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Curriculum for midwifery education
CURRICULUM FOR MIDWIFERY EDUCATION
j Mann received her B S degree 111Nurslny frvrn Case Wrstern Krservc (Jnlurrsity and her MS degree in maternity nursing icith a cetiijicate in NurseMiduiferv jrom Co/urn& University. Presrntly. shr is an Assistant CIiinrcal Professor and Director of the Nurse-Midusijery Service and Educatron Program through the Department of Obstetrics. Gynrcoloyy. and Reproductive Science at thp University of Calijornia. San Francisco Rowmarv
This curriculum is designed as an example of a program that can be incorporated into existing educational institutions in the state of California. It purports to educate a new health professional. the midwife. on the foundation of secondary school preparation The midwife will assume the position of a paramedical specialist, delivering high-quality health care to a select population and utilizing collegial and consultative relationships within the professions of medicine and nursing currently exemplified by the relationship between the medical specialist and the medical family practitioner. The curriculum is composed of 3 levels of achievement: The first is foundation knowledge: the second is knowledge and skills common to all health care professionals; the third is the knowledge and skills specific to the profession of midwifery In designing this curriculum. 4 issues assumed paramount importance. These issues are the challenge process. the use of modularized programs, the use of pre-
Address
comspondence
to. Rosemary
Education. Francisco
Mann. Director. Nurse-Midwifery Unruersity of California. San Genera1 Hospital, San Francisco. 94110
Journal
of Nurse-Midwifery
J.
Calijornio
l
Vol.
requisites. and the arbitrary time limitation of 18 months. Decisions were made between educational alternatives based on the biases and experiences of the author. These issues are discussed at the end of this document. It is imperative that it be clearly understood that the choices made by the author do not represent the only choices that could be made. Learning is an elusive. dynamic. and fragile process impeded rather than facilitated by the rigidity of the educational framework. Finally, the underlying and critical assumption associated with this curriculum is that there is an existing midwifery service with caseload and trained midwives sufficient to deliver high-quality health care and to supervise and teach students. The lack of adequate clinical experience, more than any other event. has been the reason for the failure of many nursemidwifery programs in the past The Midwifery Education Program is founded upon the following beliefs cornmonly helti by all faculty members: Midwifery, as one of the health care professions, shares in the obligation to provide high-quality health care to all consumers maximizing the health potential while minimizing exposure to risk. Midwifery education programs must facilitate a learning experience that results in the development of highly trained professionals with sound knowledge of normal development and a sensitive awareness of deviation from normalcy. Pregnancy and childbirth events that occur within ment of individual and tioning. An appreciation cept is essential in the high-quality health care.
are dynamic the environfamily funcof this conprovision of
The provision of health care services and the education of health care providers
24, NO. 2, March/April
1979
Rosemary
J. Mann, C.N.M.
must coexist with the individual’s right of choice over the cl)vironment of care. Health care provjders must acquire a sensitivity to that right of choice and a willingness to participate with the individual in the decisionmaking process Recognizing individuality extends to the students and faculty in the program. Students learn effectively at their own pace and under their own motivation. Faculty have individual preferences for teaching Ttrategies and learning techniques Responsibility for learning belongs to the student. The faculty function as facilitators. experts. and guides. rather than the sole source of knowledge Completion of the learning process is individual and based on performance of a wide variety of activities All content areas may be challenged based on prior knowledyc All students, challenging or not, must meet the same standard of performance The purpose of this program is to provide the clinical and cognitive learning experiences in which the student can gain the knowledge and skills to extend the limits of practice into the areas of: Management of the care c,f normal childbearing women during the anteparturn. intrapartum, and postpartum periods and of the infant as a normal neonate Family-centered care founded on the premise that pregnancy and childbirth are normal developmental events with many ramifications for adult-adult and adult- child interactions. Teaching and counseling necessary to facilitate the progress of normal pregnancy and childbirth. Joint midwifery- medical management of child-bearing women who become
33
high-risk during the course nancy and childbirth.
of preg-
The implementation of a professional role with necessary interactions with the professions of nurse-midwifery, medicine, and nursing. 1. FOUNDATION
KNOWLEDGE
In order to enter the Midwifery Education Program the applicant must produce evidence by transcript or equivalency document that the following courses have been completed with a grade of excellent (A) or above average (B) or pass (P). These courses must be geared to first year or freshman year college level. (Course descriptions taken from the 1977- 1978 Bulletin of City College of San Francisco are added for further information. It is estimated that these courses can easily be completed in 1 year of full-time study.) Introduction to Human Anatomy and Physiology 4 units An integrated course covering the fundamental principles of human anatomy and physiology. Introduction to Chemistry 4 units Chemistry for nonscientists-a general non-mathematical course for non-science majors. Introductory study of basic chemical principles with emphasis on the applications and social relevance of these principles. introductory Sociology 3 units Introduction to human interaction from the sociological perspective and through the utilization of sociological concepts, theories, and principles. Topics such as culture, institutions, the community, collective behavior, personality, social roles, social disorganization, social planning, and social change. General Psychology 3 units An introductory survey of the basic areas of psychology. English-First Year Reading and Composition 3 units Practice in expository writing using reading selections from various genre of literature. II. HEALTH CARE SKILLS Description: A combination of didactic presentation and clinical experience to achieve mastery of those concepts and skills basic to patient care and com-
34
mon to all health care professions, ie, taking and interpreting vital signs, learning techniques for the relief of discomfort and pain, collecting laboratory specimens, administering drugs. Length:
6 calendar
months
Course content: To be delivered by lecture, seminar, programmed learning, audiovisual aids, and readings. Content includes but not limited to: 1. Review of human anatomy and physiology. 2. Health interruptions, disease processes such as infection, trauma, acquired physical malfunction. 3. Pharmacological interventions. 4. Supportive patient care interventions-massage, relaxation, use of heat, cold, muscle exercise. 5. Principles of communication. 6. Techniques of teaching and counseling. 7. Principles of interpersonal relationships. 8. Ethics and morality in health care. 9. Reproductive anatomy and physiology-advanced. Skills
achieved
at completion
of
course:
1. Determination of vital signs. 2. Administration of drugs and intravenous solutions. 3. Bedside nursing techniques. 4. Catheterization. 5. Blood-drawing. 6. Urinalysis by reagent strip. 7. Hematocrit determination. 8. Skin preparation. 9. Enema. 10. Use of sterile technique. 11. Routine daily newborn care and feeding. 12. Accurate chart recording.
seminar per week will be offered. Class time for students will be structured so that one specific period is identified and the student can spend the rest of the week in the clinical environment. This will enable students to attend the program on a long-distance basis, having to come in only once a week. Evaluation: To complete the second level of content and advance to the third or midwifery level the student must consistently demonstrate satisfactory to excellent clinical practice and must achieve written examination scores of no less than 80%. III. MIDWIFERY
KNOWLEDGE
AND SKILLS Description: Content is offered in 6 learning modules and 1 weekly seminar designed to integrate theories and skills common to all modules. A module is a written learning tool in which lecture, seminar, reading, audiovisual aids, and clinical practice are combined to assist the student in mastering theory and skills. Modules are physical assessment, antepartum care, intrapartum care, postpartum care, techniques of family planning, and care of the fetus and newborn. Length: Students complete modules at their own pace, but average length with widely available clinical experience is 1 year for all modules. Students with prior knowledge and skills can challenge any or all of the modules but must meet the same completion standards as students taking the modules. Thus a student could finish in less time than 1 year.
Setting: Thirty hours of clinical experience per week will be offered within an institution or agency providing direct patient care to childbearing women during the intrapartal and postpartal periods and to the normal newborn. A portion of those clinical hours not to exceed 20% will be offered in an alternative care environment and an equal portion in a high-risk center. Students will be supervised at all times by qualified instructors in a ratio of more than 1 instructor to 4 students. A minimum of 8 hours of lecture and integrative
Journal of Nurse-Midwifery
Course Content: Physical assessment: Complete physical examination skills including gynecologic evaluation. Also laboratory evaluation such as hematocrit. urinalysis. urine and wet mount microscopic exam. Antepartum care: Reproductive anatomy and physiology, evaluation of physical and emotional status in pregnancy, management of normal pregnancy and discomforts, identification of deviations from normal, implementation of family-centered teaching and counseling. Intrapartum care: Anatomy and physiology of the birth process,
l
Vol. 24, No. 2, March/April
1979
4.
5.
6.
7.
assessment of normal labor, management of normal labor and birth, identification of de+ ations from normal, emergency interventions, conduct of labor and birth in alternative surroundings. episiotomy and laceration repair, fetal monitoring. Postpartum/family planning care: Anatomy and physiology of the involution process. management of the postpartum period and methods of contraception. identification of complications, teaching and counseling for parent-infant interaction. breast-feeding, and human sexuality. Fetus and newborn care: Developmental anatomy and physiology of the embryo and fetus, antenatal fetal assessment. physiological changes during labor and birth. immediate management of the newborn, neonatal resuscitation, detection of deviations from normal. teaching and counseling for the care of the newborn in the enlarging family. Integration: Comprehensive clinical management of normal pregnancy and childbirth with emphasis on integrating the knowledge and skills learned previously When possible, experience in the environment of potential future practice will be encouraged. Midwifery seminar: Developmental aspects of pregnancy and childbirth, concepts of family-centered care, alternative birthing styles, communi-
cation techniques for teaching and counseling, issues around role development and professional interactions. Setting: The setting for clinical experience will vary with the module that the student is using (antepartum care + antepartum clinics). The hours will vary with the student’s individual needs in that particular area. On an average. the student will spend 6-8 hr/week in class or seminar. 20 hr/week in clinical experience, and 20+ hr/week in .self-guided study. Given sound clinical experience and the availability of a qualified and competent midwife instructor, the student could complete the entire module in the area of residence rather than in the school. The student would have to come in for class once each week. Evaluation: The student must satisfactorily complete all activities in the module including written and oral theory examinations and a practical clinical examination. The student must complete 100 antepartum visits, 40 postpartum visits, 20 new patient assessments, and a minimum of 20 labor and delivery primay management experiences. as well as 20 newborn exams. The issues listed in the introduction, namely the use of challenge techniques, prerequisites, and learning modules, all involve learning processes that can be used to meet the last issue, which is the arbitrary program length of 18 months. Of far more importance is the use of these processes to facilitate the most flexible curriculum possible open to a wide variety of highly motivated students who are willing and able to take responsibility for their learning and determine
when they have completed the program. For example, the level identified as foundation knowledge can be completed by attending any number of courses offered both in recognized colleges and in alternative education resources. I felt it was not necessary for the program to attempt to teach content that was so widely available in a far more flexible format than could be offered in the program. Course content has become standardized in these areas after years of teachinglearning experience: therefore, it is sufficient for the program to accept a transcript or equivalency document validating an acceptable course. In the area of health care skills, however, the program has a greater responsibility to ensure quality and so must c:onstruct challenge techniques for the student who claims prior knowledge. Students are most commonly required to pass the same theoretical and clinical examinations required of the students completing the module, thereby eliminating duplicate standards of performance. There is a basic inconsistency between this curriculum which is self-motivated and self-paced and the arbitrary program length of 18 months. It is necessary for people to accept the concept that the parameter of time does not equate quality. The same concept must be applied to the number of experiences required for completion. Twenty deliveries does not ensure competency. However time and numbers are easily observable and accountable and are commonly expressed as minimum levels. This is appropriate only so long as it does not impede the free and easy flow of well-qualified people through the program and toward the goal of excellent care for all mothers and babies
The American College of Nurse-Midwives regrets to announce the death of Donald Fairbanks Richardson I913- 1979.
Journal of Nurse-Midwifery
l
Vol. 24, No. 2, March/April
1979
35
j Mann received her B S degree 111Nurslny frvrn Case Wrstern Krservc (Jnlurrsity and her MS degree in maternity nursing icith a cetiijicate in NurseMiduiferv jrom Co/urn& University. Presrntly. shr is an Assistant CIiinrcal Professor and Director of the Nurse-Midusijery Service and Educatron Program through the Department of Obstetrics. Gynrcoloyy. and Reproductive Science at thp University of Calijornia. San Francisco Rowmarv
This curriculum is designed as an example of a program that can be incorporated into existing educational institutions in the state of California. It purports to educate a new health professional. the midwife. on the foundation of secondary school preparation The midwife will assume the position of a paramedical specialist, delivering high-quality health care to a select population and utilizing collegial and consultative relationships within the professions of medicine and nursing currently exemplified by the relationship between the medical specialist and the medical family practitioner. The curriculum is composed of 3 levels of achievement: The first is foundation knowledge: the second is knowledge and skills common to all health care professionals; the third is the knowledge and skills specific to the profession of midwifery In designing this curriculum. 4 issues assumed paramount importance. These issues are the challenge process. the use of modularized programs, the use of pre-
Address
comspondence
to. Rosemary
Education. Francisco
Mann. Director. Nurse-Midwifery Unruersity of California. San Genera1 Hospital, San Francisco. 94110
Journal
of Nurse-Midwifery
J.
Calijornio
l
Vol.
requisites. and the arbitrary time limitation of 18 months. Decisions were made between educational alternatives based on the biases and experiences of the author. These issues are discussed at the end of this document. It is imperative that it be clearly understood that the choices made by the author do not represent the only choices that could be made. Learning is an elusive. dynamic. and fragile process impeded rather than facilitated by the rigidity of the educational framework. Finally, the underlying and critical assumption associated with this curriculum is that there is an existing midwifery service with caseload and trained midwives sufficient to deliver high-quality health care and to supervise and teach students. The lack of adequate clinical experience, more than any other event. has been the reason for the failure of many nursemidwifery programs in the past The Midwifery Education Program is founded upon the following beliefs cornmonly helti by all faculty members: Midwifery, as one of the health care professions, shares in the obligation to provide high-quality health care to all consumers maximizing the health potential while minimizing exposure to risk. Midwifery education programs must facilitate a learning experience that results in the development of highly trained professionals with sound knowledge of normal development and a sensitive awareness of deviation from normalcy. Pregnancy and childbirth events that occur within ment of individual and tioning. An appreciation cept is essential in the high-quality health care.
are dynamic the environfamily funcof this conprovision of
The provision of health care services and the education of health care providers
24, NO. 2, March/April
1979
Rosemary
J. Mann, C.N.M.
must coexist with the individual’s right of choice over the cl)vironment of care. Health care provjders must acquire a sensitivity to that right of choice and a willingness to participate with the individual in the decisionmaking process Recognizing individuality extends to the students and faculty in the program. Students learn effectively at their own pace and under their own motivation. Faculty have individual preferences for teaching Ttrategies and learning techniques Responsibility for learning belongs to the student. The faculty function as facilitators. experts. and guides. rather than the sole source of knowledge Completion of the learning process is individual and based on performance of a wide variety of activities All content areas may be challenged based on prior knowledyc All students, challenging or not, must meet the same standard of performance The purpose of this program is to provide the clinical and cognitive learning experiences in which the student can gain the knowledge and skills to extend the limits of practice into the areas of: Management of the care c,f normal childbearing women during the anteparturn. intrapartum, and postpartum periods and of the infant as a normal neonate Family-centered care founded on the premise that pregnancy and childbirth are normal developmental events with many ramifications for adult-adult and adult- child interactions. Teaching and counseling necessary to facilitate the progress of normal pregnancy and childbirth. Joint midwifery- medical management of child-bearing women who become
33
high-risk during the course nancy and childbirth.
of preg-
The implementation of a professional role with necessary interactions with the professions of nurse-midwifery, medicine, and nursing. 1. FOUNDATION
KNOWLEDGE
In order to enter the Midwifery Education Program the applicant must produce evidence by transcript or equivalency document that the following courses have been completed with a grade of excellent (A) or above average (B) or pass (P). These courses must be geared to first year or freshman year college level. (Course descriptions taken from the 1977- 1978 Bulletin of City College of San Francisco are added for further information. It is estimated that these courses can easily be completed in 1 year of full-time study.) Introduction to Human Anatomy and Physiology 4 units An integrated course covering the fundamental principles of human anatomy and physiology. Introduction to Chemistry 4 units Chemistry for nonscientists-a general non-mathematical course for non-science majors. Introductory study of basic chemical principles with emphasis on the applications and social relevance of these principles. introductory Sociology 3 units Introduction to human interaction from the sociological perspective and through the utilization of sociological concepts, theories, and principles. Topics such as culture, institutions, the community, collective behavior, personality, social roles, social disorganization, social planning, and social change. General Psychology 3 units An introductory survey of the basic areas of psychology. English-First Year Reading and Composition 3 units Practice in expository writing using reading selections from various genre of literature. II. HEALTH CARE SKILLS Description: A combination of didactic presentation and clinical experience to achieve mastery of those concepts and skills basic to patient care and com-
34
mon to all health care professions, ie, taking and interpreting vital signs, learning techniques for the relief of discomfort and pain, collecting laboratory specimens, administering drugs. Length:
6 calendar
months
Course content: To be delivered by lecture, seminar, programmed learning, audiovisual aids, and readings. Content includes but not limited to: 1. Review of human anatomy and physiology. 2. Health interruptions, disease processes such as infection, trauma, acquired physical malfunction. 3. Pharmacological interventions. 4. Supportive patient care interventions-massage, relaxation, use of heat, cold, muscle exercise. 5. Principles of communication. 6. Techniques of teaching and counseling. 7. Principles of interpersonal relationships. 8. Ethics and morality in health care. 9. Reproductive anatomy and physiology-advanced. Skills
achieved
at completion
of
course:
1. Determination of vital signs. 2. Administration of drugs and intravenous solutions. 3. Bedside nursing techniques. 4. Catheterization. 5. Blood-drawing. 6. Urinalysis by reagent strip. 7. Hematocrit determination. 8. Skin preparation. 9. Enema. 10. Use of sterile technique. 11. Routine daily newborn care and feeding. 12. Accurate chart recording.
seminar per week will be offered. Class time for students will be structured so that one specific period is identified and the student can spend the rest of the week in the clinical environment. This will enable students to attend the program on a long-distance basis, having to come in only once a week. Evaluation: To complete the second level of content and advance to the third or midwifery level the student must consistently demonstrate satisfactory to excellent clinical practice and must achieve written examination scores of no less than 80%. III. MIDWIFERY
KNOWLEDGE
AND SKILLS Description: Content is offered in 6 learning modules and 1 weekly seminar designed to integrate theories and skills common to all modules. A module is a written learning tool in which lecture, seminar, reading, audiovisual aids, and clinical practice are combined to assist the student in mastering theory and skills. Modules are physical assessment, antepartum care, intrapartum care, postpartum care, techniques of family planning, and care of the fetus and newborn. Length: Students complete modules at their own pace, but average length with widely available clinical experience is 1 year for all modules. Students with prior knowledge and skills can challenge any or all of the modules but must meet the same completion standards as students taking the modules. Thus a student could finish in less time than 1 year.
Setting: Thirty hours of clinical experience per week will be offered within an institution or agency providing direct patient care to childbearing women during the intrapartal and postpartal periods and to the normal newborn. A portion of those clinical hours not to exceed 20% will be offered in an alternative care environment and an equal portion in a high-risk center. Students will be supervised at all times by qualified instructors in a ratio of more than 1 instructor to 4 students. A minimum of 8 hours of lecture and integrative
Journal of Nurse-Midwifery
Course Content: Physical assessment: Complete physical examination skills including gynecologic evaluation. Also laboratory evaluation such as hematocrit. urinalysis. urine and wet mount microscopic exam. Antepartum care: Reproductive anatomy and physiology, evaluation of physical and emotional status in pregnancy, management of normal pregnancy and discomforts, identification of deviations from normal, implementation of family-centered teaching and counseling. Intrapartum care: Anatomy and physiology of the birth process,
l
Vol. 24, No. 2, March/April
1979
4.
5.
6.
7.
assessment of normal labor, management of normal labor and birth, identification of de+ ations from normal, emergency interventions, conduct of labor and birth in alternative surroundings. episiotomy and laceration repair, fetal monitoring. Postpartum/family planning care: Anatomy and physiology of the involution process. management of the postpartum period and methods of contraception. identification of complications, teaching and counseling for parent-infant interaction. breast-feeding, and human sexuality. Fetus and newborn care: Developmental anatomy and physiology of the embryo and fetus, antenatal fetal assessment. physiological changes during labor and birth. immediate management of the newborn, neonatal resuscitation, detection of deviations from normal. teaching and counseling for the care of the newborn in the enlarging family. Integration: Comprehensive clinical management of normal pregnancy and childbirth with emphasis on integrating the knowledge and skills learned previously When possible, experience in the environment of potential future practice will be encouraged. Midwifery seminar: Developmental aspects of pregnancy and childbirth, concepts of family-centered care, alternative birthing styles, communi-
cation techniques for teaching and counseling, issues around role development and professional interactions. Setting: The setting for clinical experience will vary with the module that the student is using (antepartum care + antepartum clinics). The hours will vary with the student’s individual needs in that particular area. On an average. the student will spend 6-8 hr/week in class or seminar. 20 hr/week in clinical experience, and 20+ hr/week in .self-guided study. Given sound clinical experience and the availability of a qualified and competent midwife instructor, the student could complete the entire module in the area of residence rather than in the school. The student would have to come in for class once each week. Evaluation: The student must satisfactorily complete all activities in the module including written and oral theory examinations and a practical clinical examination. The student must complete 100 antepartum visits, 40 postpartum visits, 20 new patient assessments, and a minimum of 20 labor and delivery primay management experiences. as well as 20 newborn exams. The issues listed in the introduction, namely the use of challenge techniques, prerequisites, and learning modules, all involve learning processes that can be used to meet the last issue, which is the arbitrary program length of 18 months. Of far more importance is the use of these processes to facilitate the most flexible curriculum possible open to a wide variety of highly motivated students who are willing and able to take responsibility for their learning and determine
when they have completed the program. For example, the level identified as foundation knowledge can be completed by attending any number of courses offered both in recognized colleges and in alternative education resources. I felt it was not necessary for the program to attempt to teach content that was so widely available in a far more flexible format than could be offered in the program. Course content has become standardized in these areas after years of teachinglearning experience: therefore, it is sufficient for the program to accept a transcript or equivalency document validating an acceptable course. In the area of health care skills, however, the program has a greater responsibility to ensure quality and so must c:onstruct challenge techniques for the student who claims prior knowledge. Students are most commonly required to pass the same theoretical and clinical examinations required of the students completing the module, thereby eliminating duplicate standards of performance. There is a basic inconsistency between this curriculum which is self-motivated and self-paced and the arbitrary program length of 18 months. It is necessary for people to accept the concept that the parameter of time does not equate quality. The same concept must be applied to the number of experiences required for completion. Twenty deliveries does not ensure competency. However time and numbers are easily observable and accountable and are commonly expressed as minimum levels. This is appropriate only so long as it does not impede the free and easy flow of well-qualified people through the program and toward the goal of excellent care for all mothers and babies
The American College of Nurse-Midwives regrets to announce the death of Donald Fairbanks Richardson I913- 1979.
Journal of Nurse-Midwifery
l
Vol. 24, No. 2, March/April
1979
35