Normes des Soins Infirmiers, Gynécologiques, Obstétricaux et Néonataux

Objectives

Improve the quality, safety, continuity and effectiveness of nursing, midwifery, obstetric, gynaecological and neonatal care across Benin’s health system through standards addressing service structures, care processes and results. The framework provides reference points for planning, delivering, monitoring and evaluating care, with intended results including competent personnel, better use of health facilities, health-supporting behaviours, lower morbidity and mortality, population satisfaction and efficient use of resources.[1][2][3]

• Provide comprehensive nursing care spanning health promotion, disease prevention, curative treatment, rehabilitation, support for vital functions, patient and family education, comfort care and end-of-life care, while responding to physical, psychological, social, economic and cultural needs.[1][4][5]
• Strengthen maternal, newborn and reproductive health care throughout pregnancy, childbirth, the post-partum and post-abortion periods, including antenatal consultations, uncomplicated deliveries, neonatal care, family planning, prevention and management of gynaecological conditions, infertility, reproductive cancers, sexually transmitted infections and HIV/AIDS.[4][6][7][8][9]
• Deliver preventive and promotive services through vaccination, nutrition support, infection prevention, healthy-child consultations, counselling, behaviour-change communication, home visits, outreach activities, surveillance of endemic and epidemic diseases, and education on hygiene, sexual health, mental health and communicable and non-communicable diseases.[10][8][9]
• Ensure emergency readiness by enabling frontline personnel to provide necessary care, stabilise and refer patients, and apply authorised emergency protocols for obstetric, neonatal and other priority conditions.[6][7]
• Develop a qualified nursing and midwifery workforce through regulated theoretical and practical education, four-year professional training leading to a State Diploma, continuing professional development, specialist and university training, supervision, mentoring and action research.[11][3][12][13]
• Improve hospital hygiene and infection prevention through dedicated services, sterilisation, asepsis monitoring, biomedical-waste management, research and training, including infection-prevention-centred preparation of nursing assistants.[9][14][13][15]
• Standardise care and workforce development through nationally applicable protocols, job descriptions, professional roles and training arrangements for nurses, midwives, nursing assistants and auxiliary personnel.[16][17][13][15]

Implementation

Implement the framework through decentralised public and private health facilities, multidisciplinary care teams and nationally authorised protocols, with nurses, midwives and nursing assistants undertaking defined autonomous, prescribed and delegated functions. Delivery combines structured clinical care, referral, documentation, supervision, training, hygiene systems and quality improvement across all levels of the health system.[16][1][5][6][12]

• Organise professional practice into autonomous nursing or midwifery care, care performed on written medical prescription, and delegated procedures undertaken under medical supervision or an authorised written protocol. Require prescriptions to be specific, dated, signed and available to the care team, except where emergency arrangements apply.[5][10][18]
• Apply national protocols for tuberculosis, malaria, sexually transmitted infections, HIV/AIDS, obstetric and neonatal emergencies, child illness, family health, and malaria affecting pregnant women and newborns. Permit nurses to use pre-written, dated and signed emergency protocols where no doctor is available, document interventions and arrange referral to an appropriate facility.[6][7]
• Deliver midwifery services across antenatal, intrapartum, neonatal, postnatal, vaccination and reproductive-health care, including home visits and behaviour-change communication. Require use of the partograph during labour and active management of the third stage of labour, while reserving specified invasive or high-risk procedures for prescribed and medically supported practice.[7][19]
• Assign nursing assistants roles in reception, registration, orientation, vital-sign measurement, patient support, transport, home visits, active case-finding, vaccination support, distribution of selected commodities, hygiene, sterilisation and supervised ward and maternity work.[19]
• Use a five-stage nursing process of data collection, analysis and nursing diagnosis, care planning, intervention, follow-up and evaluation. Update individual care plans regularly, organise care by time period or intervention type, and use shared daily work plans to allocate responsibility, location and estimated duration of activities.[17][8][15][20][21]
• Maintain clinical monitoring and records through observations of vital signs, consciousness and other patient indicators; surveillance during high-risk treatments and procedures; dated and signed reports for specified injections and infusions; and documentation of emergency care in patient files.[5][10][18][6]
• Govern services through nursing and midwifery managers who participate in facility decision-making, workforce planning, action plans, ethical oversight, activity management and links between administrators and care staff. Involve the Ministry of Health, departmental health directorates and health zones in competency development, supervision and implementation.[14][12][13]
• Strengthen quality assurance through standards, protocols, emergency-care kits, referral and counter-referral, complete records, service statistics, supervision and a care-quality assessment tool developed by the Directorate of Nursing and Midwifery Care. Conduct supervision at least monthly at municipal level, quarterly at departmental level and twice yearly at central level.[14][12]
• Regulate training institutions through ministerial authorisation, partnership with a departmental or university hospital for placements, adequate infrastructure and equipment, qualified teaching staff, admission requirements, class-size limits, examinations, programme review and inspection or audit. Finance operating budgets through student contributions, subsidies and donations, although no monetary allocations or costed plans are specified.[2][11][22]

Monitoring & Evaluation

Monitoring and accountability are principally embedded in care-quality standards, clinical documentation, supervision, training assessment and service-level control systems. Care quality is assessed through structural, process and outcome dimensions, while nursing and obstetric services are subject to follow-up, evaluation, supervision and control.[16][1][3]

• Assess service performance through personnel competence and performance, health-facility attendance, adoption of health-supporting behaviours, morbidity and mortality trends, population satisfaction, and efficient use of health-care resources.[3]
• Apply the five-stage nursing process of data collection, analysis and nursing diagnosis, care planning, intervention, and follow-up and evaluation; update care plans regularly to support continuity and individualised care.[17][8]
• Monitor patients through observations including temperature, pulse, blood pressure, respiratory rate, urine output, weight, body measurements, pupillary and cutaneous reflexes, and level of consciousness.[5]
• Undertake clinical surveillance for patients receiving nutritional support, dialysis, oxygen therapy, immobilisation, surgery, puncture procedures, sterile-environment care, intensive newborn care and medical transport between facilities.[5][10][18]
• Record emergency acts performed by nurses in the patient record through a signed report, and document specified injections and infusions through central venous catheters in dated and signed nursing reports.[10][6]
• Use the partograph to record labour progress, and monitor immediate post-partum care, medication effects, cold-chain maintenance and other midwifery services.[7]
• Maintain complete records and data-support tools, compile statistics, and manage records relating to medicines, medical equipment, human resources, and students’ school and placement activities.[14]
• Develop, use and comply with care standards, protocols and emergency-care kits, supported by quality monitoring and evaluation, referral and counter-referral arrangements, and communication between health-system levels.[12]
• Use the general nursing and midwifery care-quality assessment instrument developed by the Directorate of Nursing and Midwifery Care to support supervision and control.[12]
• Conduct supervision at least monthly at municipal level, quarterly at departmental level and twice yearly at central level.[12]
• Evaluate training through an institutional evaluation system, examinations and public dissertation defence; schools must comply with approved admission conditions and theoretical and practical teaching programmes, and institutional management may be inspected or audited.[11][22][3]
• Use work plans as written coordination and control tools, allowing team members to record completed activities and retain a trace of care actions in the patient file.[21][23]
• Include infection-risk prevention, transfusion safety, medical-device vigilance and continuous quality improvement within the care-quality framework.[16][1]

The supplied material does not set out a unified numerical indicator set, routine reporting schedule, comprehensive surveillance architecture or named accountability bodies for the overall framework. Its accountability provisions are mainly clinical and administrative, centred on records, protocols, supervision, inspections, examinations and care-quality assessment.[6][19][13][15][20]

Costing & Financing

Financial provisions are limited and primarily concern the financing of nursing and obstetric training institutions. The operating budget of a training institution is funded through student contributions, subsidies and donations, and its revenue and expenditure must be balanced within a budget approved by the governing board.[22]

• Ensure training schools have sufficient financial resources alongside appropriate infrastructure, equipment and qualified human resources.[11]
• Manage available service resources efficiently, as efficient use of financial resources is identified among the intended results for nursing and obstetric services.[3]
• Schedule refresher workshops and seminars annually or biennially according to available means; no associated monetary allocation is provided.[13]

No budget amounts, unit costs, monetary allocations, funding gaps, costed implementation plan, resource-mobilisation strategy or economic assumptions are specified for service delivery, supervision, quality assurance, hospital hygiene, professional development or nursing-assistant training.[9][12][13][15]