Postgraduate Diploma in Midwifery

Purpose

The purpose of this qualification is to produce high-quality professionals, who can function with advanced intellectual and practical competencies, in complex specialized areas, as specialist practitioners in providing evidence-based maternal and neonatal care together with other team members. In addition, qualifying learners will contribute to the continuous development of midwifery and neonatal nursing, as well as the associated healthcare services through the development of scientific and professional knowledge for the advancement of midwifery and neonatal nursing practice, as well as its research, management, and education. Qualifying learners will work as clinical nurse specialists in neonatal nursing, or as advanced midwives in the health sector. They are independent practitioners in their own right in the speciality.

The qualification aims to

• Produce high-quality advanced midwives and neonatal nurse specialists who can be competent specialist nursing practitioners in a range of health service settings.
• Provide advanced midwives and neonatal nurse specialists with a range of skills, knowledge, values, and attitudes that will enable them to set trends and fulfil leadership roles in a meaningful and sustained contribution to health services.
• Equip advanced midwives and neonatal nurse specialists with a developed sense of equity, justice and service ethics that will ensure that they work in an accountable manner irrespective of their chosen workplace.
• Offer a wide range of transferable skills for application in other professions, disciplines, and general life.

Qualifying learners will be able to

• Apply specialist knowledge and principles when communicating, making theoretical arguments, or developing documentation.
• Engage in policy development at local, regional, national, and international levels to position Midwifery in the health care system at all levels.
• Assess and implement health and other policies,
• Affect areas of policy change, development, and implementation,
• Plan and implement and manage projects of a varied nature,
• Work independently and as part of a team.

Rationale

It is important to frame the need for this qualification, with a view of the Millennium Development Goals (MDG), now called the Sustainable Development Goals (SDGs) for South Africa. The Statistics South Africa (STATS SA) Country Report for MDG 4 (reduce child mortality), reported that five out of the nine indicators for this goal were not achieved. For MDG 5 (improve maternal health), both the goals for maternal mortality rates and the number of births attended by skilled health personnel were not achieved (Millennium Development Goals: Country Report, 2015). This supports a national imperative to continue to train highly skilled midwives who can function independently to reduce maternal mortality and attend births. The South African Nursing Council (SANC) has realigned the nursing qualifications to the changes in the NQF Act, 67 of 2008. New nursing education standards and curriculum guidelines have been published and the scope of practice of the envisaged new nursing cadres has been incorporated into this qualification.

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 ensure constructive responsiveness to burdens such as HIV/AIDS, tuberculosis, and other lifestyle-related diseases.

The National Strategic Plan for Nurse Education, Training and Practice published by the Department of Health in South Africa specifically mentions the shortage of specialist midwives, and therefore the need for training this category of specialist midwives will play a large role in delivering care in the re-engineering of the health care system. The skills expected of specialists in midwifery and neonatal nursing are higher-order, they will perform higher-level activities on a strategic level. They will provide leadership to the health team. The South African context needs the right skills at the point of service. They contribute to policy changes and help to maintain the excellence of practice. The educational subject matter of this postgraduate diploma prepares midwives to work as specialist practitioners for the promotion of maternal, reproductive, and neonatal health, and the prevention of maternal and neonatal morbidity and mortality, for individuals, groups, and communities. The qualification was informed by the National Strategic Plan for Nurse Education, Training and Practice: National Department of Health, 2012- 2017 to include instruction in reproductive health, antenatal care, intrapartum care, postpartum care, and neonatal nursing.

Learners qualified with this qualification will be able to function with advanced intellectual and practical competencies in specialised nursing settings as competent advanced midwives and neonatal nurse - leaders, in providing evidence-based care to other team members. Qualifying learners will be able to work as advanced midwives or neonatal nurse specialists in the health sector, and hospitals in charge of specialisation units/areas which need this category of specialised nurses. Furthermore, these advanced midwives may also function independently within the primary health care setting, or even set up their own private midwifery practice.

Recognition of Prior Learning (RPL)

The institution has an approved Recognition of Prior Learning (RPL) policy applicable to equivalent qualifications for admission into the qualification. RPL will be applied to accommodate applicants who qualify. RPL thus provides alternative access and admission to qualifications, as well as advancement within qualifications. RPL may be applied for access, credits from modules and credits for or towards the qualification.

RPL for access

• Learners who do not meet the minimum entrance requirements or the required qualification that is at the same NQF level as the qualification required for admission may be considered for admission through RPL.
• To be considered for admission in the qualification based on RPL, applicants should provide evidence in the form of a portfolio that demonstrates that they have acquired the relevant knowledge, skills, and competencies through formal, non-formal and/or informal learning to cope with the qualification expectations should they be allowed entrance into the qualification.

RPL for exemption of modules

• Learners may apply for RPL to be exempted from modules that form part of the qualification. For a learner to be exempted from a module, the learner needs to provide sufficient evidence in the form of a portfolio that demonstrates that competency was achieved for the learning outcomes that are equivalent to the learning outcomes of the module.

RPL for credit

• Learners may also apply for RPL for credit for or towards the qualification, in which they must provide evidence in the form of a portfolio that demonstrates prior learning through formal, non-formal and/or informal learning to obtain credits towards the qualification.
• Credit shall be appropriate to the context in which it is awarded and accepted.

Entry Requirements

The minimum entry requirement for this qualification is

• Bachelor of Nursing, NQF Level 7.

Or

• Advanced Diploma in Midwifery, NQF Level 7.

And

• Registered Professional Nurse and Midwife with SANC.

This qualification consists of the following compulsory modules at National Qualifications Framework Level 8 totalling 120 Credits.

Compulsory Modules, Level 8,120 Credits

• Evidence Based Practice and Dynamics, 20 Credits.
• Advanced Community Midwifery, 20 Credits.
• Advanced Reproductive Health, 20 Credits.
• Advanced Midwifery, 20 Credits.
• Emergency Obstetric Care, 20 Credits.
• Advanced Neonatal Nursing, 20 Credits.

1. Demonstrate knowledge of and engagement in an area at the forefront of a field, discipline or practice; an understanding of the theories, research methodologies, methods and techniques relevant to the field, discipline or practice; and an understanding of how to apply such knowledge in a particular context.
2. Practice within the ethical-legal parameters of the profession and resolve professional-ethical dilemmas by using decision-making and moral reasoning models.
3. Implement standards to render and co-ordinate comprehensive specialist midwifery care according to the patients' needs using the scientific approach.
4. Demonstrate the ability to interrogate multiple sources of knowledge in an area of specialisation and to evaluate knowledge and processes of knowledge production.
5. Engage in policy development at local, regional, national, and international levels to position midwifery in the health care system at all levels.
6. Manage community health needs, plan, and implement appropriate programmes to address care for the Maternal, Neonatal, Child and Women's Health (MNCWH) population.
7. Facilitate efficient integrated implementation of appropriate packages of care at a specialist level to ensure good outcomes in MNCWH.
8. Demonstrate an understanding of the complexities and uncertainties of selecting, applying or transferring appropriate standard procedures, processes or techniques to unfamiliar problems in a specialised field, discipline

or practice.

1. Critically reflect on plans, and provide specialized high quality, culturally sensitive reproductive counselling, health education, and clinical services to all in the community to promote healthy reproductive lives.
2. Analyse and apply evidence-based principles and theories in midwifery and neonatal nursing.
3. Demonstrate an understanding of the complexities and uncertainties of selecting, applying or transferring appropriate standard procedures, processes or techniques to unfamiliar problems in a specialised field, discipline or practice.
4. Demonstrate the ability to use a range of specialised skills to identify, analyse and address complex or abstract problems drawing systematically on the body of knowledge and methods appropriate to a field, discipline or practice.
5. Demonstrate the ability to identify and address ethical issues based on critical reflection on the suitability of different

ethical value systems to specific contexts.

1. Lead interprofessional teams within the health care system to manage reproductive health, obstetric emergencies, maternal health issues and high-risk neonates.
2. Actively participate in the multi-professional team by demonstrating shared leadership and decision-making.

Associated Assessment Criteria for Exit Level Outcome 1

• Apply the basic principles and process of research, evidence-based practice, professional development, management, and leadership within the area of midwifery.
• Analyse a range of research methods and approaches with regard to their appropriateness for investigating particular research problems in midwifery.
• Apply advanced research methods in investigating complex and/or ill-defined problems in midwifery practice.
• Implement evidence-based practice in the field of midwifery.
• Function effectively as a clinical midwife specialist with other members of the health team within the healthcare system.
• Apply different mentoring models and preceptor techniques to develop self and novices in midwifery practice.
• Establish academic and professional relationships to sustain lifelong learning in a variety of settings and the field of midwifery practice.
• Use performance appraisal to monitor the development of self and others and enhance continuous professional development.
• Manage and evaluate specialised nursing services at district, provincial and national level within the constraints of national health policy and international guidelines and in different settings.
• Analyse and apply the principles and theories of management and leadership within a midwifery healthcare service context.
• Evaluate the various components of operations in management in midwifery healthcare service.
• Differentiate between the external and internal factors that influence midwifery healthcare service delivery in the South African context.
• Design a strategic plan for services in a midwifery healthcare facility according to the strategic management process.

Associated Assessment Criteria for Exit Level Outcome 2

• Apply critical decision-making and moral reasoning models to guide clinical practice and resolve professional-ethical dilemmas within Midwifery and Neonatal care.
• Apply the relevant latest legislation, policies, protocols, regulations, guidelines, directives and applicable ethics regarding Midwifery and Neonatal care in practice.
• Apply professional/ethical legal frameworks to guide the Midwife Specialist practice.
• Practice and facilitate advocacy for the rights of women, partners, husbands, children, and families in their best interests.
• Apply and interpret ethical codes, professional accountability, responsibility, confidentiality, and standards for the practice of Midwifery and Neonatal nursing consistently and correctly.

Associated Assessment Criteria for Exit Level Outcome 3

• Manage maternal and neonatal conditions and interpret health assessment findings based on their relationship to biomedical, pharmacology and psychosocial sciences.
• Implement epidemiologically informed programmes to raise community awareness.
• Create and sustain healthy environments for pregnant women, mothers, and their infants of different ages across the health continuum, which is based on the best available evidence and resources.
• Co-ordinate the activities of the inter-professional team within midwifery and neonatal nursing care.
• Analyse, create and implement clinical standards to optimise the health of mothers and neonates.
• Execute and coordinate clinical care standards competently within an inter-professional team.

Associated Assessment Criteria for Exit Level Outcome 4

• Apply specialist knowledge and principles when communicating, making theoretical arguments, or developing documentation.
• Evaluate the current evidence-based guidelines to improve maternal and reproductive health care.
• Apply professional and academic writing skills through the creation of reports and guidelines.
• Critically appraise and adopt the evidence-based practice, best practice guidelines, theories, and models in maternal and reproductive health care.

Associated Assessment Criteria for Exit Level Outcome 5

• Engage in debates and compare the best available evidence, theories, or models on mother-and-child health.
• Identify and debate the legislation that applies to mother-and-child health and communicate recommendations to authorities.
• Debate the influence of social, political, cultural, and economic developments within the country on the provision of Midwifery and Neonatal nursing care and communicate recommendations to authorities to improve midwifery and neonatal practice.
• Create comprehensive individual, people-centred, inter-professional midwifery and neonatal specialist treatment plans which are based on assessment findings and standardised national and contextually appropriate guidelines.

Associated Assessment Criteria for Exit Level Outcome 6

• Integrate Midwifery and specialist nursing care efficiently across the different levels of healthcare provision to promote health outcomes.
• Create and plan a community awareness programme/campaign for the Maternal, Neonatal, Child and Women's Health (MNCWH) population by using and interpreting epidemiological data on mother-and-child health.
• Create, execute and co-ordinate comprehensive, family-centred packages of care which are based on community assessment findings, within an inter-professional team.

Associated Assessment Criteria for Exit Level Outcome 7

• Implement Midwifery and specialist nursing care efficiently across the different levels of healthcare provision to promote health outcomes.
• Assess the implementation of Maternal, Neonatal, Child and Women's Health (MNCWH) care packages at a specialist level through the interpretation of epidemiological data on mother-and-child health.
• Create and sustain healthy environments for pregnant women, mothers, and their infants of different ages across the health continuum based on the best available evidence and resources.

Associated Assessment Criteria for Exit Level Outcome 8

• Evaluate the current evidence-based guidelines used in Reproductive Health to improve health care.
• Critically appraise and apply principles, theories, and models on Reproductive Health to improve health care service delivery.
• Identify and debate the legislation that applies to Reproductive Health and communicate recommendations to authorities.

Associated Assessment Criteria for Exit Level Outcome 9

• Co-ordinate and render specialist reproductive health care across the different levels of healthcare provision to promote health outcomes.
• Render specialist reproductive health care by considering social determinants of health and all relevant clinical findings at the appropriate level.
• Create, execute and co-ordinate comprehensive, family-centred care plans which are based on assessment findings, within an inter-professional team.
• Manage the reproductive health needs of mothers in various healthcare settings by using technology appropriately and safely while providing specialised reproductive health care.
• Negotiate the reproductive care plan with women across the lifespan by using principles of healthy dialogue.
• Use care pathways and referral systems appropriately and effectively for optimal reproductive health services delivery.
• Improve clinical practice by capturing and utilising reproductive health data accurately.
• Debate the influence of social, political, cultural, and economic developments within the country on the provision of reproductive health care and communicate recommendations to authorities with the goal of improving reproductive health practice.

Associated Assessment Criteria for Exit Level Outcome 10

• Engage in debates and compare the best available evidence, theories or models on midwifery and neonatal nursing.
• Operationalise the underlying theories that endorse the role of the Midwife Specialist.
• Create and sustain healthy environments for pregnant women, mothers, and their infants of different ages across the health continuum, which is based on the best available evidence and resources.
• Evaluate and report on, the current evidence-based guidelines to improve maternal and neonatal health care.
• Critically appraise and adopt evidence-based practice, best practice guidelines, theories, and models in maternal and neonatal health care.
• Implement evidence-based practice to promote quality of patient care and safety in midwifery and neonatal health.
• Create comprehensive individual, people-centred, inter-professional midwifery and neonatal specialist treatment plans which are based on assessment findings and standardised national and contextually appropriate guidelines.

Associated Assessment Criteria for Exit Level Outcome 11

• Utilise specialist midwife/accoucheur skills to manage maternal health issues during the peripartum period.
• Interpret subjective and objective assessment findings to make a specialist midwife diagnosis.
• Create comprehensive individual, people-centred, inter-professional treatment plans which are based on assessment findings and standardised national and contextually appropriate guidelines for the optimisation of maternal health.
• Debate the rationale and safety measures of technology used in assessing and treating pregnant women.
• Critically analyse maternal care pathways and the referral system to optimise maternal health care.
• Conduct audits of care of pregnant women on medico-legal standards (national core standards).
• Evaluate the accuracy of data in reporting about the maternal health status.
• Co-ordinate and render midwifery and specialist health care across the different levels of healthcare provision to promote health outcomes.

Associated Assessment Criteria for Exit Level Outcome 12

• Manage emergencies during pregnancy, intrapartum and postnatal periods according to the best available evidence and national protocols.
• Engage in debates and compare the best available evidence, theories, or models on obstetric emergencies.
• Analyse and apply the principles, underlying theories, and emerging issues in the management of obstetric emergencies.
• Evaluate and report on, the current evidence-based guidelines on the management of obstetric emergencies to improve maternal and neonatal health care.
• Critically appraise and adopt evidence-based practice, best practice guidelines, theories, and models in the management of obstetric emergencies.
• Implement evidence-based practice to promote quality of patient care and safety in the management of obstetric emergencies.
• Create comprehensive individual, people-centred, inter-professional obstetric emergency treatment plans which are based on assessment findings and standardised national and contextually appropriate guidelines.

Associated Assessment Criteria for Exit Level Outcome 13

• Apply appropriate assessment methods to identify, manage and refer at-risk mothers and neonates.
• Assess and diagnose at-risk mothers and neonates by considering social determinants of health and all relevant clinical findings to demonstrate clinical reasoning at the appropriate level.
• Execute and co-ordinate comprehensive individualised family-centred care plans, which are based on assessment findings, for at-risk mothers and neonates.
• Diagnose, monitor, and manage high-risk mothers and neonates by using technology appropriately and safely while providing specialised care.
• Negotiate the care plan of pregnant women and significant others, by using principles of healthy dialogue.
• Critically analyse and use care pathways and efficient referral systems appropriately and effectively for at-risk mothers and neonates.
• Compile the midwife specialist care according to care-and legal standards.
• Evaluate the standards of care based on audits of the records of at-risk mothers and neonates.
• Capture maternal and neonatal health data accurately and utilize it appropriately to improve midwifery practice.

Associated Assessment Criteria for Exit Level Outcome 14

• Apply appropriate leadership styles by the specialist midwife within the inter-professional team.
• Develop indicators for quality and cost-effectiveness based on benchmarks and best practices within

the health care system to optimise the care for reproductive health, obstetric emergencies, maternal health issues and high-risk neonates.

• Analyse and optimise care pathways and referral systems within the health care system to manage reproductive health, obstetric emergencies, maternal health issues and high-risk neonates.
• Co-ordinate the activities of the inter-professional team within the health care system to manage reproductive health, obstetric emergencies, maternal health issues and high-risk neonates effectively.

Associated Assessment Criteria for Exit Level Outcome 15

• Create and document shared decision-making opportunities regarding Midwifery and Neonatal healthcare services.
• Mobilise and use resources are to optimize midwifery and neonatal nursing care.
• Facilitate and develop the thinking/reasoning processes of self and others through facilitation of learning.
• Create a positive learning environment by supporting peers and novices and establishing academic networks to sustain personal development.

INTEGRATED ASSESSMENT

The Postgraduate Diploma in Midwifery aligns with the assessment policy of the institution in this way

• Each module guide designed by lecturers will inform learners about the type and weight of the assessment and the dates on which assessments are due.
• Learners will be assessed continuously, and the assessment will include tests, individual and group assignments, presentations, classroom-based group work, projects, case studies, portfolios, and clinical/practical learning. The assessments could be paper-based, online or oral and the number of assessments per module will depend on the module credits.
• Learners will be required to complete certain tasks in class as individuals or in groups.
• Oral presentations will be done in class, individually and with groups. This will allow learners to work co-operatively, share experiences and learn from each other, and gain confidence as they participate in class. All these forms of formative assessments aim at strengthening learners' communication skills, their sense of independence and their ability to work as a team. They prepare them for the world of work as midwives where they must work as members of an academic team.
• An assessment plan will be given to learners at the start of the semester as per the module descriptor. These activities will aim at assessing the learners' level of competence in both theory and practice and the extent to which they can apply, analyse, critique, and evaluate knowledge and practice as prospective midwives.

Formative and summative assessment

The institution uses continuous and final assessments where the formative assessments make up the continuous assessments and the summative assessment in the form of a final assessment. In this qualification learner assessment, in most cases, will be continuous and a final assessment. Each assessment will carry a specific weight/percentage towards the final mark for the module. Lecturers will give regular feedback on continuous assessment tasks which include:

• Tests.
• Assignments (individual and group).
• Presentations.
• Online quizzes.
• Discussions.
• e-portfolios.
• Practical competency tests.

These assessments will be reviewed by individual lecturers and clinical supervisors. Feedback will be provided to learners either individually or as a group to enable learners to reflect on their performance and identify areas for improvement where necessary. The lecturers will also be able to identify struggling or at-risk learners who require additional support.

The final assessment will occur at the end of each module, at the end of a semester. It usually occurs in May/June and in October/November of each year. This assessment usually contributes the highest weighting/ percentage towards the final mark. There are existing procedures in the institution for internal and external moderation. This qualification will adopt these procedures to manage the quality of the assessment process.