RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA,
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE
Mrs. SARITHA.N.
CANDIDATE AND
SRI LAKSHMI COLLEGE OF NURSING
ADDRESS
SRI GANDADAKAVAL, MAGADI MAIN ROAD,
VISHWANEEDAM POST, SUNKADAKATTE,
BANGALORE-91.
2.
NAME OF THE
SRI LAKSHMI COLLEGE OF NURSING SRI
INSTITUTION
GANDADA KAVAL, MAGADI ROAD,
VISHWANEEDAM, SUNKADAKATTE,
BANGALORE-91.
3.
4.
COURSE OF STUDY
I YEAR M.Sc., NURSING
AND SUBJECT
PEDIATRIC NURSING
DATE OF ADMISSION 17-06-2008
TO COURSE
5.
TITLE OF THE TOPIC A STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON
“IMPORTANCE
AND
HAZARDS
OF
PLAY
AMONG TODDLER” AMONG MOTHERS OF
TODDLER
IN
BANGALORE.
URBAN
COMMUNITY
AT
6.
BRIEF RESUME OF THE INTENDED WORK:
6.1
NEED FOR THE STUDY:
Play is the universal language of childhood. Children’s lives and learning
are full of play. It is through play that children understand each other and the world
around them.
Through play they develop the skills required to competence in
cognitive, creative and social spheres.1
Toddler is the age group between the first year to three years. The toddler
period is a time, when children strive to integrate, their inner desires with in the
limitation of external reactivity, play is a method of exploring the world, venturing in
to the unknown, and testing reality against personal powers. Play permits children to
respond to challenge, to learn power in influencing the environment, and the initiate
action and observe results.
It is also a method of integrating experiences and
develop.2 Toys being given to children must be carefully assessed to safety features.
Toys may be appealing to adult and even children could be potentially hazardous.
Small toys that a toddler can put into the mouth should be avoided because the child
may swallow or aspirate them. Children may attempt to place small object in their
ears and nose.3
In worldwide young children, from birth to age five, are particularly
vulnerable to injuries in the home. According to the Canadian Hospitals Injury
Reporting and Prevention Programme (CHIRPP) for children under five years, 88%
of home injuries occur in the children’s own home. The other 12% of injuries occur
in and around private homes other than their own. CHIRPP Data base 1997-2003.
Out of 100% of (148.768 children) injury 58.2% of (86,528 cases) due to fall, 3.6%
(5,399 cases) due to Burn, 3.4% (5,105 cases), 1% (1,546 cases) Dog bites, 0.2%
(247 cases) due to Asphyxia, threat to breathing, 0.1% (109 cases) due to Drowning
or near drowning , 0.1% (92 cases) due to Motor vehicles).4
In India 16% of child injured with clothing, 9% children are injured with
furniture 14% due to nursery, 20% due to sports and play ground and 42% of child
injured with toys. 5
In Bangalore 17.65% children injured with mechanical injury 58.82%
1
injured with agent related, 23.53% due to environment, 32.35% with mild injuries,
45.59% with moderate injuries, 22.06% with sever injuries. 6
The study was conducted to assess mother’s attitude towards her child’s
health, education, and play to 419 mothers of children in Dalmau and Lalganj Blocks
in India. The integrated child development services has been operating in Dalmau
Block women here made up the study group. The mothers in Lalganj Block, which
was similar to Dalmau Block, comprised the control group. The majority of children
from both groups had mothers who were apathetic towards their child’s health,
education and play. There was a significant between the positive attitude towards
child health of mother of ICDS children (38.78%) and those of non-ICDS children
(17.56%) [p<001], however.
Researchers observed a negative attitude towards
health in the mothers of 1.41% of ICDS children and 5.37% of non-ICDS children
(p<.0001). Further, more mothers in the ICDS block (24.76% of the children) had a
positive attitude towards child education than those in the non-ICDS block
(16.59%)[p<001]. 2.34% of the ICDS children mothers 10.24% of the non-ICDS
children’s mothers had a negative attitude towards education (p<.001). Even though
a significant difference also existed between the positive attitudes of two groups
concerning child play (p<.01), the difference was less significant that it was for
health and education. Moreover most of the mothers did not realize the importance
of play in child development.7
The study was conducted in 990 injured infants, found that 21% required
medical intervention.
Hospital admissions for this age group were mainly for
fractures 58%, head injuries 19% and burns 9.5%. Falls were reported to be the most
common cause of injury and most commonly resulted in head injuries 36%.
Superficial injuries 26.3% and fractures / dislocations (12.2%). Falls accounted for
95% of skull fractures. Had injury for infants are of particular concern as they may
have effects over the child’s lifespan. Even with a minor head injury, problems with
loss of memory, language and spatial Orientation are present several months after the
injury. Since falls occur. So frequently, even a small percentage of serious cases
represents a large burden.8
The study was conducted, play is an integral part of a child’s life working
with children in the hospital is based on the worldly view that claims that the patient
2
is first and foremost a child. Investing n his mental well being will assist him and his
parents to better cope with his illness and hospitalization. From the point of view,
many activities have been developed at Schneider children Medical Center of Israel
(SCMCI), Where the focus is on play. It is vital that the nurses work in co-operation
with the educational staff and integrate components of play during routine activity, in
preparing children for surgeries and invasive procedures, and during, painful or
uncomfortable interventions.9
The study was conducted injuries are the leading cause of death during
childhood. Although many injuries occur when children are at home and being
supervised by caregivers, there has been little research examining how parents
respond to children approaching injury-risk hazards. In the present study mothers and
their toddlers were unobtrusively videotaped as they waited in an office containing
number of contrived hazards that could result injury to the child. From the video
records we examined when mothers attended to hazards (before or after the child
approached the hazard). What they said or did (remove hazard, redirect childverbally or physically) and children’s responses to their mother’s efforts to redirect
them away from injury hazards. Other factors that were examined as potential
influences or parents’ responses included the child’s injury history.10
More children are injured between the first and second year than any other
year. The researcher found that many mothers of toddler having inadequate
knowledge on play needs. So it will affect the physical, mental and social behaviour
of the toddlers. So the researcher is interested and felt that there is a need for
structured teaching programme on importance and hazards of play needs among the
mothers of toddler to improve the growth and development of the toddler in all
aspect.
6.2
REVIEW OF LITERATURE;
Studies related to Play needs of the Toddler:
The study was conducted the relation between social interaction and
complexity of toddlers symbolic play was investigated 57 toddlers between 15 and
24 months of age were observed under fourcondition:1)Child play alone 2)Child play
with mother. 3) Child modeling mother and 4) Child play with mother following the
3
modeling condition.
Each subject was rated on completing of play, maternal
attention directing, reciprocity, and maternal intrusiveness. Significance condition
effect were found in which more complex forms of play were observed when the
children were playing with their mothers than workers when playing by themselves.
Maternal instructions and questioning were negatively related to symbolic play. Turn
taking was more negatively related to simple exploratory play.
Results of a
sequential analysis demonstrated that turn taking was more likely to precede
demonstrated that symbolic play, and maternal instrusiveness was more likely to
precede simple exploratory play. The role of active partnership in symbolic play
development is discussed.11
The study was conducted play with toys provides children with the
opportunity to practice behaviours that have relevance to gender role development.
By 18 months, toddlers consistently choose to play with sex appropriate toys. This
study was designed to investigate parents and toddlers initiation of p lay with baby
dolls and a stuffed clown to determine whether boys are provided with the same
opportunity for feminine play as girls are when playing with the same type of toys.
42 parent toddler dyads from Caucasian middle-class families were observed playing
with two baby dolls and a soft stuffed clown for four minutes. Parent toddler play
was coded for doll appropriate and in animate object type play. The baby dolls and
the clown elicited different play behaviors from both the parent and the toddlers.
Same-sex dyads engaged in different types of play than opposite sex parent toddler
dyads. Findings of this study lend evidence that not all dolls are alike. Consequently,
parents who provide their toddlers with baby dolls are providing different
experiences from parents who provide soft stuffed toys. Implications for gender role
development are discussed.12
The study was conducted regarding pretend play has recently been of great
interest to researcher studying children understanding of the mind. Pretend play
might be a zone of proximal development, an activity in which children operate at a
cognitive level higher than they operate at in non-pretense situations. Alternatively,
pretend play might be fool’s gold, in that it might appear to be more sophisticated
than it really is this Maternal management of the home as a developmental play
space for infants and toddlers.13
4
The studies related hazards of play
The recent study have suggested that day care may be a relatively unsafe
environment. In this population based study, the incidence of injuries in day care and
home care were evaluated based on the number of hours children were exposed to
each environment. In this population, 43.6% of children less that 5 years of age spent
part of the year in day care. The rate of injuries in day care was 2.50 per 100 000
child-hour of exposure compared with a rate of 4.88 per 100000 child hours of
exposure in the home environment. There were no difference in overall severity of
injuries in the two groups. It was concluded that children are at no greater risk of
injury in day-care settings than in the home environment. 14
The study was conducted there were an estimated 64373 stroller-related
injuries (95% confidence interval [CI]: 49 223-79 514) to children 3 years old and
younger treated in hospital emergency department during the 5 year study period.
The median age at the time of the injury was 11 months, 51% were males. The
annual rate of injury among children <1 year old was 184.4 per 100 000. 76% of
injuries resulted from a fall from stroller. A motor vehicle was involved in <1% of
cases. Most injuries involved the head (44%) or face (43%). Injury diagnoses
included contusions or abrasions (38%), lacerations (25%), closed head injury (22%)
and extremity fractures (3%). Two percent of injured children, an estimated 992
(95% CI:428-1556), were admitted to the hospital during the study period, an annual
admission rate of 1.3 per 100 000. 70% of admission were for head trauma. It
conclude the data suggest that restraint use would prevent many stroller related
injury.15
The study was conducted to examined the relationship between the type of
parental supervision and the young child’s risk of injury due to play. The results
showed that injury was most likely to occur when there was no supervision or
intermittent supervision. The lowest late of injury occurred when thus was constant
supervision for both boys and girls. With boys intermittent supervision led to higher
rates of injury. But for girls, intermittent supervision was associated with a lower
rate of injury. The researcher suggested this may be because girls engage in risks
behaviours where parents might have more time to react; whereas top boys this
behaviour led to injury more guilty.16
5
Studies related to knowledge of mothers on importance and hazards
of play to the Toddler:
The study was conducted the investigation of mother and toddler play had
two goals. This primary goal was to examine the types of play mother introduce in
direct response to their toddlers play. A secondary and exploratory goal was to
examine the relation between maternal knowledge about child play and actual
maternal play behaviours.
So mother and their 21 months old toddlers were
observed at home during free play. Mother and child exploratory, non-symbolic, and
symbolic play were coded sequential analyses revealed that mothers adjusted their
play to their children play level by responding to their children with play that was
either at the same level or at a higher level than their children’s play by introducing
higher level play. There finding suggest that mother sent to play with their toddlers
in way that might promote their child’s development and that mothers with more
knowledge about play development provide their children who appropriately
challenging play interactions.17
The study was conducted to examine the parent knowledge of child
development to maternal behavioural competence among mothers of high risk
infants. 65 mothers completed questionnaires regarding parental self-efficacy and
knowledge of child development on were assessed for behavioural competence
during 10-min free play session with their infants. There were no independent
contributions of parental self-efficacy or parent knowledge of development in
predicting parenting competence.
By contrast, parental self-efficacy beliefs and
parenting competence were inversely associated when knowledge of development
was low. Mothers reporting high parental self efficiency, but low knowledge of
development.18
The study was conducted 64 mothers of children ranging in age from 6 to 58
months were asked to determine, for pairings of play and language items, which item
was more advanced developmental. This procedure was repeated within 2 weeks.
Mothers’ knowledge about language development was stronger than and unrelated to
their knowledge about play, suggesting that maternal knowledge about development
of domains is differentiated and specific.
6
Finally, mother suggested about
developmental milestones depended on their children’s current development stage:
Mothers were less accurate at estimating the timing of milestones that their children
had mastered many months earlier, supporting the view that mothers’ knowledge is
informed by their children’s recent rather than past achievements in specific areas.19
The study was conducted the injuries are the leading cause of death during
childhood. Although many injuries to toddlers occur when children are at home and
being supervised by caregivers, there has been little research examining how parents
respond to children approaching injury-risk hazards. In the present study mothers and
their toddlers were unobtrusively videotaped as they waited in an office containing a
number of contrived hazards that could result in injury to the child. From the video
records we examined when mothers attended to hazards (before or after the child
approached the hazard), what they said or did (remove hazard, redirect childverbally or physically), and children's responses to their mother's efforts to redirect
them away from injury hazards. Other factors that were examined as potential
influences on parents' responses included the child's injury history, the parent's report
of the child's typical level of risk taking, and the child's level of receptive language
development. Boys were more likely than girls to approach injury-risk hazards and
were more likely immediately to touch or retrieve the item; frequency of touching
hazards positively correlated with mothers' reports of children's risk taking and injury
histories. Mothers used more, and more effortful, redirection strategies for boys, and
boys were less compliant than girls in response to their mother's efforts to redirect
them from hazards.20
The study was conducted to measure supervision and these are extensively
discussed, along with reporting on the recent development of two questionnaire
measures of supervision (Beliefs About Supervision Questionnaire and Parent
Supervision Attributes Profile Questionnaire) that have shown good validity and hold
promise for addressing the problem of measuring caregiver supervision in reliable
and valid ways. A review of the findings on relations between supervision and childinjury risk reveals that many substantive questions remain unanswered. A number of
recommendations for future research are given and a conceptual model is presented
that focuses attention on the need for research that examines how factors interact to
influence child-injury risk. This model has relevance not only for research but also
7
for prevention and serves to emphasize the complementary nature of environmentoriented and person-oriented approaches to child-injury prevention. It concluded
Direct evidence linking supervision to child-injury risk is scarce and many important
questions remain unanswered. Based on the conceptual model presented, in future
research it is important to examine how supervision interacts with other key factors to
influence children’s risk of injury. 21
Studies related to STP in urban area.
The study was conducted to 240 mothers were interviewed. Planned home
deliveries were 140 (58.3%) and 100 (41.7%) were unplanned. Only 6.2% of
deliveries had a skilled birth attendant present and 38 (15.8%) mothers gave birth
alone. Only 46 (16.2%) women had used a clean home delivery kit and only 92
(38.3%) birth attendants had washed their hands. The umbilical cord was cut after
expulsion of placenta in 154 (64.2%) deliveries and cord was cut using a new/boiled
blade in 217 (90.4%) deliveries. Mustard oil was applied to the umbilical cord in 53
(22.1%) deliveries. Birth place was heated throughout the delivery in 88 (64.2%)
deliveries. Only 100 (45.8%) newborns were wrapped within 10 minutes and 233
(97.1%) were wrapped within 30 minutes. Majority (93.8%) of the newborns were
given a bath soon after birth. Mustard oil massage of the newborns was a common
practice (144, 60%). Sixteen (10.8%) mothers did not feed colostrum to their babies.
Prelacteal feeds were given to 37(15.2%) newborns. Initiation rates of breast-feeding
were 57.9% within one hour and 85.4% within 24 hours. Main reasons cited for
delivering at home were 'preference' (25.7%), 'ease and convenience' (21.4%) for
planned deliveries while 'precipitate labor' (51%), 'lack of transportation' (18%) and
'lack of escort' during labor (11%) were cited for the unplanned ones. It concluded
the high-risk traditional newborn care practices like delayed wrapping, bathing,
mustard oil massage, prelacteal feeding and discarding colostrum need to be
addressed by culturally acceptable community-based health education programmes.22
6.3
STATEMENT OF THE PROBLEM :
A study to assess the effectiveness of structured teaching programme on
importance and hazards of play of toddler among their mothers in selected
urban community, Bangalore.
8
6.4
OBJECTIVES OF THE STUDY :
1. To assess the pretest knowledge of mothers of toddler regarding
importance and hazards of play.
2. To assess the effectiveness of structured teaching programme on
importance and hazards of play to the mothers of toddler.
3. To find the association between knowledge score with selected
demographic variable.
6.5
OPERATIONAL DEFINITIONS :

Effectiveness: Refers to the changes in the pretest and posttest scores of
assessment of play needs on toddler’s mother.

Play : Play is the work of children. It consist of these activities performed for
self-amusement that have behavioural, social and psychomotor rewards.

Mother : A female person who is pregnant with or gives birth to a child.

Toddler : Refers to the age group from 1—3 years

Hazards: Anything which has the ability to cause injury.
 STP : Structured teaching programmed refers to the systematically planned
program refers to the systematically planned programmed designed to
provide information regarding toddlers play needs for mother of toddler.
6.6
HYPOTHESIS :
H1 : There will be significant different between pretest and posttest knowledge score
of mothers of toddler.
H2 : There will be a significant association between knowledge score with selected
demographic variable.
6.7
ASSUMPTIONS :
1. Mothers of toddlers may have some knowledge regarding importance
and hazards of play of the children.
2. Structured teaching programme enhance the awareness of he mother of
toddlers regarding importance and hazards of play.
6.8
DELIMITATION :
1. The study is delimited to importance and hazards of play of toddler only.
2. The studies delimited to 40 samples only.
9
6.8
DELIMITATION :
1. The study is delimited to importance and hazards of play of toddler only.
2. The study is delimited to 40 samples only.
6.9
PROJECTED OUTCOME :
The study will enhance the knowledge on importance and hazards of play
among the mothers of toddler.
7.
MATERIALS AND METHOD :
7.1
SOURCE OF DATA :
Data will be collected from the mothers of toddler in
the urban community, Bangalore.
7.2
METHODS OF COLLECTION OF DATA :
7.2.1
SAMPLING
- Mothers who are willing to participate in this study.
CRITERIA
- Mothers of toddler can understand, speak & read
INCLUSION CRITERIA
Kannada.
- Mothers of toddler undergone any training program
on importance and hazards of play.
EXCLUSION CRITERIA
- Mothers of toddler who are sick.
- Mothers of infant and preschool children.
7.2.2
RESEARCH DESIGN
The research design adopted for the studies preexperimental, one group pretest post test design.
7.2.3. VARIABLES UNDER
STUDY
INDEPENDENT
VARIABLE
Structured teaching programme
Knowledge of play needs
DEPENDENT VARIABLE
7.2.4
ATTRIBUTE VARIABLE
Age, sex, socio economic status, education.
SETTING
The setting of the study is selected Urban
community.
10
SAMPLING
The setting adopted for the study is convenience
TECHNIQUE
sampling techniques.
7.2.6
SAMPLE SIZE
The sample of the study consist of 40.
7.2.7
TOOLS OF
SEC A: Structured interview schedule to the
RESEARCH
demographic data of mothers of toddler.
7.2.5
SEC B: Structured interview schedule to asses the
knowledge of the mother of toddler on importance
and hazards of play
7.2.8
COLLECTION OF
-
A prior formal permission will be obtained from
the authorities for collecting the required
DATA
information
-
Informed consent will be obtained from the
samples, and assure them regarding maintain the
privacy & confidentiality of the information
which will be given.
-
Structural
interview
schedule
will
be
administered to assess the knowledge of mothers
of toddler on importance and hazards of play
interms of pre-test
-
Structure teaching programme will be given on
importance and hazards of play.
-
Structural
interview
schedule
will
be
administered to assess the knowledge of mothers
of toddler on importance and hazards of play in
terms of post test.
7.2.9
Duration of the study 30 days
METHODS OF DATA
Investigator would analyze the data collected by
ANALYSIS AND
using descriptive and inferential statistics.
PRESENTATION
The plan of data analysis will be as follow :
1.
Assessing the knowledge of the mother will be
interpreted by descriptive statistics such as
11
mean, median, standard deviation.
2.
Effectiveness of structured teaching programme
between experimental and control group will be
analyzed by ‘t’ test.
3.
Association of effectiveness of structured
teaching program with demographic variables is
analyzed by Chi. Square (X2).
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON MOTHERS OR
OTHER HUMAN OR ANIMALS? IF SO, PLEASE DESCRIBE
BRIEFLY.
Yes, the study requires specific intervention to be conducted on importance
and hazards of play of the toddler.
7.4
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3?
Yes, informed consent will be obtained from institution, authorities, privacy,
confidentiality and anonymity will be guarded, scientific objectivity of the study will
be mentioned I honesty & impartiality
8.
LIST OF REFERENCES:
1. Kamna raj. Play: essential for all children. Association for childhood
education. 2002 April 23
2. Parenting and child health – Health topics. Play with children.
http://www.cyh.com/healthtopic/healthtopicdetails.aspx?p
3. Walsh.Tm. Timelesstoys : Classic toys and the play makers who
created them. Andrews Mc meet publishing 2005.
http://en.wikipedia.org/wiki/toys.
12
4. Health surveillance and epidemiology division. Public health agency of
Canada 2005
5. Kids in Danger. Hazards of child’s play: Children’s product recalls in
2004. Reported by kids in danger. March 2005.
6. Impact. The injury prevention centre of children’s hospital. Karnataka
7. Chaturvedi.S.Prasad.M.
Mothers
attitude
towards
child
health
education and play in ICDS and non ICDS areas. Popline document.
November
8. Fischer John. Safer homes for children. A guide for communities royal
and surveillance.
9. Bar.H.Haiat. Mor.G. Division of pediatric nursing. Dina academic
school of nursing. Robin Medical Centre. Tiqva.
Israel. Dina school at clalit. org. oil.
10. Schwebel.David C. PhD;. Pediatric Uniintentional Injury: Behavioral
Risk factors and implications for prevention. June 2007. (245-254)
11. Fiese.BH. Playful relationships: a contextual analysis of mother –
toddler interaction and symbolic play. Department of psychology
Syracuse university.
12. Yvonne.M.Caldera and Mary.A. Sciarffa division of neonatology.
Department of pediatric. University of Maryland. Baltimore.
13. Lillard. A.S. Department of Pyschology. case western reserve
university. Cleveland Ohino.
[email protected]
13
14. Frederick.P.Rivara. MD.MPH. Risk of injury to children less than
5years of age in day care versus home care settings. 1988 Dec.16.
15. Elizabet.C.Powell. MD.MPH. Incidene and description of strollerrelated injuries to children. Us consumer product.
16. Yvonne. M. Caldera. Mary.A. Sclaraffa parent –toddler play with
feminine toys: A journal of research. Vol.39.1998
17. Damsat.A.M. Tamis –Le Monda.CS Bornstein MH. Sequential
interactions and the relation between maternal beliefs and behaviours.
Albert Einstein College of Medicine USA.
18. Gardner-Hussey. Division of Neonatology. Department of Pediatrics.
University of Maryland. Baltimore.
19. Tamis –Le Monda. Mothers knowledge about children’s play and
language development. Developmental psychology. 1998. January.
20. Barbara A. Morrongiello and Tess Dawber. University of Guelph.
Canada. January 2000.
21. Barbara A. Morrongiello. Caregiver supervision and child injury risk.
Psychology department. University of Guelph.
22. Chandrashekhar T Sreeramareddy. Home delivery and newborn care
practices among urban women. In India.
14
9.
SIGNATURE OF THE CANDIDATE :
10.
REMARKS OF THE
GUIDE
11.
NAME AND DESIGNATION OF
11.1
GUIDE
11.2
SIGNATURE
11.3
CO-GUIDE
11.4
SIGNATURE
11.5
HEAD OF THE
DEPARTMENT
11.6
SIGNATURE
11.7
REMARKS OF THE
CHAIRMAN/PRINCIPAL
SIGNATURE
15