1 | Midwifery Specialty

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Table of Contents

Content Page

1 Introduction 3

2 Program Overview 4

3 Program Objectives 5

4 Admission Requirements 6

5 Program Requirements 7

6 Method of Teaching and Evaluation 7

7 Curriculum Plan 9

8 Health Assessment of Women and Newborns. 10

9 Principles of Midwifery (Anatomy, physiology, pharmacology, health

education and counselling).

13

10 Normal pregnancy 15

11 High Risk Pregnancy 17

12 Women Health Module 20

Didactic Modules

13 Nursing Ethics 22

14 Biostatistics 24

15 Epidemiology 27

16 Nursing Research and Evidence Based Practice 30

17 Nursing Informatics 33

18 Nursing Leadership and Management 37

19 References for the programme 39

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Advanced Midwifery Nursing Diploma

Introduction:

Women are the cornerstones of the family; therefore, the health of women is a prerequisite for

the health of the whole family and the communities. Midwifery contributes to the well being of

women during the childbearing period and the health of their babies, therefore will influence the

future health of the community. Saudi Arabia is a developing country and has high fertility rate

with an average of 5 – 6 children per family. Ministry of Health annual report stated that

morbidity and mortality rate among women and children are still high in the country. World

Health Organization (2011) also stated that the major reason for maternal mortality rate (MMR)

that attributable to health services includes inadequate coverage of antenatal care, lack of trained

assistance at delivery, insufficient essential obstetric care and poor referral system.

Moreover, many studies suggested that having skilled midwives in antenatal, natal, or postnatal

is one of the key interventions for reducing maternal and prenatal mortality. The quality of care

that women, babies and families receive during pregnancy, birth and the early weeks after birth

influences the life chances of babies particularly for women with complex needs who have

increased risk factors. The appropriate access to trained midwives is a crucial part in national

strategies that aimed to reduce maternal mortality and morbidity. Therefore, well-developed

midwifery programme will strengthen the role of midwife in midwifery practice through

reducing maternal and infant deaths and improving the quality of the birth experience especially

in rural areas.

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Midwifery in Saudi Arabia

Developing Advanced Midwifery programme in Saudi Arabia is one of the chances for

improving efficiency in the healthcare for the women. In the Kingdom of Saudi Arabia, the

Ministry of Health initiated in 1980’s midwifery, as one of their diploma programmes.

Unfortunately, the programme was unable to continue. A very few students graduated from the

diploma midwifery programme (after secondary school) and are working in different cities in

Saudi Arabia. The majority of Saudi nurses, who are working in the antenatal, labour and

postnatal, are not well trained as midwife. Most of the midwives work in the hospitals (private

and government) are expatriates. Having well trained midwives from the same culture familiar

with the pregnant woman’s needs, culture, beliefs, language and diet would benefit women and

their family. According Midwifery 2020 (2010) report that midwives will contribute the quality

and cost effective maternity services for women, newborns and families across the country

beside other healthcare professionals. Internationally, the literature shows that midwives are the

key professionals ensuring women to have a safe and emotionally satisfy experience during

pregnancy, childbirth and postnatal period.

Program Overview

This programme is designed to provide an opportunity for professional nurses to develop a

specialized knowledge and clinical competence in the area of midwifery based on national and

international standards. The learner is prepared to meet the health needs of women and their

newborns during their lifespan through provision of cultural sensitive care. The programme aims

to consolidate critical thinking and clinical experience of the midwives in the field of women’s

health from premarital until the menopause age within the primary, secondary and tertiary

preventive level. The learner will be introduced to issues and trends in midwifery with emphasis

on evidence-based practice, quality principles and research finding. The learner will be guided

for self-learning and leadership skills in the field of midwifery.

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Upon the completion of the programme, the learner will earn an Advanced Diploma in

Midwifery Specialization. This programme is offered under the supervision of Saudi

Commission of Health Specialties.

Program Objectives:

Upon completion of the post- Graduate Nursing Diploma in Midwifery Specialization, the

learner will be able to:

1. Apply knowledge of nursing and health sciences to provide quality maternity care.

2. Deliver safe, holistic and quality maternity care

3. Apply critical and analytical skills in provision of evidence-based maternity care for

women during their life span for better outcome.

4. Demonstrate competently in dealing with various ethical issues related to women’s health

in accordance to Islamic Shariaa rules and regulations.

5. Use effective communication skills to interact with women, families, and the

interdisciplinary healthcare team.

6. Provide appropriate health education and counselling according to the needs of women

and their families.

7. Demonstrate competently independent and an interdependent role within the obstetrics

multidisciplinary health team.

8. Apply infection control measures when caring for the women and newborns in various

health settings

9. Implement concepts and skills of leadership and management in planning, management

and collaboration in maternity care in various health settings.

10. Demonstrate self-directed professional development activities to maintain high

professional standards of care and behaviour

11. Use competently healthcare technology to improve maternity care and midwifery

efficiency.

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Admission Requirements

To be eligible to enroll in the program, the applicant must conform to application requirements

established by the Saudi Council of Health Specialties, in addition to the following:

Hold a Bachelor of Science in Nursing (BSN) degree from an accredited nursing

programme or equivalent.

Have a minimum of two years current post-graduate clinical experience in nursing

(including the internship).

Provide a minimum of three professional letters of reference.

Pass an oral and written interview.

Have a current license to practice.

Have basic computer knowledge/skills and successfully pass a written exam.

In a good physical health status (provide a recent physical exam report).

Demonstrate competency in writing and comprehension of English evident by TOEFEL

or ILET test.

Commitment to study on a full time basis.

Program Requirements

1. The required period for the completion of the Midwifery Specialty Diploma programme is a

two-calendar-year. Each calendar year is equal Eleven Months (11) of study including

registration, orientation and examination period and one month holiday.

2. Theoretical and clinical experience components are integrated. The midwifery programme

consists of 11 modules (5 Specialty + 6 Didactic) and are distributed throughout the two

calendar years. The programme is arranged in a way that the learner progresses from basic

concepts, principles and topics, to advanced and complex topics

3. The leaner is required to attend the first six weeks of each calendar year classes from 8am – 5

pm to cover the essential theoretical part to support later training.

4. After the first six weeks, there is one study day per week for lectures and discussion.

5. The language of instruction in the specialty diploma programme is English.

6. There are six (6) didactic models namely: Ethics, Leadership, Epidemiology, Biostatistics,

Research and Evidence-Based, and Informatics shared among all the specialty programme.

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7. The Five specialty modules include: Health Assessment of Women and Newborns; Principles of

Midwifery; Normal pregnancy and Newborn; High Risk Pregnancy and Newborns; and

Women’s Health.

8. The leaner is required to

a. Conduct 100 normal deliveries

b. Assist in 25 high risk deliveries (Instrumental deliveries e.g. forceps delivery; vacuum

delivery; Caesarean sections; Breech birth; Shoulder Dystocia; Postpartum

Haemorrhage; Cord prolapse)

c. Care of 100 newborns (immediate care and resuscitation in labour room)

d. Attend 100 normal antenatal pregnant women (antenatal clinic and postnatal clinic)

e. Attend 50 high risk women across pregnancy, labour and birth (Bleeding; Gestational

diabetes; Hypertensive; Cardiac; Medical and Surgical conditions during pregnancy)

f. Attend actual or simulated episiotomy, artificial rupture of amniotic sac, abdominal

palpation, vaginal examination, perineal care and perineal suturing

g. Provide 25 organized health education and counseling to women on family planning,

breast feeding and infant care.

h. Attend 25 gynecological women

i. Conduct 10 pap smear

j. Insert 5 IUD (intrauterine device)

Clinical Placement

Laboratory simulation during the first six week of each calendar year

Antenatal and postnatal unit (Antenatal screening, counselling, referring and interpreting laboratory

results)

Labour Room

Nursery

Neonatal

Gynecology unit and clinic

Infertility clinic

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Teaching Methods:

Theoretical Part:

1. Interactive lecture and discussion.

2. Computer assisted interactive instructional programs

3. Weekly reading assignments

4. Presentations of case study

Methods of Evaluation

There are formative evaluation and summative evaluation in each calendar year. The training

centres execute the formative evaluation. Saudi Commission conducts summative evaluation that

includes promotion exam and final exam. The learners sits for the promotion exam that includes

only written exam to transfer to the second year. If the leaners fail in passing the promotion exam

will repeat the year and exam. The final exam includes written and clinical

A. Formative evaluation: (training centre) 100 %

Participation 5%

Assignments 15%

Clinical evaluation + OSCE 50%

Quizzes 30%

B. Summative evaluation (Exit assessment): (Saudi Commission)

Promotion examination (written) 100% (at the end of the first year)

Final examination* (written & OSCE) 100% (at the end of the second year)

*Those pass the written final exam will sit for OSCE exam

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Curriculum Plan

First Year

Title of the module Duration Didactic

Health Assessment of Women and

Newborns

Two weeks (during the

first 6 weeks)

Didactic

Principles of Midwifery (anatomy &

physiology, pharmacology, health

education, counselling)

One month (during the

first 6 weeks)

Didactic

Normal pregnancy:

Antenatal

Labour

Postnatal

Newborn

Two months & two weeks

Three months

Two months

Two months

One day per

week

Leave One month

Second Year

Title of the module Duration Didactic

High Risk Pregnancy:

High Risk Antenatal

Labour related complications

Postnatal complications

High Risk Newborns

Three months

Three months

Two months

Two months

One day per

week

Women Health One months One day per

week

Leave One month

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Midwifery Specialization

Course Descriptions

All modules offered in the midwifery diploma programme are listed below with a brief

description of each module.

Health Assessment of Women and Newborns

Introduction

This module provides learners with essential health assessment skills and interviewing

techniques pertaining women health and newborn. The modules covers history taking,

inspection, palpation, percussion, auscultation and reporting. It focuses on various laboratory

investigations that concerns women and newborns’ health that will assist the learners in the

decision-making.

Learning Objectives:

At the end of the module, the learner will be able to:

Comprehend the various component of comprehensive health assessment for the

women during the lifecycle and the newborn

Determine the four basic assessment techniques of physical examination

Demonstrate health assessment skills competently.

Conduct accurate interview techniques

Integrate the knowledge of physiologic changes during pregnancy and

pathophysiological disease of women’s health in conducting the health assessment.

Analyze and interpret the data collected accurately

Document data correctly

Module Outlines:

1. General and obstetric client history.

2. General approaches to physical examination on women and newborn.

3. Comprehensive system assessment (Head to Toe assessment) in women and newborn.

4. Assessment of nutritional states, spiritual and behavior changes in women and

newborn.

5. Assessment of childbearing women during antenatal, natal and postnatal

6. CTG monitoring

7. Laboratory investigations

8. Document progress of labour and care provided

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Competencies:

Prepare the appropriate equipment for health assessment procedure.

Utilize the principles of interviewing techniques in assessing women and newborns.

Obtain complete personal and obstetrical history accurately.

Perform physical examination techniques in a correct sequence.

Performs abdominal palpation.

Assess the progress of labour.

Interpretate the CTG strips

Conduct immediate newborn assessment.

Analyze, interpret and document data collected.

References

American Psychological Association. (2011). Publication manual of the American psychological

association. (6th Edition.). Washington, DC.: APA

Davidson, M., London, M. and Ladewig, P. (2012). Olds’ Maternal-Newborn Nursing &

Women’s Health: across the lifespan. 9th edition. Boston: Pearson:

Davidson, M., London, M., & Ladewig, P. (2012). Clinical handbook for maternal-newborn

nursing and women’s health care. Upper Saddle River, N.J.: Prentice Hall.

Doenges, M., Moorhouse, M., & Murr, A. (2010). Nursing care plans: Guidelines for

individualizing client care across the lifespan. (9th Edition Philadelphia: F. A. Davis

Guage, Susan (2012) CTG Made Easy. 4th ed. UK: Churchill Livingstone. ISBN-13: 978-

0702052149

Hacker, N., Moore, G., & Gambone, J. (2013). Essentials of Obstetrics & Gynaecology. 4th Ed.

USA: Elsevier Saunders

Cunningham, G., Leveno, K., Bloom, S., Hauth, J., Rouse, D.,& Spong., C (2014) Williams

Obstetrics. 24 edition, USA: McGraw-Hill

Essentials of Obstetrics and Gynecology: With STUDENT CONSULT Online Access, 5e

(Essentials of Obstetrics & Gynecology by February 18, 2009 | ISBN-10: 1416059407 | ISBN-

13: 978-1416059400 | Edition: 5

Foster, I. R and Lasser, J. (2011) Professional Ethics in Midwifery Practice. Boston: Jones&

Bartlett learning. ISBN978-0-7637-6880-5

Leeuwen, A. & Poelhuis, D. (2009), Davis's Comprehensive Handbook of laboratory and

diagnostic tests with Nursing Implications. (8rth Edition).Philadelphia: F.A Davis

Jayne Marshall Maureen Raynor (ed.) (2014) Myles Textbook for Midwives. UK: Churchill

Livingstone. ISBN: 978-0-7020-5145-6

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Lewis, L. (2015) Fundamental of Midwifery: A Texbook for Students. UK : Willy Blackwell:

Schorge,J., Schaffer, J., Halvorson, L., Hoffman, B., Bradshaw, K., & Cunningham,G (2012)

Williams Gynecology. USA: McGraw-Hill

Schneider, Z., Whitehead, D. & Elliott, D. (2007). Nursing & midwifery research: methods and

appraisal for evidence-based practice (3rd ed.). Marrickville, N.S.W, Australia: Elsevier.

Schneider, Z. (2013). Nursing and midwifery research: methods and appraisal for evidence-based

practice (4 ed.). Chatswood, N.S.W, Australia: Elsevier

Sharon Smith Murray, Emily Slone McKinney, Emily Slone McKinney (2010) Foundations of

Maternal-Newborn Nursing. UK: Elsevier Health Sciences ISBN13: 9781416001416

Tappero, Ellen, P. and Honeyfield, Mary, E. (2009) Physical Assessment of the Newborn: A

Comprehensive Approach to the Art of Physical Examination. UK: NICU INK Book Publishers

Tharpe, Nell, L., Farley, Cindy and Jordan, Robin G. (2013) Clinical Practice Guidelines For

Midwifery and Women’ Health. 4 edition, Boston: Jones & Bartlett Learning. ISBN:978-1-

4496-4575-5

Weber, J. and Kelly, J. (2014) Health Assessment in Nursing. 5th edition. Philadelphia:

Lippincott

Electronic resources:

http://www.pregnancy.com.au/midwifery/midwifery-resources/index.shtml

http://www.midirs.org/

http://www.midwife.org/journal-of-midwifery-women-s-health

http://www.journals.elsevier.com/midwifery/

http://www.nursingcenter.com/evidencebasedpracticenetwork/JournalArticle.aspx?Article_ID=1

494834

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Principles of Midwifery (anatomy & physiology, pharmacology, health

education, counselling)

INTRODUCTION

This module introduces the learner to concepts and principles that enhance the midwifery

practice. Anatomy & physiology of reproduction from gametogenesis through birth and the

neonatal period, the pathophysiology in antenatal, natal, postnatal and neonatal period are

introduced. In addition, it reviews basics of pharmacology and focuses on pharmacological and

pharmacokinetic principles and its application to midwifery practice. An emphasis on the

implications of common drugs used in antenatal, labour, postpartum

and neonate periods. The midwife’s roles and responsibilities in medication administration and

prescribing are emphasized. It covers also the concepts and principles of health education and

counselling.

Learning Objectives:

At the end of the module, the learner will be able to:

Comprehend the anatomy and physiology of female reproductive system.

Comprehend the common medication used during the reproductive period.

Determine the medication used for immediate newborn care

Identify the midwife’s role in medication administration

Implement health promotion activities to enhance women and newborn health

through counselling and education.

Module Outlines:

Anatomy and physiology of reproductive system.

a. Female pelvis and the reproductive organs

b. Female urinary tract

c. Hormonal cycles

Foetal formation & development (from conception till delivery)

a. Fertilization

b. Embryonic development

c. Foetal formation

d. Placenta formation

e. Foetal circulation

Physiological changes during pregnancy

a. Physical changes

b. Psychological changes

Hormonal and vitamin therapy during pregnancy and lactation

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a. Hormonal therapy

b. Vitamins and mineral supplement

c. Tocolysis

d. Induction and augmentation of labour

Pain management during labour

a. Nurses role in supporting pain relief

b. Natural pain relief

c. Systemic analgesics

d. Regional analgesics

e. Complications

f. Contraindications

Medications after birth

a. Emergency resuscitation drugs

b. Vitamin K

c. Anti-Rh antibodies

Basic principles for counselling

Basic principles for health education

Competencies:

Implement the principles of drug calculation

Administer the appropriate medications during labour and resuscitation

Identify the women and their family’s needs

Conduct health education & counselling for women during the lifespan.

Advocate for the women and newborn

Provide guidance and assistance to women according to their need

References

See the above

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Normal Pregnancy

INTRODUCTION

This module provides learners with knowledge and skill needed in management of women

during normal antenatal, natal and postnatal period using a family centred approach. The

evidence based care and management of normal newborns is also introduced. The clinical

component will include experiences in primary health care centres; hospital’s antenatal, labour,

postpartum units and nursery.

Module Objectives:

At the end of the module, the learner will be able to:

Demonstrate knowledge of normal physiological changes during pregnancy.

Comprehend the various component of care for the women during pregnancy

(antenatal, natal and postnatal)

Provide comprehensive nursing care to women during pregnancy

Provide immediate care of the newborn

Integrate the knowledge of physiologic changes during pregnancy and

pathophysiological disease of women’s health during the care

Demonstrate skill in women counselling and education

Module Outlines:

Normal physiological changes in women throughout antenatal, natal and postnatal.

The common physiological needs of the women during the three trimesters.

Management during the three trimesters

Nutritional needs during pregnancy, postpartum and lactation

Process of labour

Management of labour

Physiological changes during postpartum

Management of postpartum

Management of normal newborn.

Lactation in pregnancy: physiology and management

Competencies:

Demonstrate the knowledge to provide care and advice to women and their families

during pregnancy, labour, birth and the postpartum period

Provide culturally appropriate and sensitive care

Obtain a complete health and obstetrical history

Perform a complete physical examination of the woman and the newborn

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Identify risk factors before and during pregnancy, labour, birth and postpartum

period

Provide appropriate evidence based care to women during the cycle of pregnancy

Prepare the equipment required for labour and delivery.

Utilize the principles of interviewing techniques in assessing women and newborns.

Performs accurately abdominal palpation.

Assess competently the progress of labour.

Interpretate correctly the CTG strips during labour

Conduct normal birth safely

Conduct immediate newborn assessment care.

Participate in collaborative, interdisciplinary partnership with obstetrician and

pediatrician to enhance pregnant women and their families

Use technology related to labour and delivery appropriately

Act as advocate for the women in all aspects of their care

Implement principle of infection

References:

See the above list

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High risk pregnancy

INTRODUCTION

This course provides knowledge and skill needed in management of women with high risk

pregnancy throughout the process using a family centred approach. The evidence based care and

management of high-risk newborns are introduced. The course also assists the learners to provide

appropriate health education programme for the groups. The clinical part of the course provides

the learner with procedures and skills in management of women with abnormal antenatal, labour

and puerperium conditions. It also focuses on the care of high-risk newborns. Clinical experience

will be acquired at hospitals in high risk areas and special care units for newborns.

Module objectives:

Upon Completion of this course, the learner will be able to:

Understand different methods for foetal and uterine monitoring during labour

Interpret the readings of foetal and uterine monitor

Evaluate the progress of abnormal labour

Comprehend the underlying causes for some gestational related complications

Provide essential care to the high risk pregnancy and complicated labour

Provide nursing care for high risk newborn competently

Develop counselling and education programme to the women and their family with

high-risk pregnancy.

Provide evidence based care for women and newborn in critical conditions

Assist in complicated deliveries

Module outlines:

Assessment and management of diseases in pregnancy

o Diabetes mellitus

o Cardiac diseases

o Chronic hypertension

o Chronic renal failure

o Haematological disorders

o Systemic lupus erythematus

o Trauma in pregnant women

o Epilepsy

Assessment and management of gestational related complications

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o Hyperemesis gravidarum

o Antepartum bleeding (early, late)

o Pregnancy induced hypertension (preeclampsia, eclampsia)

o Other problems associated with bleeding

o Disorders of amniotic fluids (polyhydramnios, oligohydramnios)

o Multiple pregnancy

o Preterm rupture of membrane

Assessment and management of complications in labour

o Dystocia

o Preterm labour and birth

o Post-term pregnancy

o Induction of labour

o Prolonged labour

o Obstructed labour

o Malpositions and malpresentations

o Hemorrhagic complications

o Prolapse of umbilical cord

o Amniotic fluid embolism

o Intrapartum fetal monitoring and care

o Nursing care and management

Assessment and management of complications in puerperium

o Postpartum haemorrhage

o Puerperal infection

o Thrombophlebitis

o Urinary tract infection

o Postpartal pregnancy induced hypertension

o Mastitis

o Nursing care and management

Management in operative labour

o Instrumental-assisted vaginal delivery

o Caesarean delivery

o Emergency midwifery practice

Emergency care of high-risk newborn

o Initial care

o Continued care

o Resuscitation of the newborn

o Sensory enrichment with the newborn

High risk infant

o Disorders of gestational age and birth weight

o Congenital disorders

o Metabolic and endocrine disorders

o Acquired disorders

o Nursing care and management

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Competencies:

Demonstrate the knowledge to provided care and advice to women and their families

during high risk pregnancy, labour, birth and the postpartum period

Provide culturally appropriate and sensitive care

Obtain a complete health and obstetrical history

Perform a complete physical examination of the woman and newborn

Identify risk factors before and during pregnancy, labour, birth and postpartum

period

Refer high risk pregnancy to medical specialist

Provide appropriate evidence base care to women during high risk pregnancy

Prepare the equipment required for labour and delivery.

Utilize the principles of interviewing techniques in assessing women and newborns.

Performs accurately abdominal palpation.

Assess competently the progress of labour.

Identify abnormal CTG strips during labour

Assist in complicated birth safely.

Conduct emergency care of newborns.

Participate in collaborative, interdisciplinary partnership with obstetrician and

pediatrician to prevent high risk pregnancy complications

Use technology in dealing with high risk pregnancy

Act as advocate for the high risk women in all aspects of their care

Implement principles of infection

References:

See the above list

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Women’s health

INTRODUCTION

This module introduces the learner a broad range of health disorders experienced by the women

from adolescence through senescence. Selected topics includes issues of menstruation, infertility,

violence, infectious diseases, chronic medical illness and mental disorder among women. In

addition, develop concepts and skills required for the midwife to provide evidence based care

and guidance for the gynaecological problems with emphasis on the development of critical

thinking, wise judgment and decision-making. Clinical experiences will include simulations and

direct patient care.

Module objectives:

Upon Completion of this module, the learner will be able to:

Comprehend different laboratory investigation for gynaecological disorders

Interpret the readings common laboratory findings

Compare medical and surgical approaches to pregnancy termination

Comprehend the underlying causes of infertility

Provide essential care to abused women

Develop family planning programme counselling and education to the women and their

family

Value evidenced-based nursing knowledge to guide practice for women with

gynaecological disorders.

Module outlines:

Pre-menstrual Syndrome

Menstruation/Menopause

Sexual transmitted diseases

Infertility disorders

Benign and Malignant in Reproductive system

Reproductive Surgery

HIV

Osteoporosis

Rape and Sexual Assault

Family planning

Termination of Pregnancy

Grief and Loss

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Competencies:

Demonstrate understanding of basic concepts related to gynecological disorders in

women

Obtain a comprehensive biopsychosocial data of the women with gynecological disorders

Use appropriate communication skill

Provide basic and advanced nursing care to gynecological clients.

Plan and prioritize nursing care plan according to the need of women with gynecological

disorders

Incorporate the evidence-based knowledge in the care of the gynecological clients.

Facilitate and coordinate access of other members of multidisciplinary team in

performing their role in the care of women with gynecological disorders.

Apply critical thinking approaches in caring women with gynecological disorders

Conduct teaching and learning strategies that are appropriate for women with

gynecological disorders and their families.

Comply with Saudi reporting regulations for birth and death registration

Reference:

Same as above list

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Nursing Ethics

INTRODUCTION

This module provides an opportunity to study the ethical and legal issues that arise in health care

and related fields. It aims to deepen learners’ understanding of health care ethics and law, and to

enhance their ability to think systematically about the moral and legal issues that health care

professionals may face in the course of their work.

It provides learners with an opportunity to develop ethical practice capabilities congruent with

those demonstrated by nurses working as advanced clinicians in the health care sector and to

continually develop and transform ethical professional practice through the process of critical

evaluation and reflection.

Module Objectives:

At the end of this module the learner will be able to:

1. Examine the nature and role of ethical theories in guiding sound ethical decision making

in workplace settings

2. Discuss the ethical and legal context of professional nursing practice.

3. Examine key ethical issues occurring in nursing and related health care contexts

4. Discuss processes for achieving desired moral outcomes in nursing and healthcare

domains

5. Analyze conflicting duties and rights inherent in moral dilemmas.

6. Discuss the impact of current issues related to health care delivery

7. Use ethical reasoning to synthesize standards of practice, ethical principles, and

legal/regulatory requirements in the resolution of ethical dilemmas.

Module Outlines:

1. Introduction to Moral and Legal Concepts:

Introduction to the concepts and theories used

The distinction between consequentialist and deontological theories of ethics

The relationship between law and morality and the nature of moral and legal

rights

2. Credentialing & licensing:

Professional nursing practice

Accountability and responsibility in professional practice

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Nursing code of ethics

3. Autonomy and Paternalism:

Ethical and legal issues raised in informed consent, consent to treatment,

confidentiality, patient choice, and medical paternalism.

Ethical principles and human rights as a decision-making framework in relation

to:

i. the relationship between law, ethics and standards of professional practice

ii. cross-cultural ethics

iii. patients’ rights to: health care, being treated with respect

4. Life and Death:

Difficult ethical issues relating to the creation and destruction of human life.

Topics include: the moral and legal status of the embryo; issues raised by

reproductive technologies; the definition of death; moral and legal problems

regarding physician assisted suicide, euthanasia and the withdrawal of medical

treatment.

5. Public Health:

Justice and resource allocation or ‘rationing’ of medical treatment;

Research ethics;

Discrimination and health care; and issues raised by new technologies.

6. Ethical Issues related to the specialty

Topics will depend on diploma specialty

Teaching Methodology:

Lecture, class discussions, reflective journaling, out of class assignments, small group work,

required reading, use of library, electronic resource use, and written assignments. Case

exemplars drawn from real life scenarios in nursing and general health care contexts are also

used to inform class discussions.

Required References:

Butt, J.B & Rich K.L. ( 2013). Nursing Ethics: Across the Curriculum and Into Practice,

3rd Edition. Jones & Bartlett Learning, L.L.C. Burlington: MA, USA. ISBN-13: 978-

1449649005

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Biostatistics

INTRODUCTION

This module is intended to help trainees understand fundamental concepts and methods

of statistics as applied to health related fields. The module includes basic concepts in descriptive

and inferential statistics as they apply to health and nursing research. Additionally, it provides

trainees with the main concepts for testing statistical hypotheses, as well as, identification of

specific statistical techniques.

MODULE OBJECTIVES

By the end of the module, each learner will be able to:

1. Demonstrate familiarity with statistical terminology and the purpose of statistics.

2. Identify different ways/ methods of organizing and summarizing data.

3. Define and compute measures of central tendency and variability.

4. Integrate the concept of statistical data analysis with the context of the research process.

5. Utilize necessary statistical background for analyzing data and drawing inferences

6. Exhibit understanding the logic of hypothesis testing.

MODULE OUTLINES:

Organizing and summarizing data

o Methods for organizing data: Tables and graphs, Frequencies, Shapes,

Univariate descriptive statistics

o Measures of Central Tendency

o Measures of Variability

Inferential statistics

o Hypothesis Testing

o Type1 Type II Errors

o Level of Significance/Critical regions

o Confidence interval

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Specific statistical techniques

o Parametric vs. nonparametric techniques

o Bivariate Inferential Statistics

Correlation

Regression

o T - Tests for Independent Groups

o Paired- t Tests (dependent groups)

o Analysis of variance ANOVA

o Analysis of covariance ANCOVA

o Contingency Tables

o Chi Square

o Multi-variate statistics:

MANOVA

MANCOVA

COMPETENCIES:

By the end of the module, each learner will be able to:

1. Exhibit familiarity with statistical terminology and the purpose of statistics.

2. Display different ways/ methods of organizing and summarizing data.

3. Compute measures of central tendency and variability.

4. Illustrate statistical data analysis in relation to the research process.

5. Apply necessary statistical background for analyzing data and drawing inferences from that

analysis.

6. Demonstrate utilization of the concept of hypothesis testing.

METHODS OF INSTRUCTION (TEACHING METHODOLOGY)

Methods of teaching will include:

Lectures, discussions, and assigned readings

Practical exercises/ assignments

Group activities

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Practical application of SPSS for statistical analysis.

REQUIRED TEXTBOOK

Kellar, Stacy P. , Kelvin, Elizabeth (2012). Munro's Statistical Methods for Health Care

Research. ( 6th Ed. ). Library of Congress China: Wolters Kluwer Health: Lippincott

Williams & Wilkins ISBN-13: 978-1451115611, ISBN-10: 145111561X

Mertler, Craig A. & Vannatta, Rachel A. (2013). Advanced and Multivariate Statistical

Methods. 5th Ed. ISBN-13: 978-1936523092, ISBN-10: 1936523094

RECOMMENED TEXTBOOK/ ARTICLES

Gravetter, F., & Wallnau, L. (2010). Essentials of Statistics for the Behavioral Sciences

(7th ed.). Belmont, CA: Thomson Wadsworth. ISBN-13: 9780495812203

ISBN-10: 049581220x

Scott, Ian & Mazhindu, Debbie (statistics for health care professionals,an introduction.

2nd Ed. Thousand oak CA: Sage publication Inc. ISBN-13: 978-1446208922

ISBN-10: 1446208923

Methodology of scientific Study: Formulation of Problem and results interpretation:

http://www.ncbi.nlm.nih.gov/pubmed/8764446

Overview of Clinical Research Design:

http://www.ncbi.nlm.nih.gov/pubmed/19202050

Epidemiological Study Design: http://www.ncbi.nlm.nih.gov/pubmed/19165940

Randomizes Clinical Trials: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196997/

Choosing Statistical Tests: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881615/

Survival Analysis: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071962/

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Epidemiology

INTRODUCTION

This module is an introduction to epidemiology and to the epidemiological approach to

population based health care. The basic principles and methods of epidemiology are presented

together with many of the applications of epidemiology to clinical practice and public health.

Topics include: dynamics of disease transmission, measuring occurrence of disease, validity and

reliability of screening tests, randomized trials, cohort studies, case control, cross-sectional

studies, inferences, bias, confounding and interaction. The laboratory session will focus on the

analyses and the evaluation of epidemiological reports.

Module Objectives

By the end of this module the leaner should be able to:

Demonstrate understanding of the mechanisms and dynamics of disease transmission in

populations and the risk factors which determine their distribution.

Calculate the measures of morbidity and mortality, incidence and prevalence.

Assess the validity and reliability of diagnostic and screening tests.

Explain the different mechanisms used to describe disease prognosis in quantitative terms

for groups of patients.

Assess the efficacy of preventive and therapeutic measures via randomized trials.

Become knowledgeable about the design and conduct of epidemiological study designs

(cohort, cross-sectional, retrospective, and prospective).

Differentiate between association and causation.

Identify potential biases, confounders, and interacting factors in an epidemiological

study.

Explain the role of genetic and environmental factors in disease causation.

Apply epidemiologic methods to evaluate screening programs.

Gain experience in locating sources of information on disease occurrence and data

collection from Internet sources.

Read publications of medical and health research studies critically.

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Module Outlines:

Defining epidemiology and defining health

Dynamics of disease transmission-infectious disease epidemiology

Measuring the occurrence of disease

Assessing the reliability and validity of diagnostic and screening tests

Assessing the efficacy of preventive and therapeutic measures: Randomized trials

Cohort studies

Case control and cross –sectional studies

Estimating risk: Is there an association?

Estimating the potential for prevention

From association to causation: Deriving inferences from epidemiologic studies

Bias, confounding and interaction

Identifying the roles of genetic and environmental factors in disease causation

Ethical and professional issues in epidemiology

Methods of Instruction:

Interactive lectures

Group discussions

Problem based learning practicum exercises and projects

F. Required Textbook:

Gordis, L. (2014). Epidemiology. 5th ed. New York: W.B. Saunders Co.

(Epidemiology: with STUDENT CONSULT Online Access, 5e. by Leon Gordis)

G. Additional Resources:

Available references on the WWW:

1. Supercourse: Epidemiology, the Internet and Global health

http://www.pitt.edu/ super1/

2. Epidemiology link from the department of Epidemiology and Biostatistics

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at the University of California San Francisco

http://www.epibiostat.ucsf.edu/epidem/ epidem.html

3. Epidemiology for the uninitiated –from the British Medical Journal

http://bmj.com/ epidem/epid.html

4. Human Participants Protection Education for Research Teams: An online course on the

ethics involved in using human subjects in research studies. The course completion

certificate can be printed following going through the course. Estimated time for

completion of course: 2 hours.

http://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp

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Nursing Research and Evidence Based Practice

INTRODUCTION

This module focuses on the framework of the research process as applied to nursing and

evidence based practice. It is designed to present basic concepts and methods of nursing

research. Emphasis is placed on critique and utilization of current nursing research. The course

highlights the role of research in establishing a knowledge base for nursing practice and nursing

research approaches. The evidence based part develops beginning competence in accessing and

evaluating scientific knowledge as a base for promoting evidence based practice in nursing care.

The course focuses on documenting and interpreting evidence for improving patient outcomes.

In addition, the course highlights the basic understanding of how evidence is developed

including the research process as applied to nursing practice.

Module objectives

At the completion of this course, the student will be able to:

1. Define and understand the basic concepts of research methodology.

2. Understand the different research designs.

3. Describe the scientific process and its use in nursing research.

4. Design a research proposal project.

5. Understand the steps of the research process in the proposal and/or conduct of a

circumscribed nursing research project.

6. Identify research problems and literature review process related to nursing practice.

7. Compare and contrast research designs.

8. Discuss appropriate statistical techniques in analysis of data.

9. Critique current studies of nursing practice.

10. Discuss utilization of research findings.

11. Define and understand the historical perspective of evidence based practice (EBP).

12. Understand how evidence based practice is developed and how it is applied to nursing

practice.

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Course content

UNIT I : Overview of Nursing Research

What is Research?

Nursing Research in Perspective

Research Methodology

Understanding the ethics of nursing research

UNIT II: Overview of Research Process

Phases and steps in the research process

Scrutinizing research problems, research questions and hypotheses

Data collection

Methods of data collection

Sampling and sample size

UNIT III : Designs for Nursing Research

Quantitative versus qualitative design

Descriptive versus exploratory

Experimental research

Quasi experimental research

Survey

Documentary/historical research

UNIT IV: Collection of Research Data

Data collection methods

Questionnaire design

Interviews

Measurement and data quality

Measurement: scaling, validity and reliability analysis of research data

Analyzing quantitative data

Analyzing qualitative data

How to Write a Research Proposal

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Critical Appraisal and Utilization of Nursing Research

Critiquing research report

Utilization of research findings in nursing practice

UNIT V: Evidence Based Practice (EBP)

Definition of EBP

The evolution of evidence based practice in the healthcare

Development of skills for evidence and determining the quality of using critical

appraisal of the literature

Issues and strategies used to implement evidence based practice

Examine the components of the inquiry as a tool to advance nursing knowledge and a

tool to promote evidence based practice

The evaluation of practice change and clinical audit

Practice

Student will select a research project of actual interest

Method of teaching

A variety of teaching methods will be utilized:

1. Classroom lectures

2. Group works/discussion

3. Paper critical analysis

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Internally prepared and produced supplementary materials.

Recommended textbooks

1. Polit, D.F., Beck, C.T & Hungler (2001). Essentials of Nursing Research: Methods,

Appraisal, and Utilization. 5th Ed. Lippincott.

2. Polit,, D.F. & Hungler, B.P (1999). Nursing Research, Principles and Methods. 6th Ed.

Lippincott.

3. Huston, C.J. (2006). Professional Issues in Nursing: Challenges & Opportunities. 1st Ed.

Lippincott Williams & Wilkins. Chapter 3, pp. 46-65

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Nursing Informatics

INTRODUCTION

This module introduces learners to the emerging field of nursing informatics (theory, and

applications) and its effect on administration, clinical practice, education and research. Here,

great emphasis is put on the critical factors that shape the nursing informatics as a specialty i.e.

roles, competencies, skills and the legislative acts that provide direction of utilization. The

learners will explore different health information systems to appreciate its utilization for

documentation, discharge planning, communication, professional development, networking and

health team collaboration and research.

Module Objectives:

At the end of this module, the learner will be able to:

1. Describe the foundation of nursing informatics as an emerging field in the nursing

profession and identify key factors & legislative organizations that help shaping nursing

informatics.

2. List & discuss evolving models and theory of informatics that define role and

competencies of nursing informatics.

3. Explain implications of nursing informatics for nursing practice, administration,

education, and research.

4. Demonstrate skills in the acquisition and retrieval of nursing information using health

information system within the institution and through the world-wide web and varied

electronic resources.

5. Apply approaches that safeguard data and information integrity while maintaining

privacy and confidentiality.

Module Outlines:

1. Introduction and overview.

The Evolution of informatics in the health care.

The foundation nursing informatics NI.

Definition process of nursing informatics.

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2. Nursing informatics goals, standard and scope of practice.

3. Nursing informatics competencies.

Computer literacy skills (software and hardware, data storage, input and output

devises, work stations; etc.)

Information literacy skills (application software that support nursing practice,

internet, LAN, WAN, WWW, etc.

4. Key nursing informatics organizations shaping nursing informatics influencing

healthcare.

The International Medical Informatics Association (IMIA) recommendations

(center on educational needs for health care professionals to acquire knowledge

and skills in information processing and information and communication

technology)

The TIGER initiative recommendations for health informatics / medical and

nursing informatics education to deliver better patient care.

5. Models and theories of informatics that indicate quality of information.

6. Internet, search engines and electronic databases and resources.

7. Selecting health care information system that supports health care organization (e.g., care

plan, documentation and staffing, decision support system... etc).

8. System implementation, maintenance and development.

9. The Computer-Based patient electronic record.

10. Data integrity, security and confidentiality.

11. Intranet, extranet and network integration.

12. Community-based health information networks (Information technology in patient

education).

13. Integrating computers and information technology in nursing education and practice.

Telemedicine and Tele-health

Research and evidence based resources for nursing:

- http://www.joannabriggs.org/index.html

- http://ebn.bmjjournals.com

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Competencies:

1. Use Information and Communication Technology (ICT) in management of client/patient

related data.

2. Identify different models of computerized health care service electronic records.

3. Differentiate between models of health information management systems.

4. Analyze implications for healthcare delivery arising from tele-health and telemedicine.

5. Recognize the impact of information technology revolution on the nursing practice.

6. Apply skills to access, create, store and retrieve of nursing –related information from the

world-wide web and the internet.

7. Demonstrate ways of integrating nursing informatics to nursing areas of administration,

education, clinical practice and research.

8. Utilize security regulations to safeguard data and information of client and organization

9. Recognize ethical issues relate to nursing informatics.

10. Assess the future of information technology and its impact on the nursing practice

References

1. McGonigle D & Mastrian K. 2012. Nursing informatics and the foundation of knowledge.

2nd edition. Jones and Bartlett Learning: LLC.

2. Toni Lee Hebda and Patricia Czar. 2012. Handbook of Informatics for Nurses &

Healthcare Professionals. 5th Edition.

3. Linda Q. Thede and Jeanne Sewel. 2010. Informatics and Nursing: Competencies and

Applications. 3rd edition. Wolters Kluwer: Lippincott Williams & Wilkins, the point.

Electronic Learning Resources

Wood, F., & Wright, P. (1996). The Impact of Information on Clinical Decision Making

by General Medical Practitioners. Information Research. http://InformationR.net/ir/2-

1/paper11.html

NINR. (1997). Nursing Informatics: Enhancing Patient Care.

http://www.nih.gov/ninr/research/vol4/

International Medical Informatics Association (IMIA)

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o AMIA Working Group – Nursing Informatics

www.amia.org

TIGER Informatics Competencies Collaborative (TICC) Team Report

www.tigersummit.com

Bibliographies:

1. ANA. (2008). Scope and Practice for Nursing Informatics. Ball, M. J., Hannah, K. J.,

Newbold, S. K., & Douglass, J. V. (2000). Nursing Informatics: Where caring and

Technology Meet (3rd ed.): Springer Verlag.

2. Blois, M. S. (1986). What is medical informatics? The western Journal of Medicine,

145(6), 776-777.

3. Brown, S. J. (1999). Knowledge for Health Care Practice: A Guide to Using Research

Evidence (1st ed.). Philadelphia, PA: W.B. Saunders Company

4. Ciliska, D. K., Pinelli, J., DiCenso, A., & Cullum, N. (2001). Resources to enhance

evidence-based nursing practice. AACN Clin Issues, 12(4), 520-528.

5. Englebardt, S. P., & Nelson, R. (2002). Health Care Informatics: an Interdisciplinary

Approach (1st ed.): Mosby.

6. Goossens, W., T. F. (1996). Nursing information management and processing: a

framework and definition for systems analysis, design and evaluation. International

Journal of Biomedical Computing, 40, 187-195.

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Nursing Management and Leadeeship

INTRODUCTION

This module examines managerial and leadership concepts, issues, roles, and functions as

applied to the role of the professional nurse in various nursing specialties.

Module Objectives:

1. Apply theories of effective leadership and management within selected health care

arenas.

2. Utilize the skills of nursing process, critical thinking, ethical decision-making,

communication, and therapeutic nursing intervention in managing culturally competent,

cost effective care of groups of clients across the wellness/illness continuum.

3. Collaborate with interdisciplinary health care team members in prioritizing and

coordinating quality/cost effective healthcare.

4. Demonstrate leadership and management of a care-giving team comprised of individuals

with varied cultural and ethnic origins, and varied levels of clinical knowledge and

competencies.

5. Utilize skills of inquiry and research as a means to enhance knowledge base, facilitate

change, and improve quality of care.

6. Demonstrate professional accountability for effective leadership within nursing practice

and for advancement of the profession

Module outlines:

Definition and application of leadership and management (Theories of Effective

Leadership, Followership, and Management and leadership styles)

Organizational and personal mission, vision and goals

SWOT Analysis and Strategic Planning

Critical thinking, problem solving and effective decision making

Quality and risk management

Budgeting, cost, care delivery models, and staffing

Communication, motivation, and team building

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Change and conflict management

Role transition and delegation

Clinical Competencies

Demonstrate systems thinking

Demonstrate time management

Manage Information in the unit

Illustrate usage of Human resources management (i.e. staffing and scheduling,

resource allocations, etc.)

Perform financial management (cost analyses, budget forecasting, etc.)

Plan for quality and risk management (quality plans, risk management models, etc.).

Carry out change management and conflict resolution

Engage in strategic planning

Apply strategic management

Implement career planning

Evaluation:

Examinations

Individual assignments

Team assignments

Case studies.

Required textbook:

Yoder-wise, P. (2014). Leading and managing in nursing (5th ed.). Mosby InC

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References for the development of the midwifery programme

American College of Nurse-Midwives (2011) Standards for the Practice of Midwifery, ACNM

American College of Nurse-Midwives (2012) Definition of Midwifery and scope of Practice of

Certified Nurse-Midwives and Certified Midwives, ACNM

International Confederation of Midwives (2011) Essential Competences for Basic Midwiferey

Practice 2010. International Confederation of Midwives. www.internationalmidwives.org

World Health Organization (2011) Strengthening Midwifery Toolkit. Module 4, WHO: Gevena

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