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1 | Midwifery Specialty
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2 | Midwifery Specialty
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
3 | Midwifery Specialty
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.
4 | Midwifery Specialty
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.
5 | Midwifery Specialty
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.
6 | Midwifery Specialty
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.
7 | Midwifery Specialty
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
8 | Midwifery Specialty
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
9 | Midwifery Specialty
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
10 | Midwifery Specialty
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
11 | Midwifery Specialty
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
12 | Midwifery Specialty
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
13 | Midwifery Specialty
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
14 | Midwifery Specialty
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
15 | Midwifery Specialty
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
16 | Midwifery Specialty
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
17 | Midwifery Specialty
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
18 | Midwifery Specialty
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
19 | Midwifery Specialty
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
20 | Midwifery Specialty
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
21 | Midwifery Specialty
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
22 | Midwifery Specialty
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
23 | Midwifery Specialty
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
24 | Midwifery Specialty
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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