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NM650 Integrated Midwifery Practicum Clinical Objectives
I.
A.
KNOWLEDGE: Primary Care of Women
Systematically compiles & updates a complete & relevant database for the
comprehensive assessment of each client’s health, incl. a thorough health hx & physical
exam.
1.
Incorporates basic principles of interpersonal relationships into interviewing and
history-taking
a.
Introduces self
b.
Accepts and values client diversity
c.
Tells patient what to expect
e.
Sees to patient's comfort
f.
Cares for immediate concerns
g.
Shows interest in patient as an individual
h.
Avoids expression of inappropriate value judgments
i.
Uses eye-contact; demonstrates interest/listening
j.
Identifies/explores "clues" & significant comments
k.
Recognizes, evaluates, and responds appropriately to patient's nonverbal
behavior
2.
Uses appropriate interviewing techniques
(1)
Starts with present circumstance
(2)
Asks specific questions clearly and succinctly
(3)
Uses appropriate vocabulary
(4)
Explains new terms
(5)
Uses open-ended questions & responses
(6)
Pauses to allow for expression
(7)
Allows sufficient time to answer questions
(8)
Controls & keeps interview moving
(9)
Obtains complete data in a logical, orderly manner
(10)
Teaches appropriately (timing & information)
(11)
Terminates interview appropriately
3.
Elicits a complete gynecological history, including:
(1)
Biographical (identifying) data
(2)
Personal/social (lifestyle, environmental) data
(3)
Chief complaint
(4)
Present obstetrical (health/illness) data
(5)
Past obstetrical/gynecological data
(6)
Past health (medical/surgical) data
(7)
Review of systems
(8)
Family health data
4.
Performs a systematic, accurate, complete, and gentle physical
examination on women in the childbearing years and screens for gross deviations
and abnormalities.
a.
Initiates physical assessment by observing general appearance for:
(1)
Level of wellness/apparent state of health
(2)
State of awareness/affect
(3)
Signs of distress
b.
Examines the heart and respiratory system
NM650: Integrated Midwifery Practicum Clinical Objectives
c.
d.
e.
Page 2
Examines the breasts and axilla
(1)
Prepares and informs client appropriately for breast examination
(2)
Inspects the breasts with the client in each of four positions for
symmetry, elevation, and dimpling (retraction):
-with arms at sides
-with arms raised above head
-with hands on waist and squeezing
-with arms extending forward, chin up and bending
forward at the waist as indicated
(3)
Inspects axilla and supraclavicular region for color, smoothness,
and contour
(4)
Palpates axilla and supraclavicular region to rule out enlarged
lymph nodes while client is sitting or after palpating breast
(5)
Palpates breast, gently but firmly, with part of fingers
systematically while client is in the supine position with arm
raised above her head
(6)
Describes any mass found in terms of location, size, shape,
consistency, outline, mobility, and tenderness
(7)
Palpates nipple noting any discharge/deviation
(8)
Determines client's knowledge of/readiness to learn Self-Breast
Examination
(9)
Teaches Self-Breast examination to client and obtains return
demonstration from client as appropriate.
Examines the abdomen
(1)
Assists client to relax abdominal wall
(2)
Monitors examination by watching client's face for sign of
discomfort
(3)
Inspects abdomen for contour, symmetry, condition of skin and
umbilicus, peristalsis, and pulsations
(4)
Auscultates abdomen for normal bowel sounds as indicated
(5)
Percusses abdomen for tympany versus dullness in four
quadrants/nine sections as indicated
(6)
Percusses right upper quadrant to outline lower edge of liver as
indicated
(7)
Lightly palpates abdomen noting and inguinal lymph nodes
noting resistance/tenderness
(8)
Deeply palpates abdomen
-Palpates lower edge of liver
-Palpates left upper quadrant for spleen
(9)
Describes any masses found in terms of size, shape, location,
consistency, mobility, and tenderness
(10)
Measures fundal height on a pregnant women
(11)
Systematically performs four steps of Leopold's maneuvers on
pregnant abdomen
Examines the back and the extremities
(1)
Notes client's movements and posture throughout the interview
and examination
(2)
Inspects for symmetry of shoulders, hips, scapula
(3)
Observes spine noting the cervical, thoracic, and lumbar curves,
and lateral curves if present
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 3
(4)
Palpates spinous processes and paravertebral muscles to rule out
tenderness
(5)
Palpates costovertebral angle area to rule out tenderness
(6)
Inspects extremities for:
-edema
-varicosities
-equal size and shape of muscle mass
-normal range of motion
f.
Examines the female reproductive system
(1)
Prepares room and assembles equipment
(2)
Prepares client by explaining/clarifying procedures and
positioning comfortably
(3)
Inspects and palpates the external genitalia
-Examines by gently "milking" the Skene's glands and
urethra looking for exudate
-Palpates for enlargement of Bartholin glands
(4)
Inspects the vagina and cervix using a speculum
-Inserts speculum correctly and visualizes vagina and cervix
-Obtains Pap Smear and/or G.C. culture, chlamydia culture
or wet prep as indicated
-Removes speculum correctly
(5)
Examines the pelvic area bimanually
-Identifies the cervix and notes its size, shape, consistency,
and mobility
-Palpates the uterus and adnexa noting location, position,
size, shape, consistency, and mobility
-Locates and palpates the following landmarks of the bony
pelvis: sacrospinous ligament, sacrum, coccyx subpubic
arch, retropubic angle, sidewalls, ischial, ischial spines,
tuberosities
(6)
Examines the rectum to evaluate sphincter tone, and explore for
masses, lesions, nodes, external and internal hemorrhoids,
fissures, fistulas, anorectal polyps or tumors
g.
Examines the extremities
5.
Records examination findings completely, accurately, concisely, legibly, and in
appropriate terminology
6. Accurately obtains or orders laboratory data as needed.
B.
Identifies problems/situations and formulates diagnoses based upon interpretation of
the database.
1. Organizes data for preliminary diagnosis:
a. clusters data appropriately
b. identifies tentative diagnosis
c. identifies missing information
d. obtains additional data as necessary (includes history, physical, laboratory
and other data)
2.
Verifies diagnoses with appropriate faculty member.
C. Identifies health care needs/problems in collaboration with the client: Provides
information & support to enable clients to make informed decisions and to assume
primary responsibility for their own health. (ACNM Code of Ethics, 2004, Statements 3 & 4)
1.
Promotes mutual goal-setting between patient & self; between instructor & self
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
2.
Page 4
a.
Identifies own goals in situation
b.
Elicits goals of other(s) in situation
c.
Discusses points of agreement/conflict
d.
Arrives at mutually acceptable compromise of conflict
Provides clear and accurate anticipatory guidance and counseling regarding:
(ACNM Code of Ethics, 2004, Statement 3)
a.
D.
general health promotion and wellness (primary, reproductive and breast
health)
b.
primary health maintenance or problems/conditions within all systems
c.
contraception, family planning
d.
gynecological deviations from normal
1.
breast findings
2.
pap findings
3.
pelvic findings
e. laboratory findings for all body systems
Develops a comprehensive plan of care with the client (ACNM Code of Ethics, 2004,
Statement 3)
1.
2.
E.
F.
G.
H.
II.
Identifies possible treatment plans and consequences of each.
Provides description of diagnosis, finalizing the plan of management of potential
problems and rationale for plan.
3.
Informs consumer of options, rationale, risks, sequelae, and limitations of
therapeutic milieu including anticipated procedures (prior to institution of
procedures)
4.
Identifies need for appropriate additional lab tests.
5.
Plans for subsequent assessment at appropriate intervals.
6.
Utilizes appropriate faculty consultation for validation of management plan.
7.
Selects most appropriate therapeutic plan based on valid rationale.
8.
Verifies plan of care with appropriate faculty member.
Assumes primary responsibility for the implementation of individualized plans.
1.
Orders appropriate additional lab tests.
2.
Orders appropriate treatment(s).
3.
Performs appropriate procedures.
4.
Arranges for subsequent assessments at appropriate intervals.
5.
Obtains appropriate medical consultation or collaboration.
6.
Records data legibly, concisely, and logically.
7.
Facilitates entry into and utilization of health care system.
8.
Verifies implementation with appropriate faculty member
Obtaining consultation, planning, and implementing collaborative management; referral or
transferring the care of the client as appropriate
Initiates management of specific complications, emergencies and deviations from normal.
1. Verifies management with appropriate faculty member
Evaluates, with the client, the effectiveness of care and modifying the plan of care as
appropriate.
1.
Predicts expected outcomes of management plan.
2.
Identifies methods for follow-up evaluation.
3.
Provides for follow-up evaluation when possible.
4.
Identifies implications of treatment results for subsequent practice
5.
Verifies evaluation with appropriate faculty member.
KNOWLEDGE: Comprehensive Antepartal Care
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
A.
Page 5
Systematically compiles & updates a complete & relevant database for the
comprehensive assessment of each client’s health, incl. a thorough health hx & physical
exam. (ACNM Code of Ethics, 2004, Statement 1)
1.
Reviews previous data when available
2.
Identifies the purpose of the visit for the patient
3.
Interviews patient appropriately, obtaining complete & relevant historical
information
a.
Family medical/surgical
b.
Personal medical-surgical
c.
Ob-gyn (include menstrual, sexual, contraceptive)
d.
Drug use (over-the counter, prescribed, and recreational)
e.
Psychosocial
f.
Current obstetric course
g.
Obtains complete & relevant information since last visit on:
(1)
common complaints/discomforts of pregnancy
(2)
potential complications/danger signs
(3)
diagnosis of and/or progress of pregnancy
(4)
emotional well-being
(5)
impact of pregnancy on family or significant others
(6)
nutrition
4.
Gives patient appropriate preparatory explanation of exam procedures
5.
Performs review of systems and appropriate physical examination of patient
systematically, completely, accurately.
a.
Checks:
blood pressure
weight status
urine (glucose, protein, ketones, leukocytes)
reflexes (as indicated)
CVAT (as indicated)
edema, (pretibial, facial, pedal, digital)
b.
head to toe PE when appropriate with special attention to abdominal
findings:
fundal height
fetal heart tones (doptone)
fetal heart tones (fetoscope)
fetal movement
fetal presentation, position, lie
estimate fetal weight
pain, tone, tenderness, contractions
c.
pelvic exam as indicated
-Locates and palpates the following landmarks of the bony pelvis:
sacrospinous ligament, sacrum, coccyx subpubic arch, retropubic angle,
sidewalls, ischial, ischial spines, tuberosities
pelvic musculature and soft tissue
cervical status
uterine sizing
d.
using instruments, performs procedure correctly
speculum
Pap smear
cultures
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 6
wet mount
microscope
sterile speculum
6.
Obtains all routine laboratory data
a.
Reviews chart for previous laboratory data
b.
Orders or obtains appropriate laboratory tests at correct times, utilizing
appropriate technique
c.
Obtains additional data as necessary
(1)
history
(2)
physical
(3)
lab
(4)
records
(5)
friends/relatives of patients
(6)
other professionals involved with care
7.
Screens patients for the following:
a.
Anemia
b.
UTI
c.
PIH
d.
Diabetes
e.
Drug/alcohol problems
f.
Infectious diseases/STDs
g.
Nausea/Vomiting
h.
Multiple gestation
i.
Vaginal bleeding
j.
Abnormal presentation
k.
Size/dates discrepancy
l.
Psychosocial/sexual problems
m.
Intimate partner violence
n.
Nutritional deficiencies
o.
Genetic counseling
p.
Indications for antenatal testing
q.
Preterm labor
B. Identifies problems/situations and formulates diagnoses based upon interpretation of the
database.
1.
Organizes data for preliminary diagnosis:
a.
clusters data appropriately
b.
identifies tentative diagnosis
c.
identifies missing information
d.
obtains additional data as necessary (includes history, physical, laboratory
and other data)
2.
Verifies diagnoses with appropriate faculty member.
C.
Identifies health care needs/problems in collaboration with the client: Provides
information & support to enable clients to make informed decisions and to
assume primary responsibility for their own health. (ACNM Code of Ethics, 2004,
Statement 3 & 4)
1.
Promotes mutual goal-setting between patient & self; between instructor & self
a.
Identifies own goals in situation
b.
Elicits goals of other(s) in situation
c.
Discusses points of agreement/conflict
d.
Arrives at mutually acceptable compromise of conflict
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 7
2.
D.
E.
F.
G.
Provides clear and accurate anticipatory guidance and counseling regarding:
a.
warning signs – indications to call provider
b.
fetal development
c.
nutrition during pregnancy
d.
minor discomforts of pregnancy and their management
e.
labor and delivery
f.
complications of pregnancy and their prevention
1.
Anemia
2.
UTI
3.
PIH
4.
Diabetes
5.
Drug/alcohol problems
6.
Infectious diseases/STDs
7.
Nausea/Vomiting
8.
Multiple gestation
9.
Vaginal bleeding
10.
Abnormal presentation
11.
Size/dates discrepancy
12.
Psychosocial/sexual problems
13.
Intimate partner violence
14.
Nutritional deficiencies
15.
Genetic counseling
16.
Indications for antenatal testing
17.
Preterm labor
Develops a comprehensive plan of care with the client
1.
Identifies possible treatment plans and consequences of each.
2.
Provides description of diagnosis, finalizing the plan of management of potential
problems and rationale for plan.
3.
Informs consumer of options, rationale, risks, sequelae, and limitations of
therapeutic milieu including anticipated procedures (prior to institution of
procedures)
4.
Identifies need for appropriate additional lab tests.
5.
Plans for subsequent assessment at appropriate intervals.
6.
Utilizes appropriate faculty consultation for validation of management plan.
7.
Selects most appropriate therapeutic plan based on valid rationale.
8.
Verifies plan of care with appropriate faculty member.
Assumes primary responsibility for the implementation of individualized plans.
1.
Orders appropriate additional lab tests.
2.
Orders appropriate treatment(s).
3.
Performs appropriate procedures.
4.
Arranges for subsequent assessments at appropriate intervals.
5.
Obtains appropriate medical consultation or collaboration.
6.
Records data legibly, concisely, and logically.
7.
Facilitates entry into and utilization of health care system.
8.
Verifies implementation with appropriate faculty member
Obtaining consultation, planning, and implementing collaborative management; referral
or transferring the care of the client as appropriate
Initiates management of specific complications, emergencies and deviations from normal.
1. Verifies management with appropriate faculty member
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 8
H.
Evaluates, with the client, the effectiveness of care and modifying the plan of care as
appropriate.
1.
Predicts expected outcomes of management plan.
2.
Identifies methods for follow-up evaluation.
3.
Provides for follow-up evaluation when possible.
4.
Identifies implications of treatment results for subsequent practice
5.
Verifies evaluation with appropriate faculty member.
III. KNOWLEDGE: INTRAPARTUM
A. Systematically compiles & updates a complete & relevant database for the comprehensive
assessment of each client’s health, incl. a thorough health hx & physical exam.
1.
Reviews previous data when available
2.
Identifies the purpose of the visit for the consumer
3.
Identifies the purpose of the visit for the health care provider
4.
Interviews consumer appropriately, obtaining complete and relevant historical
information
a.
Family medical-surgical
b.
Personal medical-surgical
c.
Obstetrical/gynecological (including menstrual, sexual, contraceptive)
d.
Medications
e.
Psychosocial/Environmental
5.
Performs review of systems and systematic review of systems in appropriate
physical examination of the client.
a.
Performs abdominal examinations:
1.
Fundal height (+ /- 1 cm)
2.
Leopold's maneuvers for lie, attitude, presentation, position
3.
Contraction intensity, frequency, duration, quality, stage of labor
4.
Fetal weight (within 1/2 lb)
5.
Uterine tonus and shape
6.
Abdominal muscles
7.
Presence or absence of hydramnios
b.
Performs vaginal examinations (including sterile speculum as needed)
1.
Cervical effacement (+/- 20%) and dilation (+/- 1 cm) and position
2.
Condition of membranes
3.
Documentation of ROM (color, odor, amount, fern, nitrazine)
4.
Fetal position, presentation, and station
c.
Performs clinical pelvimetry
d.
Completes focused physical exam incl. above
1.
Edema
2.
Varicosities/Homan's sign
3.
DTR’s and clonus
4.
CVA tenderness
5.
Vital signs
6.
Heart, lungs, breast exam
e.
Auscultates fetal heart tones with attention to baseline, variability,
acceleration, deceleration, periodic changes.
f.
Monitors maternal/fetal vital signs
1.
Maternal pulse, blood pressure, temperature
2.
Shows knowledge of satisfactory techniques for intermittent
auscultation of FHT
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 9
3.
g.
h.
i.
j.
Shows knowledge of continuous fetal monitoring application and
interpretation
Times and performs procedures appropriately
1.
FHT monitoring
a.
Fetoscope
b.
Doptone
c.
External fetal and uterine electronic monitoring
d.
Internal fetal scalp electrode
2.
uterine pressure catheter
3.
AROM
4.
IV therapy
5.
Medication
6.
Local perineal anesthesia
Performs episiotomy if indicated:
1.
Assesses the need for episiotomy appropriately
2.
Selects appropriate time for cutting episiotomy
3.
Administers anesthesia correctly and with minimal discomfort to
client
4.
Cuts episiotomy firmly and smoothly with minimum number of cuts
5.
Correctly obtains hemostasis via suturing for episiotomy or
laceration
Supports birth of infant skillfully:
1.
Observes the following mechanisms of 2nd stage: descent, internal
rotation
2.
Keeps head flexed
3.
Assesses perineum
4.
Maintains slow controlled extension of head (uses modified Ritgen
maneuver if necessary)
5.
Suctions with bulb and/or wipes face as indicated
6.
Feels for nuchal cord and slips cord over head, or delivers infant
through cord, or clamps and cuts cord and unwinds cord
7.
Observes the following mechanism of 2nd stage: restitution and
external rotation
8.
Places hands securely on head
9.
Guides birth of shoulders, while observing perineum, by providing
steady pressure downward for anterior shoulder, upward for posterior
shoulder
10. Supports birth of body by sliding posterior hand down neck and over
shoulder with fingers on chest, thumb on back, head resting on arm
11. Further secures newborn by sliding anterior (top) hand down back,
grasping legs with index finger between ankles
12. Moves in close to perineum to avoid strain and pulling on cord
13. Tucks infant's body under appropriate arm, supporting head in palm
of hand
14. Keeps head lowered and turned to one side
15. Clamps and cuts cord appropriately, takes specimens
16. Modifies the above as appropriate depending upon client’s position
Initiates newborn resuscitation as needed including:
1.
Establishes airway, suctions and dries infant
2.
Performs bag and mask ventilation
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 10
3.
Initiates cardiac compressions
4.
Performs tracheal intubation
5.
Calls for pediatric help
6.
Evaluates for hypothermia, hypoglycemia while awaiting help.
k.
Delivers and examines placenta and membranes:
1.
Obtains cord blood
2.
Observes for signs of placental separation
3.
Checks placental separation by modified Brandt-Andrews, following
cord up vagina to cervix if necessary
4.
If not separated, waits appropriately
5.
Inspects perineum while awaiting placental separation
6.
Delivers placenta by:
a.
Guarding uterus
b.
Controlled cord traction
c.
Encouraging maternal efforts
d.
Following curve of Carus
7.
While supporting placenta guards membranes by twisting or
applying ring forceps to membranes
8.
Examines placenta, membranes and cord
6.
Obtains all routine laboratory data
a.
Venipuncture/fingerstick
b.
Urine specimen (clean catch/catheterization)
c.
Cervical culture by sterile speculum exam
d.
Others as needed
e.
Labels specimens/requisitions correctly
7.
Organizes data for preliminary diagnosis and completes data base
a.
Clusters data appropriately
b.
Identifies tentative diagnoses
c.
Identifies missing information
d.
Obtains additional data as necessary (includes history, physical, laboratory
and other data)
8.
Validates assumptions.
B.
Identifies problems/situations and formulates diagnoses based upon interpretation of
the database.
1.
Malpresentation
2.
Cord Prolapse
3.
Shoulder Dystocia
4.
Postpartum Hemorrhage
5.
Uterine Rupture
6.
Uterine Inversion
7.
Hematomas
8.
Fetal Distress
9.
Prolonged Labor/Dysfunctional Labor
10. Maternal anxiety
11. Cultural attitudes regarding care
12. Prematurity/Postmaturity
13. Prolonged ROM
C. Identifies health care needs/problems in collaboration with the client: Provides
information & support to enable clients to make informed decisions and to assume
primary responsibility for their own health.
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 11
D. Develops a comprehensive plan of care with the client
1.
Identifies possible treatment plans and consequences of each.
2.
Provides description of diagnosis, finalizing the plan of management of potential
problems and rationale for plan.
3.
Informs consumer of options, rationale, risks, sequelae, and limitations of
therapeutic milieu including anticipated procedures (prior to institution of
procedures)
4.
Identifies need for appropriate additional lab tests.
5.
Plans for subsequent assessment at appropriate intervals.
6.
Utilizes appropriate faculty consultation for validation of management plan.
7.
Selects most appropriate therapeutic plan based on valid rationale.
E.
Assumes primary responsibility for the implementation of individualized plans.
1.
Orders appropriate additional lab tests.
2.
Orders appropriate treatment(s).
3.
Performs appropriate procedures.
4.
Arranges for subsequent assessments at appropriate intervals.
5.
Obtains appropriate medical consultation or collaboration.
6.
Records data legibly, concisely, and logically.
7.
Facilitates entry into and utilization of health care system.
F.
Obtaining consultation, planning, and implementing collaborative management;
referral or transferring the care of the client as appropriate
H. Initiates management of specific complications, emergencies and deviations from normal.
1.
Malpresentation
2.
Cord Prolapse
3.
Shoulder Dystocia
4.
Postpartum Hemorrhage
5.
Uterine Rupture
6.
Uterine Inversion
7.
Hematomas
8.
Fetal Distress
9.
Prolonged Labor/Dysfunctional Labor
10. Maternal anxiety
11. Cultural attitudes regarding care
12. Prematurity/Postmaturity
13. Prolonged ROM
H. Evaluates, with the client, the effectiveness of care and modifying the plan of care as
appropriate.
1.
Predicts expected outcomes of management plan.
2.
Identifies methods for follow-up evaluation.
3.
Provides for follow-up evaluation when possible.
4.
Identifies implications of treatment results for subsequent practice
IV. KNOWLEDGE: MATERNAL/NEWBORN CARE DURING THE PUERPERIUM
AND NEONATAL PERIODS.
A. Systematically compiles & updates a complete & relevant database for the comprehensive
assessment of each client’s health, incl. a thorough health hx & physical exam.
1.
Reviews the women's chart for pertinent data from prenatal, labor/delivery, and
postpartum courses. Includes significant information regarding the cultural,
socioeconomic, psychosocial and physical factors that influence family
relationships.
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
2.
3.
4.
5.
6.
7.
8.
Page 12
Identifies preliminary goals of the visit for the consumer and for the nursemidwife.
Obtains interim maternal history to elicit relevant additional data
1.
common physical discomforts
a.
elimination
b.
diet and nutrition
c.
breast-feeding / bottle feeding
d.
analysis of significant abnormal signs or symptoms
e.
medications, rationale for use, implications
f.
sleep/rest
2.
Risk Factors for inappropriate emotional response to postpartum period
Conducts a thorough and relevant physical examination, including assessment of
the breasts, abdomen, perineum, extremities, and back.
Expands physical examination appropriately when a deviation from normal
occurs.
a.
Breast examination - demonstrate/teach self breast exam
b.
Abdominal examination including:
1.
Musculature and tone
2.
Diastasis recti
3.
Fundus - location and levels, involution, tenderness
4.
Urinary bladder
c.
Perineal examination including:
1.
Vulva - hematoma, edema, varicosities, lacerations
2.
Perineum/episiotomy - discomfort, healing, hematomas
3.
Rectum - hemorrhoids
d.
Lochia evaluation - color, amount, odor
e.
Lower extremities - edema, pain, varicosities
Orders and/or obtains appropriate laboratory tests and referrals necessary for
evaluation of a deviation from normal.
Reviews the infant's chart when available for pertinent data from
a..
family medical history
1.
social and cultural history
2.
mother's antepartal / intrapartal history
3.
newborn's status since birth - nutritional/developmental
4.
laboratory data
Screens newborn for indications for the following:
a.
hypothermia, hyperthermia
b.
abnormal heart rate or rhythm
c.
failure to make cardiovascular adjustments
d.
failure to make pulmonary adjustments
e.
size/dates discrepancy, SGA / LGA
f.
neurological deficits
g.
physical anomalies
h.
drug dependency
i.
infection
j.
jaundice
k.
blood incompatibilities
l.
feeding and elimination
m. breastfeeding problems
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 13
B. Identifies problems/situations and formulates diagnoses based upon interpretation of the
database.
1.
Organizes data for preliminary diagnosis:
a.
clusters data appropriately
b.
identifies tentative diagnosis
c.
identifies missing information
d.
obtains additional data as necessary (includes history, physical, laboratory
and other data)
2.
Verifies diagnoses with appropriate faculty member
3.
For conditions, see B.1. and B.2.
C. Identifies health care needs/problems in collaboration with the client: Provides
information & support to enable clients to make informed decisions and to assume
primary responsibility for their own health.
1.
Provides clear and accurate anticipatory guidance and counseling regarding:
a.
processing of labor and delivery experience
b.
potential psychological / emotional adjustment
c.
nutrition
d.
activity/sleep
e.
breast care for nursing / non-nursing mothers
f.
relief of breast engorgement/sore nipples
g.
relief of afterbirth pains
h.
diaphoresis/diuresis
i.
relief of episiotomy/laceration pain
j.
lochia
k.
perineal hygiene
l.
relief of hemorrhoid pain
m. resumption of sexual activity
n.
contraception
o.
warning signs
p.
follow-up visits/tests
q.
infant care
r.
lab tests / referrals
D. Develops a comprehensive plan of care with the client
1.
Identifies possible treatment plans (incl. alternatives) and consequences of each.
2.
Provides description of diagnosis, finalizing the plan of management of potential
problems and rationale for plan.
3.
Informs consumer of options, rationale, risks, sequelae, and limitations of
therapeutic milieu including anticipated procedures (prior to institution of
procedures)
4.
Identifies need for appropriate additional lab tests.
5.
Plans for subsequent assessment at appropriate intervals.
6.
Utilizes appropriate faculty consultation for validation of management plan.
7.
Selects most appropriate therapeutic plan based on valid rationale.
8.
Verifies plan of care with appropriate faculty member
E.
Assumes primary responsibility for the implementation of individualized plans.
1.
Orders appropriate additional lab tests.
2.
Orders appropriate treatment(s).
3.
Performs appropriate procedures.
4.
Arranges for subsequent assessments at appropriate intervals.
5.
Obtains appropriate medical consultation or collaboration.
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 14
6.
Records data legibly, concisely, and logically.
7.
Facilitates entry into and utilization of health care system.
8.
Verifies implementation with appropriate faculty member
F.
Obtains consultation, plans, and implements collaborative management; referral or
transferring the care of the client as appropriate
1.
For conditions listed in B.1 and B.2
2.
Makes observations relevant to psychosocial/emotional adjustment of client and
family
a.
investigates client's / family's processing of the labor and birth experience
b.
observes family interactions revealing clues to bonding, family
relationships, and adaptation to the infant
c.
identifies client's/family's grief process when relevant
G. Initiates management of specific complications, emergencies and deviations from
normal.
1.
Verifies management with appropriate faculty member
2.
For conditions listed in B.1 and B.2.
H. Evaluates, with the client, the effectiveness of care and modifying the plan of care as
appropriate.
1.
Predicts expected outcomes of management plan.
2.
Identifies methods for follow-up evaluation.
3.
Provides for follow-up evaluation when possible.
4.
Identifies implications of treatment results for subsequent practice.
5.
Verifies evaluation with appropriate faculty member.
V.
SKILLS
A.
Performs all skills in a manner which:
1.
Demonstrates correct and efficient utilization of hands, instruments, and
equipment.
2.
Results in obtaining accurate data or in the safe completion of an appropriate
procedure/maneuver.
3.
Causes the least possible physical and/or psychological discomfort to the
consumer.
4.
Demonstrates consistency.
VI.
VALUES
A.
Incorporates appropriate values in the assessment process.
1.
Values diversity.
2.
Respects and integrates client’s values.
B.
Demonstrates actions, interactions and attitudes consistent with ACNM Standards for the
Practice of Midwifery (2003) and ACNM Code of Ethics (2004.)
1.
Demonstrates actions, interactions and attitudes that positively facilitate intra and
interdisciplinary collegiality.
C.
Demonstrates actions, interactions and attitudes that facilitate achievement of the
following Hallmarks of Midwifery (2002):
 Recognition of pregnancy, birth, and menopause as a normal physiologic and
developmental process
 Advocacy of non-intervention in the absence of complications
 Incorporation of scientific evidence into clinical practice
 Promotion of family-centered care
 Empowerment of women as partners in health care
 Facilitation of healthy family and interpersonal relationships
 Promotion of continuity of care
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,
NM650: Integrated Midwifery Practicum Clinical Objectives
Page 15




V.
A.
B.
Health promotion, disease prevention, and health education
Promotion of a public health care perspective
Care to vulnerable populations
Advocacy for informed choice, shared decision-making, and the right to selfdetermination
 Cultural competence
 Familiarity with common complementary and alternative therapies
 Skillful communication, guidance, and counseling
 Therapeutic value of human presence
 Collaboration with other members of the health care team.
MEANINGS
Individual Qualities
1.
Takes responsibility for own learning.
2.
Achieves appropriate theory grasp.
3.
Accepts responsibility for decision-making and consequences.
4.
Demonstrates integrity and reliability.
5.
Develops an environment of mutual respect in any professional interaction.
6.
Demonstrates ability to cope with stressful or emotional situations in a
constructive manner.
7.
Knows own limitations; protects the safety of the client.
Communication
1.
Exchanges information in manner which consumer understands and provides an
opportunity for asking questions (interaction).
2.
Communicates appropriately with health care team members, faculty and peers.
3.
Promotes family centered care and provides opportunity for consumer to receive
support from significant other.
4.
Maintains and respects privacy.
5.
C.
Promotes consumer's rights to make and be responsible for decision concerning
personal health care.
6.
Demonstrates sensitivity to the biases/constraints of the consumer.
Approach to Health Care System
1.
Identifies bioethical considerations related to reproductive health.
2.
Uses appropriate community resources.
3.
Advocates principles of health promotion and disease prevention.
4.
Promotes pregnancy as a normal physiologic process.
5.
Demonstrates awareness of cost/benefits ratio in health care.
Revised, 2011 according to:
ACNM Standards for the Practice of Midwifery, 2003, and
ACNM Code of Ethics, Revised 2004
,