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 Change
Success FactorsChallenges
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 referral
Infection 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 practices
  • Abbreviations: AMTSL, active management of the third stage of labor; MNCH, maternal, newborn, and child health; MO, medical officer; PHC, primary health center.