Essential Newborn Care at 24/7 PHCs
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Essential Newborn
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SUKSHEMA
Facilitator's Manual
Volume: 3
Part D
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Essential Newborn
Care at 24/7 PHCs
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Karnataka Health Promotion Trust
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SUKSHEMA
Nurse Mentors
Training Program
Essential Newborn Care at 24/7
Primary Health Centers
Sukshema
Maternal, Neonatal a
SOCHARA
Community Health
Library and Information Centre (CLIC)
Community Health Cell
85/2,1st Main, Maruthi Nagar,
Madiwala, Bengaluru - 560 068.
Tel: 080-25531518
email: clic@sochara.org / chc@sochara.org
www.sochara.org
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Essential Newborn Care at 24/7 Primary Health Centres
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An overview of the On - Site mentoring intervention to institutionalize quality improvement
strategy within 24/7 Primary Health Care centers in Karnataka state. The philosophy, design,
The philosophy, design, implementation process and results are detailed herein.
Copyrights
: Karnataka Health Promotion Trust and St John's National Academy of
Health Sciences
Year of Printing : 2014
Publisher’
: Karnataka Health Promotion Trust
IT Park, 5th Floor
# 1-4, Rajajinagar Industrial Area
Behind KSSIDC Administrative Office
Rajajinagar, Bangalore- 560 044
Karnataka, India
Phone:91-80-40400200
Fax:91-80-40400300
www.khpt.org
This process document is published with the supportfrom the Bill & Melinda Gates Foundation under
Project Sukshema. The views expressed herein do not necessarily reflect those ofthe Foundation.
Part 3: Essential Newborn Care
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Government of Karnataka
Department of Health and Family Welfare
National Health Mission
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PREFACE
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Institutional deliveries in Karnataka have risen over recent years due to the efforts by the state.health
directorate which wer„e strongly complemented by various innovations and schemes implemented under
the National Rural Health Mission (NRHM) such as Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha
Karyakram (JSSK), ASHA support, 108 ambulance services, etc. There has been a reduction in maternal and
newborn mortality rates (MMR, NMR), but not enough to achieve the proposed state targets. With over
80% of pregnant women now delivering in facilities, it is critical that these deliveries are conducted as per
the highest standards for quality of care. To accommodate this rising demand, government had prioritized
upgradation of Primary Health Centres into 24/7 facilities to provide delivery services in rural areas and
reduce the burden on district and larger hospitals enabling them to function more appropriately as first
referral units (FRU) to provide emergency care. To achieve good quality of services provided in public
health facilities it is important that the service providers working at these facilities are proficient in skills
and practices that are appropriate particularly with reference to pregnant women, mothers and newborns. To facilitate this, the need for dedicated teams to improve and monitor quality is crucial.
As a part of technical assistance to NRHM, Karnataka Health Promotion Trust and its consortium of
partners developed an innovative nurse mentor led quality improvement program after detailed situation
assessment and consultations with government. It was pilot tested in Bellary and Gulbarga during 20122013 where trained Nurse Mentors, worked with. 24/7 primary healthx.entres-(PHCs) .staff to Jrppxo^e Jthe..^
quality of delivery and postpartum care. The mentoring programme integrated elements of clinical
mentoring with facility-based quality improvement processes. Another critical component of the
intervention was the use of revised case sheets by the staff that helped them in multiple ways, i.e. as job aid
to adhere to standard practices, as a simple case documentation tool and as a tool to monitor and audit
quality of care. The intervention results showed marked improvements in facility readiness and provider
preparedness to deal with institutional deliveries and associated complications. Subsequently the
program was scaled up in the remaining high priority districts of northern Karnataka and further taken up
both within and outside the country.
As a part of this intervention, several technical products and training material were developed; they consist
of 1) process documentation of the intervention that details the process of planning, implementing and
monitoring the mentoring program, 2) Facilitator/ Trainer and Participant manuals. These materials have
"as annexures within them, various tools including the case sheets that were implemented under 'this
initiative. We sincerely hope that these resources will be found useful by program managers in terms of
gaining an in-depth understanding of the intervention and replicating it in their respective contexts.
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Sri. Atul Kumar Tiwari, IAS
Principal Secretary,
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Essential Newborn Care
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SUKSHEMA Nurse Mentors Training Program Volume 3
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Contents
Acknowledgments
v
About the Manual
vi
Abbreviations
viii
Glossary of Terminology
xi
Week 3 Essential Newborn Care
1
Methods used forTraining
2
Introduction to Newborn Curriculum
5
Session 1.
Classification of Newborns
6
Session 2:
Care of a Normal Newborn at Birth till First Hour of Life
9
Session 3:
Newborn Care - Immediately after Birth
10
Session 4:
Newborn Resuscitation
17
Session 5:
Preparation of Newborn Corner
19
Session 6:
Breast Feeding
22
Session 7:
Thermal Control of a Newborn
30
Session 8:
Kangaroo Mother Care
33
Session 9:
Care of Newborn from 1 hour of Birth till Discharge including Discharge Counselling
35
Session 10:
Danger Signs and Common Problems of Newborns
41
Session 11:
Care of Low Birth Weight Newborn
45
Session 12:
Referral and Transport of a Sick Newborn
46
Rapid clinical assessment
48
Log book for use during newborn clinical posting
83
Part 3: Essential Newborn Care
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Acknowledgements
The authors appreciate the support provided by numerous individuals over an extended period of time to allow
documentation of this important innovation. Special thanks to Dr B.M. Ramesh, former Project Director of Sukshema
Project, for recognizing the importance of documenting the mentoring programme so others can learn from
this activity and for the guidance provided throughout. Thanks to Anna Schurmann for helping to structure the
project's knowledge management strategy and to Baneen Karachiwala who provided independent observation and
interviews of the first mentor training. The dedication of project staff—including several Bangalore-based technical
leaders, support staff, and district programme specialists who coordinated numerous field visits to several districts—
ensured high-quality observations at primary health centres and insightful interviews with those implementing
the intervention. These staff include Dr Swaroop, Dr Mahantesh, Dr Seema, Dr B. Pavan, Dr Nazia Shekhaji, and
Laxshmi C. We thank the team from St John's Research Institute that included Dr Prem Mony, Maryann Washington,
Dr Annamma Thomas, Dr Swarnarekha Bhat, Dr Suman Rao and other consultants for their support in the trainings
and handholding visits and for sharing their experiences that have informed the process document. We appreciate
the support of clinical consultants from University of Manitoba, Lisa Avery and Maryanne Crockett for their support
during the design of the program. We also acknowledge the efforts of DrSudarshan and Dr Nagarajfrom Karuna Trust
for their support to the implementation of the program. Appreciation is extended to Arin Kar, Deputy Director of
Monitoring and Evaluation, for providing data support and to H.L. Mohan, Director of Community Interventions and
Somshekar Hawaldhar, Deputy Director of the community intervention component for contributing to the discussion
on program coordination. Special appreciation is also due to the nurse mentors for their enthusiastic participation
in Interviews and focus groups,"and for facilitating the ability to observe their work in action. We thank the many
primary health centre staff and district government officials who met with us to share their candid views about the
mentoring programme. Finally, we thank Stephen Moses, Professor and Head of Community Health Sciences of Dr
James Blanchard, Director, Centre for Global Public Health, University of Manitoba for their valuable reviews and
inputs.
The funding support for development of this manual was provided by Bill and Melinda Gates Foundation.
The following institutions and individuals have contributed to development of volume 3 of the SUKSHEMA
Facilitator's Manual.
Karnataka Health Promotion Trust (KHPT)
St John's National Academy of Health Sciences (SJNAHS)
University of Manitoba (UoM)
Dr LTroy Cunningham, KHPT
Ms N Gayathri, SJNAHS
Mrs Janet Bradley, UoM
Dr Reynold Washington, KHPT/UoM
Dr John Stephen SJNAHS
Dr Lisa Avery, UoM
Ms Maryann Washington, SJNAHS
Dr B M Ramesh, KHPT/UoM
Dr Sanjiv Lewin SJNAHS
Mr Arin Kar, KHPT
Dr K Karthikeyan, Independent Consultant
Mohan H L, KHPT/UoM
Dr Manoharan, Independent Consultant
Dr Swaroop N, KHPT
Dr Savitha Kamalesh, SJNAHS
Dr Krishnamurthy, KHPT/UoM
SUKSHEMA Nurse Mentors Training Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
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About the Manual
The Sukshema project aims at providing technical support to National Rural Health Mission of Karnataka
to improve the maternal, newborn and child health (MNCH) outcomes in Karnataka with a focus on eight
districts of northern Karnataka. As a part of the project, several interventions are implemented at facility,
community and health systems level to improve the availability, accessibility, quality, utilization and
coverage of critical MNCH services. One of the interventions is onsite mentoring to 24/7 PHCs to improve
the quality of delivery and postpartum care with the help of a new cadre of nurse mentors. Being a new
cadre, the project designed a training program and manuals for training this cadre. The nurse mentors are
expected to be proficient in clinical skills related to delivery and postpartum care and also have the right
attitudes and abilities to provide mentorship to the PHC staff. They will be responsible for onsite, on the
job coaching and facilitating change in provider practices that will ensure better quality care for mothers
and newborns. The purpose of this manual is to guide the MNCH mentors of the Sukshema project in how
to assist health care providers at primary health care centers (PHCs) to improve the quality of labour and
delivery, postpartum and newborn care services.This manual is used by participants during initial training
and also as a guide during mentoring activities in the field.
This manual is divided into 3 volumes.
Volume 1 - Volume 1 has two sections.
Section A - Quality Improvement Principles and Approaches
This section introduces the context of MNCH mentoring intervention in the Sukshema Project, Karnataka,
principles of quality improvement, Sukshema's quality improvement approach and tools, and their use at
various levels, qualities of an MNCH mentor, and mentor responsibilities.
Section B - PHC Systems Strengthening
This section contains technical information related to systems strengthening in PHCs and covers infection
prevention, referral system strengthening and supply chain management.
Volume I appendix include various tools and reporting formats that the MNCH mentors use to plan,
implement and report on their PHC visit activities.
Volume 2 - Skilled Birth Attendance during Labour, Delivery and Postnatal Periods at 24/7 PHCs
This volume contains information related to clinical knowledge and skills required to provide quality care
during labour, delivery and postnatal period at 24/7 primary health centers.The section covers both provision
of routine delivery and postnatal care as well as identification, management and referral of most common
maternal complications during these periods.
Part 3: Essential Newborn Care
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Volume 3 - Essential Newborn Care at 24/7 PHCs
This volume contains information related to clinical knowledge and skills required to provide quality care
during the early neonatal period at primary health centers. The section covers both provision of routine
newborn care as well as identification, management and referral of most common newborn complications.
Though this manual is divided into three volumes for the convenience of readers, each volume has links and
cross references with the others. It is highly recommended that the mentors consult all three volumes when
preparing for a mentoring visit and also have them available for ready reference during a mentoring visit.
In the first volume of the manual we introduce the A.M.M.A approach to quality improvement. A.M.M.A
approach refers to assess (A), manage (M), measure (M) and advocate (A) for continuous quality improvement
and has at its core, the key principles of client and provider rights, self assessment and team building, and
mentoring. This approach can be used at several levels to improve PHC linkages with the community, to
address PHC level problems, to improve individual provider's knowledge and skills and to improve PHC
linkages with the wider health system.
SUKSHEMA Nurse Mentors Training Program Volume 3
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Abbreviations
ABO
Blood groups A, B, O
coc
Combined oral contraceptive
A.M.M.A
Assessing and diagnosing,
CPD
Cephalopelvic disproportion
managing, measuring and
CVS
Cardiovascular system
DBF
Direct breast feeding
DDK
Disposable delivery kit
DHO
District health officer
DMPA
Depot medroxyprogesterone
advocating
Active management of the third
AMTSL
stage of labour
ANC
Antenatal care
ANM
Auxiliary nurse midwife
APH
Antepartum hemorrhage
DNS
Dextrose normal saline
ASHA
Accredited social health activist
DPS
District programme specialist
acetate
ART
-
Antiretroviral therapy
EBM
-
Expressed breast milk
AWW
-
Anganwadi worker
ECP
-
Emergency contraceptive pill
AZT
Zidovudine
EDD
-
Expected date of delivery
BCC
Behaviour change communication
FEFO
-
First expired, first out
BEmONC
Basic emergency obstetric and
FHR
Fetal heart rate
neonatal care
FHS
Fetal heart sound
BM
Breast milk
FIFO
First in, first out
BMV
Bag and mask ventilation
FRU
First referral unit
BPL
Below poverty line
FS
Female sterilisation
CBO
Community-based organisation
Gol
Government of India
CCT
Controlled cord traction
H/O
History of
CEmONC
Comprehensive emergency
Hb
Haemoglobin
obstetric and neonatal care
HBV
Hepatitis B virus
CMC
Community health centre
HCP
Health care providers
CBMWTF
Common bio-medical waste
Hg
Mercury
treatment facilities
HBsAg
Hepatitis B surface antigen
Chief medical officer
HCG
Human chorionic gonadotrophin
CMO
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7 -Hydj
HIV
Human immuno deficiency virus
HLD
High level disinfection
HMIS
Health management information
MoWCD
Ministry of Women and Child
Development
MPHW
Multipurpose health worker
system
MRP
Manual removal of placenta
HR
Heart rate
MTP
Medical termination of pregnancy
H2O
Water
MVA
Manual vacuum aspiration
IM
Intramuscular
NFHS
National Family Health Survey
Inj
Injection
NGO
Non-governmental organisation
IV
Intravenous
NRHM
National Rural Health Mission
ICTC
Integrated counselling and testing
centre
NS
Normal saline
NSSK
Navjaat Shishu Suraksha
Karyakram
IFA
Iron and folic acid (supplements)
IMNCI
Integrated management of
NSV
No-scalpel vasectomy
neonatal and childhood illness
PEP
Post-exposure prophylaxis
IUCD
Intrauterine contraceptive device
PHC
Primary health centre
IUD
Intrauterine deat
PIH
Pregnancy induced hypertension
IUGR
Intrauterine growth retardation
PIP
Project implementation plan
JSY
Janani Suraksha Yojana
PNC
Postnatal check-up
JHFA
Junior health female assistant
POC
Products of conception
KMC
Kangaroo mother care
PPE
Personal protective equipment
LAM
Lactational amenorrhea method
PPH
Postpartum hemorrhage
LBW
Low birth weight
PPTCT
Prevention of parent-to-child
LHV
Lady health visitor
LMP
Last menstrual period
MgSO4
Magnesium sulfate
MM
MNCH mentor
MMR
Maternal mortality ratio
MNCH
Maternal neonatal and child health
MO
Medical officer
MoHFW
Ministry of Health and Family
transmission
PPV
Positive pressure ventilation
PRI
Panchayati Raj Institution
PROM
Premature or pre-labour rupture of
membranes
P/A
Per abdomen
P/S
Per speculum
P/V
Per vaginum
QI
Quality improvement
RCH
Reproductive and child health
Welfare
SUKSHEMA Nurse Mentors Training Program Volume 3
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RDK
Rapid diagnostic kit
STI
Sexually transmitted infection
Rh
Rhesus factor
TBA
Traditional birth attendant
RL
Ringer lactate
TT
Tetanus toxoid
RPR
Rapid plasma reagin
UTI
Urinary tract infection
RR
Respiratory rate
VDRL
Venereal Disease Research
RTI
Reproductive tract infection
SBA
Skilled birth attendant
SC
Sub-centre
SDM
Standard days method
SN
Staff nurse
Laboratory
VHND
Village health and nutrition day
WBC
White blood cell
WHO
World Health Organization
3TC
Lamivudine
Units of measurement
- At the rate of - to measure speed
Kg
- Kilogram - to measure weight
%
- Percent - to compare anything to 100
L
- Litre to measure volume
°C
- Degree Celsius-fortemperature
lb
- Pound to measure pressure
cc
- Cubic centimetre - to measure volume
mcg
- Microgram to measure weight
cm
- Centimetre - to measure length
mg
- Milligram to measure weight
dl
Decilitre - to measure volume
min
- Minute
ml
- Millilitre to measure volume
mm
- Millimetre to measure length
°F
- Degree Fahrenheit - for temperature
gm - Gram - to measure weight
hrs
Hours - to measure time
mmHg - Millimetreof mercury to measure BP
IU
International units - to measure dose
secs
- Seconds
U
- Units to measure dose
KCal - Kilocalories-to measure energy produced
Part 3: Essential Newborn Care
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Glossary of Terminology:
Abortion: Termination of pregnancy by the removal or expulsion of a foetus or embryo from the uterus
before 20 weeks of pregnancy
Abscess: A localized collection of pus in any part of the body, with pain and redness.
Amniotic fluid: Fluid present in the uterus during pregnancy which protects the fetal inside
Amnionitis: Infection of the protective lining around the baby (amnion or inner lining);
occurs in PROM
Anaemia: Condition caused by low hemoglobin in blood
ANC: Check up done during pregnancy to determine the condition of the woman and fetus
APGAR: The APGAR score indicates the newborn's well-being. It will be calculated at 1 minute and at
5 minutes after birth. An APGAR score of more than 7 is considered satisfactory. Less than 7 APGAR babies
need referral to a higher centre for further management
APH: Bleeding in pregnancy (before delivery^
Asphyxia: Condition in a newborn due to severely deficient supply of oxygen to the body when the
baby is unable to breathe normally
Atonic: Lack of muscle tone; loose or soft
Assisted deliveries: Vaginal delivery when the baby's delivery has to be assisted/helped out by using
forceps or vacuum extraction applied to the baby's head
Blurred vision: Unclear or hazy vision, associated with high blood pressure, weakness
Breech presentation: When the buttocks of the fetus are in the lower area of the uterus
Chorioamnionitis: Infection of the protective lining around the fetus (amnion or inner lining and
chorion or outer lining); occurs in premature rupture of membranes (PROM)
Clammy skin: When the skin is cool, moist, and pale. Sign of emergency such as shock, dehydration
CRD: Size or space of pelvis is narrow and does not allow baby to pass through
CVS: System related to heart and circulatory system
Diastolic blood pressure: Lower reading of blood pressure
Depressed/depression: Sadness, no interest in surroundings; may be seen in postnatal period
SUKSHEMA Nurse Mentors Training Program Volume 3
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DMPA: Injectable contraceptive whose action lasts for 6 months
ECP: To be taken by a woman within 72 hours of unprotected, unplanned sexual contact to prevent a
pregnancy
Effacement: Thinning of cervix at the time of labour
Endometritis: Infection of uterus; after PROM, repeated per vaginal (PV examination, unsterile
conditions, after abortion/ MTP done in unsterile conditions
Engorgement: Filling up/ swelling
Flank pain: Pain in the side of the abdomen below the ribs
Fluctuant: Moving
Floppy: Poor muscle tone, limp
Fetal: Developing unborn baby inside the uterus
Fetal distress: Condition when the fetus is having some problem inside the uterus; detected by
abnormal heart rate (FHR more than 160/min or less than 120/min), or irregular FHR
Fundal height: Height of the uterus which increases with pregnancy and decreases after delivery;
measuring the upper border of the uterus and comparing with the standard in weeks of pregnancy gives
the approximate duration of pregnancy
Gestation: Pregnancy / the period of development of the fetus in the uterus from conception until birth
Gestational age: Age of an embryo or fetus; calculated in weeks
Gravidity/gravid:The number of times the woman has been pregnant
Icterus: Jaundice or yellowish discolouration of sclera (white part of eye) in adult or skin in newborn
Infant: Baby from one month after birth to oneyear of age
IUGR: Inadequate/ slow growth of a fetus inside the uterus
Jerky movement: Fast movements which are not controlled and that have no purpose. Seen in fits
KMC: Care given to small baby by placing over the chest of mother/parent to provide extra warmth to
the baby
LAM: Used as a traditional temporary method of contraception, when a woman does not have her
monthly periods due to breast feeding
Latent: Developing or present but not visible
LBW: When the baby weight is below 2500gms (standard weight)
Lump: A localised swelling; may be hard or soft
Part 3: Essential Newborn Care
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Lochia: Discharge from the vagina from delivery up to a week
Liquor: Same as amniotic fluid
LMP: First day of last menstrual period a woman had before pregnancy, used to calculate EDD
Madilu kit: This is a postnatal kit given to mothers after delivery under a government scheme for
postnatal care of mother and baby
Mastitis: Infection of breast; seen as pain and redness
Meconium: Yellow or green coloured stools passed by the fetal inside uterus or by newborn at birth
MRP: Done by removing the placenta by hand in condition of retained placenta
Murmur: An abnormal sound of the heart
MVA: Method of performing MTP where suction is created by a manual pump to remove contents in
uterus
Misoprostol: Drug used to cause contraction of uterus and thereby prevent or treat postpartum
hemorrhage; available as tablets of 200mcg; not given to women with asthma
Magnesium sulfate: An anti-convulsant drug used for preventing/treating eclampsia/severe
pre eclampsia without causing sedation in mother or baby
Monitoring: Observe aTid check the progress or quality over a period of time
Nasal flaring: An increase in nostril size due to any difficulty in breathing
Newborn: A recently born baby
Obstetric: Related to pregnancy
Obstructed: Blocked; unable to come out
Oedema: Swelling due to accumulation of water
Outcome: End result
Pallor: Lack of colour especially in the face; seen in anaemia and long standing diseases
Parity/Para: Total number of deliveries and abortions a woman has had till present pregnancy
Pelvis: Cavity formed by joining together of the two hip bones and sacrum; contains, protects, and
supports the intestines, bladder, and internal reproductive organs
Perineum: Area around vagina and the anus in females
PIH: Increased blood pressure (more than 140/90 mmHg) without proteinuria in a woman after 20 weeks
gestation
Preterm: Pregnancy less than 37 completed weeks gestation
SUKSHEMA Nurse Mentors Training Program Volume 3
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Pre-referral management: Activities carried out to stabilise the complicated cases before referring
to a higher centre
Presentation: That part of the fetal lying over the pelvic inlet which would be first to come out at
delivery
P/S: Using the speculum to view the vagina and cervix
P/V: Vaginal examination
Prolonged: Long duration/delayed
PROM: Rupture of membranes (bag of waters) before labour has begun; can be before 37weeks -
premature or before delivery - term or mature
Puerperal: The period immediately after delivery to 42 days
Purulent: Containing pus
Pustule: A small boil over skin filled with pus; a pimple
Retained: To hold in a particular place; not coming out
RPR: A newer blood test to screen routinely for syphilis in pregnant women
RR: Rate of breathing in one minute
Respiratory distress: Condition in which patients are not able to breathe properly and get enough
oxygen
SBA: Person (doctor, nurse, ANM) trained in pregnancy, delivery, postnatal and newborn care
SDM: Used as a traditional temporary method of contraception where a woman tracks the days of her
menstrual cycle and avoids unprotected sexual contact on fertile days of the cycle
Sepsis: Condition where infection from any site spreads throughout the body
Seizures: Convulsions, fits
Spontaneous: Without any effort or natural
Sterilization: A procedure to make free from live bacteria, virus or other microorganisms, used for
cleaning needles and surgical instruments
Stillbirth: Birth of a dead fetus anytime after the completion of 20 weeks of gestation.
Syphilis: A sexually transmitted disease which in pregnancy may cause congenital defects in the fetus
Systolic blood pressure: The upper level of blood pressure
Tender/tenderness: Pain felt if touched
Term: State of pregnancy which has completed 37 weeks
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Transverse: Lying across
Traction: Pulling force
Tubectomy: It is a female sterilization procedure where a part of the fallopian tubes is cut. It is a
permanent method of female sterilization
Umbilicus: A scar where an umbilical cord was attached
Unconsciousness: Person not responding to calls, stimulus
Uterine massage: Gently rubbing the uterus after the delivery of placenta to help the uterus contract
and become hard
Uterine tone: Tightness of uterine muscles
Vasectomy: A surgical procedure performed on males in which the vas deferens (male tubes) are cut. It
is a permanent method of male sterilization
VDRL: Blood test done routinely for syphilis in pregnant women; similar to RPR test
Vertex: Normal presentation of the fetus in which the head lies at the opening of the uterus
Voiding: Emptying the urinary bladder
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The training is aimed at increasing knowledge and skills in basic early and
late neonatal care to enable them to be effective mentors in the provision
of quality neonatal care along its continuum by staff nurses in PHC It is
designed such that all mentors will have integrated theory and practical
sessions and 1 hour recap during each day. In addition mentors will have
to do two night duties in neonatal ICU and OB area respectively to get
relevant practical experience that is recorded in a log book for the same
purpose.
II
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Hours: Theory: 27 hours; Practical in Wards: 48 hours
■ Objectives
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end of the course, participants will be able to
■ By the
❖ Comprehend essentials of basic neonatal immediate and newborn
❖
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❖
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care
Demonstrate skill in essential newborn care and basic neonatal
resuscitation
Recognise, assess and provide immediate management for neonatal
complications
Demonstrate competence in all basic procedures for immediate and
normal newborn care
Use checklists / appropriate tools to supervise, audit staff in
provision of early and late newborn care
to
1.
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Methods used for Training
Several participatory methods will be used for training. This is necessary since all participants are adults
and thus following the principles of learning, it will be experiential and thus presumably more permanent.
Method
Case Scenarios/
Case studies
What is it
When to use
Other important points
Participants study
To encourage
The situation presented in the
briefly a situation
participants to apply
case scenarios is comparable to
that either describes
their knowledge
one experience by participants.
a problem and then
and skills to similar
Details in the scenario will
develops possible steps
to problems and
be just enough to enable
to solve the problem
Participants discuss
related issues that arise
situations that they may
participants to recommend
encounter on the job or
solutions/discuss related issues
elsewhere
or actions
Generally case scenarios
from the case scenario
are more extensive than
hypothetical situations and
raise more issues. Give enough
time to facilitate as much
discussion as possible within the
predetermined objectives
Demonstration
Facilitator demonstrated To improve the skills or
the steps of a procedure
competencies
This method follows the
principle - learning by doing is
in an artificial
more permanent. A major part
situation, to familiarise
of the training is dependent
participants with it.
on demonstration of how to
do certain procedures on the
mother, new born or how to
document information on the
case sheets. It is important that
time is given to participants
to practice the same so that
they are confident in doing the
procedure especially if it is a new
skill. Checklists could be used to
assist them to monitor their own
progress.
SUKSHEMA Nurse Mentors Training Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
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_____________________________________
Discussion
Facilitators exchange
ideas for the purpose of
reaching a specified set
of objectives
To increase knowledge
This method could be most
useful if predetermined
To improve
communication skills
To test progress towards
learning objectives
objectives are made. It could
allow the participants to
openly express their opinions
on a subject as well as listen
to the opinions of others thus
facilitating learning through
exchange of ideas
This method is one of the
commonest methods used in
training.
It is important to ensure that
all participants take part in the
discussion. This is best done
by dividing the whole lot into
smallergroups.
Mini lecture /
Facilitator speaks to a
“o increase knowledge
Mini lectures are an efficient
presentation
group from prepared
and to convey
way to deliver information. The
notes or using slides
information, facts or
biggest disadvantage of this
.concepts,.
method is that communications
is usually one way - flowing
from the facilitator to the
participants.
The participation of the
participants is limited. It is
used when a new concept is
introduced to the participants.
Question
Facilitator prepared
To increase the
This is an efficient way to
answer session
questions pertaining
participants
encourage self-learning and
/brainstorming
to a topic; then asks
introspections and
participation. It helps to generate
/quiz
questions in a series to
internal inquiry
ideas quickly and fluidly while
the participants in order
to reach the predefined
objectives
permitting freedom to express
To increase the
participants ability to
collect information
through analysis
any idea or thought. It could have
a snowball effect as one person's
thought may help another
person's thought process and
thus increase learning.
It is important to pay attention
to every response of participants
as this will encourage their
participation
Part 3: Essential Newborn Care
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Role plays
This is a simulation
To increase one's own
It allows participants to practice
technique and involves
awareness of one's
and thus think about situations
participants to imitate
thought processes
even before they encounter such
or act out a situation
situations in real life. It could
To encourage
participants to apply
their knowledge and
skills to problems
like those they may
encounter in the real life
be interesting to participants.
It may take time and thus clear
guidelines must be given to
participants of what is expected
of them (preferably a day before
the role play is to be enacted)
To sensitise participants
and how much time is allotted
to issues that they may
for the role play. It is best if
be uncomfortable to
feedback is taken from the
address
participants who enacted as well
as from those who observed the
To provide an
role play on what worked well
opportunity for
and what could be improved.
participants to practice
how they would
communicate on the
job to the patients
videos
-
• •
Facilitator-uses videos
To sensitise participants
It is an efficient way to get
to help participants
on issues / demonstrate
participants to reflect on
comprehend a concept
procedures that are best concepts that seem abstract or
difficult to comprehend or to
learnt by seeing and
I procedure better
hearing
reinforce steps of a procedure
that is vital.
It is important to check for
sound and need for other
equipment such as DVD player,
speakers, etc to be effective
It is also important to be familiar
with the video for it to be used
efficiently.
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SUKSHEMA Nurse MentorsTraining Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
——
I
Introduction to Newborn Curriculum
Materials: Flip chart, marker pens
Session Time: 20minutes
Training methods: lecture, discussion
Session Objectives:
By the end of the session the participants should be able to
❖ Get acquainted with the learning objectives for the week
❖ Aware of the clinical requirements that have to fulfilled during the week
❖ Identify what steps they would take to achieve the objectives
Teaching steps
Duration
1. Highlight the topic and session objectives
Introduction
2. Introduce the participants to the neonatal health care team
and orient them to clinical setting
*
•”
10 minutes
3. Show them the requirements to be completed during the
posting to respective areas, and discuss how they could
achieve the requirements
Materials used
4. Show them the materials that will be used as resources for
them during the training
5 minutes
5. Reinforce they continue to follow ground rules.
Summarize
6. Reinforce the focus of Sukshema is on improving quality of
care during the early neonatal period and emphasise on their
role in ensuring mentoring staff nurses in delivery of care
during these crucial periods and supporting them.
S •
Part 3: Essential Newborn Care
5 minutes
——-
—
—
11 Classification of Newborns
Materials:
PPTs-Pictures for GA, Weighing machine clean/sterile towels, baby doll or mannequin,
case scenarios for discussion, SBA guidelines and mentors manual (Volume 3)
Session time: SOminutes
Training methods: Discussion, demonstration
Session Objectives:
By the end of the session the participants will be able to:
❖ Recall how to classify a newborn by gestational age (history) / ultrasound report or physical
characteristics or by birth weight.
Demonstrate how to classify newborn by gestational age, weight or physical features.
❖ Demonstrate accurate documentation of gestational age of newborn.
❖ Demonstrate mentoring skills for classification of newborn.
Teaching steps
Duration
1. Introduce the topic and session objectives (slide 1-2).
2. Explain why it is important to classify newborns at birth (Slide 3).
General
discussion
3. Then enquire "what are some ways you can establish the
gestational age of a newborn?" Explain gestational age could be
determined in the antenatal period by collecting the history of last
menstrual period and calculating the expected date of delivery
(EDD); noting the fundal height; taking an ultrasound at 20 weeks
(Slide 4-7).
5 minutes
4. Then ask the participants if they have seen a preterm baby? Have
you seen a low birth weight baby?
5. Emphasise that 30% of newborns in India are LBW; 12-14% are
preterm.
6. Ask participants "What do you mean by a preterm newborn? How
do decide if a newborn is low birth weight? Very low birth weight?
SUKSHEMA Nurse Mentors Training Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
Teaching steps
..
..
Duration
7. Explain classification by weight (Slide 8), inform them that if the
newborn appears very small and weight is less than 1800 grams
the newborn would require immediate referral.
8. Then explain classification by gestation; that newborns are
classified as small, appropriate or large for gestational age based
on gestational age in weeks and weight in kilograms and show
- related pictures of newborns based on size (Slide 9-11).
Pictures for GA
9. Ask participants "what if gestational age is not known, there
20
is no ultrasound report, what would you do to decide on GA?"
minutes
(Response: check physical features and then classify the newborn
(Slide 12).Show participants pictures differentiating (Slide 13-25) a
term and a preterm newborns by
❖ Posture, lanugo, vernix
1
❖ Ears
❖ Breast bud
❖ Genitalia
' ■■ ■
❖ Soles
W.Explain4he importance of documenting the birth weight-soon
after the newborn is born.
❖ To support the health worker in assessing if extra supportive
care for a LBW infant is needed
11. Demonstrate how to check the weight.
Checking weight
Demonstration for
weight
❖ Materials
♦ Infant weighing machine
♦ Clean towel
♦ Cleaning solution
❖ Caution
♦ The machine must be clean
♦ Complete the procedure fast to maintain warmth for newborn
♦ See that the newborn is not placed on the tray directly
Part 3; Essential Newborn Care
Teaching steps
❖ Procedure
Duration
HBHBH
♦ Clean the machine before and after use with spirit
I
♦ Place a clean/sterile towel on the machine
♦ Bring the machine to zero weight
♦ Place the baby on the towel
Demonstration for
weight
♦ -Wait till the weight stops fluctuating to the nearest 0.01 kg
♦ Record the weight in the baby's case sheet
10
minutes
♦ Identify a newborn with birth weight <1800 for referral
♦ Cover the newborn immediately and rewarm under radiant
warmer if needed
I
12. Divide participants into smaller groups and allow at least one
from each group to demonstrate how to check the weight of the
dummy newborn.
13.Give them a sample graph for plotting the newborn weight.
Narrate the case scenarios given in Slide 26.
Ask them to plot the details on the graph and thus comment on
wthe status of the neonate (Slide 27):
❖ A-neonate is normal for gestational age (AGA), does not need
referral, but would have to be watched carefully
❖ B-neonate is small for gestational age (SGA); does not need
referral but must be watched carefully
14. Project the case scenarios as a Drill to see if participants are able
to identify babies as low birth weight, term or preterm requiring
Case scenarios to
referral or not. (Slide 28-31).
estimate GA
10
minutes
❖ Slide 28: Does not require referral, term baby by posture
❖ Slide 29:Term newborn borderline LBW, not requiring referral,
but could be taken care at the facility, and must be watched
carefully
❖ Slide 30: Preterm newborn since only 30 weeks, VLBW; would
require immediate referral after initial steps of resuscitation
done
❖ Slide 31: Term baby, but SGA; would require referral since
the birth weight is below 1800grams after initial steps of
resuscitation is done
Summarize
15. Summarise the key messages of the session. Clarify any doubts
(Slide 32-33).
________ Ml
SUKSHEMA Nurse Mentors Training Program Volume 3
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8
CARE OF A NORMAL NEWBORN AT BRTH
TILL FIRST HOUR OF LIFE
II
Ili
If
Learning objectives
III
■
By the end of the session participants will be able to
❖ Recall the steps of routine care in the first hour of birth.
||
❖ Demonstrate how to assess and provide routine care in the first hour of
birth.
p
I
❖ Demonstrate accurate documentation of immediate care of the newborn
such as drying and wrapping the newborn, providing skin to skin
contact, using radiant warmer, cleaning umbilical cord and eye, checking
temperature by touch and thermometer, administering vitamin K,
assisting a mother to initiate breast feed.
❖ Demonstrate mentoring skills for provision of routine care of newborn.
Refer to Chapter 3 of mentors manual (Volume 3) for details of the session.
—
9
Part 3: Essential Newborn Care
..
il
111
hmhbhhhi
12 Newborn Care - Immediately after Birth
MHMI
Materials: PPT, weighing machine, thermometer, mucus sucker, cord clamp, Hand-out 2.1 (one each
participant), NSSK guidelines (pg 26-28), SBA (pg 52-54)
Session time: 1 Hour 15 minutes
Training methods: Lecture, demonstration, case scenarios- group discussions
Session Objectives:
Teaching steps
1. Tell the group about the topic, and the session objectives and rationale
for routine care (Slidel-3).
General
discussion
2. Direct participants to section in NSSK guidelines (Pages 26-28) /SBA
guidelines (Pages 52-54) that describe protocols for essential newborn
.care .. ...
-
Time
3
minutes
3. Divide them into 4 groups (Slide 4). Tell them that each one will discuss
a case scenario (Handoutl) in the context of the respective component
for essential newborn care (ENBC) and will be called to present.
4. After 5 minutes call groupl forward, ask one volunteer to read aloud
the case and another respond to the questions. Highlight the routine
Recall of
care at birth (Slide 5-7).
components of
ENBC through
<♦ Call a participant forward to show what steps they would take soon
case scenarios
after birth of a baby using the mannequin.
and group
❖ Reinforce that respiraiion /breathing must be checked„at the time of
discussions
drying the baby
40
minutes
♦ If baby's cry is strong and breathing well (chest rising smoothly
40-60/minute): no intervention needed
♦ If baby is not breathing-start neonatal resuscitation
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
Teaching steps
Time
❖ Explain how to check APGAR (Slide 8-10) and interpret it at 1 and 5
minute.
♦ Reinforce how to interpret APGAR:8-10 is normal; 5-7 is low; <5
need intervention.
♦ Remind them that APGAR is not used usually to start neonatal
If
II
resuscitation but a good indicator of the status of the baby. Show
them where the APGAR is to be recorded in the new case sheet.
♦ Give the exercise to participants to do. Call aloud the two cases
and ask participants what the APGAR score would be. Clarify any
doubts.
5. Call group 2 forward and ask them to present their responses to the
case.Then reinforce steps to be taken and how to maintain warm chain
after delivery (Slide 11-14).
❖ Demonstrate how to wrap / swaddle a newborn.
❖ Ask a volunteer to return demo the same.
6. Call group 3 forward and ask them to present their responses to case 3.
Recall of
Reinforce eye care and cord care and 5 cleans to prevent infection
components of
(Slide 15-17).
ENBC through
❖ Inform participants that Vitamin K must be administered to
case scenarios
all newborns if or once stable (Slide 18-20). The best site is the
and group
vastuslateralis.
discussions
♦ Divide the thigh into 2 halves from the greater trochanter of the
femur to the knee. One inch just above the line on the lateral
surface is the site.
♦ Use a needle 5/8 to 1 inch length
♦ Go at 90 degree
♦ Do not inject the needle completely to avoid damage to bone
7. Call group 4 forward and ask them to present their responses.
Reinforce information after that (Slide 21-26).
❖ Show them video on breast crawl to highlight that a newborn has
feeding cues immediately after birth. Explain specific observations
and teaching with regards breast feeding in the first day of life.
Reinforce the 5 cleans during delivery and the steps to be taken
after delivery to prevent infection.
❖ Inform them newborn's respiration/breathing; warmth and colour
must be monitored every 15 minutes soon after birth and show
them where it needs to be recorded on the case sheet.
II
___
Part 3: Essential Newborn Care
40
minutes
Teaching steps
Time
I
8. Announce that participants will be made into 2 groups. Each group will
go through the different skill stations (Slide 27). The skills stations (5)
include skills essential for immediate newborn care:
❖ drying and wrapping the newborn;
❖ cord care, eye care, and checking weight,
❖ checking temperature by touch and thermometer
Demonstration
of skills
Observation
for defects or
.traurna
. 4.
Summarize
.
❖ using radiant warmer,
❖ administering Vitamin K. (Please note: At least two facilitators are
required)
9. One volunteer from the group must demonstrate the required
procedure and the others must comment on the correct and wrong
steps (Checklist 1). Then they will have to move to the next skill
station. Each participant must take a turn to demonstrate at least one
procedure.
10. Explain specific observations that need to be made on the newborn
within 24 hours (Slide 28-39). Show them where they would check for
these details in the newcase sheet. Demonstrate the same in the wards
during their posting.
30
minutes
I
10
minutes
1T. Explain how they could-audit routine care in the first hour either by
doing an audit of records or by direct observation (Slide 40).
12. Reinforce the key messages (Slide 41). Clarify if the participants have
any doubts (Slide 42).
2
minutes
12
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
CASE SCENARIOS - ROUTINE CARE OF NEWBORN
Facilitator's Copy
Case 1: A mother at 38 weeks of gestation delivers a newborn through normal delivery (Warmth/normal
breathing)
♦ What would you do immediately after birth of newborn?
Immediate care of a normal newborn at birth
❖ Call out the time of birth.
❖
Receive newborn on a warm, clean, dry towel.
❖
Dry newborn and place the baby between mothers breast.
❖ Assess newborn's breathing; colour; cry.
❖ Wipe each eye with separate sterile gauze/cotton.
❖
Leave newborn on mother's chest-start skin to skin care.
❖
Place an identity tag on newborn's leg/hand.
❖ Cover newborn's head with cap, cover mother and baby.
❖
How to check APGAR.
Case 2: A newborn newborn is cold to touch. What will you observe for and teach the mother? (warmth)
❖ Check if room temperature >25°C.
❖ Check if the newborn was wiped, dry and on the mother's chest-skin to skin contact.
❖ Check if the newborn and mother are covered with a warm cloth; has a cap.
❖ Check later if the newborn is close to the mother, has a cap and is wrapped well.
❖
If needed use radiant warmer or heat source with a bulb 200 watt.
❖ Teach the mother how to wrap the newborn; maintain skin to skin contact, change clothes if
wet, when to report.
Case 3: A newborn newborn is just born to a mother. What are the normal eye care / cord care to be
provided? (cord and eye care)
❖ Place the newborn on mother's abdomen or on a warm dry surface close to mother.
❖ Change gloves.
❖ Give vitamin K(1 mg for all newborns <1000gms and 0.5mg for those >1000gms).
❖ Clean eyes with sterile gauze soaked in boiled cold water, use one for each eye.
❖
Put sterile clamp / tie around cord at 2cm (2 finger space) from abdomen.
❖ Cut between the clamp and artery for ceps with a sterile scissors
(approximately 2 finger space).
Part 3: Essential Newborn Care
.............
❖ Check for oozing blood; if yes, place second tie between the skin and first clamp / tie.
❖ DO NOT apply anything on the stump, or bind or bandage it. Leave it uncovered.
Case 4: A normal weight newborn was put on the mother's breast soon after birth. How would you help
to initiate breast feeding? What must you check for when the newborn is feeding?
❖ Place baby between mother's breast for skin to skin contact if breathing, soon after drying and
cutting the cord.
❖ Check if
♦ Position and attachment is correct
♦ Newborn's suck is strong
♦ Newborn is satisfied after the feed
♦ Newborn passed urine and stool on the first day
♦ Newborn takes 6-8feeds/day
♦ Mother has any problems
SUKSHEMA Nurse Mentors Training Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
■
HAND-OUT 2.1: CASE SCENARIO - FOR DISCUSSION
Instructions
Go through the case scenario assigned. Discuss and answer the questions in 5 minutes. The facilitator will
then call a volunteer from each group forward. The volunteer will read the scenario out aloud, present the
points of discussion to the rest of the group. Following this the facilitator will summarise the points for the
case scenario using the power-point slides. Then the next group volunteer will be called forward.
Case 1:
A mother at 38 weeks of gestation delivers a newborn through normal delivery
What would you do immediately after the newborn is born?
Case 2:
A newborn is cold to touch.What will you observe for and teach the mother?
Case 3:
A newborn is just born to a mother. What are the normal eye care / cord care to be provided?
Case 4:
A normal weight newborn was put to the mother's breast soon after birth. How would you help
to initiate breast feeding? What must you check for when the newborn is feeding?
Part 3: Essential Newborn Care
il
-... —........
HMi
IIHHBil
NEWBORN RESUSCITATION INCUDING
PREPARATION OF NEWBORN CORNER
Session 4: Newborn resuscitation
Session 5:
Learning objectives
By the end of the session participants will be able to
❖ Recall the steps in basic newborn resuscitation with their indication and
rationale
❖ Demonstrate the steps of basic resuscitation on the mannequin
❖ Demonstrate accurate documentation of basic neonatal resuscitation
measures done for the newborn
bi
I
■
❖ Demonstrate mentoring skills for basic newborn resuscitation
i
Refer to Chapter 4 in mentors manual (Volume 3) for details
I
_____ _,........ _.. . I16
SUKSHEMA Nurse Mentors Training Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
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13 Newborn Resuscitation
Materials: Mannequin for newborn resuscitation, table, three clean towels, suction catheters 8,10,12,14
F, oxygen tubing, mucous sucker, foot operated suction, self-inflating bag, mask (2 sizes ),
reservoir,
radiant warmer, Oxygen cylinder. SBA guidelines (Pages 54-68), NSSK manual
(Pages 9-19)
Lesson time: 2 hours 50 minutes
Training methods: Demonstration lecture, followed by skill stations for initial steps, bag and mask
ventilation and chest compression
Teaching steps
1.
Time
Introduce the topic, session objectives and organisation
of content (Slide 1-3). Inform participants that the session
will be for the whole day, or at least half a day if full day not
Introduction
if ft
possible. Highlight the importance of a baby crying, the most
10 minutes
important step of newborn resuscitation is to ventilate the
» i, '.
newborn (Slide 4-9).
Requirements for
2.
preparedness, are requirements for successful resuscitation
resuscitation
20minutes
(Slide 10-12).
3.
Reinforce the assessment that needs to be done at birth, and
who might require initial steps of resuscitation (Slide 13-18).
Overview of
resuscitation
Emphasise that trained personnel during delivery,
10 minutes
4.
Run through the steps of routine care of newborns that do not
5.
List the steps: placing newborn under radiant warmer,
require resuscitation. Demonstrate the steps of routine care.
position, suction, dry and stimulate (Slide 19-29).
Initial steps
6.
Inform participants that these steps will be described and
30 minutes
demonstrated on mannequin including projected on the
slide. Get a return demonstration before you move to the
next step.
7.
Demo lecture on equipment for bag and mask (Slide 30-37).
Give opportunity for the participants to handle the equipment.
Bag, Mask ventilation
8.
Discuss the need for bag and mask resuscitation and how
to give it. Demonstrate once. Get return demonstration in 3
groups till they are confident.
Part 3: Essential Newborn Care
30minutes
■
Teaching steps
Need for oxygen
9.
Explain need for oxygen if there is prolonged bag and mask
ventilation, and how to insert the orogastric tube (slide 38-40).
Time
10 minutes
Chest compression
10. Describe indications and demonstrate steps of chest
compression. Mention the method post resuscitation care
(Slide 41-52)
20 minutes
Medications
11. Go through the medications (Slide 52).
10 minutes
Ethical .
considerations
12. Ask participants what are some ethi call considerations during
resuscitation. Discuss with them the ethical consideration
during resuscitation and the post resuscitation measures
including referral (Slide 53-55).
10 minutes
13. Divide the participants into 2 groups and ask them to go
through the stations
Routine care
-w
Demonstration
tatfoh*S"'
Initial steps
30 minutes
Bag and mask
Chest compressions
Medication
Summarize
14. Conclude by clarifying any doubts (Slide 56).
I 10 minutes
18
__
SUKSHEMA Nurse Mentors Training Program Volume 3
, ,
*
~
Essential Newborn Care at 24/7 Primary Health Centres
____________ _
14 Preparation of Newborn Corner
Materials:
PPTs, flip chart, marker pens
Lesson time:
50 minutes
Training methods:
Lecture, case discussion, role play
Teaching steps
1. Introduce the topic and session objectives (Slide 1-2). Ask
participants "if you were expecting guests at home, how would you
prepare?" Wait for responses and then relate the same to need to
prepare the newborn corner for the newborn. Since timing of births 5 minutes
is unpredictable it is necessary that the PHC is ready ALWAYS.
Introduction
■
................................■
~
Time
■
-
2. Highlight that most neonatal deaths occur in the first hour of birth.
^Thu^ii*irnpcManttobeTeadyfora bfrth atal ttmesfStide S). 3. Ask participants, "since most often you might be alone or without
-much help, how do you think you can prepare yourselves for birth?"
Wait for responses and then explain :
❖ The nurse must identify a helper (qualified staff, any other health
care professional available, relative or ASHA worker who brought
the woman to PHC).
Preparation of
labour room
❖ Explain the role of the helper based on the skill possible.
❖ Ensure the helper understands his/her role-helping mother hold
- newborn on abdomen; assisting in wiping and wrapping the
newborn, helping in transfer of newborn if needed,
4. Brainstorm: "How must the labour room be kept ready?" "What
articles must be kept specifically to receive the newborn?"
❖ Wait for responses and then present information on the PPT
(Slide 4).
19
Part 3: Essential Newborn Care
10 minutes
■
~~r-
1
T-
Time
Teaching steps
5. Explain the components of a dedicated newborn corner (Slide 5-6).
Newborn corner
6. Ask participants "What articles must be kept ready in the newborn
5 minutes
corner?" Explain articles, emergency medication, supplies to be kept
at newborn corner (Slide 7-9)
■,
ofc' s
7. Divide participants into three groups. Ask each group to read the
participants manual on
How to check
whether the
articles and
equipment are
ready always
!
❖ Surface and radiant warmer
❖ Suction apparatus
20 minutes
❖ Bag and mask
❖ Tell each group to read aloud the points given while projecting
the same on the slide (Slide 10-12)
8. Ask a participant to volunteer and demonstrate how they could
check if the bag and mask are operating well.
9. Narrate to them a situation, "you are going to the PHC for the first time.
How would you check if the newborn corner is being maintained?"
■
f
I
10. Project Slide 13 and explain that mentoring could be done by either
doing an audit
Of records maintained for the newborn corner or
Mentoring
opportunity
-
•:-*
•
■
-
■
❖ By direct observation (readiness of newborn corner with all 5 minutes
I
articles and equipment during a delivery).
They could also provide one to one teaching of staff when the
opportunity arises on the importance of a newborn corner and its
components.
'I
11. Highlight the Do's and Don'ts (Slide 14-15).
J;: : . .'/
Summarize
12. Check if participants have any doubts.
5 minutes
13. Summarise with key points.
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
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. —.—
h.
—I
mt
BREAST FEEDING
I
IfI
Session 5: Breast feeding
Learning objectives
By the end of the session participants will be able to
♦> Recall the steps in basic newborn resuscitation with their indication and
rationale
❖ Demonstrate the steps of basic resuscitation on the mannequin
❖ Demonstrate accurate documentation of basic neonatal resuscitation
measures done for the newborn
❖ Demonstrate mentoring skills for basic newborn resuscitation
Refer to Chapter 5 in mentors manual (Volume 3)
:
/■
- If?
;;
___
21
Part 3: Essential Newborn Care
Ils
h
- -------------- gas.*-
~
J
15 Breast Feeding
Materials: PPTs, videos on breast crawl and IMNCI videos, Case scenario, Mannequin, Breast model, Chart
on Do's and Don't's
Lesson time: 360 minutes
Training methods: Lecture, case discussion, role play, demonstration
Session Objectives: By the end of the session participants will be able to
❖ Discuss the importance of early breastfeeding
❖ Recognise that breastfeeding is an effective intervention to save newborn lives by.
❖ Describe the physiology of breast feeding
❖ Explain how knowledge of physiology could impact/or successful breast feeding
❖ Explain how to prepare a woman for breast feeding during pregnancy and after delivery
❖ Demonstrate how to initiate breast feeding
'*❖ Identify correct position and good attachment
❖ Discuss the steps of successful breast feeding
❖ Explain the indications for expressing breast milk
❖ Demonstrate steps for expressing breast milk
❖ Use AMMA approach for breast feeding problems
❖ Demonstrate skill in assisting, educating and counselling a mother in breast feeding
❖ Demonstrate mentoring skills for successful breast feeding practices
SUKSHEMA Nurse MentorsTraining Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
Teaching steps
Time
5 minutes
1. Introduce the topic and session objectives (Slide 1 -4). Give
an opening introduction about importance of breastfeeding
(Slide 5-8).
2. Explain with PPTs (Slide 9-13) the differences between human
and cows milk and then the difference between preterm and
term milk (Slide 14-16).
Introduction to
-breast feeding,
3. Brainstorm "What are the benefits of breastfeeding?" Wait for
benefits of breast
responses and then project the advantages and benefits of BF
feeding
(Slide 17-35).
20 minutes
❖ Highlight that exclusive breastfeeding protects against
fatal infection.
❖ Explain the meaning of exclusive breast feeding and the
components of colostrum. (Slide 36-40).
20 minutes
4. Explain the physiology of lactation (mother's and newborn's
reflexes) in the context of promoting breast feeding (Slide 41 67).
't
Physiology of BF
.
. - . .......
20 minutes
❖ Oxytocin reflex
.<• Let down reflex
. ....
... ....
❖ Rooting reflex
❖ Sucking reflex
❖ Swallowing reflex
Support to
mothers for
successful breast
feeding
- Initiation of BF
- correct
attachment and
position
5. Brainstorm on ways that mothers could be supported to
breastfeed. Then explain how mothers could be supported
(Slide 68-81).
10 minutes
<♦ Examine a woman's breast during pregnancy. Explain the
types of breasts and how to elicit breast feeding history.
<* How to assists mother to initiate breast feeding soon
after birth. Show the video on Breast crawl - Maharashtra
UNICEF (Slide 82-96).
6. Discuss correct position, ask a participant to demonstrate
with a doll correct position. (Slide 97-110). Then check if the
participants are able to identify correct position from pictures
projected (Slide 111-113).
23 _ __
Part 3: Essential Newborn Care
20 minutes
.................■............................................................................ ................................... .......................
.
—
-
Teaching steps
7. Then discuss good attachment, ask participants to identify
from pictures projected if the attachment is good or not
and if not why? (Slide 114-122). Explain the causes of poor
attachment, how to help a newborn attach, and the impact of
poor attachment (123-128).
Time
5 minutes
8. Explain how good attachment could help in effective suckling
and demand feeding (Slide 129-132).
' 'Km ;
9. Explain how to check if breast feeding is adequate
(Slide 133-134). Go through the Handout 13.1: Breast feeding
assessment form, and inform them that they could use this to
assess breastfeeding.
Successful breast
feeding
10. Describe the 10 steps for successful breast feeding
(Slide 135-137). Tell them that they could use this as a
mentoring tool to assess breastfeeding practices in the PHC,
and teach staff within a PHC.
4
10 minutes
11. Ask participants "what is rooming in?" Explain the advantages
of it in the
12. Explain expression of breast milk. Ask participants to use
the breast models and practice on how they would-teach
expression of breast milk in pairs (Slide 139-155).
Expression of
breast milk
❖ Ask if any have expressed breast milk for a mother in the
past. Check what they have used and ask them to explain
how they have used it.
15 minutes
❖ Highlight what can be used to express breast milk and the
method to feed the newborn with EBM.
13. Divide the participants into 3 groups. Assign each group
2 cases. Give them 5 minutes to discuss their cases. Then
conduct a case discussion (Case 1 -Slide 156-160) of flat/
inverted nipple.
Problems
related to breast
Feeding
❖ Ask the group to give their points of discussion. Thank
them and then explain management of flat nipple and use
of syringe for it.
14. Go through all the case scenarios in a similar manner
30 minutes
<♦ Case scenario on 2 - sore nipple (Slide 161 -163)
Case Scenario 3 - breast engorgement using (Slide 164168)
❖ Case scenario 4- Have a case discussion on less milk (Slide
169-174)
Case scenario 5-Mastitis (Slide 175-179)
❖ Case scenario 6- Refusing to feed (Slide 180-182).
SUKSHEMA Nurse Mentors Training Program Volume 3
:•>>
-
Essential Newborn Care at 24/7 Primary Heah
Teaching steps
Time
15. Explain the "Do's and Don'ts" of breastfeeding with the help of
PPTs (Slide 183):
Do
❖ Encourage to initiate breastfeeding as soon after birth as
possible
❖ Give colostrum, it is very good for the baby
❖ Give exclusive beastfeeding for 6 months
❖ Continue breastfeeding for 2 years
Do s and Don't s
of breast feeding
❖ Support a mother for correct position and attachment
5 minutes
Do Not
❖ Give prelacteal feeds
❖ Tell mother there is restriction of food or water
❖ Give honey, janamghutti, gripe water, bonnison
❖ Discard colostrums
❖ Give bottle feeding or pacifiers
16. Show them with the baby model the correct position of the
baby. Ask one of two volunteers to return-demonstrate the
same.
■■■■■■■■■■■■■■■■■■■■■■■■■■■I
Summarize
17. Conclude the session with key messages (Slide 184-188).
Part 3: Essential Newborn Care
IH — •
II
_
.
.
.
.
-
.......
•:
................................................................................................
,•
.'
■..................
.
.
•
■
.
.
.
Hand-out 5.1: THE BREASTFEEDING OBSERVATION FORM
It summarizes the key points for assessing a breastfeed. This form is to be used to practice observing
breastfeeds with mothers & newborns. Tick where applicable
Mother's Name:
Date.
Newborn's Name:
Age of newborn:.
Signs that breastfeeding is going well
Signs of possible difficulty
BODY POSITION
Mother relaxed and comfortable
Shoulders tense, leans over baby
Newborn's body close, facing breast
Newborn's body away from mother's
Newborn's head and body straight
Newborn's neck twisted
Newborn's chin touching breast
Newborn's chin not touching breast
[Newborn's bottom supported]
[Only shoulder or head supported]
RESPONSES
Newborn reaches for breast if hungry
No response to breast
[Newborn roots for breast]
[No rooting observed]
Newborn explores breast with tongue
Newborn not interested in breast
Newborn calm and alert at breast
Newborn restless or crying
Newborn stays attached to breast
Newborn slips off breast
Signs of milk ejection [leaking, afterpains
No signs of milk ejection
EMOTIONAL BONDING
Secure, confident hold
Nervous or limp hold
Face-to-face attention from mother
No mother/newborn eye contact
Much touching by mother
Little touching
Shaking or poking newborn
________ Q|
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
ANATOMY
□ Breasts soft after feed
□ Breasts engorged
□ Nipples stand out, protractile
□ Nipples flat or inverted
□ Skin appears healthy
□ Fissures or redness of skin
□ Breast looks round during feed
□ Breast looks stretched or pulled
SUCKLING
□ Mouth wide open
□ Mouth not wide open, points forward
□ Lower lip turned outwards
□ Lower lip turned in
□ Tongue cupped around breast
□ Newborn's tongue not seen
□ Cheeks round
□ Cheekstenseor pulled in
□ More areola above newborn's mouth
□ More areola below newborn's mouth
□ Slow deep sucks, bursts with pauses
□ Rapid sucks only
□ Can see or hear swallowing
□ Can hear smacking or clicking
TIME SPENT SUCKLING
□ Mother takes newborn off breast
□ Newborn releases breast
Newborn suckled for
I 27 I
minutes
Part 3: Essential Newborn Care
■**»^»*
llllls
Hand-out 5.2: PROBLEMS OF BREAST FEEDING
CASE SCENARIOS
Case Scenario 1: You are seeing a woman for the first time, in the labour room. You notice she has flat
nipples and anticipate she will have problem for feeding her newborn.
❖
What can you do?
Case Scenario 2: A 18 year delivers a term female newborn, newborn cried at birth and was stated on
breast feeding within 15 minutes of birth. On day 3 she says her nipples are sore.
❖ • What will you enquire and do?
Case Scenario 3: A mother seems to have extreme breast pain, nipple is stretched and she has
slight fever
❖ What do you think is the problem ? What can you do to help her?
Case Scenario 4:
A 24 year old woman delivers a term newborn. She tells you on day 1 that she does not
have enough milk.
❖ What will you do ?
Again at day 7 the mother returns to the PHC and tells you that the she feels that she does not have enough
milk?
❖ What will you do ?
Case Scenario 5:
A mother is found to have fever and hard swelling on the breast with localised redness
❖ What do you think is the problem? What can you do?
Case Scenario 6: A mother says the newborn is refusing to feed. The newborn looks lethargic and
feels cold to touch
SUKSHEMA Nurse Mentors Training Program Volume 3
■:
Essential Newborn Care at 24/7 Primary Health Centres
__________________
THERMAL CONTROL AND
KANGAROO MOTHER CARE (KMC)
Session 6: Thermal control of a newborn
Session 7: Kangaroo mother care
Learning objectives
By the end of the session participants will be able to
♦♦♦ Recall factors which contribute to heat loss
❖ Demonstrate ways to prevent heat loss in a newborn
❖ Document the temperature accurately in the case sheet
❖ Demonstrate mentoring skills for KMC and thermal control of newborn.
Refer to Chapter 6 in mentor's manual for details of the session.
. 29
Part 3: Essential Newborn Care
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Thermal Control of a Newborn
Materials: PPTs, case scenarios, posters, video, SBA guidelines (pg 53), NIHFW training manual on Basic NB
Resuscitation Training Program.
Lesson time: minutes
Training methods: Lecture. Discussion of case situations
Time
Teaching steps
1. Introduce the topic and objectives of the session (Slide 1 -2)
Introduction
Newborns
susceptibility
to
hypothermia
H
•■Rill
2. Ask participants "what are some common problems of newborns?"
2 minutes
Wait till they come up with hypothermia, then project the slide on
significance of hypothermia (Slide 3).
3. Describe the reasons why newborns are more prone to hypothermia,
of whom LBW newborns are more susceptible (Slide 4-9):
❖ Brown fat metabolism resultingin thermogenesis
-
- ....
❖ Heat loss from the newborn
❖ Thermal neutral environment
4. Explain the severity of hypothermia in newborns, how to assess by
thermometer and touch method, the causes and signs of symptoms
of chronic hypothermia (Slide 10-16). Reinforce that if the newborn is
severely hypothermic it is important to refer the newborn as soon as
possible to a higher centre.
Hypothermia
5 minutes
5. Brainstorm, "what are ways by which you can prevent hypothermia?"
Wait for responses and then highlight the methods of preventing
hypothermia. (Slide 17-23).
10 minutes
6. Describe ways by which hypothermia could be managed (Slide 2427).
Hyperthermia
7. Explain the meaning of hyperthermia, its signs and symptoms and
5 minutes
management (Slide 28-32)
SUKSHEMA Nurse Mentors Training Program Volume 3
....
e
Ill
Essential Newborn Care at 24/7 Primary Health Centres
■
8. Distribute the case scenarios one to each group. Give them 5 minutes
to discuss the case scenario (Handout 1) and then ask each group to
report their points of discussion (Slide 33-35). Reinforce
❖ Need for a Thermal neutral environment to be maintained
Case scenarios
for discussion
❖ Avoid placing the mother and newborn in the draft
Rooming jn
# „
❖ Kangaroo mother care
20 minutes
❖ Breast feeding on demand
❖ Need to monitor the temperature
■■
'd
❖ Avoid bath
❖ Clothe the newborn appropriately
Summarize
9. Summarise with key points. Clarify any doubts (Slide 36-37).
Part 3: Essential Newborn Care
3 minutes
*
HAND-OUT 6.1: CASE SCENARIOS ON
THERMAL CONTROL OF NEWBORNS
Case Scenario 1
You are asked by a senior staff to check if there is a problem in the delivery room. You discover several
reasons why the delivery room may be too cold for newborns and their mothers.
❖
What is the problem ? List possible reasons
❖
What action you will take ?
Case Scenario 2
You are in-charge of the postnatal ward in a district hospital. You have noticed that mothers are wearing
jackets and think the ward is cold.
You spend an afternoon assessing the postnatal ward.
❖
What could be the problem ?
❖ List what you might have seen.
❖
What are the simple doable actions?
Case Scenario 3
The climate is very hot where you live.
❖
What advice can you give to mothers and their families when they take their new newborn home, to
prevent their newborn from becoming overheated?
SUKSHEMA Nurse Mentors Training Program Volume 3
>
Essential Newborn Care at 24/7 Primary Health Centres
.
'
______________
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Kangaroo Mother Care
Materials: Case scenarios, Posters, video, SBA guidelines (pg 53).
Lesson time: 60 minutes
Training methods: Lecture. Discussion of case situations
Teaching steps
Time
1. Introduce the topic and objectives of the session (Slide 1 -3)
2. Review with participants "what are some common problems
associated with hypothermia in newborns?" Wait for responses
Introduction
and then reinforce the significance of hypothermia (Slide 4).
Explain how KMC is a low cost method to prevent hypothermia
5 minutes
and the history of how it came into practice (Slide 5-8).
3. Ask if anyone has practiced KMC in their own setting. Tell them to
share their experience.
4. Explain the benefits of KMC (Slide 9-20). Highjight the findings of
Benefits of KMC
research on the benefits of KMC such as co-morbidities, weight
gain, increase in anthropometric measurements and other
15 minutes
benefits.
Review
5. Review with participants'thermoregulation (Slide21 -26).
mechanism of
6. Highlight the benefit of KMC over the use of incubator with
thermoregulation
KMC and pain
10 minutes
relevant research (Slide 27-29).
7. Explain the benefit of KMC in reducing pain through relevant
research (Slide 30-34).
5 minutes
8. Discuss with participants the components of KMC. (Slide 35-56)
❖
How to prepare a woman for KMC
❖ Kangaroo positioning
❖ Who can give KMC
Components of
❖ When to give KMC
KMC
❖
Precautions in KMC
<♦
KMC and breast feeding direct or through other methods
20 minutes
9. Ask a volunteer to use the doll and towel provided to demonstrate
the position for KMC.
10. Discuss about KMC and follow up as well as ambulatory care
11. Summarise the key messages of KMC, clarify and doubts (Slide 57-
58)
Summarize
12. Ask them whether they would see any challenges in implementing
this in their set up
Part 3: Essential Newborn Care
5 minutes
■
;
-
________
■_______________________________________________
CARE OFTHE NEWBORN
AT FACILITYTILL DISCHARGE
<
■ Rfe
Session 8: Care if the newborn from 1 hour of birth till discharge including
discharge counselling.
■i'
*
Learning objectives
r- ■■
By the end of the session participants will be able to
♦♦♦ Recall the components of care in the first 48 hours of life till discharge.
iii
Demonstrate skill in counselling and assisting mothers in components of
care in the first 48 hours of life.
,•
;7
.
? '■ i
'
❖ Document components of care in the first 48 hours of life in the case sheet.
♦
❖ Demonstrate mentoring skills for care provided in first 48 hours of life.
■ ? :< ■
■: J
• U'A••
7
;
Refer to Chapter 7 in mentors manual (Volume 3) for details of the session.
34
SUKSHEMA Nurse Mentors Training Program Volume 3
......
■
.
S
.
..
.
.
-------- -—------- ----------
Essential Newborn Care at 24/7 Primary Health Centres
Care of Newborn from 1 hour of Birth till
Discharge including Discharge Counselling
18
■Hum
Materials:
Danger signs chart / Power point, Immunization chart, Case sheet, Check list prior to discharge,
SBA Guidelines
Lesson time: 60 minutes
Training methods: Role Play,Brainstorming, Group discussion
Teaching steps
Introduction
1. Introduce the title and objectives of the session (slide 1 -2).
Reinforce that this is mainly a review of content already taken.
2. Role play (2 facilitators - one acts as nurse and the other the woman
who is getting discharge) on discharge advice on the following 3
issues (Slide 3):
Time
5 minutes
5 minutes
❖ Newborn is feeding well
No danger signs present
❖ Mother confident in care of newborn
Danger signs
3. Reinforce information on the routine care in postnatal environment
(Slide 4-6) and review everyday care at home (slide 7) (use
discussion since a lot of the content has aready been covered):
<♦ breast feeding, the do's and don't as well as how to assess if the
newborn is feeding well or has difficulty in feeding (SlideS-'l 0);
❖ Ensuring warmth in the hospital and at home (Slide 11-15);
❖ Cord care and hygiene- do's and don'ts (Slide 16-17);
❖ Danger signs, how to identify and when to seek care urgently if
the newborn has any (Slide 18);
❖ Prevent infection (Slide 19-21).
Part 3: Essential Newborn Care
15 minutes
--------------- -—
—
——I—I
Teaching steps
I
Time
H
4. Reinforce signs that mother and newborn are ready for discharge
Review with participants the points to keep in mind to ensure
mother and newborn are ready for discharge (Slide 22-24).
Readiness
for discharge
when mother
is confident in
care of baby
5. Divide the participants into small group of 4-5. Assign one topic
for each group to practice and then ask them to come forward
and put up a role play. One must act as a nurse and another as the
client- mother who has recently delivered a newborn.
6. Ask other group members to give feedback on how well the role
play went, what points were missed and what could be improved
on.
7. Refer participants to case sheet and as“k them "in which of the case
sheet will you record counselling done for the newborn?" Wait for
Summarize
30 minutes
8. Ask participants if they have any doubts.
9. Review main points of the session (Slide 25-26).
■
J 5 minutes
SUKSHEMA Nurse Mentors Training Program Volume 3
. ....
- •. ;
■
.
:
Essential Newborn Care at 24/7 Primary Health Centres
Role play
Guidelines for the role play:
❖ One facilitator as nurse, one as the mother.
❖ Teach/Counsel the mother on aspects she must know and be confident of before discharge.
❖
Script is given below. Either two facilitators or volunteer participants can be shown the script to
prepare for the role play.
❖
Encourage participants to observe the role play and to note down key points discussed.
❖ Tell them to also note down positive points and negative points of the counselling session
❖
At the end of the role play get feedback from participants.
♦ What were their key learnings?
♦ What were the positives?
♦ What could be improved?
♦ How would counselling help the mother?
Script for role play
❖
Nurse
: Good morning. How are you and the newborn? I am .
.and will be looking after you and
your baby today.
❖ Mother : I am fine. The newborn is also fine to me.
: How would you know if the newborn is feeding well?
❖
Nurse
❖
Mother : She is feeding well, I know because she is sleeping enough.
♦♦♦
Nurse
: Very good yes the newborn must be sleeping enough, but the next way to remember that
the newborn is getting enough milk is to see if newborn is feeding at least 8 feeds every
day passing urine 5-6 times a day, passing stool 3-4 times a day and also the newborn must
be satisfied. Remember give the newborn only breast milk
❖
Mother : OK, but on a hot day can I give some water to the newborn. Everyone says it is OK
❖
Nurse
: No, do not give anything else to the newborn unless it is a medicine that has been
prescribed by the doctor. It is best for the newborn's growth and to prevent any infection.
You must try to give only breast feeds till the newborn is 6 months of age.
❖
Mother : Can I go home today, since I know the newborn is feeding well.
❖
Nurse
: Yes, I think there does not seem to be any problem for the baby now. But you need to
watch out and see if the newborn is having any breathing difficulty, chest indrawing,
abnormal sound when breathing; or if the newborn is having convulsions, discharge or
erythema from the umbilicus; feeding difficulty (not sucking well, refusing feeds etc);
Part 3: Essential Newborn Care
-- -
slil
■HI
has blood in stools or vomiting, hypothermia or fever; icterus or yellow skin; stiffness or
flopping; irritable or lethargic or has more than ten skin pustules bring the newborn
immediately to the centre. Will you remember what I told you? Can you repeat some of the
danger signs or problems for which you must come to the hospital immediately?
❖ Mother : Ok you said yellow skin, not feeding well, tiredness, or crying constantly; sleeping too
much; breathing problem. Yes I will remember to bring the newborn
❖ Nurse
: Very good! You can go from head to toe that way it will be easy
is the newborn active?
And alert? Is the newborn feeding well, is the newborn passing normal stools? Is the
newborn yellow? Is there any discharge from the umbilicus or is the skin red? Is the
newborn crying always? Are there pustules in the skin? Is the newborn having low
temperature, stiff and sleeping always?
Do you have any more questions? You can go home. Come for a follow up at 4 weeks. Or if you think the
newborn is not doing well at any time. Good bye.
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
Hand-out 8.1: Checklist - Mother Is Ready For Discharge Of Newborn
.
Main
areas
.. .....
J
Place a
Tick if
YES
Specific aspects
Suckling effectively 8 times in 24 hours, day and night
Passing urine 5-6 times a day
Feeding well
*■
Passing stool 3-4 times a day
Danger signs and when to report
Mother knows
When to come for routine follow up
Immunization schedule
Feeding
J
Mother confident
oftakingcareofthe
newborn.. ■.-. ■■■ ■ —
r
Warmth
■ Bath
...
. .. ....
~- ■■
.
.......
Aware of traditions that are harmful and that should be avoided
Part 3: Essential Newborn Care
■■■
____
COMMON PROBLEMS OF
NEWBORN AND REFERRAL
Session 9: Danger signs and common problems of newborn
Session 10: Feeding a low birth weight newborn
Session 11: Referral and transport of a sick newborn
Learning objectives
By the end of the sessions participants will be able to
•
‘
❖ Recall causes and initial management of common neonatal problems.
❖ Demonstrate skill in identification and initial management of common
neonatal problems.
B
❖ Mentor staff nurses on care of newborns with specific problems such as
asphyxia, sepsis, hypothermia and hypoglycaemia, as well low birth weight
babies and referral of those requiring it
Identify records on which details of care provided could be documented in
the PHC.
III
■(K
i|||
Refer to Chapter 8 in mentors manual (Volume 3) for details of these sessions.
■
40
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
■
- - - ,-
_____________________________________
Danger Signs and
Common Problems of Newborns
Materials: Case scenarios, video, SBA guidelines,
Lesson time: 100 minutes
Training methods:
Lecture. Discussion of case situations or photo's /videos
Teaching steps
Time
1. Introduce the topic and objectives of the session (Slide 1 -2).
Introduction 2. Ask participants "what are the main causes of mortality in newborns?"
5 minutes
Wait till they come up with correct responses (Slide 3).
3. Introduce the first main problem, respiratory distress. Show slides to
depict signs of respiratory distress such as grunt, retractions, increased
respiratory rate and presence /absence of cyanosis (Slide 4-10). These
Respiratory
distress
slides are linked to videos. Double click on the blue coloured title and
30 minutes
the video will open.
4. Explain the causes of respiratory distress (Slide 11 -18), and the
approach to such a case (Slide 19-25).
Asphyxia
5. Explain the meaning, causes and prevention of Asphyxia (Slide 26-30).
10 minutes
6. Describe the causes, signs and symptoms and early management of
sepsis in newborns and about superficial infections (Slide 31-45).
Neonatal
sepsis
7. Highlight how infection can be prevented (Slide 46-47).
25minutes
8. Read out the cases and check if participants are able to pick out the
possible problem (Slide 48).
9. Show them photos of other danger signs. Tell them that it is important
to refer any newborn presenting with these (Slide 49-64).
10. Give 4 case scenarios to participants after dividing them in small
Other
danger signs
groups of 4-5 members (Handout 1). After 10 minutes ask participants
30 minutes
to come group wise and present their responses. Reinforce correct
points, encourage them to come out with all possible responses till all
are exhausted.
Summarize
52
11. Highlight which newborns would require referral. Clarify any doubts
and conclude with key points (Slide 65-67).
Part 3: Essential Newborn Care
5 minutes
—
■
■
CASE SCENARIO FOR COMMON NEWBORN PROBLEMS
(Facilitator's Copy)
Case 1: A newborn delivered at 34 weeks weighing 1.8kgs, cried soon after birth. Breastfeed was initiated.
What can you do? What are the possible problems you can anticipate?
❖ Check if the newborn is able to suck effectively, if not teach mother to express breastfeed and
how to feed with a paladai
❖ Note weight, feed intake
❖ Promote skin to skin care
❖ Check if newborn is active, warm, sleeping well, with good colour daily
❖ Counsel mother on feeding, warmth, skin to skin
Case 2: A term newborn, cried soon after birth presents with raised body temperature, lethargy on day
2. Discharge is present from the umbilicus.
What is the possible problem? What can you do?
❖ ? infection
❖ Clean umbilicus
❖ Administer antipyretics
❖ Administer first dose of antibiotics if indicated
❖ Check if baby is feeding, alert/active, sleeping well
❖ Record if newborn is lethargic/floppy; temperature is altered-hypothermic or hyperthermic;
stiff; crying excessively
❖ Refer if needed
Case 3: A term newborn doing well on the first day presents with respiratory distress
What is the possible problem? What can you do?
❖ ? Aspiration/infection
❖ Check respiratory rate, colour of newborn, if newborn is breathing rapidly, if there are
retractions?
❖ Check if temperature is normal or not? if newborn is able to feed well? is alert /lethargic?
❖ Suction if need be
❖ Start on oxygen
❖ Find out from mother, if she burbed the baby? When she last fed the newborn? When the
breathing difficulty was first noticed?
❖ Refer if newborn is not improving and transport
Case 4:
A term newborn resuscitated presents with convulsions on day 1 ?
What is the possible problem? What can you do?
❖ Hypoxic ischemic injury/HIE-hypoxic ischemic encephalopathy
❖ Continue supportive management-warmth-radiant warmer, oxygen, fluid (IV access) with
10% dextrose
❖ Assess RR, HR, capillary filling time, temperature, oxy gen saturation, output, GRBS
❖ Administer Vitamin K: 1 mg (IM)
❖ Refer urgently
❖ Transport the sick neonate
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
.. —....
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•■-I-
Hand-out 9.1: CASE SCENARIO FOR COMMON NEWBORN PROBLEMS
(Participant's Copy)
Case 1: A newborn born at 34 weeks weighing 1 .Skgs, cried soon after birth. Breast feed was initiated.
What can you do? What are the possible problems you can anticipate?
Case 2: A term newborn, cried soon after birth presents with raised body temperature, lethargy on day 2.
Discharge is present from the umbilicus.
What is the possible problem? What can you do?
Case 3: A term newborn doing well on the first day presents with respiratory distress
What is the possible problem? What can you do?
Case 4: A term newborn resuscitated presents with convulsions on day 1 ?
What is the possible problem? What can you do?
Part 3: Essential Newborn Care
•i
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FEEDING A LOW BIRTHWEIGHT
NEWBORN
Session 10: Care of a low birth weight newborn
Learning objectives
By the end of the sessions participants will be able to
❖ Describe the dietary requirements of a LBW newborn and how they can be
met with by use of expressed breast milk.
❖ Describe the method of feeding for different categories of LBW newborns.
❖ Demonstrate how to feed a LBW with a palada.
❖ Demonstrate mentoring skills in meeting the nutritional needs of LBW
babies in the PHC.
........
...
:
.
: . .............
W
Refer to Chapter 9 of mentors manual (Volume 3) for details of the session.
bibiIWiiimiIMII
44
SUKSHEMA Nurse Mentors Training Program Volume 3
4
h ar;
Essential Newborn Care at 24/7 Primary Health Centres
110 Care of Low Birth Weight Newborn
Materials: Case scenarios, pictures, SBA guidelines,
Lesson time: 55 minutes
Training methods: Lecture. Discussion of case situations
Time
Teaching steps
1. Introduce the topic and objectives of the session (Slide 1-3)
Introduction
2. Ask participants "who is a LBW newborn? Explain the meaning and
the significance of LBW (Slide 4-5).
5 minutes
Types of LBW
3. Explain the types and etiology of LBW newborns (Slide 6-17).
20 minutes
Problems of
LBW
4. Highlight the problems of newborns (LBW) and those that require
immediate referral (Slide 18-21). Reinforce how the newborn can be
kept warm at hospital or home (Slide 22-24).
5 minutes
Feeding a LBW
5. Explain how decision is made about method of feeding, choice of
milky, amount of feed and assessing adequacy of feeding
(Slide 22-39).
25 minutes
Summarize
6. Conclude with the key messages (Slide 40-42).
,
,
.
7. Ask any participant to share their experience if any on care of a LBW.
I .
Part 3: Essential Newborn Care
5 minutes
■■■■■■■■I
c
.2
tn
Referral and Transport of
a Sick Newborn
Materials: PPTs, flip charts with marker pens
Lesson time: 60 minutes
Training methods: Lecture, demonstration, discussion
Teaching steps
Time
1. Introduce the topic and objectives of the session (Slide 1 -2).
❖ Brainstorm with participants"why is neonatal support important?"
i
Possible responses: So that a sick newborn is transferred as safely
as possible and as soon as possible to a health centrethat can
Introduction
5 minutes
manage the problem effectively. Management could mean
intensive monitoring, ventilation, additional investigations or
medical or surgical intervention. A newborn who is transported
safely .could have better chances of survival and outcomes. ,
■«■ ■■■■■■
2. Ask participants "Which newborns would require transport to a
higher center for further management?" List the newborns that
might require immediate" transport after initial management
(Slide 3-4).
❖ LBW
❖ Asphyxia
♦♦♦
Breathing difficulty
❖ Yellow palms and feet
Babies requiring
❖ Bleeding
to be transported
❖ Lethargy
10 minutes
Crying excessively
❖ Hypothermia/hyperthermia
❖ Convulsions
Any malformation requiring immediate management-
diaphragmatic hernia, esophageal atresia, blue baby (CHD),
ARM
3. Brainstorm challenges they are likely to face in referral and transport.
After a brief discussion present the slides (Slide 6-8).
SUKSHEMA Nurse Mentors Training Program Volume 3
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:
Essential Newborn Care at 24/7 Primary Health Centres
4. Highlight a case (Slide 9). Inform participants that they can do a role
play, provide case scenarios which include good and bad practices.
Tell them they have a newborn with breathing difficulty. Ask three
volunteers to act out the scene. Tell the rest to comment after they
have enacted it on what was good, what could be improved on,
what are the challenges. Then reinforce the main points.
❖ Vehicle to be arranged-clean
Requirements for
transport
❖ Newborn must be kept warm at all times - wrapped/head 20
covered with cap
"
minutes
❖ Oxygen administration continued or bag and mask ventilation to
be continued
❖ Referral centre must be informed and ready to receive the
newborn
<♦ Medical records of treatment initiated and condition of the
newborn at transport
❖ Support for the mother- another relative to be with her
5. Then discuss the important components of effective referral (slide
10-20)
Before
Stabilize
. a. . ... .
.. . .
.. . .
❖ Communication to referral centre, family member/accompanying
member
<♦ Equipment and supplies
Components of
referral
During
20 minutes
❖ Care during transport - STABLE
<♦ Prevention of hypothermia / hypoxia
❖ Support
<♦ Record/document in case sheet/referral form
After
❖ After transport debrief
❖ Followup
Summarize
6. Check for any doubts. Conclude with main points (Slide 21-23).
Part 3: Essential Newborn Care
5 minutes
OSCE FOR NURSE MENTORS SUKSHEMA PROJECT TRAINING PROGRAM
DATE
VENUE:
Osce Plan For Obstetrics-lntranatal and Immediate Postnatal
1.
2.
BP
Calculation of gestational Age
'3
Observed
2
Unobserved
3.
Abdominal Examination
8
Observed
2
Unobserved
4. .
5.
Postnatal counselling •
6
Observed
6.
Preparation of Labour room
4
Unobserved
7.
Complication - PPH, fill in the
blanks
5
Unobserved
5
Unobserved
8
Observed
7
Observed
8.
9.
AMTSL
10.
....
L
...
■.
■
tab 50.
General instructions to be given by one facilitator to all the participants
❖
Each one will go through 10 stations and 2 rest stations
❖ There are 5 observed and 5 unobserved stations
❖
In the observed station you will be expected to perform some activity. Complete the task within
time given
❖
In the unobserved station you will be asked to write some information on the answer sheet.
Write your name on the answer sheet and participant number. Once you complete it fold the
answer sheet and place it in the box provided.
❖ The duration of each station will be 4 minutes. Two of the observed stations will be longer
(6 minutes). Hence the rest stations will be 2 minutes.
❖
None of the facilitators will give any comments or assistance
❖ Three stations have volunteers to help in completing the station
❖ A bell will ring, each one go to the assigned station based on participant number.
❖
Do not face the station first
❖ When the bell rings again, each participant can turn and read participant instructions.
Complete the task given.
SUKSHEMA Nurse Mentors Training Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
____________________________________ •
❖
If you complete the task before time given, sit in the chair and wait
❖
When the bell rings again, you must switch to the next station.
❖
All participants will go through all the stations.
❖
The test will take approximately 50 minutes.
❖
No one will be allowed to go out of the room during the exam.
MBH
Candidates
OSCE Overall Evaluation - Stations ~
Observed
(6)
(8)
(7)
(32)
3
i:5
10
12
Total
2.
3.
1 |
c
J.
SBSMNI
7.
.8.
9.
10. <;
11.
12.
13.
14.
|
15.
16.
17.
|
18.
19.
Part 3: Essential Newborn Care
Unobserved
■
11(2:)
(3): )i(8)
1
4.
••
8
(2)
(4)
i (5) .
4
7
8
(5)
(18)
Total
OSgft W
Grand
Total
(50)
4——1
-
—
ISIS
OSCE Overall Evaluation
Stations
Observed
Candidates
Unobserved
(4)
(8)
(8)
(8)
(8)
(32)
(4)
(3)
(4)
(3)
(4)
(18)
j
2
3 .
2
3
Total
6
7
8
9
10
Total =
Grand
Total
(50)
1.
2
3
4
5
6
7
8
9
' ro
ll
12
13
14
15
16
17
18
19
20
21
22
23
gM
SUKSHEMA Nurse Mentors Training Program Volume 3
Requirements for OSCE (General requirements will be the same as mentioned for Obstetric OSCE)
Requirements for Station 1: Resuscitation
Requirements for Station 2: Radiant warmer
❖ Three newborn sheets
❖ Answer sheet for each candidate to fill in
the answer
❖ Suction catheters
❖ Key for scoring candidate
❖ Mannequin
❖ Bag - both sizes
♦> Mask - both sizes
❖ Oxygen tubing
❖ Reservoir
❖ Key for scoring candidate
Requirements for Station 3: Checking the
weight of a newborn
Requirements for Station 4: Identification of
Danger Sign
❖ One baby sheet/ towel
❖ Answer sheet to write answer for each
question
❖ Cotton swab with spirit
❖ Laminated pictures of danger signs
❖ Mannequin
❖ Weighing machine
1. Cyanosis or blue baby / oral thrush
♦♦♦ Kidney tray
2. Skin pustules/conjunctivitis
❖ Chitof paper to record weight of
mannequin
3. Stiff baby
❖ Key for scoring candidate
. 4. Jaundice (both)
❖ Key for scoring candidate
Requirements for Station 5: Counselling a
mother for referral of her newborn
Requirements for Station 6: Infection Control
❖ Table
❖ Answer sheet for each candidate to fill in
the answer
❖ Volunteer- cum observer
❖ Key for scoring candidate
❖ Chair 3
❖ Key for scoring candidate
Part 3: Essential Newborn Care
Requirements for Station 7: Discharge
Requirements for Station 8: Breast feeding -
Counselling of a woman for a LBW on thermal
position and attachment
control of newborn
❖
❖ Laminated picture for position and
attachment
Mannequin
❖ One baby sheet/towel
❖ Answer sheet for each candidate
❖ Volunteer - Ms Shanthy
❖
Key for scoring candidate\
❖ Chair x3
❖ Table
❖
Key for scoring candidate
Requirements for Station 9: Mentoring a staff
nurse to check temperature
❖
Mannequin
❖ Volunteer nurse (acts the following correct
Requirements for Station 10: Case Record entry
❖ Answer sheet for each candidate - case
sheet on newborn section
❖ Key for scoring candidate
I wrong steps out for the participant to
observe):
*
S
Uses hand rub
S
Cleans thermometer with spirit
x
Does not shake thermometer
x
Does not check the reading before
using it for the newborn
X
Keeps it horizontally, not vertically
X
Keeps it for 1 minute
X
Holds bulb end of thermometer while
checking temperature
❖ Thermometer
❖ Spirit swab
❖
Kidney tray Container to keep
thermometer in after completing the
procedure
❖ Alcohol rub solution
❖ Chair
❖ Table/couch
<♦
Alcohol hand scrub
❖ Case sheet
❖
Key for scoring candidate
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
_ _ ______
Kay for Station 1: Resuscitation
Participants Serial No.
S.
Observations
NO
Marks
Says that bag and mask
ventilation must be given
0.25
2
Chooses the correct size bag
and mask
0.25x2
3.
Connects the bag and mask
0.5
Does not connect reservoir
and oxygen
0.25x2
5.
Checks position of newborn
0.25
6.
Places the mask correctly
over mouth and nose to
Know if good seal ~‘
“
0.25x2
' 7.
Initiates breathing and says
aloud breath 2-3- (40-60/
minute)
0.5
8.
Checks for chest raise
(Observer will check if chest
raises adequately, if yes mark)
0.5
5-
Evaluates after 30 seconds ~
0.5
TOTAL
4
1
K.
Part 3: Essential Newborn Care
—........................................ ...
Kay for Station 1: Resuscitation
Participants Serial No.
.....
kiz^ Observations
NO
s.
..
Marks
1.
Says that bag and mask
ventilation must be given
0.25
2.
Chooses the correct size bag
and mask
0.25x2
3.
Connects the bag and mask
0.5
4.
Does not connect reservoir
and oxygen
0.25x2
5.
Checks position of newborn
0.25
Places the mask correctly
6- . oyer mputh and nose to
know if good seal
0.25x2
7.
Initiates breathing and says
aloud breath 2-3- (40-60/
minute)
0.5
8.
Checks for chest raise
(Observer will check if chest
raises adequately, if yes mark)
0.5
9.
Evaluates after 30 seconds
0.5
TOTAL
4
SUKSHEMA Nurse Mentors Training Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
Key for Station 2: Radiant Warmer - True or False
■
..
.
Participants
S.
Observations
Marks
1
Answer - False
0.5
2
Answer -True
0.5
3
Answer -True
0.5
4
Answer -True
0.5
5
Answer -True
1.0
NO
1
2
3
4
5
6
7
8
9
10
7
8
9
10
TOTAL
Key for Station 2: Radiant Warmer - True or False
Participants
S.
Observations
Marks
1
Answer - False
0.5
2
Answer -True
0.5
3
Answer -True
0.5
4
Answer -True
0.5
5
Answer -True
1.0
NO
TOTAL
Part 3: Essential Newborn Care
1
2
3
4
5
6
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•
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■
—... .. .......
Key for Station 3: Checking weight
Participants
Marks
S. NO Observations
1
Cleans the tray of weighing
scale with spirit
2
Cover the tray with a clean
cloth
3
Sets the weighing scale to zero
after placing the cloth
4
Uses alcohol hand rub
5
Removes mannequins clothes
Places the newborn in the
centre of the tray
7
Notes and records the weight
accurately
8
3
2
3
5
6
7
8
9
10
5
6
7
8
9
10
0.5
0.5
0.5
0.5
except the napkin
6
2
Newborn returned to place,
and clothes put on
TOTAL
0.5
0.5
0.5
0.5
4
Key for Station 3: Checking weight
■
..
■
S. NO Observations
1
Marks
Cleans the tray of weighing
scale with spirit
2
Cover the tray with a clean
cloth
3
Sets the weighing scale to zero
after placing the cloth
4
5
ES6
Uses alcohol hand rub
Removes mannequins clothes
except the napkin
Places the newborn in the
Notes and records the weight
accurately
8
4
0.5
0.5
0.5“
0.5
centre of the tray
7
1
Newborn returned to place,
and clothes put on
TOTAL
0.5
0.5
0.5
0.5
4
SUKSHEMA Nurse Mentors Training Program Volume 3
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Essential Newborn Care at 24/7 Primary Health Centres
_____________________ _
Key for Station 4: Identification of Danger Signs
Participants
S.
NO
Observations
Marks
1
Identifies correctly and write in
answer sheet ~ cyanosis or oral thrush
0.5
2
Identifies correctly and write in
answer sheet -skin pustules or
conjuncitivitis
0.5
Identifies correctly and write
in answer sheet —Stiff baby/
opisthotonus
0.5
4
Identifies correctly and write in
answer sheet -jaundice
0.5
5
Writes all danger signs from case
scenario
3
Not feeding
1
2
3
4
5
6
7
8
9
10
7
8
9
10
0.5x4
Lethargic
RR 72/minute
J
Temperature 35°C
4
TOTAL
Key for Station 4: Identification of Danger Signs
Participants
S.
NO
Marks
Observations
1
Identifies correctly and write in
answer sheet - cyanosis or oral thrush
0.5
2
Identifies correctly and write in
answer sheet -skin pustules or
conjuncitivitis
0.5
Identifies correctly and write
in answer sheet —Stiff baby/
opisthotonus
0.5
4
Identifies correctly and write in
answer sheet -jaundice
0.5
5
Writes all danger signs from case
scenario
3
Not feeding
0.5x4
Lethargic
RR 72/minute
Temperature 35°C
TOTAL
Part 3: Essential Newborn Care
4
1
2
3
4
5
6
■
-
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111^
Key for Station 5: Counselling of mother for referral of her newborn
■■■
?
■
Participants
Marks
S. NO Observations
4
Introduces self and greets
parents
0.5
Explain that the newborn is
preterm and LBW and therefore
needs referral
0.5
x2
Explain that the newborn
might have problems include:
infection, feeding problems,
temperature
0.5x3
- .
6
7
I
8
2
3
4
5
6
7
8
9
Explainsthat the concerned
doctor/ nurse in the district
hospital has been spoken to
5
1
Explains she has arranged for
the ambulance
0.5
0.5
Tells mother how to feed
newborn during transport if
needed
1.0
Tells mother how to keep
newborn warm during
transport
1.0
Body posture/tone of voice/eye
0.5 x4
to contact/asks for any doubts
= 2.0
and clarifies
TOTAL
8
SUKSHEMA Nurse MentorsTraining Program Volume 3
10
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Essential Newborn Care at 24/7 Primary Health G
Key for Station 6: Infection Control
S. NO Observations
Marks
Mucous suction trap
1
0.25
Single use only
flHHHH
2
Clean with soap and water/
spirit allow to air dry 0.25
3
0.25
Ambu bag
0.5
Soap and water, dry and pack
Radiant warmer
4
Soap and water/ Disinfectant
solution, once a day
0.5
5
Thermometer
0.5
6
Clean with spirit swab before
and after use *
Weighing scale
..., Pisinfectgnt solution./ spirit
prior to every use
0.25
7
Suction catheter
8
Single use
Suction tubing
0.25
Clean with soap and water/
rinse and drip dry
9
Oxygen tubing
10
Clean with soap and water/
rinse and drip dry
Feeding tube
11
Single use
ETTube
0.5
0.5
0.25
0.25
TOTAL
59,
Part 3: Essential Newborn Care
4
1
2
3
4
Participants
7
5
6
8
9
10
Key for Station 7: Discharge Counselling of a mother for a LBW baby
IS® II!
p=r.iclp.MS
Marks
S. NO Observations
1
Introduce self
0.25
2
Explains to mother what she is
going to talk about
0.5
Body language/tone of voice/
eye to eye contact
0.25x3
3
4
Tells mother to keep room
warm
0.5
5
Tells her not to allow place the
newborn in the draft i.e. near
open windows or doors
0.5
6
Explains to cover the head with
i < i M a cap always
®S®-s s
7
0.5
8
Advise to delay bath till
newborn is 2.5Kgs
1.0
9
Instruct to change napkin
when wet
0.5
Teaches mother how to check
temperature using touch
method
1.0
Instruct to give KMC
0.5
Tell her that others could also
provide KMC
0.5
Asks if she has doubts/has
understood and then clarifies
doubts
0.5
10
12
13
TOTAL
2
3
4
5
6
7
8
9
10
1.0
Informs to cover the body of
- ‘ the newborn
** •
1
8.0
60
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
. ..... . "" '
Key for Station 8: Position and Attachment for Breast Feeding
Participants
S.
Observations
NO
1
POSITION
Newborn's head and body NOT
2
in straight line
Newborn's head and body NOT
facing mother
3
Newborn's body NOT close to
4
mother
Newborn's whole body NOT
Marks
1
2
3
4
5
6
7
8
9
10
0.25
0.25
0.25
Q
well supported
ATTACHMENT
Mouth NOT wide open
Chin NOT touching breast
More areola NOT seen above
5
6
7
than below
Lower lip NOT everted
NOT correctly POSITIONED
NOT correctly ATTACHED
TOTAL
8
9
10
0.25
0.25
0.25
0.25
0.5
0.5
3
Key for Station 8: Position and Attachment for Breast Feeding
_____
Participants
S.
Observations
NO
1
POSITION
Newborn's head and body NOT
2
in straight line
Newborn's head and body NOT
3
facing mother
Newborn's body NOTxIose to
4
mother
Newborn's whole body NOT
well supported
ATTACHMENT
Mouth NOT wide open
5
6
7
Chin NOT touching breast
More areola NOT seen above
than below
Lower lip NOT everted
NOT correctly POSITIONED
NOT correctly ATTACHED
TOTAL
8
9
10
r
i
L2L Part 3: Essential Newborn Care
Marks
0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.5
0.5
3
1
2
3
4
5
6
7
8
9
10
Key for Station 9: Mentoring a staff nurse to check temperature
Participants
Marks
S. NO Observations
1
2
3
4
Starts with telling nurse the
correct things she did
3
4
5
6
7
8
9
10
Identifies the mistakes (5)
7
8
9
10
1.0
0.25x5
Demonstrates correctly all the
steps (8)
0.25x8
Asks if nurse has understood
0.5
6
Asks her to demonstrate
1.0
7
Gives positive reinforcement
0.5
9
2
0.25
Introduces self
5
8
1
Is gentle, non-threatening, non-
judgmental
Explains why it is important to
do the procedure correctly
TOTAL
1.0
0.5
8.0
Key for Station 9: Mentoring a staff nurse to check temperature
Participants
S. NO Observations
1
2
3
4
Marks
Introduces self
Starts with telling nurse the
correct things she did
3
4
5
6
Identifies the mistakes (5)
Demonstrates correctly all the
steps (8)
1.0
0.25x5
0.25x8
Asks if nurse has understood
0.5
6
Asks her to demonstrate
1.0
7
Gives positive reinforcement
0.5
9
2
0.25
5
8
1
Is gentle, non-threatening, non-
judgmental
Explains why it is important to
do the procedure correctly
TOTAL
1.0
0.5
8.0
Bi# ■■
SUKSHEMA Nurse Mentors Training Program Volume 3
Key for Station 10: Case Record entry
Participants
S.
Records the following on the case sheet
NO
Marks
1
Sex - Male
0.25
2
Weight - 2000grams
0.25
3
LBW-yes
0.5
4
Outcome - live
0.25
5
APGAR-9
0.25
6
Maturity-Term
0.25
7
Anomalies - Nil
0.25
8
Resuscitation - Nil
0.25
9
Medication given - Inj vitamin K 1 mg
0.5
10
Breast feeding initiated at 5.50am (20
minutes from birth)
0.5
11
Skin to skin contact- No
0.25
12
Cord application “No
0.25
13
Newborn attended by - Ms Asha staff
nurse
TOTAL
1
2
3
4
5
6
7
8
9
10
7
8
9
10
0.25
4
Key for Station 10: Case Record entry
Participants
S.
Records the following on the case sheet
NO
Marks
1
Sex - Male
0.25
2
Weight - 2000grams
0.25
3
LBW - yes
0.5
4
Outcome - live
0.25
-5
APGAR- 9
0.25
6
Maturity-Term
0.25
7
Anomalies - Nil
0.25
8
Resuscitation - Nil
0.25
9
Medication given - Inj vitamin K 1 mg
0.5
10
Breastfeeding initiated at 5.50am (20
minutes from birth)
0.5
11
Skin to skin contact- No
0.25
12
Cord application -No
0.25
13
Newborn attended by - Ms Asha staff
nurse
0.25
TOTAL
$
Part 3: Essential Newborn Care
4
1
2
3
4
5
6
■BHS
OSCE Station 1
Resuscitation
-•
After initial steps of resuscitation this term
newborn is still not breathing.
What action will you take?
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
OSCE Station 2
Radiant Warmer
You have 5 questions on the radiant warmer.
Circle either "True" or "false" for all 5 questions
k
in the answer sheet.
65
Part 3: Essential Newborn Care
■
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OSCE Station 3
Checking weight
Show how you will check the weight
of the newborn mannequin using this
weighing scale.
:aail
__________ ____
.
66
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
III
OSCE Station 4
Name the common problem
or danger signs
There are 4 different pictures of a
newborn presenting with a common
problem or danger sign (No 1-4).
❖ Identify from the picture the common
neonatal problem or danger signs.
Write the answer in the blank given
against each question number.
,67
Part 3: Essential Newborn Care
■■mn
68
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
_____
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OSCE Station -4: Picture 2
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Essential Newborn Care at 24/7 Primary Health Centres
□•OSCE Station -4: Picture 4
71
Part 3: Essential Newborn Care
OSCE Station -4 contd
Question 5: A term newborn is not
feeding on day 2.
IB
On examination the newborn is lethargic,
RR is 72/minute and temperature is 350C.
j Write all the danger signs in this case.
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72
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
OSCE Station 5
Counseling a mother
for referral of newborn
A 34 weeks 1700 grams female newborn
is born in your PHC by normal delivery.
You decide to refer the newborn to a
nearby district hospital.
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Counsel the parent for referral
73/:
Part 3: Essential Newborn Care
....
________
___________
OSCE Station 6
Infection Control
Given are some items or equipment.
Some can be reused. Some are for single
use only.
j
,dj
Write against each item or equipment,
how you could clean or sterilise it before
reuse.
I
If for single use write "for single use"
against the said item or equipment.
Please use the answer sheet provided
74
SUKSHEMA Nurse MentorsTraining Program Volume 3
.0
Essential Newborn Care at 24/7 Primary Health Centres
MMMHj
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1
■
OSCE Station 7
Discharge counseling for
a LBW baby
IO
Ms Shanty delivered a term male
newborn who is 2kgs.
■1
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Newborn is stable and is ready for
discharge.
-•
■
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Counsel Ms Shanthy on how to keep
the newborn warm, at home.
75•< <*.
Part 3: Essential Newborn Care
IS
OSCE Station 8
Breast Feeding
Look at the picture of a newborn breast
feeding. Then read the points given
under position and attachment in the
ANSWER SHEET.
Write against each POINT if CORRECT
OR WRONG.
76
SUKSHEMA Nurse Mentors Training Program Volume 3
&
Essential Newborn Care at 24/7 Primary Health Centres
OSCE Station 9
.... .g
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I
II
Mentoring of a Nurse who is
■
■
■ Checking Temperature
I1
■H
■
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■■
■ A nurse is checking temperature on a
II newborn mannequin.
I
I
I■ You are the mentor. First see if the nurse
I
did procedure correctly or not
H.
IHI 4
V’
I Then using mentoring principles model/ !
■i
■■ demonstrate to the staff nurse on how
to check temperature
1
77
Part 3: Essential Newborn Care
OSCE Station 10
Case Record Entry for Newborn
Read the case given below. Record the details
in the case sheet provided.
'F
II
Ms. Seema gave birth to a 2000 grams,
term, male newborn at 5.30am on 20.7.12.
II
II
The newborn cried soon after birth, was
active, heart rate 110/minute, respiratory
rate 60/minute, feet were blue but rest of
the body pink (APGAR 9 at 1 minute).
The newborn was dried and handed over
to the attendant immediately. Later the
baby was kept near the mother.
I
I
No anomalies were detected at birth.
Injection vitamin K 1 mg was administered
on the left thigh. Newborn started feeding
at 5.50am. The cord and eyes were cleaned.
Staff nurse Asha conducted the delivery
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78
SUKSHEMA Nurse Mentors Training Program Volume 3
Essential I
Answer Sheet for Station 2: Radiant Warmer
Candidate Name:,
1. The servo mode temperature is set at 38°C
True/False
2. The manual mode is used when a newborn is first placed under radiant warmer
True/False.
3. A newborn under radiant warmer loses more fluids
True/False
4. All newborns requiring resuscitation must be placed under a radiant warmer
True/False
5. If a newborn is overheated with radiant warmer, then the skin will flushed (red),
axilla temperature will be high, the body and feet/hands will be warm to touch.
True/False
I
Answer Sheet for Station 2: Radiant Warmer
Candidate Name:,
1. The servo mode temperature is set at 38°C
True/False
2. The manual mode is used when a baby is first placed under radiant warmer
True / False.
3. A newborn under radiant warmer loses more fluids
True / False
4. All newborns requiring resuscitation must be placed under a radiant warmer
True / False
5. If a newborn is overheated with radiant warmer, then the skin will flushed (red),
axilla temperature will be high, the body and feet/hands will be warm to touch.
True/False
Part 3: Essential Newborn Care
Answer Sheet for Station 4: Identification of Danger Sign
Name of Candidate:
Write the answer to each question in the answer sheet
Picture 1
Picture 2,
Picture 3.
Picture 4,
Question 5,
Answer Sheet for Station 4: Identification of Danger Sign
Name of Candidate:
Write the answer to each question in the answer sheet
Picture 1
Picture 2,
Picture 3.
Picture 4.
Question 5
Si
SUKSHEMA Nurse Mentors Training Program Volume 3
f,„;
Essential Newborn Care at 24/7 Primary Health Centres
■■
■
■
■
■■
"
feta
Answer Sheet for OSCE 8: Breast Feeding
Position and Attachment
Candidate Name
Write against each point if "CORRECT" or "WRONG"
Correct or Wrong
Position
■
■
1
Newborn's head and body in straight line
2
Newborn's head and body facing mother
3
Newborn's body close to mother
4
Newborn's wholebody well supported
-....
•
..
.
Attachment
IWi
5
Mouth wide open
6
Chin touching breast
7
More areola seen above than below
8
Lower lip everted
9
NOT correctly POSITIONED
10
NOT correctly ATTACHED
Total
Bi
Part 3: Essential Newborn Care
■
i.i bi
—
Answer Sheet for OSCE 10 - Case Record Entry
Candidate's Name:,
B. PARTICULARS OF THE NEWBORN
Mi
General
Sex Male
WeightgmsLBW (<2500 gms) ! Y
Female
Still birth
Outcome Live birth
If still birth, Fresh
N.
Macerated QMaturity Preterm(<37 wks) LJ
Term (37 to 42 wks)
Post term (>42 wks) QApgar score
Any anomalies Y
N
at 1 min
at 5 mins
If yes, list
Resuscitation
Suction done Y U N Q Oxygen given Y
N Q newborn breathing after 30 secs Y U N U
If no, use bag and mask for 30 secs Y Q N
newborn breathing after another 30 secs Y U N Q
If still not breathing (Asphyxia), continue bag and mask ventilation Y
N
Oxygen given Y
N
Chest compressions done (if trained) Y U N U and Manage and refer using Complication Sheet G
Medication given
Injection Vitamin K Y
N
Dose 1 mg for > 1500 gms
or 0.5 mg
1500 gms
Others
(specify)
Breastfeeding initiation
Time of initiating breastfeeding hrsmins
Initiation of immediate skin to skin contact Y U N U Chlorhexidine applied on cord Y Q N LI
Newborn attended by Name
Signature
Designation SN Q
MO
Other
COMPLETE THE CHILD SECTION OFTHAYI CARD
SUKSHEMA Nurse Mentors Training Program Volume 3
■ ■■Si
Essential Newborn Care at 24/7 Primary Health Centres
_____
________________
SHI
___
Ll
LOG BOOK FOR USE
DURING NEWBORN
CLINICAL POSTING
Part 3: Essential Newborn Care
-»
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j
■■■■
Objectives of the Neonatal Practical
Training
By the end of the training program, you will
■M
❖ Demonstrate how to do an initial gestational age assessment of
a newborn newborn (weight, by weeks based on IMP, physical
features)
<♦ Assist in or perform initial steps of basic neonatal resuscitation for
those neonates requiring it (warmth, suction if needed, position,
stimulation, position, bag and mask)
❖ Demonstrate routine care of a newborn from birth to discharge
(warmth, breast feeding, prevention of infection, cord and eye care)
❖ Demonstrate how to feed a LBW baby using a paladai, cup, spoon
II
!l^
❖ Demonstrate how to assist and counsel a woman to give KMC
❖ Identify danger signs based on observation
❖ Initiate initial management for a newborn who presents with danger
signs
❖ Counsel a woman during postnatal period on various aspects
concerning the newborns care (warmth, prevention of infection,
breastfeeding, immunisation, danger signs)
❖ Complete referral procedure for a newborn needing it.
ill
I
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SUKSHEMA Nurse Mentors Training Program Volume 3
Essential Newborn Care at 24/7 Primary Health Centres
HMHI
(To be completed during practical at Training Institution)
J Signature will be put only if the participant has demonstrated the procedure as instructed and
given in the checklist.
SNo
1.
Competency
Weighing newborn accurately (OB)
Observed (Date)
Demonstrated Signature(Date)
1.
1.
2.
3.
4.
5.
2.
Wrapping newborn with a towel (OB)
1.
1.
2.
3.
3.
Giving cord care (OB)
1.
4.
Giving eye care (OB)
1.
1.
2.
3.
1.
. 2.
3.
5.
Assess APGAR of a newborn (OB)
1.
k
.
.■
2.
3.
4.
5.
6.
Assist in neonatal resuscitation (OB/NICU)
1.
1.
2.
3.
7.
Keep a newborn corner ready (OB)
1.
1.
2.
3.
8.
Check if all resuscitation equipment are ready,
working condition (OB/NICU)
1.
1.
2.
3.
4.
5.
9.
Gives immediate newborn care (OB)
1.
1.
2.
3.
4.
5.
85/,'
Part 3: Essential Newborn Care
al
■
10.
Observes breastfeeding (OB)
1.
1.
2.
3.
4.
5.
11.
Gives Vitamin K (OB)
1.
1.
2.
3.
4.
5.
12.
1
Assists mother to give KMC (NICU)
1.
2.
3.
4.
5.
13.
1.
Feeds a newborn with paladai (NICU)
1.
2.
4.
5.
14.
1.
Care of radiant warmer (NICU)
1.
2.
3.
15.
1.
Observes a new born newborn (OB /NICU)
1.
2.
3.
4.
5.
16.
Cares for a newborn with sepsis (NICU)
1.
17.
Cares for a newborn with asphyxia (NICU)
1.
18.
Cares for a newborn with LBW (NICU)
1.
19.
Counsels a mother for breast feeding (OB)
£
20.
Counsels a mother for KMC (NICU)
1
21.
22.
23.
24.
Counsels / teaches a mother about danger
signs (OB/NICU)__________________________
Counsels a mother for referral / follow-up (OB/
NICU)___________________________________
Counsels /teaches a mother about keeping
1
1
1
1
the newborn warm at home (OB/NICU)
Counsels / teaches a mother about prevention
of infection (OB/NICU)_____________________
1
Comments of supervisor of overall performance
SUKSHEMA Nurse Mentors Training Program Volume 3
■
.
-
Essential Newborn Care at 24/7 Primary Health Centres
-------------- ■
<
■■
...
'
MKMM
(To be completed during practical at Training Institution)
Signature will be put only if the participant has demonstrated the procedure as instructed and
given in the checklist
SNo
1.
Competency
Weighing newborn accurately (OB)
Observed(Date)
Demonstrated
1.
Demonstrated
1.
2.
3.
4.
2.
Wrapping newborn with a towel (OB)
1.
5.
1.
2.
3.
Giving cord care (OB)
1.
3.
1.
2.
4.
Giving eye care (OB)
1.
3.
1.
2.
5.
Assess APGAR of a newborn (OB)
1.
3.
1.
2.
3.
4.
6.
Assist in neonatal resuscitation (OB/NICU)
1.
5.
1.
2.
7.
Keep a newborn corner ready (OB)
1.
3.
1.
2.
8.
Check if all resuscitation equipment are ready,
working condition (OB/NICU)
1.
3.
1.
2.
3.
4.
9.
Gives immediate newborn care (OB)
1.
5.
1.
2.
3.
4.
Part 3: Essential Newborn Care
Signature(Date)
gjl
—------------.
10.
1.
Observes breastfeeding (OB)
5.
1.
2.
3.
4.
11.
Gives Vitamin K (OB)
1.
5.
1.
2.
3.
4.
12.
Assists mother to give KMC (NICU)
1
5.
1.
2.
3.
4.
13.
1.
Feeds a newborn with paladai (NICU)
5.
1.
2.
3.
4.
14.
Care of radiant warmer (NICU)
1.
5.
1.
2.
15.
Observes a new born newborn (OB /NICU)
1.
3.
1.
2.
3.
4.
16.
Cares for a newborn with sepsis (NICU)
r.
5.
17.
Cares for a newborn with asphyxia (NICU)
L
1.
18.
Cares for a newborn with LBW (NICU)
L
1.
19.
Counsels a mother for breast feeding
J
1
20.
Counsels a mother for KMC
1
21.
22.
23.
24.
Counsels / teaches a mother about danger
1
signs
Counsels a mother for referral / followup
1
Counsels /teaches a mother about keeping
1
the newborn warm at home
Counsels / teaches a mother about prevention
of infection______________________________
1
Comments of supervisor of overall performance
SUKSHEMA Nurse MentorsTraining Program Volume 3
■
i
B
:
J ■
Essential Newborn Care at 24/7 Primary Health Centres
___________________________________
Checklist for Procedures
Observed / demonstrated
Competency
SNo
Weighing baby accurately
S
Cleans the weighing machine with disinfectant
J
Washes hands
Places cloth over the tray
Checks if"O"is adjusted
Place newborn on the tray with nappy only
z Check weight
Remove nappy and check weight of nappy
z Record accurate weight on case sheet
Assess gestational age of newborn accurately
S
By weight
S
By physical features: skin, ears, genitalia, sole
creases, posture
By gestational ag'£
Wrapping baby with a towel
J
Washes hands
S
Place towel under newborn's back
J
Wrap one end over the body and tuck under back
S
Do similar movement with other end
Giving cord care
S
Change gloves if delivery was conducted
Cut cord with clean scissors
J
Clean cord with sterile swab
S
Keep dry
Tie napkin below level of cord
Giving eye care
J
Wash hands
S
Clean eye with clean swab dipped in sterile or
boiled water from inner canthus to outer canthus
Use separate pieces of cotton swabs for each eye
Part 3: Essential Newborn Care
1
2
3
4
5
—--- --■
;
■
.
;
I
Assess APGAR of a newborn
S Uses APGAR chart to score
J Records in the case sheet
Assist in neonatal resuscitation
S Checks if all equipment and articles are available
J Washes hands
Dries newborn and wraps with warm towel
Checks for breathing
Clamps and cuts the umbilical cord
z
Places newborn in a warm hard surface
Position newborn correctly with a rolled towel
beneath the shoulder
z Gently stimulates newborn
J
Suction if needed
z
Position newborn again
Give bag and mask ventilation
Reassess, if needed assist in chest compressions
Keep a newborn corner ready
Uses checklist for newborn corner
Check if all resuscitation equipment are ready, working
condition
z Check if ambu bag inflating on own palm after
pressing
Check if ambu bag is clean
z Check if all articles required are in place
Check if all articles are cleaned
J Check if medications are available
SUKSHEMA Nurse Mentors Training Program Volume 3
J
•• •
Essential Newborn Care at 24/7 Primary Health Centres
A
Gives immediate newborn care
Washes hands
Places newborn over warm towel on mothers
abdomen
Z
Dries newborn and changes towel / cloth
Cuts cord with clean scissors after clamping it
J
Places newborn between mothers breasts for skin
to skin
S
Wraps newborn
S
Cleans newborn's eyes
S
Cleans cord
Z Gives vitamin K
S
Assists mother to feed the newborn
Observes breastfeeding
Z Use observation checklist
Z Check for correct position
Check for good attachment
Z Check for effective suckling
Check if newborn is having adequate feed
Gives Vitamin K
Z Washeshand
Takes correct dose in syringe
Identifies site correctly
S
Cleans the site
S
Injects medication slowly
J
Removes needle
Z
Massages the site
Z Discards needle in appropriate manner
S
Washes hands
Records in the case sheet
Assists mother to give KMC
J
Removes clothes of the newborn
Puts cap and socks for the newborn
z
t
Places newborn between mothers breasts so that
skin to skin contact is there
Wraps a towel around the newborn's back and to
the mother
Asks mother to assume comfortable position
Encourage to feed as per need
Part 3: Essential Newborn Care
.
™
.
■ •
r r 'VM- t f ■:
Feeds a newborn with paladai
J
Wash hand
J
Check if container to measure milk is clean
Take syringe and measure amount of feed.
Pour required amount in the paladai
J
Hold newborn so that head is slightly extended
and back is supported
Tilt the paladai gently over the mouth
J
Check if newborn is taking the feed by self with
sucking movements
Care of radiant warmer
J
Cleans radiant warmer with disinfectant
J
Places clean towel /cloth on the mattress
J
Puts the radiant warmer on and adjusts the
temperature
J
Washes hands
J
Undresses newborn and place under radiant
warmer
J
Places skin temperature probe correctly
S
Records temperature on case sheet
Observes a new born baby
Checks if newborn is feeding well
J
Checks if newborn has any danger signs
J
Checks if mother is confident in daily care
- keeping warm, feeding newborn, prevent
infection, follow up and recognition and reporting
danger signs
Counsels a woman for breast feeding
J
Introduces self
J
Assesses how breast feeding is occurring
J
Explains the benefits of breast feeding
J
Explains about exclusive breast feeding and
feeding on demand both day and night
S
Checks if the woman has any doubts
Tells woman the signs of adequate feeding
SUKSHEMA Nurse Mentors Training Program Volume 3
0
J ' •
< < :
'
Z
Essential Newborn Care at 24/7 Primary Health Centres
li
Counsels a woman for KMC
Introduces self
J Assesses woman's awareness of KMC
Z
Explains benefits of KMC
Z
Shows her how to implement KMC
S Informs woman when, for how long and who else
could give KMC
Clarifies any doubts
J Tells woman what she needs to check when the
newborn is with KMC
Counsels a woman for referral
S Introduces self
S Assesses what the woman knows about her
newborn's condition
J Informs the woman about the reason for referral
Finds out what support she has and who could
accompany the newborn
z
Checks about transport arrangements
J Clarifies doubts
Cares for a newborn with sepsis
Cares for a newborn with asphyxia
Cares for a LBW newborn
Part 3: Essential Newborn Care
*
sukshema
Improved Maternal, Newborn & Child Health
Centre for
Global Public Health
*-—-—o——-—----- University of Manitoba
University
qf Manitoba
BO
Infra Health
INTERNATIONAL ^^£7''A A’*
Because Health Workers Save Lives.
St John's National Academy of
Health Sciences
|<aruna tbu^t
' 20 years of Integrateil Ru ria I Development .
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