NURSE PERSPECTIVE ON THE

ESSENTIAL NEWBORN CARE

PROTOCOL IMPLEMENTATION IN
PRIVATE TERTIARY HOSPITALS IN
DAGUPAN CITY
Minerva Soriano Pamutan, RN, MAN
University of Luzon
INTRODUCTION
• Newborns are the most vulnerable patient
population in the world. Not only are they
biologically immature and therefore uniquely
susceptible to a range of life-threatening
illnesses, they are also wholly dependent on
others to advocate for their health and welfare. As
many as 70 percent of neonatal deaths could be
prevented with known, simple, non-intensive
interventions: basic resuscitation, management of
low birth weight, and treatment of sepsis
(Sayeed, 2012).
INTRODUCTION
• Essential newborn care (ENC) is designed to improve health of
newborns through a minimum set of interventions that should
be made available for all births (World Health Organization
[WHO], 2006; WHO Europe, 2006). Essential newborn care is
based on simple principles of prevention of infection, thermal
protection, resuscitation of newborn with asphyxia, early and
exclusive breast feeding, care of low-birth weight babies, and
appropriate referral of sick neonates (Costello & Manandhar,
2008; WHO, 2006; WHO South East Asia Region [SEAR],
2007). It is recognized that practice of cleanliness, that is, hand
washing, clean delivery surface, and care of the umbilical cord,
is associated with a reduction in perinatal morbidity and
mortality (Bhutta, Darmstadt, Hasan, & Haws, 2008).
INTRODUCTION
• Nurses play a vital role in ensuring that newborns receive
the best neonatal care. Their knowledge and expertise in
essential newborn care can promote healthy newborn
care practices to prevent neonatal infections and
illnesses. Programs were implemented by the Department
of Health like “Unang-Yakap” for the prevention of infant
mortality and promote maternal care.
INTRODUCTION
• The aim of the study is to determine the level of
Implementation of Essential Newborn Care (ENC)
protocols in tertiary, private hospital in Dagupan City, and
to assess the problems that limit the implementation of
ENC related interventions as perceived by nurses.
Statement of the Problem
• 1. What is the level of implementation of the Essential
Newborn Care (ENC) protocol in the private tertiary
hospitals as perceived by the nurses along the following
areas:
• a. Governance;
• b. Service Delivery; and
• c. Regulation?
• 2. What problems limit the implementation of Essential
Newborn Care (ENC) related interventions as perceived
by the nurses in the two private tertiary hospitals in
Dagupan City?
Methods
• Research Dresign
• The study used descriptive survey method
• Population and Sampling Scheme
• Total enumeration with 45 respondents in two tertiary
private hospitals of Dagupan City, Luzon Medical Center
and Dagupan Doctors Villaflor Memorial Hospital.
• Instrumentation
• The study used a questionnaire to generate data
• Tools for Data Analysis
• Frequency count, mean and rank were used to treat data.
Results and Discussion
RELATED INTERVENTIONS FOR NURSES FOR THE
PROMOTION OF ESSENTIAL NEWBORN CARE
PROGRAM
Introduction
Essential newborn care has been widely practiced
by nurses of different countries. Each country may have
different policies or protocols regarding essential newborn
care with the main goal of preventing infant death.
The main factor that has been missing is attention to
the newborn with the mother at all levels of decision
making. Because all fetal deaths and most neonatal deaths
are related to maternal causes, priority should be given to
interventions that benefit both the mother and baby.
This can be addressed if nurses will be able to
practice interventions for the promotion of essential
newborn care.
Results and Discussion
Objective Activity Person Performance/
Responsible Success Indicators
1. Governance  The Medical Center  Essential
To promote and administration Chief newborn care
educate nurses among the Chief Nurse will implement
on the importance Tertiary all the
of the essential hospitals administrative
newborn care should plan to policies and
practice with conduct group protocols and
regards to the discussion with be able to
adoption of new the nurses on eliminate the
administrative the mortality rate of
policies on implementing the newly born
newborn care. rules and babies.
regulations of
essential
newborn care
to clearly
understand the
program.
Results and Discussion
Objective Activity Person Performance/
Responsible Success Indicators
2. Service Delivery  Conduct seminar, Medical Center  Enhancement and
workshop or be updated on the
training for the
Chief policies and
To enhance Chief Nurse
nurses to update guidelines on
understanding of their knowledge and Supervisors Newborn Care and
nurses on ways and skill on essential can provide a
means of rendering newborn care. potential for the
essential newborn  A mechanism to Tertiary Hospitals to
care and to train reduce the become a center of
nurses on problems that limit development with
interventions the implementation regards to the
Essential Newborn adaptation of the
necessary in Care (ENC) new administrative
achieving the goal of protocol-related policies and
essential newborn interventions should protocol of the
care, especially on be developed Essential Newborn
delivery networks based on Care (ENC)
and referral system. institutional setting
and available
resources.
Results and Discussion
Objective Activity Person Performance/
Responsible Success Indicators
 Organize a video
presentation/
demonstration for
the nurses
regarding Essential
Newborn Care in
order to visualize it
for easy application
into practice.
3. Regulation
 Provide training of  Collaborative care will
nurses in Fabella
Medical Center be implemented and
To deliver time Hospital, a training Chief quality assurance will
bound interventions hospital for Chief Nurse be maintained with the
for nurses to hospitals and be able
maternal and Supervisors to provide a
practice essential newborn care, and spontaneous
newborn care and to avail of IEC monitoring and
provide appropriate materials, i.e. evaluation of the
VCD/DVD, administrative policies
interventions to and protocol of the
regarding the
assist mother and Unang Yakap. essential newborn
infant during delivery care.
and cord care while
Results and Discussion
Objective Activity Person Performance/
Responsible Success Indicators
Complying with the  Conduct seminar,
standards of workshop for the
newborn care in the trained nurses
MNCHN. Health among
care institutions primigravida
should adopt mothers before
mechanisms on how giving birth to
to regulate update them
implementation of about their
ENC protocol at the knowledge and
micro-level. for the nurses to
practice skill on
essential
newborn care.
Results and Discussion
Objective Activity Person Performance/
Responsible Success Indicators
 Have a brief role
play on essential
newborn care so
that nurses will be
able to put
themselves in the
situation of the
mother and the
infant.
 Conduct evaluation
of the nurses and
mothers while
performing
essential newborn
care.
 Institute a
monitoring and
evaluation
mechanism in the
hospital to evaluate
compliance of ENC
protocol and
monitor neonatal
and infant mortality.
Conclusion
• The implementation of Unang Yakap is poor in private
tertiary hospitals in Dagupan City; time pressure, lack of
cooperation from the mothers and lack of related
seminars and trainings pertinent to Unang Yakap are the
main problems encountered by nurses in the
implementation of it.
Recommendation
• It is therefore recommended that: Nursing administrators
must have a forum regarding the importance of the
implementing mechanisms on governance, service
delivery and the regulation of the Essential Newborn Care
(ENC). It is recommended that hospitals should forge
networks with institutions at various levels of the health
system, and work with the community health teams. There
should be clear, focused goals on how to meet the
standards and provide a highly implementation within all
levels of Essential Newborn Care.
• THANK YOU
Results and Discussion
Table 1
Level of Perception of Nurses in the Implementation of Essential
Newborn Care (ENC) Protocol on the Mechanism
of Service and Delivery n=45
Service Delivery Subject Hospitals Mean DE

Hospital A Hospital B

Mean R DE Mean R DE
Standard for the physical structure, equipment and
human resource for Implementing Health Reforms 3.77 1 HI 4 1 HI 3.89 HI
towards the Rapid Reduction of Maternal Neonatal
Mortality Manual Operations shall be strictly followed.

The newborn protocol has been integrated likewise

with the BEmONC training module. 3.14 3 MI 2.83 5 MI 2.99 MI

The protocol served as the reference document on

Newborn Care during conduct of the BEmONC and to- 2.45 5 PI 2.87 4 MI 2.66 MI
be-developed CEmONC training programs.

Home care for the newborn shall be developed and

integrated with existing training course for 2.82 4 MI 3.04 3 MI 2.93 MI
Community/Women’s Health Teams.

Communication for Behavior Impact (COMB) or

Behavior Change Communication strategy is utilized 3.36 2 HI 3.43 2 HI 3.40 HI
targeting behaviors of all major stakeholders, from the
mothers to the health workers to the policy makers.

Pooled Mean 3.11 MI 3.23 MI 3.17 MI

Results and Discussion
Table 2
Level of Perception of Nurses in the Implementation of Essential Newborn
Care (ENC) Protocol on the Mechanism of Regulation
n=45
Regulation Subject Hospitals Mean DE

Hospital A Hospital B

Mean R DE Mean R DE

The PHIC Benchbook is integrated with the key

Essential Newborn Care protocol interventions. 2.55 2 MI 1.57 2 PI 2.06 PI

The Benchbook enforces the standards of care

described in the Administrative Order along with other
auxiliary issuances from the Department of Health. 2.73 1 MI 1.96 1 PI 2.35 PI
The DOH advocates medical and paramedical
societies and appropriate learning institutions to
adopt the policies and protocols described herein.

Pooled Mean 2.64 MI 1.77 PI 2.21 PI

Results and Discussion
Table 3
Summary of the Level of Perception of Nurses in the Implementation
of Essential Newborn Care (ENC) Protocol
n=45
Implementing Mechanisms Subject Hospitals Mean DE

Hospital A Hospital B
n-22 n-23

Mean R DE Mean R DE

3.01 2 MI 3.17 1 MI 3.09 MI

Governance

3.23 1 MI 3.11 2 MI 3.17 MI

Service Delivery

Regulation
2.64 3 MI 1.77 3 PI 2.20 PI

Weighted Mean 3.04 MI 2.93 MI 2.98 MI

Results and Discussion
Table 4
Problems that Limit the Implementation of the Essential Newborn Care (ENC) Protocol in the
Subject Hospitals.
n=45
Problems Subject Hospitals Mean DE R

Hospital A Hospital B
n-22 n-23
Mean R DE Mean R DE
Lack of information or knowledge on the
protocols of “Unang Yakap”- Essential Newborn 2.45 5 HL 2.87 2.5 HL 2.66 HL
4
Care

Lack of related seminars and trainings pertinent

to “Unang Yakap”- Essential Newborn Care 2.82 4 HL 2.70 4 HL 2.76 HL
3

Lack of participation from the doctors or

Obstetric- Gynecologists 1 9.5 NL 1 9.5 NL 1 NL
9.5

Nurses are hesitant to perform the “Unang

Yakap”- Essential Newborn Care 2.86 3 HL 1.13 8 NL 2 ML 8

Lack of cooperation from other nurses

1.68 7.5 ML 1.22 7 NL 1.44 NL 7

Lack of materials such as no bonnet provided

9.5
1 9.5 NL 1 9.5 NL 1 NL
Insufficient availability of medication like
hepatitis B vaccine, vitamin K and eye 1.68 7.5 ML 1.65 6 NL 1.66 ML
6
prophylaxis

Lack of cooperation from the mothers

2.91 2 HL 2.87 2.5 ML 2.89 HL 2

Time pressure, like many patients to be

1
monitored 3 1 NL 3 1 HL 3 HL
‘Unang Yakap” –Essential Newborn Care is not
strictly implemented by the hospital. 2.36 6 HL 2.13 5 HL 2.24 ML
5

Pooled Mean 2.18 ML 1.96 ML 2.07 ML