Postgraduate Diploma in Midwifery

Purpose

The purpose of the Postgraduate Diploma in Midwifery is to produce independent postgraduate Midwife Specialists who can demonstrate the competencies required to provide Midwifery and Neonatal specialized care and improve reproductive, maternal, neonatal, women and child health, to reduce maternal and neonatal morbidity and mortality rates.

The competencies acquired by the Midwife Specialist include reflective practice, clinical judgement, independent decision making and deliberate practice to improve maternal and neonatal outcomes. The graduate will be clinically focused and service-orientated, able to deliver specialized care, including preventive, promotive, curative, and rehabilitative care, using a wide range of skills such as accountability, service ethics and effective decision-making.

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, implement and manage projects of a varied nature.
• Work independently and as part of a team.

Rationale

Positioning of Nursing Education within the higher education band is a legislative mandate responding to both transformation in the education system of the country and the health care system agenda as indicated below:

• In compliance with the provisions of the Higher Education Act (Act 101 of 1997 as amended in 2008) the change in the educational landscape of the country mandates the alignment of the nursing qualifications to the National Qualification Framework (NQF).
• Government Notice No. 801 of 2016, Published in Government Gazette of 6 July 2016 Gazette - Circular 7 of 2016. The circular stipulates information regarding the phasing out of legacy nursing qualifications and implementation of nursing qualifications to be aligned to the Higher Education Qualification Sub Framework (HEQSF).
• The Nursing Act No. 33 of 2005 provides for training, leading to registration as a Midwife Specialist.
• SANC Regulation No. 635 of 2020 prescribes the requirements for registration in the category of Midwife Specialist.

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. The Sustainable Development Goals (SDGs) make a bold commitment to end the epidemics of AIDS, tuberculosis, malaria, and other communicable diseases by 2030. The qualification will contribute to the provision of qualified midwife specialists and the achievement of SDG 3: "Ensure healthy lives and promote well-being for all at all ages".

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 qualification 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.

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. This qualification is intended to produce a Midwife Specialist with the competencies required to respond to the reproductive, maternal, neonatal, women and child health needs of the country.

The teaching and learning process incorporates government programmes in reproductive, maternal, neonatal, women and child health needs (HIV/AIDS and TB, Maternal and Neonatal Morbidity and Mortality, Injuries and Violence and Noncommunicable diseases) through a primary and acute care approach. The curriculum uses an outcome-based approach whereby learners are placed for Work Integrated Learning in specialized midwifery practice and other healthcare settings to apply the required competencies. A collaborative teaching and learning approach will promote evidence-based midwifery practice.

The competencies acquired by the graduates will enable them to be problem solvers, critical, analytical thinkers, and change agents able to identify and analyse needs, contributing meaningfully to the formulation and application of policies and procedures to improve the quality of maternal and neonatal care.

On successful completion of the qualification, the graduate will be registered as a Midwife Specialist with the SANC to practice as defined by the Nursing Act No. 33 of 2005.

Recognition of Prior Learning (RPL)

The institution has an approved Recognition of Prior Learning (RPL) policy which is 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 advanced standing 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 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 from 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 144 Credits.

Compulsory Modules, Level 8, 144 Credits

• Research in Service Dynamics, 16 Credits.
• Health Sciences Research, 12 Credits.
• Midwifery Specialty Care I, 27 Credits.
• Midwifery Specialty Care II, 19 Credits
• Midwifery Specialty Work Integrated Learning, 70 Credits.

1. Practice and facilitate specialised midwifery care within the ethical and legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice in the specialised midwifery field to solve contextual problems and develop policies and guidelines.
3. Appraise and develop self, peers, and Midwife Specialist learners by facilitating self-directedness/leadership and lifelong learning to maintain competence.
4. Facilitate advocacy for the profession and provision of specialised midwifery professional support for personnel, patients, families, and communities.
5. Engage in planning, commissioning, and managing specialised midwifery units.
6. Engage in scholarly activities to inform evidence-based practice in specialised midwifery units.
7. Utilize, manage, and communicate data to support decision-making and research.
8. Render and coordinate patient care specialised midwifery practice within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences including advanced pharmacology.
9. Mobilize appropriate resources to implement standards of practice relevant to midwifery specialisation, to ensure quality patient care and safety.
10. Collaborate within the inter-professional team by engaging in health dialogue, shared leadership, decision making and sound clinical judgment.
11. Participate in the design, development, implementation, and evaluation of midwifery policies, programmes, and projects.
12. Develop and implement policies, protocols, and guidelines in midwifery practice, utilizing the process of change management in the improvement of quality of care.

Associated Assessment Criteria for Exit Level Outcome 1

• Conform to the relevant code of ethics and behaviour in the practice of specialised midwifery care.
• Apply critical decision-making and moral reasoning models and principles to make clinical judgements and resolve ethical dilemmas within the specialised midwifery practice.
• Account for own professional judgement, actions, and outcomes of specialised midwifery care and provide continued competence.
• Identify and apply the relevant current legislation, policies, regulations, and guidelines pertaining to specialised midwifery practice.
• Document accurately, comprehensively, and timeously all specialised midwifery care activities considering the legal requirements for record keeping.
• Demonstrate knowledge of the Midwife Specialist role 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 specialised midwifery practice and the process of evidence-based practice.
• Apply the evidence-based specialised midwifery practice, and appropriate methodology of gathering evidence for the practice, for example, systematic or scoping reviews, appraisal of articles, practice-based research, and publication.
• Use the evidence-based specialised midwifery practice, and critically analyse the various levels of evidence.

Associated Assessment Criteria for Exit Level Outcome 3

• Apply the leadership skills appropriate to the leadership styles, principles, and theories.
• Effectively facilitate Continuous Professional Development (CPD) for self and others as well as for lifelong learning by creating a positive learning climate in the workplace through the processes of mentorship, preceptorship, supervision, performance appraisal, etc.
• Conduct the performance appraisal and processes of the performance management and development system.
• Utilise the feedback gained from self-reflection, peers, learners, management, and other relevant stakeholders to improve effectiveness in the Midwife Specialist's role.
• Examine 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

• Discuss the purpose of the advocacy role for a Midwife Specialist.
• Apply advocacy principles to ensure safe and quality care/ in various midwifery care settings.
• Use of appropriate communication skills and channels in facilitating advocacy.
• Lobby and or participate in interest groups to influence legislation and policy affecting role performance.

Associated Assessment Criteria for Exit Level Outcome 5

• Analyse the levels and or classification of the respective specialised midwifery units.
• Delegate the task considering the burden of diseases and priority services as determined by current events.
• Participate in the evaluation of the existing specialised midwifery unit and develop the guidelines for provisioning a specialised midwifery unit.
• Analyse the roles and responsibilities of specialised midwifery in planning and commissioning within inter and intra-professional teams.

Associated Assessment Criteria for Exit Level Outcome 6

• Practice in the respective specialised midwifery setting; demonstrates knowledge of appropriate search engines and databases for review of the literature to inform evidence-based practice in specialised midwifery care.
• Use appropriate methods to generate evidence for utilisation in specialised midwifery practice such as research and systematic reviews.
• Use peer-reviewed journals for sharing the evidence.
• Base activities in the specialised midwifery practice on scientifically proven evidence.
• Actively participate in inter and interprofessional dialogues, debates, or discourses in quality improvement.

Associated Assessment Criteria for Exit Level Outcome 7

• Gather all data/information in the context of the specialised midwifery practice, for utilisation and storage in accordance with the set standards.
• Use comprehensive data, information, and emerging evidence pertinent to the respective specialised midwifery practice.
• Base the problem identification, diagnoses, and opportunities for improvement on gathered and critically analysed assessment data from the patients/clients, families, communities, learners, or employees including current scientific evidence.
• Documentation demonstrates respect for intellectual property and is without plagiarism.

Associated Assessment Criteria for Exit Level Outcome 8

• Explain the position of specialised midwifery service within the health care system.
• Perform the full range of services within the specialised midwifery practice.
• Render the specialised midwifery care that integrates promotive, preventive, curative, and rehabilitative care in a healthcare continuum.
• Apply knowledge, skill, and attitudes in rendering specialised midwifery care according to the national and international standards and protocols of the specialised midwifery field.
• Formulate midwifery diagnoses congruent with the patient's/client's clinical manifestations/data and 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 midwifery interventions considering patient's/client's needs, values, beliefs, preferences, culture, and contextual variables, for example, disease burden, health risks and national priorities.
• Base the planned midwifery interventions on formulated midwifery diagnoses, and application of specialised knowledge and skills, competencies including advanced pharmacology in collaboration with inter and intra-professional teams.
• Implement timeously, accurately, safely, and effectively the planned midwifery interventions in accordance with set evidence-based standards, guidelines, protocols, algorithms etc. specific to the specialised midwifery field.
• Plan the health care interventions in collaboration with the patient or client, family, and relevant members of the health care team.
• Prepare the midwifery interventions which include preparation of patients/clients, families, and midwives in the lower-level care for continued care in the hospital and community in accordance with the health status and health literacy of the patient/client.
• Document and revise timeously and effectively midwifery interventions based on critical analysis of the monitoring and evaluation data and reaching a sound clinical judgement.

Associated Assessment Criteria for Exit Level Outcome 9

• Discuss the infrastructure and equipment required in the specific area of midwifery specialization.
• Render care to operate and monitor the equipment used in the Midwife Specialist area.
• Employ sound asset management principles to ensure appropriate, adequate, well-maintained, and up-to-date equipment.
• Assign staff to midwifery care considering the Midwife Specialist's qualification and competencies, experience, standard nurse-patient ratios for the area of midwifery specialisation, job description and skill mix.

Assessment Criteria for Exit Level Outcome 10

• Identify, share, and collaboratively solve practice problems in the specialised midwifery area by informed decisions and sound clinical judgement.
• Consult and provide appropriately and timeously holistic care in a healthcare continuum through awareness of one's competence.
• Carry out patient referrals appropriately and timeously as dictated by the patient's condition and in accordance with the referral guidelines.
• Promote participation in the inter- and interprofessional team, visible and recognised by the members of the team.

Associated Assessment Criteria for Exit Level Outcome 11

• Explore the steps in and or levels of the development of policies, programmes, and projects within inter and interprofessional policy/project teams.
• Participate in the development of policies, programmes, and projects.
• Participation in policy development, programme and project development demonstrates advocacy for the midwifery profession and patients/clients, families, and communities in the Midwife Specialist area.

Associated Assessment Criteria for Exit Level Outcome 12

• Explore 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 and processes in the development and evaluation or testing of guidelines and protocols.
• Implement the new policies, protocols, and guidelines for the specialist area change process.
• Collaboratively revise at appropriate intervals and approve the developed policies, protocols, and guidelines as per the institutional policy for the Midwife Specialist area.