Assessment of Nurses’ Performance Related to Postnatal Care Against the International Confederation of Midwives Competencies and Impact of Plan-Do-Check-Act Cycle in Maternity Unit of Selected Hospital, Medinipur

Abstract

Postnatal period is a very vulnerable time because most of the maternal and neonatal death occur during this period. Nurses and midwives are the most important stakeholders in the health care delivery system in order to meet the quality care for the patients. PDCA cycle as a rapid improvement cycle is very helpful to build a standard practice of quality care within the facility. A study was undertaken to assess nurses’ performance related to postnatal care against the International Confederation of Midwives competencies and impact of Plan-Do-Check-Act cycle in maternity unit of selected Hospital, Medinipur. Pre-experimental research design was adopted. Total 14 nurses working in postnatal ward of selected hospital were selected as study subjects by total enumerative sampling technique. Final data were collected by using validated and reliable semi-structured questionnaire (r=1), structured knowledge questionnaire(r=0.72), structured observation checklist(r=1) and semi-structured interview schedule(r=1). Three PDCA cycles were applied cyclically. The strategies undertaken in the PDCA cycle were identifying the gaps and reasons of gaps in postnatal care and rectifying them in the subsequent PDCA cycle. The main findings of the study revealed that in pretest, very few staff nurses (7.14%) had poor knowledge, more than half of the staff nurses (64.29%) had average knowledge and 28.57% staff nurses had good knowledge. So, gaps were present in nurses’ knowledge on postnatal care as only 35.71% nurses had good knowledge. Majority of the nurses (85.72%) had average skill and very few of staff nurses (7.14%) had poor skill and also very few nurses (7.14%) had good skill in postnatal care. The gaps were identified in skill of checking BP, temperature, breast condition, uterine involution, PV bleeding of mother, checking temperature, respiration and related complications, reflexes, general conditions & other complications of baby, providing support for breast feeding, health education and counselling services. The stated reasons for these gaps were inadequate supply of articles and equipment, less manpower in relation to nurse patient ratio, inadequate space and area for postnatal examination & discharge, forgetting proper steps of some procedures, others (some parameters were checked by doctors, so nurses did not check such as uterine involution of mother, reflexes, general condition & other complications of baby). After taking appropriate strategies in PDCA cycle to reduce the gaps in nurses’ performance it was seen that there was significant differences in mean values between pretest knowledge score with the posttest knowledge score in 3rd PDCA cycle [t=8.683 at df(13), p<005]. There were also significant differences in mean skill scores between pretest & 1st PDCA cycle, 1st & 2nd PDCA cycle, 2nd & 3rd PDCA cycle, pretest & 3rd PDCA cycle [t=16.312, t=8.0, t=6.624, t=17.539 at df(13), p<0.05] respectively. The study can be replicated for other nursing practice area to improve quality patient care through PDCA cycle. So, the current study concludes that PDCA cycle is effective to increase nurses’ knowledge and skill in postnatal care and to increase quality of postnatal care by reducing the gap in the administrative level, logistic level, human resource development (training on knowledge and skill), and infrastructure development. Keywords: Nurses’ performance, Postnatal care, The International Confederation of Midwives Competencies, Plan-Do-Check- Act cycle.