University of Technology Sydney - EDUCATIONAL FRAMEWORK … · Core Competencies and Educational Framework for Maternity Services in Australia Project DRAFT FOR CONSULTATION (Issued

EDUCATIONAL FRAMEWORK FOR

PRIMARY MATERNITY SERVICES

PART 2

Draft for Consultation (Version 4)

Issued 8 February 2010

A Project co-sponsored by the National Health

Workforce Taskforce and the Maternity Services

Inter-jurisdictional Committee

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Core Competencies and Educational Framework for Maternity Services in Australia Project DRAFT FOR CONSULTATION (Issued 8 February 2010)

PROJECT TEAM

Professor Caroline Homer

Professor of Midwifery

University of Technology Sydney

Professor David Ellwood

Professor of Obstetrics and Gynaecology

Australian National University and the Canberra Hospital

Professor Sue Kildea


The Mater Hospital (Qld) and the Australian Catholic University

Professor Pat Brodie


Sydney South West Area Health Service and the University of Technology Sydney

Dr Austin Curtin

School of Health Services, Southern Cross University

Adjunct Senior Lecturer, University of Sydney

Sub Dean Northern Clinical School (Lismore)

Marnie Griffiths (Project Officer)

University of Technology Sydney

ACKNOWLEDGMENTS

We thank the members of the Steering Committee and Reference Group for their contribution

and commitment to this Project. We also thank the individuals and organisations who

provided comment and feedback on earlier versions of this document.


TABLE OF CONTENTS

INTRODUCTION.................................................................................................................. 1

Purpose ................................................................................................................................... 2

Scope ...................................................................................................................................... 2

BACKGROUND ................................................................................................................... 2

DEVELOPING THE EDUCATIONAL FRAMEWORK ................................................................. 2

Literature review ..................................................................................................................... 3

Underpinning Principles ........................................................................................................... 3

Educational principles .............................................................................................................. 4

Primary Maternity Service Provider Attributes.......................................................................... 6

Key Challenges ......................................................................................................................... 8

Linking the Educational Framework with the Core Competencies .............................................. 8

Consultation ............................................................................................................................ 9

THE EDUCATIONAL FRAMEWORK .................................................................................... 10

Suggested process for curriculum development ...................................................................... 17

Examples of strategies of delivery formats and assessment tools ............................................ 17

ACRONYMS ...................................................................................................................... 19

GLOSSARY OF TERMS ....................................................................................................... 20

REFERENCES ..................................................................................................................... 26


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INTRODUCTION

The Educational Framework for Primary Maternity Services provides Part Two of the Core

Competencies and Educational Framework for Maternity Services in Australia Project.

This document provides an overview of the Educational Framework. It identifies educational

principles that are broad and general and support the Core Competencies for Primary

Maternity Services Model. Suggested learning areas, objectives and assessment elements as

components for curricula relevant to the undergraduate, postgraduate, continuing professional

development, up skilling or return to practice learning needs of primary maternity service

providers are presented from an interprofessional approach to learning rather than a

profession specific approach for individual professional groups or individual learning

situations.

This project was co-sponsored by the Maternity Services Inter-jurisdictional Committee and

National Health Workforce Taskforce. The educational framework is to be read in

conjunction with the provider’s usual scope of practice and published practice standards.

This framework has been developed as a benchmark for the training, education and assessing

of professionals involved in maternity care and to inform the development of curricula for

providers of primary maternity services.

There are a range of health care professionals involved in maternity care. Three main

professional groups, obstetricians; midwives and GP obstetricians, provide core maternity

services. Many other health care professionals are also involved in maternity care, such as

anaesthetists, maternal, child and family health nurses, aboriginal health workers,

neonatologists, mental health professionals, dieticians, social workers and physiotherapists.

We are seeking comment and feedback from all health care professionals who are

involved in providing any aspect of maternity care as well as from consumers.

It is essential that every provider of maternity care (primary or otherwise) has at a minimum a

beginning level understanding of the specific health care needs of childbearing women, their

babies and families to ensure the quality and safety of maternity services in Australia.

The aims of the Educational Framework are to:

provide a set of general educational principles to inform curricula development for the training, education and assessment of primary maternity care providers in Australia

be consistent with and articulate with existing national frameworks and competency and education standards for primary maternity care providers in Australia

promote and support increased opportunities for interprofessional collaboration and

education for primary maternity service providers

demonstrate that the core competencies for primary maternity services readily assimilate into current education frameworks/accreditation frameworks for education

providers/relevant curricula


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Purpose

The purpose of this Educational Framework is to present education providers for primary

maternity services with a set of guidelines for success in developing and delivering core

primary maternity service provider group curricula based on an interprofessional approach to

learning and primary maternity service practice.

Scope

This Educational Framework has been developed for an array of core maternity service

providers who work in a range of primary maternity care settings across remote, rural and

urban Australia and their relevant education providers.

BACKGROUND

Initially, Part One of this project focused on the identification and development of Core

Competencies for Primary Maternity Services for the care of pregnant, birthing and

postpartum women who are considered to be of normal risk, that is, experiencing an

uncomplicated pregnancy, labour and birth and postnatal period. We recognise that women

with complex risks or needs need an additional level of care and support.

The Core Competencies include the needs and preferences of women, the promotion of

greater access to continuity of care and the fostering of collaborative working relationships

between providers of care. They identify key skills, knowledge, behaviours and attitudes

(competencies) required for core maternity service providers involved in the provision of

primary maternity care across remote, rural and urban Australia.

The Core Competencies have been used to guide the development of the general educational

principles and the Educational Framework. This framework aims to inform curricula

development and continuing professional development for primary maternity service

providers across Australia.

DEVELOPING THE EDUCATIONAL FRAMEWORK

To develop the Educational Framework, the assumptions that guided the development of the

core competencies were reviewed. These assumptions also represent the underpinning

principles of this Education Framework. They have been developed with relevance to the

current primary maternity service provider workforce group. Similarly as with the initial part

of the project, a set of general educational principles has been identified and relevant current

literature, together with professional curricula and frameworks for the accreditation of

education programs have been reviewed.

The purpose of the Education Framework is to provide a mechanism to ensure that the Core

Competencies can be met.


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Literature review

A search of documents related to curriculum for maternity services, accreditation frameworks

for maternity education and courses, and educational frameworks in health was undertaken. A

number of websites were also individually searched for documents related to midwifery and

obstetric registration, education standards and frameworks. These websites included those of

RANZCOG, RACGP, ACCRM, CDNM, CPME, CDAMS and ANMC as well as the NMRA

for each state and territory. The documents reviewed included the ANMC National

Framework for Accreditation of Nursing & Midwifery Courses1, RACGP Curriculum for

General Practice2, ACCRM Vocational Training Handbook

3 , CDAMS Indigenous Health

Curriculum Framework4, NZCOM Education Framework

5, RANZCOG Curriculum

Framework6, and WHO Europe Midwifery Curriculum for Accredited Nurses

7, ACRRM

Primary Curriculum Statements8, and CPME Australian Curriculum Framework for Junior

Doctors (version 2.1)9.

The documents reviewed revealed a number of similarities in standards for education

programs and criteria for accreditation. These similarities included requirements for core

curriculum content to address relevant national professional competency standards and

demonstrate an incremental process of learning and a commitment to lifelong learning.

The curriculum documents were similar in themes and content. The emphasis of the majority

of curriculum documents was the development of skills for critical self reflection, the

integration of theoretical and clinical components appropriate to the professional practice

role, the roles and context of professional practice and the development of knowledge, skills

and professional qualities commensurate with the profession.

The Educational Framework recognises that different disciplines already have competency

standards and/or educational standards. The Core Competencies and Educational Framework

for Maternity Services aim to complement these rather than replace them. The framework is

to be considered in line with the individual provider groups’ usual scope of practice. In

addition, individual provider groups have their own competency based education and

assessment programs. Again, the framework aims to build on these but not over-ride them.

The framework is designed to be used to be in its entirety. However, we recognise that for

some provider groups and disciplines, different aspects of the framework may have more

application and relevance. Therefore, there is an opportunity to use components of the

framework to meet the needs of particular provider groups as appropriate.

This next section outlines the underpinning principles, the educational principles and the

provider attributes.

Underpinning Principles

Pregnancy, labour, birth and parenting are significant and meaningful life events. All women and families have a right to access quality primary maternity care that is safe,

feels safe and this should be reflected in the content and components of the curricula

and its assessment processes. Some women will also need a higher level of care.


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It is acknowledged that all women may experience a change in their health during their childbearing journey. The Educational Framework supports the primary

maternity care provider to recognise when the pregnancy is more complex and ensure

safe consultation occurs.

Primary maternity services in Australia are provided by a number of different

providers in a variety of settings. To address this, curricula should develop, value and

support interprofessional learning and collaborative practice to assist in creating a

competent and flexible workforce, ensuring safe primary maternity services that

promote continuity of care and carer.

Primary maternity services provide care that is individualised, evidence-informed and woman-centred. This should be valued and supported by the competency standards,

curricula and continuing professional development activities.

Primary maternity services need to be based upon the principles of primary health care. The curricula should reflect an understanding of primary health care principles

and the particular needs of rural, remote and Indigenous Australia.

The Educational Framework has been developed to complement, not replace, existing statements relating to education standards, continuing professional

development and continuing competence produced by regulatory authorities and

professional colleges.

The Core Competencies for Primary Maternity Services and the Educational

Framework are based on principles rather than identifying specific tasks for individual

professional groups or settings. This should be reflected in the curricula learning

areas, objectives and outcomes.

Educational principles

A number of general educational (and learning) principles have been identified:

Primary maternity service providers are adult learners1

This means that learning must value prior knowledge and skills by assisting learners to

see connections between what they already know, have the skills to do and the new

information provided. To achieve this, the reasons for primary maternity service provider

participation in learning activities should be clearly articulated (e.g. for competency

requirements, up skilling and continuing professional development) and the barriers

reduced.

Learning should be self directed and personal goal setting encouraged. Educational

activities for primary maternity service providers should be applicable to real-life

situations and relevant to practice (e.g. by stories that link theory to practice, and role play

situations that offer opportunities to test out new skills and attitudes).

1 Knowles suggests that adult learners like to be respected and direct and be actively involved their own learning and that

they learn best when they are able to connect their learning to their life experiences and have specific learning experiences linked to specific goals. Adult learners need to see a reason for learning something and embrace the opportunity to apply

their knowledge to practical situations (Dunn, (2000). Theories of Learning, Oxford UK, Oxford Centre for Staff

Development and Learning.)


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Learning activities that incorporate opportunities and time for skill development and

consolidation should be valued. The primary maternity service provider should support

learning and the fostering of professional relationships to enhance practice. Feedback

should be sensitive and timely whereby errors are corrected and appropriate knowledge,

skills and attitudes are reinforced10-12

.

Interprofessional learning that is based upon different professions working together in practice in respectful, collegial interprofessional relationships is a recommended

strategy to ensure the best outcomes for women and their babies.

For the purposes of this document, collaborative practice encompasses working together to

facilitate better outcomes for women and their babies through respect, trust and teamwork

that utilises individual skills and knowledge to reach the highest of maternity care standards.

Definitions of interprofessional learning and interprofessional education and interprofessional

practice are varied, although a number of the key elements remain the same. For the purposes

of the Educational Framework for Primary Maternity Services the definitions for

interprofessional learning, interprofessional education and interprofessional practice as

defined by the Australian Learning and Teaching Council and Learning and Teaching for

Interprofessional Practice, Australia (L-TIPP) have been adopted. They are:

Interprofessional learning (IPL): Learning that occurs through planned

interprofessional education or spontaneous incidental interactions between

members of two or more professions in the workplace or education settings 11

.

Braithwaite and Travalgia (2005) and L-TIPP suggest that improved collaborative skills

through IPL enriches communication and trust between different healthcare professionals and

a greater understanding of roles thereby reducing the ‘silo’ effect existing between

professions and

enhancing professional relationships, respect, collaborative skills and

improving job satisfaction10 11

.

Interprofessional education (IPE): Occasions when two or more professions

learn from, with and about each other to improve interprofessional relationships,

collaborative practice and the quality of care 11

.

IPE is concerned with the knowledge, skills and attitudes (competency) required for

collaborative practice 10

.

Interprofessional practice (IPP): Occurs when two or more professions work

together as a team with a common purpose, commitment and mutual respect11

.

For the purposes of this project this may also be referred to as collaborative

practice.

IPP in the context of the maternity workplace is essentially focussed on maternity care

provider knowledge and understanding of the contribution of other disciplines to the care of

pregnant, childbearing and postpartum women, the skills to seek out, communicate with and

work with other maternity care providers, and the ability to value such contributions10

.

This framework acknowledges the current dichotomy that exists between interprofessional

learning and interprofessional practice. It is anticipated that this framework will promote the


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achievement of a competent and flexible maternity workforce where care providers

understand and work with each other to make the best use of their professional knowledge,

skills and attitudes ensuring safe primary maternity services that promote woman-

centredness, continuity of care and carer11

.

Learning is lifelong2, firmly based in clinical practice situations and includes formal

education, continuing professional development and informal learning experiences

within the workplace.

Primary Maternity Service Provider Attributes

A generic description of Primary Maternity Service Provider attributes is useful as a guide for

education providers in the development and implementation of primary maternity service

provider curricula.

This generic description stems from the four domains of primary maternity care identified in

the Core Competencies for Primary Maternity Services Part 1. These domains include

women centred focus; professionalism; workplace; service provision; and communication.

Woman centred care

The primary maternity care provider (known as the ‘provider’ for the remainder of this

document) works in partnership with women to provide safe and effective care across the

interface between hospital and community; in any setting and is able to:

comprehensively and accurately assess the needs of the woman and her baby.

provide the woman with a comprehensive, honest and balanced perspective of options

about her choices of providers for her maternity care.

plan, implement and evaluate maternity care antenatally, during labour and birth and

throughout the postpartum/newborn period.

The provider practises within a woman centred, primary health care framework and is

committed to seeing maternity care as a public health strategy, acknowledging the influence

of socio-cultural, spiritual, emotional and politico-economic factors on the life of the woman,

her baby and family.

The provider has the knowledge, skills and attitudes to provide primary maternity services

according to their provider group.

The provider integrates knowledge and evidence appropriate to their provider group and

recognises complications, high risk situations and responds in emergency situations with

appropriate and timely consultation and referral.

The provider understands the significance of past pregnancy experiences for the woman and

her family works collaboratively with other health care providers and community supports

when necessary.

2 Lifelong learners take responsibility for their own learning and are prepared to invest time, money and effort in

training or education on a continuous basis. Both informal and formal learning experiences and opportunities are

valued and recognised for their personal and social as well as employment benefits (Department of Education

Science and Training (2003). Lifelong Learning in Australia: Commonwealth of Australia).


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The provider recognises and supports women who experience domestic violence, or need

support with addiction, drugs or alcohol misuse and support health promotion activities

including smoking cessation.

The provider has the knowledge, skills and attitudes to inform, support, respect and

encourage a woman in her choice of feeding for her baby. Professionalism The provider has a sound knowledge of the Australian health care system and the role of

primary maternity services and complies with the relevant legislation and common law

applicable to their provider group. The provider provides care in accordance with national

policies, standards and guidelines and practice in accordance with relevant codes of ethics,

professional conduct and state and federal privacy obligations.

Acknowledging and advocating for the rights of the woman, the provider respects and

supports the woman’s right to be self-determining. Integral to this process is the ability to

enhance the dignity and integrity of others as well as understanding and identifying the

impact of their own culture, values and beliefs on the care provided.

The provider is accountable and responsible for their own practice and actions. The provider

recognises their own knowledge base, scope of practice and the standards of care expected.

The provider is able to identify unsafe practice. The provider is able to act appropriately and

consult and refers in a timely manner.

Understanding and valuing the analysis, synthesis and integration of evidence from multiple

sources, the provider demonstrates information literacy and uses research to inform practice,

policy, guidelines and decision-making.

The provider maintains competence through continual professional development, workplace

experiences and formal and informal educational opportunities. Lifelong learning is key to

continuing professional development, self appraisal and peer review. The provider is

reflective and can assess the self assess the effectiveness of their work.

The provider contributes to, and evaluates the learning experiences and professional

development of others and supports and mentors students.

Workplace The provider supports effective management, risk management and leadership by fostering

and valuing reflection, critical thinking and service improvement. Identifying and responding

to factors that facilitate or hinder interprofessional relationships the provider works in

partnership with the woman to improve the woman’s maternity experience.

The provider forms part of the wider healthcare team and understands, recognises and

respects the roles of other members of the health care team. The provider invites, acts upon

and offers constructive feedback from peers and colleagues.

The provider supports safety in the workplace by understanding and complying with safe

working practices.


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Communication The provider is competent in verbal and written communication and documents legibly

according to legal and professional guidelines. The provider engages in effective and

appropriate interactions with the woman as well as others with whom they interact on an

interprofessional and intraprofessional basis. The provider has knowledge of, value and uses

a range of interpersonal communication skills.

The provider supports and values effective and ongoing interprofessional learning as a tool

for successful interprofessional communication13

.

The provider is reflective and able to communicate effectively with a woman in situations

where her choice is not consistent with reasonable primary maternity provider practice.

Providers need to consider how they would manage when a woman's choice is not consistent

with what is commonly seen as reasonable or evidence-based practice. The provider will

communicate effectively with the woman and her family and ensure that accurate

documentation of the discussions and decisions is made.

Key Challenges

The key issues that are challenging the development of this educational framework are the

need to accommodate a diversity of needs both from the perspective of level of preparation

(undergraduate, postgraduate, continuing professional development) and the different primary

care provider disciplines for which the framework is being developed. To address these key

challenges the Framework offers a broad rather than specific approach to curricula

development.

Determining what the competencies might look like in practice in order to be described as

measurable performance elements has also been challenging. This is because the core

competencies identified for Primary Maternity Services are broad, do not direct the setting in

which a service should be provided and are based on principles rather than identifying

specific tasks for individual professional groups. The performance elements/outcomes

described within the Educational Framework are therefore also broad, non specific in regards

to the setting they are to be measured within, and are based on principles rather than specific

tasks.

Linking the Educational Framework with the Core Competencies

The Core Competencies were used to guide the development of the Educational Framework

and the framework reflects and addresses the Core Competencies. This has been achieved by

ensuring the presence of the same domains for the Core Competencies and the Educational

Framework whilst altering the remaining titles, content and the perspective from which the

Competencies and Framework are expressed. These alterations have been undertaken to meet

the needs of context within each individual document.

An example of this is detailed in the table below:


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Table 1 Linking the Educational Framework and the Core Competencies

Educational Framework Core Competencies

Domain Workplace Domain Workplace

Learning/Subject Area Teamwork Sub-Domain Teamwork

Learning Objective

13. develop effective strategies to implement and support interprofessionalism and collaborative practice.

Competency Standard

12. Develops effective strategies to implement and support interprofessionalism and collaborative practices.

Performance Elements/Outcomes

Adopts effective styles and methods of communication and referral/consultation that recognises and respects the roles of other members of the health care team.

Negotiates an appropriate plan of care in consultation with the woman and other colleagues as needed. Invites and acts upon constructive feedback from peers and colleagues. Offers constructive feedback to peers and colleagues when appropriate. Effectively negotiates change in a team environment Recognises the value of effective interprofessional relationships to achieve the best possible outcomes for the woman and her baby.

Competency Elements

Knowledge Understands others’ roles. Understands when and who to refer to/consult with.

Skills Recognises the role of other members of the health care

team Adopts effective styles and methods of communication. Negotiates a collaborative care plan in consultation with

the woman. Readily invites, acts upon, and offers, constructive

feedback from peers and colleagues. Effectively manages change in a team environment.

Attitude Appreciates the differing professional roles in maternity

care. Acts to identify and respond to factors that facilitate or

hinder interprofessional relationships. Respects differences in views. Recognises the value of effective interprofessional

relationships to achieve the best possible outcomes for the woman and her baby.

Consultation

The initial consultation commenced in November 2009. The Educational Framework was

reviewed a number of times by the project Steering Committee and Reference Group

representatives prior to being sent out to the regulatory and accreditation authorities for

health professionals with a direct or indirect stakeholder interest in this project for feedback

and comment. Feedback from these groups informed the development of this version

(Version 4) of the Educational Framework.

This Version is now presented for this planned broader public web based consultation

process. We are seeking comment and feedback from a wide range of health care

professionals and others who have involvement in maternity care as well as from

consumers.

The feedback received will be collated and will inform the development of the final

Educational Framework for Primary Maternity Services in Australia document.

The final Educational Framework and Core Competencies Model documents will be merged

into one document at the projects’ completion.


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THE EDUCATIONAL FRAMEWORK

This document provides an overview of the Educational Framework and identifies educational principles that support the Core Competencies

Model.

The Educational Framework identifies key learning areas, learning objectives, and performance elements required to be considered for inclusion

in undergraduate, postgraduate and continuing professional development programs for core maternity service providers involved in the provision

of primary maternity care across remote, rural and urban Australia. This Educational Framework has been developed based on adult learning

principles with a focus on interprofessional learning, the importance of lifelong learning and learning in practice based situations. This

Framework and its suggested components are to be considered for inclusion with curricula relevant to primary maternity service providers. The

Framework enables the Core Competencies for Primary Maternity Services to readily assimilate into current education frameworks/accreditation

frameworks for education providers/relevant curricula.

Domain Learning/Subject Area Learning Objectives – The

Primary Maternity Service Provider (PMSP) will…


WOMAN CENTRED CARE

PHILOSOPHY OF CARE

1. demonstrate a philosophy of

care that is woman-centred, based upon the principles of primary health care and evidence-informed in every practice situation. 2. demonstrate respect,

cooperation and collaboration in every interaction with all health care providers involved in primary maternity services to ensure the best outcomes for the woman and her baby.

Provides individualised care that encompasses a woman’s social, emotional, physical, psychological, spiritual and cultural needs and expectations. Relates the significance of past pregnancy experiences to a woman’s current pregnancy. Provides unbiased and current information and evidence to assist the woman to arrive at the best decisions for her and her baby. Provides care that is culturally responsive, contextual, equitable, accessible, woman-centred and based on shared decision making. Works in partnership with the woman, her family and other support people in planning, implementing and evaluating care through pregnancy, birthing and the transition to parenthood. Provides and supports continuity of care. Reflects on care provided and responds to feedback to continuously improve practice. Promotes childbirth as a normal, physiological process and a significant


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Domain Learning/Subject Area Learning Objectives – The Primary Maternity Service Provider (PMSP) will…


life event for most women. Respects the right of the woman to determine her own pregnancy, birth and postnatal care needs while ensuring she has appropriate and accurate information on which to base her decisions. Works collaboratively with other clinicians and health professionals. Acknowledges the potential for adverse outcomes at times and minimises risk.

PROFESSIONAL BODY OF KNOWLEDGE

3. apply maternity knowledge and

profession specific skills to optimise maternal and newborn health outcomes.

Provides care that is based on relevant, evidence-based integrated knowledge of the human sciences, pregnancy, childbirth and postpartum/newborn period. Recognises and refers in a timely manner when pregnancy, childbirth and postpartum/newborn period are no longer a normal, physiological and or psychological process or care at a higher level is required. Performs history-taking, physical examination, assessment and screening and referrals. Is confident in own knowledge and evidence and uses this to support the needs and preferences of the woman. This includes her choice of infant feeding. Recognises and addresses limitations and deficits in own knowledge and practice. Develops a sound knowledge of relevant pharmacology and related issues. Develops the ability to critically analyse health care outcomes. Is confident in finding and critiquing research into relevant maternity related issues.

SERVICE PROVISION

4. promote maternity care as a

public health strategy.

Provides care that considers and integrates the impact of a woman’s social determinants of health on her health and the health of her family

Recognises, acknowledges and responds appropriately to a woman’s social, emotional, physical, psychological, spiritual cultural and economic influences.


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Promotes health care practices that address inequalities in health. Responds appropriately in situations where there is domestic violence, or for women who need support with addiction to drugs and/or alcohol. Is confident in own knowledge around public health issues, including national health priorities and preventative heath Recognises preventative health opportunities and acts upon these to promote health and wellbeing. Recognises the role and value of community-based self-help (mutual support) organisations in antenatal and postnatal care.

5. demonstrate the capacity to

provide effective care for pregnant, birthing and postpartum women who are of normal risk.

Provides care that integrates the physiological processes of normal pregnancy, birth and postpartum and the social, emotional, psychological and cultural needs of the woman and her family where pregnancy is of normal risk. Maintains up to date practical skills and knowledge concerning the care of the woman and her baby considered of normal risk. Manages the practical antenatal, birthing and postpartum care of the woman and her baby who are considered of normal risk. Provides the woman with a balanced perspective of options for infant feeding and supports her choice.

6. demonstrate the capacity to provide effective care when complications arise.

Provides appropriate, timely and effective care where a woman or her baby has complex health needs and/or where complications, emergencies or urgent situations arise.

Maintains currency, competency and capability in the management of complications, emergencies or urgent situations. Demonstrates ability to remain woman centred when complications arise

Works collaboratively with other clinicians and health professionals.. Provides emergency care, stabilising and transferring as soon as practicable. Considers the needs of the woman’s family where appropriate throughout an emergency situation.


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PROFESSIONALISM

EQUITY

7. establish links with the woman/her family/community that are culturally appropriate, respectful and responsive.

Provides care that is courteous, respectful and culturally responsive to the needs, priorities and preferences of the woman and her family. Reflects on own personal beliefs in relation to the provision of care and acts appropriately to eliminate care that diminishes, demeans or disempowers women’s identity and/or wellbeing.

Provides care that actively promotes strategies that seek to provide outreach services to those disadvantaged by distance / race / religion or disability.

ETHICS

8. adhere to and promotes the

professional code of ethics relevant to own practice/maternity service provider group (as available).

Provides care in accordance with relevant codes of ethics and professional conduct. Works collaboratively to address ethical issues and breaches of confidentiality and privacy. Provides honest and comprehensive information to the woman including when things do not go to plan. Protects the woman from involvement in different/conflicting professional positions and practices by providing unbiased information from all viewpoints Supports the woman to take responsibility for her own health and that of her baby. Supports the woman to identify and evaluate her own needs and those of her baby when planning for appropriate and effective maternity care and infant feeding choice. Provides care that encourages the woman and her community to be involved in maternity service development, improvement and evaluation.

PERFORMANCE IMPROVEMENT

9. use and evaluate current relevant evidence to inform practice.

Provides individualised care that is informed by current relevant evidence. Supports the woman to make decisions for her care and that of her baby by providing her with timely, appropriate and meaningful evidence where needed. Respects the woman’s right to choose different options and care pathways


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Participates in data collection and reporting as a mechanism to measure performance and health outcomes. Uses research, evidence and practice guidelines for own professional practice and the provision of safe maternity care

10. continuously enhance own

professional development and the professional development of others.

Participates in regular reviews of own and others professional development and learning needs. Provides care that is based upon up to date skills, knowledge, attitudes and experience. Supports and embraces opportunities for interprofessional learning and collaboration.

11. demonstrate accountability and responsibility for own practice and actions.

Provides care that adheres to own knowledge base, scope of practice and standards of practice/care expected of own maternity provider group. Accepts responsibility and accountability for care provided and provides that care according to national strategic frameworks, policies, standards, guidelines, relevant legislation and common law. Supports and encourages debriefing, multidisciplinary review regular audit processes, and open disclosure policies to address unsafe practice. Supports, participates in and maintains intra-and interprofessional collaboration and multi-disciplinary collegial networks.

Respects the right to autonomous practice of each maternity provider group as regulated health professionals. Readily initiates activities and delegates as appropriate in accordance with relevant policies, guidelines and scope of practice. Maintains appropriate professional boundaries within the episode of care. Concludes the professional relationship in a timely and appropriate manner.


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WORKPLACE

MANAGEMENT AND LEADERSHIP

12. work effectively with, and between, organisations.

Provides care that promotes a climate of reflection, critical thinking and continual service improvement to continually enhance the woman's maternity care experience. Supports others through mentoring and clinical supervision. Recognises and manages change processes in the healthcare/maternity care environment. Seeks knowledge to support effective management, risk management and leadership.

TEAMWORK

13. develop effective strategies to

implement and support interprofessionalism and collaborative practice.

Recognises the value of effective interprofessional relationships to achieve the best possible outcomes for the woman and her baby. Adopts effective styles and methods of communication and referral/consultation that recognises and respects the roles of other members of the health care team.

Negotiates an appropriate plan of care in consultation with the woman and other colleagues as needed. Invites and acts upon constructive feedback from peers and colleagues. Offers constructive feedback to peers and colleagues when appropriate. Effectively negotiates change in a team environment.

OCCUPATIONAL HEALTH AND SAFETY

14. develop, participate in and maintain effective strategies that contribute to, manage and improve Occupational Health and Safety (OHS) processes within the workplace.

Provides care that complies with relevant OHS requirements and safe working practices that include risk management and risk/hazard reporting processes and the maintenance of OHS documentation/records appropriate to professional role.

COMMUNICATION

PATIENT/CLIENT COMMUNICATION

15. engage in effective

patient/client communication to ensure optimal maternal and newborn health outcomes.

Responds in a calm, confident and approachable manner when communicating with each woman and her family. Uses a range of interpersonal communication principles and processes and adapts communication to the needs of and a level suited to the


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individual to communicate effectively with each woman and her family. Recognises and addresses barriers to effective communication by utilising resources that promote and enhance understanding i.e. culturally appropriate information, resources and healthcare interpreters. Legibly documents decisions, actions and evaluation of outcomes.

PROFESSIONAL COMMUNICATION

16. engage in effective, appropriate

intra and interprofessional communication to ensure optimal maternal and newborn health outcomes.

Provides care that demonstrates effective and collegial relationships and effective communication styles and methods of consultation, referral and handover with all other health care providers. Recognises and responds to factors that facilitate or hinder intra and interprofessional communication. Respects differences in communication styles. Uses communication skills to negotiate compromise where differences exist in professional opinions and recommendations for healthcare choices. Recognises respects and values collaborative practice and ongoing/effective intra and interprofessional communication. Uses a range of strategies to communicate effectively with other health care providers particularly where there is a transition from one care provider or care provider group to another.


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Suggested process for curriculum development

The fundamental outcome of this project is to develop a flexible competency and educational

framework for primary maternity services that increases opportunities for interprofessional

collaboration, teamwork and education. It is anticipated that this framework will act as a

benchmark for training, education and assessment of health professionals involved in primary

maternity services.

To this end, a whole of (primary maternity service) workforce commitment to implementing

this framework and its guidelines is encouraged along with the embedding of this

commitment and the goals and outcomes of the educational framework into strategic

documents, curriculum maps and program outcome and participant attribute statements.

Additionally, it is anticipated that providers of primary maternity service provider education

will work together to provide education that enables the competencies to be met. This process

of horizontal integration means that the common goals that different disciplines and

professions hold will be integrated and accommodated within individual curricula.

The following six steps offer a means of integrating this framework into primary maternity

service provider curricula and educational programs

1. engage, encourage and participate

2. embed commitment

3. review current curriculum in terms of content of framework

4. identify where and include framework components in current curricula

5. ensure vertical integration with all primary maternity service provider curricula

6. identify processes and tools for evaluation

Examples of strategies of delivery formats and assessment tools

A number of proposed strategies that may assist in the achievement of the Performance

Elements/Outcomes identified in the Educational Framework are provided in the table below.

Additionally, suggestions of suitable assessment tools with which to measure the success of

the delivery format and hence the Performance Elements/Outcomes are also provided in the

table below.

These proposed strategies are intended to provide a guide only, as it will be the education

provider who decides on the delivery format and assessment tools most suitable to their

particular circumstances. Health professional disciplines have their own strategies of delivery

and means of assessment and these should be utilised as appropriate.

Table 2 Proposed Strategies to assist in the achievement of Performance Elements/Outcomes

Examples of Suitable Delivery Format

Examples of Suitable Assessment Tools

Case Studies

Clinical placements

Communication and collaboration skill workshops

Emergency drill workshops

Face to face workshops

Facilitated discussion

Assignments

Clinical assessments

CPD program membership

Discussion groups

Emergency drills in practice

Exams/quizzes


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Interactive multimedia e-activities

Interprofessional online learning groups

Interactive reflective e-activities

Journals

Lectures

Mentoring

Online facilitated discussion, learning programs and

reflection

Reflective discussions and questioning processes

Role play using scenarios

Self guided learning

Simulation including practice and debriefing exercises

Observation in practice

Observed interactions

Online self assessment

Peer and/or practice review

Portfolio maintenance

Practice assessment

Reflective journaling

Self assessment

Simulated testing stations


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ACRONYMS

RANZCOG - Royal Australian College of Obstetricians and Gynaecologists

RACGP - Royal Australian College of General Practitioners

ACCRM, -Australian College of Rural and Remote Medicine

CDNM - Council of Deans of Nursing and Midwifery,

CPMEC - Confederation of Postgraduate Medical Education Councils

CDAMS - Committee of Deans of Australian Medical Schools

ANMC - Australian Nursing and Midwifery Council

NMRA - Nursing Midwifery Regulatory Authorities


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GLOSSARY OF TERMS

Adult Learning14

Attitude

Andragogy (adult learning) is a theory that holds a set of

assumptions about how adults learn. Andragogy emphasises

the value of the process of learning. Knowles identified the

six principles of adult learning outlined below.

Adults are internally motivated and self-directed

Adults bring life experiences and knowledge to

learning experiences

Adults are goal oriented

Adults are relevancy oriented

Adults are practical

Adult learners like to be respected

A state of mind or a feeling; disposition.

Baby When baby is used this also includes the foetus.

Capability15

Capability is viewed as the sum of expertise and capacity.

Capability extends the concept of competence to include the

ability or capacity to apply the necessary knowledge, skills

and attitudes to a range of complex and changing settings.

Code of Ethics

Code of Professional

Conduct

Public declaration of the beliefs and values of a profession

and the members of that profession.

Statement and description of required behaviours,

responsibilities and actions expected of members of a

professional body when acting in a professional capacity.

Collaboration

Collaborative

Practice

An active and ongoing partnership, often between people

from diverse backgrounds, who work together, and to

cooperate with other members of the health care team,

including medical officers, midwives, students, social

workers, allied health professionals and unregulated health

care workers.

Within the practice setting, collaboration is “an

interprofessional process for communication and decision-

making that enables the separate and shared knowledge and

skills of care providers to synergistically influence the

client/patient care provided"16

. Collaborative practice is then

both patient-centred and team-based; and maximises the

strengths and skills of each contributing health and social

care worker to increase the quality of patient care15

.

Community Used to describe people who share a sense of identity or


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have common concerns. Communities are not always within

a neighbourhood or locally-based.

Competence17

Encompasses a combination of skills, knowledge, attitudes,

value and abilities and the ways in which those attributes are

observable that underpin effective and/or superior

performance in a profession or occupational area.

Competent17

The person has competence across all the domains of

competencies applicable to profession or occupation, at a

standard that is judged to be appropriate.

Competency17

Competency within health gains its meaning within a

professional context. Competency as used in this document

represents core elements of professional performance (skills,

knowledge, behaviours, attitudes and values)) from a

primary maternity service perspective that underpin effective

professional/occupational performance at an identified level.

Competency Element Sub-sections of competencies describing key aspects of each

competency unit.

Continuity of care18

Consistent philosophy or organisational structure

underpinning the care provided.

Continuity of carer18

Care by a primary maternity service provider whom the

woman has previously met, feels she has developed a

‘relationship’ with and believes she ‘knows’.

Continuing

Professional

Development

To regularly update, develop and refine knowledge, skills

and attitudes relevant to professional practice.

Disease processes Includes pathological physical problems/conditions that

affect the health of pregnant women.

Domain An organised cluster of core competencies that characterise a

central aspect of primary maternity care.

Evidence informed

practice

The judicious use of the best evidence available so that the

clinician and the woman and her family arrive at the best

decision, taking into account, the needs and values of the

individual patient.

Health care

providers

Refers to all health professionals and the ancillary services

that support them. This includes midwives, nurses,

obstetricians, general practitioners, Aboriginal Health

Workers and allied health staff including social workers and

mental health providers and anaesthetists.


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Interprofessional

learning19

A tool for successful interprofessional communication in

which life long learning, adult learning principles and an

ongoing, active learning process, between different cultures

and health care disciplines is embraced to enable two or

more professions learn with, from and about each other to

improve collaboration and the quality of care.

IPE is more than common learning, valuable though that is

to introduce shared concepts, skills, language and

perspectives that establish common ground for

interprofessional practice. It is also comparative,

collaborative and interactive, a test-bed for interprofessional

practice, taking into account respective roles and

responsibilities, skills and knowledge, powers and duties,

value systems and codes of conduct, opportunities and

constraints. This cultivates mutual trust and respect,

acknowledging differences, dispelling prejudice and rivalry

and confronting misconceptions and stereotypes. -

Interprofessionalism13

Interprofessionalism improves healthcare outcomes. Defined

as the provision of comprehensive health services to patients

by multiple health caregivers who work collaboratively to

deliver quality of care within and across settings.

Interprofessionalism requires that health care providers

know about the roles of other professional groups and are

able to work with other professionals, in the context of a

team where each member has a clearly defined role.

Knowing about and working with other professional groups

may also be represented as a framework which allows for the

recognition of the commonalities, distinguishing

(complementary) and collaborative features of different

roles.

Interprofessional working is not about merging the practice

boundaries between the professions and trying to create a

generic care worker. It is instead about developing

professionals who are confident in their own core skills and

expertise, who are fully aware and confident in the skills and

expertise of fellow health and care professionals, and who

conduct their own practice in a non-hierarchical and

collegiate way with other members of the working team, so

as to continuously improve the health of their communities

and to meet the real care needs of individual patients and

clients.

Knowledge

The confident understanding of a subject with the ability to

use it for a specific purpose when appropriate.

Open Disclosure The open discussion of incidents that result in harm to a

http://en.wikipedia.org/wiki/Understanding


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patient while receiving health care. The elements of open

disclosure are an expression of regret, a factual explanation

of what happened, the potential consequences and the steps

being taken to manage the event and prevent recurrence.

Ottawa Charter20

Developed in 1986. Recognises that improvement in health

requires a secure foundation in a number of basic

prerequisites including advocacy, enabling and mediation.

Health promotion action was defined as including building

healthy public policy; creating supportive environments;

strengthening community action, reorientating health

services and developing personal skills.

Primary health care

principles

Encompasses equity, access, the provision of services based

on need, community participation, collaboration and

community based care. Primary health care involves using

approaches that are affordable, appropriate to local needs

and sustainable.

Primary maternity

services or models

Professional

Efficacy21

Maternity services provided for women with uncomplicated

pregnancies. PMS are most likely to be managed by

midwives and general practitioners (GPs), who work in

collaboration with a specialist obstetrician and refer or

consult when required. Primary maternity services may be

provided in public maternity units, birth centres, in the

community or in a combination of these settings. Care

includes antenatal, birthing, and postnatal care for women

with low-risk pregnancies.

Efficacy is the belief in one's capabilities to organize and

execute the courses of action required to produce given

attainments. Efficacy plays a central role in motivation

because people expend effort based on the effects they are

expecting from their actions.

Professional efficacy describes the level of knowledge and

skill, and the approach to using that knowledge. It captures

the sense of professional identity and authority which

supports delivering extended skills based on patient/client

need and delivering them from a sound knowledge base.

The critical component of professional efficacy is the ability

to respect the right of people to determine their own journey

through a health/ illness episode while ensuring that people

have accurate and appropriately interpreted information on

which to base their decisions.

Professional efficacy also means that the practitioner

participates as a senior member of any multidisciplinary

team, recognising autonomy and giving and accepting

referrals as appropriate. To do this they implicitly understand


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their own accountability but also work collaboratively with

other clinicians to secure the best care of each patient or

client.

Professionally

recognised standards

Those standards recognised by a profession.

Professional

responsibilities

The broad ethical duties/obligations of the primary care

provider that are not practice, education or research specific.

Public health20

An expression used to encapsulate the aims and methods of

all whose concern it is to protect and promote the health of

all citizens in the interests of both each individual and

society as a whole. It includes health promotion activities,

disease prevention programs, and the treatment of illness as

well as care of those who are disabled or disadvantaged. A

public health perspective in maternity care is one that

explicitly acknowledges the impact that an individual

woman’s social, economic and psychological life, as well as

her personal behaviour, has on her health. For primary

maternity care providers this means effective care must

focus on the wider context within which each woman’s

pregnancy occurs if we are to maintain and improve

outcomes for women and their babies.

Risk management A process of assessing risks and developing strategies to

coordinate the prevention, reduction and management of

those risks.

Secondary maternity

services

Secondary maternity services meet the needs of women who

have higher risk pregnancies, or who develop complications

and require transfer to more specialist secondary level input

or referral to specialist medical care.

Skil20

Proficiency, facility, or dexterity that is acquired or

developed through training or experience.

Tertiary maternity

services

Tertiary maternity services provide multidisciplinary

specialist care for women and babies with complex and/or

rare fetal–maternal needs.

Sub-Domain Specific competencies within a broader domain

Unit of Competency A discrete component within a competency standard. It is

made up of a title, its constituent elements and performance

criteria. A short description of its purpose may also be

present.

Woman centred

care20

Woman-centred care is a concept that implies that maternity

care:


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is focused on the woman’s individual, unique needs, expectations and aspirations, rather than the needs of

institutions or professions;

recognises the woman’s right to self determination in

terms of choice, control, and continuity of care;

encompasses the needs of the baby, the woman’s family, significant others and community, as

identified and negotiated by the woman herself;

follows the woman between institutions and the community, through all phases of pregnancy, birth

and the postnatal period; and,

is ‘holistic’ – addresses the woman’s social, emotional, physical, psychological, spiritual and

cultural needs and expectations.


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REFERENCES

1. Australian Nursing and Midwifery Council. National Framework for Accreditation of Nursing & Midwifery

Courses Leading to Registration, Enrolment, Endorsement and Authorisation in Australia Canberra,

2009.

2. RACGP. Curriculum for Australian General Practice. Melbourne Royal Australian College of General

Practitioners, 2007.

3. Australian College of Rural and Remote Medicine. Vocational Training Handbook. Canberra: Australian

College of Rural and Remote Medicine, 2007.

4. Committee of Deans of Australian Medical Schools. CDAMS Indigenous Health Curriculum Framework,.

Melbourne: University of Melbourne Design and Print Centre, 2004.

5. NZCOM. Education Framework. NZ College of Midwives Journal, 2000:5-14.

6. Royal Australian and New Zealand College of Obstetricians & Gynaecologists. Curriculum: A Framework to

Guide the Training and Practice of Specialist Obstetrician and Gynaecologists, 2003.

7. WHO European Strategy for Continuing Education for Nurses and Midwives. WHO Europe Midwifery

Curriculum for Qualified Nurses, 2003.

8. ACRRM. Primary Curriculum Statements (3rd edition) Canberra: Australian College of Rural and Remote

Medicine, 2007.

9. Confederation of Postgraduate Medical Education Councils. Australian Curriculum Framework for Junior

Doctors (Version 2.1), 2006.

10. Braithwaite J & Travaglia JF. Inter-professional learning and clinical education: an overview of the

literature. Canberra: Braithwaite and Associates and the ACT Health Department, 2005.

11. Australian Learning and Teaching Council. Learning & Teaching for Interprofessional Practice, Australia

(L-TIPP, Aus), Developing interprofessional learning and practice capabilities within the Australian

health workforce – a proposal for building capacity within the higher education sector. Canberra:

Australian Government Department of Education Employment and Workplace Relations, 2009.

12. Merriam SB. The Professional and Practice of Adult Education: an introduction. San Francisco: Jossey-

Bass, 2007.

13. Centre for the Advancement of Interprofessional Education (CAIPE), Australian Interprofessional Practice

and Education Network. What is IPE/IPL?, 2002.

14. Dunn L. Theories of Learning, 2000.

15. Victorian Government Department of Human Services. Health workforce competency principles: A

Victorian discussion paper. Melbourne: Victorian Government Department of Human Services 2009.

16. Way D. Jones L. & Busing N. Implementing strategies: Collaboration in Primary Care - Family Doctors &

Nurse Practitioners delivering shared care: Discussion paper written for the Ontario College of Family

Physicians.: Ontario College of Family Physicians 2000.

17. Australian Nursing and Midwifery Council. An examination of the role and scope of practice of Australian

midwives and the development of competency standards for Midwifery - FINAL REPORT, 2005.

18. Homer C. Brodie P & Leap N. Developing and implementing models of midwifery care: A guide for

midwives and managers. Sydney: Centre for Midwifery and Family Health, UTS, 2001.

19. Australasian Interprofessional Practice & Education Network. What is IPE/IPL/IPP? , 2009.

20. Nurses and Midwives Board of NSW. An Examination of the Role and Scope of Practice of Australian

Midwives and the Development of Competency Standards for Midwifery Final Report, 2005.

21. ANMC. Competency Standards for the Nurse Practitioner. Canberra, 2009.

Documents

University of Technology Sydney - EDUCATIONAL FRAMEWORK … · Core Competencies and Educational Framework for Maternity Services in Australia Project DRAFT FOR CONSULTATION (Issued