On-site clinical mentoring as a maternal and new-born care quality improvement method: evidence from a nurse cohort study in Nepal

Abstract

Background: We describe an on-site clinical mentoring program aimed at improving emergency obstetrical and newborn care (EmONC) in Nepal and assess its effectiveness on nurses' knowledge and skills. In Nepal, both the maternal mortality ratio (MMR, 239/100,000 live births) and the neonatal mortality rate (NMR, 21/1000 live births) were among the highest in the world in 2016, despite impressive progress over recent decades considering the challenging environment. Methods: From September 2016 to April 2018, three experienced nurses conducted repeated mentoring visits in 61 comprehensive or basic EmONC centers and birthing centers located in 4 provinces of Nepal. Using updated national training manuals and teaching aids, these clinical mentors assessed and taught 12 core EmONC clinical skills to their nurse-mentees. Clinical mentors worked with management mentors whose goal was to improve the nurses' working environment. We assessed whether the cohort of nurse-mentees performed better as a group and individually performed better at the end of the program than at baseline using relevant tests (chi-square test, Wilcoxon matched-pairs signed-rank test, and Kruskal-Wallis equality-of-population rank test). Results: In total, 308 nurses were assessed, including 96 (31.2%), 77 (25.0%) and 135 (43.8%) who participated in all three, two or only one mentoring session, respectively. In total, 225 (73.0%) worked as auxiliary nurse-midwives (ANMs), while 69 (22.4%) worked as nurses. One hundred and ninety five (63.3%) were trained as skilled birth attendants, of which 45 (23.1%) were nurses, 141 (72.3%) were auxiliaries and 9 (4.6%) had other positions. The proportion of ANMs and nurse-mentees who obtained a knowledge assessment score ≥ 85% increased from 57.8 to 86.1% (p < 0.001). Clinical assessment scores increased significantly for each participant, and therefore for the group. SBA-trained mentees had better knowledge of maternal and newborn care and were better able to perform the 12 core clinical skills throughout the program. Conclusions: Our study suggests that on-site clinical mentoring of nurses coupled with health facility management mentoring can improve nurses' clinical competences in and performance of maternity and newborn care. Assessing evidence of impact on patient safety would be the next stage in evaluating this promising intervention.

Utilisation of quality antenatal, delivery and postnatal care services in Nepal: An analysis of Service Provision Assessment

“…Health staff supervised by a higher authority provided better quality MNH services. Supervision and monitoring of HFs and staff at a lower level can improve the management and capacity for better quality services delivery [ 65 ]. Further, women utilised better technical quality of MNH services from the nursing staff than physicians’ services.…”

“…Studies suggest staff supervision can improve quality MNH services: by improving management functions and improving technical capacity for the delivery of clinical services [ 72 , 73 ]. Supervision and monitoring of HFs and HWs at the peripheral HFs could improve the quality of health services in Nepal [ 65 ]. In Tanzania, a study reported that supervision visits improved health management functions in peripheral HFs and delivered better quality primary health care (PHC) services [ 74 ].…”

Policies and actions to reduce maternal mortality in Nepal: perspectives of key informants

“…On-site clinical mentoring of nurses coupled with health facility management mentoring can improve nurses’ clinical competencies in the performance of maternity care. 64 The provision of selected, trained, and supported community health workers and innovative training and supervision of health workers are identified strategies that can work in difficult to access, rural, mountainous locations. 31 …”

Healthcare Providers' Experiences With a Clinical Mentorship Intervention to Improve Reproductive, Maternal and Newborn Care in Mwanza, Tanzania

“…Under-investment in adequate education and training of healthcare providers (HCPs) is reported worldwide and contributes to the critical shortages, and lack of adequate and essential knowledge and skills (4)(5)(6)(7)(8). The mismatch between HCP educational strategies, health system requirements, and community demand directly affects the quality of RMNH, especially in the sub-Saharan African region (5).…”

“…This calls for a change of strategy in formal educational training and continuous professional development to meet the critical requirement for skilled birth attendants that deliver a high-quality health services through the continuum of RMNH, especially in the underserved areas. Consequently, there is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more result oriented (6)(7)(8)(9)(10)(11).…”