Simulation and nurse-mentoring in a statewide nurse mentoring program in Bihar, India: diagnosis of postpartum hemorrhage and intrapartum asphyxia

Rakesh Ghosh; Susanna Cohen; Hilary Spindler; Divya Vincent; Mona Sterling; Aritra Das; Aboli Gore; Tanmay Mahapatra; Dilys Walker

doi:10.12688/gatesopenres.13490.1

Simulation and nurse-mentoring in a statewide nurse mentoring program in Bihar, India: diagnosis of postpartum hemorrhage and intrapartum asphyxia

Gates Open Res. 2022 Jun 13:6:70. doi: 10.12688/gatesopenres.13490.1. eCollection 2022.

Authors

Rakesh Ghosh¹, Susanna Cohen², Hilary Spindler¹, Divya Vincent³, Mona Sterling¹, Aritra Das⁴, Aboli Gore⁵, Tanmay Mahapatra⁴, Dilys Walker^{1

6}

Affiliations

¹ Global Health Sciences, University of California, San Francisco, San Francisco, CA, San Francisco, 94158, USA.
² College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
³ Obstetrics and Neonatal, PRONTO India, State RMNCH, AG Colony, Patna, 800025, India.
⁴ Concurrent Monitoring learning and Evaluation, CARE India, 14 Patliputra Colony, Patna, Bihar, 800013, India.
⁵ Capacity Building, CARE India, 14 Patliputra Colony, Patna, Bihar, 800013, India.
⁶ Department of Obstetrics and Gynecology and Reproductive Services, University of California, San Francisco, San Francisco, CA, 94110, USA.

Abstract

Background: Mentoring programs that include simulation, bedside mentoring, and didactic components are becoming increasingly popular to improve quality. These programs are designed with little evidence to inform the optimal composition of mentoring activities that would yield the greatest impact on provider skills and patient outcomes. We examined the association of number of maternal and neonatal emergency simulations performed with the diagnosis of postpartum hemorrhage (PPH) and intrapartum asphyxia in real patients. Methods: We used a prospective cohort and births were compared between- and within-facility over time. Setting included 320 public facilities in the state of Bihar, India May 2015 - 2017. The participants were deliveries and livebirths. The interventions carried out were mobile nurse-mentoring program with simulations, teamwork and communication activities, didactic teaching, demonstrations of clinical procedures and bedside mentoring including conducting deliveries. Nurse mentor pairs visited each facility for one week, covering four facilities over a four-week period, for seven to nine consecutive months. The outcome measures were diagnosis of PPH and intrapartum asphyxia. Results:Relative to the bottom one-third facilities that performed the fewest maternal simulations, facilities in the middle one-third group diagnosed 26% (incidence rate ratio [IRR] = 1.26, 95% confidence interval [CI]: 1.00, 1.59) more cases of PPH in real patients. Similarly, facilities in the middle one-third group, diagnosed 25% (IRR = 1.25, 95% CI: 1.04, 1.50) more cases of intrapartum asphyxia relative to the bottom third group that did the fewest neonatal simulations. Facilities in the top one-third group (i.e., performed the most simulations) did not have a significant difference in diagnosis of both outcomes, relative to the bottom one-third group. Results:Relative to the bottom one-third facilities that performed the fewest maternal simulations, facilities in the middle one-third group diagnosed 26% (incidence rate ratio [IRR] = 1.26, 95% confidence interval [CI]: 1.00, 1.59) more cases of PPH in real patients. Similarly, facilities in the middle one-third group, diagnosed 25% (IRR = 1.25, 95% CI: 1.04, 1.50) more cases of intrapartum asphyxia relative to the bottom third group that did the fewest neonatal simulations. Facilities in the top one-third group (i.e., performed the most simulations) did not have a significant difference in diagnosis of both outcomes, relative to the bottom one-third group. Conclusions: Findings suggest a complex relationship between performing simulations and opportunities for direct practice with patients, and there may be an optimal balance in performing the two that would maximize diagnosis of PPH and intrapartum asphyxia.

Keywords: Mentorship; birth asphyxia; low- and middle-income countries; maternal health; neonatal health; non-vigorous infant.

Grants and funding

This work was supported by the Bill and Melinda Gates Foundation [OPP1112431]. The funding body had no role in study design, data collection, analysis, interpretation, manuscript writing, or the decision to submit the manuscript for publication.