Figures & Tables
Figures
- FIGURE 1.
Eight Priority Districts of the Mentoring Intervention, Northern Karnataka, India
- FIGURE 2.
Typical Nurse Mentoring Visit
A nurse mentor (left) in Karnataka, India, explains how to complete and use patient case sheets with staff nurses (right).
A nurse mentor (right) in Karnataka, India, uses a training model to demonstrate newborn resuscitation to staff nurses.
Tables
% Institutional Deliveries % Deliveries in Government Facility 2007–08 2012–13 2007–08 2012–13 Northern Karnataka (8 districts) 50.4 79.9 18.2 43.4 Karnataka state 65.1 89.0 33.0 51.8 Source: Regression analysis of data from the District-Level Household and Facility Survey (DLHS)9 2007-08 and 2012-2013 based on methodology by Somayajulu et al.10
Study Methods Participants Number of Sessions/Participants Purpose Mentor observations Trained mentors • 13 observations
• 11 participants (2 observed twice)Document behaviors of mentors and their interactions with PHC staff Focus group discussions Mentors • 9 focus groups
• 56 participants in groups of 6–8 each (including 18 mentors interviewed more than once)Gather mentor self-assessments and perceptions of the mentoring process and changes in PHCs Individual and small-group interviews PHC medical officers, staff nurses, pharmacists, district health officers • 25 interviews
• 25 participants (1–4 per session)Gather perceptions of the mentoring process and assess mentoring tools and procedures, challenges, successes, and PHC improvements Abbreviation: PHC, primary health center.
- TABLE 3 Key Findings About Nurse Mentoring Program in Northern Karnataka, India, Based on Qualitative Interviews and Observations
Quality of Primary Health Centers:
✓ Areas Improving
X Areas Resistant/Slower to ChangeSuccess Factors Challenges Clinical Practices ✓ Better understanding and use of AMTSL
✓ Diminished use of labor augmentation
✓ Routine administration of vitamin K
✓ Use of radiant warmers for low birth weight newborns
✓ Better understanding of how to handle complications such as newborn resuscitation and postpartum hemorrhage
X Postnatal check-ups at 15-minute intervals difficult to comply with
X Objections by MOs who were not updated with latest clinical guidelines• Rapport and trust between nurse mentors and staff nurses
• Strengthening of nurses’ clinical skills through demonstrations, bedside teaching, case sheet reviews, and case studies• High-volume PHCs require more support than low- or moderate-volume facilities
• More difficult for mentors to engage with busy staff nurses
• Cultural practices that undermine provision of comprehensive care (e.g., arriving in advanced stages of labor, discharge before 48 hours)Availability of Equipment, Drugs, and Supplies ✓ Procurement of needed equipment, drugs, and supplies
✓ Creation of MNCH complication kits
✓ Replacement of damaged equipment
✓ Increased availability of drugs and supplies
X Deficiencies in basic infrastructure harder to address• Quality improvement processes and tools, including team-based assessment and action plans
• Access to government untied funds to procure needed supplies• Absent or inadequate PHC (MO) leadership support discouraged teamwork in a small number of facilities Referral Processes ✓ Improved appropriate identification and pre-referral management
✓ PHCs posted referral directories
✓ Nurses called referral facilities in advance more often
✓ Nurses increasingly tracked referral outcomes
X Automatic referral without prior assessment continued in some instances• Use of case sheets to identify complications requiring referral
• Case reviews and mentor reinforcement of referral guidelines• Understaffed facilities and overworked staff find it hard to perform complete pre-referral management
• Inadequate referral facilities
• Patient and family member resistance to referralInfection Prevention ✓ Improved sterilization practices
✓ Greater cleanliness in labor rooms
X Overall facility cleanliness still deficient
X Deficiencies in basic infrastructure (water, toilets)• Mentor reinforcement of infection prevention
• Demonstration of infection prevention practices with all nurses and cleaners• Cleaning staff resistant to changing practices
• Long time needed to change ingrained attitudes and practicesAbbreviations: AMTSL, active management of the third stage of labor; MNCH, maternal, newborn, and child health; MO, medical officer; PHC, primary health center.
- TABLE 4 Average Monthly Delivery Volume at Primary Health Centers (PHCs) in Eight Districts in Northern Karnataka, 2013
Volume Level Low (0–19 deliveries/month) Moderate (20–39 deliveries/month) High (≥40 deliveries/month) No. (%) of PHCs 298 (77%) 67 (17%) 20 (5%) No. (%) of deliveries 2800 (50%) 1710 (31%) 1060 (19%)
GHSP-D-15-00142 Supplementary Material
Fischer et al. doi: 10.9745/GHSP-D-15-00142
- Supplementary Material - Fischer et al. doi: 10.9745/GHSP-D-15-00142
- Supplementary Material - Fischer et al. doi: 10.9745/GHSP-D-15-00142
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