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JAN – JUN 2017    VOL-18, NO.1

Reflective Journaling Practice in Nursing

* Irin Light, M.Sc (N)., M.A (Psychology)., Ph.D (N)
* Principal, Dr.G. Sakunthala College of Nursing, Trichy

ABSTRACT

Reflective journaling is a tool in developing critical thought and reflection through clarifying concepts. It gives nurses the opportunity to define and express clinical experiences in their own words. This improves observation and descriptive skills. Each nurse should examine the personal thoughts and actions through reflective journaling. The two types - reflection on action and reflection in action will help nurses to improve professional competence. Reflection requires adequate knowledge and is necessary for self-evaluation. The skills helpful for reflection are self-awareness, description, critical analysis, synthesis, and evaluation.

Keywords: reflective journaling, reflective skills, Gibbs model of reflection

REFERENCES

Cowan, E. (2012) Reflective practice: A tool to enhance professional practice. Interprofessional learning thorugh simulation. Retrieved from https://www.ecu.edu.au/data/assets/pdf_file/0011/376958/ User-Manual-Reflective-Practice-FINAL.pdf

Gibbs, G. (1988). Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Oxford Further Education Unit.

Kozier, B. (2008). Fundamentals of nursing: Concepts, process and practice. Upper Saddle River, NJ. Pearson Education.

Potter, P. A., & Perry, A. G. (2009).Fundamentals of nursing (Vol. 3, pp. 6-9). St. Louis, MO: Mosby Elsevier.

Ravindran, V. (2016).Completing the knowledge cycle by utilizing research findings.Indian Journal of Continuing Nursing Education, 17(2), 3.

Taylor C. R., Lillis, C. Lemone, P. & Lynn P. (2011). Fundamentals of Nursing: The art and science of nursing care. Tokyo. Lippincott Williams and Wilkins

University of Cumbria.(2016). Gibbs reflective cycle. Retrieved from http://my.cumbria.ac.uk/Public/LIS S/Documents/skillsatcumbria/ReflectiveCycleGibbs.pdf

Wrigglesworth, S. (2016). Understanding reflective practice: A CPD article improved Sue Wrigglesworth's knowledge of reflective practice. Nursing Standard, 31(8), 72-73.

Mental Health of Refugees

*Rogina J. S. Savarimuthu, M.Sc (N)., M.Sc (Psychology).,M.S (Psychotherapy &Counseling )., C.A.F.E.
*Associate Professor, Chettinad College of Nursing, Chennai

ABSTRACT

In today's world there is a growing number of asylum seekers and refugees owing to conflicts and persecutions worldwide. Asylum seekers and refugees' demographic characteristics, pre-flight and post-flight adversities, and challenges, influence their mental health and psychological well being. Studies report that majority of the refugees have no mental illness. They use their own resources and coping strategies to cope with considerable difficulties encountered in their country of origin, during migration, in their new host country, and in the asylum seeking process. Post-traumatic stress disorder, depression, anxiety, infectious diseases, co-morbidity of physical ill health such as malnutrition, continuation of symptoms and impairment, complications from injuries due to trauma, including torture and violence have been reported among asylum seekers and refugees. The mechanism involved in the cause of mental health problems are complex. The difference in language, culture, and specific stressors associated with mental health problems among refugees and asylum seekers pose a challenge to the existing mental health approach. Hence identifying problems in adaptation and undertaking mental health promotion, prevention or treatment interventions in a timely fashion is crucial. Nursing curriculum should include the care of asylum seekers and refugees. Nurses should be empowered in trans-cultural nursing especially in the care of asylum seekers and refugees.

Keywords: asylum seekers, refugees, mental health

REFERENCES

Akinsulure-Smith, A. M. (2009). Brief psychoeducational group treatment with re-traumatized refugees and asylum seekers. The Journal for Specialists in Group Work, 34(2), 137-150.

Andrulis, D. P., & Brach, C. (2007). Integrating literacy, culture, and language to improve health care quality for diverse populations.American Journal of Health Behavior, 31(1), S122-S133.

Bhui, K., Warfa, N., Edonya, P., McKenzie, K., &Bhugra, D. (2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7(1), 15.

Burnett, A., & Peel, M. (2001). Health needs of asylum seekers and refugees. British Medical Journal, 322(7285), 544.

Fazel, M., &Silove., D. (2006). Detention of refugees. British Medical Journal, 332, 251-252.

Fazel, M., Wheeler, J., &Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309-1314.

Flores, G. (2005). The impact of medical interpreter services on the quality of health care: A systematic review. Medical Care Research and Review, 62(3), 255-299.

Iversen, V. C., &Morken, G. (2004).Differences in acute psychiatric admissions between asylum seekers and refugees. Nordic Journal of Psychiatry, 58(6), 465-470.

Karliner, L. S., Jacobs, E. A., Chen, A. H., &Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754.

Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., . . .&Pottie, K. (2011). Common mental health problems in immigrants and refugees: General approach in primary care. Canadian Medical Association Journal, 183(12), E959-E967.

Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: The problem of cultural competency and how to fix it. PLoS Med, 3(10), e294.

Llosa, A. E., Ghantous, Z., Souza, R., Forgione, F., Bastin, P., Jones, A., . . .&Grais, R. F. (2014). Mental disorders, disability and treatment gap in a protracted refugee setting. The British Journal of Psychiatry, 204(3), 208-213.

McColl, H., McKenzie, K., &Bhui, K. (2008).Mental healthcare of asylum-seekers and refugees. Advances in Psychiatric Treatment, 14(6), 452-459.

Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Social Science and Medicine, 70(1), 7-16.

Mindframe National Media Initiative.(n.d.).Hunter Institute of Mental Health. Retrieved from http://www.mindframe-media.info/for-media/ reporting-mental-illness/priority-population-groups/culturally-and-linguistically-diverse-populations

Murray, K. E., Davidson, G. R., & Schweitzer, R. D. (2010). Review of refugee mental health interventions following resettlement: Best practices and recommendations. American Journal of Orthopsychiatry, 80(4), 576-585.

Office of the United Nations High Commissioner for Refugees. (2006). Refugees: Victims of intolerance. Refugees, 142 (1).UNHCR. Retrieved from http://www.unhcr.org/cgi-bin/texis/vtx/publ/opendo

Patel, V., Boardman, J., Prince, M., &Bhugra, D. (2006).Returning the debt: How rich countries can invest in mental health capacity in developing countries. World Psychiatry, 5(2), 67-70.

Porter, M., &Haslam, N. (2005).Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Journal of American Medical Association, 294(5), 602-612.

Promoting Refugee Health.(2012). A guide for doctors, nurses and other health care providers caring for people from refugee backgrounds. Retrieved from https://refugeehealthnetwork.org.au/wp-content/uploads/PRH-online-edition_July2012.pdf

Summerfield, D. (2003). Mental health of refugees. British Journal of Psychiatry, 183, 459 - 460.

Thabet, A. A., Ibraheem, A. N., Shivram, R., Winter, E. A., &Vostanis, P. (2009). Parenting support and PTSD in children of a war zone. International Journal of Social Psychiatry, 55(3), 226-237.

The Refugee Experience. (n. d.). Participants' guide. Retrieved from http://www.forcedmigration.org/rfgexp /rsptre/video/toc_tr.htm

Tribe, R. (2005). The mental health needs of refugees and asylum seekers. Mental Health Review Journal, 10(4), 8-15.

United Nations High Commissioner for Refugees. (1951). The 1951 refugee convention. Geneva: UNHCR.

United Nations High Commissioner for Refugees.(2016). Stateless people figures. Retrieved from http:// www.unhc r.org/pages/49c3646c26.html

Van Ommeren, M., Sharma, B., Sharma, G. K., Komproe, I., Carderia, E., & de Jong, J. T. (2002). The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: Examination of comorbidity with anxiety and depression. Journal of Traumatic Stress, 15(5), 415-421.

Vostanis, P. (2014). Meeting the mental health needs of refugees and asylum seekers. The British Journal of Psychiatry, 204, 176-177

Watters, C. (2001).Emerging paradigms in the mental health care of refugees. Social Science and Medicine, 52(11), 1709-1718.

Williams, M. E., & Thompson, S. C. (2011). The use of community-based interventions in reducing morbidity from the psychological impact of conflict-related trauma among refugee populations: A systematic review of the literature. Journal of Immigrant and Minority Health, 13(4), 780-794.

Mitochondrial Respiratory Chain Disease: A Case Presentation

*JeyasuthaChokkian, M.Sc (N)
*Assocaite Professor, Narayana Hrudayalaya CON, Bengaluru

ABSTRACT

Mitochondrial respiratory chain diseases are a clinically heterogeneous group of disorders caused by mutation of genes encoded by either nuclear DNA or mitochondrial DNA. It is an incurable disease. Most of the patients die due to progression of condition with majority of the body systems getting affected. Nurses play a vital role in providing supportive management to the patient. A case study is presented in this article. The patient's clinical condition, diagnostic tests done, and management are compared with the book picture.

Keywords: mitochondrial respiratory chain disease, case study, nuclear DNA, mitochondrial DNA

REFERENCES

Jorde, L. B., Carey, J. C., &Bamshad, M. J. (2015).Medical genetics. Canada. Elsevier Health Sciences.

Mattman, A., Sirrs, S., Mezei, M. M., Salvarinova-Zivkovic, R., Alfadhel, M., &Lillquist, Y. (2011). Mitochondrial disease clinical manifestations: An overview. British Columbia Medical Journal, 53(4).

Parikh, S., Saneto, R., Falk, M. J., Anselem, I., Cohen, B. H., & Haas, R. (2009).A modern approach to the treatment of mitochondrial disease. Current Treatment Options in Neurology, 11(6), 414-430.

Saneto, R., Parikh, S., & Cohen, B. H. (Eds.). (2015). Mitochondrial Case Studies: Underlying Mechanisms and Diagnosis. USA. Academic Press.

Sue, C. M., &Schon, E. A. (2000). Mitochondrial respiratory chain diseases and mutations in nuclear DNA: A promising start? Brain Pathology, 10(3), 442-450.

Perceived Quality of Life and Coping in Parents of Children with Chronic Kidney Disease

* Esther Kanthi, M.Sc (N)., M.B.A (Hosp Admin)
**Mary A. Johnson, M.Sc.(N)., M.A (Pub Admin)
***Indira Agarwal, M.D (Paed), F.I.S.N (PaedNeph)

*Junior Lecturer, College of Nursing, CMC, Vellore
**Professor, College of Nursing, CMC, Vellore
**Professor, College of Nursing, CMC, Vellore
***Professor, Department of Paediatrics, CMC, Vellore

ABSTRACT

Chronic kidney disease (CKD) is a condition related to irreversible kidney damage that can progress to end-stage renal disease. It is a devastating disease that can cause considerable reduction in the quality of life. It may be difficult for the parents to cope with having a child with this disease. The aim of this study was to assess the parental perception of quality of life of children with CKD and their coping, the relationship between perceived quality of life and parental coping and its association with selected demographic and clinical variables of children with CKD attending paediatric nephrology clinic and paediatric surgery outpatient department. A descriptive design was used. eighty two parents who fulfilled the inclusion criteria were selected using total enumerative sampling method. PedsQLTM End stage Renal Disease Module was administered to assess the parental perception of quality of life and Coping Health Inventory for Parents was used to assess parental coping. The findings showed that most (35.4%) of the children had stage II CKD. Thirty nine percent of the parents perceived the quality of life of their children as moderate and 46.3% of the parents had good coping. The study revealed a significant positive correlation (r = .394, p = .0001) between parental perception of quality of life and parental coping. There was also a significant association between perceived quality of life and monthly family income (p = .001) and serum haemoglobin level of the child (p = .05). The findings suggest that CKD can considerably affect the quality of life in children. There is a need to educate the parents regarding the condition and suggest methods to cope better with the illness. There is also a need to train the staff to counsel the children and parents.

Keywords: parental perception, quality of life, chronic kidney disease, parental coping

REFERENCES

Aparicio-Lopez, C., Fernandez-Escribano, A., Garrido-Cantanero, G., Pablos, A. L., &Izquierdo-Garcia, E. (2013).The influence of clinical situation on health-related quality of life in paediatric chronic kidney disease patients.Nefrologia, 33(1), 61-67. doi:10.3265/nefrolgia.2012.11484

Bhimma, R., Adhikari, M., Asharam, K., & Connolly, C. (2008).The spectrum of chronic kidney disease (stages 25) in KwaZulu-Natal, South Africa.Pediatric Nephrology, 23(10), 1841 - 1846. doi:10.1007/ s00467-008-0871-5

Buyan, N., Turkmen, M. A., Bilge, I., Baskin, E., Haberal, M., Bilginer, Y., .Dogrucan, N. (2010). Quality of life in children with chronic kidney disease (with child and parent assessments). Pediatric Nephrology (Berlin, Germany), 25(8), 1487 - 1496. doi:10.1007/s00467-010-1486-1

Cavallo, S., Feldman, D. E., Swaine, B., &Meshefedjian, G. (2008). Is parental coping associated with the level of function in children with physical disabilities? Child: Care, Health and Development, 35(1), 33-40. doi:10.1111/j.1365-2214.2008.00884.x

Coresh, J., Astor, B. C., Greene, T., Eknoyan, G., &Levey, A. S. (2003). Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third national health and nutrition examination survey. American Journal of Kidney Disease, 41,112.

El Nahas, A. M., & Bello, A. K. (2005). Chronic kidney disease: the global challenge. Lancet, 365, 31-40.

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Gerson, A. C., Wentz, A., Abraham, A. G., Mendley, S. R., Hooper, S. R., Butler, R. W., . Furth, S. L. (2010). Health - related quality of life of children with mild to moderate chronic kidney disease. Pediatrics, 125(2), e349357. doi:10.1542/peds.2009-0085

Goldstein, S. L., Graham, N., Warady, B. A., Seikaly, M., Mcdonald, R., Burwinkle, T. M., . . .Varni, J. W. (2008). Measuring health - related quality of life in children with ESRD: Performance of the generic and ESRD-Specific instrument of the pediatric quality of life Inventory (PedsQL). American Journal of Kidney Diseases, 51(2), 285-297. doi:10.1053/ j.ajkd.2007.09.021

Gulati,S. (2015). Chronic Kidney Disease in Children. Retrieved from http://emedicine.medscape.com /article/984358-overview

Harambat, J., van Stralen, K. J., Kim, J. J., &Tizard, E. J. (2012).Epidemiology of chronic kidney disease in children.Pediatric Nephrology (Berlin, Germany), 27(3), 363 - 373. doi:10.1007/s00467-011-1939-1

Kanitkar, M., (2009). Chronic Kidney Disease in children: An Indian perspective. Medical Journal Armed Forces India, 65(1), 45-4.

Kalyva, E., &Melonashi, E. (2015).Parental perceptions of health - related quality of life of Albanian children with epilepsy.Health Psychology Research, 3(2). doi:10.4081/hpr.2015.2244

Kilioe-Pstrusinska, K., Medynska, A., Chmielewska, I. B., Grenda, R., Kluska-Joywiak, A., Leszczynska, B., .Zwolinska, D. (2013). Perception of health - related quality of life in children with chronic kidney disease by the patients and their caregivers: Multicentre national study results. Quality of Life Research, 22(10), 2889 - 2897. doi:10.1007/s11136-013-0416-7

McCubbin, H. I., McCubbin, M. A., Patterson, J. M., Cauble, A. E., Wilson, L. R. & Warwick, W. (1983). CHIP-Coping Health Inventory for Parents: An assessment of parental coping patterns in the care of the chronically ill child. Journal of Marriage and the Family, 359 - 370.

McKenna, A. M., Keating, L. E., Vigneux, A., Stevens, S., Williams, A., & Geary, D. F. (2006).Quality of Life in children with chronic kidney disease patient and caregiver assessments. Nephrology Dialysis Transplantation, 21(7), 1899-1905. doi:10.1093 /ndt/gfl091

Park, K.-S., Cho, M. H., Ha, I. S., Kang, H. G., Cheong, H. I., Park, Y. S., . Cho, H. Y. (2012). Validity and reliability of the Korean version of the pediatric Quality of Life ESRD module.Health and Quality of Life Outcomes, 10, 59.doi:10.1186/1477-7525-10-59

Riano-Galan, I., Malaga, S., Rajmil, L., Arceta, G., Navarro, M., Loris, C., &Vallo, A,.(2009). Quality of life of adolescents with end-stage renal disease and kidney transplant.Pediatric Nephrology, 24, 1561-1568

Tong, A., Lowe, A., Sainsbury, P., & Craig, J. C. (2008). Experiences of parents who have children with chronic kidney disease: A systematic review of qualitative studies. Pediatrics, 121(2), 349-360. doi:10.1542/peds.2006-3470

Tsai, T. C., Liu, S. I., Tsai, J. D., & Chou, L. H. (2006). Psychosocial effects on caregivers for children on chronic peritoneal dialysis. Kidney International, 70(11), 1983-1987. doi:10.1038/sj.ki.5001811

vanDellen, Q. M., Stronks, K., Bindels, P. J. E., Ory, F. G., Bruil, J., van Aalderen, W. M. C., & Peace Study Group. (2007). Health-related quality of life in children with asthma from different ethnic origins. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 44(2), 125-131. doi:10.1080/02770900601182459

Varni, J. W. (2014). Scaling and scoring of the Peds QLTM End Stage Renal Disease. Retrieved from http://www.pedsql.org/PedsQL-Scoring.pdf

Warady, B. A., &Chadha, V. (2007). Chronic kidney disease in children: The global perspective. Pediatric Nephrology (Berlin, Germany), 22(12), 1999-2009. doi:10.1007/s00467-006-0410-1

Warni, J.W.(2014). Paediatric Quality of life Inventory.Mapi Research Trust. Retrieved from http:// www.pedsql.org/PedsQL-Scoring.pdf

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Psychosocial Behaviour in Children after Selective Urological Surgeries

* Ida S. Priyadarsini, M.Sc (N)., M.B.A
**Margaret Manoharan, M.Sc.(N)
*** John Mathai, M.S., D.N.B., M.Ch (Paediatric Surgery)
****Antonisami Belavendra, Ph.D., F.R.S.S. F.S.M.S

*Junior Lecturer, College of Nursing, CMC, Vellore
**Professor, College of Nursing, CMC, Vellore
***Professor, Paediatric Surgery, CMC, Vellore
****Professor, Biostatistics, CMC, Vellore

ABSTRACT

Caring for children with surgical issues is multidimensional. Urological surgeries result in prolonged and repeated hospitalizations and presence of urinary diversions such as stoma alters the child's psychosocial status. Therefore it is important for nurses to explore the psychosocial behaviour of such children to enhance child and family coping. A cross sectional descriptive study was done to assess the parental perception of psychosocial behaviour in children undergoing selective urological surgeries. Purposive sampling technique was used to select parents of 105 children between 2-16 years of age who underwent selective urological surgery attending the paediatric surgery out patient department or admitted in the ward. Data were collected using demographic and clinical profoma which included Indian Academy of Pediatrics growth chart and the Child Behaviour Check List from the Achenbach System of Empirically Based Assessments, University of Vermount, USA. The findings revealed that 20.7% of pre-school children and 9.61% of children in the schooler age group had behavioural problems as perceived by the parents. The highest behavioural problems were perceived in the aggressive domain (24.6%) in pre-schooler and in the social domain (13.6%) among the schooler age group. There was no significant difference in the psychosocial behaviour between the two age groups. No significant association was found between the demographic, clinical variables, and psychosocial behaviour. Children after urological surgeries need to be followed for psychosocial behavioural changes. It is important for nurses to address these concerns and educate the parents on coping strategies to help the child and family to cope.

Keywords: psychosocial behaviour, selective urological surgeries, parents, children

REFERENCES

Achenbach system of Empirically Based Assessments.(2015). ASEBA forms and reports. Retrieved from http://www.aseba.org

Davies, D. (2010). Child development: A practitioner's guide. New York. Guilford Press.

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Ebert, A., Scheuering, S., Schott, G., &Roesch, W. H. (2005).Psychosocial and psychosexual development in childhood and adolescence within the exstrophy-epispadiascomplex. The Journal of Urology, 174(3), 1094 - 1098. doi:10.1097/01.ju.0000169171.97538.ed

Kalkman, C. J., Peelen, L., Moons, K. G., Veenhuizen, M., Bruens, M., Sinnema, G., & de Jong, T. P. (2009).Behavior and development in children and age at the time of first anesthetic exposure. The Journal of the American Society of Anesthesiologists, 110(4), 805-812.

Kliegman, R. M., Behrman, R. E., Jenson, H. B., & Stanton, B. M. (2007).Nelson Textbook of Pediatrics. Philadelphia. Elsevier Health Sciences.

Kyle, T., & Carman, S. (2013). Essentials of Pediatric Nursing (2nd ed.). New Delhi: Lippincott Williams and Wilkins Publisher.

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Sameroff, A. J, &Fiese, B. H. (2000). Transactional regulation: The developmental ecology of early intervention. Handbook of early childhood intervention. New York: Cambridge University Press.

Shamnas, M., Arya, P. S., Thottumkal, V. A., & Deepak, M. G. (2013). Congenital anomalies: A major public health issue in India. International Journal of Pharmaceutical, Chemical & Biological Sciences, 3(3).

Wagstaff, K. E., Woodhouse, C. R. J., Duffy, P. G., &Ransley, P. G. (1992). Delayed linear growth in children with enterocystoplasties. BJU International, 69(3), 314-317.

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Knowledge of Staff Nurses regarding Neonatal Hypothermia and Effectiveness of Embrace Thermopod in Prevention of Hypothermia

* Dhanamani, M.Sc (N)
** Ebenezer E. Benjamin, M.Sc (N)
***Anne Jarone, M.Sc (N)

*Tutor, CSI Kalyani College of Nursing, Chennai
**Professor, College of Nursing, CMC, Vellore
***Professor, College of Nursing, CMC, Vellore

ABSTRACT

Hypothermia is one of the main causes of neonatal mortality. Temperature of the environment during delivery and the postnatal period has a significant effect on the baby's survival. The health professionals must be aware of the risk of falling body temperature immediately after birth. The main objective of this study was to assess the knowledge of staff nurses regarding neonatal hypothermia and effectiveness of Embrace thermopod in prevention of hypothermia among the babies born by Cesarean section in a tertiary care centre in South India. An experimental study design was used for the study. Data were collected from 73 staff nurses working in maternity wards and operating room who were recruited for the study by consecutive sampling technique. The self-reported knowledge questionnaire was administered to assess their knowledge on neonatal hypothermia. A total of 112 babies born by cesarean section (elective) were selected by simple random sampling technique while consecutive sampling technique was used for those requiring emergency cesarean section. Subjects were then randomised into experimental and control group. Control group babies received standard care and experimental group babies received standard care along with application of thermopod. After the transfer to the ward, the baby's body temperature was measured by axillary temperature using digital thermometer. The findings showed that knowledge of staff nurses on neonatal hypothermia was inadequate. There was statistically significant association between staff nurses knowledge and area of work. The mean difference of temperature between thermopod group and standard care group was highly significant (p < .001).

Keywords: hypothermia, embrace thermopod, knowledge, thermoregulation, cesarean section.

REFERENCES

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Guertin, S. (n. d).Golden hour thermoregulation protocol. Retrieved from https :// nursing.uiowa. edu/ sites/ default /files/documents/academicprograms/graduate/dnp/Spr14_posters/Stacey%20Guertin%20Poster.pdf

Hackman, P. (2001). Recognizing and understanding the cold-stressed term infant.Neonatal Network, 20(8), 35-41.

Panicker, R. A. (2010).A clinical trial study to assess effect of embrace infant warmer in maintaining thermostability against conventional care.Clinical Trial Registry India, 091.

Wall, S. N., Lee, A. C., Niermeyer, S., English, M., Keenan, W. J., Carlo, W., & Lawn, J. E. (2009). Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up?.International Journal of Gynecology& Obstetrics, 107, S47-S64.

World health Organization. (1997). Department of reproductive health and research, thermal protection of the newborn: A practical Guide. Geneva, Switzerland: WHO.

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Conceptual Models and Theories: Developing a Research Framework

* Beulah Premkumar, M.Sc (N)., M.Phil
** Shirley David, M.Sc (N).,Ph.D (N)
*** VinithaRavindran, M.Sc (N).,Ph.D (N)

*Professor, College of Nursing, CMC, Vellore
**Professor, College of Nursing, CMC, Vellore
***Professor, College of Nursing, CMC, Vellore