Using a mobile nurse mentoring and training program to address a health workforce capacity crisis in Bihar, India: Impact on essential intrapartum and newborn care practices

Creanga, Andreea A.; Jiwani, Safia S; Das, Aritra; Mahapatra, Tanmay; Sonthalia, Sunil; Gore, Aboli; Kaul, Sunil C.; Srikantiah, Sridhar; Galavotti, Christine; Shah, Hemant

doi:10.7189/jogh.10.0201009

Cited by 9 publications

(3 citation statements)

References 13 publications

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“…This intervention (training program) was unique because it covered the range of knowledge and skills in RMNH and was supplemented by mentorship program in the real-life clinical setting. Mentorship interventions have been reported to have a statistically significant positive impact on competencies among healthcare providers [ 49 ]. The CPD courses and mentorship program were effective and may be less expensive than other training options because they used local trainers and mentors.…”

Section: Discussionmentioning

confidence: 99%

The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey

et al. 2022

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Background Delivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of training with onsite clinical mentorship towards self-reported performance in RMNH among healthcare workers in Mwanza Region, Tanzania. Methods The study used a quasi-experimental design with pre-and post-intervention evaluation strategy. The baseline was compared with two endline groups: those with intervention (training and onsite mentorship) and those without. The differences among the three groups in the sociodemographic characteristics were analyzed by using chi-square test for categorical variables, independent-sample t-test for continuous variables and Mann–Whitney U test for ordinal or skewed continuous data. The independent sample t-test was used to determine the effect of the intervention by comparing the computed self-reported performance on RMNH services between the intervention and control groups. The paired-samples t-test was used to measure the differences between before and after intervention groups. Significance was set at a 95% confidence interval with p ≤ 0.05. Results The study included a sample of 216 participants with before and after intervention groups comprising of 95 (44.0%) and 121 (56.0%) in the control group. The comparison between before and after intervention groups revealed a statistically significant difference (p ≤ 0.05) in all the dimensions of the self-reported performance scores. However, the comparison between intervention groups and controls indicated a statistical significant difference on intra-operative care (t = 3.10, df = 216, p = 0.002), leadership skills (t = 1.85, df = 216, p = 0.050), Comprehensive emergency obstetric and newborn care (CEMONC) (t = 34.35, df = 216, p ≤ 0.001), and overall self-reported performance in RMNH (t = 3.15, df = 216, p = 0.002). Conclusions This study revealed that the training and onsite clinical mentorship to have significant positive changes in self-reported performance in a wide range of RMNH services especially on intra-operative care, leadership skills and CEMONC. However, further studies with rigorous designs are warranted to evaluate the long-term effect of such training programs on RMNH outcomes.

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Section: Discussionmentioning

confidence: 99%

The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey

et al. 2022

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“…The NM incorporated diverse teaching strategies including on-the-job demonstrations of evidence-based practices on actual patients (antenatal and postnatal women and the newborns), bedside mentoring, didactics, and PRONTO International's low-technology, high delity simulation and team-training. The AMANAT program was effective in improving evidence-based practices in normal as well as complicated births 11 however, given that the nurse mentors were 'external' to the system (i.e. they were employed by Bihar Technical Support Program but were not part of the state's public health system), the program was neither nancially nor realistically sustainable.…”

Section: Introductionmentioning

confidence: 99%

Training nurse simulation educators at scale to improve maternal and newborn health: a case study from Bihar, India

Madriz

Afulani

Spindler

et al. 2022

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BackgroundSimulation has been shown to improve clinical and behavioral skills of birth attendants in low-resource settings at a low scale. Populous, low-resource settings such as Bihar, India, require large cadres of simulation educators to improve maternal and newborn health. It’s unknown if simulation facilitation skills can be adopted through a train of trainers’ cascade. To fill this gap, we designed a study to evaluate the simulation and debrief knowledge and skills of a cadre of 701 simulation educators in Bihar, India. In addition, we assessed the physical infrastructure where simulation takes place in primary healthcare facilities in Bihar, India.Methods We performed a 1 year before–after intervention study to assess the simulation facilitation strengths and weaknesses of a cadre of 700 nurses in Bihar, India. The data included 700 pre-post knowledge and self-efficacy tests; videos of simulations and associated debriefs conducted by 700 providers at 40 primary healthcare centersResults We observed a statistically significant difference in knowledge and self-efficacy scores before and after the 4-day PRONTO simulation educator training. The average number of participants in a simulation video was 5 participants (range 3-8). The average length of simulation videos was 10:21 minutes. The simulation educators under study, covered behavioral in 90% of debriefs and cognitive objectives were discussed in all debriefs. Conclusion This is the first study assessing the simulation and debrief facilitation knowledge and skills of a cadre of 700 nurses in a low-resource setting. Simulation was implemented by local nurses at 353 primary healthcare centers in Bihar, India. Primary healthcare centers have the physical infrastructure to conduct simulation training. Some simulation skills such as communication via whiteboard were widely adopted. Advanced skills such as eliciting constructive feedback without judgement require practice.

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“…Using simulation, debriefs and team training activities, PRONTO’s program is focused on improving the management of the most common maternal and newborn emergencies. The AMANAT program was effective in improving evidence-based practices in normal as well as complicated births [ 11 ] however, given that the nurse mentors were ‘external’ to the system (i.e., they were employed by Bihar Technical Support Program but were not part of the state’s public health system), the program was neither financially nor realistically sustainable. Thus, to bolster the health gains obtained with the AMANAT program and to make the program more affordable and sustainable, the government of Bihar and their collaborators launched the AMANAT-Jyoti program in 2018.…”

Section: Introductionmentioning

confidence: 99%

Training nurse simulation educators at scale to improve maternal and newborn health: a case study from Bihar, India

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Simulation has been shown to improve clinical and behavioral skills of birth attendants in low-resource settings at a low scale. Populous, low-resource settings such as Bihar, India, require large cadres of simulation educators to improve maternal and newborn health. It’s unknown if simulation facilitation skills can be adopted through a train of trainers’ cascade. To fill this gap, we designed a study to evaluate the simulation and debrief knowledge, attitudes and skills of a third generation of 701 simulation educators in Bihar, India. In addition, we assessed the physical infrastructure where simulation takes place in 40 primary healthcare facilities in Bihar, India. Methods We performed a 1 year before–after intervention study to assess the simulation facilitation strengths and weaknesses of a cadre of 701 nurses in Bihar, India. The data included 701 pre-post knowledge and attitudes self-assessments; videos of simulations and associated debriefs conducted by 701 providers at 40 primary healthcare centers. Results We observed a statistically significant difference in knowledge and attitude scores before and after the 4-day PRONTO simulation educator training. The average number of participants in a simulation video was 5 participants (range 3-8). The average length of simulation videos was 10:21 minutes. The simulation educators under study, covered behavioral in 90% of debriefs and cognitive objectives were discussed in all debriefs. Conclusion This is the first study assessing the simulation and debrief facilitation knowledge and skills of a cadre of 701 nurses in a low-resource setting. Simulation was implemented by local nurses at 353 primary healthcare centers in Bihar, India. Primary healthcare centers have the physical infrastructure to conduct simulation training. Some simulation skills such as communication via whiteboard were widely adopted. Advanced skills such as eliciting constructive feedback without judgment require practice.

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Using a mobile nurse mentoring and training program to address a health workforce capacity crisis in Bihar, India: Impact on essential intrapartum and newborn care practices

Cited by 9 publications

References 13 publications

The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey

The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey

Training nurse simulation educators at scale to improve maternal and newborn health: a case study from Bihar, India

Training nurse simulation educators at scale to improve maternal and newborn health: a case study from Bihar, India

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