Standards of proficiency for pre-registration midwifery education

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1 & NURSING MIDWIFERY COUNCIL & NURSING MIDWIFERY COUNCIL Standards of proficiency for pre-registration education standards Portland Place, London W1B 1PZ Telephone Fax Protecting the public through professional standards Protecting the public through professional standards

2 & NURSING MIDWIFERY COUNCIL Standards for pre-registration education Protecting the public through professional standards

3 Introduction This booklet has been developed from Midwives rules and code of and Requirements for pre-registration programmes, both of which the former United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) published in 1998 and 2000 respectively. Incorporated also is content previously published in Statutory Instruments and Council policy. Combining all of these resources into one comprehensive publication has developed the standards and guidance for pre-registration education, which are contained in this booklet. 3

4 Contents Section 1 Standards for pre-registration 5 programmes of education Section 1 Standards for pre-registration programmes of education Section 2 Standards for the Lead Midwife for Education 12 4 Standard 1 Appointment of the Lead Midwife for Education 12 Standard 2 Development, delivery and management of 13 programmes of education Standard 3 Signing the supporting declaration for good health and 15 good character Section 3 Standards for admission to, and continued 17 participation in, pre-registration programmes Standard 4 Age of entry 17 Standard 5 General entry requirements 18 Standard 6 Interruption in pre-registration programmes 21 of education Standard 7 Admission with advanced standing 22 Standard 8 Transfer between approved educational institutions 23 Section 4 Standards for the structure and nature of 24 pre-registration programmes Standard 9 Academic standard of programme 24 Standard 10 Length of programme 24 Standard 11 Student support 25 Standard 12 Balance between clinical and theory 26 Standard 13 Supernumerary status 27 Standard 14 Assessment strategy 28 Section 5 Standards of education to achieve the NMC standards 30 Guiding principles 30 The international definition of a midwife 33 The second Midwifery Directive 33 Standard 15 Standards of education to achieve the NMC standards 36 References 48 Introduction The Nursing and Midwifery Council (NMC) is required by the Nursing and Midwifery Order (the Order) to establish and maintain a register of qualified nurses and midwives [Article 5(1)], and from time to time establish standards to be met by applicants to different parts of the register, being the standards it considers necessary for safe and effective [Article 5(2)(a)]. This booklet provides standards and standards of education required for pre-registration programmes of education. These have been developed in support of the Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules (the Registration Rules). The rules and standards replace all previous requirements for preregistration programmes of education issued by the Nursing and Midwifery Council or previously the UKCC and the National Boards for Nurses, Midwives and Health Visitors for England, Wales, Scotland and Northern Ireland (National Boards). Their status is mandatory, in accordance with statutory legislation. Establishment of the NMC The NMC was established under the Order and came into being on 1 April 2002 as the successor to the UKCC and the four National Boards. At that time the NMC adopted the existing rules and standards of the UKCC and, where relevant, those of the National Boards. In addition to the Registration Rules, new rules for, fees and fitness to practise 3 5 have also been developed. These all came into force on 1 August The NMC register The NMC has determined there shall be three parts to the register for nurses, midwives and specialist community public health nurses. Additionally that the 5

5 nurses part will be divided into two sub-parts for first and second level nurses, and that a further distinction will be applied in respect of nursing registrants to indicate by mark on the entry the branch in which the standards of proficiency have been met. Standards for Standards for the midwives part of the register were initially defined as competencies in Requirements for pre-registration programmes 6 and were an interpretation of the outcomes contained in a Statutory Instrument 7. The term standards is identified in the Order and relates to the standards necessary to enter the register as a midwife. The standards are as follows: communicate effectively with women and their families throughout the preconception, antenatal, intrapartum and postnatal periods diagnose pregnancy, assess and monitor women holistically throughout the pre-conception, antenatal, intrapartum and postnatal periods through the use of a range of assessment methods, and reach valid, reliable and comprehensive conclusions determine and provide programmes of care and support for women provide seamless care and interventions in partnership with women and other care providers during the antenatal period care for and monitor women during the puerperium, offering the necessary evidence-based advice and support regarding the baby and self-care select, acquire and administer safely, a range of permitted drugs consistent with legislation, applying knowledge and skills to the situation that pertains at the time complete, store and retain records of monitor and evaluate the effectiveness of programmes of care and modify them to improve the outcomes for women, babies and their families contribute to enhancing the health and social wellbeing of individuals and their communities practise in accordance with The NMC code of professional conduct: standards for conduct, performance and ethics 8 (the Code), within the limitations of the individual s own competence, knowledge and sphere of professional, consistent with the legislation relating to practise in a way which respects, promotes and supports individuals rights, interests, preferences, beliefs and cultures practise in accordance with relevant legislation maintain confidentiality of information work collaboratively with other practitioners and agencies manage and prioritise competing demands refer women who would benefit from the skills and knowledge of other support the creation and maintenance of environments that promote the individuals health, safety and wellbeing of women, babies and others care for, monitor and support women during labour; monitor the condition contribute to the development and evaluation of guidelines and policies and of the fetus and support spontaneous births make recommendations for change in the interests of women, babies and undertake appropriate emergency procedures to meet the health needs of their families women and babies review, develop and enhance the midwife s own knowledge, skills and fitness examine and care for babies immediately following birth to practise work in partnership with women and other care providers during the demonstrate effective working across professional boundaries and develop postnatal period to provide seamless care and interventions professional networks examine and care for babies with specific health or social needs and refer to apply relevant knowledge to the midwife s own in structured ways other professionals or agencies as appropriate which are capable of evaluation 6 7

6 inform and develop the midwife s own and the of others through using the best available evidence and reflecting on manage and develop care utilising the most appropriate information technology (IT) systems contribute to the audit of to review and optimise the care of women, babies and their families. Directive (the requirements of which are reproduced in paragraphs 1, 2(b),3, 4, A and B of Schedule 1 and paragraphs 1, 2, 3, 4, A and B of Schedule 2). (2) The requirements for entry to an approved programme of education shall include the requirements of article 1.2(a) of the second Nursing Directive or article 1.2 of the second Midwifery Directive, (the requirements of which are reproduced in paragraph 2(a) of Schedule 1 and paragraph 2 of Schedule 2). Rules, standards and guidance Rules are established through legislation and they provide the legal strategic framework from which the NMC develops standards. The standards support the rules being put into. The standards are mandatory and gain their authority from legislation, in this case the Order and the rules. The guidance is provided by the NMC to enable interpretation of the rules and standards, supporting their implementation. All of the content of the standards in this booklet has either been consulted on, in accordance with Article 3(14) of the Order, or has been transferred from previous rules, standards and guidance. Where appropriate terminology has been updated to bring it in line with the requirements of the Order. The standards reflect the requirements of the European Community (EC) Midwifery Directives 80/154/ECC and second Midwifery Directive 80/155/EEC (as amended by Directive 89/594/EEC). Detailed information of such requirements is in Schedule 2 of the Registration Rules and within Standard 15 in this booklet. The standards should be read in conjunction with NMC principles for delivery of approved programmes a and the Registration Rules and the relevant Schedule to these Rules. The relevant part of Rule 3, is reproduced below: 3 (1) Where an approved programme of education leads to the award of a qualification listed in the Annex to the Nursing Directive or Midwifery Directive, it shall comply with the training requirements in articles 1 and 2 of the second Nursing Directive or articles 1 and 3 of the second Midwifery 8 a at the time of going to print this is a working document to be published in the near future 9

7 Summary of the standards for pre-registration There are 15 standards related to pre-registration education. These cover the Lead Midwife for Education; admission to, and continued participation in, education programmes; the structure and nature of programmes and the standards. The standards, and the section of this document in which they may be found, are as follows: Standards for the Lead Midwife for Education: in Section 2 Standards for the structure and nature of pre-registration programmes: in Section 4 Standard 9 Standard 10 Standard 11 Standard 12 Standard 13 Academic standard of programme Length of programme Student support Balance between clinical and theory Supernumerary status Standard 1 Appointment of the Lead Midwife for Education Standard 14 Assessment strategy Standard 2 Standard 3 Development, delivery and management of programmes of education Signing the supporting declaration for good health and good character Standards of education to achieve the NMC standards : in Section 5 Standard 15 Standards of education to achieve the NMC standards of proficiency Standards for admission to, and continued participation in, pre-registration programmes: in Section 3 Standard 4 Standard 5 Age of entry General requirements for admission to approved pre-registration programmes of education and entry to the register 5.1. literacy and numeracy 5.2. good health and good character Standard 6 Standard 7 Standard 8 Interruption in pre-registration programmes of education Admission with advanced standing Transfer between approved educational institutions 10 11

8 Section 2 Standards for the Lead Midwife for Education Introduction This section provides standards and guidance relating to the Lead Midwife for Education. The Lead Midwife for Education is a requirement for approval of programmes of education that lead to application to the midwives part of the register or a recordable qualification. The principle function of the Council, as identified in Article 3(2) of the Order, is to establish, amongst other standards, standards of education and training, and to ensure the maintenance of those standards. The Lead Midwife for Education is an essential part of the quality assurance process that assures Council that the standards leading to either registration or a recording on the midwives part of the register are maintained. Standard 1 Appointment of the Lead Midwife for Education The Council shall only approve a programme of education that leads to application to the midwives part of the register or a recordable qualification where the approved educational institution makes provision for a practising midwife to be appointed to the post of Lead Midwife for Education. The Lead Midwife for Education is a practising midwife and therefore must notify her intention to each year. She must also meet the NMC requirements for updating and continuous professional development in order to remain on the register as a practising midwife. Having a recorded teaching qualification on the NMC register demonstrates that the Lead Midwife for Education has met the NMC standards for teaching. The approved educational institution should notify the NMC of the appointment of the Lead Midwife for Education on the appropriate form, which can be downloaded from the NMC website, These details will be entered onto the NMC contact database to enable the NMC to communicate effectively with the Lead Midwife for Education. Examples of external agencies may include the NMC, Local Supervising Authorities, commissioners and purchasers of education, NHS Trusts, Departments of Health, other higher education institutions, professional organisations, as well as voluntary sector and private sector employers. In working collaboratively with such agencies, the Lead Midwife for Education will enable education to develop and meet current and future needs for midwives that are fit for purpose. In addition the Lead Midwife for Education will enable the approved educational institution to ensure it meets the NMC requirements to prepare midwives to be fit for. The approved educational institution will: appoint a Lead Midwife for Education who is a practising midwife and has recorded a teaching qualification on the NMC register confirm the appointment of a Lead Midwife for Education with the NMC Standard 2 Development, delivery and management of programmes of education use the Lead Midwife for Education for strategic liaison with external agencies such as purchasers of the education provision, for all matters affecting education. The Lead Midwife for Education shall lead the development, delivery and management of the programmes of education provided by the approved educational institution, ensuring that they comply with the standards established by the Council from time to time in accordance with the Order

9 The approved educational institution will: consult with the Lead Midwife for Education on all matters that affect education. The Lead Midwife for Education will: contribute to the internal systems that inform the quality assurance processes of education programmes collaborate with maternity services, service users and user groups in all matters that affect education provide professional input, at strategic and operational levels within the approved educational institution, to ensure the NMC s requirements for due regard are met work at a strategic level with Heads of Midwifery, Local Supervising Authority Midwifery Officers, supervisors of midwives and purchasers of education provision in all matters that affect education. The Lead Midwife for Education is an expert in education and has the knowledge and skills to develop policy as well as advise others on all matters relating to education. It is essential that programmes of education meet the needs of users of the maternity services as well as students. It is therefore important that women who use the maternity services are involved in all stages of curriculum planning, development and programme evaluation. This will enable student midwives, at the point of registration, to meet the needs of women and their babies. Strategic collaboration is necessary because education impacts upon care, workforce planning and commissioning of student numbers. Standard 3 Signing the supporting declaration for good health and good character In accordance with rule 6(1)(a)(ii) of the Registration Rules the Lead Midwife for Education shall be responsible, at her discretion, for signing the supporting declaration of good health and good character for all applications to the register. The Lead Midwife for Education will: ensure processes are in place to satisfy the NMC entry requirements for: (i) admission to a programme of education that leads to initial registration or readmission to the register following a return to programme (ii) the continued participation of a student in a programme of education that leads to initial registration or readmission to the register following a return to programme (iii) any person being admitted to the midwives part of the register for the first time or readmission to the register following a return to programme be accountable for her signature on the supporting declaration form for good health and good character have the right to refuse to sign any supporting declaration of good health and good character where available evidence identifies the student may not be of sufficient good health and good character to carry out safe and effective as a midwife. As a practising midwife the Lead Midwife for Education is accountable for her in accordance with the Code and the Midwives rules and standards 9. If a Lead Midwife for Education cannot be assured of a student s good 14 15

10 health and good character she must not sign the supporting declaration required by the NMC. The student therefore cannot be recommended for admission to the midwives part of the register. It would be regarded as good to inform the NMC and explain why the student is not being recommended for admission to the register and that the student has been discontinued from the programme. Section 3 Standards for admission to, and continued participation in, pre-registration programmes Introduction This section provides the standards and guidance related to admission to and continued participation in NMC approved pre-registration programmes of education, in accordance with Article 15(1)(b) of the Order, which requires the NMC from time to time to establish: the requirements to be satisfied for admission to, continued participation in, such education and training which may include requirements for good health and good character. Standard 4 Age of entry Those entering a programme of education at an approved educational institution shall not be less than 17 years and six months of age on the first day of the commencement of the programme. In exceptional circumstances and related to specific programmes, the Council may agree to an earlier age of entry, but this may not be less than 17 years of age. The minimum age is in keeping with the European Midwives Directive 80/155/EEC, that states applicants must have completed at least 10 years of general school education, and are able to show that they have acquired the relevant qualification before entering a programme of education. The NMC is required to comply with the EC Directives as they change from time to time

11 The current age of entry has been agreed to comply with the completion of secondary education, which is set at 17 years and six months in England, Wales and Northern Ireland and in Scotland 17 years. abilities or through the approved educational institutions own processes, which may include portfolios or tests for those without formal qualifications c. Approved educational institutions are entitled to set their own specific educational entry requirements, which may be at a higher level than that required by the NMC. It would be regarded as best if the educational entry requirements were agreed jointly by the approved educational institution, service providers as well as education commissioners. Standard 5 General requirements for admission to approved pre-registration programmes of education and entry to the register 5.1 Literacy and numeracy Approved educational institutions must ensure that applicants for preregistration programmes of education have provided evidence of literacy and numeracy sufficient to undertake a pre-registration programme of education at a minimum level of diploma of higher education. Where the International English Language Testing System (IELTS) is offered as evidence d, programme providers should apply the NMC requirements for overseas applicants to the register. For these applicants, the NMC accepts IELTS examination (academic or general version) with an overall score of 6.5 and not less than 5.5 in any one section. The NMC requires access to information about, and evidence of application of, the systems and policies developed to assess literacy and numeracy of applicants to pre-registration programmes of education for quality assurance purposes. Applicants to pre-registration programmes of education who hold an existing NMC registration may be deemed to have met the Council s requirements at their initial registration. 5.2 Good health and good character Applicants must demonstrate that they have good health e and good character, sufficient for safe and effective as a midwife, on entry to, and for continued participation in, programmes leading to registration with the NMC 10. If an applicant has a conviction or formal caution issued by the police, this must be declared. The NMC requirements ensure, in the interests of public protection, that entrants to pre-registration programmes have a foundation of literacy and numeracy from which to develop proficiency in communication b and drug calculations. Evidence of literacy and numeracy may be determined from academic or vocational qualifications, through evidence such as key skills Approved educational institutions will obtain evidence of the applicant s good health and good character as part of their selection, admission and ongoing monitoring processes. c These examples are for guidance only, approved educational institutions have the right to set their own standards but must satisfy the NMC that there is sufficient evidence to meet its requirements d This would only apply to overseas applicants outside of the EEA e Overseas applicants must meet the requirements of good health and good character as defined for UK applicants and additionally those requirements set by the UK government for health care workers from overseas 18 b Those midwives wishing to in Wales must be able to demonstrate the use of the Welsh language where this is required 19

12 A student already registered with the NMC on a different part of the register is not exempt from this requirement. Approved educational institutions must have systems in place demonstrating an audit trail of evidence to support this requirement. The NMC requires programme providers f to ensure that processes are in place for assessment of applicant/student s good health and good character at admission to, during and on completion of pre-registration programmes. Such processes may involve a combination of selfassessment health questionnaires, self-declaration of good character, routine health screening, occupational health assessment, character references, Criminal Record Bureau checks and other measures agreed between the programme providers. The Lead Midwife for Education, confirming the student s declaration of good health and good character on completion of the programme, must have knowledge of the student. She is accountable for her decision to sign the declaration. Throughout the programme the NMC would expect that students develop their in accordance with the Code. Students who declare on application that they have a disability should submit a formal assessment of their condition and specific needs, from a GP or other medical or recognised authority, to the relevant Occupational Health Department. Programme providers should apply local policy in accordance with the Disability Discrimination Act and 12g for the selection and recruitment of students/employees with disabilities. Where appropriate the institution s student support services should also be involved. The NMC would require evidence of how such students would be supported in both academic and environments to ensure safe and effective sufficient for future registration. Standard 6 Interruption in pre-registration programmes of education A student midwife who has an interruption to a pre-registration programme of education shall complete the outstanding period of that programme. Programme providers must ensure that the student s acquired knowledge and skills remain valid to enable the completion of the proficiencies set by the NMC. 20 Entry to the register The NMC has determined that it requires a self-declaration of good health and good character [Rule 5(1)(a)] from all of those entering the register for the first time. On completion of the programme of education the student will submit this self-declaration. Rule 6(1)(a)(ii) requires this declaration be supported by the Lead Midwife for Education, whose name has been notified to the Council, and is responsible for education in the relevant approved educational institution, or her designated registered midwife substitute. f The approved educational institutions and their service partners g Amended by the Special Educational Needs and Disability Act with effect from October 2004 For the purpose of this standard, interruption means any absence from a programme of education other than annual leave, statutory and public holidays. If there are interruptions to a three-year full-time programme of education, the programme must be completed within five years of the commencement date. Where the student attends part-time, the programme must be completed within seven years of the commencement date. 21

13 22 If there are interruptions to an 18-month full-time programme of education, the programme must be completed within two years and six months of the commencement date. Where a student attends parttime, the programme must be completed within three years and six months of the commencement date. When a student returns to a programme it is recommended the student have a period of orientation appropriate to the length of interruption. See also Standard 10 Length of programme. Standard 7 Admission with advanced standing Where a student is already registered with the NMC as a nurse level 1 (adult), the length of the pre-registration programme of education shall be no less then 18 months full-time (equivalent to 78 weeks full-time). Advanced standing is where a student enters a pre-registration programme as a result of prior registration, thus being able to undertake a shortened programme. This standard complies with EU Directive 80/155/EEC Article 1(2), where applicants are entitled to a shortened programme by virtue of previous registration as a nurse level 1(adult) with the NMC. Applicants who are registered with the NMC as a nurse level 1 from the other branches of nursing (mental health, learning disabilities and children) are not entitled to undertake a shortened programme. All applicants, other than those registered as a nurse level 1(adult), must complete a minimum three years full time pre-registration programme of education. Standard 8 Transfer between approved educational institutions Students may transfer their programme with credit for prior learning only where: they transfer from and to an approved educational institution they transfer from and to an NMC approved pre-registration programme of education the NMC requirements for good health and good character for continued participation in an approved pre-registration programme of education are met their prior learning has been mapped against the programme they will complete for registration and all NMC requirements and standards of education and proficiency will be met. Approved educational institutions have full responsibility for deciding whether to accept an application for transfer if they can accommodate such a request. Where such an application is accepted for processing, the student applying for transfer should be assessed to ensure compliance with good health and good character requirements for the new programme. Where these criteria are met then further assessment of the student s prior learning should be made to ensure that, through transfer to a new institution, the student will continue to meet all of the NMC required outcomes and standards. The approved institution will then agree a programme of study that will meet both NMC requirements and their own programme outcomes. 23

14 Section 4 Standards for the structure and nature of pre-registration programmes Introduction This section provides the standards for pre-registration programmes of education, in accordance with Article 15(1)(a) of the Order, which requires the NMC to, from time to time, establish: the standards of education and training necessary to achieve the standards of proficiency it has established under article 5(2). Where the student is already registered with the NMC, as a nurse level 1 (adult), the length of the pre-registration programme of education shall not be less than 18 months (equivalent to 78 weeks fulltime) or an equivalent pro-rata part-time period. A full-time programme containing a minimum of 156 weeks or 78 weeks includes any annual leave as part of the programme. See also Standard 6 Interruption in pre-registration programmes of education. Standard 9 Academic standard of programme The minimum academic standard of pre-registration programmes of education is that of diploma of higher education. Standard 11 Student support Midwife teachers and mentors are required to meet the NMC Standards for the preparation of teachers of nursing and It is a matter for programme providers (approved educational institutions and their service partners) to determine higher academic levels where appropriate. This should be done in consultation with education commissioners. Standard 10 Length of programme The length of a pre-registration programme of education shall not be less than three years in length (equivalent to 156 weeks full-time), and each year shall contain 45 programmed weeks. Where the programme is delivered full-time it must be completed in not more than five years including interruptions, or where the student attends part-time in not more than seven years. Student midwives should be supported in both academic and learning environments. Midwife teachers and midwife mentors have the knowledge, skills and expertise to provide appropriate support to student midwives. As such they are able to identify appropriate learning opportunities for the student midwife and offer her advice and guidance to develop safe woman centred that enables the student to become a midwife. A variety of members of the teaching and health care team may contribute to the student s learning, but to enable the application of theory to, the majority of the teaching/academic input must be from a midwife teacher. 25

15 Approved educational institutions must carry our regular audits of the learning environments that students are placed in. One of the outcomes of these audits will be to identify the number of students that an environment can support effectively. Standard 12 Balance between clinical and theory The balance between clinical and theory in the programmes shall be 50% clinical and 50% theory. The programme is required to have a variety of learning and teaching strategies, which may include simulation, but ensuring that all of the clinical part of the programme involves direct contact with the care of women and babies. The clinical experience must be sufficient to enable students to achieve the required NMC standards as well as the requirements of the second Midwifery Directive. When applying theory to in the academic learning environment a practising midwife teacher must undertake this teaching h. assess the need for and extent of care on the basis of their acquired knowledge and skills. Clinical should provide the student with the opportunity to experience 24-hour/seven-day care to enable her to develop understanding of the needs and experiences of women and babies throughout a 24-hour period. Clinical experience should include different models of care such as home births, midwife-led units, birth centres and caseload holding. Health education for individuals and small groups in the hospital, home or community should also be included. The student midwife is working towards autonomous at the point of registration. She should be assisted to develop the skills to work as an effective member of a multi-professional team in which she will provide the lead for care. Whilst it is essential that students are able to access a full range of experiences to achieve the standards it is for the midwife to decide whether delegation of tasks is appropriate in the care of a woman or her baby. The midwife remains accountable for the appropriateness of any delegation of care. Fifty percent of the available curriculum hours must be spent in clinical. This takes into account the variable hours per working week that universities apply to the programme. Clinical is that part of the programme of education whereby the student midwife is under direct or indirect supervision of a practising midwife when providing care to women and babies. The student is in direct contact with women and babies to plan, provide and Standard 13 Supernumerary status All students undertaking a pre-registration programme of education shall have supernumerary status to enable them to achieve the required standards. Supernumerary status means, in relation to a student, that she shall not as part of her programme of education, be employed by any person or body under contract of service to provide care. 26 h This would not exclude student midwife teachers 27

16 Supernumerary status applies to all student midwives whether undertaking a three year or 18 month pre-registration programme of education. Experiences should be educationally led and the supernumerary status of students is a way of assisting this. Standard 14 Assessment strategy register. Although other members of the teaching and health team may contribute to the assessment of student midwives theory and, they should not undertake summative assessments of the standards of proficiency for entry to the midwives part of the register. A student who is unsuccessful in passing all elements of the assessment strategy approved by the NMC, including the agreed processes for retesting will not be eligible to register as a midwife at the end of the programme. A student must complete and have passed all elements of an assessment strategy approved by the NMC. This is designed to confirm that the student has the theoretical knowledge, practical skills and attitude to achieve the standards for entry to the part of the register. A student midwife shall achieve the standards under the supervision of a mentor who shall be a practising midwife. A mentor who is a practising midwife shall confirm that the student midwife has met the standards. A range of assessment strategies should be used to assess the varying dimensions of knowledge, practical skills and attitude. This should include at least one unseen examination. An examination is defined as an unseen piece of work completed under supervised conditions that tests appropriately, the student s theoretical knowledge, practical skills and attitude. The form may vary, for example, for students with specific learning needs, eg. dyslexia; or to meet subject needs, eg. the use of Objective Structured Clinical Examinations. Both midwife teachers and midwife mentors shall be involved in assessing the student s standards to enter the midwives part of the 28 29

17 Section 5 Standards of education to achieve the NMC standards Introduction This section presents the standards of education to achieve the NMC standards for. The NMC sets the standards for pre-registration programmes of education for the UK. These standards also apply when assessing overseas trained midwives, outside the European Economic Area, who wish to join the NMC midwives part of the register. Guiding principles These guiding principles establish the philosophy and values underpinning the NMC s requirements for programmes leading to entry to the midwives part of the register and should be reflected in the programmes. They relate to professional competence and fitness for. Programmes of education must be designed to prepare the student to practise safely and effectively so that, on registration, the student can assume the responsibilities and accountability for her as a midwife. The standards are based on the principles that the education of student midwives will: demonstrate a women-centred approach to care based on partnership, which respects the individuality of the woman and her family i promote ethical and non-discriminatory s reflect the quality dimension of care through the setting and maintenance of appropriate standards Provision of women-centred care Midwifery must be women-centred and responsive to the needs of women and their families in a variety of care settings. This will be reflected in the midwife s ability to assess the needs of women, and to determine and provide programmes of care and support for women throughout the preconception, antenatal, intrapartum and postnatal periods. The programmes will prepare the student to provide care but also to accept responsibility for the effective and efficient management of care for women by managing and prioritising competing demands. The student will develop the capacity to work collaboratively within the multidisciplinary care team, whilst demonstrating overall competence in fulfilling the role. The emphasis must be on the provision of holistic care for women and their families, which respects their individual needs, contexts, cultures and choices. Principles of equity and fairness are fundamental values, which must be addressed in all programmes of preparation. Ethical and legal obligations The Code requires all midwives to conduct themselves and practise within an ethical framework based on respect for the well being of women and their families. While various rule-orientated and principle-based ethical models may assist in informing ethical decisions, many ethical dilemmas are complex. They may not easily be resolved by using one ethical approach. Midwives must recognise their moral obligations and the need to accept personal responsibility for their own ethical choices within specific situations based on their own professional judgement. In making such choices, midwives must be aware of, and adhere to, legal as well as professional requirements. 30 develop the concept of lifelong learning in students, encompassing key skills including communications and teamwork take account of the changing nature and context of base on the best available evidence. i The use of the word family in this document may refer to significant others, as identified by the woman. Respect for individuals and communities All members of the profession must always demonstrate respect for persons and communities, without prejudice, and irrespective of orientation and personal, group, political, cultural, ethnic or religious characteristics. Midwifery care must be provided without prejudice and in a non-discriminatory way. No member of the profession should convey any allegiance to any individual or group which opposes or threatens the human rights, safety or dignity of 31

18 individuals or communities, irrespective of whether such individuals or groups are recipients of care. Quality and excellence The -centred standards essential in are not separate and insular professional aspirations. They are directly linked to the wider goals of achieving clinical effectiveness within health care teams and agencies, with the ultimate aim of providing high quality care for women and their families. Assuring the quality of care is one of the fundamental underpinnings of clinical governance. It is essential that the standards enable the student to contribute to this wider health care agenda, and quality must be addressed within all programmes of preparation. Evidence-based and learning Within the complex and rapidly changing health care environment, it is essential that the best available evidence informs. This need is reflected in the standards. It includes searching the evidence base, analysing, critiquing and using evidence in, disseminating research findings and adapting and changing where appropriate. This must be reflected throughout programmes of education. The international definition of a midwife The standards for proficiency have been guided by the definition of a midwife adopted by the International Confederation of Midwives (ICM), the International Federation of Gynaecologists and Obstetricians (FIGO) and the World Health Organisation (WHO). Lifelong learning Lifelong learning skills will be an essential component of all programmes of preparation. Midwives must be prepared for and understand the need for continuing professional and personal development throughout their career. This will include the acquisition and development of new knowledge and skills. Programmes must provide the midwife with communication skills which enable the effective delivery of programmes of care and which support care in a multicultural environment. Midwives must be prepared for partnership working with other members of the health care team, working effectively across professional boundaries in the best interests of women and their families. The midwife... must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and the infant. This care includes preventative measures, the detection of abnormal conditions in the mother and the child, the procurement of medical assistance and the execution of emergency measures in the absence of medical help. She has an important task in health counselling and education, not only for women, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynaecology, family planning and child care. She may practise in hospitals, clinics, health units or in any other service. 32 The changing nature and context of As the nature and context of changes, it is essential that all midwives are prepared for and understand the need to update and enhance their knowledge and skills. The provision of effective care, which is responsive to the changing needs of women and their families, requires the capacity to improve and develop constantly. Midwives must have the capacity to adapt to change but also to be able to identify the need for change and to initiate it. Programmes must prepare the midwife for in a rapidly changing environment and to adapt to changes in technology and new systems of care delivery as they are introduced. The NMC has added to this definition by requiring the inclusion of community-based. The Second Midwifery Directive The standards for proficiency have been set at the point of registration, such that the student would be able to fulfil the requirements of a midwife as laid down in the definition of a midwife and would comply with the European Union Midwives Directive 80/155/EEC Article 4 as follows: "Member States shall ensure that midwives are at least entitled to take up and pursue the following activities: 33

19 to provide sound family planning information and advice to diagnose pregnancies and monitor normal pregnancies; to carry out examinations necessary for the monitoring of the development of normal pregnancies to prescribe or advise on the examinations necessary for the earliest possible diagnosis of pregnancies at risk to provide a programme of parenthood preparation and a complete preparation for childbirth including advice on hygiene and nutrition to care for and assist the mother during labour and to monitor the condition of the fetus in utero by the appropriate clinical and technical means to conduct spontaneous deliveries including where required an episiotomy and, in urgent cases, a breech delivery to recognise the warning signs of abnormality in the mother or infant which necessitate referral to a doctor and to assist the latter where appropriate; to take the necessary emergency measures in the doctor s absence, in particular the manual removal of the placenta, possibly followed by a manual examination of the uterus to examine and care for the new born infant; to take all initiatives which are necessary in case of need and to carry out where necessary immediate resuscitation to care for and monitor the progress of the mother in the post-natal period and to give all necessary advice to the mother on infant care to enable her to ensure the optimum progress of the new born infant to carry out treatment prescribed by a doctor to maintain all necessary records." and as amended by European Union Directive 89/594/EEC: it may be reduced to a minimum of 30, provided that the student participates actively in 20 further deliveries active participation with breech deliveries. Where this is not possible because of lack of breech deliveries may be in a simulated situation performance of episiotomy and initiation into suturing. Initiation shall include theoretical instruction and clinical. The of suturing includes suturing of the wound following an episiotomy and a simple perineal laceration. This may be in a simulated situation if absolutely necessary supervision and care of 40 women at risk in pregnancy, or labour or postnatal period supervision and care (including examination) of at least 100 post-natal women and healthy new-born infants observation and care of the new-born requiring special care including those born pre-term, post-term, underweight or ill care of women with pathological conditions in the fields of gynaecology and obstetrics initiation into care in the field of medicine and surgery. Initiation shall include theoretical instruction and clinical." Midwifery standards The NMC uses the term standards to describe the skills and ability to practise safely and effectively without the need for direct supervision. Each proficiency statement is followed by some examples of outcomes that must go toward the achievement of the standards. The examples are intended to illustrate the intent of the standard and are not an exhaustive list. 34 "advising of pregnant women, involving at least 100 pre-natal examinations supervision and care of at least 40 women in labour the student should personally carry out at least 40 deliveries; where this number cannot be reached owing to the lack of available women in labour, 35

20 Standard 15 Standards of education to achieve the NMC standards Domain Standards of education to achieve the NMC standards Domain Standards of education to achieve the NMC standards Communicate effectively with women and their families throughout the pre-conception, antenatal, intrapartum and postnatal periods. Communication will include: listening to women, jointly identifying their feelings and anxieties about their pregnancies, the birth and the related changes to themselves and their lives enabling women to think through their feelings Determine and provide programmes of care and support for women which: are appropriate to the needs, contexts, culture and choices of the women, babies and their families are made in partnership with women are ethical are based on best evidence and clinical judgement involve other practitioners when this will improve health outcomes. This will include consideration of: enabling women to make informed choices about their health and health care plans for birth place of birth actively encouraging women to think about their own health and the health of their babies and families, and how this can be improved plans for feeding their babies needs for postnatal support preparation for parenthood needs. communicating with women throughout their pregnancy, labour and the period following birth. Diagnose pregnancy, assess and monitor women holistically throughout the pre-conception, antenatal, intrapartum and postnatal period through the use of a range of assessment methods and reach valid, reliable and comprehensive conclusions. The different assessment methods will include: history taking Provide seamless care, and where appropriate interventions, in partnership with women and other care providers during the antenatal period which: are appropriate for women s assessed needs, context and culture promote their continuing health and wellbeing are evidence-based are consistent with the management of risk draw upon the skills of others to optimise health observation outcomes and resource use. physical examination These will include: biophysical tests acting as lead carer in normal pregnancies social, cultural and emotional assessments. contributing to providing support to women when their pregnancies are in difficulty (such as women who will need operative or assisted delivery) 36 37

21 Domain Standards of education to achieve the NMC standards Domain Standards of education to achieve the NMC standards providing care for women who have suffered pregnancy ensuring that the care is sensitive to individual women s loss culture and preferences discussion/negotiation with other professionals about further interventions which are appropriate for individual women, considering their wishes, context and culture using appropriate clinical and technical means to monitor the condition of mother and fetus, providing appropriate pain management ensuring that current research findings and other providing appropriate care to women once they have evidence are incorporated into given birth. team-working in the best interests of individual women. Refer women who would benefit from the skills and knowledge of other individuals: to an individual who is likely to have the requisite skills Undertake appropriate emergency procedures to meet the health needs of women and babies. Emergency procedures will include: manual removal of the placenta and experience to assist manual examination of the uterus at the earliest possible time managing post-partum haemorrhage supported by accurate, legible and complete information which contains the reasoning behind making the referral and describes the woman s needs and preferences. Referrals might relate to: women s choices health issues social issues resuscitation of mother and/or baby. Examine and care for babies immediately following birth. confirming their vital signs and taking the appropriate action full assessment and physical examination. financial issues psychological issues child protection matters Work in partnership with women and other care providers during the postnatal period to provide seamless care and interventions which: the law. are appropriate to the woman s assessed needs, context and culture Care for, monitor and support women during labour and monitor the condition of the fetus and support spontaneous births. promote their continuing health and well-being are evidence-based are consistent with the management of risk communicating with women throughout and supporting them through the experience are undertaken by the midwife because she is the person best placed to do them and is competent to act 38 39

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