Quality Improvement of the Pre-Service Nursing and Midwifery Education in India

7/23/2019 Quality Improvement of the Pre-Service Nursing and Midwifery Education in India

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Quality Improvement of the

Pre-Service Nursing and

Midwifery Education in

India

Dr Bulbul Sood

Country Director Jhpiego/India

Global Maternal Health Conference,

Arusha, Tanzania,

January 15-17, 2013


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Presentation Outline.

Programmatic approach How strengthening of

PSE for the nursing andmidwifery cadre was

initiated and scaled up

Lessons learned Current GoI strategy


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Goal of strengthening PSE Program

To strengthen the foundation of ANM/GNM education resulting in better

prepared service providers, higher

functioning educational institutions and

ultimately ANMs/GNMs who are

competent, confident and ready to work

upon graduation.


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What is planned.

Long term plan is to build extensive systemsfor supporting effective education of the

midwifery and nursing workforce

TA from MCHIP is catalytic in bringing aboutfundamental change at multiple levels of the

educational system.


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INCs strategic approach for strengthening

the Pre-Service Nursing and Midwifery

Education

Strategic guidanceDesign of intervention

Use of educationalstandardsClinical & pedagogiccourses

Improvement of own centerStructured support to ANMschools

Higher functioningeducationalinstitutions

Competent confidentANMs

TA for

1.Qualityimprovementby use ofeducationalstandards

2.Strengthenthe clinical &trainingskills of the

tutors

Jhpiego identified as the Technical Agency by the INC/GoI


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Program Components

6

Improved

Quality ofPSE

Improved

EducationalProcesses(at the institutions)

ImprovedClinical

Practices

(at the clinicalpractice sites)

StrengthenedCapacity of the

Faculty

(both teaching andclinical skills)

Strengthenedtraining

infrastructure

(Class rooms, skilllabs, IT)

Introductionof internshipfor ANMs


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Development of Performance

Standards

Performance standards foruse by the NNCs/SNCs and

ANMTC/GNM Schools

developed.

Educational Standards Clinical Standards

The standards tell Tutorsand providers not only

what to do

but alsohow to do it

Before starting the 10-days TOT at the NNC/SNC or6-weeks training of the Nursing Tutors it is critical

that the Nursing schools should achieve 60-70%

Educational and clinical standards


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How Performance Standards work??

Empowers teachers at theschools & healthcare workers at

facilities

Establishes a clear goal Shows progress and results

easilywithin and across sites

Generates healthy competition

Creates internal change vs.external monitoring


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Performance Standards Implemented at

NRSCN-Kolkata, CMC-Vellore, CMC-Ludhiana, SCON-Delhi,GCON- Vadodara

10 ANMTCs in Jharkhand, 5 ANMTCs and SNC in Uttarakhand,, 21 ANMTCs,

6 GNM schools & SNC in Bihar.

Sections Areas Number ofStandards

1. Class room and practical instruction 152. Clinical instruction and practice 173. School infrastructure and training

materials 134. School management 165. Clinical site practices 21

TOTAL 82


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Strengthening of National Nodal

Centers

Quality improvement at the NNCs using the SBM-R approach

0%

10%

20%

30%

40%

50%

60%

70%

80%90%

100%

CMC

Vellore

NRSCoN,

Kolkata

St

Stephens

CoN

CMC

Ludhiana

GCoN

Vadodara

Eduactional Standards

BL

1st IA

2nd IA

3rd IA

4th IA

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Clinical Standards

BL

1st IA

2nd IA


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Token of appreciation for the achievement

of the educational standards


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Strengthening Skills Labs

Identification of spacefor the skills lab at NNC

Procurement of modelsand equipment as perINC approved list

Setting up stations- ANC corner Labor corner Newborn corner, PNC corner Family Planning Infection Prevention Special Procedures

12


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Strengthening Skills Lab Stations

13

Labour corner

Infection Preventioncorner

Special skills corner

ANC and PNCcorners

Family PlanningCorner


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ANMTC Library


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Computer Labs, class rooms


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3 Days Clinical Skills Standardization

Training of Labor room staff

All health care providersof MCH area including

nursing tutors are trained

on

AMTSL ENBC NB resuscitation Partograph Infection prevention

practices

ManagingComplications like

Eclampsia and PPH

IPP Before and After Training


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Strengthening of selected ANMTCs

Jharkhand and Uttarakhand

Quality improvement using the performance standards

26%21% 24%

38%45%

85% 88% 88% 85% 86%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Simdega Chaibasa Giridih Ranipokhri Gadarpur

Jharkhand Uttarakhand

Baseline Current Status


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6-weeks training for Nursing Tutors

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Course Description and Evaluation methods

Knowledge: A score of at least 85% on the knowledge assessment.

Skills: Satisfactory performance of clinical skills evaluated by Objective Structured

Clinical Examination (OSCE).

Practice: Demonstrated ability to provide quality services in the clinical setting and

demonstrated good facilitation skills.

Week 1 Week 2 Week 3 & 4 Week 5 Week 6

Effectiveteachin

g &BasicComputer skills

SkilledBirth

Attendance

Clinical

training

IMNCI&

FamilyPlanning

Preventionof RTI,STI/HIV/PPTCT

&Educationalstandards

Evaluation: Knowledge and Skill


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What have we learned so far

Use of educational and clinical standardshave worked at the level of NNC, SNC, GNM

& ANM schools and in different region of the

country 6 weeks trainings of the nursing tutors is

leading to tremendous improvement in the

teaching at the ANM and GNM schools Much needed impetus to nursing education is

empowering the nursing profession


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Current GoI strategy:

To scale up strengthening of PSE for thenursing and midwifery cadre in 10 high

focus states in the country, using the

above programmatic approach with plan tocreate 10 State Nodal Centers

MCHIP to conduct orientation of allstakeholders including donors who areinvesting in PSE NIPI, DFID, UNFPA,

Unicef, WHO


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Acknowledgements

Co-authors Somesh Kumar Rashmi Asif Princy Fernando Pallavi Sinha

USAID supported MCHIP initiative MoH&FW, Government of India Indian Nursing Council


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Every Journey begins with a single

step, But you will never finish if youdont start

Quality Improvement of the Pre-Service Nursing and Midwifery Education in India

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