSING ,

#69, BWSSB COLONY,
CHIKKAGOLLARAHATTI, MAGADI MAIN
ROAD,VISHWANEEDAM POST,
BENGALURU – 500 091.

3. COURSE OF STUDY & I YEAR M.Sc. ( NURSING ),

SUBJECT
OBSTETRICS AND GYNAECOLOGICAL
NURSING.
4. DATE OF ADMISSION 01-06-2012

5. TITLE OF THE TOPIC “ A STUDY TO EVALUATE THE

EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON
PREVENTION OF NEONATAL INFECTIONS
AMONG POST-NATAL MOTHERS IN
SELECTED MATERNITY HOSPITAL AT
BENGALURU

6. BRIEF RESUME OF INTENDED WORK

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INTRODUCTION

“Health should mean a lot more than escape from death or for that matter escape from
disease”

-K.PARK

Jawaharlal Nehru once said ‘The nation walks on the feet of little children. The

children of today ought to have sound health in order to build a healthy nation''

Children constitute the foundation of a nation. Healthy new born evolve become

healthy adults and effectively participate in national development programs. The child’s

health while in the womb depends on the health of the mother. But after being born its

survival, health and growth depend not only its own health but also on the mothers

knowledge about child rearing practices and the immediate environment in which the

family lives.1

At birth a baby is transposed from the warm contentment of the uterine

environment to the out side world where the role of independent existence is assumed.

The baby must be able to make this sharp transition swiftly, and in order to achieve the

series of adaptive functions have been developed to accommodate the dramatic change

from the intrauterine to extra uterine environment.2

Neonatal infection refers to the bacterial, viral or fungal infection of the infants

during the 1st month of the life and it may be acquired by transplacental [congenital

infection], during the process of delivery or postnatal from the mother or from the

environment of the baby. The common infection that can occur in a new born baby

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during the neonatal period can be infection of the eye, skin, and umbilicus, respiratory

and gastrointestinal tract. Low birth weight and prematurity has been reported as the

important risk factors for neonatal infection.3

Infection is a major cause of fatality during the first month of life, contributing to

13-15% of all neonatal deaths. Neonatal meningitis, a serious morbidity of neonatal

sepsis, occurs in 2-4 cases per 10,000 live births and significantly contributes to the

mortality rate in neonatal sepsis; it is responsible for 4% of all neonatal deaths. In the

preterm infant, inflammatory mediators associated with neonatal sepsis may contribute to

brain injury and poor neurodevelopment outcomes.4

Neonatal mortality rate can be defined as neonatal deaths of infants weighing

above 1000gm during first 28 days after birth per 1000 live birth. Current neonatal

mortality rate in India is 43.4 per 1000 live births. Almost 50% of neonatal deaths occur

within first one week of life and majority of within the first 24 hours of life.5

NEED FOR THE STUDY

The first week of life is the most crucial period in the life of an infant. In
India 50-60% of all infant death occurs within the first month of life. The risk of death is
the greatest during the first 24-48hrs after birth. Neonatal deaths now account for up to
two-thirds of all infant deaths and half under the age of 5 child mortality in developing
countries.6

The world health organization (WHO) estimates that more than 4 million
neonates die each year. In 1995 neonatal deaths are 5 million; the numbers of neonatal
deaths are decrease to 4 million in 2005,but 98% still occurred in the less developed

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countries among them Infection was the main cause. Neonatal morbidity death occurs due
to respiratory illness, skin problems, eye infections and neonatal sepsis.7

Current status of neonatal health services in India is disorganized recently

only 20 of the 125 medical colleges in the country have special care neonatal units. A
series of services of neonatal centres conducted in the country revealed that out of 28
units only 50% had satisfactory resuscitation facilities while 33% had inadequate.8

Major causes of death in neonates in India were due to respiratory disorders,

GI disturbances and injuries, chickengunya. More than 1.25 million suspected cases have
been reported and (752245) were from Karnataka state, and also affected states were
Andhra Pradesh, Madhya Pradesh, Tamilnadu, Maharashtra and Gujarat.9

A study in Australia the risk of death from pneumonia in child hood is in the
neonatal period. It is estimated that pneumonia contributes to between 750000- 1.2
million neonate’s deaths annually according for 10% of global child mortality.10

Study was shown that the incidence of neonatal herpes simplex virus
infections were identified 35 confirmed cases of herpes simplex virus and incidence was
(12.9%) per 1,00,000 live births in Atlanta Georgia, USA.11

In adequate postnatal counselling to mothers on neonatal care including

neonatal danger signs was observed. The potent risk factors for neonatal infection were
the number of siblings and baby care at post-natal care facilities. A recent study focused
on the duration of exclusive breast feeding necessary to protection against infection
during infancy.12

Separation of new born from young siblings to prevent neonatal infection

needs to be emphasized to mothers. Furthermore can found new risk factors post-natal
care facilities and home aides to decrease the incidence of neonatal infection, standards of
hygiene for post -natal care facilities need to be established for the prevention of
infections in neonates.13

When women’s acquired the knowledge prior to or during pregnancy, one to

prevent infection is through simple hygiene practices, such hand washing and particularly

5
adapts the hygienic behavior to prevent also heard about it from a doctor, hospitals,
clinics and other professionals 29%. The awareness of women’s knowledge on hand
washing, not sharing drinking glass and not kissing young children on the mouth
appeared to be generally acceptable. These are the preventable practices give the
awareness to the mothers to prevent the neonatal infection.14

Based on the review of literature and the personal experience of the

investigator during hospital visits in urban areas was found that many neonates affected
with neonatal infections and there was less awareness and practices on prevention of
neonatal infections.15

Hence the investigator felt the need to assess the knowledge on prevention of
neonatal infections among post-natal mother, with a view to prepare structure teaching
programme which will be useful for the mothers for prevention of neonatal infections.

6.2 REVIEW OF LITERATURE

Literature review refers to the activities involved in identifying and searching

for information on a topic and developing an understanding of the state of knowledge on
that topic.16

Review of literature is a key step in research process and it refers to extensive,

exhaustive and systematic examination of publication relevant to research project. The
task of reviewing literature involves the identification, section, critical analysis and
reporting of existing information on the topic of interest. A review will acquaints the
researcher with what has been done in the field and it minimizes the possibility of
unintentional duplications.

A review of literature pertaining to the present study is aimed to evaluate the

effectiveness of Structured Teaching Programme on prevention of neonatal infections
among post-natal mothers in selected maternity hospitals, Bangalore.

The review of various studies was organized and presented in the following headings:

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 1) Literature related to neonatal infection and prevention of neonatal infections.
2) Literature related to structured teaching programme.

1 .Literature related to neonatal infection and prevention of neonatal infections.

A study was conducted to determine whether 1) residents trained in the SEEK (A

Safe Environment for Every Kid) model would report improved attitudes, knowledge,
comfort, competence, and practice regarding screening for psychosocial risk factors ; 2)
intervention residents would be more likely to screen for and assess those risk factors.
Pediatric residents in a university-based pediatrics continuity clinic were enrolled onto a
randomized controlled trial of the SEEK model. The model included resident training
about psychosocial risk factors, a Parent Screening Questionnaire, and a study social
worker. Ninety-five residents participated. In 4 of 6 risk areas, intervention residents
scored higher on the self-assessment compared to control subjects, with sustained
improvement at 18 months. Intervention residents were more likely than control subjects
to screen and assess parents for targeted risk factors. The model shows promise as a way
of helping address major psychosocial problems in pediatric primary care.17

A study was conducted in Udupi District, Karnataka to determine the knowledge

of postnatal mothers on health neonatal health and to determine the effectiveness of
Structured Teaching Program on knowledge of neonatal health in selected hospital. One
group pre test post test design and non-probability convenient sampling was used. Data
were collected from 35 samples by structural knowledge questionnaire and STP were
administered. Data was analyzed by descriptive and inferential statistics. The t test
showed that the post -test knowledge mean score (29.74%) as significantly higher than
that of pre-test mean score (16.16%) i.e U9 = 27.77, P < 0.01 was highly significant
indicated that STP was effective in improving the knowledge level of postnatal mothers.
Majority of mothers (87.7%) strongly agreed that STP was highly effective to a great
extent. The study concluded that it was important to provide information to mothers
about neonatal health and Structured Teaching Program was an effective strategy for
gaining their knowledge.18

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 A study was conducted to evaluate impact of postnatal health education for
mothers on neonatal infection using randomized controlled trial with community follow
up at 3 and 6 months post partum by interview at Main maternity hospital in Kathmandu,
Nepal. 540 mothers randomly allocated to one of four groups: health education
immediately after birth and three months later (group A), at birth only (group B), at three
months only (group C), or none (group D). Structured baseline household questionnaire;
20 minute, one to one health education at birth and three months later was administered.
Mothers in groups A and B were slightly more likely to use contraception at six months
after birth compared with mothers in groups C and D. Findings suggested that the
recommended knlowledge of individual health education for postnatal mothers has
enhanced uptake of baby care.19

A study was conducted Screening pregnant women for group B streptococcus

infection between 30 and 32weeks of pregnancy in a population at high risk for
premature birth. The objective of the study is To assess the benefits of a
chemoprophylaxis program based on screening women for group B streptococcus (GBS)
infection between 30 and 32weeks of pregnancy in a population with a high rate of
premature births. From 1995 to 2011, 24 950 women were screened for GBS infection
between 30 and 32weeks of pregnancy at Markusovszky Teaching Hospital,
Szombathely, Hungary. Those who tested positive, and those who tested negative but
were at risk of infecting their newborns, underwent intrapartum prophylaxis. Neonatal
outcomes were compared with those of a historical cohort that underwent no screening or
treatment, and with those published in CDC/ACOG guidelines recommending screening
closer to term. There were 63 infected newborns (0.2%) in the study cohort, and 1 of 8
with sepsis died. There were 149 infected newborns (0.7%) in the historical cohort, and
29 of 31 with sepsis died. Screening women early in a population with a high rate of
premature births may simplify preterm labor management. It results, however, in a higher
incidence of early onset neonatal GBS disease than when screening is done closer to
term.20

A study was conducted Prompt Control of an Outbreak Caused by Extended-

Spectrum β-Lactamase-Producing Klebsiella pneumoniae in a Neonatal Intensive Care

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Unit. The objective is To assess the effectiveness of a set of multidisciplinary
interventions aimed at limiting patient-to-patient transmission of extended-spectrum β-
lactamase-producing Klebsiella pneumoniae (ESBL-KP) during a neonatal intensive care
unit (NICU) outbreak, and to identify risk factors associated with ESBL-KP colonization
and disease in this setting. A 61-infant cohort present in the NICU during an outbreak of
ESBL-KP from April 26, 2011, to May 16, 2011, was studied. Clinical characteristics
were compared in infected/colonized infants and unaffected infants. A multidisciplinary
team formulated an outbreak control plan that included (1) staff reeducation on
recommended infection prevention measures; (2) auditing of hand hygiene and
environmental services practices; (3) contact precautions; (4) cohorting of infants and
staff; (5) alleviation of overcrowding; and (6) frequent NICU-wide screening cultures.
Neither closure of the NICU nor culturing of health care personnel was instituted. Eleven
infants in this level III NICU were infected/colonized with ESBL-KP. The index case
was an 18-day-old infant born at 25 weeks' gestation who developed septicemia from
ESBL-KP. Two other infants in the same room developed sepsis from ESBL-KP within
48 hours; both expired. Implementation of various infection prevention strategies resulted
in prompt control of the outbreak within 3 weeks. The ESBL-KP isolates presented a
single clone that was distinct from ESBL-KP identified previously in other units. Being
housed in the same room as the index infant was the only risk factor identified by logistic
regression analysis (P = .002).21

A study was conducted Specific antibodies against vaccine-preventable

infections: a mother-infant cohort study. The objective is To determine maternal and
neonatal specific antibody levels to selected vaccine-preventable infections (pertussis,
Haemophilus influenzae type b (Hib), tetanus and pneumococcus). Prospective cohort
study. Specific antibody levels were determined using standard commercial ELISAs.
Specific antibody to pertussis antigens (PT and FHA) of >50 IU/ml, defined as 'positive'
by the test manufacturer, were interpreted as protective. Antitetanus antibody titres >0.1
IU/ml and anti-Hib antibody titres >1 mg/l were regarded as protective. Only 17%
(19/111) of women exhibited a protective antibody response against pertussis. 50%
(56/111) of women had levels of antibody protective against Hib and 79% (88/111)
against tetanus. There was a strong positive correlation between maternal-specific and

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infant-specific antibodies' responses against pertussis (rs=0.71, p<0.001), Hib (rs=0.80,
p<0.001), tetanus (rs=0.90, p<0.001) and pneumococcal capsular polysaccharide
(rs=0.85, p<0.001). Only 30% (33/109) and 42% (46/109) of infants showed a protective
antibody response to pertussis and Hib, respectively. Placental transfer (infant:mother
ratio) of specific IgG to pertussis, Hib, pneumococcus and tetanus was significantly
reduced from HIV-infected mothers to their HIV-exposed, uninfected infants (n=12
pairs) compared with HIV-uninfected mothers with HIV-unexposed infants (n=96 pairs)
by 58% (<0.001), 61% (<0.001), 28% (p=0.034) and 32% (p=0.035), respectively.22

2. Literature related to Structured teaching programme

A study conducted on “Success of an educational intervention on

maternal/newborn nurses breast feeding knowledge and attitudes” to test the effect of a
breastfeeding educational program for improving breastfeeding knowledge, attitudes, and
beliefs of maternal/newborn nurses, and to improve their intentions to provide
breastfeeding support to new mothers. Maternity units of 13 hospitals located in mid
western and east coast states. A sample size of 240 registered nurses (RNs); 206 RNs in
the experimental sites and 34 RNs in the control sites. Participation in the experimental
groups involved the completion of two questionnaires upon study entry and then again
after completion of a self-study module. Findings suggest that this educational strategy
was effective in improving maternal/newborn nurses' breastfeeding knowledge, attitudes,
and beliefs, and intentions to support breastfeeding mothers. Nurses may find this type of
teaching modality to be less intimidating than a structured classroom setting, and more
desirable for their busy schedules.23

A study conducted on “Effectiveness of a newborn care Structured teaching

programme” to evaluate the effectiveness of a Structured teaching programme in
increasing nurses' knowledge of newborn care. Pretest/posttest study design was used.
Participants completed a pretest questionnaire. Participants then reviewed a structured
teaching programme and completed a posttest questionnaire. Study materials were mailed

10
to 262 registered nurses involved in screening egg donors at 177 reproductive health
centers in the United States. There was a significant increase of 20.8% in participants'
mean knowledge score on the posttest as compared with the pretest. A newborn care
Structured teaching programme for registered nurses was effective in increasing
knowledge of basic knowledge and risk assessment.24

PROBLEM STATEMENT
“A study to evaluate the effectiveness of structured teaching programme on
prevention of Neonatal infections among Post-Natal mothers in selected maternity
hospital at Bengaluru”.

6.3 OBJECTIVES
1. To assess pre- existing knowledge regarding the prevention of neonatal
infections among Post-Natal mothers as measured by structured knowledge
questionnaire.
2. To evaluate the effectiveness of self instructional module regarding
knowledge of prevention of neonatal infections among Post-Natal
mothers in terms of fair in post test scores.
3. To find the association between the mean pre-test knowledge with
selected demographic variables.

6.3.1 HYPOTHESIS
H1 The mean post test score will be significantly higher than the mean pre test score
regarding knowledge of prevention of neonatal infections among Post-Natal mothers.
H2 There will be a significant association between the knowledge levels with selected
demographic variables among workers at selected industries.

6.3.2 VARIABLES
1. Independent variable: Self instructional module on of neonatal infections.
2. Dependent variable: Knowledge of workers at selected industries regarding neonatal
infections.

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3. Attribute variable: Age, education, number of birth, area of living.

6.4 OPERATIONAL DEFINITIONS

a) Effectiveness: Refers to gain in knowledge as determined by significant
difference in pre-test and post-test knowledge scores regarding neonatal infection.
b) Structured Teaching Programme: It refers to planned series of information in
ordered to provide teaching on prevention of neonatal infection among post-natal
mothers.
c) Prevention: It refers to Steps taken by the mother for the prevention of neonatal
infections for eyes, umbilical cord, skin and oral cavity.
d) Neonates: It refers to the newborn from 0th till the 28th day of life.
e) Neonatal Infections: It refers to infection of umbilical cord, eye, skin and oral
cavity which occurs between age group of 0 till 28 days.
f) Post-natal Mothers: The mother who had delivered a neonate.

6.5 ASSUMPTION
1. Post-Natal mothers may have some knowledge regarding the prevention of
Neonatal infections.
2. STP may improve the knowledge of post-natal mother regarding prevention of
Neonatal infection.
6.6 LIMITATIONS
1. The study is limited to Post-Natal mothers from selected hospitals at Bengaluru.
2. The study sample size is limited to 60 Post-Natal mothers.
3. The study is limited to Post-Natal mothers, who know Kannada and English.
7. MATERIALS AND METHODS

7.1 Sources of Data : Post-Natal mothers from selected hospitals at Bengaluru

7.1.1 Research Approach: Evaluative approach.
7.1.2 Research design : Pre experimental one group pre-test post-test design.
7.1.3 Setting : At selected hospitals at Bengaluru.
7.1.4 Sample size : 60 mothers at selected hospital bengaluru

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7.1.5 Inclusion criteria:
 Postnatal mothers from selected hospitals at Bengaluru.
 Postnatal mothers willing to participate in study.
 Postnatal mother who are available during the period of collecting data.
 Postnatal mother who are able to write English & Kannada.

7.1.6 Exclusion criteria

 Postnatal mothers who are not willing to participate in study.
 Postnatal mother who are not available during the period of collecting data.
 Postnatal mother who are not able to write English & Kannada.

7.2 Method of collection of data

7.2.1 Sampling technique: Purposive sampling.
7.2.2 Tool of research: Structured knowledge questionnaire, Structured teaching
program.
Structured questionnaire will be constructed in two parts.
Part I - Demographic data.
Part II- Knowledge based questionnaire regarding neonatal infection.

7.2.3 Collection of data

The investigator collects data from selected hospital.
1. Investigator introduces himself to subject and notifies about his objectives, and
steps of study and takes written consent.
2. Selection of subjects (mothers).
3. Assess the mothers for knowledge regarding neonatal infection structured
knowledge questionnaire.
4. Administer structured teaching program (STP) on neonatal infection.
5. Assess the gain in knowledge of workers regarding neonatal infection using same
structured questionnaire.

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7.2.4 Method of data analysis and presentation
1. In the present study descriptive and inferential statistics will be used to analyze
the data.
2. The analyzed data will be presented by using tables and graphs.

7.3 Does the study require any investigation to be conducted on patients or other
human or animals? If so please describe briefly?
Yes, [Structured teaching program to postnatal mothers]

7.4 Has ethical clearance has been obtained from your institution?
1. Yes, Consent will be obtained from concerned authority.
2. Privacy, confidentiality and anonymity will be guarded.
3. Scientific objectivity of the study will be maintained with honesty and
impartiality.

8. List of Reference
1. Neonatal infection [Internet]. Wikipedia the free encyclopedia 2010 [cited 2012
Nov 25]. Available from: http/ www.en.wikipedia.org/wiki/Play.
2. Schmidt CA, Harris JK, Miller LM. Asbestos related Neonatal infection
[Internet]. 2012 [cited 2012 MAY 18].Available from: URL:
pages.uoregon.edu/cfc/classes/CPSY_64.

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3. Naderi F, Heidarie A, Bouron L,Asgari P. Neonatal infection.[Internet]. 2008
[cited 2012 MAY 18]. Available from: URL:
pages.uoregon.edu/cfc/classes/CPSY_64.

4. Sue CB, Dee R, Tammy R. The prevention of Neonatal infection: Geographical

Distribution and Secular Trends [Internet]. 2009 [cited 2012 MAY 18]. Available
from: URL: pages.uoregon.edu/cfc/classes/CPSY_64.
5. Christianson CA, Prows CA, West EB. Neonatal infection. [Internet]. 2002 [cited
2012 MAY 18]. Available from: URL: pages.uoregon.edu/cfc/classes/CPSY_64.
6. Shen JF, Chen CW. Neonatal infection [Internet]. 2011 [cited 2012 MAY 18].
Available from: URL: pages.uoregon.edu/cfc/classes/CPSY_64.
7. Umapathy, effectiveness of oral rehydration theraphy, nightihgale nursing times,
july-2007(3),9-10.
8. Ganagbai.B.kulkarni,assessment of antenatal nursing services at primary health
center, nightingale nursing times, July 2007(3)24.
9. M.L.kulkarni,manual of neonatology,2000,Ist edition ,J P brothers medical
publishers,new delhi,P:2-3.
10. Myles,a text book of mid-wives, 2003,14THedition,elsevies british library
publications.
11. Naveen Thacker, improving status of neonatal health in India, journal of the
Indian academy of pediatrics, Nov 12 -Dec 2007, (44). 891-892.
12. Poonm joshi,nanthini subbiah,termal protection during neonatal transport,
nightingale nursing times,nov 2008,8(4),67.
13. Park.K,“text book of preventive and social medicine”1998 15 TH edition
Banarsidas Bharot publishes; Jabalpur, P-350.
14. Hye Sun Yoon, Youn Jeong Shin, Moranki, Risk factors for neonatal infections in
full term babies in South Koria (2008), 49(4). 530-39(6): p. 658-66.
15. Li S, Faustino EV, Golombek SG. Reducing Central Line Infections in Pediatric
and Neonatal Patients. Curr Infect Dis Rep. 2013 Apr 16.
16. Blue Cross Blue Shield Assocciation:”Home Phototherapy For Neonatal
Jaundice,”Medicalpolicy reerence manual 01-01-07,2004 Nov 9.

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 17. Martins MR, Ribeiro CA, de Borba RI, da Silva CV. [Protocol for the preparation
of neonate to venous puncture using]. 2001 Mar;9(2):76-85.
18. Tine Catherina, Effectiveness of structured teaching programme on prevention of
neonate. “The Nursing Journal of India”. March 2005; (6):132-133.
19. Collern O, Swank, MS carol A, Christianson et al. Effectiveness of a structured
teaching programme for nurses involved in egg donor screening. Journal of
obstetric, gynecologic and neonatal nursing. (2008); 30(6): 617-625.
20. Jones C, Pollock L, Barnett SM, Battersby A, Kampmann B. Specific antibodies
against vaccine-preventable infections: a mother-infant cohort study. BMJ Open.
2013 Apr 11;3(4). pii: e002473. doi: 10.1136/bmjopen-2012-002473. Print 2013.
21. Cantey JB, Sreeramoju P, Jaleel M, Treviño S, Gander R, Hynan LS, Hill J,
Brown C, Chung W, Siegel JD, Sánchez PJ. Prompt Control of an Outbreak
Caused by Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae in
a Neonatal Intensive Care Unit. J Pediatr. 2013 Apr 10. pii: S0022-
3476(13)00266-7. doi: 10.1016/j.jpeds.2013.03.001.
22. Horváth B, Grasselly M, Bödecs T, Boncz I, Bódis J. Screening pregnant women
for group B streptococcus infection between 30 and 32weeks of pregnancy in a
population at high risk for premature birth. Int J Gynaecol Obstet. 2013 Apr 8. pii:
S0020-7292(13)00139-2.
23. Bernaix LW, Beaman ML, Schmidt CA, Harris JK, Miller LM. Success of an
educational intervention on prevention of infection. PMID. 2010 Nov; 39(6): p.
658-66.
24. Swank C, Christianson CA, Prows CA, West EB, Warren NS. Neonatal infection.
J Obstet Gynecol Neonatal Nurs. 2001 Nov; 30(6): p. 617-25.
9 Signature of Candidate

10 Remarks of the Guide The study is feasible and of genuine

interest of the student
11 Name & Designation Of

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 11.1 Guide Mrs. Manjula Devi, M Sc (N)
Professor
Brite college of nursing

Chikkagollarahatti, bengaluru -560091

11.2 Signature

11.3 Co-Guide Miss. Nithya P

Professor
Brite college of nursing

Chikkagollarahatti, bengaluru -560091

11.4 Signature

11.5 Head of the Department Mrs. Manjula Devi, M Sc (N)

Professor
Brite college of nursing

Chikkagollarahatti, bengaluru -560091

11.6 Signature

12 12.1 Remarks of the The topic for the study is relevant and
Principal forwarded for needful action.
12.2 Name and Signature

17