Background We describe an on-site clinical mentoring program aimed at improving emergency obstetrical and new-born 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 new-born 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 new-born care. Assessing evidence of impact on patient safety would be the next stage in evaluating this promising intervention.

中文翻译：

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现场临床指导作为提高孕产妇和新生儿护理质量的方法：来自尼泊尔护士队列研究的证据。

背景 我们描述了一项旨在改善尼泊尔紧急产科和新生儿护理 (EmONC) 的现场临床指导计划，并评估其对护士知识和技能的有效性。在尼泊尔，2016 年产妇死亡率（MMR，239/100,000 活产婴儿）和新生儿死亡率（NMR，21/1000 活产婴儿）均位居世界前列，尽管近几十年来取得了令人瞩目的进展，考虑到具有挑战性的环境。方法 2016 年 9 月至 2018 年 4 月，3 名经验丰富的护士在尼泊尔 4 个省的 61 个综合或基础 EmONC 中心和分娩中心进行了多次指导访问。这些临床导师使用更新的国家培训手册和教具，向他们的护士学员评估和教授 12 项核心 EmONC 临床技能。临床导师与管理导师合作，他们的目标是改善护士的工作环境。我们使用相关检验（卡方检验、Wilcoxon 配对符号秩检验和 Kruskal-Wallis 等式检验）评估了护士学员队列在项目结束时的整体表现和个体表现是否优于基线人口等级检验）。结果 总共评估了 308 名护士，其中分别参加了全部三个、两个或仅一个辅导课程的 96 人（31.2%）、77 人（25.0%）和 135 人（43.8%）。总共有 225 人 (73.0%) 担任辅助助产士 (ANM)，而 69 人 (22.4%) 担任护士。195人（63.3%）接受过熟练助产士培训，其中护士45人（23.1%），助产141人（72.3%），其他岗位9人（4.6%）。获得知识评估分数 ≥ 85% 的 ANM 和护士指导者的比例从 57.8 增加到 86.1% (p < 0.001)。每个参与者的临床评估分数显着增加，因此对于该组而言。受过 SBA 培训的学员对孕产妇和新生儿护理有更好的了解，并且能够在整个项目中更好地执行 12 项核心临床技能。结论 我们的研究表明，护士的现场临床指导与卫生设施管理指导相结合可以提高护士在产科和新生儿护理方面的临床能力和绩效。评估对患者安全影响的证据将是评估这种有希望的干预措施的下一个阶段。每个参与者的临床评估分数显着增加，因此对于该组而言。受过 SBA 培训的学员对孕产妇和新生儿护理有更好的了解，并且能够在整个项目中更好地执行 12 项核心临床技能。结论 我们的研究表明，护士的现场临床指导与卫生设施管理指导相结合可以提高护士在产科和新生儿护理方面的临床能力和绩效。评估对患者安全影响的证据将是评估这种有希望的干预措施的下一个阶段。每个参与者的临床评估分数显着增加，因此对于该组而言。受过 SBA 培训的学员对孕产妇和新生儿护理有更好的了解，并且能够在整个项目中更好地执行 12 项核心临床技能。结论 我们的研究表明，护士的现场临床指导与卫生设施管理指导相结合可以提高护士在产科和新生儿护理方面的临床能力和绩效。评估对患者安全影响的证据将是评估这种有希望的干预措施的下一个阶段。结论 我们的研究表明，护士的现场临床指导与卫生设施管理指导相结合可以提高护士在产科和新生儿护理方面的临床能力和绩效。评估对患者安全影响的证据将是评估这种有希望的干预措施的下一个阶段。结论 我们的研究表明，护士的现场临床指导与卫生设施管理指导相结合可以提高护士在产科和新生儿护理方面的临床能力和绩效。评估对患者安全影响的证据将是评估这种有希望的干预措施的下一个阶段。