Strengthening Pre-Service Education for Nursing Cadre in Bihar
Conducting a gap analysis in selected nursing institutions in Bihar to enhance pre-service education for nursing and midwifery cadres. The project aims to achieve maximum standards and improve the quality of nursing education for better healthcare outcomes.
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( 1stFeb 1stMay 13 ) Dissertation at JHPIEGO
GAP ANALYSIS IN SELECTED ANMTCS AND DERIVING THE ACTION PLAN TO ACHIEVE THE MAXIMUM STANDARDS TO STRENGTHEN THE PRE SERVICE EDUCATION FOR NURSING AND MIDWIFERY CADRE IN BIHAR Presented By: Nagendra Babu (PG/11/051)
Pre Service Education for strengthening of nursing cadre (PSE): The goal of this project is to improve the quality of pre- service education for the nursing and midwifery cadre in Bihar state. The Bihar state health society is leading the implementation of this program with strategic technical assistance from Jhpiego and in partnership with NIPI. Jhpiego providing technical assistance and mentoring center for the process of strengthening the six general nursing and midwifery schools and 22 ANM training centers in the state of Bihar
Bihar State Map showing ANMTC/GNMTC Schools Study ANMTC s (5 Facilities) West Champaran Sheohar East Champaran Gopalganj Sitamarhi Madhubani Supaul Kishanganj Araria Muzaffarpur Siwan Darbhanga Madhepura Purnia Saran Vaishali Samastipur Saharsa Bhojpur Patna Khagaria Katihar Buxar Begusarai Nalanda Bhagalpur Sheikhpura Munger Arwal Rohtas Jehanabad Lakhisarai Kaimur Nawada Banka Jamui Aurangabad Gaya
Rationale: ANMs and GNMs are the pillars of the primary health care This project which mainly focuses on the improving the quality of the nursing education which in turn produces the competent and skilled midwives Hence the effective implementation of this project is highly essential As the present study gives the detailed present status of selected ANMTCs and provide action plan for improving performance, hence it is essential to conduct the present study
Objectives: GENERAL OBJECTIVE: To assess the gaps between standards achieved and what need to be achieved in selected ANMTC s and deriving the actionable points to achieve the maximum standards to strengthen the pre service education for nursing and midwifery cadre in Bihar
Specific Objectives: To compare the results achieved during base line and 1stinternal assessment of ANMTC s in various sections. To rule out the existing gaps which needs improvement and deriving the action plan for the same. To determine the factors which helped to improve the performance standards of the ANMTC s To develop the clear actionable points for each and every standard which helps to achieve more standards
Methodology: Study Design: Descriptive, Cross - Sectional study. Study area: ANMTC-Bettiah, ANMTC-Gopalganj, ANMTC-Chapra, ANMTC-Motihari and ANMTC Sitamarhi of Bihar. Sample and sample design: Purposive sampling was used. All districts were selected which are under one Jhpiego field officer.
Study Tool The Study Tool: Performance Standards for School of Nursing in Bihar Performance standards =78 Verification criteria for each standard Categorized into 5 sections
Sections No. of Standards in each Sec. no Categories No. of standards 1 Classroom and Practical Instruction 15 2 Clinical Instruction and practice 17 3 School infrastructure and training materials 11 4 School Management 15 5 Clinical areas where student midwives undertake clinical experience 20 Total 78
Data collection and analysis The method used in collection of data included: The observation Interviews with ANMTC teaching staff and healthcare providers of respective dist s Interview with CS and DPM of respective dist s Microsoft Excel was used to analyze the data
Scoring Tool is a summary sheet of scores. The total number of standards was observed. The score % was estimated by = Total number of standards met X100 Total number of standards observed
Study Findings: Analyzed Data Present Status Actionable Points Performance levels Achievements of Comparison in between five Summary of each school Section-IV Section-III Section-V Overall Section-II Section-I schools
Present status of ANM schools 100% Summary of Achievements_Bettiah 90% 80% 70% 60% 50% 37.50% 40% 35.29% 33.33% 30% 22.22% 20% 13.33% 11.76% 6.67% 10% 6.25% 4.94% 0.00% 0.00% 0% Classroom and Practical Instruction Clinical Instruction and practice School School Clinical areas where student midwives undertake clinical experience Overall infrastructure and training materials Management
Summary of Achievements_Chapra 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Classroom and Practical Instruction Clinical Instruction and practice School School Clinical areas where student midwives undertake clinical experience Overall infrastructure and training materials Management
Summary of Achievements_Gopalganj 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Classroom and Practical Instruction Clinical Instruction and practice School School Clinical areas where student midwives undertake clinical experience Overall infrastructure and training materials Management
Summary of Achievements_Motihari 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Summary of Achievements_Sitamarhi 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Base line Assessment Summary 100% 90% 80% 70% 60% Bettiah BL 50% 40% Chapra BL 30% 20% 10% Gopalganj BL 0% Motihari BL Sitamarhi BL
Ist Internal Assessment Summary 100% 90% 80% 70% Bettiah Ist 60% 50% 40% Chapra Ist 30% 20% 10% Gopalganj Ist 0% Motihari Ist Sitamarhi Ist
Overall Performance 100% 90% 80% 70% 60% 51.3% Overall BL 50% 40.7% 38.3% 40% 31% Overall Ist 30% 22.2% 16% 20% 14% 13.50% 11% 10% 5% 0% Bettiah Chapra Gopalganj Motihari Sitamarhi
Recommendations Recruiting the tutors preferably of young age as soon as possible according to eligibility criteria set by INC, as they are motivated and willing to contribute Recruitment of Data operator cum trainer as soon as possible to avoid misusage of installed IT infrastructures in all schools. Advocacy with Civil Surgeon to get procured minimal essential equipment to ensure the effective management of patients
Contd.. The efforts should be focused on maximum utilization of contingency fund of GoB which was provided annually. Recruiting the clinical staff immediately to decrease the work load of existing staff Ensuring continuous supply of PPE equipment and infection prevention material like bleaching powder to maintain standard of preventing infection transmission
For improving Section I: Regular knowledge updates like CSS, SBA, MODCAL etc., Sending tutors for six week training at NNC Kolkata, Developing structured examination system and Developing competency based evaluation system.
For improving Section II: Providing opportunity for students at clinical sites, Developing memorandum of understanding with various clinical sites, Developing MRP & CRP and Distributing skill checklist to every student.
For improving Section III: Class room should be made equipped with sufficient furniture and with AV aid equipment The efforts should be taken at the state level to provide funds for the ANM school, for the procurement of essential infrastructure. Library books and models for skill lab should be procured and supplied to each ANM school
For improving Section IV: Developing student academic performance policy Maintain cumulative record of every student from entry to exit of the school Keep in place of job description of every staff of each cadre of school including class IV employees Staff performance evaluation system should be developed and implemented for appraisal annually
For improving Section V: Procuring the essential infrastructure for provision of better care, Training of the staff on essential things which are highly essential Providing opportunity for the students to practice in the clinical sites. Involving students during clinical duties in some areas to decrease work load of existing staff
CONCLUSION Various areas where gaps exists. Infrastructure, training material, essential equipment and supplies at ANMTC and clinical areas needs an immediate attention. Human resource SHORTAGE in the ANMTCs is affecting not only the teaching but also the clinical Great need of update on teaching methodology and MNCH & FP as teachers were still using the conventional way of teaching. Lack of coordination between clinical area and school staff Infection Prevention practices were not followed at the clinical areas
Strengthening of Nursing and Midwifery Cadre - PSE Project Its NOT just a project.. But .a mission!!
Its a long road ahead... But Challenge is to ensure that every mother counts !!! MDG-5
