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Skill Lab

Strengthening of Skills Lab at Nursing Institutions – Odisha

1. Introduction
The Millennium Development Goal 4 & 5 on Improving Maternal and Child Health aims at reduction of MMR to 109 / 100,000 live births and IMR to 41 / 1,000 live births in India by 2015. Reduction of MMR, IMR, NMR and TFR are priorities of the Government of India. Various steps have been taken by GOI and the State Governments for accelerating the pace of decline of key indicators and to achieve the goals & targets set under NRHM. However, for achieving 12th plan goals and international commitments such as MDGs, there is a need to further accelerate the initiatives with special focus on quality parameters. Improvement and achievements on these goals are possible only if the health care delivery system is strengthened with technically competent health care providers at all levels to deliver critical Reproductive, Maternal, Neonatal and Child Health (RMNCH) services at institutional and outreach levels with universal coverage, equity and quality. Hence, capacity building of health care providers to make them proficient in technical skills and knowledge requires key intervention for ensuring the desired outcomes.

Various types of skill based trainings are being implemented by the State with NRHM support, but ensuring practice of standard technical protocols impacting quality of servicesstill remains a challenge. Despite the various types of trainings in RMNCH, it is observed that the health care providers are less confident in applying skills. Limited focus on assessing the competencies acquired by the trainees during the training, inadequate exposure / opportunity to practice them during training, lack of post training follow up and under utilization of trained manpower at functional health facilities,have resulted in compromise of skill acquisition,practices and sustenance. As a result, manytrainees, who have not acquired the requisite skillscontinue to provide services, impacting qualityhealth outcomes. Moreover, the opportunities forre-training of these health care providers are alsolimited.Another challenging area, is the weak infrastructure, poor technicalcapacity and inadequate teaching – learningcapabilities of the Nursing Schools and the ANMTraining Centres. There is no structured plan forContinuing Nursing Education / Continuing MedicalEducation or reorientation training. RMNCHMonitoring visits have also revealed many of theequipments provided to the health facilities remainunutilized for want of operational knowledge andskills. Preventive maintenance of these equipmentsis also limited. Hence, strengthening the pre-serviceand in- service trainings is also critical for ensuringquality of services in health facilities. Strengtheningpre-service training will further reduce the burdenon ‘in service trainings’ of these cadres.
2. Overview
Comprehensive Skills Lab with skill stationsare designed with the aim of acquisition andupgradation of the skills of health care providers toenhance their capacity to provide quality RMNCHservices leading to the improved health outcomes.A Skills Lab will comprise of skill stations wherethe trainees learn through practicing skills onmannequins, simulation exercises, demonstrationvideos and presentations. The basic objectiveis the reorientation of the personnel during inservicetraining and continuing medical educationof health care providers for RMNCH services. Theskills lab will also be utilized to train and orientthe students pursuing ANM, GNM and Midwiferycourses. The certification will be based on thecompetencies acquired during the training. TheSkills Lab will have dedicated trainers who provideon-site mentoring to ensure practicing of the skillsand adherence to the technical protocols acquiredby the trainees.

The College of Nursing, Berhampur, is being developed as Centre of Excellence(the State Nodal Centre) and will have one Skills lab. Further the Skills labwill also be set up at divisional level comprising ofa cluster of 4 to 5 districts and in due course it is soenvisaged that every district will also have one Skills Lab.

In the NHM PIP for the 2013-14, it was planned to establish 4 fully functional skills labs at the following institutions:

  1. College of Nursing, Berhampur
  2. GNMTC, Burla
  3. ANMTC, Bolangir
  4. ANMTC, Bhubaneswar.

3. Objectives of establishing Skills Lab
A competency is a grouping of elements ofknowledge and skills necessary for the effectiveperformance of a job / task. "Competent" staff hasthe ability – i.e, the requisite knowledge and skills– to proficiently perform their job. The competencybased training intends to achieve this objective.The competency based learning approach providesa means for learners to practice and acquire clinicalskills and also upgrade their knowledge. It allowsfacilitators to demonstrate the correct steps andgives an opportunity for repetition and feedbackto the learners. It permits individualized learningthrough videos and self practice on mannequins.The skill stations help in clearly defining the learningoutcomes against each activity being demonstratedat different stations. Thus the assessment of thetrainees becomes specific for the competenciesacquired. This will also help in identifying thetrainees who are weak in a particular skill, gettingan opportunity to have their skills reinforcedthrough periodic reorientation.Skills Lab serves as a prototype demonstration andlearning facility for health care providers so thatthey develop desired competencies. Skills Lab isequipped with various skill stations as per the skillrequirements for various cadres of the health careproviders. This will also aid in institutionalizing theusage of Standard Operating Procedures (SOPs)and adherence to technical protocols, so that theybecome a part of routine practice. Such labs havean edge over other didactic methods by providingthe opportunity for repetitive skill practice,simulating clinical scenarios under the supervisionof a qualified trainer.

  1. A Skills Labfacilitates acquisition / reinforcement of keystandardized technical skills and knowledgeby service providers for RMNCH services.
  2. Ensures the availability of skilled personnel athealth facilities.
  3. Improves the quality of pre service trainingprovides Continuing Nursing Education /Continuing Medical Education

4. Setting up of Skills Lab
The Skills Lab will have a set of structured skillstations with the specific objective of impartingcompetency in skills. The teaching and training atthe Skill Lab will be through interactive learning. Themethodology for such learning focuses on gainingknowledge through power point presentation anddiscussions, use of videos and skill acquisitionsthrough repeated hands on practices on themannequins. These skill stations are of two levels;basic level, add-on and advanced level. Basic skillsare the essential skills required for all cadres i.e.ANM, Staff Nurses, Lady Health Visitors, MedicalOfficers, Nursing supervisors, Teachers and Trainersinvolved in imparting knowledge of EssentialRMNCH services and supervision of provision ofEssential RMNCH services. The add-on stationshave skill stations to provide specialised skillsrequired for Medical Officers, Nursing supervisorsand Trainers. The advanced skill stations focus onspecialized skills expected of Medical officers andSpecialists, which most often requires advancedmannequins capable of simulating various clinicalscenarios. The skills labs being set up will deal with only the Basic and Add-on skills. The list of Skillstations with skills is given in annexure 1.

  1. Designate a District Nodal (DNO)officer for Skills Lab operationalization andits functioning. Preferably,either the officer in charge of Reproductive andChild Health (RCH) programmes or the ADMO (Medical) / MedicalSuperintendent of the hospital where trainingfacility is located should be designated as District Nodal Officer (DNO).
  2. Select a location and space for setting up SkillsLab. This should ideally be established in thepremises of a well-functioning District Hospital/ MCH centre, Govt Nursing Institute or any other government hospitalhaving adequate delivery load, conducting C-Section, adequate Human Resources, good andfunctional Labour Room, Operation Theatreand other related services. The Skills Lab must be linked with district hospital /any other hospital for exposure visits and realtime learning opportunities.

5. Prerequisites for Skills Lab

  1. One of the critical steps will be to establish amodel Labour Room in the attached hospital, wheredefined Standard Operating Procedures (SOPs) andtechnical protocols are practiced so that the traineesvisiting these facilities can learn to upgrade / set upsimilar facilities at their own institutions.Ideally, there should be enough space toaccommodate all skill stations in one big hall whichis about 1000 sq.ft . Attached to this hall there willbe a space of about 300 sq.ft, which will function asa seminar room where facilities for presentations(computer / laptop, LCD projector, screen, etc.) areavailable. Every lab must have net connectivity.There should be another small room attached tothe lab which will function as office.
  2. The second important requirement for carrying out the in-service staff training is availabilityof accommodation for 16 trainees (not necessarilyin the same premises but at least nearer to thetraining site).
  3. The space allocated for skills lab should haveuninterrupted power supply, water supply,adequate lighting and ventilation. A provisionfor class room sessions with LCD projector isto be ensured.
  4. Parallel steps to be undertaken for procurementof mannequins, equipments, consumables,teaching - learning aids, computers, laptopsetc. as per list and specifications specified foreach skill station.
  5. Providing enabling environment for traineesand trainers in terms of continuous availabilityof supplies, day to day maintenance andinfrastructural requirement, food and othersuch requirements which if not provided forcan compromise quality in training.
  6. Appropriate accommodation needs to beprovided to the trainees along with facilitiesfor transport, in case it is located at a distance.
  7. Initiating process of recruitment of trainersfor the skills lab.
  8. Prepare the training plan as per the trainingload estimate.
  9. Timely conduct of the scheduled trainings is to be ensured.
  10. Schedule the mentoring visits of the mobiletrainers.
  11. Ensure maintenance of database of thetrainees with competencies acquired, skillsgaps for re-training and details of mentoringvisits.
  12. DNO to communicate to the ChiefDistrict Medical Officers for ensuring rectification / fillingof gaps identified during supervisory visits ofthe Skills Lab trainer.
  13. Regular reporting of progress to the State. Nodal Officer (SNO).
  14. Coordination with nursing institutions for theconduct of pre-service training using SkillsLab.
  15. Monitor the key performance and processindicators.

6. Human Resource
Every Skills Lab will have dedicated staffmembers consisting of 4 faculties / trainersand among them one will be designated as in-chargetrainer or Skills Lab coordinator.
Among the 4 faculties, one will be MBBS withhigher qualification, preferably LMO and threegraduate / post graduate nursing staff. Besidesthis, there will be one data entry operator andone grade IV staff as multipurpose worker.The selection shall be done by the State NRHM. Selection will be done strictly as per theGOI defined Terms Of Reference (TOR) andfollowing the defined selection proceduresstipulated by GOI.

Skill Lab Training Manual

Skills Lab Operational Guidelines

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