Surveypoint

Q01

NAME OF THE NURSE

Q02

CODE

Q03

Health Facility Name

Q04

Health Facility Code

Q05

District

Q06

District Code

Q07

State

Rajasthan

Madhya Pradesh

Q08

Type of Facility

DH

SDH

FRU CHC

CHC

24*7 PHC

PHC

Q09

Level of Facility

L1

L2

L3

Q10

ASSESSMENT DATE

Q11

ASSESSMENT TIME

A01

Name and code of staff nurse/ANM

A02

How old are you?

A03

For how many months/years have you worked in this facility?

A04

How long you have been working as a Nurse?

A05

How many months / years ago did you finish your basic nursing course?

A06

Have you had Skilled Birth Attendant (SBA) 21 day training from the government?

Yes

No

A07

How many months/years ago you had the Skilled Birth Attendant (SBA) training?

A08

Have you attended a Skilled Birth Attendant (SBA) refresher training for 3-4 days?

Yes

No

A09

How many months/years ago did you attend the Skilled Birth Attendant (SBA) refresher training?

A09A

Did you receive any training on communication and behaviour skills?

Yes

No

A10

Have you ever received/ attended any training on the following topics?

Navjaat Shishu Suraksha Karyakram (NSSK) (2 days)

IUCD insertion

Contraceptive update

Home Based New Born Care (HBNC)

RTI/STI/HIV (2 days)

Infection Management and Environment Plan (IMEP)

Integrated Management of Neonatal and Childhood Illness (IMNCI) (8 days)

Comprehensive child survival programme (CCSP) (10 days)

Immunization

Kangaroo Mother Care (KMC)

Not received any training

A10A

Do you know about the Dakshata/ JHPIEGO ASMAN program for improving delivery and postpartum services at the facility?

Yes

No

A10B

Does any nurse mentors/Dakshata trainer/any other trainer visit this hospital? if yes from which organization they come from?

No

Government nurse mentors

Jhpiego /Dakshata trainer

Nurse mentors of other organization or body

A11

Have you received any training / handholding support from Dakshata trainer of Jhpiego -ASMAN project?

Yes

No

A12

What are the topics covered during training / support provided by the Dakshata trainer?

Temperature

Blood pressure

Haemoglobin

Urine for protein

Respiratory rate

Foetal heart rate

Partograph

Abdominal examination

Per Vaginum examination

Active Management of Third Stage of Labour

Routine new-born care

Management and pre-referral management for mother for complication

Management and pre-referral management for new-born for complication

Calculation of gestational age

Management of PPH

Normal delivery

New-born resuscitation

PPIUCD

IUCD

KMC

Infection prevention protocols

A12A

Trained?

Yes

No

A12B

Trained in last 3 months?

Yes

No

A12C

Number of times trained in the last 3 months?

A12D

Received training in skill station/mannequin ?

Yes

No

Skill station not available

A13

Did you receive any training on using paper based Safe Birth Checklist from Jhpiego -ASMAN?

Yes

No

A14

Did you receive any training on using paper based Partogram from Jhpiego -ASMAN?

Yes

No

A15

Do you think that mentoring by Dakshata trainer improved your knowledge?

Not improved

Improved moderately

Improved very much

A16

Do you think that mentoring by Dakshata trainer improved your skill?

Not improved

Improved moderately

Improved very much

A17

Do you think mentoring by Dakshata trainer improved your practice?

Not improved

Improved moderately

Improved very much

A18

Did you receive any handholding training at labour room?

Yes

No

A19

Did you receive training on PPIUCD?

Yes

No

A20

Have you received any training on using technology or electronic devices for delivery management from Jhpiego - ASMAN?

Yes

No

A21

How long ago have you received this training?

A22

How long was the training? Number of days

A23

Who gave you the training?

ASMAN expert

Dakshata trainer

Doctor

Others, specify

A24

Have you received any kind of training on using technology or electronic devices from Jhpiego -ASMAN given below?

Yes

No

A24A

Electronic case sheet, safe birth checklist and partograph on tablet device

Yes

No

A24B

Monitoring Foetal Heart Rate on MOYO Device

Yes

No

A24C

Monitoring Blood Pressure using digital device

Yes

No

A24D

Using video game for learning

Yes

No

A24E

Using Remote Support Centre to seek advice on complication management from the doctors

Yes

No

A25

Did you receive any further handholding support when needed for using technological aids from Nurse Mentors / Jhpiego -ASMAN team?

Yes

No

A26

How frequently do you use any of the following technological aids from Jhpiego -ASMAN?

A27A

Electronic case sheet, safe birth checklist and partograph on tablet device

Never

Rarely

Sometimes

Often

Always

A27B

Monitoring Foetal Heart Rate on MOYO Device

Never

Rarely

Sometimes

Often

Always

A27C

Monitoring Blood Pressure using digital device

Never

Rarely

Sometimes

Often

Always

A27D

Using video game for learning

Never

Rarely

Sometimes

Often

Always

A27E

Using Remote Support Centre to seek advice on complication management from the doctors

Never

Rarely

Sometimes

Often

Always

A28

How comfortable you are in using

Very uncomfortable

Uncomfortable

Comfortable

Very comfortable

A28A

Electronic case sheet, safe birth checklist and partograph on tablet device

Very uncomfortable

Uncomfortable

Comfortable

Very comfortable

A28B

Monitoring Blood Pressure using digital device

Very uncomfortable

Uncomfortable

Comfortable

Very comfortable

A28C

Monitoring Foetal Heart Rate on MOYO Device

Very uncomfortable

Uncomfortable

Comfortable

Very comfortable

A28D

Using video game for learning

Very uncomfortable

Uncomfortable

Comfortable

Very comfortable

A28E

Using Remote Support Centre to seek advice on complication management from the doctors

Very uncomfortable

Uncomfortable

Comfortable

Very comfortable

A29

Under what circumstances, are you not able to use the digital case sheet?

During night deliveries

When handling delivery cases alone

During normal deliveries

Others, Specify

A30

If uncomfortable using digital case sheet, please give the reason for feeling uncomfortable?

Do not know how to use

Not used to it

Make more mistakes using it

Others, specify

A31

Do you find the digital platform (case sheet) useful in timely decision making

Yes

No

A31A

For high risk cases,

Yes

No

A31B

For routine care

Yes

No

A31C

For timely referral

Yes

No

A31D

Complication identification

Yes

No

A32

Do you find the digital platform (case sheet, technological aids,etc) useful in providing care as compared to case management through the paper based case sheet and conventional monitoring devices like sphygmomanometer or fetoscope?

Yes

No

A33

Have you ever used video game module for increasing learning about delivery management?

Yes

No

A34

What level of game have you completed in the video game?

Yes

No

A35

Do you know how to use the Remote Support Centre (RSC) for seeking advice from doctors?

Yes

No

A36

Have you ever used the Remote Support Centre (RSC) for seeking advice on complication management from doctors?

Yes

No

A37

Have you ever used the Remote Support Centre (RSC) for referral of cases?

Yes

No

A38

Under what circumstances, are you not able to use the remote support centre even when required?

During night deliveries

When handling delivery cases alone

During normal deliveries

Others, Specify

A39

Do you think that Remote support centre is useful in managing complicated cases?

Yes

No

A40

Do you think that Remote support centre is useful in receiving training?

Yes

No

A41

Do you think that Remote support centre is useful in routine practice?

Yes

No

A42

Do you think technological tools or processes have improved your clinical practices?

Yes

No

A43

Do you think there are improvement in delivery care services of your hospital due to technological tools or processes?

Yes

No

A44

What are advantages or benefits of technological tools or processes?

Saves time

Saves a lot of work/efforts

Easy to handle

Comprehensive

Readily available

Helps in better monitoring

Good reminder tool

Helps in giving better quality of care

Assist in decision making

Others: Specify

A45

What are the disadvantages or drawback of technological tools or processes?

Too cumbersome to handle along with patients

Takes more time

Don’t know how to use

Device/hardware not available

Device/hardware not functioning

Worried about damage to the device

Others: Specify

B01

What is the normal range of foetal heart rate at full term?

120-160 beats per minute

Others

Don’t Know

B02

What are the different grips performed during abdominal examination?

Fundal grip/Fundal Palpation

Lateral grip/Lateral palpation

First pelvic grip/superficial pelvic grip

Second pelvic grip/deep pelvic grip

Others

Don’t Know

B03

Safe birth checklist is used at which different points of intrapartum and postpartum care?\

At the time of admission

Just before pushing

Within 1 hour after birth

Before discharge

Others

Don’t Know

B04

What are risk factors associated with high risk delivery?

Preterm, gestation<37 weeks

Post term, gestation>42 weeks

Significant medical diseases – Hypertension, Diabetes, heart disease, anaemia

Post C-Section pregnancy

Intrauterine growth retardation (IUGR)

Malpresentation/Abnormal presentation

Antepartum Haemorrhage

Pregnancy Induced hypertension (PIH), Pre-eclampsia, eclampsia

Multiple pregnancy

Grand multigravida

Elderly primigravida

Bad Obstetric History

Premature Rupture Of Membranes

Decreased foetal movement

Compromised foetus

Others

Don’t Know

B05

What is the criteria for severe anaemia in pregnant women defined?

Haemoglobin level in blood less than 7 gm

Others

Don’t Know

B06

What are the danger signs that should be looked for /a pregnant woman should be evaluated on arrival for delivery?

Severe headache

Blurred vision

Fits/convulsions

Blood pressure ≥ 140/90

Vaginal bleeding

Temperature> 100.5°F or 38°c

Foul discharge per vagina

FHR <120 bpm or >160bpm

Severe abdominal pain

History of heart disease or major illnesses

Difficulty in breathing

Others

Don’t know

B07

What are the major signs of obstructed labour?

Strong contractions, no progress in dilatation, no descent of presenting part

Partograph is to the right of the alert line

Foetal distress

Rapid maternal pulse

Horizontal ridge across uterus below umbilicus

Others

Don’t know

B08

What are the major antibiotics that can be administered for a case of obstructed labour?

IV fluids

Ampicillin (or Ampicillin+ Cloxacillin or Ampilox or Ampoxin)

Metronidazole

Gentamicin / Amikacin

Others

Don’t know

B09

What is the appropriate dose of Ampicillin (or Ampicillin+ Cloxacillin or Ampilox or Ampoxin)?

Dose 1 gm

Others

Don’t know

B10

What is the appropriate route of giving/ administring Ampicillin (or Ampicillin+ Cloxacillin or Ampilox or Ampoxin)?

IV route or orally

Others

Don’t know

B11

What is the appropriate dose of Metronidazole?

Dose 400mg (orally)

Dose 500mg (IV)

Others

Don’t know

B12

What is the appropriate route of giving / administering Metronidazole?

Orally (Dose 400mg)

IV (Dose 500mg)

Others

Don’t know

B13

What is the appropriate dose of Gentamicin / Amikacin?

Dose 80mg (2mls)

Others

Don’t know

B14

What is the appropriate route of giving / administering Gentamicin / Amikacin?

Route IM or IV

Others

Don’t know

B15

What are the signs of pregnancy induced hypertension?

High BP ≥ 140/90 High BP ≥ 140/90

No proteinuria

Gestation ≥ 20 weeks

No proteinuria

Gestation ≥ 20 weeks

Others

Don’t know

B16

What is the treatment for pregnancy induced hypertension

Give oxygen

Give Nifedipine

Give Labetalol

Give Hydralazine

Others

Don’t know

B17

What is the appropriate dose of Nifedipine?

Dose 10mg

Others

Don’t know

B18

What is the appropriate route of giving/administering Nifedipine?

Orally

Sublingual

Others

Don’t know

B19

What is the appropriate dose of Labetalol?

Dose 100mg (orally)

Dose 20mg (IV bolus)

Others

Don’t know

B20

What is the appropriate route of giving/administering Labetalol?

Orally (Dose 100mg)

IV bolus (Dose 20mg)

Others

Don’t know

B21

What is the appropriate dose of Hydralazine?

Dose 5mg

Others

Don’t know

B22

What is the appropriate route of giving / administering Hydralazine?

IV route

Others

Don’t know

B23

What are the signs of mild pre-eclampsia?

High BP ≥ 140/90 and ≤ 160/110

Proteinuria (> 2+)

Others

Don’t know

B24

What are the signs/symptoms of severe pre-eclampsia?

High BP ≥ 160/110

Proteinuria (> 3+)

Others

Don’t know

B25

What is the drug that will be used for controlling convulsions in a pregnant woman? (Woman in labour with a BP of 160/110)?

Magnesium sulphate

Other

Don’t know

B26

What is the appropriate dose of Magnesium sulphate?

Dose 10ml (5mg)

Others

Don’t know

B27

What is the appropriate route of giving / administering Magnesium sulphate?

IM in each buttock

Others

Don’t know

B28

What are the major causes of antepartum hemorrhage?

Abruptio placentae

Placenta praevia

Ruptured uterus

Others

Don’t know

B29

What are the steps in the management and referral for a case of antepartum haemorrhage in a pregnant woman?

Call and determine nearest facility with C-section facilities

Arrange transport

Arrange for blood transfusion

Give oxygen

Keep the women NPO

Give oxytocin

Record vitals

Insert foley’s catheter

Give antibiotics (Ampicillin/metronidazole/ gentamicin)

Start IV fluids

Others

Don’t know

B30

What are the signs of puerperal sepsis?

Fever > 38° c

Lower abdominal pain or tenderness

Abnormal lochia (foul smelling or blood strained)

Uterus not well contracted

Others

Don’t know

B31

What are the drugs that should be given in case of puerperal sepsis before referral of the case?

Ampicillin

Metronidazole

Gentamicin

Others

Don’t know

B32

What are the pre-referral management steps for a case of pre-term labour of gestation 24-34 weeks?

Call and determine if the facility has the required services for a preterm delivery

Arrange transport

Give antenatal corticosteroids first dose (inj. Dexamethasone)

Others

Don’t know

B33

What is the appropriate route of giving/administering Inj. Dexamethasone?

Intramuscular injection (Dose 6 mg)

Others

Don’t know

B34

What is the appropriate dose of Inj. Dexamethasone?

Dose 6 mg

Others

Don’t know

B35

What are the pre-referral management steps for a case of rupture of membranes?

Call and determine if the facility has the required services for a preterm Delivery

Arrange transport

Give antibiotics

Others

Don’t know

B36

What are the pre-referral management steps for a case of pre-term rupture of membranes without labour and without fever?

Call and determine the facility has required services for pre-term rupture of membranes

Arrange transport

Give antibiotics Erythromycin

Give antibiotics Amoxicillin

Others

Don’t know

B37

What is the appropriate dose of Erythromycin?

Dose 250 mg

Others

Don’t know

B38

What is the appropriate route of giving / administering Erythromycin?

Oral

Others

Don’t know

B39

What is the appropriate dose of Amoxicillin?

Dose 500 mg

Others

Don’t know

B40

What is the appropriate route of giving / administering Amoxicillin?

Oral

Others

Don’t know

B41

What are the assessments required / need to be done for PPH case after it is diagnosed?

Vital signs-Pulse/BP

Check for uterine tone/contracted uterus

Estimate the blood loss

Check for trauma/tears

Others

B42

What are the steps for managing a case of PPH?

Put in an IV line with ringer lactate

Give oxytocin

Massage the uterus

Start bimanual compression of the uterus

Raise her legs higher than her head

Keep her warm with a blanket

Monitor pulse and BP every 15 minutes

Encourage her to pass urine/catheterize

Others

Don’t know

C01

What are the items you will plot on a partograph to monitor foetal conditions?

FHR

Amniotic fluids

Others

Don’t know

C02

What are the components partograph for monitoring maternal conditions?

Vitals of mother

Cervical contraction

Others

Don’t know

C03

When does the first stage of labour start? When do you say the pregnant woman is in the first stage of labour?

Onset of labour pain

Others

Don’t know

C04

How do you know the 1st stage of labour has finished?

Full dilation of cervix (10 cm)

Others

Don’t know

C05

At what level of dilation of the cervix should you start plotting the partograph?

4 cm

Others

Don’t know

C06

How frequently is FHR to be measured for plotting on the partograph?

Every half hour

Others

Don’t know

C07

How frequently should you measure Amniotic fluid for plotting on the partograph?

Every half hour

Others

Don’t know

C08

How frequently should Cervical dilatation be measured for plotting on the partograph?

Every four hours

Others

Don’t know

C09

How frequently should you monitor contractions for plotting on the partograph?

Every half hour

Others

Don’t know

C10

How frequently should pulse be measured for plotting on the partograph?

Every half hour

Others

Don’t know

C11

How frequently should BP be measured for plotting on the partograph?

Every four hours

Others

Don’t know

C12

How frequently should temperature be measured for plotting on the partograph?

Every four hours

Others

Don’t know

C13

How you will identify a case of prolonged labour from partograph readings?

Plotted cervical dilatation line crossing the alert line

Contraction do not increase in frequency and duration

Cervix not dilated >4 cm after 8 hrs of regular contraction

Cervix not dilating at least 1 cm an hour in active labour.

No cervical change with repeat PV

Full dilation of cervix but no descent of foetal head

Two or less contraction in 10 minutes lasting less than 40 seconds when in active labour

Others

Don’t know

C14

How you will identify a case of obstructed labour from partograph readings?

Plotted cervical dilatation line is to the right of the alert line

No cervical change with repeat PV after 4 hrs in active phase of labour

Significant caput and moulding

Cervix that not well applied to presenting part

Swollen, oedematous cervix

Ballooning lower uterine segment

Formation of reaction band felt over abdomen

Foetal or maternal distress

Active labour for more 24 hours duration

Others

Don’t know

C15

When does the third stage of labour start?

From delivery of foetus

Others

Don’t know

C16

When does the third stage of labour end?

After expulsion of placenta

Others

Don’t know

C17

What are the steps of managing third stage of labour?

Give utertonics (Oxytocin)

Controlled cord traction

counter pressure

Uterine massage

Others

Don’t know

C18

What is the appropriate dose of Oxytocin?

10 IU

Others

Don’t know

C19

What is the appropriate route for giving/ administering Oxytocin?

Intra muscular

Others

Don’t know

C20

Can you tell me when do/ would you administer Oxytocin?

< 60 seconds after delivery of newborn and before delivery of placenta

Others

Don’t know

C21

What is the ideal temperature to store/ for storage of oxytocin?

2 to 8 °C

Others

Don’t know

C22

Which colour bag is used to dispose off the placenta?

Red Bin

Yellow Bin

Black Bin

Blue Bin

Others

Don’t Know

C23

What should be done to decontaminate the instruments used in the labour ward?

Washed with soap and water and boiled for 2 hours

Soaked in 0.5% chlorine solution for 10 minutes

Washed in soap and water

Boiled the instruments for 20 minutes

Others

Don’t know

E01

When does the fourth stage of labour start?

From the expulsion of placenta

Others

Don’t know

E02

When does the fourth stage of labour end?

2 hours after expulsion of placenta

Others

Don’t know

E03

How frequently should temperature be measured during the fourth stage of labour?

Every one hour

Others

Don’t know

E04

How frequently should pulse be measured during the fourth stage of labour?

Every 15 minutes

Others

Don’t know

E05

How frequently should blood pressure be measured during the fourth stage of labour?

Every 15 minutes

Others

Don’t know

E06

How frequently should uterine contractions be measured during the fourth stage of labour?

Every 15 minutes

Others

Don’t know

E07

How frequently bleeding PV should be measured during fourth stage of labour?

Every 15 minutes

Others

Don’t know

E08

How frequently urination should be measured during fourth stage of labour?

Every 15 minutes

Others

Don’t know

E09

How frequently should new-born breastfeeding be examined in the first one hour?

Every 15 minutes

Others

Don’t know

E10

How frequently should new-born colour be examined in first one hour?

Every 15 minutes

Others

Don’t know

E11

How frequently should new-born nasal flaring be examined in the first one hour?

Every 15 minutes

Others

Don’t know

E12

How frequently should new-born grunting be examined in the first one hour?

Every 15 minutes

Others

Don’t know

E13

How frequently should new-born chest reaction be examined in the first one hour?

Every 15 minutes

Others

Don’t know

E14

How frequently should new-born respiratory rate be examined in the first one hour?

Every 15 minutes

Others

Don’t know

E15

How frequently should new-born heart rate be examined in the first one hour?

Every 15 minutes

Others

Don’t know

E16

How frequently should new-born temperature be examined in the first one hour?

Every 15 minutes

Others

Don’t know

E17

How frequently should new-born cord be examined for bleeding in the first one hour?

Every 15 minutes

Others

Don’t know

F01

Counselling related to what topics should be given to the mother during the postpartum period

Feeding the newborn

Warmth for the newborn

Bathing of the newborn

Cord care: Nothing on cord

Immunization for the newborn

Care of skin/ eyes for the newborn

Maternal nutrition

Family planning

Others

Don’t know

F02

What are the maternal danger signs that you will counsel the mother to report immediately at the time of discharge?

Bleeding

Severe abdominal pain

Severe headache or visual disturbance

Breathing difficulty

Fever or chills

Difficulty emptying bladder

Epigastric pain

Others

Don’t know

F03

What are the neonatal danger signs that you will counsel the mother to report immediately at the time of discharge?

Fast/difficult breathing

Fever

Unusually cold

Stops feeding well

Less activity than normal

Whole body becomes yellow

Others

Don’t know

G01

What is the gestation age?

G02

Is this preterm, term, or post term?

Preterm

Term

Post term

H01

Did the nurse wash hands?

Yes

No

H02

Did the nurse inform the mother about the procedure?

Yes

No

H03

Did the nurse clean the thermometer with a spirit cotton swab?

Yes

No

H04

Did the nurse shake the thermometer to ensure mercury was below normal temperature (98.4° F)?

Yes

No

H05

Did the nurse place the bulb end of thermometer under the tongue of the mother?

Yes

No

H06

Did the nurse inform the mother to keep her mouth closed?

Yes

No

H07

Did the nurse inform the mother to keep the thermometer for 3 minutes?

Yes

No

H08

Did the nurse remove the thermometer by holding the stem end of thermometer?

Yes

No

H09

Did the nurse note the reading by holding the thermometer at eye level?

Yes

No

H10

Did the nurse wipe the thermometer from stem to bulb?

Yes

No

H11

Did the nurse inform the mother about the findings?

Yes

No

H12

Did the nurse write the temperature readings on the notepad?

Yes

No

H13

Did the nurse wash her hands?

Yes

No

I01

Did the nurse wash hands?

Yes

No

I02

Did the nurse inform the client about the procedure?

Yes

No

I03

Did the nurse ensure to bare the arm of the pregnant woman?

Yes

No

I04

Did the nurse extend the arm of the pregnant woman?

Yes

No

I05

Did the nurse rest the arm of the woman at level with the heart?

Yes

No

I06

Did the nurse loosen the valve on bulb?

Yes

No

I07

Did the nurse expel the remaining air from the cuff by squeezing?

Yes

No

I08

Did the nurse locate the brachial artery?

Yes

No

I09

Did the nurse wrap the cuff around the upper arm, one inch (2.5 cms or 2 fingers) above the elbow?

Yes

No

I10

Did the nurse place the diaphragm of the stethoscope directly over the brachial artery?

Yes

No

I11

At what level did the nurse raise the cuff bulb and inflated the cuff until pulse was no longer felt?

I12

Did the nurse deflate the cuff at an even rate of 2-4mm per second by turning valve counter clock wise?

Yes

No

I13

Did the nurse verbalize change in sound?

Yes

No

I14

Record the reading when the sound is heard?

I15

Can you tell me, the name of the reading when the first sound is heard?

Systolic reading

Diastolic reading

Other

Don’t know

I16

Record the reading when the sound disappears?

I17

Can you tell me the name of the reading when the sound disappears?

Systolic reading

Diastolic reading

Other

Don’t know

I18

Did the nurse fully open the valve to deflate the cuff?

Yes

No

I19

Did the nurse inform the client woman of her blood pressure?

Yes

No

J01

Did the nurse wash hands?

Yes

No

J02

Did the nurse inform the pregnant woman about the procedure?

Yes

No

J03

Did the nurse wear gloves?

Yes

No

J04

Did the nurse clean the tip of the pregnant woman’s finger with a spirit swab?

Yes

No

J05

Did the nurse prick the finger with a lancet?

Yes

No

J06

Did the nurse allow a blood drop to form on the fingertip?

Yes

No

J07

Did the nurse discard the first drop of blood?

Yes

No

J08

Did the nurse use a pipette to suck the blood drop?

Yes

No

J08A

Can you tell me up to which mark you need to suck the blood?

20 cu.mm

Others

Don’t know

J09

Did the nurse clean the pregnant woman’s finger?

Yes

No

J10

Did the nurse wipe the tip of the pipette?

Yes

No

J11

Did the nurse transfer the blood to the Hb tube?

Yes

No

J11A

Can you tell me what the solution inside the Hb tube is?

N/10 HCL

Others

Don’t know

J12

Did the nurse wait for ten minutes?

Yes

No

J13

Did the nurse dilute the acid by adding distilled water drop by drop?

Yes

No

J14

Did the nurse use a stirrer to mix?

Yes

No

J15

Did the nurse match the color of the comparator?

Yes

No

J16

Did the nurse note down the reading in gms%?

Yes

No

J16A

Can you tell me which reading is to be considered, the lower or upper meniscus?

Lower meniscus

Upper meniscus

Others

Don’t know

J17

Did the nurse dispose of the used lancet in a puncture proof container?

Yes

No

J18

Did the nurse discuss the results with the pregnant woman’s?

Yes

No

J19

Did the nurse dispose the gloves as per protocol (IN 0.5 CHLORINE SOLUTION)?

Yes

No

J20

Did the nurse rinse Hb chamber and pipette with N/H10?

Yes

No

K01

Did the nurse wash hands?

Yes

No

K02

Did the nurse informed process to the client?

Yes

No

K03

Did the nurse wear gloves?

Yes

No

K04

Did the nurse remove one reagent strip from the bottle?

Yes

No

K05

Did the nurse immediately recap the bottle?

Yes

No

K06

Did the nurse immerse the reagent strip in the urine?

Yes

No

K07

Did the nurse remove the reagent strip immediately?

Yes

No

K08

Did the nurse remove the excess urine?

Yes

No

K09

Did the nurse compare the strip against the chart area on the bottle?

Yes

No

K10

Did the nurse wait 30 seconds to read the glucose level?

Yes

No

K11

Did the nurse wait 60 seconds to read albumin level?

Yes

No

K12

Did the nurse dispose off the used strip in the red bin?

Yes

No

K13

Did the nurse note down the findings?

Yes

No

L01

Did the nurse wash hands?

Yes

No

L02

Did the nurse inform the pregnant woman about the procedure?

Yes

No

L03

Did the nurse ask the pregnant women to flex her knees?

Yes

No

L04

Did the nurse ask the pregnant women to relax her abdomen?

Yes

No

L04A

Can you tell me the purpose of these abdominal grips that you are performing?

Help in assess presentation

Other

Don’t know

L04B

Can you tell me what should be the minimum gestational age for assessing the fetal growth?

32 weeks onwards

Other

Don’t know

L05

Did the nurse palpate the funds with both hands?

Yes

No

L05A

Can you tell me how you will differentiate between head vertix and breech presentations?

Normal-feels hard

Breeach-soft

Other

Don’t know

L06

Did the nurse place one hand on each side of the abdomen?

Yes

No

L06A

Can you tell me what the fetal back feels like on palpation?

Continuous hard, flat surface

Other

Don’t know

L06B

Can you tell me what the limbs feel like on palpation?

Irregular small knobs

Other

Don’t know

L07

Did the nurse spread her right hand widely over the symphysis pubis?

Yes

No

L08

Did the nurse try to approximate the finger and thumbs?

Yes

No

L09

Did the nurse apply deep pressure over the lower parts of the uterus?

Yes

No

L10

Did the nurse face the foot end of the bed?

Yes

No

L11

Did the nurse palpate the lower pole of presentation part with both hands?

Yes

No

L12

Did the nurse’s fingers point downwards and inward?

Yes

No

L13

Did the nurse’s finger’s joined on the presentation part?

Yes

No

L13A

Can you tell me how the head feels, if it’s not engaged?

Like firm, round mass

Other

Don’t know

L13B

Can you tell me the correct place to auscultate for the fetal heart rate?

Fetal back

Other

Don’t know

L13C

Can you tell me after what gestational age do we check fetal heart rate?

24 weeks onwards

Other

Don’t know

M01

Did the nurse wash hands?

Yes

No

M02

Did the nurse wear gloves?

Yes

No

M03

Did the nurse clean the perineum with anti-septic solution?

Yes

No

M04

Did the nurse encourage the woman to make small pushes with contractions?

Yes

No

M05

Did the nurse ask the mother to take deep breathe in between contractions?

Yes

No

M06

Did the nurse control the birth of the head with fingers of one hand to maintain flexion?

Yes

No

M07

Did the nurse support the perineum with other hand using a clean pad?

Yes

No

M08

Did the nurse feel gently around the baby’s neck for presence of umbilical cord?

Yes

No

M09

Did the nurse allow the baby’s head to turn spontaneously?

Yes

No

M10

Did the nurse keep hands on either side of the baby’s head and deliver the anterior shoulder?

Yes

No

M11

Did the nurse deliver posterior shoulder once axillary crease is seen by guiding head in an upwards direction?

Yes

No

M12

Did the nurse support the rest of the baby’s body with one hand as it slides out?

Yes

No

M13

Did the nurse place the baby on the mother’s abdomen over the clean towels?

Yes

No

M14

Did the nurse note the time of birth and sex of the baby and tell the mother?

Yes

No

M15

Did the nurse thoroughly dry the baby and cover with a clean, dry cloth?

Yes

No

M16

Did the nurse look for any vaginal or perineal tear?

Yes

No

N01

Did the nurse wash hands?

Yes

No

N02

Did the nurse wear gloves?

Yes

No

N03

Did the nurse rule out any additional babies (2nd baby)?

Yes

No

N04

Did the nurse administer oxytocin?

Yes

No

N04A

Can you tell me the route of administration for oxytocin?

Intramuscular

Intravenous

Others

Don’t know

N04B

Can you tell me the dose of Oxytocin that you will administer?

10 IU

Others

Don’t know

N05

Did the nurse tell the mother that delivering the placenta will not hurt?

Yes

No

N06

Did the nurse hold the clamped end of the umbilical cord with one hand?

Yes

No

N07

Did the nurse place the other hand just above the symphysis pubic?

Yes

No

N07A

Can you tell me the most important reason, why your hand should be placed just above the symphysis pubic?

Counter traction

To feel for a contraction

Others

Don’t know

N08

Did the nurse gently pull the cord downwards to deliver the placenta?

Yes

No

N08A

Can you tell me when you will pull the cord downward’s?

During a contraction

Others

Don’t know

N09

Did the nurse apply counter traction by push upwards with the other hand?

Yes

No

N09A

Can you tell me what will you do if the placenta does not descend within 30-40 seconds of CCT?

Stop & wait for next strong contraction

Other’s

Don’t know

N10

Did the nurse gently twist the membranes?

Yes

No

N10A

Can you tell me why you twisted the membranes?

Palcenta expelled intact

Others

Don’t know

N10B

Did the nurse hold the placenta in both hands?

Yes

No

N10C

Did the nurse examine the completeness of placenta before putting in the tray?

Yes

No

N11

Did the nurse place the placenta in the tray?

Yes

No

N12

Did the nurse place a cupped palm on the uterine fundus?

Yes

No

N13

Did the nurse massage the uterine fundus in a circular motion?

Yes

No

N14

Can you tell me how long the massage has to be done?

Until the uterus is well contarcted

Others

Don’t know

O01

Did the nurse wash hands?

Yes

No

O02

Did the nurse wear gloves?

Yes

No

O03

Did the nurse wear double gloves?

Yes

No

O04

Did the nurse remove the upper gloves?

Yes

No

O05

Did the nurse dry the new-born with a clean and dry towel?

Yes

No

O06

Did the nurse assess the breathing of the newborn while drying the baby?

Yes

No

O07

Did the nurse wrap the baby with a separate towel?

Yes

No

O08

Did the nurse clamp and cut the cord?

Yes

No

O09

Did the cord was cut after completion of all three steps above (step no.5-7)?

Yes

No

O10

Did the nurse wipe the eyes of the newborn with separate sterile gauze?

Yes

No

O11

Did the nurse place the baby between mother’s breasts for skin to skin care?

Yes

No

O12

Did the nurse tie the identity label to the newborn?

Yes

No

O13

Did the nurse cover the baby with a separate cloth?

Yes

No

O14

Did the nurse cover the mother with a separate cloth?

Yes

No

O15

Did the nurse cover the newborn’s head with a cap?

Yes

No

O16

Did the nurse cover the newborns with socks?

Yes

No

O17

Did the nurse encourage the initiation of breastfeeding?

Yes

No

P01

If meconium present, what are the steps you will you follow?

Yes

No

P02

Did the nurse suction the new-born’s mouth?

Yes

No

P03

Did the nurse suction the new-born’s nose?

Yes

No

P04

Did the nurse suction the mouth before the nose?

Yes

No

P05

Did the nurse dry the new-born with cloth?

Yes

No

P06

Did the nurse remove the wet cloth?

Yes

No

P07

Did the nurse assess the breathing / crying?

Yes

No

P08

If the newborn is not breathing/crying, what steps you will follow?

Yes

No

P09

Did the nurse clamp and cut the cord immediately?

Yes

No

P10

Did the nurse provide a warm environment?

Yes

No

P11

Did the nurse place the newborn on radiant warmer?

Yes

No

P12

Did the nurse suction the newborn’s mouth?

Yes

No

P13

Did the nurse suction the newborn’s nose?

Yes

No

P14

Did the nurse suction the mouth before the nose?

Yes

No

P15

Did the nurse place the newborn on firm flat surface?

Yes

No

P16

Did the nurse position the newborn with its neck slight extended?

Yes

No

P17

Did the nurse appropriately stimulate the newborn?

Yes

No

P18

Did the nurse reposition the newborn?

Yes

No

P19

Did the nurse assess the breathing/crying?

Yes

No

P20

If the newborn is not breathing/crying, what steps you will follow?

Yes

No

P21

Did the nurse provide bag and mask ventilation?

Yes

No

P22

Did the nurse correctly position herself to visualize chest movement?

Yes

No

P23

Did the nurse hold the mask on the face with the thumb, index and/or middle finger encircling the rim in a ‘C” shape?

Yes

No

P24

Did the nurse use the ring and fifth finger to bring the chin forward?

Yes

No

P25

Can you tell me how will you ensure a proper seal?

Slight downward pressure on the rim

Others

Don’t know

P26

Did the nurse achieve gentle chest rise with ventilation?

Yes

No

P27

Can you tell me what will you look for to ensure adequacy of ventilation?

Chest movement

Others

Don’t know

P28

If chest movement is inadequate what are the first 2 steps to improve ventilation?

Reapply mask to face

Reposition head

Others

Don’t know

P29

Did the nurse ventilate at the rate of 40-60 beats per minute?

Yes

No

P30

Did the nurse follow the protocol of breath…2, 3?

Yes

No

P31

Did the nurse assess the breathing/crying after 30 seconds of bag and mask?

Yes

No

P32

If the newborn is not breathing/crying, what steps you will follow?

P33

Did the nurse assess the heart rate? Either feeling cord pulse or listening via stethoscope?

Yes

No

P34

Did the nurse give chest compression?

Yes

No

P35

Did the nurse indicate that oxygen could be added?

Yes

No

P36

Did the nurse call for help?

Yes

No

P37

Did the nurse arrange for referral?

Yes

No

QQ01

Did the nurse take two 10 ml sterile syringes?

Yes

No

QQ02

Did the nurse draw 5 ampoules of MgSO4 50 % into each syringe?

Yes

No

QQ03

Can you tell me how many grams of MgSO4 are in each 2ml ampule?

1 gram

Others

Don’t know

QQ04

Did the nurse add 1 ml of 2% lignocaine to each syringe?

Yes

No

QQ04A

Can you tell me the route of administration of MgSO4 in this situation?

Intramuscular

Others

Don’t know

QQ04B

Can you tell me the site of injection?

Each buttock

Others

Don’t know

R01

Did the nurse shout for help?

Yes

No

R02

Did the nurse measure and record pulse?

Yes

No

R03

Did the nurse measure and record BP?

Yes

No

R04

Did the nurse measure and record respiration rate?

Yes

No

R05

Did the nurse measure and record temperature?

Yes

No

R06

Did the nurse establish two I.V lines?

Yes

No

R06A

Can you tell me the correct size needle gauge that you will use?

16-18 Gauge

Others

Don’t know

R06B

What steps will you follow if the woman is in hypovolemic shock?

R07

Did the nurse give IV normal saline or Ringer’s lactate or 5% dextrose normal saline?

Yes

No

R07A

Can you tell me the rate of flow of IV fluids?

60 drops per minute

Others

Don’t know

R08

Did the nurse give Oxytocin?

Yes

No

R08A

Can you tell me dose of Oxytocin given via infusion?

20 IU

Others

Don’t know

R08B

Can you tell me the rate of flow for next 500ml of IV fluids?

20 IU

Others

Don’t know

R09

Did the nurse elevate the women’s feet?

Yes

No

R10

Did the nurse give oxygen?

Yes

No

R11

Did the nurse insert a Foley’s catheter?

Yes

No

R11A

Can you tell me one major cause of PPH?

Uterine atony

Trauma

Retained placenta

Coagulation defects

Others

Don’t know

S01

Did the nurse greet the client?

Yes

No

S02

Did the nurse show respect for the client?

Yes

No

S03

Did the nurse help the client to feel at ease?

Yes

No

S04

Did the nurse ask about her medical history?

Yes

No

S05

Did the nurse ask about her reproductive history?

Yes

No

S06

Did the nurse ask about desired number of children?

Yes

No

S07

Did the nurse encourage the client to explain her needs on family planning (spacing or permanent)?

Yes

No

S08

Did the nurse explore client’s knowledge about family planning?

Yes

No

S09

Did the nurse explore client’s knowledge on benefits of family planning?

Yes

No

S10

Did the nurse explain to the client about various methods of family planning based on her needs?

Yes

No

S11

Did the nurse listen carefully to the client concerns on family planning methods?

Yes

No

S12

Did the nurse encourage the client to ask questions on family planning services and methods?

Yes

No

S13

Did the nurse determine if the client had a preference for a specific method based on prior knowledge or the information provided?

Yes

No

S14

Did the nurse provide the client with information about the various family planning methods?

Yes

No

S15

Did the nurse give the client additional information that she may need and answer any question that she might need to make decision?

Yes

No

S16

Did the nurse include the client’s husband or important family member with her consent in the discussion?

Yes

No

S17

Did the nurse explore partner’s/family’s knowledge about family planning?

Yes

No

S18

Did the nurse determine if client had used any method of family planning previously?

Yes

No

S19

Did the nurse determine any problems with the method?

Yes

No

S20

Did the nurse determine attitude of family about birth spacing and use of family planning to improve health?

Yes

No

S21

Did the nurse ask her to discuss with client family members, if she is not able to arrive at a conclusions?

Yes

No

S22

Did the nurse make a notation in the client’s record about her choice or interest?

Yes

No

S23

Did the nurse acknowledge what the client has chosen?

Yes

No

S24

Did the nurse determine if she can safely use the method?

Yes

No

S25

Did the nurse tell her what the next steps will be for providing her with her choice of method for FP?

Yes

No

S26

Did the nurse discuss the advantages of the selected method?

Yes

No

S27

Did the nurse discuss limitations of the selected method?

Yes

No

S28

Did the nurse discuss warning signs and explain when to return to the facility?

Yes

No

S29

Did the nurse check that the client understood advantages/disadvantages of selected methods?

Yes

No

S30

Did the nurse provide information about when the client should come for the desired procedure/method?

Yes

No

S31

Did the nurse addresses any related needs such as protection from sexually transmitted infections including HIV?

Yes

No

S32

Did the nurse explain and support condom use as a method of additional protection?

Yes

No

T01

Did the nurse remove any rings?

Yes

No

Not applicable

T02

Did the nurse remove her watch?

Yes

No

Not applicable

T03

Did the nurse remove other jewelry below elbow?

Yes

No

Not applicable

T04

Did the nurse apply enough soap to cover all the surfaces of the hand?

Yes

No

T05

Palm to palm?

Yes

No

T06

Left palm over right dorsum with interlaced fingers?

Yes

No

T07

Right palm over left dorsum with interlaced fingers?

Yes

No

T08

Palm to palm with fingers interlaced?

Yes

No

T09

Back of finger to opposing palms with fingers interlocked?

Yes

No

T10

Rotational rubbing of left thumb clasped in the right palm?

Yes

No

T11

Rotational rubbing of right thumb clasped in the left palm?

Yes

No

T12

Rotational rubbing, backwards and forwards with clasped fingers of the right hand in the left palm?

Yes

No

T13

Rotational rubbing, backwards and forwards with clasped fingers of left hand in right palm done?

Yes

No

T14

Rubbing left wrist with right finger?

Yes

No

T15

Rubbing right wrist with left finger?

Yes

No

T16

Did the nurse rinse hands with water?

Yes

No

T17

Did the nurse use the towel or elbow to turn off the water faucet?

Yes

No

U01

Did the nurse wear the gloves?

Yes

No

U02

Did the nurse take 1 liter of water in a plastic bucket?

Yes

No

U03

Did the nurse remove some water from plastic bucket using a plastic mug?

Yes

No

U04

Did the nurse measure 3 level teaspoons (15 grams) bleaching powder?

Yes

No

U05

Did the nurse mix the water and bleaching powder in the plastic mug?

Yes

No

U06

Did the nurse pour the paste in plastic bucket?

Yes

No

U07

Did the nurse cover the bucket after preparation of the solution?

Yes

No

V01

Did the nurse wash hands?

Yes

No

V02

Did the nurse inform the client about the procedure?

Yes

No

V03

Did the nurse extend the arm of the pregnant woman?

Yes

No

V04

Did the nurse rest the arm of the pregnant woman at level with the heart?

Yes

No

V05

Did the nurse switch on the BP measuring device?

Yes

No

V06

Did the nurse loosen the valve on bulb?

Yes

No

V07

Did the nurse expel the remaining air from the cuff by squeezing?

Yes

No

V08

Did the nurse wrap the cuff around the upper arm, one inch (2.5 cms or 2 fingers) above the elbow?

Yes

No

V09

Did the nurse ensure that the device reading is 0 before starting?

Yes

No

V10

Did the nurse inflate the cuff until 200 mm Hg reading was seen on the device screen?

Yes

No

V11

Did the nurse leave the valve as it is to let it deflate?

Yes

No

V12A

Record the reading when the device displays a stable number.

V12B

Can you tell me, the name of the upper reading on the screen?

Systolic reading

Diastolic reading

Other

Don’t know

V12C

Can you tell me the name of the lower reading on the screen?

Systolic reading

Diastolic reading

Other

Don’t know

V13

Did the nurse ensure that the cuff was fully deflated?

Yes

No

V14

Did the nurse inform the client woman of her blood pressure?

Yes

No

V15

Did the nurse record the blood pressure reading in the notepad?

Yes

No

W01

Did the nurse wash hands?

Yes

No

W02

Did the nurse inform the client about the procedure?

Yes

No

W03

Did the nurse ensure to bare the abdomen of the pregnant woman?

Yes

No

W04

Did the nurse switch on MOYO device measuring device?

Yes

No

W05

Did the nurse check the display of the device?

Yes

No

W06

Did the nurse apply gel on the ultrasound sensor of the device?

Yes

No

W07

Did the nurse place the ultrasound sensor on mother’s abdomen around the area of fetal back?

Yes

No

W08

Did the nurse ensure that the fingers are not covering the upper sides of the MOYO pad while holding it?

Yes

No

W09

Did the nurse check for fetal heart rate sounds?

Yes

No

W10

If no sound was heard, did the nurse reposition the sensor on the mother’s abdomen until heart sounds are heard?

Yes

No

W11

Rhythmic Heart sound is heard

Yes

No

W12

Can you show me how to check if the heart rate heard and displayed on screen is not that of mother using the device.

Yes

No

W13

Asks the mother to hold the MOYO pad from both the sides covering left and right?

Yes

No

W14

Can you tell me what is the reading shown at the center of the device display? (the place from where it is picked up)

HR picked up on the abdomen

Others

W15

Can you tell me whose reading is shown on the lower part of the device display in small font?

Mother’s Heart rate

Others

W16

Did the nurse inform the client woman of the fetal heart rate?

Yes

No

W17

Did the nurse record the fetal heart rate reading in the notepad?

Yes

No

W18

Did the nurse switch off the MOYO device?

Yes

No

W19

Did the nurse clean the ultrasound sensor with cloth dampened in soapy water?

Yes

No

W20

Did the nurse clean the monitor pad with cloth dampened in soapy water?

Yes

No

W21

Did the nurse clean the device with cloth dampened in clean water?

Yes

No

W22

Did the nurse disinfect the device with cloth dampened in 70% ethanol?

Yes

No

X01

Did the nurse open the digital case sheet tab in 1-3 attempts?

Yes

No

X02

Did the nurse fill the identification details like name, etc. of the woman?

Complete

Incomplete

No

X03

Did the nurse fill the identification details like name, etc. of the woman correctly?

Complete

Incomplete

No

X04

Did the nurse fill the initial assessment information in the Admission notes section?

Complete

Incomplete

No

X05

Did the nurse fill the initial assessment information in the Admission notes section correctly?

Complete

Incomplete

No

X06

Did the nurse fill the safe childbirth checklist-1 completely?

Complete

Incomplete

No

X07

Did the nurse fill the safe childbirth checklist-1 correctly?

Complete

Incomplete

No

X08

Did the nurse plot the partograph?

Complete

Incomplete

No

X09

Did the nurse plot FHR correctly at 9 a.m.?

Yes

No

X10

Did the nurse plot FHR correctly at 10 a.m.?

Yes

No

X11

Did the nurse plot FHR correctly at 11 a.m.?

Yes

No

X12

Did the nurse plot FHR correctly at 12 noon?

Yes

No

X13

Did the nurse plot FHR correctly at 1 p.m.?

Yes

No

X14

Did the nurse plot the amniotic fluid status correctly at 9 a.m.?

Yes

No

X15

Did the nurse plot the amniotic fluid status correctly at 10 a.m.?

Yes

No

X16

Did the nurse plot the amniotic fluid status correctly at 11 a.m.?

Yes

No

X17

Did the nurse plot the amniotic fluid status correctly at 12 noon?

Yes

No

X18

Did the nurse plot the amniotic fluid status correctly at 1 p.m.?

Yes

No

X19

Did the nurse plot the cervical dilatation correctly at 9 a.m.?

Yes

No

X20

Did the nurse plot the cervical dilatation correctly at 1 p.m.?

Yes

No

X21

Did the nurse plot the blood pressure correctly at 9 a.m.?

Yes

No

X22

Did the nurse plot the blood pressure correctly at 1 p.m.?

Yes

No

X23

Did the nurse plot the pulse correctly at 9 a.m.?

Yes

No

X24

Did the nurse plot the pulse correctly at 1 p.m.?

Yes

No

X25

Did the nurse fill the safe childbirth checklist-2 completely?

Complete

Incomplete

No

X26

Did the nurse fill the safe childbirth checklist-2 correctly?

Complete

Incomplete

No

X27

Did the nurse fill the delivery notes section in the case sheet?

Complete

Incomplete

No

X28

Did the nurse fill the delivery notes section correctly?

Complete

Incomplete

No

X29

Did the nurse fill the newborn notes section in the case sheet?

Complete

Incomplete

No

X30

Did the nurse fill the newborn notes section correctly?

Complete

Incomplete

No

X31

Did the nurse fill the safe childbirth checklist-3 completely?

Complete

Incomplete

No

X32

Did the nurse fill the safe childbirth checklist-3 correctly?

Complete

Incomplete

No

X33

Did the nurse fill the safe childbirth checklist-4 completely?

Complete

Incomplete

No

X34

Did the nurse fill the safe childbirth checklist-4 correctly?

Complete

Incomplete

No

X35

Did the nurse fill the discharge slip section in the case sheet?

Complete

Incomplete

No

X36

Did the nurse fill the discharge slip section correctly?

Complete

Incomplete

No

X37

Did the nurse save the digital case sheet?

Yes

No

X38

Reopen the saved digital case sheet and check for correct responses. Is the case sheet filled completely?

Complete

Incomplete

No

X39

Is the digital case sheet filled correctly?

Complete

Incomplete

No

Y01

Did the nurse fill the identification details like name, etc. of the woman?

Complete

Incomplete

No

Y02

Did the nurse fill the identification details like name, etc. of the woman correctly?

Complete

Incomplete

No

Y03

Did the nurse fill the initial assessment information in the Admission notes section?

Complete

Incomplete

No

Y04

Did the nurse fill the initial assessment information in the Admission notes section correctly?

Complete

Incomplete

No

Y05

Did the nurse fill the safe childbirth checklist-1 completely?

Complete

Incomplete

No

Y06

Did the nurse fill the safe childbirth checklist-1 correctly?

Complete

Incomplete

No

Y07

Did the nurse plot the partograph?

Complete

Incomplete

No

Y08

Did the nurse plot FHR correctly at 9 a.m.?

Yes

No

Y09

Did the nurse plot FHR correctly at 10 a.m.?

Yes

No

Y10

Did the nurse plot FHR correctly at 11 a.m.?

Yes

No

Y11

Did the nurse plot FHR correctly at 12 noon?

Yes

No

Y12

Did the nurse plot FHR correctly at 1 p.m.?

Yes

No

Y13

Did the nurse plot the amniotic fluid status correctly at 9 a.m.?

Yes

No

Y14

Did the nurse plot the amniotic fluid status correctly at 10 a.m.?

Yes

No

Y15

Did the nurse plot the amniotic fluid status correctly at 11 a.m.?

Yes

No

Y16

Did the nurse plot the amniotic fluid status correctly at 12 noon?

Yes

No

Y17

Did the nurse plot the amniotic fluid status correctly at 1 p.m.?

Yes

No

Y18

Did the nurse plot the cervical dilatation correctly at 9 a.m.?

Yes

No

Y19

Did the nurse plot the cervical dilatation correctly at 1 p.m.?

Yes

No

Y20

Did the nurse plot the blood pressure correctly at 9 a.m.?

Yes

No

Y21

Did the nurse plot the blood pressure correctly at 1 p.m.?

Yes

No

Y22

Did the nurse plot the pulse correctly at 9 a.m.?

Yes

No

Y23

Did the nurse plot the pulse correctly at 1 p.m.?

Yes

No

Y24

Did the nurse fill the safe childbirth checklist-2 completely?

Complete

Incomplete

No

Y25

Did the nurse fill the safe childbirth checklist-2 correctly?

Complete

Incomplete

No

Y26

Did the nurse fill the delivery notes section in the case sheet?

Complete

Incomplete

No

Y27

Did the nurse fill the delivery notes section correctly?

Complete

Incomplete

No

Y28

Did the nurse fill the newborn notes section in the case sheet?

Complete

Incomplete

No

Y29

Did the nurse fill the newborn notes section correctly?

Complete

Incomplete

No

Y30

Did the nurse fill the safe childbirth checklist-3 completely?

Complete

Incomplete

No

Y31

Did the nurse fill the safe childbirth checklist-3 correctly?

Complete

Incomplete

No

Y32

Did the nurse fill the safe childbirth checklist-4 completely?

Complete

Incomplete

No

Y33

Did the nurse fill the safe childbirth checklist-4 correctly?

Complete

Incomplete

No

Y34

Did the nurse fill the discharge slip section in the case sheet?

Complete

Incomplete

No

Y35

Did the nurse fill the discharge slip section correctly?

Complete

Incomplete

No

Z01

Did the nurse plot FHR correctly at 10 a.m.?

Yes

No

Z02

Did the nurse plot FHR correctly at 11 a.m.?

Yes

No

Z03

Did the nurse plot FHR correctly at 12 a.m.?

Yes

No

Z04

Did the nurse plot FHR correctly at 1 p.m.?

Yes

No

Z05

Did the nurse plot FHR correctly at 2 p.m.?

Yes

No

Z06

Did the nurse plot the amniotic fluid status correctly at 10 a.m.?

Yes

No

Z07

Did the nurse plot the amniotic fluid status correctly at 11 a.m.?

Yes

No

Z08

Did the nurse plot the amniotic fluid status correctly at 12 a.m.?

Yes

No

Z09

Did the nurse plot the amniotic fluid status correctly at 1 p.m.?

Yes

No

Z10

Did the nurse plot the amniotic fluid status correctly at 2 p.m.?

Yes

No

Z11

Did the nurse plot the cervical dilatation correctly at 10 a.m.?

Yes

No

Z12

Did the nurse plot the cervical dilatation correctly at 2 p.m.?

Yes

No

Z13

Did the nurse plot the blood pressure correctly at 10 a.m.?

Yes

No

Z14

Did the nurse plot the blood pressure correctly at 2 p.m.?

Yes

No

Z15

Did the nurse plot the pulse correctly at 10 a.m.?

Yes

No

Z16

Did the nurse plot the pulse correctly at 2 p.m.?

Yes

No

101

Did the nurse unlocked the tablet device easily?

Yes

No

102

Did the nurse locate the remote support centre app on the device?

Yes

No

103

Did the nurse use the contact the doctor tab in the remote support centre app?

Yes

No

104

Did the call connect to the remote support centre?

Yes

No

105

Did the nurse talk to the doctor about the client’s condition and ask for support in diagnosis?

Yes

No

106

Was there any technical issue related to sound, reception, etc?

Yes

No

107

Was the nurse able to troubleshoot the technical issue?

Yes

No

108

Did the nurse end the call properly?

Yes

No

109

Did the call get completed successfully?

Yes

No

110

Did the nurse lock the device?

Yes

No

Knowledge And Skill Template -Form Fill

NAME OF THE NURSE

CODE

Health Facility Name

Health Facility Code

District

District Code

State

Type of Facility

Level of Facility

ASSESSMENT DATE

ASSESSMENT TIME

Name and code of staff nurse/ANM

How old are you?

For how many months/years have you worked in this facility?

How long you have been working as a Nurse?

How many months / years ago did you finish your basic nursing course?

Have you had Skilled Birth Attendant (SBA) 21 day training from the government?

How many months/years ago you had the Skilled Birth Attendant (SBA) training?

Have you attended a Skilled Birth Attendant (SBA) refresher training for 3-4 days?

How many months/years ago did you attend the Skilled Birth Attendant (SBA) refresher training?

Did you receive any training on communication and behaviour skills?

Have you ever received/ attended any training on the following topics?

Do you know about the Dakshata/ JHPIEGO ASMAN program for improving delivery and postpartum services at the facility?

Does any nurse mentors/Dakshata trainer/any other trainer visit this hospital? if yes from which organization they come from?

Have you received any training / handholding support from Dakshata trainer of Jhpiego -ASMAN project?

What are the topics covered during training / support provided by the Dakshata trainer?

Trained?

Trained in last 3 months?

Number of times trained in the last 3 months?

Received training in skill station/mannequin ?

Did you receive any training on using paper based Safe Birth Checklist from Jhpiego -ASMAN?

Did you receive any training on using paper based Partogram from Jhpiego -ASMAN?

Do you think that mentoring by Dakshata trainer improved your knowledge?

Do you think that mentoring by Dakshata trainer improved your skill?

Do you think mentoring by Dakshata trainer improved your practice?

Did you receive any handholding training at labour room?

Did you receive training on PPIUCD?

Have you received any training on using technology or electronic devices for delivery management from Jhpiego - ASMAN?

How long ago have you received this training?

How long was the training? Number of days

Who gave you the training?

Have you received any kind of training on using technology or electronic devices from Jhpiego -ASMAN given below?

Electronic case sheet, safe birth checklist and partograph on tablet device

Monitoring Foetal Heart Rate on MOYO Device

Monitoring Blood Pressure using digital device

Using video game for learning

Using Remote Support Centre to seek advice on complication management from the doctors

Did you receive any further handholding support when needed for using technological aids from Nurse Mentors / Jhpiego -ASMAN team?

How frequently do you use any of the following technological aids from Jhpiego -ASMAN?

Electronic case sheet, safe birth checklist and partograph on tablet device

Monitoring Foetal Heart Rate on MOYO Device

Monitoring Blood Pressure using digital device

Using video game for learning

Using Remote Support Centre to seek advice on complication management from the doctors

How comfortable you are in using

Electronic case sheet, safe birth checklist and partograph on tablet device

Monitoring Blood Pressure using digital device

Monitoring Foetal Heart Rate on MOYO Device

Using video game for learning

Using Remote Support Centre to seek advice on complication management from the doctors

Under what circumstances, are you not able to use the digital case sheet?

If uncomfortable using digital case sheet, please give the reason for feeling uncomfortable?

Do you find the digital platform (case sheet) useful in timely decision making

For high risk cases,

For routine care

For timely referral

Complication identification

Do you find the digital platform (case sheet, technological aids,etc) useful in providing care as compared to case management through the paper based case sheet and conventional monitoring devices like sphygmomanometer or fetoscope?

Have you ever used video game module for increasing learning about delivery management?

What level of game have you completed in the video game?

Do you know how to use the Remote Support Centre (RSC) for seeking advice from doctors?

Have you ever used the Remote Support Centre (RSC) for seeking advice on complication management from doctors?

Have you ever used the Remote Support Centre (RSC) for referral of cases?

Under what circumstances, are you not able to use the remote support centre even when required?

Do you think that Remote support centre is useful in managing complicated cases?

Do you think that Remote support centre is useful in receiving training?

Do you think that Remote support centre is useful in routine practice?

Do you think technological tools or processes have improved your clinical practices?

Do you think there are improvement in delivery care services of your hospital due to technological tools or processes?