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Influence of Neonatal Jaundice Education on Neonatal Jaundice Recognition among Nurses in Nigerian Hospitals

Abstract

Neonatal jaundice is a common condition among newborns, but severe or untreated hyperbilirubinaemia can result in serious neurological complications and long-term disability. Nurses play an important role in the early recognition of neonatal jaundice because they are frequently involved in routine newborn observation, assessment, monitoring, and communication with parents and other healthcare professionals. Neonatal jaundice education provides nurses with knowledge and practical skills relating to the causes and risk factors of neonatal jaundice, normal and abnormal jaundice, clinical signs, timing and progression of jaundice, risk assessment, appropriate newborn observation, identification of danger signs, use of available assessment tools, timely reporting, referral, and appropriate monitoring. Neonatal jaundice recognition refers to nurses' ability to identify the clinical signs, characteristics, severity indicators, and risk factors associated with neonatal jaundice and to recognize newborns requiring further assessment, investigation, treatment, or referral. In Nigeria, inadequate neonatal jaundice education, limited access to regular newborn-care training, high workloads, staff shortages, inadequate bilirubin assessment equipment, and inconsistent availability of neonatal care guidelines may affect nurses' ability to recognize neonatal jaundice promptly and accurately. Effective neonatal jaundice education may improve nurses' knowledge, observation skills, clinical decision-making, and ability to identify newborns at risk of severe hyperbilirubinaemia. Against this background, this study investigates the influence of neonatal jaundice education on neonatal jaundice recognition among nurses in Nigerian hospitals. The study is anchored on Social Cognitive Theory, the Knowledge-Attitude-Practice framework, and Experiential Learning Theory. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping nurses' clinical behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how structured neonatal jaundice education may improve knowledge and recognition practices. Experiential Learning Theory emphasizes learning through practical experience, observation, simulation, reflection, and application, making it particularly relevant to clinical recognition education. Collectively, these theoretical perspectives provide a suitable framework for explaining how neonatal jaundice education may influence neonatal jaundice recognition among nurses in Nigerian hospitals. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from nurses providing neonatal and newborn care in selected public and private hospitals in Nigeria using a structured self-administered questionnaire, neonatal jaundice knowledge assessment, and standardized clinical case scenarios or recognition assessment. A multistage sampling technique will be employed to select states, local government areas, hospitals, neonatal units, maternity wards, and eligible nurses. Where feasible, selected hospitals or nurse groups will be assigned to intervention and comparison groups. Nurses in the intervention group will receive structured neonatal jaundice education covering causes and risk factors, physiological and pathological jaundice, clinical signs, timing and progression of jaundice, risk assessment, newborn observation, recognition of danger signs, appropriate use of available assessment tools, timely reporting, referral, and monitoring of newborns with suspected jaundice. Neonatal jaundice recognition will be assessed using indicators such as identification of jaundiced newborns, recognition of abnormal timing or progression, identification of risk factors, recognition of danger signs, identification of newborns requiring urgent assessment, and appropriate decisions regarding reporting, referral, or further evaluation. Clinical case scenarios will be incorporated where feasible to assess the practical application of recognition knowledge. Descriptive statistics will be used to summarize nurses' sociodemographic and professional characteristics, previous neonatal training, exposure to neonatal jaundice education, and recognition scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple regression analysis, will be used to determine the influence of neonatal jaundice education on neonatal jaundice recognition. Where appropriate, pre-intervention and post-intervention recognition scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that neonatal jaundice education has a significant positive influence on neonatal jaundice recognition among nurses in Nigerian hospitals. Nurses exposed to structured neonatal jaundice education are expected to demonstrate improved knowledge of the causes, risk factors, clinical signs, timing, progression, and danger signs associated with neonatal jaundice. Education may improve nurses' ability to distinguish potentially serious jaundice from less concerning presentations, identify newborns requiring urgent assessment, communicate concerns promptly, and initiate appropriate referral or escalation. Improved recognition may contribute to earlier assessment and management of severe hyperbilirubinaemia and reduce delays in care. However, education alone may not guarantee accurate recognition in routine clinical settings because nurses may continue to face barriers such as inadequate bilirubin assessment equipment, heavy workloads, insufficient staffing, limited access to laboratory services, inadequate newborn monitoring resources, and weak referral systems. Consequently, neonatal jaundice education is expected to be most effective when supported by appropriate newborn assessment equipment, clear clinical guidelines, adequate staffing, regular supervision, continuing professional development, and accessible diagnostic and referral services. The study is expected to contribute to the literature on neonatal jaundice, newborn health, neonatal nursing, maternal and child health, clinical education, early disease recognition, neonatal emergency care, and public health in Nigeria by providing empirical evidence on the influence of neonatal jaundice education on neonatal jaundice recognition among nurses. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Nursing and Midwifery Council of Nigeria, state ministries of health, hospital management authorities, neonatal units, nursing training institutions, professional nursing associations, newborn health programmes, development partners, and policymakers regarding strategies for improving early recognition of neonatal jaundice. The study will also provide evidence-based recommendations for strengthening neonatal jaundice education and continuing professional development, improving newborn assessment capacity, ensuring availability of appropriate diagnostic equipment, strengthening clinical supervision, improving referral pathways, and enhancing nurses' capacity to recognize and respond to neonatal jaundice promptly in Nigerian hospitals.

Keywords: Neonatal jaundice education, neonatal jaundice recognition, nurses, Nigerian hospitals, neonatal jaundice, hyperbilirubinaemia, newborn health, neonatal nursing, maternal and child health, clinical education, early recognition, neonatal care, public health, Nigeria.