Postgraduate Diploma in Midwifery

Purpose

The Postgraduate Diploma in Midwifery is a career-orientated qualification designed for Midwives employed in the public and private sectors which have maternal and neonatal services. Midwives are also capable of becoming independent private practitioners in maternal care.

The purpose of the qualification is to strengthen and deepen the learners' knowledge and expertise in midwifery, as a speciality. It will enable the Midwife specialist to undertake advanced reflection and development by means of a systematic survey of current thinking, practice and research methods in their field or discipline. The qualification aims to develop a midwife specialist who will use expert knowledge to enhance the care of women. This includes preventing disease, injury, complications, screening, appropriate management, and prompt referral of patients with specific and complex problems in all clinical settings.

The qualification will provide a high level of theoretical engagement, sound clinical judgement, and intellectual independence, as well as the ability to relate knowledge to a range of contexts to render professional and competent midwifery care. The qualification is designed to equip candidates with relevant knowledge and skills combined with the required attitude and values to enter the field of midwifery education as a career. The qualification includes research and high demand on theoretical engagement as well as independent learning with the emphasis on higher-order meta-cognitive skills such as analysis, synthesis, and evaluation. Reflective practice and critical thinking will be developed across all modules.

The competencies of the Midwife specialist overlap with some of the competencies of the other specializations. The competency domains for the Midwife specialist include the following:

• Professional, Ethical and Legal Practice.
• Clinical Practice: Care Provision and Management.
• Personal and Quality of Care.
• Management and Leadership.
• Research.

Upon completion of the qualification, qualifying learners will be able to

• Design and develop new midwifery and/or nursing curricular interpret, apply, and evaluate an existing nursing qualification.
• Review and improvement of Midwifery education practice.
• Apply innovative teaching and learning methods in line with global trends.
• Assess and implement health and other related policies.

Rationale

There is a strong need for Nurses and Midwives to be equipped to promote the quality of health care in South Africa. They are expected to initiate quality measures and take full responsibility for all Nursing and Midwifery practices. The qualification is therefore intended to address the Human Resource Development needs for Midwife specialists. A Midwife practitioner is a registered nurse who has acquired the expert clinical knowledge and skills that include complex decision-making abilities and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which she/he has the credentials to practice.

South Africa has experienced many changes in the Midwifery scope of practice, prescribed curricula, and government strategies to address the health care needs of the entire population. These changes can be attributed to various factors such as the changing priorities of health care such as more emphasis on Midwifery in the prevention of morbidity and mortality, a review of the ideal professional nurse that fits the changing needs of the country, as well as the increasing sophistication of health care technologies. The qualification will enable the graduate to function as a leader who is clinically focused, service-orientated; autonomous, innovative nurse specialist who can render comprehensive, scientific Midwifery care, as determined by the appropriate legislative framework.

There has been a shift in the tasks performed by professional Midwives because of the local shortage of other health professionals, especially Doctors - the trend is to broaden the scope of practice of the professional nurse and expect them to perform tasks that only doctors were allowed to perform in the past. In addition, the health care system leaders are committed to meeting the Sustainable Development Goals (SDGs) that aim to address the complex burden of disease as well as ensuring constructive responsiveness to burdens such as HIV/AIDS, tuberculosis, and other lifestyle-related diseases.

The ongoing Midwifery drain has depleted the health care system in South Africa, especially in the public sector, where only 60% of Midwives are serving potentially 85% of the population who rely largely on public health services. All indications are that the supply-demand gap is growing. This trend has a significant negative effect on the quality of health care, both in the Midwifery and the secondary as well as tertiary sectors. The qualification is intended to address the supply-demand gap in the health system.

The Department of Health held a Midwifery Summit in April 2011, on the theme "Reconstruction and Revitalizing the Midwifery Profession". The Summit culminated into six core priority areas such as nursing education and training; leadership, governance, policy, and legislation; ethical matters as well as nursing practice. The Midwifery sector needs Midwifery professionals with stronger leadership skills at all levels. The qualification is designed to respond to the sector's needs by incorporating these six priority areas in the qualification.

The qualification will qualify successful candidates for registration as Midwifery Specialist with the professional body, SANC. The qualification will enable learners to gain access to the Master's Degree.

Recognition of Prior Learning (RPL)

Due to the variety of qualifications that precede the new SANC requirements, recognition for prior learning is of great importance in this field of study. The institution adheres to the national policies and procedures for RPL and Credit Accumulation and Transfer (CAT) as well as the statutory body (SANC). RPL processes are used to increase access to qualifications by individuals through experience at the workplace, experiences through daily life or credit-bearing exemption.

The institution implements the following forms of RPL

• RPL for access: Learners who do not meet admission requirements to gain access to the qualification based on the previous experience and/or learning.
• Admission of learners through the RPL route should not constitute more than 10% of the learner intake for the qualification
• RPL for credits: Learners may provide evidence of prior learning for which they may receive credit towards the qualification.
• RPL for advanced standing: Learners obtain advanced standing in the prescribed learning qualification.

RPL candidates should demonstrate competence in respect of certain specified knowledge, skills and/or attitudes pertaining to this qualification.

• The qualification in its entirety cannot be obtained through RPL.

Entry Requirements

The minimum entry requirement for this qualification is

• Bachelor of Nursing, NQF Level 7.

Or

• Advanced Diploma in Nursing, NQF Level 7.

Or

• Registered Professional Nurse and Midwife with SANC.

This qualification consists of the following compulsory and/or elective modules at National Qualifications Framework Level 08 totalling 120 Credits.

Compulsory Modules, Level 8,120 Credits

• Praxis of Specialist Practice, 8 Credits.
• Applied Research, 8 Credits.
• Leadership and Development in Specialist Practice, 8 Credits.
• Evidence-Based Nursing and Midwifery Practice, 8 Credits.
• Maternal Care Specialisation, 20 Credits.
• Neonatal Care Specialisation, 20 Credits.
• Maternal and Neonatal care Pharmacology, 8 Credits.
• Specialist Midwifery Practice, 40 Credits.

1. Practice and facilitate specialist nursing or midwifery, nursing education or health service management within ethical-legal parameters of the profession.
2. Apply knowledge of and facilitate evidence-based practise, nursing education or management in the specialist field to solve contextual problems and develop policies and guidelines.
3. Appraise and develop self, peers and nurse specialist or midwife specialist students by facilitating self-directedness or leadership and lifelong learning.
4. Facilitate advocacy for the profession and provision of specialist professional support, personnel, patients or clients, families, and communities.
5. Engage in planning, commissioning, and managing a specialist unit, educational entity, or health service.
6. Engage in scholarly activities to inform evidence-based practice, education, or management.
7. Utilise, manage, and communicate data to support decision-making and research.
8. Render and co-ordinate patient-centred specialist nursing or midwifery practice within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences including advanced pharmacology.
9. Mobilise appropriate resources to implement standards of practice relevant to the area of specialisation to ensure quality care and safety.
10. Collaborate within the inter-and intra-professional team by engaging in health dialogue, shared leadership, decision making and sound clinical judgement.
11. Participate in the design, development and evaluation of nursing policies, programmes, and projects at a provincial or national level.
12. Develop and Implement institutional policies, protocols, and guidelines in the area of specialisation, utilising the process of change management in the improvement of quality of care.

Associated Assessment Criteria for Exit Level Outcome 1

• Conform to the relevant codes of ethics in the practice of specialist nursing or midwifery, nursing education and health service management.
• Use critical decision making, and moral reasoning models and principles to make clinical judgements and resolve ethical dilemmas within the specialist practice.
• Demonstrate accountability for own professional judgement, actions, outcomes of specialist care, nursing education or health service management provided, and continued competence.
• Identify and apply relevant current legislation, policies, regulations, and guidelines pertaining to specialist practice or nursing education or Health Services Management.
• Documented all care activities accurately, comprehensively and timeously taking into account the legal requirements for record-keeping.
• Demonstrate knowledge of the nurse specialist or midwife specialist roles in the management of Professional misconduct and risks taking into consideration the institutional protocols and ethical-legal framework.

Associated Assessment Criteria for Exit Level Outcome 2

• Engage in specialist practice, demonstrate understanding and the process of evidence-based practice.
• Apply evidence-based specialist practice, nursing education and health services management taking into consideration the appropriate methodology of gathering evidence for the practice, education, and management, for example, systematic or scoping reviews, and appraisal of articles, practice based-research and publication.
• Use of evidence-based practice, nursing education and health services management demonstrates knowledge and critical analysis of the various levels of evidence.

Associated Assessment Criteria for Exit Level Outcome 3

• Demonstrate leadership skills through the application of appropriate leadership styles, principles, and theories of health services management.
• Effectively facilitate Continuous Professional Development (CPD) for self and others for lifelong learning by creating a positive learning climate in the workplace through the processes of mentorship, preceptorship, supervision, performance appraisal, etc.
• Engage in performance appraisal to demonstrate the understanding of the purpose and processes of the performance management and development system.
• Utilise feedback gained from self-reflection, peers, students, and management to improve effectiveness in the specialist role.
• Demonstrate understanding of the various risk factors that impact health and wellness within the workplace and apply strategies to care for self, peers, employees, and learners.

Associated Assessment Criteria for Exit Level Outcome 4

• Demonstrate understanding and the purpose of the advocacy role for a nurse or midwife specialist.
• Use advocacy principles to advocate for safe and quality care in various health care settings or nursing education of health service management.
• Demonstrates the use of appropriate communication skills and channels in facilitating advocacy.
• Demonstrate the ability to lobby or participate in interest groups to influence legislation and policy affecting the role performance.

Associated Assessment Criteria for Exit Level Outcome 5

• Demonstrate understanding of levels and or classification of the respective specialist units, health services or educational entities.
• Commission tasks taking into consideration the burden of diseases and priority services as determined by current events.
• Participate in the evaluation of the existing specialist unit, health or education entity demonstrates knowledge or guidelines for provisioning a specialist unit or health service or educational entity.
• Engage in planning and commissioning and examine the role and responsibilities of the intra- and inter-professional team.

Associated Assessment Criteria for Exit Level Outcome 6

• Practice in the respective specialisations and demonstrate knowledge of appropriate search engines and databases for review of the literature to inform evidence-based practice, education, and health services management.
• Use appropriate methods to generate evidence for utilisation in specialist practice, education, and health services management.
• Demonstrate awareness of the peer-reviewed journals to use for sharing of evidence.
• Base activities in the specialist practice, education, and health services management on scientifically proven evidence.
• Actively participate in inter-professional dialogues/debates/discourses in quality improvement.

Associated Assessment Criteria for Exit Level Outcome 7

• Document all data/information gathered in the context of the specialist practice, education and health services for utilisation and storage following the set standards.
• Demonstrate utilisation of comprehensive data, information, and emerging evidence pertinent to the respective specialist practice.
• Base problem identification, diagnoses, and opportunities for improvement on gathered and critically analysed assessment data from the patients/clients, families, communities, students, or employees including current scientific evidence.
• Demonstrate respect for intellectual property and ensure that documentation is without plagiarism.

Associated Assessment Criteria for Exit Level Outcome 8

• Demonstrate understanding of the position of own specialist service within the health care system.
• The nurse or midwife specialist is conversant with the full range of services within the specialist area of practice.
• Integrate promotive, preventive, curative, rehabilitative and palliative care in a continuum to the specialist care rendered.
• Knowledge and skill of rendering specialist care is in accordance with standards and protocols of the specialist field.
• Formulated nursing or midwifery diagnoses are congruent with the patient's/client's clinical manifestations/data and are based on accurate analysis and interpretation of data obtained from scientific, laboratory, diagnostic, technological and psycho-sociocultural assessment including consultation of relevant/current literature/evidence.
• Plan individualized nursing or midwifery interventions considering patient's/client's needs, values, beliefs, preferences, culture, and contextual variables, for example, disease burden, health risks, national priorities, etc.
• Delegate staff to nursing care taking into consideration the specialist qualification and its competencies, experience, standard nurse-patient ratios for the area of specialisation, job description and skill mix.

Associated Assessment Criteria for Exit Level Outcome 10

• Identify, share, and collaboratively solve practical problems in the specialist area informed by decisions and sound clinical judgement.
• Seek and provide consultation appropriately and timeously in the provision of holistic care in a continuum through awareness of one's competence.
• Carry out patient referral appropriately and timeously as dictated by the patient's condition and in accordance with the referral guidelines.
• Participate visibly in the inter-professional team and recognise the members of the team.

Associated Assessment Criteria for Exit Level Outcome 11

• Participate in the development of policies, programmes and projects demonstrate understanding of the steps in and or levels of the development of policies, programmes, and projects.
• Participate in project and policy development and demonstrate knowledge of own role and responsibilities within the inter-professional policy/project team.
• Conduct advocacy about policy development, programme and project development for the nursing profession and patients/clients, families, and communities in the specialist area.
• Participate in project and development and include appropriate communication (negotiation, bargaining, assertive, persuasive, etc).
• Provide adequate and timely feedback to relevant stakeholders as and when necessary.

Associated Assessment Criteria for Exit Level Outcome 12

• Demonstrate knowledge of the process and or steps of development of policies, standards, guidelines, and protocols.
• Involve the relevant and pre-determined stakeholders in the development of policies, standards, protocols, and guidelines.
• Use the appropriate methods in the development and evaluation or testing of guidelines and protocols.
• Implement the new policies, protocols and guidelines to the specialist area and application of the change process.
• Develop policies, protocols and guidelines and collaboratively revise at appropriate intervals as per the institutional policy for the specialist area.