Professional Documents
Culture Documents
The capacity to care is the thing that gives life its deepest meaning and
significance
-Pablo Casals
Wisdom is the product of brain. Man has relied wisdom and development of
language to achieve his current state of dominance in the world. Intelligence is
clearly a salient feature in permitting the species to adapt to a wide range of
differing environments. The people of restricted intelligence are at a disadvantage
in solving problems and coping with new complex situations 9.
Mental retardation is not a disease or single entity. It refers to a
developmental mental disability and that appears in children by birth or under the
age of 18years. In most of the cases, it persists throughout adulthood. It can be
defined as a level of intellectual functioning is well below average and results in
significant limitations in the persons daily living skills. It exists when there is
significantly sub average general intellectual functioning with concurrent
deficits in adaptive behavior.2 Failure to achieve developmental milestones is
suggestive of mental retardation. These limitations will cause a child to learn and
develop more slowly than a typical child. They are likely to have trouble in the
school. They will learn, but it will take them longer. The causes for mental
*Mild (Educable)
50-70
*Moderate (Trainable)
35-49
20-34
Below 20
As the behavior and abilities associated with each of these levels are
different therefore care also should give accordingly; that is mild cases needs mere
guidance rather than physical care but profound cases depends on another person
for their routine care. 2
Mental retardation is a challenge not only to any nation, but also to the entire
human race. All over the world 83 million people are mentally retarded. Prevalence
of mental retardation is believed to be between 1% and 3%, with mild retardation
being most prevalent. Prevention is better than cure. Mental retardation can be
prevented by immunization against disease such as measles and Hib prevents many
of the illnesses that can cause mental retardation. Pregnant women should be
educated about the risks of alcohol consumption and need to maintain good
nutrition during pregnancy. Children should undergo routine developmental
screening as part of their pediatric care. Parenting a child with a disability is above
and beyond that of caring of a normal typical child but good parental care also will
prevent retardation. Mothers are the first teachers and children spend maximum
time at home, so mothers needs to be involved in training of mentally retarded
child in learning self care comprising of brushing, bathing, feeding , toileting,
dressing and grooming22.
Since mental retardation is common developmental problem among
children. Further, the investigator during practice in the school and community
observed that most of the parents have misconceptions and have lack of knowledge
about the care of mental retarded children and also number of study reported that
there is a lack of knowledge among the mothers regarding care of mentally
retarded children. It is very much important for nurses to assess and focus on each
mother regarding how they have to care their mentally retarded children. As a
nurse and researcher I have a vital role in recognizing problems of mental
retardation care and giving health education to mothers to improve the quality of
life3.
Play is the key centre of a healthy childs life. Play provides the
opportunities to be free, creative and expressive. In play children expand their
understanding of themselves and others, their ability to communicate with peers
and adults. Play is the business of the childhood, allowing your child free rein to
experiment with the world around him and the emotional world inside him, says
Linda Acredolo professor of Psychology at the university of California. In play
children expand their understanding of themselves and others, their knowledge
of physical world and their ability to communicate with peers and adults. Play is
crusial for your child social, emotional, physical, cognitive growth.
Children under five years of age constitute the 15-20% of total
population. Morbidity rate among them is 35-65% of children population. In the
history of health services of many developing countries their social and health
needs were realized rather later. Now ministry of health in India has focuses
attention to provide better health services to this group because A healthy child
is a sure future is one of the themes of WHO. To make the child healthy quality
child care is needed. One of the important parts of childs development is play.
It is often seems that all children do is play. They play until they are five
or six, then they go off to school and start to learn. They play until they are big
enough to really begins to do things. Play helps children to relax which makes
parents to relax4. Play is a childs work and this is not a trivial pursuit, says
Alfored Adler. Play is synonyms with being a child and it is the universal
language of children. Hospitalization to any child is very unpleasant and
traumatic experience. The child undergoes break from his normal routine due to
illness but also separated from his peer group and friends3.
Essential child care needs play therapy should be included with medical
therapy in hospitals. Mothers should be enhanced to provide play needs during
hospitalization to lessen the emotions.
their non disabled children. Parents are stressed and worried due to care of their
defective child 15.
A cross sectional and descriptive study was conducted to find out the
refractive error among the students in the Nepal at school for mentally retarded
children. Estimated the prevalence of mental retardation in Nepal is 4.1%. A total
of 140 clinically diagnosed cases of mentally retarded students from three different
schools of Kathmandu Valley were examined. Examination revealed that more than
half of the examined had one or more ocular disorders with refractive error being
the most common type of ocular morbidity followed by ocular disorders.
Refractive error were found in 34.4%.Vision being the best sense for their
education and daily activities 6.
It is said in developing countries Down syndrome is very common cause for
mental retardation in children and it is estimated that in India there may be more
than one million children are suffering with mental retardation. Consanguine
marriage is the major cause for mental retardation in southern States like Andhra
Pradesh, Karnataka, Tamil Nadu, Kerala. People believe that, marriage should do
within the relation then children will be healthy and property also will not go out of
the family. Therefore pre marriage counseling is very much important 14.
behavioral
parents to
be
developmental disabled
children. Study revealed that 80% parents were demands for training in
communication, management of behavior problems and training in home-based
care of the MR children. About 1.8 percent of mothers knows proper care of
mental retarded children; approximately 12 millions are
knowledge
about
care of
having
deficient
exposure to highly responsive parenting styles through out the early childhood
period may provide variety of important child benefits in terms of language,
cognitive, social, emotional development. Maternal responsibility as a dynamic
construct of central importance to the development of children with intellectual
disabilities just as it is for typically developing children.
An expert explained how to care the mentally handicap children by their
parents with good example, you have dream to go for Italy and got a chance to go
there so u prepared well and started journey but ultimately the plane will drop you
in Holland due to some reason. And you meet people came back from Italy will
praise and explain the beauty of Italy then you feel gilt because you have missed a
chance to go there mean while you will miss the enjoyments of Holland. Therefore
instead of thinking bad fate we should enjoy the present. Likewise, children are
always children only so you should have a mentality to care and enjoy properly.
Since mental retardation is a developmental problem among children. It is
evident that mental retardation can be preventable and manageable. This calls for a
more concentrated effort on the part of medical profession and those engaged in
child care activities. As a nurse and researcher I have significant role in
recognizing problems of mental retardation care and giving health education for
mothers to improve knowledge and practice of mothers regarding care of preschool
mental retarded children.
Malnutrition is the major cause of death among children in India. According Dr.
B.M. Chauhan (1981), the magnitude of the problem is that every one lakh
children die either directly or indirectly attributable malnutrition. The ICDS
programme acknowledged that young child is most vulnerable to malnutrition,
which leads to morbidity and mortality of children under six years. This program
helps to promote holistic development of children under six
years through
2)
3)
Growth monitoring
4)
5)
Non formal Pre-School Education of the children between 3-6 years of age.
6)
Assisting the health staff in immunization, distribution of Vit. A and Iron &
Folic Acid and health check up.
7)
Referral Services
8)
9)
The studies also revealed that there is a need to strengthen the Anganwadi
worker in these areas.
Study conducted revealed that several Anganwadi workers are not following
the norms laid down for enrolling the beneficiaries and they are also providing
supplement to all children equally, irrespective of their age, nutritional grade and
served twice to the children who wanted more. Another study in 1992 stated that
there is a need to improve the skills in growth monitoring and supplementary
feeding and recommended short-term feeding and frequent in-service training
programmes to the Anganwadi Workers.
As the investigator observed that the Anganwadi Workers are not having
adequate knowledge in performing their set functions specially with emphasise to
growth, monitoring and supplementary nutrition. The Anganwadi workers also are
not following principles while checking growth monitoring and distribution of
supplementary food. The investigator also found that there is no study related to
knowledge and practices of Anganwadi workers in Bangalore rural Anganwadi
Centres.
The investigator felt that the Anganwadi worker should be self sufficient to
deliver these activities in prevention and control of malnutrition among children at
grass root level by providing services at doorstep.
The investigator found that the Anganwadi worker not only identify the
malnourished children but also children at risk for malnutrition through growth
monitoring and supplementary feeding. Since these two activities takes major
contribution in maintaining the health of the children, the investigator taken these
two activities in the study in a limited time.5
Health care of children has been markedly changed in
developed countries. There is a change in the view of children from,
miniature adults, to unique individuals with special needs and
qualities.
and creating awareness and making changes towards the health care
branches.
regarding importance of play in childs life the investigator found the need
for study.
REVIEW OF LITRETURE
Review of literature is a summary of research on a topic of interest, often
prepared to put research problem in the context as the basis for an implementation
project (Polit & Hungler).
Review of literature explains the research and non research literature to
broaden the understanding and gain insight into the selected problem under study.
A review helps to lay the foundation for a study and can also inspire new research
ideas. The task of reviewing research literature involves the identification,
selection, critical analysis and written description of existing information on a
topic 2.
Review of literature refers to an extensive, exhaustive and systemic
examination of publications relevant to the research project. A very few studies
have been alone in the field of mothers regarding care of mental retardation. The
review of literature for the present 0study has been done from published articles,
journals, pub med and internet search on care of preschool mental retardation 11.
A survey was done to reveal the Impact of Cultural Beliefs and Practices on
Child Health among the Yoruba. Data were analyzed to determine 1) mothers
perceptions on etiology of childhood diseases and the effect of these beliefs on
which curative measures they suggested and 2) the persistence of the belief in
abiku (special children who have come from the spirit world and can die at will
unless certain rituals performed) and how the belief can influence the way of
mothers to manage childhood diseases. The data for this study, collected via
formal interviews with 1559 respondents supplemented by in-depth interviews and
focus group discussions, were submitted to simple cross tabulation and logistic
regression analysis. And found that 1) many of the mothers lack accurate
information about the causes of the selected childhood diseases, especially mental
retardation; 2) many of the mothers nevertheless recommended modern curative
methods; 3) the belief in abiku remains strong among these mothers; and 4) the
curative measures adopted by a mother may depend upon whether the sick child is
believed to an abiku. Over half of the mothers believed that an abiku required
treatment from traditional healers and religious institutions irrespective of the
nature of the illness. Thus, the probability of a child is perceived to be abiku. This
study underscores the need to consider local beliefs and practices when
implementing health policies 8, 10.
A cross-sectional descriptive survey was done in school of Washington to
determine how siblings are affected by having a brother or sister with
developmental disability. The study evidenced that, there is a negative effect on
sibling of child with mental retardation when compared with sibling of healthy
and isolated in house. Had poor knowledge regarding self care, health problems,
and diet of mental retarded child. Report shows 15% of mothers had good
knowledge, 27% moderate, and 48% of the mothers had very poor knowledge
regarding care of defective child 15.
A survey was done in Hyderabad to assess knowledge of people about
causes and treatment of mental retardation in children. In society there is a
stigma about mental illness as well as mental retardation. People believe that
mental retardation is due to black magic, gods disgrace, or sins of ancestors. Even
educated people believe that no treatment for mental disorder. Half of the
population seek required treatment from traditional
healers
and religious
institutions irrespective of the nature of the illness; 20% of the people seek
medical treatment as well as religious care for mental illness; and Only 10% of
the people go to mental hospital. People believe that going to mental hospital will
reduces family dignity and have to face religious stress. Post natal mother will
keep semi starve for 3 months it cause nutritional deficiency intern leads to
mental retardation. Consanguineous marriage is most prominent cause for mental
retardation in South India 9.
A comparative study conducted to assess prevalence of mental retardation.
The data from the Metropolitan Atlanta Developmental Disabilities were used. The
administrative prevalence of mental retardation (I.Q of 70 or lower) was identified
by review of records from multiple sources, with the public schools as the primary
source. The overall administrative prevalence of mental retardation is 12.0 per
1000 children. The rate from mild m r (I.Q of 50-70) was 8.4 per 1000 and the rate
of sever m r (I.Q <50) was 3.6 per 1000. The prevalence was higher in Black
children than White children (prevalence odds ratio [POR] =2.7) and in boys than
in girls (POR=1.4). Children with severe mental retardation had more coexisting
disabilities than children with mild mental retardation. The mental retardation
prevalence rates reported here, especially the race-specific rates, may reflect social
and demographic feature unique to the metropolitan Atlanta area and therefore
should be used with caution in making comparisons with other populations 16.
A specific cause is identifiable in only about 25% of people who are
mentally retarded and of these only 10% have the potential for cure. In the
remaining 75%, predisposing factors, such as deficient pre natal care, inadequate
nutrition, poor social environment, and poor child-rearing practices, contribute
significantly to mental retardation. Mental retardation has no cure but we can
prevent before it develop or we can best manage with proper care 14.
A study on evaluation of an intervention system for parents of children with
intellectual disability and challenging behavior, among 115 families in Japan.
During educational program signpost material such as information booklets, a
workbook, videotape for parents and a series of educational programs were
delivered to the parents. On post-test 80% of the subjects reported that they felt
more efficacious about managing their childs behavior and reported high levels of
satisfaction with the delivery of the material and educational programme 20.
The study was conducted on 95 families to assess the effectiveness of parent
skill teaching program regarding care of mentally retarded children. 20 week
behavioral training program had given to the parents with mental retarded children.
Feed back have
test significant difference between pre test and post-test scores. Findings indicated
that 60% of the parents had improved awareness towards the same item. Post-test
scores were higher than pre-test scores with mean scores difference of 15.5 andt
value 29.27,14.
The study conducted on parents practices regarding care of mental retarded
children. Most of the parents experience mixed and some time contradictory
feelings. They may feel left out new family development and changing roles guilt
and sad when their disabled child is unable to participate in activity or play game.
Even parents feel embarrassed and ashamed, having a mental retarded child in
family. Father Judge wrong about what future holds for their child as well as
his/her ability to manage the increasing financial burdens. Mothers experience
stress and guilt often while caring a defective child 16.
Dorthy R.Marlow says that the play helps the children to form concept,
classification, and contrast and compare relationship among objects, cause
effect relationship. Concept of time, object characteristics and problem
solving.
Garvey (1984) conducted a study regarding toys and plays and expressed
his ideas that play and play toys develop the ability to represent
Piaget (1962), Bergen (1988) states through their study that children
expand their understandings of themselves and others, their knowledge of
physical world and their ability to communicate with peers and adults. At
9 month infants learn that a ball rolls away, a rattle make noise. At 12
months objects bring forth more specific and differentiated actions. By the
age of 4 or 5, childs ideas about the social word initiate most pretend
play. In Toddler, there is growing awareness. They share, communicate,
expresses anger or joy through play.
silently ,three out of twenty not shown any interest, but they remain silent
and looking towards the others. It shows that toys attract the children.
They enjoy as a fun for them14.
B. Review of literature related to curtail of play and its effect on under five
children during hospitalization.
Bergan D (1988) states in his study that play is an important part of the
care we provide to the children which allow them acknowledge and deal
with their illness and treatment through play. They keep children
occupied, they help them to cope with pain, anxiety and fear, to make
friends to regain skills they have last as a result of their illness and learn
new skills
Nursing Clin North Am 1984 Jun,say that play for most hospitalized
children centers around self and stressful situations as perceived by the
child and is restricted in terms of what the environment and physical
limitations so the child present. Play can be a tool to understand and
intervene with pediatric patients. Collaboration with nurses who are
clinical specialists, early childhood educators, and others who have expert
knowledge of children and play equipment is useful to plan purposeful
play programs or programs or play sessions for the special need of
hospitalized children. Such collaboration will insure that play will be
carried out in consistent growth promoting manner. For some children,
. Play can really make a differenceo Create an environment where stress and anxiety are reduced.
o Help the child to regain confidence and self esteem.
o Provide an outlet for feelings for anger and frustration.
o Help the child understand the treatment and illness through play.
o Aids in assessment and diagnosis.
o Speed recovery.
o Advance physical development.
o Promoted social skills.
o Build imagination.
Statement of problem
A study to assess the effect of structured teaching programme on the
knowledge of care of mentally retarded children among the mothers who attend
selected special schools at Bangalore.
6.3 Objectives of the study
To assess the level of knowledge on care of preschool mentally
retarded children among the mothers
To determine the effect of structured teaching programme on the
knowledge of care of preschool mentally retarded children among
mothers
To find out the association between level of knowledge and selected
demographic variables among mothers
Operational definitions
Assess
It refers to the statistical measurement of the knowledge and practice of
mothers regarding care of preschool mental retarded children.
Structured teaching program (STP)
Knowledge
It refers to the correct answers to the items in the questionnaire regarding
care of preschool mental retarded children.
Mothers
It refers to the mothers who have children with mental retardation in the
age group of 3 to 5 years
Mental Retardation
Mental retardation refers to significantly sub average general intellectual
functioning existing concurrently with deficits in adaptive and functional behavior
manifested during the developmental period.
METHODOLOGY
Source of data:
The source of data were primigravida mothers who were attending the
antenatal clinic at Hospital, Bareilly.
Methods of data collection:
Data was collected by the investigator her-self by using structured closed
ended questionnaire and check list. During this period investigator collected both
pre and post-test data and also implement the structured teaching programme.
Research design and approach:
Quasi-experimental design in which one group per and post-test design
without control group will be selected for the present study.
Setting:
The study was conducted at antenatal clinic in Manas Maternity Hospital at
Bareilly.
Population:
The population for the present study will be the primigravida mothers who
attending antenatal clinic in a Manas Maternity Hospital, Bareilly.
Sample size:
The sample size was 50 primigravida mothers.
Sampling technique:
Purposive sampling technique was used for the proposed study.
SAMPLING CRITERIA:
Inclusion criteria:
Primigravida mothers who are
- Attending the antenatal clinic Hospital, Bareilly.
- In 21 to 35 weeks of pregnancy.
- Able to read and understand Kannada and English.
- Willing to participate in the study.
- Available during data collection period.
- Not having labour pain.
Exclusion criteria:
Primigravida mothers who are
- Not attending the antenatal clinic in Manas Maternity Hospital, Bareilly.
- Not in 21 to 35 weeks of pregnancy.
- Not able to read and understand English.
- Not willing to participate in the study.
- Not available during data collection period.
-
The inferential statistics was used for chi-square test and paired t test. The
paired t test was used to find out the differences in knowledge between pre
and post-test.
Chi-square was used to find out the association between demographic
variables with post-test knowledge scores.
The data was planned to be presented in the form of tables and figures.
STATISTICAL ANALYSIS
The data obtained will be analyzed in terms of objectives of the study by using
descriptive and inferential statistics. Frequency and percentage will be used for
analysis of demographic data of group. Mean, Median and Standard Deviation
will be used to assess knowledge and practice of primi antenatal mothers. A
Paired t test will be used to compare pretest knowledge and practice with post
test knowledge and practice for both groups. Co- relation co-efficient to find the
relationship between knowledge and practice of primi antenatal mother on
antenatal diet. A chi square will be used to determine the association between
post test level of knowledge and practice score on antenatal diet with their selected
demographic variables.
DISCUSSION
The term malnutrition can be applied to any disorder that prevents an
individual from achieving optimal nutritional state. The cause of malnutrition are
poor feeding practices, and infection, particularly frequent or persistent diarrhoea,
pneumonia measles, and malaria and poor feeding practices ,such as inadequate
breast feeding offering the wrong foods, giving insufficient quantities,
Malnourished children are more vulnerable to disease and the improved feeding
practices to prevent or treat malnutrition could save 8, 00,000 lives/year7
Core health indicators of India from multiple WHO sources show that
children aged under five years stunted for age (%) rural and urban are 48.5 and
35.7, children aged under five years stunted for age (%) lowest and highest wealth
quintile are 58.1 and 26.7, and child aged under five years stunted for age (%)
lowest and highest educational level of mother are 54.9 and 30.6. Hence these
statistics shows that rural under five children are at high risk for malnutrition. So
mothers of preschool children should be educated on measures to improve
nutritional status of children8
A survey on global hunger index was conducted in year 2007 by
International Food policy Research Institute (IFPRI), Washington. The study was
conducted in 118 countries. The results shows that India ranks 94 th, China 47th,
Pakistan 88th and one in seven people go bed to hungry and 40% of the worlds
underweight children under five live in India the study indicates the need for
sharing information on prevention of malnutrition in children among mothers. 9
A case-control study was conducted by school of Epidemiology and Public
Health, Yale University USA in rural south India in 1997 on maternal knowledge
of malnutrition and health-care-seeking attitudes 34 cases and 34 controls were
selected from the population of approximately 97,000 and the results shows that
the two groups showed a significant difference in nutrition related knowledge of
mild mixed malnutrition (OR=2.62,P=.05) the gender of child and socioeconomic
factors were stronger risk factors for malnutrition. These results suggested a need
for intensive nutritional programmes targeted toward poor female children and
their mothers 10
A descriptive study was conducted in Aligarh in 1991 to evaluate the role of
weaning in determining the nutritional status of infants as well as to identify the
socio-cultural factors affecting weaning practices in rural areas and results shows
that nutritional status was not associated with social class, inadequate knowledge
about proper weaning, not lack of food, was the limiting factor in infant nutrition.
Education about the importance of food, was the limiting factor in infant nutrition.
Education about the importance of proper weaning and weaning foods imparted by
grassroots level workers is needed11.
A historical study was conducted in India in the year 1985. The purpose was
to study nutritional histories of severely and moderately malnourished and
adequately nourished Indian preschool children within a homogenous community.
Maternal perceptions and ratings of regularity of food intake, types of weaning
foods, and the types of food eaten at breakfast, lunch and supper formed significant
variables. It was suggested that any campaign against malnutrition must be
implemented within the framework of existing food patterns12.
A descriptive study conducted in Dharawad by the Population Research
Centre to determine individual, household, programme and community effects on
childhood malnutrition in rural India. The results showed that maternal
characteristics such as socioeconomic and behavioural factors were more
influential in determining childhood nutritional status than the prevalence of
programme factors13.
The above studies and statistics suggest that mothers are primary caregivers
of children and the causes of malnutrition are preventable through education. So
mothers should have adequate knowledge on nutritional status of their
children.Hence there is need to conduct a study and share information on
nutritional needs and factors affecting nutritional status of preschool children to the
mothers.
considerable higher among Pre School & children who live in at risk environment
(Gimpel and Holland). Research has shown that the emergence of early onset
conduct problems in young children is related to a variety of health and behavior
problems such as peer rejection, drug abuse depression and school dropout in later
years. So a right start in the early years is an invaluable aid to continuous unfolding
of a childs potentials.2
CONCLUSION
A descriptive study to assess mothers knowledge on factors affecting
nutritional status of preschool children in selected rural areas of Mangalore
Dakshina Kannada with a view to develop a health education pamphlet.
Assumptions
The investigator assumes that
1) the mothers from selected rural area will have some knowledge regarding
the factors affecting nutritional status of preschool children.
2) there are certain factors affecting nutritional status of preschool children.
3) health education pamphlet will increase the mothers knowledge on
factors affecting nutritional status, prevention and management of
malnutrition.
6.7
Delimitations
The study is delimited to:
1.
2.
3.
4.
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