Revathy, G (2011) Effectiveness of Positions upon Vital Parameters among Preterm Neonates. Masters thesis, Apollo College of Nursing, Chennai.
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Abstract
The heart of the research project has in reporting the findings. This is the most creative demonstrating part of the study. This chapter deals with summary of this study findings, conclusion, implications and recommendations. A quasi-experimental study was conducted to assess the effectiveness of positions upon vital parameters among preterm neonates admitted in NICU at selected hospital, Chennai. The objectives of the study were, 1. To determine the effectiveness of positions upon the vital parameters among preterm neonates 2. To compare the effectiveness of various positions upon the vital parameters among preterm neonates. 3. To find out the association between the selected neonatal variables and the level of oxygen saturation among preterm neonates. 4. To assess the level of satisfaction of the nurses regarding effect of positions upon the vital parameters among preterm neonates. Null Hypotheses Ho1: There will be no significant difference in vital parameters between the positions. Ho2: There will be no significant association between the selected neonatal variables and level of oxygen saturation in various positions among preterm neonates. The conceptual framework was based on This Al’s synactive theory was modified for the present study. An intensive review of literature and guidance by experts laid the foundation to the development of neonatal variable proforma, demographic and obstetrical variable proforma, observational checklist and rating scale on level of satisfaction of nurses. A quasi experimental research approach with alternating treatment design was used to achieve objectives of the study. The present study was conducted in Kanchi Kamakoti Childs Trust Hospital in Chennai, with the sample size of 30, selected through non-probability purposive sampling technique The data collection tools were validated and reliability was established. After the pilot study, the data collection of the main study was done using the validated tool. The relevant data was collected then positioning was done to preterm neonates then the data was collected after the administration of each position. The collected data were analyzed. The major findings of the study The major findings of the study were Neonatal variables The study findings reveals that among the preterm neonates assessed most of them were males (60%) and they were born between 26-29 weeks of gestation (56.7%) who had birth weight of ≤ 1500gms. Significant percentage of them had an Apgar score of 4-6 (43.3%) and 40% were less than 7 days old. Demographic and obstetrical variables Majority of the mothers had received 2 doses of tetanus toxoid (86.7%). Most of the mothers were primi (73.3%) and they were unemployed (66.7%). Most of them were living in urban residence (66.7%) and had a sedentary nature of work (60%). Among them had at least two antenatal visits (63.3%). Significant percentage of them had primary education (30%) and 33.3% of them had anemia during pregnancy. Effectiveness of positions Comparison of mean vital parameters among preterm neonates in lateral, supine and positions Among preterm neonates the vital parameters were assessed at 5, 30 and 60mts mean temperature was between 35.66 to 35.88◦ C in lateral position, 35.38 to 35.480C in supine position and 35.60 to 35.660 C in prone position. Preterm neonates in lateral position and in prone position had higher mean temperature than in supine position. The mean heart rate of them was between 150.11 to 147 b/mt in lateral position, 150.11 to 147.33 b/mt in supine position and 148.55 to 142.22 b/mt in prone position. The mean respiratory rate was ranged between 45.66 to 43.22 b/mt in lateral position, 50.44 to 47.33b/mt in supine position and 43.77 to 40.55 b/ mt in prone position. Their mean arterial pressure found to be between 42.9 to 41.83 mmHg in lateral position, 46.95 to 43.88 mmHg in supine position and 47.21 to 46.16 mmHg in prone position. The mean oxygen saturation of preterm neonates ranged from 94.16% to 97.11% in lateral position, 92.05% to 95.72% in supine position and 95.94% to 98.33% in prone position. The result of analysis of variance revealed that vital parameters among preterm neonates between three positions varied significantly at P<0.001. The findings of this study showed significant difference in vital parameters in lateral position, supine and prone position (P<0.001). These results can be attributed to the effectiveness of positions with statistical significant at P<0.001. Thus the nullhypotheses Ho1 was rejected. Association between selected neonatal variables with the level of oxygen saturation of preterm neonates in lateral position, supine position and prone position There was no significant association between the selected neonatal variables namely, gender, Apgar score, gestational age , birth weight age in days and the oxygen saturation of Preterm neonates in different positions at the level of confidence at p<0.05; hence the hypotheses Ho2 was accepted. Level of satisfaction of nurses who cared the preterm neonates. The study findings revealed that most of the nurses (60%) were highly satisfied with the prone position. Significant percentage of them (20%) were highly satisfied with lateral position and 20% of them were satisfied with supine position. CONCLUSION: The findings of this study indicated that preterm neonates need immediate attention to prevent them from morbidity and mortality. Neonatal intensive care unit nurses play important role in meeting the basic needs of the preterm neonates, the excavated results supported that prone and lateral positions are appropriate for preterm neonates to facilitate the optimal outcome of ventilation and development. However supine position is necessary for neonates who are intubated. Implications The findings of the study has implications in different branches of nursing profession, i.e. nursing practice, nursing education, nursing administration and nursing research. By assessing the effectiveness of positions we get a clear picture regarding different steps to be taken in all these fields, to improve the standards of nursing profession. Nursing Practice Nurses as team leaders can plan and co ordinate activities for betterment of preterm neonates. They can plan and formulate strategies regarding positioning neonate will have energy expenditure, increased oxygen consumption, and change in stability. Prolong supine position may contribute to the shoulder retraction, neck hyper extension, and abducted, extremely rotated extremities. Positioning neonates in lateral and in prone position is effective intervention for increasing oxygen saturation and temperature control. In critical period supine position is necessary for preterm neonates with assisted ventilation. Thus neonatal nurses should arrange neonate’s position similarly to fetal position in intrauterine by positioning preterm neonates in the supine with flexion position when the preterm neonate is on mechanical ventilation. And turn position to lateral position when preterm neonates are clinically stable. Hence as clinical nurses we need to follow cost containment methods in improving the quality of nursing care with cost effective care which is based on evidence based nursing. Nursing Education Integration of theory and practice is a vital need and it is important in nursing education. Care of preterm has been included in beginning years of Nursing Education. Hence Nurse Educators can lay emphasis on importance of position and its role in health maintenance of preterm neonates. With changing health care trends, nursing education must emphasize primary health care approach focusing on prevention than cure. Nurse educators need to lay emphasis on positions in the curriculum and the nursing students should be taught about the importance of positions on ventilation and development. Advanced educational technology such as simulation, video assisted teaching could be incorporated for students while teaching positioning during mechanical ventilation also. Nursing Administration Technological advances and ever growing challenges place a great demand on health care professionals. Nurse Administrators have great responsibilities to provide nurses with substantive continuing education to tackle these challenges and demands. Continuing Nursing Education programmes enable nurses to update their knowledge and to acquire skill and demonstrate high quality care. This will enable the nurses to update their knowledge and to acquire special skills in practicing care. Nursing Research There is a need for extensive and intensive research in this area. It upon a big avenue for research on innovative methods of creating awareness, development of teaching material and setting up of multi media centers for teaching and for creating awareness among the nurses regarding position and its benefits, health promoting properties and its availability. Disseminate the findings through conferences, seminars, publications in professional, national, international journals and World Wide Web. Recommendations
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Effectiveness, Positions, Vital Parameters, Preterm Neonates. |
| Subjects: | NURSING > Paediatric Nursing |
| Depositing User: | Subramani R |
| Date Deposited: | 18 Aug 2020 18:39 |
| Last Modified: | 18 Aug 2020 18:39 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12888 |
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