Exploring Cultural Competence of Staff Working In Obstetric Ward Caring For Postnatal Mothers and Their Newborn Babies

Introduction

This study was to explore cultural competence of staff working in obstetric ward caring for postnatal mothers and their newborn babies as well as the knowledge and practices of postnatal mothers regarding neonatal care from selected urban and rural settings of Bangalore. “Good quality neonatal care, better our children shall fare” “Children are the wealth of tomorrow – take care of them, if you wish to have a strong India, ever ready to meet various challenges”. “Jawaharlal Lal Nehru” (Atkinson, 2005)

Healthy children are the greatest resource and pride of a nation. Investment in child development is an investment in the future of the nation. Children ought to be healthy and happy to become productive and contented adults of the future.

Aims and Objectives

1. To assess the knowledge of postnatal mothers regarding neonatal care

2. To describe the practices followed in their family regarding neonatal care

3. To determine the association between knowledge and practice of neonatal care

4. To determine the association of knowledge with selected baseline variable

5. To compare the knowledge and practice of mothers from selected urban and rural settings of Bangalore.

The conceptual framework used for this study is developed by the researcher from “nursing process model” It focuses on assessment of knowledge and practice of postnatal mothers and determining the need for a teaching program in the postnatal ward from the following sources;

Atkinson, K. (2005). Physiotherapy in orthopaedics: a problem-solving approach. New York: Churchill Livingstone.

This source generally talks about physiotherapy in orthopedics where Atkinson talks about Caring for Postnatal Mothers and Their Newborn Babies. The research approach adopted for the study is comparative descriptive design, which was considered appropriate for the present study. Purposive sampling method was used to select to samples from the postnatal ward of St. John’s Medical College Hospital and post natal mothers selected from Anekal Taluk Hospital for comparison. The data gathered from this source schedule was analyzed by descriptive and inferential statistics(Atkinson, 2005).

Armiger, P. and Martyn, M.A. (2010). Stretching for functional flexibility. Philadelphia: Wolters Kluwer Health/Lippincott, Williams, and Wilkins.

The two authors in this source talk about stretching for functional flexibility and the findings of the study are that the mean percentage of knowledge score of postnatal mothers from rural setting was 38.43% and mothers from urban setting were 49.77%. The correlation between knowledge and practice was assessed by correlation co-efficient (‘r’) test. It was found that there was a positive correlation between knowledge and practice except knowledge and practice of umbilical cord care. Association between knowledge and baseline variables of postnatal mothers showed that association between mother’s knowledge and their age, occupation and parity status was significant (Armiger and Martyn, 2010).

Andrews, J.R., & Harrelson, G. L. (2004). Physical rehabilitation of the injured athlete. Philadelphia: Saunders.

Physical rehabilitation of the injured athlete may seem irrelevant when it comes to the care of postnatal mothers and their new born babies but reading through the book makes one understand the relationship. The study reveals that irrespective of staff competency and postnatal mother’s educational status, their knowledge regarding the neonatal care was limited. Postnatal mothers from urban setting had more knowledge of good practice postnatal mothers from rural setting. To give newborn babies a happy and healthy childhood, we must safeguard their health right from the beginning. While each newborn baby is perceived as a precious gift to the family, it also brings with it new responsibilities, changes in behaviors and altered family dynamics. The major task of a family with a newborn according to this source is the healthy incorporation of the new person into the existing family structure (Andrews & Harrelson, 2004).

Anderson, M.K. (2002). Fundamentals of sports injury management (2nd ed.). Philadelphia: Lippincott, Williams & Wilkins

After the baby’s birth, the mother establishes a realistic image of the newborn. This is what the source expounds on and Anderson the author of the source talks of the fundamentals of injury management and how the mother absorbs the newborn into her everyday world and into the social system through an acquaintance – attachment process. Through her, the newborn gradually establishes a firm relationship with other siblings and the rest of the family members. Care and nurturing of the newborn become the primary responsibilities of the parents, especially the mother.

According to this author, one of the most crucial needs often felt by the newborn’s parents is based on their sense of insufficient knowledge. The inherent need to learn more about the care of the newborn motivates the mother to learn from the environment, family members and health personnel.

American Physical Therapy Association. (2001). Topics in physical therapy: pediatrics. Alexandria, VA: American Physical Therapy Association

According to this source, a review of literature is an essential aspect of scientific study. It involves the systematic identification, location, scrutiny and summary of the written materials that contains information on a research problem. The ‘American Physical Therapy Association is a body that concentrates on pediatrics and mainly in the physical therapy topics. It broadens the view of investigator regarding the problem under investigation, helps in focusing on the issues specially concerning the study. The neonatal period is the most vulnerable period in the human life. It provides that Perinatal and neonatal mortality are increasingly important public health issues in the developing countries (American Physical Therapy Association, 2001).

American Physical Therapy Association. (2002). Topics in physical therapy: neurology. Alexandria, VA: American Physical Therapy Association.

American Physical Therapy Association in this context is a body that concentrates on neurology and mainly in the physical therapy topics. The concerned efforts of the past decade have resulted in gains, which though not dramatic still reflect trends as displayed throughout the source. These include greater awareness and concern about newborn health, distinct improvement in outreach and quality of newborn services at district and urban areas, declining trends in neonatal mortality rate and improvement in survival of Low Birth Weight (LBW) and high-risk infants. But the gradual and almost stagnant neonatal mortality in the last few weeks coupled with its impact on under five mortality rate as an indicator of human development has caused tremendous concern and interest globally and nationally in the state of neonatal health and delivery of newborn care in India. Newborn care includes breastfeeding and physical care (American Physical Therapy Association, 2002).

Stanley, D. (2011). Clinical leadership: Innovation into action. Palgrave Macmillan. Sydney.

Stanley is a recognized author experienced in matters related to clinical leadership, which plays a very big role in ensuring that the postnatal mothers are given proper care together with their newborn babies. The book talks of how the objectives of early neonatal care aim to assist the newborn in the process of adaptation to an alien environment. The late neonatal period according to this book carries the common and serious hazards of infection and failure of satisfactory nutrition. Diarrhea and pneumonia take a heavy toll of life in infants exposed to unsatisfactory environment. The case fatality rate of what would normally be trivial episodes can increase dramatically when elementary care is not given (Stanley, 2011).

Niemi, PM. (2008). Medical students’ professional identity: self-reflection during the preclinical years. London: Med Educ.

Related to how well the postnatal mothers are taken care of together with their newborn babies, this source targets Medical students’ professional identity. This source talks about self-reflection during the preclinical years where any wrong practices are carried out the world due to illiteracy and superstitious beliefs especially among people who reside in remote areas where poverty is prevailing and health facilities are far available. It is presumed that personal and socioeconomic factors have an influence on the knowledge of mothers about newborn care. These both aspects are interrelated.

Studies related to the topic Knowledge and practices about breast feeding: Education has a greater influence in the area of hygienic practices of breastfeeding. Studies conducted among nurses and other health workers to assess their knowledge related to breastfeeding practices (Niemi, 2008).

Gómez, D; Elena, HYPERLINK “javascript:__doLinkPostBack(”,’ss%7E%7EAR%20%22Jordà%2C%20Mireia%22%7C%7Csl%7E%7Erl’,”);” o “Search for Jordà, Mireia” J; Mireia, HYPERLINK “javascript:__doLinkPostBack(”,’ss%7E%7EAR%20%22Peinado%2C%20Miguel%20Angel%22%7C%7Csl%7E%7Erl’,”);” o “Search for Peinado, Miguel Angel” P and Miguel, A. (2012). Plos pathogens. Spain: Institut de Biologia Evolutiva (IBE, CSIC-UPF), Barcelona.

This book clearly gives evidence towards epigenetic mechanisms of a growing body and the mechanisms being responsible for biological phenomena regardless of the type of plant. The authors having many affiliations to caring for postnatal mothers and their newborn babies have great exposure to pathogens and one can tell with the contents of the book. According to the authors, there is great evidence of interaction of pathogens and hosts when it comes to epigenetic mechanisms. There are epigenetic technologies that the authors cross apply to host pathogen studies. Having gone through the book, one will be in the best position to understand the reason behind bees sucking nectar from only the good-looking flowers whereas there is nectar in other flowers and plants. The book contains enough charts, diagrams and graphs to understand epigenetic and genetics as well as parasitism and plant growth. Works in this book date 2012 showing that the content is up to date and valid (Gómez, Elena, HYPERLINK “javascript:__doLinkPostBack(”,’ss%7E%7EAR%20%22Jordà%2C%20Mireia%22%7C%7Csl%7E%7Erl’,”);” o “Search for Jordà, Mireia” Mireia, HYPERLINK “javascript:__doLinkPostBack(”,’ss%7E%7EAR%20%22Peinado%2C%20Miguel%20Angel%22%7C%7Csl%7E%7Erl’,”);” o “Search for Peinado, Miguel Angel” and Miguel, 2012).

Guardia, D; Conversy, L; Jardri, R; Lafargue, G; Thomas, P; Dodin, V; Cottencin, O; Luyat, M; Tsakiris, M. (2012). PLOS ONE. United Kingdom: Royal Holloway, University of London.

A good that talks of Anorexia nervosa patients and according to the many authors that have contributed to this book describe Anorexia nervosa patients report the larger feeling than normal. This closely relates to postnatal mothers where one feels uncomfortable with how she looks. This book therefore tends to explain the feeling and the factors that lead one to developing Anorexia nervosa. The authors get out of the way and mention something to do with confidence where lack of confidence can cause diseases such as Anorexia nervosa. It is the book for anyone planning to lose weight and someone going through self-crisis. Having gone through the book, the authors seem to have more information than expected because the title of the book does not look that wide. The study, where Guardia, Conversy, Jardri, Lafargue, Thomas, Dodin, Cottencin, Luyat and Tsakiris sought to establish the truth behind the erroneous judgement concerning the action. They further continue through the chapters to pose a question of whether the observed action on one’s body brings about discrimination or not. Despite the authors of the book being many, they also have many affiliations meaning there is more exposure (Guardia, Conversy, Jardri, Lafargue, Thomas, Dodin, Cottencin, Luyat, and Tsakiris, 2012).

Gibbs. (2008). Reflective Cycle as a tool for expressing the reflection. New York: New York Times.

Gibbs concentrates on issues related to giving care to postnatal mothers and their newborn babies and in Reflective Cycle as a tool for expressing the reflection, Fifty-nine female health functionaries working in 12 blocks of Kangra were selected at random. 58% of the respondents initiated breastfeeding within one hour of birth. 15.4% of urban and 11.9% rural women initiated breastfeeding within one hour of birth. 42% had initiated within one day of birth.

Majority (63%) breast-feed for more than one year. As high as 50% gave one or other prelacteal feeds. Most of the functionaries (69%) bottle-fed their youngest child. In another study out of 322 nurses were interviewed about their knowledge and attitude towards breastfeeding, only 50% of the nurses felt that breastfeeding should be initiated soon after birth. 76% of the nurses felt that mother should stop breastfeeding on developing nipple crack or fissure. 23.2% of the nurses felt that breastfeeding should be stopped during diarrhea. According to the source, regarding the age of continuation of breastfeeding only 25.4% of the nurses felt that it should be continued up to 2 years of age (Gibbs, 2008).

Boud , D. (2004). Avoiding the traps: seeking good practice in the use of self assessment and reflection in professional courses. New York: Social Work Education.

This is a good source for the topic “Exploring Cultural Competence of Staff Working in Obstetric Ward Caring for Postnatal Mothers and Their Newborn Babies.” Avoiding the traps and seeking best practice in the use of self assessment and reflection in professional courses is what this source feeds the researcher or reader with and gives Variations that exist in the actual practice of breastfeeding that depends on the education and socioeconomic level of the woman. In many parts of the country breastfeeding is delayed from hours to days. One reason commonly cited for delaying breastfeeding is the set beliefs surrounding colostrums (Boud , 2004).

Cox, L. (2011) A Presidency Upstaged: The Public Leadership of George H.W. Bush. Texas: Texas A&M University Press.

The baby is fed with any one form of a combination of prelacteal feeds like cow’s milk, employing others mothers with small children from the family or neighboring families for breast-feeding the neonate, sugar water, honey, castor oil to clear the gut from me conium, mixture of herbal preparation etc. All this is what makes up the book above by Cox a Texas A & M university Press publication suggesting that until the mother is free from production of colostrums. According to Sushruta (Ancient IndianScripture) breastfeeding should begin on the5thday and sometimes breastfeeding is initiated on the 6th day after celebration called “Chatti.” (Cox, 2011)

Hart, P. & Uhr, J. (2008). Public Leadership: Perspectives and Practices. Atlanta: ANU E Press.

This source relates to the topic because there must be leadership for proper care to be given. The two authors talk about how in west Delhi, 600 breastfeeding mothers in the age group 16-40 were assessed to find out the popularity of the practice of breastfeeding. All mothers had breastfed their babies. Fifty two (91%) mothers said that they had discarded their colostrum thinking that it is harmful for the newborn, and usually cause constipation, vomiting and other digestive problems. Eight mothers discarded their colostrum at the advice of older women without having any knowledge regarding its harmful or beneficial effect. Four mothers (0.7%) kept squeezing out their breast milk for 3-14 days as some customary rituals could not be performed by some of the relatives due to their late arrival. Initiation of breastfeeding varies from 52.7% starting within 6 hours to 0.7% starting beyond the 3rd day of delivery, and the babies were fed with cow’s milk, “Ganga water”, sugar solution or honey (Hart and Uhr, 2008).

Paul, A. (2006). Labor Relations and Collective Bargaining. New York: new Yew York times.

The source is among the many sources that make the topic interesting as it talks about how some women continue to have concerns about their newborns cord site after discharge and they perceive the cord as being of concern only when the typical signs of cord infection such as order and bleeding with separation are present. Another study revealed that mother had good knowledge about the need for hygiene when cutting the cord, need for knowledge and practice in other aspects of cord care, and was afraid of handling the cord.

Poor knowledge and practices in the source were associated with poor young mothers with low education who had acquired their knowledge from sources other than health workers were incorrect and outdated. There is considerable debate among parents and health care professionals about the most effective treatment of newborns umbilical cord (Paul, 2006).

Bobbitt, Philip, 1998, Parlor Games. Constitutional Stupidities, Constitutional Tragedies. New York, New York University Press.

This source talks of the Constitutional Stupidities, Constitutional Tragedies for example In Nigeria and Pakistan. Incidences of neonatal tetanus occurred in some chapters of the book due to delivery conducting in unhygienic surroundings when poor methods of cutting and managing the cord. The cords were treated with hot compresses, Shea butter or ghee heated with dried cow dung after cutting. Complications of umbilical hernia are seen more often in malnourished children of low socioeconomic status being brought in unhygienic surroundings. It is a good source for getting the idea to write about the quality of care given to the postnatal mothers and their newborn babies (Bobbitt and Parlor, 1998).

Robert, T. Croyle (2005). Theory at a Glance: Application to Health Promotion and Health Behavior (Second Edition). U.S. Department of Health and Human Services, National Institutes of Health.

This source by Robert addresses mothers on the Knowledge and practices about prevention of infection. The national institute of health source suggests that Agents of bacterial sepsis in the neonate are thought to enter the body through the conjunctiva, respiratory orgastro intestinal tracts or the skin. Evidence for the skin as a potentially important portal of entry for invasive infections comes from several sources. A healthy developmentally mature skin, presence of vernix, biochemical, e.g. acidic pH and antimicrobial factors e.g. free fatty acids, polar lipids. The first week of life when epithelial barriers are relatively immature is the neonate’s most vulnerable period, when 50 to 70% of fatal and life threatening neonatal illness, most of which are infectious in nature occur in developing countries (Robert, 2005).

George, B. (2009). Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. Ltd.

Regarding the topic of the paper, this source helps the caregiver opportunity to explore the underlying requirements of helping a postnatal mother. The caregiver becomes well versed in matters related to her skin and that of the newborn baby. If skin serves as a potential portal of entry for invasive pathogens, the prevention of skin injury, reduction of skin contact and colonization with potential pathogens and augmentation of skin barrier function may serve as an effective means to reduce the infection risk of neonates. Aspects of care that are particularly important include caregiver hygiene especially hand washing, routine bathing and skin care (George, 2009).

Centers for Medicare and Medicaid services. (2011). Government – US Federal,  Science & Health,  Government – US States,  Children’s Health Insurance Program (CHIP),  Affordable Care Act,  Medicaid. Florida: Centers for Medicare and Medicaid services.

This source talks about Government – US Federal, Science & Health, Government – US States, Children’s Health Insurance Program (CHIP), Affordable Care Act, Medicaid. This is to prevent skin irritation and injury care of the umbilical cord stump and the preparation of the skin prior to invasive procedure that have the potential to introduce infections organisms into the skin or deeper tissues and blood stream coverage level is more than 90%. In rural areas, children with low parent education and socio economic status and those from high household size had significantly low immunization coverage levels compared with children from other groups (Centers for Medicare and Medicaid services, 2011).

Wegner, J. (2009). Health promotion. New York: New York times

According to this source, the main reason for the low immunization coverage was that the mothers do not care in completing the immunization partly due to lack of awareness and partly due to non-availability of health services. Knowledge and practices about maintenance of warmth: Newborn baby is a homothermous, but his ability to stay warm may be easily overwhelmed by extremes of environmental temperatures. A newborn is more prone to develop hypothermia because of large surface area per unit of body weight. Hypothermia is a common problem in neonates, particularly in developing countries where it is an important contributory factor to neonatal mortality and morbidity (Wegner, 2009).

Conclusion

A retrospective study of traditional concept and practices for the prevention of neonatal hypothermia was conducted in three Himalayan villages the community was found to believe that newborns are vulnerable to cold induced disease for the first few months of life. Birth attendant & mother practiced traditional means for thermo regulation like a warm heated room, early rooming in, oil massage & layers of warm clothes. Nevertheless, the ritual practice of bathing immediately after birth and then up to three times each day even in winter is not perceived by them to provoke hypothermia.