WHO MPS 10.1 Clinical Practice Eng

7/31/2019 WHO MPS 10.1 Clinical Practice Eng

1/80Essential Newborn Care Course Cc Pctc Woboo

CliniCal PraCTiCe WOrkBOOk

Essential newborn care course

How to se the Cinica Practice

Workbook5

Genera inormation 6

Module

M1 Care o the bab at the time o birth 11Module

M2 Examination o the newborn bab 25Module

M3

Care o the newborn bab nti

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M4 Specia sitations 57Module

M5 Optiona sessions 73

Cassroom practice 77


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aby

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How to th Cc Pctc WobooRead Section 3.9 o the Trainers Guide or ull inormation about Clinical Practice sessions:

This Clinical Practice Workbook is or trainers and clinical acilitators. It is divided into 6

sections.

The rst section contains:1. Clinical Practice: general inormation or trainers and clinical aci litators, which applies tothe organisation and running o ALL the clinical sessions and should be read beore the coursebegins.2. Four documents:

Role PlayBreasteeding Observation Form 1

These are or Clinical Practice 1 and Observe a birth (Session 3)

Breasteeding Observation Form 2Examination recording Form

These are or Clinical practice 2, 3 and 4

The Breasteeding Observation Forms 1 and 2 and the Examination Recording orm should bephotocopies as required (see individual session ront pages or more details)

The Module SectionsEach o the next 5 section are arranged in the same order.Each section contains instructions, task sheets and checklists which can be used according tohow the course is organised.

The rst part o each modular section contains:

Instruction Sheet

Task sheetChecklist

These three documents cover the clinical practice requirements or each topic in a completemodule. They should be used or courses o 4 or 5 consecutive or individual days which ollowALL o the sessions in each o the rst our modules.

The Instruction and Task sheets give the trainer and clinical acilitator specic guidance onhow to organise the practice session and what tasks have to be completed or that module.

The checklist can be used to monitor the progress o participants during a module CP sessionand practical demonstrations.

Participants Task sheets are part o the Participants Workbook. They should be photocopiedBEFORE the course begins. It is recommended that specic module clinical practice task sheetsare given out during the appropriate clinical practice preparation period.

The remaining documents are:Task sheet or acilitator or trainerTask sheet or part icipantChecklist

These task sheets and checklists are or each individual session. They should be used orsessions taught individually or where a course is taught on hal a day a week or several weeks.

The task sheet or participants should be photocopied as required and given to the participantduring the clinical practice preparation period.

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This inormation applies to ALL Clinical Practices

1. Group organizationThe class will be divided into groups or Clinical Practice:

One TRAINER/CLINICAL FACILITATOR with 4 participantsPlan the groups as soon as the participants list becomes available

BEFORE the course begins. Print a list o all the groups and trainer/clinical acilitator responsible and display it clearly or participantsto see on arrival.

2. General preparation beore eachclinical practice session

Each morningONE TRAINER/CLINICAL FACILITATOR must liaise with

the clinical area and carry out the ollowing tasks:

Ensure mothers and babies available (in the dierent requiredcategories or each Clinical Practice).Write down

the location o the mothers and babies.current numbers o women in labour room and number o womenin early labour (until all groups have observed a delivery andimmediate newborn care).

Prepare appropriate mothers and obtain their permission BEFOREthe participants visite them or clinical session.Plan the rotation o each group and the location where each group

will begin.Conrm the availability o a small room/area where participants cangather between tasks and or discussion.Check i acilities are available or washing and drying hands easilyin the clinical areas. I they are not, arrange or a handrub to beavailable or all participants.Inorm health workers in the clinical areas about the visit.Ask permission or supervised groups to access the mothers orbabies notes.

dring the week beore the course begins, acilitators and trainersshould:

Meet and visit the clinical area and briefy discuss how the clinicalpractice is organized.Decide who will liaise with the clinical areas each day.Decide in advance where participant groups will work.Decide how to organize the rst clinical practice so that each groupvisits the labour ward in rotation when a delivery is about to takeplace.

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3. General inormation or participantsGive this general inormation to the whole class beore the groups go tothe clinical area or the rst clinical practice.

During each clinical practice participants havea. two main tasks whichare:To observe the care o newborn babies in relation to the topicscovered in the classroom beore the clinical practice session andto practice, where possible, some o the skills learnt.To use what they learn on the course to refect on the clinicalpractices in their own workplace.

Participants will work in groups o 4 with 1 trainer or clinicalb.acilitator.

The clinical acilitator will arrange where to meet and prepare eachc.group BEFORE the clinical practice.

At this meeting each group will be told:d.Where they will begin the cl inical work,What they will seeWhat they will doWhat order they should carry out tasksHow they should work.

Each participant will be given:e.A sheet with instructions or the sessionRelevant orms appropriate to the clinical practice

In addition participants should take with them:Pen/pencil and notebookPCPNC Guide (one between two participants)

Ater each task is completed participants will have a short.discussion with the trainer or clinical acilitator about what theyhave seen or done. This should be in a quiet, private part o theclinical area, away rom the mothers. Corridors should not beblocked. Chairs in a public waiting area should not be used, unlessthey are available.

During some tasks the trainer or clinical acilitator will assess theg.participants. I the task is not completed satisactori ly it may have to

be repeated.

Participants will only pass the course i they attend all sessions andh.pass the assessed tasks.

Participants can also make notes o what they see, o anything oi.interest or questions related to the topic, which they would like todiscuss later with their trainers, acilitators and colleagues in thePractice Review session.




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eMPHasize the ollowing points:

The aims o the clinical practice are to eeop an improe

participants own skis an working practices.In the clinical setting they may see practices that are not bestpractices.They should NOT criticize what they see. Instead, they should think

about how changes can be made.They should ensure their own care o the newborn baby and motheris o a high standard.They MUST NOT discuss individual cases they visit in the clinicalarea.They MUST speak quietly.They must wear their name badges and appropriate clothing in theclinical area.I they have any problems or questions during the clinical practicethey must FIRST o all consult their clinical acilitator.

ASK if there are any questions.

Cinica aciitators an trainers can now prepare their grops.Remember that beore Clinical Practice 1 begins, there is a short roleplay that all the class must see prior to going to the clinical area.

Frther etais abot the organization o the cinica practice sessions

can be on in the Trainers Gieines.

4. The role o the trainers and clinicalacilitatorsIn the clinical area the role o the trainer and clinical acilitator is to:

a.Arrange with participants in the group where to meet orpreparation o the Clinical practice session.Instruct participants where to begin.

b.Ensure the clinical experience meets the practical objectives o thetaught sessions.Demonstrate set skills and oversee participants practicing theseset skills.Ensure participants have relevant instructions. Read theinstructions with the group so they are clear about the purpose othe session and what they are doing.Instruct participants in what order they will carry out their tasks.

c.Demonstrate set skills to their group at the beginning o eachsession.Assign group members to particular mothers and babies.

d.

Discuss participants ndings in a quiet part o the clinical area

away rom the mothers and babies when each task is completed.Ensure all participants carry out tasks.




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Fill in the Clinical Assessment Checklist record or eachparticipant.

e.I participants have not completed the tasks successully (andthere is adequate time), repeat the task.

.

Note any weak participants who may need extra help.Identiy any participants unable to demonstrate the skills learnedwho would need additional support or to attend an additionalsession.

g.Note any parts o the session which have not taken place or havenot worked well, which should be included and discussed in thePractice Review Session or Daily Review.



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Instructions

C of th wbo bby t thtm of vyBeore Clinical practice 1, perorm a short role play demonstrating the

immediate management o newborn care at the time o delivery seeaccompanying Role play sheet.

OBJECTIVE:For Participants to observe the care o a mother and herbaby in the immediate period ater birth.

1. Beore clinical practice 1Meet trainers/Clinical acilitators. Decide:

Where group will begin workingOrder o Clinical Practice tasksOrder o groups to visit labour room to observe a deliveryHow to contact each group or visit to labour room

Collect details about:Mother and baby pairs available to visit,Names and location o mothers and babies.

Minimum requirementsONE normal cephalic delivery per group o 4 participantsONE breasteeding mother and baby pair or 1 participant (4 pergroup)

2. Group preparation beore going to theclinical areaGo through Participants Clinical Practice 1 instructions. Ensure groupunderstands what they are expected to do and in what order. Writeorder on task sheet.

Remind group the ocus o this Clinical Practice is:Care o the baby at the time o birthCord and eye care

Keeping the baby warmObservation o a breasteed (and possibly see the rst breasteed)

Each participant should have:Breasteed Observation Forms 1 (2 copies)Pen/pencil and notebookPCPNC Guidelines (ONE between two participants)

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The PRACTICE REVIEW topic or discussion will be:Identiy one aspect o care at the time o birth which could be donedierently.

What COULD YOU realistical ly do to bring about any changes?What would be the main barriers to change?

3. Direct group to their frst task.Tasks can be done in any order according to the situation in theward area. However the priority is to see a delivery and the care oa baby immediately aterwards.Ater each task discuss with the group or individuals rom the groupwhat they have seen/done.Choose an area away rom the mothers e.g. outside the ward, in acorridor or in a designated room

Inormation about YOUR ROLE in each set task is contained in theollowing CLINICAL PRACTICE TASK SHEET.

4. Ater Clinical practice 1Check Clinical Assessment Form or Clinical Practice 1.See any participant who needs to repeat any task or who is weak in aparticular area.Note any parts o the session which did not work well or was notcompleted by all participants. Keep a record o what may still needto be covered in the Practice review session.

Return to the classroom

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Instructions

C of th wbo bby t thtm of vyParticipants must wash their hands beore and ater touching a motheror baby

Care o the newborn baby immediatelyater birthTask or 4 participants (maximum)

In the delivery room:Observe a normal vaginal delivery.

ONLY 4 participants to be in delivery room. Supervise groupthroughout.Group to observe only. Participants MUST NOT help in the delivery.DO NOT OBSTRUCT STAFF.NO discussion in delivery room.Point out important details group should see- speak quietly.Participants to watch the birth and observe care o baby in rst 10minutes ater delivery. I enough time stay until breasteed starts.

Preparation o the delivery roomMake notes o obvious preparations in delivery room or the birth o thebaby i.e. resuscitation equipment, warm cloth etc. The notes should be

used in group discussion ollowing the delivery.

Observing a delivery and the immediate care o the newborn baby

Is the ollowing sequence ollowed? I NOT make notes o whathappens.

Call out time o birth.Deliver baby onto abdomen.Thoroughly dry baby immediately and assess breathing.Wipe eyes. Discard wet cloth.Cover/wrap baby with dry cloth.Cut and clamp/tie cord.

Leave baby on mothers chest in skin to skin contact.

Place identication labels on baby.Cover mother and baby with blanket.Cover babys head with a hat.Encourage breasteeding.

Hand washingTask or 2 pairs

UNIVERSAL PRECAUTIONS must be observed in ALL clinical areas.Participants to bring a small hand towel or their own use in clinical

practices.Pairs to nd sinks in each area they visit, and note the ollowing:

How many sinks are there?Is there clean running hot and cold water? Soap ?

duraTiOn 90 minutes

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Tasksheet

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How do sta and mothers dry their hands?Are sinks easy to get to, when sta are busy?Can mothers easily use them?Are they in a convenient place?ANY OTHER OBSERVATIONS

Keeping the baby warmTask or 2 pairs

Supervise participants making general observations in thePOSTNATAL WARD and the LABOUR AND DELIVERY AREA, notethe ollowing:Ask participants what they have seen so ar. Point out your ownobservations.

How babies are kept warmFactors which may contribute to babies getting cold

BreasteedingTASK or 1 mother/baby pair or 1 or 2 participants

Introduce participants to a mother who is going to breasteed.A complete breasteed should be observed using BreasteedObservation Form 1.I a mother is having breasteeding diculties a sta member shouldbe inormed.I the babys rst eed is observed, the baby instinctive behaviourshould be noted.

Eye careTask or 4 participants

Arrange to see eye care being given soon ater delivery (i possible)

I all tasks and discussion have been completed but you have not yetbeen called to delivery room:

Participants can expect to be called to a delivery later.Check how many women are likely to deliver in the next ewhours.

I it is not possible to see a delivery in the rst CP it should be apriority in the second practice.I group is called during a taught session ater the CP they shouldgo to the delivery.

Participants to nd a mother who delivered in the last 2-6 hours.Ask about her delivery and the immediate care her baby receivedincluding:

When she was rst given her baby,Did she have skin-to-skin contact?When she rst breast ed, Did she have help?When was she rst parted rom her baby?

Make notes or discussion in the Practice review session.

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Task sheet

C of th bby t th tm of bthTask or 4 participants

In the delivery room:Observe a normal vaginal delivery.

NO MORE than 4 participants to be in delivery room.

You are to observe only. You MUST NOT become involved in thedelivery. DO NOT OBSTRUCT STAFF.

Be very quiet and stand in a position where you can see the deliveryo the baby clearly.

I you need to speak to the acil itator speak quietly.

Watch the birth and observe care o baby in rst 10 minutes aterdelivery. I there is enough time, stay until the rst breasteedbegins.

Preparation o the delivery roomMake notes o any preparations you see in delivery room or thebirth o the baby i.e. resuscitation equipment, warm cloth etc. Thesenotes should be used or group discussion

Observing a delivery and the immediatecare o the newborn baby

Is the ollowing sequence ollowed? I NOT make notes o whathappens.

Call out time o birth.Deliver baby onto abdomen.Thoroughly dry baby immediately and assess breathing.Wipe eyes. Discard wet cloth.Cover/wrap baby with dry cloth.Clamp/tie and cut the cord.Leave baby on mothers chest in skin to skin contact.Place identication labels on baby.Cover mother and baby with blanket.Cover babys head with a hat.Wait or the baby to crawl to the breastThe baby initiated breasteeding.

Eye careTASK or 4 participants

Arrange with your trainer to see eye care being given soon aterdelivery (i possible)

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C of th bby t th tm of bthChecklist or assessing clinical knowledge and skills (Facilitator)date Participant nmber 1 2 3 4

Participants initias

Obsere ONE cephaic eier an immeiatenewborn care

THE dElIvERy ROOM

In grop iscssion ater obsering a eier:

Observed evidence o preparations or the birth in

delivery room

Correctly comments on whether observed delivery

ollowed prescribed sequence

Recognizes good and poor practices

Makes suggestions or changing practices

HANd WASHING FACIlITIES

Observed to wash hands beore and ater touching

mothers or babies in the clinical area

KEEPING THE BABy WARM

In group discussion:

Recognizes i clinical practice area eective in preventing

babies rom getting cold

OBSERvING A BREASTFEEd

Observed at least 1 complete breasteed

Completed Breasteed Observation Form 1

OBSERvING EyE CARE

Observed eye care in clinical area ater delivery

OBSERvEd ROuTINE POST dElIvERy EyE CARE GIvEN TO ONE BABy

Can demonstrate and describe routine eye care

observed AFTER delivery

Knows how to treat a local eye inection and on

which page in PCPNC Guide to fnd instructions or

treatment K13

Participants name Faciitators comments

1

2

3

4

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S2Clinical practice st pcto

INSTRuCTIONS FOR FACIlITATORS

H whg fct

Task or 2 participants

STANDARD PRECAUTIONS must be observed in ALL clinical areas.a.Participants should bring a sma han towe or hanrb or their ownuse in cl inical practices.

Pairs to nd sinks in each area they visit and note the ollowing:b.How many sinks are there?Is there clean running hot and cold water? Soap?How do sta and mothers dry their hands?Is there a waste bin nearby?Are sinks easy to get to when sta are busy?Can mothers easily use them?Are they in a convenient place?

Any other observations.

duraTiOn 20 minutes

lOCaTiOn All clinicalareas

INSTRuCTIONS TO BE GIvEN TO PARTICIPANTS

H whg fctTask or 2 participants

In the clinical areas you visit nd the sinks and consider the ollowingpoints make notes to remind you o what you see:

How many sinks are there?Is there clean running hot and cold water? Soap?How do sta and mothers dry their hands?Is there a waste bin nearby?Are sinks easy to get to when sta are busy?

Can mothers easily use them?Are they in a convenient place?Any other observations.

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Task sheet

Obvg bthTask or 4 participants (maximum)

In the delivery room:Observe a normal vaginal delivery.ONly 4 participants to be in delivery room. Supervise groupthroughout.

Group to observe only. Participants MuST NOThelp in the delivery.

dO NOT OBSTRuCT STAFF.

NO discussion in delivery room.

Point out important details group should see speak qiet.Participants to watch the birth and observe care o baby in rst 10minutes ater delivery. I enough time, stay until breasteed starts.

Observation the preparation o the delivery roomMake notes o obvious preparations in delivery room or the birth othe baby i.e. resuscitation equipment, warm cloths, etc.The notes should be used in the group discussion ollowing thedelivery.Wash hands.

Observing a delivery and the immediate care o thenewborn babyIs the ollowing sequence ollowed?I NOT make notes o what happens.

Call out time o birth.Deliver baby onto abdomen.Thoroughly dry baby immediately and assess breathing.Wipe eyes. Discard wet cloth.Cover/wrap baby with dry cloth.Clamp/tie and cut cord.Leave baby on mothers chest in skin-to-skin contact.Place identication labels on baby.Cover mother and baby with blanket.Cover babys head with a hat.Encourage breasteeding.

Observing eye careTask or 4 participants

Arrange to see eye care being given soon ater delivery (i possible).

duraTiOn 90 minutes

lOCaTiOn Delivery room

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Obvg bthChecklist or assessing clinical knowledge and skills (Facilitator)date Participant nmber 1 2 3 4


Obsere ONE cephaic eier an immeiate

newborn care

PREPARATION ANd IN THE dElIvERy ROOM

1. Can escribe preparation o the eier room:

MuST ince:

Resuscitation equipment near delivery bed

Resuscitation equipment checked and ready to use

Warm delivery room (25 C) with no draught

Warm towel/cloth available to dry baby

Other

2. list the newborn babs or ke nees

To breathe, to be warm, to be ed, to be protected

4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1

3. Can escribe immeiate care o newborn bab ater eier

Note time o delivery/deliver onto abdomen

Dry the baby, wipe eyes, change cloth/assess breathing

Clamp and cut cord

Start skin-to-skin contact

Cover with cloth, hat on head

Encourage breasteeding

4. Abiit to refect on how to improe practices

In observed practice

In own health acility (i working in maternity care)

5. Has obsere skin-to-skin contact immeiate ater eier

6. First breastee obsere


1

2

3

4

Checklist

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Task SheetINSTRuCTIONS FOR FACIlITATORS

kpg th bby wmTrainers/Clinical acilitator:

TWO pairs

Supervise participants making general observations inthe POSTNATAL WARD and the LABOUR AND DELIVERYAREA note the ollowing:Ask participants what they have seen so ar. Point outyour own observations.

How babies are kept warmFactors which may contribute to babies getting cold


kpg th bby wmPairs

In the POSTNATAL WARD and LABOUR AND DELIVERYAREA look to see:

How babies are kept warm

Factors which may contribute to babies getting cold

duraTiOn 10 minutes

lOCaTiOn Ward

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Task SheetINSTRuCTIONS FOR FACIlITATORS

Tg bby tmptFOUR participants

DEMONSTRATE to group: Assessing and taking a babys temperatureFollow directions in Section 5 o the session Taking a babystemperature

Supervise each participant:Assessing and taking a babys temperature using a thermometer in thearmpit (axilla)Taking at least ONE temperature


Tg bby tmptGroup

Facilitator demonstration to group o assessing and taking a babystemperature

In pairs, take turns and observe your colleague

Practice assessing and taking a babys temperature using athermometer in the armpit (axilla)Take at least ONE temperature

duraTiOn 10 minutes

lOCaTiOn Ward

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Instructions or acilitators

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OBJeCTiVe: For participants to examine a newborn baby within 12 hours of

birth.

1. Beore Clinical Practice 2Meet trainers/clinical acilitators. Decide

Where group will begin workingOrder o Clinical practice tasks.

Collect details about:Babies who can be examinedMother and baby pairs available to visit or breasteeding

observationbabies with a birth injury or malormation.

Minimum requirements:ONE mother and baby or each participantONE baby with a birth injury or malormation or 4 participantsMother and baby records or baby examination.

2. Group preparation beore going to the

clinical areaGo through Participants Clinical Practice 2 TaskSheet.

Ensure group understands what they are expected to do and in whatorder.Participants to write order on task sheet.

Remind the group that the ocus o this ClinicalPractice is:

Examining a newborn babyCommunication skil lsBreasteeding

Each participant should have:Examination Recording orms (3 Copies)Breasteeding observation orm 2 (3 Copies)Pen/pencil and notebookName badge

PCPNC Guide ( ONE between two participants)

Wash hans beore an ater toching a mother or bab.

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Tell the group what the Practice Review topic ordiscussion will be:

To describe an example o good or poor communication youobserved in the cl inical practice. I it was poor how could it have

been improved?To describe any interest ing cases you examined or observed in theclinical area.

Direct group to their irst task.

reMeMBer

Tasks can be done in ANY order according to the situation in theclinical area.Ater each task discuss with the group what they have seen.Choose an area away rom the mothers, e.g. outside the ward, in acorridor.

3. Ater Clinical Practice 2Complete Clinical Assessment Form or Clinical Practice 2.See any participants who need to repeat any task or who are weak ina particular area.Note any parts o the session that did not work well or was notcompleted by all participants. Keep a record o any issues that needto be discussed in the Practice Review session.

Return to the classroom.

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Tasksheet

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Task sheet

exmto of th wbo bbyCommunication skills

Task or each participant

To be used and practised in ALL tasks and interactions with mothersand sta.

When supervising participants l isten to the way they ask questions,note particularly use o:

Open and closed questionsListening skillsPraiseUsing simple language to give inormation and advice.

Observe non-verbal skills participants use.

Comment on what you have observed with participants ater eachtask is completed. Praise what they have done well.Discuss participants reactions to their own, or their colleagues,communication skills.Complete the Clinical Assessment Checkl ist at the end o the ClinicalPractice.

ExaminationTask or 4 participants

Wash hands.deMOnsTraTe to a group o 4 participants how to conduct anexamination o the newborn baby. Follow instructions on J2J8 .

Remin participants to wash hans beore toching the bab


Divide group into PAIRS, introduce them to a mother and baby.Observe each participant examining a baby using J2J8 . Findings tobe recorded on Examination Recording Form.

Discuss ndings and Treatment and advise that are appropriate orthe baby and mother.

Fill in a Clinical Assessment Checklist. Identiy weak participantswho may need additional support.

I there is time examine a second baby. Give additional support toweak participants.




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Babies with malormations and difcultiesTask or 2 or 4 participants

Take group to see any babies with malormations or with noticeablebirth injuries.I there are enough babies in this category divide the group intoPAIRS to conduct examinations.Carry out an examination as ar as possible without having to touchthe baby (i touching the baby is not possible). Participants shoulduse J2 and J8 to:

Identiy the signsClassiy the babyTreat, advise and ollow-up care.

Observation o a breasteedOne mother/baby pair or each participant.

Task or one mother/baby pair or 1 or 2 participants

Each participant should observe and assess a breasteed using the

Breastee Obseration Form 2.

I a mother is having diculty with attachment and positioningyou should decide i the participant is ski lled enough or i it isappropriate or the participant to help that mother correct herproblem.

Tasksheet

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exmto of th wbo bbyChecklist or assessing clinical knowledge and skills (or acilitators)date Participant nmber 1 2 3 4


Concts an examination on a bab beore ischarge

1. Conducts one examination successully, ollowingJ2J8

2. Classies baby correctly

3. Is able to describe appropriate treatment and advice, and ollow-

up care

Commnication skis

3. Uses:

open questions eectively to get inormation

praise

Assessing a breastee

1. Assesses at least one breasteed ollowingJ4

2. Observes a complete breasteed using the Obseration Form 2.

Correctly classies the babys ability to breasteed

3. Lists the key points to:

good attachment

good positioning

Examine a bab at a oow-p isit or a bab with probems in the neonata nit

1. Conducts an examination usingJ2J8

2. Uses open questions and listening skills to get inormation

3. Correctly classies the baby

4. Can list the 3 occasions when a mother should return with her

baby


1

2

3

4




33Title sbttClinical practice Btfg S5M2


Obvto of btf

Task or 1 or 2 participants or one mother (depending upon number o

mothers)

Introduce participants to a mother who is going to breasteed.

A complete breasteed should be observed using Breastee

Obseration Form 2.I a mother is having breasteeding diculties a sta member shouldbe inormed.I the babys rst ee is observed, the baby instinctive behaviourshould be noted.

duraTiOn 20 minutes

lOCaTiOn All clinicalareas

FOrF

aCiliTaTOr

FOrParTiCiPanT


Obvto of btf

Task or 1 or 2 participants

Observe at least ONE complete breasteed using Breastee Obseration

orm 2.

Discuss your observations with your acilitator.

I you observe any mothers having diculties with attachment andpositioning, inorm your acilitator.Discuss with your acilitator what help and advice you would givethe mother.I appropriate, advise and help the mother and baby to a betterposition and improved attachment.

Return to class to prepare or eedback session.



34 Title sbtt

Obvto of btfChecklist for assessing clinical knowledge and skills (for facilitator)

Sessions 3 and 5date Participant nmber 1 2 3 4 Faciitators comments


Obsere ONE compete breastee

(BEFORE rst taught Breasteeding session)

1. Completed Breastee Obseration

Form 1

2. Can ist:

signs o eective attachment seen on Clinical

Practice

signs o poor attachment seen on Clinical

Practice

3. Can ist:

signs o eective positioning seen on Clinical

Practice

signs o poor positioning seen on Clinical

Practice

amt of btfSession 5date Participant nmber 1 2 3 4 Faciitators comments


Assesses at east ONE breastee

1. Correctly assesses a breasteed ollowingJ4

2. Observes a complete breasteed

using the Breastee Obseration Form 2

3. Is abe to hep a mother in the oowing sitations:

Exclusive breasteeding K2-K3

Helping to initiate breasteeding K3

Teaching attachment and posit ioning K3

4. lists the ke points to:

good attachment

good positioning

5. *With the acilitator observes a SECOND

mother and describes attachment and

positioning and advises on any help needed* Optional.


1

2

3

4

Clinical practice BtfgS5M2



35Title sbttClinical practice Comcto S6M2


Comcto Task or each participant

To be practised in ALL tasks and interactions with mothers and sta:When supervising participants l isten to the way they ask questions,note particularly their use o:

Open and closed questionsListening skillsPraiseUsing simple language to give inormation and advice.

Observe the non-verbal skills participants use.

Comment on what you have observed with participants ater eachtask is completed. Praise what they have done well.

Discuss participants own reactions to their and their colleaguescommunication skills.

Complete the Clinical Assessment Checklist at the end o theClinical Practice.

duraTiOn 20 minutes

lOCaTiOn Ward

FOrF

aCiliTaTOr

FOrParTiCiPanTINSTRuCTIONS TO BE GIvEN TO PARTICIPANTS

Commcto Task or each participant

During ANY conversation with mothers take the opportunity to:Practise using open and closed questionsPraise what the mother is doing wellGive inormationBe aware o how you show interest with your body language.

I you are observing your colleague communicating with a mother,make a note o whether he/she uses the communication skil ls listedabove.

You should practise using your communication skills in all yourtasks rom now onwards (and at other times as well).

Ater examining a newborn baby discuss with your acilitator whatyou noticed about your use o communication skills and the skills oyour colleagues.


36/80



37Title sbtt S7Clinical practice exmto of th wbo bby M2


exmto of th wboTask or 4 participants

Wash hands.deMOnsTraTe how to conduct an examination o the newborn baby.Follow instructions on J2J8 .

REMINd PARTICIPANTS TO WASH HANdS BEFORE TOuCHING THE BABy


Divide group into PAIRS, introduce them to a mother and baby.Observe each participant examining a baby using J2J8 . Findings to

be recorded on Exmination Recoring Form.

Discuss ndings and Treatment an aice that are appropriate or

the baby and mother.Fill in a Clinical Assessment Checklist. Identiy weak participantswho may need additional support.I there is time examine a second baby. Give additional support toweak participants.

duraTiOn 20 minutes

lOCaTiOn Ward

FOrF

aCiliTaTOr

FOrParTiCiPanTINSTRuCTIONS TO BE GIvEN TO PARTICIPANTS

exmto of th wboSession 7 Task Card

TASK or participants working in pairs

Wash your hands beore examining any baby.

Examine a baby as demonstrated by your trainer/clinical acilitator.Follow J2J8 , to:

Identiy the signs

Classiy the babyTreat, advise and give ollow-up care.

Record your ndings using an Examination Recording Form or eachbaby examined.

Discuss your ndings and the treatment and advice you think isappropriate or this baby and mother.

I you have time examine more babies.

Remember to use your communication skills



38 Title sbtt

exmto of th wboChecklist or assessing clinical knowledge and skills (Facilitator)date Participant nmber 1 2 3 4


1. Concts one examination sccess, oowingJ2J8

2. Cassies bab correct

3. Is abe to escribe appropriate treatment an aice an

oow-p care

4. Can:

List danger signs

Describe reerral procedure as described on K14

exmto of th bby t foow-p vt o ot tChecklist or assessing clinical knowledge and skills (Facilitator)date Participant nmber 1 2 3 4


1. Concts an examination singJ2J8

2. uses open qestions an istening skis to obtain

inormation

3. Correct cassies the bab

4. Is abe escribe appropriate treatment an aice an

oow-p care

5. Can ist the 3 occasions when a mother sho retrn with

her bab


1

2

3

4

Clinical practice exmto of th wbo bbyS7M2





C of th wbo bby t chg MOdule 3

Clinical Practice Bc wbo ctto

itcto fo fctto 41

T ht 42

sco c 46


Clinical Practice 3 rot c of th wbo bby (1)

itcto 49

T ht 51



T ht54



40/80



41Title sbtt

FOrFaCiliTaTOr

Instructions or acilitators

Bc wbo cttoThis practical session immediately ollows Session 2a.This is a classroom-based assessment.

Participants are divided into groups o 4 with one acilitator.They practice resuscitation on a manikin.

NOTE: In an ideal situation there will be one resuscitation manikinand set o equipment or each participant group. Where this is notpossible alternative arrangements will need to be made to ensure thatall participants acquire the necessary skills and can make appropriatedecisions.

ObjectivesAt the end o this session, each participant should be able to:Demonstrate, at least twice, care o the baby at birth and basic

resuscitation.Make decisions about resuscitation based on scenarios.Explain to the mother reasons or the resuscitation and the outcome baby is well, needs urther ventilation or has died.Demonstrate care ater resuscitation.Clean the resuscitation equipment and prepare it or the next baby[optional].

RequirementsResuscitation manikin

Sel-infating bagNeonatal masks size 0 and 1Oral suction apparatusBucket and water3 pieces o sot cloth 1x1 m, 1 piece 0.5 x 0.5 m, or assorted towelsLarge clock with second hand

FormsLabour Record N4 (or recording the event),Reerral orm N2

Scenario cardsCut Clinical Practice Workbook page 46 into 6 scenario cardsMix them and use to give dierent scenarios to participants.

Tasksheet

Clinical Practice 3 Bc wbo ctto M3 S8



42 Title sbtt

Task sheet

Bc wbo cttoTrainer demonstratesFirst, the trainer repeats the procedure as demonstrated in the lecture

in real time:1. Time o birth is cal led out2. Newly born baby is received in a cloth, dried, cloth changed,wrapped in a dry cloth, breathing assessed, cord cut.3. Head positioned4. Mouth and nose suctioned5. Seal, ventilation, chest observation6. Stopping and assessment7. Summarizing the time needed or each step8. Skin-to-skin contact and breasteeding the baby9. Talking to the mother10. Recording the event.

The trainer next explains each step slowly:

Open the airwayPosition the head so that it is slightly extended (emphasize not toover-extend).Suction rst the mouth and then the nose.Introduce a suction tube 5 cm into the babys mouth rom the lipsand suck while withdrawing.Introduce suction tube 3 cm into each nostril and suck whilewithdrawing unti l no mucus. Take no more than 20 seconds orsuctioning.

I still no breathing, ventilatePlace mask to cover chin, mouth and noseForm sealSqueeze bag attached to the mask with 2 ngers 2 or 3 timesObserve rise o the chest. I chest not rising:

reposition headcheck mask seal

I chest stil l not rising, squeeze bag harder with whole handOnce good seal and chest rising, ventilate at 40 squeezes per minuteuntil baby starts crying or breathing.

Participants now take turnsA. Wet manikin and ensure real-lie situation. Ensure time cal led outand that all participants take part. Participants repeat the individualsteps until they can do it well. Then, the participant practises steps110 together (in real time) unti l two good resuscitations. Fil l outparticipant check list.

B. The trainer gives 4-5 dierent decision making scenarios to thegroup. Each participant perorms at least 1 scenario in real time. Noteweak participants who will need extra teaching.

C. Communicating with the mother:

Reasons or resuscitationGood outcomeBad outcome (death)

D. Recording: N4 , N6 , N7 .

Clinical Practice 3 Bc wbo cttoS8M3



43Title sbtt

FOrFaCiliTaTOr

E. RESUSCITATION: Scenarios or practising and demonstrating onmanikins

Scenario 1This baby has just been born.Ater drying, the baby is not breathing at all.

What would you do?

Resuscitate the baby:keep the baby warmopen the airway

positionsuction

ventilate at 40 breaths per minute

Ater 2 minutes o ventilation, the baby begins to breathe.Decide what to do next

Count number o breaths in 1 minuteLook or chest in-drawing

Baby is breathing 36 breaths per minute.There is no chest in-drawing.

Decide what to do next.Do not ventilate anymorePut the baby in skin-to-skin contact and encourage breasteedingMonitor every 15 minutes or breathing and warmthTell the mother that baby will probably be wellDO NOT leave the baby alone.

Scenario 2The baby has just been born and is gasping 1 minute ater birth.What do you do?

Resuscitate the baby:Dry the baby and keep the baby warmOpen the airway

positionsuction

Ventilate at 40 breaths per minute

Ater 1 minute o ventilation, the baby starts crying.When you stop ventilating, the baby continues to cry.

What should you do next?

When baby is calm,Count number o breaths in 1 minuteLook or chest in-drawing

Baby is breathing 50 breaths per minute; there is no chest in-drawing.Decide what to do next.

Do not ventilate anymore

Put the baby in skin-to-skin contact and encourage breasteedingMonitor every 15 minutes or breathing and warmthTell the mother that baby will probably be wellDO NOT leave the baby aloneRecord in the babys notes.

Clinical Practice 3 Bc wbo ctto S8M3

Tasksheet



44 Title sbtt

Scenario 3This baby has just been born. He took a ew gasps and then stoppedbreathing.

What do you do?

Resuscitate the baby:Dry the baby and keep the baby warmOpen the airway

positionsuction

Ventilate

Ater 2 minutes o ventilation, the baby starts crying.

What should you do next?Count number o breaths in 1 minuteLook or chest in-drawing

Baby is breathing 42 breaths per minute; there is no chest in-drawing.

Decide what to do next.Do not ventilate anymorePut the baby in skin-to-skin contact and encourage breasteedingMonitor every 15 minutes or breathing and warmthTell the mother that baby will probably be wellDO NOT leave the baby aloneRecord in the babys notes

Scenario 4This baby has just been born. Ater drying, the baby is not breathing atall.

What do you do?

Resuscitate the baby:Keep the baby warmOpen the airway

positionsuction

Ventilate

The baby is not breathing spontaneously at all ater 20 minutes oventilation.

What should you do next?Assess breathing - i no breathing or gasping, stop ventilating - thebaby is dead.Explain to the mother what happened. Ask her i she wants to holdthe baby.Fill out the death certicate.Record in the medical record and the logbook.

Clinical Practice 3 Bc wbo cttoS8M3



45Title sbtt

FOrFaCiliTaTOr

Scenario 5This baby has just been born. The baby is not breathing at al l 1 minuteater birth.

What do you do?

Resuscitate the baby:Keep the baby warmOpen the airway

positionsuction

Ventilate

Ater 4 minutes o ventilation, the baby starts breathing spontaneously.

What should you do next?Count number o breaths in 1 minuteLook or chest in-drawing

Baby is breathing 56 breaths per minute and has severe chest in-drawing.

What should you do?Continue ventilatingArrange or immediate reerralExplain to the parents what has happened, what you are doing andwhyVentilate during reerralKeep the baby warm during reerralPrevent hypoglycaemiaFill out the reerral ormRecord the events in the babys notes

Scenario 6This baby has just been born. Amniotic fuid was meconium stained.Baby starts crying ater drying.

What should you do?Count number o breaths in 1 minuteLook or chest in-drawing

Frequency o breathing is 46 breaths per minute. There is no chest in-drawing.

What do you do?Do not ventilate anymorePut the baby in skin-to-skin contact and encourage breasteedingMonitor every 15 minutes or breathing and warmthTell the mother that baby will probably be wellDO NOT leave the baby aloneRecord in the babys notes

Explain to the participants that they will be examined individually ontheir skills in basic resuscitation. To pass the course they must be ableto competently demonstrate basic resuscitation.

Clinical Practice 3 Bc wbo ctto S8M3

Tasksheet



46 Title sbtt

Scenario 1This baby has just been born.Ater drying, the baby is not breathing atall.

What would you do?

Ater 2 minutes o ventilation, the babybegins to breathe.

Decide what to do next


Decide what to do next.

Scenario 3This baby has just been born.He took a ew gasps and then stoppedbreathing.

What do you do?

Ater 2 minutes o ventilation, the babystarts crying.




Scenario 5This baby has just been born.The baby is not breathing at all 1 minuteater birth.

What do you do?

Ater 4 minutes o ventilation, the babystarts breathing spontaneously.


Baby is breathing 56 breaths per minute

and has severe chest in-drawing.

What should you do?

Scenario 2The baby has just been born,He is gasping 1 minute ater birth.

What do you do?Ater 1 minute o ventilation, the baby

starts crying.When you stop ventilating, the babycontinues to cry.


Baby is breathing 50 breaths per minute;there is no chest in-drawing.


Scenario 4This baby has just been born.Ater drying, the baby is not breathing atall.

What do you do?

The baby is not breathing spontaneously atall ater 20 minutes o ventilation.


Scenario 6This baby has just been born.Amniotic fuid was meconium stained.Baby starts crying ater drying.

What should you do?

Frequency o breathing is 46/minute.There is no chest in-drawing.

What do you do?

Clinical practice 3 Bc wbo cttoS8M3



47Title sbtt

FOrFaCiliTaTOr

Bc wbo cttoChecklist or assessing clinical knowledge and skills(Facilitators)

date Participant nmber 1 2 3 4


demonstrates correct procere or resscitation on TWO occasions

PREPARATION FOR RESuSCITATION

1. Calls out time o birth

2. Maintains warmth

Newly born baby is received in a cloth:

Dries baby

Breathing assessed while drying

Wet cloth discarded

Baby wrapped in a dry cloth

IF BABy NOT BREATHING OR ONly GASPING

Ties and cuts cord quickly

Transers to a dry clean and warm surace

OPEN THE AIRWAy

3. Positions babys head so that it is slightly extended

4. Uses suction:

First to the mouth

Introduces tube into mouth, 5 cm rom lips

Suctions on withdrawal

5. Uses suction:

To the nose

Introduces tube 3 cm into each nostril

Suctions on withdrawal

6. Repeats suction i necessary:

No more than twice

No longer than 20 seconds

vENTIlATION 1 2 3 4

7. Chooses correct size mask

8. Places mask to cover chin, mouth and nose

9. Good seal ormed

10. Bag squeezed 2 or 3 times, according to size with:

2 fngers

Clinical practice Bc wbo ctto S8M3



48 Title sbtt



whole hand

11. Observes rise o chest

12. I chest not rising:

Head repositioned

Mask seal checked

13. Bag squeezed slightly harder with whole hand

14. Once a good seal and chest rising:

Ventilates 40 squeezes per minute until newborn crying or spontaneous breathing

STOPPING vENTIlATION

15. Stops and assesses baby:

Looks at chest or in-drawing

Counts breaths per minute

Stops ventilation i breathing more than 30 breaths per minute and no chest in-drawing

16. Puts the baby in skin-to-skin contact

17. Monitors every 15 minutes or breathing and warmth

18. Explains situation to the mother

19. Records the event

CONTINuING vENTIlATION

20. I less than 30 breaths per minute or severe chest in-drawing

21. Arranges or immediate reerral

22. Explains situation to the mother

23. Ventilation continues during reerral

24. Record on:

Reerral orm

Labour record


1

2

3

4

Clinical practice 3 Bc wbo cttoS8M3



49Title sbtt

FOrFaCiliTaTOr

Instructions


OBJeCTiVe: For participants to carry out routine daily care of the newborn

baby and to teach mothers to care for their new babies.

1. Beore clinical practice 3Meet trainers/Clinical acilitators. Decide:

Where group will be workingWhat order to carry out CP tasksWhich clinic/location

Collect details about:Mother and baby pairs available (including babies with problemsneeding extra care)

Mother and baby pairs to be dischargedBabies due to be seen in ollow-up clinicNames and location o mothers and babies

Minimum requirements:TWO mother and baby pairs or each participantONE baby being discharged or at a ollow-up clinic or 2 participantsRecords o the mother/baby pairs your group will be working with.

2. Group preparation beore going to theclinical areaGo through Participants Clinical Practice 3 instructions with the group.Ensure the group understands what they are expected to do and inwhat order.

Remind group the ocus o this Clinical Practice is:Routine care o the baby until dischargeExamination o a baby beore discharge or having a ollow-up visitGiving an injection (optional)

Each participant should have:Examination Recording Forms (rom Trainers Guide Part 3)Breasteeding Observation Form 2 (2 copies)Pen/pencil and notebookPCPNC Guide

duraTiOn 90 minutes

lOCaTiOn Ward

Tasksheet

M3Clinical Practice 3 C of th wbo bby t chg



50 Title sbtt

Tell group the topic to be discussed in the PRACTICE REVIEWSession will be:

Select an example o good practice in the routine care o the newbornbaby you have seen a mother or health worker use. Why did it impress

you?

Direct each group to their rst taskTasks can be done in any order according to the situation in theward area.Ater each task discuss with the group or individuals rom the groupwhat they have seen/done.Choose an area away rom the mothers, e.g. outside the ward, in acorridor or in a designated room.Emphasize hand washingInormation about your role in each set task is contained in theollowing Clinical Practice Task Sheet (see below).

3. Ater Clinical Practice 3Check Clinical Assessment Forms or Clinical Practice 3.See any participant who needs to repeat any task or who is weak in aparticular area.Note any parts o the session that did not work well or was notcompleted by all participants. Keep a record o what may stil l needto be covered in the Practice Review Session.

Return to the classroom.

Clinical Practice 3 C of th wbo bby t chgM3



51Title sbtt

FOrFaCiliTaTOr

Task sheet

rot c of th wbo bby

Wash handsParticipants must wash hands beore and ater touching a mother orbaby.

Care and monitoring a babyTASK or 4 participants

Demonstrate examining a new baby using J2J8 , then carry out care inthe ollowing situations J10 , Section K

Assess breathingWatching the way baby breathes

Counting number o breaths per minute

Assess warmthFeel eetTaking axillary temperature

Check cordIs it clean and dry and let open to air?

Assess breasteedingUse J4 , K2K4Use Breasteeding Observation Form 2

Supervise participants, in pairs, assess a baby and carry out requiredcare, and teaching mother J2J8 J10 Section K:

Assessing breathingAssessing warmthCheck the cordAssessing breasteeding

Task or 2 participantsI participants assess a baby with additional care needs ater theycomplete their assessment discuss with them what they have decidedthey need to do or the baby.Participants should assess a minimum o two babies, more i

available.Fill in the Clinical Assessment checklist. Give additional assistanceto weak participants.

Hygiene: the babyTask or 4 participants

WASH HANDS and Demonstrate washing or bathing a baby to thegroup ollowing direct ions in K10B.Ask participants to write down the KEY points that should betaught to the mother.

Make sure participants wash hands beore touching the babyDivide the group into pairs and introduce each pair to a mother andbaby,

duraTiOn 90 minuteslOCaTiOn Ward

Tasksheet

M3Clinical Practice 3 C of th wbo bby t chg



52 Title sbtt

One participant should prepare the equipment and the other shouldwash or bath the baby. Each should teach the mother about whatthey are doing.Supervise participants during this task.Fill in a clinical assessment orm or each participant. Identiy weakparticipants who may need additional support.

Taking a babys temperatureTask or 4 participants

Demonstrate to group: Assessing and taking a babys temperatureFollow directions in Section 5 o the session Taking a babystemperature

Supervise each participant:Assessing and taking a babys temperature, using a thermometer inthe armpit (axilla)

Taking at least ONE temperature

Other baby care: SleepingTask when giving other advice to mothers

When talking to mothers participants should nd out what positionsthey place their babies in to sleep.Following the inormation in the PCPNC Guideline K10 participantsshould advise mothers on sleeping positions and other related issues.

Examination beore discharge or or aollow-up visitTask or 1 or 2 participants

Take group to the outpatients clinic or postnatal ward.

Each participant should carry out a ull examination using J2J8PCPNC Guide and a Clinical Recording Form or a baby who is:

To be dischargedAttending a ollow-up clinic

Supervise participants examining babiesFill in a clinical assessment orm or each participant. Identiy weakparticipants who may need additional support.

Giving an injection (optional)Task or 4 participants

Observe preparation and administration o an IM injection.

Clinical Practice 3 C of th wbo bby t chgM3



53Title sbtt

FOrFaCiliTaTOr

rot c of th wbo bbyChecklist or assessing clinical knowledge and skills (Facilitators)date Participant nmber 1 2 3 4


Washing/bathing a bab/o

1. Demonstrates washing/bathing a baby/doll

2. Teaches a mother/participant how to bathe/wash a baby/doll

Includes the ollowing inormation:

Importance o washing hands beore handling baby

Adequate preparation o room and equipment

Using water which is warm enough

Washing babys ace, neck and underarms (daily)

Bathing as necessary

Ensuring the baby is warm, dried well, dressed and covered

Keeping the bab warm 1 2 3 4

1. Teaches a mother/participant how to put a baby/doll in skin-to-skin contact to

keep warm

2. Can describe how to keep the baby warm AFTER the rst ew hours o delivery

ollowing inormation in K9

Taking a babs temperatre 1 2 3 4

Demonstrates correct technique or taking an axilla temperature

Cor care 1 2 3 4

1. Correctly demonstrates routine cord care on a baby/doll K10

2. Teaches a mother/participant how to carry out routine cord care and what to do i

the umbilicus is red or draining pus/blood

Monitoring the bab: Assess breathing 1 2 3 4

1. Assesses a baby breathing correctly

Listens or grunting

Counts breaths

Looks or chest in-drawing

2. Knows immediate action i the baby has ast (>60 breaths per minute) or slow

breathing (


54/80



55Title sbtt

FOrFaCiliTaTOr

Task 2

Hygiene: the babyTask or 4 participants

WASH HANDS and demonstrate washing or bathing a baby to thegroup ollowing directions in K10Ask participants to write down the KEY points that should betaught to the mother.Make sure participants wash hands beore touching the baby.Divide the group into pairs and introduce each pair to a mother andbaby.One participant should prepare the equipment and the other shouldwash or bathe the baby. Each should teach the mother about whatthey are doing.Supervise participants during this task.Fill in a Clinical Assessment Form or each participant. Identiy

weak participants who may need additional support.

Task 3

Other baby care: SleepingTask or 4 participants

When giving other advice to mothersWhen talking to mothers, participants should nd out what positionsthey place their babies in to sleep.

Following the inormation in the PCPNC Guide

K10 , participantsshould advise mothers on sleeping positions and other related issues.

S9M3Clinical practice rot c of th wbo bby

Tasksheet



56 Title sbtt

rot c of th wbo bbyChecklist or assessing clinical knowledge and skills (Facilitators)date Participant nmber 1 2 3 4


Washing/bathing a bab/o

1. Demonstrates washing/bathing a baby/doll

2. Teaches a mother/participant how to bathe/wash a baby/doll

Includes the ollowing inormation:

Importance o washing hands beore handling baby

Adequate preparation o room and equipment

Using water which is warm enough

Washing babys ace, neck and underarms (daily)

Bathing as necessary

Ensuring the baby is warm, dried well, dressed and covered

Keeping the bab warm

1. Teaches a mother/participant how to put a baby/doll in skin-to-skin contact to

keep warm

2. Can describe how to keep the baby warm AFTER the rst ew hours o delivery

ollowing inormation in K9

3. Can explain how to keep a baby warm when the baby is at home

4. Can assess a babys warmth as described in K9

Cor care

1. Correctly demonstrates routine cord care on a baby/doll K10

2. Teaches a mother/participant how to carry out routine cord care and what to do i

the umbilicus is red or draining pus/blood

3. Identies DANGER SIGNS

4. Demonstrates how to treat an umbilical inection K13

Monitoring the bab: Assess breathing

1. Assesses a baby breathing correctly

Listens or grunting

Counts breaths

Looks or chest in-drawing

2. Knows immediate action i the baby has ast (>60 breaths per minute) or slow

breathing (





spc tto MOdule 4

Clinical practice 4 spc tto

itcto 59

T ht 61


Mgg bt pobm

T ht 64


H xpo of btm

T ht 66


attv mtho of fg bbyT ht 68


exm m bby

T ht 70

Chct fo Fctto 71


58/80



59Title sbtt

FOrFaCiliTaTOr

Sessions 10, 11, 12 and 14Instructions

spc tto

OBJeCTiVe: For Participants to carry out routine daily care and examinationof the small baby.

1. Beore Clinical Practice 4

Meet trainers/clinical acilitators. Decide:Where group will begin workingWhat order to carry out CP tasksWhere in hospital/community group working

Collect details about:Small baby and mother pairs to visitBabies cup-eeding or using other methods o eedingNames and location o mothers and babies.

Minimum requirements:TWO small babies, one preterm and one term small or group o 4participantsONE small baby and mother pair or 2 participantsONE baby cup-eeding per group o 4 participantsRecords are available or the mother/baby pairs or your group.

Group preparation beore going to theclinical areaGo through Participants Clinical Practice 4 instructions with the group.Ensure the group understands what they are expected to do and inwhat order.

Remind group the ocus o this Clinical Practice is:The small babyAlternative methods o eedingGiving help and advice to mothers with breast conditionsKangaroo Mother Care (Optional)

duraTiOn 30 minutes

lOCaTiOn Ward

Tasksheet

M4Clinical practice 4 spc tto



60 Title sbtt

Each participant should have:Examination recording orms (2 copies)Breasteeding Observation Forms 1 (2 copies)Pen/pencil and notebookPCPNC Guide (ONE between two participants)Name badge

Tell group the topic to be discussed in the PracticeReview Session will be:

I you could change just one o the practices in your workplace a terthis course, what would it be and why?

Direct each group to their irst taskTasks can be done in any order according to the situation in theward area.Ater each task discuss with the group or individuals rom the groupwhat they have seen/done.

Choose an area away rom the mothers, e.g. outside the ward, in acorridor or in a designated room.

Inormation about your role in each set task is contained in theollowing Clinical Practice Task Sheet.

3. Ater clinical practice 4Check Clinical Assessment Forms or Clinical Practice 4.See any participant who needs to repeat any task or who is weak in aparticular area.

Note any parts o the session that did not work well or was not completed by all participants. Keep a record o what may stil l needto be covered in the Practice Review Session.Return to the classroom.

Clinical practice 4 spc ttoM4



61Title sbtt

FOrFaCiliTaTOr

Sessions 10, 11 and 14Task sheet

spc tto

Wash handsExamine the small babyTask or 4 participants

Take group to see at least TWO small babies:One preterm babyOne small term baby (low birth weight).

1) Ask i any dierences can be seen between the babies?2) Discuss how they are similar and how they are dierent, reerring to

Session 4a The Small Baby.


WASH HANDS and demonstrate to group how to examine a smallbaby ollowing J2J8 .Divide the group into pairs and introduce each pair to a mother andbaby.

Make sure participants wash hands beore touching the baby.Ensure small babies are kept warm during the examination.

Supervise each participant examining a small baby using the PCPNC

Guideline J2J8 , Examination Recording Form. Note additional riskactors and danger signs.Discuss participants ndings and the advice, treatment and ollow-up care suggested.Fill in a Clinical Assessment Form or each participant. Identiyweak participants who may need additional support.

Giving help and advice to mothers withbreast conditionsTask or 2 or 4 participants

Introduce participants to mothers who have a breast condition.With the mothers permission let participants look at and examineher breast and ask about her symptoms using J9 .Discuss the participants diagnosis, advice and treatment, then, iappropriate, discuss with the mother. Follow J9 .Fill in Clinical Assessment Checklist or each participant. Identiyweak participants who may need additional support.

duraTiOn 30 minutes

lOCaTiOn Ward


Tasksheet



62 Title sbtt

Alternative methods o eeding a babyTask or 4 participants

Show the group examples o alternative methods o eeding used in thehealth acility and in the special care unit.Discuss the methods with participants. Are the methods appropriate?

Cup-eedingTask or each participant

Demonstrate cup-eeding to the group ollowing directions on K6.Take group to observe a mother or health worker cup-eeding a baby (ipossible).Observe at least one other alternative method o eeding (i possible).Supervise EACH participant practising cup-eeding (i possible).

Fill in a Clinical Assessment Checklist or each participant. Identiy weakparticipants who may need additional support.Show group o participants a baby with a clet lip and palate/other dicultybeing ed with an alternative eeding method o breasteeding (i possible).

Hand expression o breast milkTask or 2 participants

Divide group into PAIRS to observe a mother hand-expressing her breastmilk.Supervise each participant teaching a mother about back and breastmassage.Supervise EACH participant teaching a mother to hand-express breast milkollowing instructions on K5 .Fill in a Clinical Assessment Checklist or each participant. Identiy weakparticipants who may need additional support.

Kangaroo mother care (optional)Task or 2 groups

Take group to meet a mother who is practising KMC. Show participants

the position o the baby and how it is secured. I possible, the group shouldobserve mothers eeding their babies.Divide the group into pairs. Introduce each pair to a mother and babypractising KMC (i possible).

Find out:How the mother eels about KMC.What inormation she was given about KMC beore she started it.What it involves or the mother and the rest o her amily.How long it will last.How her baby is eeding.Observe position o the baby and method or securing the inant.How many hours per day she practises KMC.What she does with the baby when she needs to bathe or attend to otherpersonal unctions.Observe the inants growth and eeding charts. Note anything o interest.

Clinical practice 4 spc ttoM4



63Title sbtt

FOrFaCiliTaTOr

spc ttoChecklist or assessing clinical knowledge and skills (Facilitators)date Participant nmber 1 2 3 4


Examine sma/preterm bab

1. Correctly assesses and classies a small/preterm baby J2J8

2. Can quickly nd inormation on counselling or breasteeding or the small baby K4

3. Can list:

The 3 clinical indicat ions or discharge

The 2 maternal requirements

Han expression o breast mik

1. Observed a mother expressing breast milk by hand

2. Correctly teaches a mother how to express breast milk by hand

3. Can list at least 3 reasons why a mother should learn to hand-express

Aternatie methos o eeing

1. Observed alternative methods o eeding being used:

Nasal or oral gastric tube eed

Spoon

Syringe/dropper

Other

2. Demonstrates sae technique or cup-eeding (with baby/doll)

3. Can list the advantages and disadvantages o cup-eeding:

avtg (baby-led, mother can do it, good eye contact, encourages tongue

movement, use o lingual lipases, baby can take what it needs in time and quantity,

sae i good technique used, easy to do)

dvtg (dribbles, can become addicted)

Managing breast probem (i seen)

1. Gives correct diagnosis or breast condition seen

2. Gives correct advice and help or the condition seen, usingJ9


1

2

3

4

Checklist




64 Clinical practice 4 spc ttoM4


Mgg bt pobmGiving help and advice to mothers with

breast conditionsTask or 2 or 4 participants

Introduce participants to mothers who have a breast condition.With the mothers permission let participants look at and examineher breast and ask about her symptoms using J9Discuss the participants diagnosis, advice and treatment then iappropriate discuss with the mother. Follow J9Fill in clinical assessment checklist or each participant. Identiyweak participants who may need additional support.

Giving help and advice to mothers with breast conditions


Mgg bt pobmGiving help and advice to mothers withbreast conditionsTask or 1 or 2 participants

You will be introduced to a mother with a breast condition.With the mothers permission look at and examine the her breast/sand ask her about her symptoms using J9Discuss the diagnosis, advice and treatment i appropriate with the

mother or with your clinical acilitator and colleagues in anotherpart o the clinical area. Follow J9

duraTiOn 20 minutes

lOCaTiOn Ward

O

C

O



65Title sbtt

FOrFaCiliTaTOr

Mgg bt pobmChecklist or assessing clinical knowledge and skills (acilitator)



Gae hep an aice to ONE mother with a breast conition

1. Gives correct diagnosis or the breast condition seen

2. Gives correct advice and help or the condition seen, usingJ9

3. Can list possible causes o diagnosed condition

4. Can correctly advise a mother with sore and ssured nipples J9


1

2

3

4

S10M4Clinical practice spc tto

Checklist



66 Title sbttSession 11 spc tto


H xpo of btm

Session 11 Clinical Practice Task card or

FacilitatorTASK or participants working in pairs

Find a mother who is going to hand express her breastmilk, ask herpermission to bring 2 participants to observe what she does.Introduce 2 participants to a mother who is interested in being taughtabout hand expression. One participant should teach the mother, theother participant should observe and ollow the instructions on K5 .

Supervise EACH participant teaching a di erent mother about breastand back massageSupervise Each participant teaching a mother how to hand expressher breastmilk ollowing instructions on K5 .Fill in a clinical assessment checklist or each participant. Identiyweak participants who may need additional support.

duraTiOn 20 minutes

lOCaTiOn Ward

O

C

O


H xpo of btmTASK or 2 participants

One o you should teach the mother and one o you should be anobserver and ollow the instructions given about hand expressionon K5 .

You should each teach at least one mother

Your task is to:Observe a mother hand expressing her breastmilk.Teach a mother about breast and back massageTeach a mother how to hand express ollowing the instructions givenon K5 .Give the mother inormation about how to store her milk

M4 S11



67Title sbtt

FOrFaCiliTaTOr

H xpo of bt mChecklist or assessing clinical knowledge and skills (acilitator)



Taght ONE mother to han-express her breast mik

1. Observed a mother expressing breast milk by hand

2. Teaches a mother how to express breast milk by hand

3. Follows the directions on hand expression on K5

Knows how to help a mother i the milk does not ow well

Can teach a mothers companion back massage

Can teach a mother breast massage

Gives the mother accurate advice on how oten to express K5

Gives the mother inormation on how to store her breast milk

4. Can list at least 3 reasons why a mother should learn to hand-express


1

2

3

4

S11M4Clinical practice spc tto

Checklist



68 Title sbttClinical practiceattv mtho of fg bby


attv mtho of fg bby


Show Group examples o alternative methods o eeding used in thehealth acility and in the special care unit.Discuss the methods with participants. Are the methodsappropriate?


Cup-eedingTask or 1 participant

Demonstrate cup-eeding to the GROUP ollowing directions on K6 .

Take group to observe a mother or health worker cup-eeding a baby

(i possible).Observe at least one other alternative method o eeding (i possible).Supervise EACH participant practising cup-eeding (i possible).Complete a Clinical Assessment Checklist or each participant.Identiy weak participants who may need additional support.Show GROUP o participants a baby with a clet l ip and palate/other diculty being ed with an alternative eeding method orbreasteeding (i possible).


attv mtho of fg bbyTask or a group

Your cl inical acilitator will show you examples o alternativemethods o eeding used in the health acility and the special careunit, and tell you when they are used.Discuss the methods with your colleagues and clinical acilitator.Consider whether the methods are appropriate or the babys need.


Cup-eedingTask or a group and one participant

Your cl inical acilitator will demonstrate cup-eeding, ollowingdirections on K6 .I possible, observe a baby being cup-ed by a mother or anotherhealth worker.I possible, observe at least one other alternative method o eeding.I possible, demonstrate cup-eeding a baby to your clinical

acilitator.I possible, observe a baby with a clet l ip and palate/other dicultybeing ed with an alternative eeding method or breasteeding.

duraTiOn 15 minutes

lOCaTiOn Ward

duraTiOn 15 minutes

lOCaTiOn Ward

S11M4



69Title sbtt

FOrFaCiliTaTOr

attv mtho of fg bbyChecklist or assessing clinical knowledge and skills (acilitator)



Aternatie methos o eeing

1. Observed alternative methods o eeding being used:

Nasal or oral gastric tube eed

Spoon

Syringe/dropper

Other

2. Demonstrates cup-eeding with a baby

3. Teaches a mother how to cup-eed, ollowing instruction on K6

4. Can list the advantages and disadvantages o cup-eeding:

Advantages (baby-led, mother can do it, good eye contact, encourages tongue

movement, use o lingual lipases, baby can take what it needs in time and quantity,

sae i good technique used, easy to do)

Disadvantages (dribbles, can become addicted)

5. Observed a baby with clet lip/palate or other diculty given breast milk by

alternative method o eeding


1

2

3

4

S11M4Clinical practiceattv mtho of fg bby

Checklist



70 Title sbttClinical practiceTh m bby


exm th m bbyTask or 4 participants

Take group to see at least TWO small babies:One preterm babyOne small term baby (low birth weight).

Ask i any dierences can be seen between the babies?Discuss how they are similar and how they are dierent, reerring tosession 4a The Small Baby.


WASH HANDS and demonstrate to group how to examine a smallbaby ollowing J2J8 .Divide the group into pairs and introduce each pair to a mother andbaby.Make sure participants wash hands beore touching the babySupervise each participant examining a small baby using the PCPNCGuide J2J8 , Examination Recording Form. Note additional riskactors and danger signs.Ensure small babies are kept warm during the examinationDiscuss participants ndings and the advice, treatment and ollow-up care suggested.Complete a Clinical Assessment Form or each participant. Identiyweak participants who may need additional support.

duraTiOn 30 minutes

lOCaTiOn Ward

O

C

O


exm th m bbyWith your group you wil l observe at least TWO small babies:

One preterm babyOne small term baby (both low birth weight).

Look careully at both babies; can you see any dierences between them?

Discuss with your clinical acilitator and group colleagues how these babies are similar and howthey are dierent.

TASK__ Group and pairs

Watch your cl inical acilitator demonstrate how to examine a small baby: ollowing J2J8 .You will be introduced to a small baby and his mother.In pairs, examine a small baby using J2J8 . Use the Examination Record Form or each babyexamined. Note additional risk actors and danger signs.

Ensure small babies are kept warm during the examinationDiscuss with the clinical acilitator and your colleague the advice and treatment you think should be

given to the mother and baby.

S12M4



71Title sbtt

FOrFaCiliTaTOr

S12M4Clinical practiceTh m bby

Checklist

exm th m bbyChecklist or Trainers and clinical Facilitatorsdate Participant nmber 1 2 3 4


Obsere at east TWO babies:

ONE preterm baby

ONE small term baby

Assess sma/preterm bab

1. Can qick n the reeant page in PCPNC or aitiona care o a sma bab

2. Correct assesses sma/preterm bab or:

Breathing

Warmth

Breasteeding

Any danger signs

3. I aternatie eeing metho se, can cacate the tota ai amont o mik

to be gien or that a accoring the babs weight K6

7.Can aise the mother what to o i the bab oes not take the cacate

amont K6

8.Can qi

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WHO MPS 10.1 Clinical Practice Eng

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