By : M. Grace Sandra Musabwasoni Team Members: Dr Mickey Kerr, Prof. - PowerPoint PPT Presentation

First Joint Scientific Conference For ASSESSING THE IMPACT OF MENTORSHIP ON RWANDAN NURSES’ AND MIDWIVES’ KNOWLEDGE AND SELF - EFFICACY FOR MANAGING POSTPARTUM HEMORRHAGE By : M. Grace Sandra Musabwasoni Team Members: Dr Mickey Kerr, Prof. Manassé Nzayirambaho, Dr Yolanda Babenko-Mould and Dr. Anaclet Ngabonzima

Disclosure  The author declares having received a scholarship for master’s studies at Western University through the TSAM project in Rwanda.  However, the TSAM project had no influence of any aspects of how the research was conducted, the data analysis process, or report of study results.

OUTLINE  Background  Literature review  Purpose  Methods  Findings  Discussion  Implications, recommendations and conclusion

Background about postpartum hemorrhage (PPH)  In 2015, worldwide maternal deaths were 303,000.  Developing countries experienced 99% of total maternal deaths, Sub-Saharan Africa alone accounts for 73.6% (223,000) of the maternal deaths. In Rwanda, the maternal mortality rate (MMR) is 210 deaths/100,000 livebirths.  PPH accounts for 70% of all causes of maternal mortality (MM) and remains the leading cause of MM in Rwanda (Ghalandari et al., 2017)  PPH involves excessive maternal blood loss of more than 500 ml vaginally(+ 1000 ml blood loss with cesarean section) within the first day after giving birth.

Mentorship  Mentorship: a professional relationship between an experienced person (the mentor) and a less experienced person (the mentee) in developing specific knowledge and skills  Mentor: supports the professional development of a less experienced colleague  Mentee: voluntarily seeks guidance from the mentor  TSAM project used a practice- based mentorship model aimed to improve nurses’ and midwives’ emergency obstetrics skills including management of PPH.

TSAM mentorship model  The TSAM project team, rather than the researcher, developed and carried out the practice-based mentorship model in HC in Rwanda  Started in October 2018 with 24 mentors from DH and 169 mentees at the selected HC  One visit per month for a period of six months  Mentors worked closely with mentees in the practice setting during direct patient care or used simulated learning with mannequins to teach mentees about PPH and its management

Literature review summary and identified gaps  Mentorship about PPH increased health care professionals’ knowledge, skills and enabled behavior change to more readily manage PPH  Gap in literature – Authors propose knowledge about PPH is not sufficient without also having self-efficacy for management of PPH. However, no known studies in Sub-Saharan Africa associating knowledge and self-efficacy for PPH management among nurses and midwives (Bissett et al., 2016; Ritchie, Bates, & Deary 2015; Veeramah 2016; Woiski et al., 2015, Friesen, Brady, Milligan, & Christensen, 2017; Scott and Brysiewicz 2017).

Literature review summary and identified gaps  In Rwanda, there is only limited evidence in the literature about mentorship or practice-based mentorship related to PPH management at the level of HC.  One study examined the management of pregnant women from antenatal care up to the delivery of the baby while assessing providers’ knowledge about signs and symptoms of PPH (Zoungrana et al., (n.d)  The study did not assess providers’ knowledge together with self -efficacy about PPH management

Study purpose To assess the impact of a practice- based mentorship model on nurses’ and midwives’ knowledge about and self -efficacy for management of PPH.

Study hypotheses  H1: Nurses’ and midwives’ knowledge for managing PPH will increase from pre- to post-mentorship.  H2 : Nurses’ and midwives’ self -efficacy for managing PPH will increase from pre- to post-mentorship.  H3: Nurses’ and midwives’ knowledge about PPH management will be associated with their self-efficacy for managing PPH at pre- and post- mentorship.  H4: Nurses’ and midwives’ post -mentorship knowledge and self-efficacy will increase with the number of mentorship visits attended.

Methods  Theoretical framework: Bandura’s self -efficacy theory  Study design: A pre-post quasi-experimental design (Polit & Beck, 2017)  Study setting: 68 Health centres from 3 districts (Gakenke, Rulindo and Gicumbi) in the Northern Province of Rwanda.  Study sample: A convenience sample of 122 nurses and midwives who were mentees in the TSAM project.

Methods  Data collection: Study survey involved three parts instrument in English that took 20-30 minutes in total to complete.  Demographic form  Knowledge about management of PPH – 19 questions adopted from Mutunga’s PPH Knowledge tool [(Knowledge, attitude and behavior, (KAP/PPH) 2015] and WHO (2012) guidelines to manage PPH and Rwanda context to manage PPH.  Self-efficacy for managing PPH - 21 items scored on a ‘0 to 10’ Likert scale with 0= not confident at all and 10 = very confident.  Data analysis: The Statistical Software Package for Social Sciences (SPSS) version 25 (IBM, 2018). A paired-t test was the main test for both variables

Methods Ethical Considerations The Western University’s Human Research Ethics Board and the Institution Review Board of University of Rwanda have reviewed and approved this research protocols

Study results The results include:  Participant demographic characteristics  Test of study hypotheses

Participant Characteristics Pre-mentorship Post-mentorship Number of Participants n=141 n=123 Sex of Participants Female: 68% (n=97); Male: 32% (n= 44) Female 73% (n=90); Male 26% (n=33) Mean Age 35.84 (SD=7.8) 35.9 (SD=7.7) Level of Education: A-Level 29.1% (n=41) 31.7% (n=39) Advanced Diploma 66.7% (n=94) 65.9% (n=81) Bachelor 4.3% (n=6) 2.4% (n=3) Professional Qualification: Registered Nurse 61.7% (n=87) 61% (n=75) Registered Midwife 18.4% (n=26) 19.5% (n=24) Registered Nurse-Midwife 3.5% (n=5) 4.1% (n=5) Associate Nurse 15.6% (n=22) 14.6% (n=18) Other 0.7% (n=1) 0.8% (n=1) Labour and Delivery Experience 7.2 (SD=7.7) 7.2 (SD=7.5) Overall Knowledge about PPH 68.9(SD=11.98) 87.01(SD=11.07) Management

Results for H1 and H2 Assessed using a paired t-test

Pre and post-mentorship results with educational level Pre-mentorship results Post-mentorship results

Pre-mentorship professional qualification results Professions Mean Knowledge% (SD) Self-efficacy p-value (0.05) Average (SD) 76.38; SD= 8.967 7.54, SD= 1.351 Midwives 68.30; SD=11.587 6.90, SD=1.711 0.005 Nurses Other 63.29; SD= 12.40 5.76, SD=2.319 <0.001 professions

Correlation results (H3)

Hypothesis 4 • Assessed with ANOVA test

Discussion  Results of the present study add to the existing evidence on the usefulness of mentorship (Scott and Brysiewicz 2017) and particularly in the area of PPH management.  The study also demonstrated that more practice-based mentorship visits was associated with an increase in knowledge about and self- efficacy for PPH management.

Implications and recommendations  According to Dale (1969) “people learn 10% of what they read, 20% of what they hear, 30% of what is demonstrated, but 90% when what is said and done is combined” ( Boctor, 2013 p.97).  The results of this study inform evidence-based mentorship about PPH management and positive changes of knowledge and self- efficacy among nurses and midwives.

Cont.  To increase knowledge and self-efficacy of nurses and midwives who work in maternity, mentorship programs should be replicated in all other areas.  Although knowledge and self-efficacy increase is of paramount importance to improve health services, other factors like knowledge retention, job satisfaction and reduced turn-over rate are also equally important for health delivery improvement. Therefore further studies in relation to mentorship program and these other factors are needed.

Conclusion  The present study investigated the impact of practice- based mentorship on Rwandan nurses’ and midwives’ knowledge and self-efficacy in managing PPH. The results of this study found the increase of knowledge and self-efficacy of nurses and midwives about PPH management.  Thus, the study suggests that maternal mortality due to PPH may be prevented if mentorship is applied to nurses and midwives especially in limited resource- settings including Rwanda

REFERENCES https://ir.lib.uwo.ca/etd/6488