The number of expected tasks as per neonatal nursing guidelines and the proportion of these tasks completed by domain and type
| Domain | Task type | Task | Required for all babies observed in a 12-hour shift | Frequency in 24 hours according to standards* | Expected tasks assuming 12 hours’ observation shifts and adjusting for category/interventions (n) | Tasks done, n (%) | 95% CI |
| Nursing/clinical tasks | General nursing | Handing over nursing care between shifts | Yes | 2 | 216 | 210 (97.2) | 87 to 99 |
| Nursing review of newborns | Yes | 2 | 216 | 83 (38.4) | 16 to 67 | ||
| Baby cleaned | No | 1 | 126 | 83 (65.9) | 43 to 83 | ||
| Linen changed | No | 1 | 126 | 70 (55.6) | 26 to 81 | ||
| Nurse attends ward round† | No | 1 | 75 | 64 (85.3) | 21 to 99 | ||
| Checking and changing diaper as required | Yes | 8 | 216 | 207 (95.8) | 87 to 99 | ||
| Communication to parent | Yes | 1 | 216 | 105 (48.6) | 30 to 67 | ||
| Handwashing/scrub‡ | Yes | 2 | 216 | 200 (92.6) | 67 to 99 | ||
| Cord care where required | No | 1 | 110 | 42 (38.2) | 17 to 65 | ||
| Temperature monitored§ | Yes | 4 | 216 | 127 (58.8) | 20 to 89 | ||
| Respiration monitored§ | Yes | 4 | 216 | 107 (49.5) | 16 to 83 | ||
| Pulse monitored§ | Yes | 4 | 216 | 122 (56.5) | 19 to 88 | ||
| Oxygen saturation monitored§ | No | 4 | 144 | 49 (34.0) | 9 to 72 | ||
| Turning done as required | Yes | 8 | 216 | 81 (37.5) | 13 to 71 | ||
| Feeding three hourly as required | No | 8 | 180 | 126 (70.0) | 58 to 80 | ||
| Phototherapy care | Clean eyes and check for discharge/infection | No | 4 | 34 | 12 (35.3) | 11 to 71 | |
| Eye pad changed | No | 2 | 34 | 12 (35.3) | 12 to 69 | ||
| Skin assessment¶ | No | 4 | |||||
| Skin assessment 1 | 34 | 19 (55.9) | 27 to 81 | ||||
| Skin assessment 2 | 34 | 5 (14.7) | 1 to 68 | ||||
| Check eyes for damage from phototherapy¶ | No | 4 | |||||
| Check eyes for damage 1 | 34 | 31 (91.2) | 53 to 99 | ||||
| Check eyes for damage 2 | 34 | 19 (55.9) | 26 to 82 | ||||
| Turning/positioning done¶ | No | 6 | |||||
| Turning/positioning done 1 | 34 | 31 (91.2) | 48 to 99 | ||||
| Turning/positioning done 2 | 34 | 26 (76.5) | 48 to 92 | ||||
| Turning/positioning done 3 | 32 | 14 (43.8) | 23 to 66 | ||||
| Oxygen therapy care | Oxygen regulated | 76 | 61 (80.3) | 36 to 97 | |||
| Check nostril tube position¶ | No | 8 | |||||
| Check nostril tube position 1 | 75 | 61 (81.3) | 60 to 93 | ||||
| Check nostril tube position 2 | 76 | 42 (55.3) | 17 to 88 | ||||
| Check nostril tube position 3 | 76 | 42 (55.3) | 19 to 87 | ||||
| Check nostril tube position 4 | 76 | 36 (47.4) | 13 to 84 | ||||
| Intravenous fluids | Fluids regulated as required** | No | 2 | 21 | 16 (76.2) | 11 to 99 | |
| Intravenous treatment | Cannula flushed before giving intravenous treatment†† | No | 2 | 126 | 51 (40.5) | 7 to 86 | |
| KMC | Counselling and supporting mother to initiate and continue with KMC | No | 2 | 32 | 29 (90.6) | 57 to 99 | |
| Supervision of the mother for correct KMC practice | No | 2 | 32 | 24 (75.0) | 31 to 95 | ||
| Documentation tasks | Documentation | Clinical nursing review | Yes | 2 | 216 | 107 (49.5) | 22 to 77 |
| Planned care | Yes | 2 | 216 | 140 (64.8) | 20 to 93 | ||
| Vital signs | Yes | 2 | 216 | 154 (71.3) | 22 to 96 | ||
| Treatment documented | No | 2 | 150 | 146 (97.3) | 90 to 99 | ||
| Ward round recommendations | No | 1 | 75 | 55 (73.3) | 44 to 91 | ||
| Phototherapy documentation | No | 2 | 31 | 19 (61.3) | 18 to 92 | ||
| Summary of feeds intake | No | 2 | 180 | 137 (76.1) | 33 to 95 | ||
| Oxygen therapy | No | 2 | 76 | 57 (75.0) | 43 to 92 | ||
| Health talks/parent communications‡‡ | Yes | 2 | 216 | 53 (24.5) | 6 to 63 | ||
| Charting of fluids administered | No | 2 | 66 | 60 (90.9) | 73 to 97 | ||
| Turning/positioning | Yes | 2 | 216 | 59 (27.3) | 6 to 67 |
*For instance, for tasks with a frequency of 2 in 24 hours we would observe one task in a 12-hour shift.
†Only one doctors ward round was expected in 24 hours.
‡At first contact with patient only since it was difficult to establish a denominator since handwashing should be done before each time the nurse makes contact with the patient.
§Monitoring done as per draft neonatal nursing guidelines.
¶Tasks have multiple sub-items.
**During the observation shift or when fluid was running, evidence for an attempt to regulate the rate.
††For twice daily medication, we would observe two tasks in 24 hours.
‡‡Health talks/parents are supposed to be continuous; however, we are interested in at least two sessions in 24 hours (one during the day and one during the night shift).
KMC, kangaroo mother care.