Summer Field

Observation
Report

Max Super Speciality Hospital,

Saket
SUBMITTED BY: Ms Angel Thomas
MSc Nursing 1st year (RCON)
SUBMITTED TO: Mrs. Somibala Thokchom
Tutor (RCON)

EAST BLOCK

WEST BLOCK

RECEPTION COUNTER

AREA
: Max Healthcare Super
Speciality
Hospital, New Delhi
SUBJECT : Obstetrics & Gynaecology
DURATION: 11th May 2015- 5th June
2015
ADVISOR : Dr Manju Chhugani
(Principal, Rufaida College of
Nursing)

Index
S.No
.

CONTENT

1.

Acknowledgement

2.

Introduction

3.

General Objectives

4.

Section 1- Institutional Profile

PAGE
NO.

5.

Section II - Advance competency gained in nursing

practice in the area of specialization maternity
nursing.

6.

Section III - Ability develops in Management and

Supervision in clinical area.

7.

Section IV - Problem Solving ability

8.

Critical appraisal of hospital

9.

Annexures
a. Letter of permission
b. Tool- Structured Questionnaire
c. Leaflet on Essential New-born care
d. Certificate of experience

Acknowledgement
I take this opportunity to express my heartfelt thanks and deep regards to Dr. Manju
Chhugani (Principal, Rufaida College of Nursing) and Mrs Somibala (Tutor, Rufaida
College of Nursing) for her kind approval for my posting in Max Healthcare Super
Speciality Hospital, New Delhi.
I am highly grateful to Dr. S Warsi (Medical Superintendent, Max Healthcare Super
Specialty Hospital) & Dr. Arthur Pinto (Medical Director) for his cooperation all
through the Posting in the hospital.
My special thanks to Dr. Anuradha, H.O.D, Obstetrics and Gynecology and Dr.
Shrishtha, Senior Consultant, Obsteritics and Gynaecology for her guidance and
support.
I am extremely thankful to, Dr. Anuradha, H.O.D Obstetrics and Gynaecology and Dr
A. Goel, H.O.D, Paediatrics for validating my tool and for their expert guidance.
I express my sincere thanks to all Nursing staff, Doctors, ANMs, paramedical and
other clerical staff for helping me to complete my experience in Max Healthcare
Super Speciality Hospital, New Delhi.
Above all, I express my deep sense of gratitude to the Supreme Lord, the Almighty
God for his abiding grace and magnanimity in completion of the summer field
posting

Introduction
Maternal health is the health of women during pregnancy, childbirth, and the
postpartum period. India continues to contribute about a quarter of all global
maternal deaths On the other hand; one million children born in India are dying every
year even before they become 28 days old. A child born in India is 14 times more
likely to die during the first 28 days than one born in the US or UK. Despite health
improvements over the last thirty years, lives continue to be lost to early childhood
diseases, inadequate new born care and childbirth-related causes. More than two
million children die every year from preventable infections. According to the World
Health Organisation (WHO) globally, 30% of children under five are estimated to be
stunted and 18% have low weight-for-height, and 43 million children are overweight.
Optimal breastfeeding could save the lives of 1.5 million children under five every
year. Promoting something such as simple as breastfeeding can reduce infant
mortality by 11.6%. But though India has among the worst infant and child mortality
figures in the world, 75% of the nations children are not breastfed from birth and
over 50% are not exclusively breastfed. Maintaining health care standards requires
interdisciplinary collaboration among doctors, midwives, auxiliary nurses and other
paramedical staff.

General
Objectives

To gain competencies in nursing

practice in the area of obstetrical &

gynaecological Nursing.
To develop problem solving ability
in the clinical area.
To develop further abilities in
Management

and

supervision

in

Clinical area.
To record & report summer field
experience

effectively

report writing ability.

&

develop

Section 1
INSTITUTIONAL
PROFILE
About the Hospital
Max Super Specialty Hospital, Saket (MSSH) is a Multi-specialty hospital, owned
and operated by Max Healthcare Institute Limited (MHIL).the hospital is designed by
architect Mr Richard wood. Located in the heart of South Delhi, Max Super Speciality
Hospital, Saket (a unit of Devki Devi Foundation), is one of the premier names in
health care domain in the world.
Designed by internationally renowned architect Mr Richard wood and constructed in
accordance with globally-accepted standards for hospitals, quality is our top priority.
A 490-bedded healthcare facility, we are approximately 15km from New Delhi railway
station and 12km from the domestic airport.
Spread in an area of 132348 sq. ft., Max Super Speciality Hospital, East Block Saket
is a forward looking healthcare center offering most advanced medical treatments to
the patients. The hospital was aesthetically designed with a view to make the
patients as relax and comfortable as possible. A unit of Devki Devi Foundation, this
international standard hospital focuses on offering world class cardiovascular care to
the patients. The hospital is also engaged in independent as well as collaborative
researches that cover diverse aspects of cardiology, cardiothoracic, vascular surgery,
Cancer Care and Minimal Access, Metabolic and Bariatric Surgery.
Designed by the internationally acclaimed designer Mr. Richard Wood, all the five
patient floors of the hospital are equipped with avant-garde amenities. Keeping in
mind the security and emergency concern of the patients, the hospital developed a
group of specialists who are well trained to handle any situation with an expert hand.
The proper distribution of the services to all the five floors helps the hospital
authorities to streamline their services and offer proactive help in case of any
emergency need.

Passion
Our passion well reflects in the fact that we set the industry standards when it
comes to cure, care and comfort.

To deliver International Class healthcare with a total service focus, by creating an

institution committed to the highest standards of medical & service excellence,
patient care, scientific knowledge and medical education.
Campus and Location
This 490-bedded healthcare facility is located in the Saket area of South Delhi,
approximately 15 km from New Delhi Railway Station and 12 km from the domestic
airport. There are two blocks in this hospital East Block and West Block.
Accreditation, Awards & Recognition
Max Institute of Minimal Access, Metabolic & Bariatric Surgery has been accredited
as a Centre of Excellence for providing state-of-the-art Clinical Services and Surgical
Training Programs for Abdominal Wall Hernia Surgery.
FICCI awarded Max Super Specialty Hospital, Saket (West) with the Award for
Operational in Healthcare Delivery on September 7, 2010.
Floor Plan of Max Super Speciality Hospital, East Block, Saket
The ground floor houses services like emergency service, diagnostic (including noninvasive cardiology), OPD, radiology & nuclear medicine and Apex coronary care
CTVS ICU/HDU, cardiac cath labs, cath recovery and operations theatres are
housed in the first floor

 Dialysis unit, inpatient area and high dependency unit are located in the
second floor of the hospital
Third floor is completely covered with impatient area
The fourth floor continues with the impatient area
Fifth floor houses the blood bank along with the impatient area
Facilities at Max Super Speciality Hospital, East Block, Saket
It is the availability of most modern medical facilities that make this hospital stand tall
and offer the best of treatments to its patients. The following are some of the facilities
that are available in this super specialty center 490 beds (Suite, Deluxe, Standard and Economy)
20 operation theatres
2 cardiac cath labs
17 - bed CTVS ICU
16 - bed apex coronary care
11 - bed cath recovery
9 - Bed Onco Surgical ICU
12 - Bed Medical ICU
11 - Bed Minimal Access Surgery recovery
8 - bed high dependency unit
17 - bed Dialysis Unit
2 Cath labs
5 types of ICUs
2 MRIs and 1 CTs across an integrated network
The blood bank of this super specialty hospital is among the few blood banks in the
country to get NABH (National Accreditation Board for Hospitals & Healthcare
Providers) accreditation in the year 2009.

Medical Services
A wide range of medical services is available at Max Super Specialty Hospital, Saket
including:
CARDIAC SCIENCES
Max Department of Cardiac Sciences strives to provide patients with expert
treatment and care. We believe in offering the patients with an ethical and open
environment to recover. Our team of expert Cardiologists, Cardiac Surgeons and
Vascular Surgeons believe in carrying out an in-depth investigation of patient
condition taking into account patients complete medical history, therefore
strategizing a tailored treatment and recovery plan for each. Our expertise in
cardiac care helps us in caring for patients with heart disease by providing
complete all-round care. From diagnosis, prevention, treatment, surgical care to
cardiac rehabilitation and wellness services, we look after your heart A to Z.

NEUROSCIENCES
Max Institute of Neurosciences is designed to provide the highest levels of
professional expertise and leadership in all major disciplines of neurosciences
through an integrated team dedicated towards providing total patient care.The
Institute boasts of high-end technology, including the first integrated Brain SUITE
(most advanced Neuro-surgical operating room with high field MR), the first of its
kind in Asia-Pacific.
ONCOLOGY
Max Cancer Centre - a centre of excellence in patient care, medical education and
research. Our doctors and surgeons in the oncology Department are specialists in
this field and aim to provide coordinated and holistic care that is focused on the
complete needs of the patients. Right from cancer screening, early detection,
multi-disciplinary treatment to rehabilitation, Max Healthcare provides complete
cancer care to patients. Max Cancer Centre is the first ever internationally
recognised Novelise Certified Radiosurgery Centre in whole Asia-Pacific.
ORTHOPAEDICS & JOINT REPLACEMENT
At Max Institute of Musculoskeletal Sciences, our primary objective is "early
mobilisation, minimal discomfort". This state-of-the-art specialised health care

facility is designed to provide the highest levels of professional expertise and

patient care. Here, every patient is tended to by a multi-disciplinary unit.
KIDNEY TRANSPLANT
A kidney transplant is a surgical procedure performed to replace a diseased
kidney with a healthy kidney from another person. The kidney may come from a
deceased organ donor or from a living donor. Family members or individuals who
are unrelated but make a good match may be able to donate one of their kidneys.
This type of transplant is called a living transplant. Individuals who donate a kidney
can live healthy lives with the remaining kidney. A person receiving a transplant
usually receives only one kidney, but, in rare situations, he or she may receive two
kidneys from a deceased donor. In most cases, the diseased kidneys are left in
place during the transplant procedure. The transplanted kidney is implanted in the
lower abdomen on the front side of the body.

UROLOGY
The Department of Urology at Max Healthcare offers comprehensive diagnostic
and treatment services for adult and paediatric urological conditions. The
Department always strives to deliver the best health care to our patients who seek
advanced urological treatments in India. The hospital is committed to maintain the
highest clinical governance standards and patient-centric care, incorporating the
latest advances in the field. This is the reason why a large number of patients
worldwide choose Max Healthcare as their most preferred health care partner.
DENTAL CARE
With experienced dentists, sophisticated tools and the most advanced technology,
Max Dental Care has raised dental surgery standards in India. Our comprehensive
range of dental services comes with the same care, comfort, and quality that brand
Max Healthcare is associated with.
INTERNAL MEDICINE
The institute of Internal Medicine comprises of a group of doctors with diverse
interests and expertise. Our Staff is dedicated to providing patient-centred,
evidence-based medical care in a clinical environment, supported by education
and research. The clinicians at the institute of internal medicine work as a team
with specialists to achieve the best possible treatment outcomes and to obtain a

high degree of patient satisfaction. The team serves a wide spectrum of patients,
including adolescents, adults and those with advanced age. The institute also
provides routine and preventative care, consultative services for patients with
complex clinical conditions, inpatient care, care to critically ill patients,
consultative services for patients who require surgery and international patient
services. We are a recognized teaching department by the NBE, India and train
students for degrees like DNB (General Medicine) and DNB (FM)
EYE CARE
With the best eye surgeons, the latest and highly sophisticated medical equipment
and facilities, Max Eye Care definitely makes for the best choice when it comes to
eye care. Whats more, being a part of the Max Healthcare group, you can rest
assured of the quality of service and the care and comfort that you will get here.

ENT

The Department of ENT is a full-fledged super speciality centre, ready to meet the
health care needs associated with Ear, Nose and Throat. Our aim is to make
available best ENT care which is accessible and affordable.
AESTHETIC & RECONSTRUCTIVE SURGERY
Whether you want to look as young as you feel or fix a lifelong flaw that makes
you conscious of your appearance, Max Institute of Aesthetic & Reconstructive
Surgery can help shape your dream into reality in a natural and safe way. With
state-of-the-art facilities, advanced technology, and world class surgeons, we offer
an endless array of options to help improve your appearance and function.
MENTAL HEALTH & BEHAVIOURAL SCIENCE
The Department of Mental Health & Behavioural Sciences is committed to provide
the highest level of comprehensive care to all those who seek world-class
treatment from minor stress and interpersonal problems to major
neurobehavioral/neurocognitive and psychiatric problems. The Department also
lends its support to people who are essentially well adjusted and normal but have
problems in specific areas like work, social or home environment.
DIABETES & ENDOCRINOLOGY
Known for its world-class health care services to patients all across the world, the
Department of Endocrinology and Diabetes is a full-fledged facility involved in
evaluating and treating patients for diabetes, obesity and endocrine disorders. A
dedicated team of Endocrinologists, Bariatric surgeons, Podiatrists, Diabetes
educators, Ophthalmologists works together to provide patients with the advanced
therapies in the care and management of complex endocrine diseases and diabetes.

The department also plays an active role in conducting various public awareness
programs to allay social myths associated with hormonal disorders and conditions.
GASTROENTEROLOGY & ENDOSCOPY
The Department of Gastroenterology & Endoscopy at Max Healthcare is
committed to provide health care services to patients with diseases of the
digestive system. Our gastroenterology & endoscopy specialists diagnose and
treat diseases and disorders of the stomach, duodenum and small and large
bowel (colon). A dedicated team of Endocrinologists, Bariatric surgeons,
Podiatrists, Diabetes educators, Ophthalmologists works together to provide
patients with the advanced therapies in the care and management of complex
endocrine diseases and diabetes.
PAEDIATRICS
Max Institute of Paediatrics is one of the renowned centres of childcare in the
country and works on the principle of "WHERE CHILDREN COME FIRST". The
Institute is dedicated to deliver complete, compassionate, state-of-the-art health care
services for children from birth to sixteen years-of-age (and older in some cases)
who have special health care needs that are different from adults.

PULMONOLOGY AND RESPIRATORY MEDICINE

The Department of Pulmonology at Max Healthcare is committed to deliver
superior clinical services and transforming our research findings into new and
effective treatments for respiratory disease. Our clinical and research programs
are focused on interstitial lung disease, pulmonary vascular disease, heart-lung
and lung transplantation, and non-tuberculosis mycobacterial disease. We have a
team of experienced clinicians, scientists, and scholars committed to improving
the lives of patients with serious lung disease.
OBSTETRICS & GYNAECOLOGY
Max Institute of Obstetrics and Gynaecology is fully committed to deliver worldclass health care services to women looking for gynaecological solutions. We
have a dedicated team of obstetricians and gynaecologists offering a wide range
of services. From pre-pregnancy care to childbearing and post-menopausal care,
there is a solution for all health concerns a woman experiences during these
stages. The primary objective of this Institute is to promote health of women by
providing them complete support, care and, empathy that they require.

DERMATOLOGY

The Department of Dermatology at Max Healthcare is dedicated to provide

superior level of skin care to patients. The Department takes a comprehensive
approach to patient care and offers a wide range of speciality services in medical,
paediatric, surgical and cosmetic dermatology. From treating recurrent skin
cancers to performing various facial treatments to prevent acne and maintain
healthy skin, our skilled dermatologists provide patients with a range of worldclass services and personalized care.

EMERGENCY SERVICES

We provide the best of medical evacuation and air ambulance services in India. We
provide retrieval and repatriations of critically ill people and injured to and from
India and abroad. Our emergency assistance and medical air ambulance services
are managed by highly experienced and qualified personnel 24 hours a day, 365
days a year. We have a 24 hours Command and Control Centre manned by
Doctors to provide advice and assistance to those in need.
Air Ambulance

Air ambulance services from IERS ensure you the safest and most secure shifting to
our hospitals or medical centres located across India. For air ambulance, please dial:
011-40554055 (from India) and +91 11 4055 4055 (From India and across the globe).
Services include:
Transporting patients on special aircraft - AIR AMBULANCE / commercial
airlines/ choppers
Special trained team of doctor/nurse accompanying the patient from "bedside
to bedside" throughout the transfer

Ticketing and ground transport for the patient

Special assistance at the airport for speedy and comfortable boarding

Arrangement of portable life- saving equipment like defibrillators , ventilators ,

infusion pumps , spine board , balloon pumps , pacemakers , monitors , oxygen
cylinders, stretchers and other special requirements in the aircraft.
Surface Ambulance
In case of a medical emergency, just call the Max Emergency Services at 011 4055
4055 and a well-equipped ambulance with trained emergency staff will reach you
within 30 minutes*. The ambulances are equipped with state-of-the-art medical
equipment like cardiac monitors, defibrillator, airway equipment etc. Transport
ventilator is also available for transport of intubated and ventilated patients.
Hospital Services
We believe that services and amenities play a highly significant role in healthcare
industry, which is why we have only the BEST. Listing the services and amenities
that we provide:

Blood Bank
24*7 Max Pharmacy
Regional Translators
Cafeteria
Waiting Lounge
Prayer Room
Bank /ATM
Business Associates
TPAs
Alliance Partners

Lab Services 24 *7

Max Labs is a 24x7 facility providing services for Max patients, walk-in
patients and non-Max clients as well.

Fully automated 24x 7 lab with state-of-the-art equipment

Fully integrated lab information system interfaced with Hospital Information

System across all the eight hospitals of Max Healthcare

Stress Thallium

On-going DNB Programme

Home collection facility available

Speciality Clinics

Women's Heart Clinic

Multiple Sclerosis (M.S.) Clinic

Headache Clinic

Geriatric Neurology Clinic

Movement Disorder Clinic

Pacemaker Clinic

Arrhythmia & Electrophysiology Clinic

A Specialised Dialysis Unit

Conforms with international standards

Haemodialysis for patients with end-stage kidney disease/requiring renal

replacement therapy.
OPD & IPD Timings
To ensure privacy and maximum comfort for our patients, we request visitors to
follow the below mentioned guidelines.
Visiting Hours

IPD Rooms - One visitor is allowed to visit the patient between 4:00 pm to
7:00 pm.

ICUs - One visitor is allowed to visit the patient between 11:30 am to 12:00
pm & 5:00 pm to 5:30 pm.

One attendant is allowed to stay with the patient in Single, Twin Sharing and
Suite.

Visitor Do's

Follow the directions of the senior person in charge of each area and/or
department if there is an emergency such as fire.

Patients are requested to wear hospital dress during hospitalization.

Security personnel might check your belongings at any point of time; please
cooperate.

Do be considerate of others present in the hospital.

Visitor Don'ts

Smoking is prohibited, so please do not smoke.

Outside eatables, sweets are not allowed in the hospital premises.

Do not bring incense to burn in the patient's room as it may cause a fire or
affect the patient's health.

Please do not bring flowers, handy cameras, and visitors below 12 years to
the hospital.

Section 2
ADVANCED
COMPETENCIES
GAINED IN
NURSING
PRACTICE IN THE
AREA OF
SPECIALIZATION

S.No
1.

ACTIVITIES

COMPETENCIES ACHIEVED

Planned the total learning

Developed initiative and gained confidence in

programme

planning ones own learning programme.

the

according

objectives

to
and

proposal.

Selected the Hospital for getting experience

according to the objectives.

Collected the permission letters for gaining

experiences.

2.

Visited and worked in

Made plan for one month.

Gained knowledge about:

different areas of the

Physical setup & different facilities.

Hospital and got oriented

Administration.

with the physical set up of

Important works.

Studied different protocols and policies in

the Hospital.
3.

Labour Room

Labour room.

Gained proficiency in intra-partum monitoring

of mother and foetus.

Developed skill in setting up of a Labour room.

Developed

competency

in

immediate

assessment and management of new born &

newborn resuscitation.

Developed skill in the active management of

third stage of labour and management of PPH,

Able to give health education to postnatal

mothers about postnatal care especially selfPerineal care, exclusive breast feeding and
new born care.

Developed

competency

in

immediate

assessment, care and daily observation of

newborn (Respiration, temperature, weight,

feeding

schedule,

eyes,

mouth,

number

character of stool, umbilical cord).

4.

Maternity Wards &

Maternity OPD

(ADD FOR NURSERY IF POSSIBLE)

Gained in depth knowledge and skill in
management of in antenatal, intra-natal and
post-natal period.

Gained knowledge about management of high

risk pregnancy.

Observed different antenatal investigations.

Given health education to antenatal mothers

according to their need for education after
assessing their knowledge. Gained skill in
assessment of the pregnant mothers.
Observed different antenatal investigations.
Gained skill in HB testing, Urine testing, T.T
injection.
Observed various activities and type of care
provided by the staff and nursing personnel.
Participated and gained ability to conduct
6.

Observed the Family

Welfare

such sessions independently.

Identified and oriented to physical setup of
family welfare.

Section 3
DEVELOPED
PROBLEM
SOLVING ABILITY
IN THE CLINICAL
AREA TO IMPROVE
THE NURSING
CARE PRACTICE
AND

MANAGEMENT OF
CARE

S.NO
1.

ACTIVITIES
Planned the total learning

ABILITIES DEVELOPED
Developed abilities to plan my own learning

experience

programme according to the objectives.

Gained experience in taking help from experts

and supervisors to make the posting more

fruitful.
2.

Gathered factual

Gained knowledge about staffing

information of the hospital

pattern, administration, policies of the hospital.

from the medical

superintendent and other
officer.
3.

Worked with sister in

charge
Read policies and

Gained skill in taking administrative rounds.

Took rounds with sister in charge.

protocols.

Gained knowledge about division of

responsibilities and job delegation.

Gained knowledge and skill in:

Preparing duty roster for staff nurses.

Planning patient assignment and

nursing activities in the ward.

Management of ward supplies and

equipments.
Maintenance of records and reports.
Gained experience in preparing

census.
Saw the management of ward
supplies and equipment and ward as
a whole.

4.

Worked with the Staff

Gained skill in following administrative functions

Nurses of a ward, labour

Management of patient care

room and nursery

Admission discharge and transfer of the

patient

 Assessment of nursing needs and assignment

of patient care
Ensuring

safety

and

care

of

patients

supervised the diet distribution and discussed

with ward in charge regarding the diet.
Supervision and provision of health education
Meeting the needs of the patient and providing
direct care to the patient
Making rounds and coordinating patient care
with other health team members
Maintenance of safe environment
Maintaining optimum environment for patient
Supervised the ward cleanliness and to
maintain an aesthetic environment
Learned about the waste management and
supervised the personnel
Maintenance of supplies and equipments
I learned about the:
Indenting articles and maintaining records
Checking of inventory
Checking and maintaining emergency drugs in
the ward
Check the stock of sterile and unsterile item
Careful storage of the items
Recording and reporting:
Gained knowledge about the:
Various records maintained in the ward
Writing daily census

6.

Health education given to

Improved communication skill and problem

solving ability.
Identified knowledge deficit on breast

the patients and their

relatives after assessing

feeding practices among lactating mothers

their learning need.

as a problem
Conducted Planned Teaching programme
on Breast feeding practices as a problem
solving approach.

7.

Worked in OPD in maternity

section.

Improved ability in supervision of nursing

personnel.
Learned about the management of OPD

Visited Family Welfare Unit

patients and staff.

Learned about the management and

and Learned various

supervision of staff and patients in Family

procedure

Welfare Unit
Learned how to motivate the mothers for
Copper T insertion& Lap ligation procedure.

Gained knowledge regarding Incentive Policy

(write down the policy.

Prepared a report on

Gained skill in reporting in N.S.

experience.

Gained experience on how to work in cooperation with the concerned authorities.

Section # 4
PROBLEM
SOLVING ABILITY

DEVELOPING PROBLEM SOLVING ABILITY IN CLINICAL AREA TO

IMPROVE NURSING CARE PRACTICE AND MANAGEMENT OF
CARE
PROBLEM SOLVING
Definition

It is a systematic process of solving simple or complex, short term or long

term problems, by applying certain observational thoughts and action process
in scientific way.

It is a process of proceeding from a state of dissatisfaction to a state of

satisfaction, which is the attainment of desired objectives or goals.

It is a scientific process that provides a theoretical framework utilized in

attaining the solution to complex problem
PROBLEM SOLVING PROCESS

Defining the problem

Collection of data

Data analysis

Finding alternatives

Evaluation of
alternatives

Implementation and
review

I NTRODUCTION:
Mothers education is not luxury but a necessity if mothers are to receive the
maximum benefits from todays knowledge of the possible treatment, prevention and
control of the disease. Health education is essentially a process that enables people
to find out their health needs and match them with suitable behaviour. If the high risk
mothers are aware of the risk of probable future health problems, it helps them to
take action early in the pregnancy to avoid the risk factors and ensure that an
appropriate care is available whenever the problem occurs. The individual and the
community have to play a very important role and participate in the effort aimed at
improving maternal and child health. Their involvement is essential for awareness,
which will lead to action. But this awareness and involvement can only come through
right kind of educational approach, which results in self-care structure and
meaningful interlocking between the community and health care providers. This will
contribute substantially in reducing maternal mortality rate and ensuring the
improvement in health of mothers and herald a healthier 21 st century.
WHO (2011) report that breastfeeding is an unequalled way of providing ideal food
for the healthy growth and development of infants; it is also an integral part of the
reproductive process with important implications for the health of mothers. The World
Health Organization (WHO) and UNICEF jointly developed the Global strategy for
infant and young child feeding in 2002 which feels malnutrition responsible, directly
or indirectly for 60% of the 10.9 million deaths annually among children under five
and over two thirds of these deaths associated with inappropriate feeding practices,
occur during the first year.
Mothers education is not luxury but a necessity if mothers are to receive the
maximum benefits from todays knowledge of the possible treatment, prevention and
control of the disease. Health education is essentially a process that enables people
to find out their health needs and match them with suitable behaviour. Thus one of
the key to successful breastfeeding is Information, Education and Communication
(IEC) strategies aimed at behavior change. Very few women in India have access to
counseling services on infant and young child feeding

IDENTIFICATION OF PROBLEM
Following measures were used for identification of problem:

Problem identification was done by formal and informal talks and discussion
with sister in charge and staff nurses.

Observing the Essential new-born care practices of post natal mothers

admitted in the ward.

Questioning & discussing with the mothers regarding Essential new-born

care.

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF MOTHERS
REGARDING ESSENTIAL NEW BORN CARE IN A SELECTED HOSPITAL OF
NEW DELHI, AND DISSEMINATING LEAFLETS.
OBJECTIVES
1. To assess the knowledge of mothers regarding Essential new-born care.
2. To assess the practice of mothers regarding Essential new-born care.
3. To correlate mothers knowledge and practice with demographic variables.
METHODOLOGY
APPROACH
Evaluative approach was considered appropriate because the primary objective of
study was to determine the knowledge deficit in mothers & the effectiveness of
Dissemination of Leaflets.
RESEARCH DESIGN
Pre-test Post-test only group design.
METHOD OF DATA COLLECTION
Structured questionnaire
TOOL
The structured questionnaire contains 20 items to judge the knowledge and practice
of postnatal mothers regarding Essential new-born care.

VALIDATION OF TOOL
Tool was validated by:
Dr Anuradha, H. O. D of Obsteritics and Gynaecology, Max Super Speciality
Hospital, New Delhi.
Dr A. Goel, H. O. D of Paediatrics, Max Super Speciality Hospital, New Delhi.
SAMPLE
Sample consists of 10 postnatal mothers admitted in the postnatal ward at Max
Super speciality Hospital, Saket, New Delhi.
SETTING
The study was conducted in Max Super Speciality Hospital, New Delhi.
SAMPLE SIZE
10
SAMPLING TECHNIQUE
Purposive Sampling
SAMPLING CRITERIA

Purposive sampling method was used.

Post natal mothers admitted at Max Super Specilaity Hospital.
Post natal mothers available during the study period
Post natal mothers willing to participate in the study

ASSESSMENT OF THE PROBLEM

A pre-test was conducted to assess the knowledge of mothers regarding essential
new-born care practices. Data analysis revealed that there was knowledge deficit in
mothers regarding the above topic.
After this a leaflet was disseminated and an explanation was given about the various
aspects of Essential new-born care practices. Later a post-test was conducted.
CRITERIA FOR SELECTION OF SOLUTION OF PROBLEM
The above mentioned solutions were implemented depending upon:

Ability of the sample group

Practicability

Utility

Resources available

Availability of time

Economy

ALTERNATIVE SOLUTIONS PLANNED

Arrange a group discussion

Plan for incidental teaching

Planned teaching programme

Preparation of charts on the selected topic

SELECTION OF BEST ALTERNATIVE

Considering the feasibility, time, resource, economy and availability of mothers
dissemination of leaflets was chosen from the alternatives.
IMPLEMENTATION OF THE PROGRAMME
The programme was conducted in Maternity ward on 25 th May 2015 between 10-11
am. 10 mothers had participated.

Information regarding the programme was given to the Doctor and Sister
in charge well in advance.

Interviews were conducted to assess the existing knowledge of the

mothers.

The participants were able to clear their doubts by asking questions.

The programme was appreciated by Doctors, Sister-in-Charge and staff

nurses.

EVALUATION
Post- Test was conducted after the Dissemination of the leaflets. Evaluation of
leaflets was done statistically by analysing pre-test and post-tests score. Result
showed marked improvement in knowledge regarding Essential new-born care.
RESULT

The mean post-test knowledge score (18.5) is more than mean pre-test knowledge
score (9.2). There is mean difference of 9.3 between mean pre-test and post-test
score. Hence the teaching programmed was found to be effective in improving the
knowledge of the mothers regarding Kangaroo Mother Care.
TABLE - 1
Pre-test & Post-test Knowledge Scores of Postnatal Mothers Regarding
Essential New-born Care.
Total Items: 20
Maximum Score: 20

S.No.

PRE-TEST SCORE

POST-TEST SCORE

1.

12

20

2.

18

3.

19

4.

19

5.

13

20

6.

15

7.

18

8.

18

9.

13

19

10.

10

17

Total
score

92

185

INFERENCE OF TABLE 1
Data presented in table 1 shows that lowest score in pre-test is 6 while lowest score
in post-test is 15 and total post-test score is greater than the total pre-test score.
TABLE- 2
Mean Difference Of Pre-test Knowledge & Post-test Knowledge Score of the
postnatal mothers regarding Essential new-born care.

KNOWLEDGE

MEAN

MEAN DIFFERENCE

SCORES
Pre-test Knowledge

9.2

Score
9.3
Post-test Knowledge

18.5

Score

INFERENCE OF TABLE 2
Data presented in table 2 shows that mean Post-Teaching Score is higher than mean
Pre- Teaching Score by a mean difference of 9.3 indicating that the Planned
Teaching Programme was effective to increase knowledge among postnatal mothers
regarding essential new-born care.
CONCLUSION
On the basis of the findings of study the following conclusion were drawn:

Mothers were having less knowledge regarding Essential new-born care.

The dissemination of leaflet was found to be effective in increasing the
knowledge of the mothers regarding essential new-born care.

CRITICAL
APPRAISA
L OF THE
HOSPITAL

EVALUATION OF EXPERIENCE
My one month experience at Max Super Speciality Hospital, New Delhi
provided me a very informative experience in the field of nursing services, education
and administration. The experience helped me in fulfilling my objectives and

enriching my knowledge in the area of clinical specialisation. Personnel at hospital

were friendly.
I could achieve all the objective of my posting that is gaining advanced
competencies in Nursing practice, developing management and supervision abilities
in the clinical area of specialisation and developing problem solving abilities in the
clinical area to improve nursing care practice and patient care management and in
turn enhancing the reporting abilities.
The posting helped me to gain advanced knowledge, skills and competencies
in almost area of Nursing practice, Nursing administration and Nursing education as
well as orientation to nursing research thus contributing to my personnel as well as
professional development.

SUMMARY
Max Super Speciality Hospital is well developed Hospital. It provides various
services like MCH & family planning to the people. The experience in this upper
speciality hospital was very much helpful in gaining knowledge & competencies in
nursing practice. Also it added my experience to develop abilities in management,
leadership & problem solving through observations involving activities & co-operative
efforts.

CONCLUSION

The summer field experience in Max Super Speciality Hospital Delhi helped me a
lot in gaining advanced competencies in obstetric nursing, management and
administration.
The summer field experience in this Hospital was very much helpful in
gaining competencies in nursing practice and also improving the knowledge, skill
and attitude in obstetric nursing. It also added my experience to develop abilities in
management, leadership and problem solving through observations involving in
activities and co-operative efforts. It was an overall good learning period as I could
co-relate my theoretical understanding with the practical and apply it in the field.

ANNEXURES
a) Letter of permission
b) Tool on Essential newborn care
c) Leaflet made for the
planned teaching
programme.
d) Certificate of experience
from Max Super Speciality
Hospital

Letter of
Permission

Tool on
Essential Newborn Care

PROBLEM STATEMENT
A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF MOTHERS
REGARDING ESSENTIAL NEWBORN CARE IN A SELECTED HOSPITAL OF NEW
DELHI, AND DISSEMINATING LEAFLETS.
STRUCTURED QUESTIONNAIRE TO ASSESS THE KNOWLEDGE OF
MOTHERS ON ESSENTIAL NEWBORN CARE PRACTICES
INSTRUCTIONS
This questionnaire consists of two parts- Section A and Section B
Section A: Demographic Profiles of mothers and new-born.
Section B: Questions related to Essential new-born care.
Read the statements carefully and tick () the appropriate answer.
SECTION-A
DEMOGRAPHIC PROFILE OF MOTHERS
1. Age of the mother
a.) Less than 25 years.
b) 26-30 years.
c) 31-35 years.
d) Above 40 years.

{ }
{ }
{ }
{ }

2. Religion
a) Hindu
b) Christian
c) Muslim
d) Others

{
{
{
{

3. Educational qualification
a) Illiterate
b) Primary School
c) Higher Secondary
d) Graduate and above.

{ }
{ }
{ }
{ }

}
}
}
}

4. Occupation
a) House wife
b) Government Employee
c) Private Employee
d) Labour

{
{
{
{

}
}
}
}

5 Income of the family per month

a) Rs. 5000
b) Rs. 5001-10000
c) Rs. 10001-15000
d) Rs. 15001 and above.

{
{
{
{

}
}
}
}

6. Place of residence
a) Metro
b) Urban
c) Semi urban
d) Rural

{
{
{
{

}
}
}
}

7. No. of pregnancy
a) One
b) Two
c) Three
d) Above three

{
{
{
{

}
}
}
}

8. No. of deliveries
a) One
b) Two
c) Three
d) Above three

{
{
{
{

9. Type of delivery
a) Normal delivery
b) Forceps delivery
c) LSCS
d) Vacuum extraction

{ }
{ }
{ }
{ }

10. Antenatal check-up during pregnancy

a) Yes
b) No

{ }
{ }

11. Any illness during pregnancy

a) Yes
b) No

{
{

}
}

{
{

}
}

{
{
{
{

}
}
}
}

}
}
}
}

DEMOGRAPHIC PROFILE OF THE NEWBORN

12. Sex of the baby
a) Male
b) Female
13. Birth weight of the baby
a) 1-1.5kg.
b) 1.5-2kg.
c) 2-2.5kg.
d) Above 2.5Kg.

14. Status of the baby

a) Healthy
b) Sick

{
{

}
}

SECTION-B
KNOWLEDGE AND PRACTICE REGARDING KANGAROO CARE
1. Essential new-born care means
a. Skin to skin contact with the baby and mother and maintain his body warmth ( )
b. providing adequate care to reduce neonatal morbidity and mortality
( )
c. Mother carries the children wherever she go
{ }
2. The specific basic needs of a LBW baby are
a. play needs
b. body warmth
c. mothers love

{ }
{ }
{ }

3. The first Breastfeed is offered to the new-born within,

a. 2 to 3 hours of birth
b. to 1 hour after birth
c. be secured

{ }
{ }
{ }

4. Kangaroo mother care can be initiated

a. Soon after birth of a baby.
b. After one week of birth
c. After two weeks of birth

{ }
{ }
{ }

5. The feed essential for the new-born is,

a. Breast milk containing colostrum
b. Cow milk rich in required fat and protein
c. Mother Dairy skimmed milk

{
{
{

}
}
}

6. Oil-massage of the new-born improves,

a. Blood circulation, muscle tone and strengthen the maternal-child bonding
b. the sleeping habit of the new-born
c. sucking ability of the new-born

{
{
{

}
}
}

7. The baby should be nursed in close proximity to the mother so that,

a. baby gains heat from maternal body heat
b. baby does not cry more
c. baby is not afraid of the doctors and nurses

{
{
{

}
}
}

8. The new-born should be bathed in a room which is,

a. fully ventilated
b. maintained warm without open windows and doors

{
{

}
}

c. fully air-conditioned

9. The umbilical cord falls off naturally within

a. 3 weeks
b. 24 days
c. 5-10 days

{
{
{

}
}
}

10. The umbilical cord should be kept dry

a. till it falls off naturally
b. for 1 month
c. till 2 days after birth

{
{
{

}
}
}

11. Eye care should be done daily with sterile water and sterile
a. cloth
b. cotton swabs
c. gauze pieces

{
{
{

}
}
}

12. The practice of applying kajal in eyes of the new-born baby

a. causes eye irritation and infection
b. makes the eyes look big and beautiful
c. protects the new-born from the evil eye

{
{
{

}
}
}

13. The clothes of the new-born should be preferably made of

a. soft non-irritant cotton material
b. soft synthetic material
c. nylon material

{
{
{

}
}
}

14. Frequency of feeding the baby is

a. every three hours
b. only after cry
c. as frequent as possible

{
{
{

}
}
}

15. If the new-born babys skin appears yellow in colour within first 24 hours of
birth it indicates,
a. skin infection
{
}
b. lack of haemoglobin
{
}
c. neonatal jaundice
{
}
16. The new-borns normally lose weight during,
a. First 10 days
b. First 2-3 days
c. First 30 days

(
{
{

17. Care of the baby after kangaroo mother care mainly is

a. monitoring baby's temperature
b. observe cleanliness `
c. observe the cloths

{
{
{

)
}
}
}
}
}

18. Regular monitoring of weight of the new-born is necessary

a. to assess the effective weight gain
b. to check the reflexes of the baby
c. to assess the effectiveness of breastfeeding

{
{
{

19. The vaccination that is given at the time of birth is,

a. Rubella vaccine
b. Rota virus vaccine
c. BCG vaccine

{ }
{ }
{ }

}
}
}

20. AS a part of the New-born care Kangaroo mother care can be provided by,
a. any relative
{ }
b. father
{ }
c. mother
{ }
SCORING:
Each correct answer is given one mark
o Good
- 16 to 20
o Average
- 8 to 15
o Poor
- 0 to 7
ANSWER KEY
QUESTION NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL

CORRECT RESPONSE
b
b
b
a
a
a
a
b
c
a
b
a
a
c
c
b
a
a
c
c

SCORE
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
20

Leaflet
Essential new
born care

Rufaida College Of Nursing,

Jamia Hamdard University

INTRODUCTION
Maintaining body temperature is an integral part of resuscitation of the
premature infant but is extremely challenging. Low temperature on
admission to neonatal intensive care has been demonstrated to be an
independent risk factor for mortality in extremely premature infants.

DEFINITIONS
Low birth weight (LBW) - infant born weighing less
than or equal to 2500g.
Very low birth weight (VLBW) - infant born weighing
less than 1500g.
Thermoregulation maintaining the heat (body
temperature)

Submitted by:
ANGEL THOMAS
M..Sc NURSING 1st YEAR

MAINTAINING ADEQUATE THERMOREGULATION

Adequate environmental temperature in delivery
suite- currently under review by labour ward,
minimize environmental difficulties, deliver-in room
is adjacent to the resuscitation bay, record the
ambient environmental temperature.
Warming the delivery room- pre heating of the
delivery room about 28C, this helps in reducing
the heat loss of the newborn.
Use of tranwarmers for infants <29 weeks- a
transwarmer should be used when ambient
temperature is <25C.
Hats & swaddling- a well fitting hat should be
placed immediately on all premature infants.
Swaddling around the infant in addition to
occlusive wrapping is essential.
Skin-to-skin method keeping them in upright
position. The kangaroo method can positively
provide a thermo-neutral environment for these
LBW babies maintaining temperature.
Breast feeding and keeping the mother and baby
together- the newborn baby immediately after
being dried and wrapped should then be
encouraged to suck on the mothers breast. With
breast feeding, the babys heat maintenance is
assured by close contact with the mothers hemothermic body. Frequent breast feeding of every 3060 minutes should be encouraged.
Water filled heated mattress (WHM)- it consist of a
poly- urethane bag filled with 10 litres of water
which is placed in the locally available baby cot.
The mattress is heated by a heating plate with

heating foil. The starting temperature of the

mattress should be 37C.
Occlusive plastic wrapping or cling film wrapping
at delivery for infants <32 weeks.
Maintaining temperature stability during
stabilization in NICU.

Certificate
of
Experience