Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94158, USA.
Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94158, USA.
BMC Pregnancy Childbirth. 2018 Oct 25;18(1):420. doi: 10.1186/s12884-018-2059-8.
Globally, an estimated 275,000 maternal deaths, 2.7 million neonatal deaths, and 2.6 million third trimester stillbirths occurred in 2015. Major improvements could be achieved by providing effective care in low- and middle-income countries, where the majority of these deaths occur. Mentoring programs have become a popular modality to improve knowledge and skills among providers in low-resource settings. Thus, a detailed understanding of interrelated factors affecting care provision and mentorship is necessary both to improve the quality of care and to maximize the impact of mentoring programs.
In partnership with the Government of Bihar, CARE India and PRONTO International implemented simulation-enhanced mentoring in 320 primary health clinics (PHC) across the state of Bihar, India from 2015 to 2017, within the context of the AMANAT mobile nurse mentoring program. Between June and August 2016, we conducted semi-structured interviews with 20 AMANAT nurse mentors to explore barriers and facilitators to optimal care provision and to implementation of simulation-enhanced mentorship in PHCs in Bihar. Data were analyzed using the thematic content approach.
Mentors identified numerous factors affecting care provision and mentorship, many of which were interdependent. Such barriers included human resource shortages, nurse-nurse hierarchy, distance between labor and training rooms, cultural norms, and low skill level and resistance to change among mentees. In contrast, physical resource shortages, doctor-nurse hierarchy, corruption, and violence against providers posed barriers to care provision alone. Facilitators included improved skills and confidence among providers, inclusion of doctors in training, increased training frequency, establishment of strong mentor-mentee relationships, administrative support, and nursing supervision and feedback.
This study has identified many interrelated factors affecting care provision and mentorship in Bihar. The mentoring program was not designed to address several barriers, including resource shortages, facility infrastructure, corruption, and cultural norms. These require government support, community awareness, and other systemic changes. Programs may be adapted to address some barriers beyond knowledge and skill deficiencies, notably hierarchy, violence against providers, and certain cultural taboos. An in-depth understanding of barriers and facilitators is essential to enable the design of targeted interventions to improve maternal and neonatal survival in Bihar and related contexts.
全球范围内，2015 年有 27.5 万名产妇死亡、270 万新生儿死亡和 260 万妊娠晚期死产。在这些死亡案例主要发生的中低收入国家，如果能提供有效的护理，就有可能大大改善这种情况。导师制已经成为一种在资源匮乏环境中提高医疗服务提供者知识和技能的流行模式。因此，深入了解影响护理提供和导师制的相关因素，不仅对于提高护理质量，而且对于最大限度地发挥导师制的影响都是必要的。
2015 年至 2017 年，CARE 印度和 PRONTO 国际与比哈尔邦政府合作，在 AMANAT 移动护士导师制的背景下，在印度比哈尔邦的 320 个初级卫生保健诊所（PHC）实施了模拟强化导师制。2016 年 6 月至 8 月，我们对半结构化访谈了 20 名 AMANAT 护士导师，以探讨影响最佳护理提供和比哈尔邦 PHC 中模拟强化导师制实施的障碍和促进因素。数据采用主题内容分析法进行分析。
导师们确定了许多影响护理提供和导师制的因素，其中许多因素是相互依存的。这些障碍包括人力资源短缺、护士-护士等级制度、产房与培训室之间的距离、文化规范以及学员的技能水平低和抵制变革。相比之下，仅在提供护理方面，物理资源短缺、医生-护士等级制度、腐败和对提供者的暴力行为就构成了障碍。促进因素包括提供者技能和信心的提高、医生参与培训、增加培训频率、建立牢固的导师-学员关系、行政支持以及护理监督和反馈。
本研究确定了影响比哈尔邦护理提供和导师制的许多相互关联的因素。导师制计划并没有设计来解决一些障碍，包括资源短缺、设施基础设施、腐败和文化规范。这些障碍需要政府支持、社区意识和其他系统变革。可以调整方案以解决一些知识和技能缺陷以外的障碍，特别是等级制度、对提供者的暴力行为和某些文化禁忌。深入了解障碍和促进因素对于能够设计有针对性的干预措施以提高比哈尔邦和相关背景下的母婴生存至关重要。
