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ASSIGNMENT ON INSERVICE EDUCATION

SUB: COMMUNITY HEALTH NURSING

SUBMITTED TO- SUBMITTED BY-

MS. BHASWATI SUTRADHAR PRITY DEVI
MSC.NURSING 2ND YEAR
LECTURER ROLL NO:- 3
CPMS COLLEGE OF NURSING CPMS COLLEGE OF NURSING

P
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INTRODUCTION

As per the requirement of 2nd year M.Sc. Nursing course syllabus (Community Health
Nursing Specialty), we are M.Sc. Nursing students were posted in Anganwadi Centre. During
this period of posting one in- service education programme was conducted for the Anganwadi
worker of different Sub-centers under the Primary Health Centre, Kamrup, Assam. The
education programme was conducted from 20/5/2020 to 22/5/2020 from 10 am to 2 pm at the
Anganwadi Centre. The total numbers of participants were 15. The theme of the programme
was- “low birth weight, kangaroo mother care and menstrual hygiene”

The programme was planned and accordingly a written permission letter from Sub-
Divisional Medical & Health Officer of PHC. The participants for the programme were selected
and intimated under his permission and guidance. The faculty in-charge of M.Sc. Nursing
students was informed about the programme details.

The programme started with the registration of the participants. Health officer of PHC
inaugurated the programme as he was invited as an honorable guest and a valuable speech was
given by him. The welcome speech and the orientation of the programme were done by one of
the M.Sc. students organizing the programme. The Programmes further continued with the
lectures were taken with different audio-visual aids by the organizing students.

TYPE OF TRAINING: In-service education

CATEGORIES OF TRAINEES: Anganwadi worker

SIZE OF BATCH: 15

DURATION OF TRAINING: 3 day

VENUE: Anganwadi Center

DATE OF TRAINING: 20/5/2020 to 23/5/2020

MODE OF COMMUNICATION: English and Assamese

OBJECTIVE OF THE INSERVICE TRAINING PROGRAM: To provide an in-service

education to the Anganwadi worker.
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TOPIC: low birth weight, kangaroo mother care and menstrual hygiene”

GENERAL OBJECTIVES: To enhance the knowledge and to improve the skills and practice
regarding low birth weight, kangaroo mother care and menstrual hygiene”

SPECIFIC OBJECTIVES: At the end of the programme the participants are expected to have
knowledge regarding:

1. Management of low birth weight baby at home

2. Technique of kangaroo mother care
3. Menstrual hygiene management

PROGRAMME SCHEDULE:

Theme: low birth weight, kangaroo mother care and menstrual hygiene

Venue: Anganwadi Center

Date Time TOPIC Resource person

20/5/2020 10 am – 10.30 am  Registration of participants Ms. \\

10.30 am – 11 am  Welcome address Mrs.

 Inauguration of the programme by Dr.
the honorable guest
 Speech by the honorable guest
 Speech by the faculty of
community health nursing
department, CPMS College of
Nursing
 Orientation of the programme

11 am – 11.30am  Tea break

11.30 am – 12pm  Concept of low birth weight Ms.

 Management of low birth weight Ms.
12pm – 1pm baby at home
1pm – 1.30 pm  Refreshment
1.30pm- 1.45pm  Interactive session Ms.
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1.45 pm – 2 pm  valedictory session Ms.

21/5/2020 10 am – 10.30 am  Registration of participants Ms.

10.30 am – 11 am  Welcome address Ms.

 Inauguration of the programme by Ms.
the honorable guest
 Speech by the honorable guest Ms.
 Speech by the faculty of Ms.
community health nursing
department, CPMS College of
Nursing
 Orientation of the programme

11 am – 11.30am  Tea break

11.30 am – 12pm  Concept of Kangaroo Mother care Ms.

12pm-1 pm  Technique of kangaroo mother Ms.
care
1pm – 1.30 pm  Refreshment
1.30pm- 1.45pm  Interactive session Ms.

1.45 pm – 2 pm  valedictory session Ms.

22/5/2020 10 am – 10.30 am  Registration of participants Ms. \\

10.30 am – 11 am  Welcome address Mrs.

 Inauguration of the programme by Dr.
the honorable guest
 Speech by the honorable guest
 Speech by the faculty of
community health nursing
department, CPMS College of
Nursing
 Orientation of the programme

11 am – 11.30am  Tea break

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11.30 am – 12pm  Concept of menstrual hygiene Ms.

management
12pm-1 pm  Hygiene during menstruation Ms.
1pm – 1.30 pm  Refreshment
1.30pm- 1.45pm  Interactive session Ms.

1.45 pm – 2 pm  valedictory session Ms.

LOW BIRTH WEIGHT:

INTRODUCTION

Low birth weight is a term used to describe babies who are born weighing less than 2,500
grams.The weight of all infants must be measured at birth so that low-birth-weight infants can be
identified.

Some babies with low birthweight are healthy, even though they’re small. But being low
birthweight can cause serious health problems for some babies. A baby with low birthweight
may have trouble eating, gaining weight and fighting off infections. Some low-birthweight
babies may have long-term health problems, too. About 1 in 12 babies (about 8 percent) in the
United States is born with low birthweight.

CAUSES:

The primary cause of low birth weight is premature birth (being born before 37 weeks gestation).
Being born early means a baby has less time in the mother's uterus to grow and gain weight.
Much of a baby's weight is gained during the latter part of pregnancy.

Another cause of low birth weight is intrauterine growth restriction (IUGR). This occurs
when a baby does not grow well during pregnancy because of problems with the placenta, the
mother's health, or the baby's condition. A baby can have IUGR and be born at full term (37 to
41 weeks). Babies with IUGR born at term may be physically mature but may be weak.
Premature babies that have IUGR are both very small and physically immature.

Other causes of LBW:

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 Smoking

 Multiple pregnancy

 Drug and alcohol abuse

 Poor nutrition

 Birth defects

RISK FACTOR:

 Race: African-American babies are two times more likely to have low birth weight
than white babies.

 Age: Teen mothers (especially those younger than 15 years old) have a much higher risk
of having a baby with low birth weight.

 Multiple births: Multiple birth babies are at increased risk for low birth weight because
they often are premature. Over half of twins and other multiples have low birth weight.

 Mother's health: Babies of mothers who are exposed to illicit drugs, alcohol, and
cigarettes are more likely to have low birth weight. Mothers of lower socioeconomic
status are also more likely to have poorer pregnancy nutrition, inadequate prenatal care,
and pregnancy complications--all factors that can contribute to low birth weight.

SYMPTOMS OF LBW:

Some signs of prematurity include the following:

 Small size, with a disproportionately large head

 Sharper looking, less rounded features than a full-term baby's features, due to a lack of fat
stores

 Fine hair (lanugo) covering much of the body

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 Low body temperature, especially immediately after birth in the delivery room, due to a
lack of stored body fat

 Labored breathing or respiratory distress

 Lack of reflexes for sucking and swallowing, leading to feeding difficulties.

Common problems of low birth weight babies:

 Low oxygen levels at birth

 Inability to maintain body temperature

 Difficulty feeding and gaining weight

 Infection

 Breathing problems, such as infant respiratory distress syndrome (a respiratory disease of

prematurity caused by immature lungs)

 Neurologic problems, such as intraventricular hemorrhage (bleeding inside the brain)

 Gastrointestinal problems, such as necrotizing enterocolitis (a serious disease of the

intestine common in premature babies)

 Sudden infant death syndrome (SIDS)

MANAGEMENT OF LOW BIRTH WEIGHT BABY AT HOME:

Special care at Home Principles:

 Prevention of infections

 Prevention of hypothermia

 Correction of malnutrition

1. Prevention of infections:

 Gentle and minimal handling

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 Handling with clean hands

 Room must be warm, clean and dust-free

 Immunization at right time

2. Prevention of hypothermia

 Avoid bath till baby attains 2500g weight

 Cover baby with clean dry & warm cloth

 Bottles filled with warm water & covered with thin cloth are kept on both sides (or) baby
without blanket is kept near 60 candle bulb burning.

3. Correction of malnutrition

 As LBW babies cannot suck milk actively, it gets tired faster. So frequent breast feeding
must be given almost

KANGAROO MOTHER CARE:

INTRODUCTION:

KMC refers to the practice of providing continuous skin-to-skin contact between mother and
baby, exclusive breast milk feeding, and early discharge from hospital. It has shown to decrease
mortality and morbidity in preterm and low birthweight infants by providing protection from
infection; regulating temperature, breathing, and brain activity; and encouraging mother-baby
bonding.

NEEDS OF KMC:

Kangaroo Mother Care is needed to provide care and protection to the newborn baby, so that the
baby may heal and grow naturally. Kangaroo care was initially practiced for low birth weight
and preterm or premature babies, but this technique is beneficial for all infants as it provides the
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necessities like mother’s warmth, protection and breast milk to the baby. So, KMC may be
practiced in the following cases:

 Premature or low birth weight babies in neonatal care

 Low birth weight and full-term babies

 Full-term babies Infants who are separated from their mothers due to some medical
reasons

 To establish breastfeeding and good milk supply

ADVANTAGES OF KMC:

1. It keeps the infant warm.

2. It allows the mother (and father) to play a major role in caring for the infant.

3. It promotes breastfeeding.

4. It reduces the risk of infection in the infant.

5. It allows the mother and infant to be discharged home earlier.

6. It reduces the work load of the nursing staff.

7. It improves weight gain.

8. The infant’s temperature, respiration and heart rate remain very stable with KMC. Apnoea is
reduced.

TECHNIQUE OF KANGAROO MOTHER CARE:

KANGAROO POSITION

 Consists of specific frog like position of LBW new born with skin-to-skin contact with
mother, in between her breasts in a vertical position.
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 The baby’s head should be placed to a side, for easy breathing and eye contact with the
mother.

  The baby’s tummy should be placed on the mother’s upper abdomen.

 The baby’s arms and legs should be folded.

 The baby’s bottom should be supported by a sling or a binder.

 Maintained 24 hrs a day, till it gains at least 2000g.

PREPARATION OF KOANGAROO BABY:

 Baby must be suitably dressed in a cap, soak-proof diaper, socks and with an open shirt
to have skin to skin contact between mother and baby and placed in a kangaroo bag.

PREPARATION OF MOTHER:

 The mother can wear a belt, or tuck her vest, shirt, T-shirt or blouse into her trousers,
to prevent the infant from falling. Special clothes are not needed although a KMC
baby carrier can be used. Other members of the family should also be encouraged to
give the infant KMC. This is particularly important for the father.

KANGAROO FEEDING POLICY

 Kangaroo position is ideal for breast feeding.

 Exclusive breast feeding is the policy.

 Feeding is done once in 90-120 min.

 If the baby can suckle , it is promoted.

 If baby cannot suckle , expressed breast milk to be fed

PREVENTION OF LBW BABY

A. DIRECT INTERVENTION MEASURES

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 Prevention of malnutrition - By nutritional education and supplementation under

ICDS.

 Prevention of anemia - By distribution of IFA tablets

 Control of infections - By early diagnosis and prompt treatment.

 Avoid strenuous exercise, smoking & alcohol among pregnant mothers.

B. INDIRECT INTERVENTION MEASURES:

These are mainly family welfare services such as

 Deciding age at marriage.

 Deciding age at first child.

 Birth spacing.

 Deciding no of children.

 Improvement of availability of health services to women.

3. MENSTRUAL HYGIENE MANAGEMENT:

INTRODUCTION:

Menstrual hygiene management (MHM) or menstrual health and hygiene (MHH) is about access
to menstrual hygiene products to absorb or collect menstrual blood, privacy to change the
materials, and access to facilities to dispose of used menstrual management materials. It can also
include the "broader systemic factors that link menstruation with health, well-being, gender
equality, education, equity, empowerment, and rights".

Menstrual hygiene management can be particularly challenging for girls and women in
developing countries, where clean water and toilet facilities are often inadequate. Menstrual
waste is largely ignored in schools in developing countries, despite it being a significant
problem. Menstruation can be a barrier to education for many girls, as a lack of effective sanitary
products restricts girls' involvement in educational and social activities.
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Menstrual Hygiene Day creates an occasion for publicizing information about menstrual
hygiene management issues in the media. The day offers an opportunity to actively advocate for
the integration of menstrual hygiene management into global, national and local policies and
Programmes.

Potential risks to health of poor menstrual hygiene

1. Unclean sanitary pads/materials Bacteria may cause local infections or travel up the vagina
and enter the uterine cavity

2. Changing pads infrequently Wet pads can cause skin irritation which can then become
infected if the skin becomes broken.

3. Insertion of unclean material into vagina Bacteria potentially have easier access to the cervix
and the uterine cavity.

4. Wiping from back to front following Makes the introduction of bacteria from the bowel into
the vagina urination or defecation (or urethra) more likely.

5 .Unprotected sex possible increased risk of sexually transmitted infections (see below) or the
transmission of HIV or Hepatitis B during menstruation. the body .

6. Unsafe disposal of used sanitary materials Risk of infecting others, especially with Hepatitis B
(HIV and other or blood Hepatitis viruses do not survive for long outside the body and pose a
minimal risk except where there is direct contact with blood just leaving.

MANAGE OF FIRST PERIOD:

 Talk to other girls and women, such as your mother, sister, aunt, grandmother, female
friend or an older woman in your community.

 Don’t be afraid. It can be scary to see the blood on your underwear, but it is normal and
natural. If you are at school, tell the matron, a female teacher or a fellow student.

 Feel proud! Your body is developing into that of a young woman.

HYGINE DURING MENSTURATION:

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1. Choose method of sanitation:

Today there are a number of ways including the use of sanitary napkins, tampons and menstrual
cups to stay clean. In India, most unmarried girls prefer to use sanitary napkins. While there are
some women who choose to use either different types of sanitary napkins on different days of
their periods or different methods of protection (like a tampon and a sanitary napkin), there are
some who prefer to stick to one type and brand. The best tip here is to try and use one brand for
one type of protection for a while to know if it helps needs.

2. Change regularly: Menstrual blood – once it has left the body – gets contaminated with the
body’s innate organisms. When these organisms remain in a warm and moist place for a long
time they tend to multiply and can lead to conditions like urinary tract infection, vaginal
infections and skin rashes.

The standard time to change a sanitary pad is once every six hours, while for a tampon is once
every two hours. While some women might have a heavy flow and would need to change more
often, others will need to change less frequently.

3. Wash yourself regularly:

When menstruate, the blood tends to enter tiny spaces like the skin between labia or crust
around the opening of the vagina and should always wash this excess blood away. This practice
also tends to beat bad odor from the vaginal region. So, it is important to wash vagina and labia
(the projecting part of female genitals) well before change into a new pad. If cannot wash before
change make sure to wipe off the areas using toilet paper or tissue.

4. Don t use soaps or vaginal hygiene products

The vagina has its own cleaning mechanism that works in a very fine balance of good and bad
bacteria. Washing it with soap can kill the good bacteria making way for infections. So, while it
is important to wash regularly during this time, all need to use is some warm water and can use
soap on the external parts but do not use it inside vagina or vulva.

5. Use the right washing technique:

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Always wash or clean the area in a motion that is from the vagina to the anus. Never wash in the
opposite direction. Washing in the opposite direction can cause bacteria from the anus to lodge in
the vagina and urethral opening, leading to infections.

6. Discard used sanitary product properly

It is essential to discard used napkins or tampons properly because they are capable of spreading
infections, will smell very foul. Wrapping it well before discarding it ensures that the smell and
infection is contained. It is advised not to flush the pad or tampon down the toilet since they are
capable of forming a block and can cause the toilet to back up. More importantly it is imperative
that wash hands well after discard used napkin likely to touch the used portion of the pad or
tampon while discarding it.

7. Beware of a pad rash

A pad rash is something that might experience during a period of heavy flow. It usually occurs
when the pad has been wet for a long time and rubs along the thighs causing it to chaff. To
prevent this from occurring, try to stay dry during periods. Change pads regularly and stay dry if
have a rash. Apply an antiseptic ointment, after a bath and before bed this will heal the rash and
prevent further chaffing. If it gets worse do visit doctor who will be able to prescribe a
medicated powder that can keep the area dry.

8. Use only one method of sanitation at a time

Some women who have heavy flow during their periods tend to use either (i) two sanitary pads,
(ii) a tampon and sanitary pad (iii) a sanitary pad along with a piece of cloth. This might seem
like a good idea, but it actually is not, changing regularly is a better option. Using two pads or a
tampon and a sanitary pad is bad because the two pads absorb the blood and don t see that they
are completely used up and unlikely to change at regular and healthy intervals. This can lead to
rashes, infections. Another consideration is that if one does use a piece of cloth as extra
protection that cloth may not be the cleanest thing to put next to private parts. Lastly, the whole
two pad structure is extremely uncomfortable and can leave with a bad rash and an even worse
temper.

9. Have a bath regularly

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To some it may seem like the most inane advice, but in some cultures it is believed that a woman
should not bathe during her periods. This myth was based on the fact that in the olden days
women had to bathe in the open or in common water bodies like a river or lake. Bathing not only
cleanses body but also gives a chance to clean private parts well. It also helps relieve menstrual
cramps, backaches, helps improve mood and makes feel less bloated. To get some relief from
backaches and menstrual cramps, just stand under a shower of warm water that is targeted
towards your back or abdomen and feel much better at the end of it.

10. Be ready with on-the-go stuff during your periods

It is important to have extra sanitary pads or tampons properly stored in a clean pouch or paper
bag, a soft towel, some paper tissues or towels, hand sanitizer, a healthy snack, bottle of drinking
water, a tube of antiseptic medication (if you are using one).

Changing pads/ tampons regularly is essential, so need extra. More importantly storing them
properly so that they don t get contaminated is as important as changing. Pads or tampons that
remain in bag without a clean pouch to protect it can also lead to infections like UTI (urinary
tract infection) or vaginal infections.

STRATEGIES FOR THE MANAGEMENT OF MENSTRUAL WASTE:

(1)Disposal of menstrual waste is of major concern as it affects health and environment. There is
a need for effective menstrual materials which needs less and cost-effective management.

(2) Companies dealing with manufacturing of sanitary pads or other articles should disclose the
information on the pads regarding the chemical composition of the pads so that appropriate
technologies could be used for their disposal and treatment.

(3) Environment-friendly chemicals should be used by manufacturers of sanitary products to stop

soil and water pollution and to fasten the decomposition process.

(4) Guidance regarding menstrual management to adolescent girls and women is a much needed
step. Menstrual hygiene management should be an integral part of education curriculum.

(5) Distribution of menstrual products should be free of cost in schools and educational institutes
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(6) The toilets must be designed and built to be girl/women friendly.

Some schools have installed sanitary napkin vending machines in toilets which are
semiautomatic and operate by inserting a coin in it. It contains 30–50 sanitary napkins to meet
the emergency needs of the girls/women in schools .

(7) There should be a separate collection system for the menstrual wastes without affecting the
privacy and dignity of women. Specific sanitary dispensers to collect menstrual waste should be
installed.

(8) There should be sufficient space for washing, cleaning private parts and hands and for
changing or dealing with stained clothes. To fulfill these requirements, there must be water
availability, toilet paper, dustbin, and a sink to wash menstrual products.

(9) Dustbins should be covered by lid and emptied from time to time to keep the toilets clean
from flies, mosquitoes, and bad odor.

(10) Covered containers and dustbins have advantage of hiding the waste being seen by others.
They are installed in a place that offers privacy.

(11) Gloves and proper safety tools should be provided to the cleaners so that they are not
exposed to pathogenic organisms and harmful gasses.

(12) Government should introduce new rules for the safe disposal and treatment of menstrual
wastes as they have made for solid or biomedical wastes. Appropriate policy and legal
framework is necessary for the management of menstrual wastes.

(13) Government and non-government organizations should come forward for making the people
aware of management of menstrual wastes. Government should give the funds to the Municipal
Corporation or NGOs for the construction of women friendly toilets.

(14) Health implications of menstrual wastes should be properly investigated. Financial support
should be given to the institutions to carry out the research in the management of menstrual
wastes.
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(15) Scientific research should be encouraged for the most suitable techniques of disposal of
sanitary pads or other menstrual products.

(16) Allocation of budget in schools to support menstrual hygiene management studies should be
conducted.

(17) Collaborative efforts (trash bins) should be made.

(18) Incinerators are a better option for disposal but should be operated in a controlled
environment so that harmful gasses emitted will not harm larger area.

CONCLUSION:

After successful completion of the in-service education, the ASHA Workers had gained lots of
knowledge regarding in-service education, and will be able to explore their knowledge for the
betterment of the community people with great ease. The programme was concluded by
providing the members present out there with light refreshment. Lastly the programme was
beneficial for me to increase my knowledge level and even to impart knowledge to the
Anganwadi workers for benefits of the community people.