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School of Nursing, Midwifery and Social Care

Bachelor of Midwifery ProgrammeMaster of Midwifery Programme

COMPETENCY ASSESSMENT BOOK

MODULE MID09120 MIDWIFERY PRACTICE 7

STUDENT MIDWIFE ……………..……………….

MODULE NUMBER & TITLE MID09120 MIDWIFERY PRACTICE 7[3-Year Route]

NAME OF STUDENT

MATRICULATION NUMBER

INTAKE

MODULE LEADER

PLACEMENT FROM: TO:

COMPETENCIESPASS/FAIL OVERALL

MARKS

NAME OF SIGN-OFF MENTOR

1. Community 2. Postnatal Marks to be completed by Module Leader

SUM OF OVERALL PLACEMENT MARKS

Signature of Module Leader

FINAL MODULE MARK

SUMMARY OF RECORD OF ABSENCE/SICKNESS FROM PRACTICE DURING PLACEMENT/S

Placement Dates Absent/Sick

Total number of days absent/sick

Comment if medical certificate submitted etc.

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INTRODUCTION TO COMPETENCY ASSESSMENT BOOK

The Nursing and Midwifery Council (NMC) has set standards for education programmes, for pre-registration midwifery these are set out within the Standards for Pre-Registration Midwifery Education (NMC 2009). This document includes the competencies required to prepare students to practise effectively and safely and is based upon the Essential Skills Clusters (ESCs).

The four domains are divided into categories:1. Effective midwifery practice2. Professional and ethical practice3. Developing the individual and others4. Achieving quality through evaluation and research

The Midwifery ESCs are categorised in the following general headings that are fundamental to best practice:

Communication Initial consultation between the woman and the midwife Normal labour and birth Initiation and continuance of breastfeeding Medicine management

The above general headings reflect women’s expectations of newly registered midwives and fulfil the NMC requirements. Students must demonstrate competence in the ESCs and will be subject to ongoing monitoring and review.

THE PROCESS OF MARKING PRACTICE Students must pass ALL the competencies as set out in the Competency Assessment Book for each placement. A practice module is made up of either one, two or three placements. The competencies assessed in each placement are grouped into four elements based on the midwifery domains and all competencies in each individual element must be achieved. The elements’ criteria statements match the Scottish Credit Qualification Framework (SCQF) of levels 7, 8 and 9 and relate to the student’s stage of study in the programme.

At the end of each placement: The sign-off mentor uses the Practice Marking Tool to assess the student’s overall performance in achieving the competencies within each element. The mentor decides on a mark from the range of marks available (100-65, 64-40 and 39-0) that reflects the overall performance of the student using the competency marking criteria.

The pass mark for each placement must be 40 or more. When a student fails any competencies, this failure will be reflected as 39 marks or less in the criteria elements and although 40 or more may be the overall score the placement outcome will be a fail.

At the end of the module: The module leader adds the marks from the placements and the average derived is the final mark for the module. Where the practice module has more than one placement the final module mark will be the average of the overall marks achieved in each placement. All competencies must be passed and the module pass mark is 40 or more. When a student fails a placement but has gained more than 40 as an average, the student will be awarded a fail for the module. A student who has a score of 65 or above will be awarded a MERIT for the module.Students should be marked using the full grading range of 0 -100 as they are being assessed on competencies expected for their level of study.

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If a student fails the practice module she/he is entitled to one re-assessment opportunity. The Board of Examiners will decide on the duration necessary for the failed element and when the component re-assessment is to be taken.

STUDENT MIDWIFE’S RESPONSIBILITIES

The NMC Code (2015) states the professional standards that nurses and midwives must uphold in order to be registered to practise in the United Kingdom.

The Code contains a series of statements that taken together signify what good nursing and midwifery practice looks like. It puts the interests of patients and service users first, promotes safety and effectiveness and promotes trust through professionalism.

Prioritise people - you put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You will ensure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.

Practice effectively - you will assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay and to the best of your abilities, on the basis of the best evidence available and best practice. You communicate effectively, keeping clear and accurate records and sharing skills, knowledge and experience where appropriate. You reflect and act on any feedback you receive to improve your practice

Preserve safety - you make sure that patient and public safety is protected. You work within the limits of your competence, exercising your professional ‘duty of candour’ and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.

Promote professionalism and trust - you uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other healthcare professionals and the public.

You should familiarise yourself with the NMC documents: The Code (2015) and the Standards for Medicines Management (2010).

Practice concernsThere may be times where you see practice that concerns you. If this happens, you have a professional duty, as an aspiring midwife, to protect the women and babies you care for. You should seek advice as soon as possible and follow the whistleblowing flow chart which is found on the Practice 7 Moodle site.

If you are involved in a practice investigation

If you are involved in a practice event that requires either investigation, you are advised to contact your Personal Development Tutor (PDT) or Link Lecturer for advice and support. If you are asked to write a factual account of your involvement in events, then always seek an appointment with your PDT.

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Hours of work/time keepingIn Practice 7, you are required to undertake 37.5 hours practice per week. The identified dates for reflection are included as clinical hours.

In preparation for the initial meeting with your mentor, you should have reflected on your learning and identified goals and expectations for the current placement as per the Practice Learning Checklist (2014). It is your responsibility to keep your practice assessment documents safe and ensure that current documents are always readily available for your mentor to sign-off competencies following discussions on your progress. You are expected to reflect and self-assess your own progress during a placement and be prepared to discuss your learning with your mentors, your PDT and link lecturer.

It is your responsibility to ensure that the mentors sign the timesheets for practice attendances daily and any sickness/absence is recorded. You should refer to your Programme Handbook for more details concerning reporting sickness when in practice.

ROLE AND RESPONSIBILITIES OF A SIGN-OFF MENTOR

The sign-off mentor must have completed the essential mentor preparation and be recorded as active on the Sign-off Mentor database held by the relevant NHS provider. It is the mentor’s responsibility to orientate the student at the start of the placement and ensure that health and safety procedures are explained. The sign-off mentor is responsible for ensuring that the learning experience available for the student enables them to meet the required learning outcomes. Sign-off mentors are accountable to the NMC for ensuring that students are fit to practice and should assess the students’ level of competence by observing their practice and discussing the knowledge and skills required to practice safely.The mentor should encourage the student to reflect, self-assess her /his own achievement of the competencies, and that they are ready to discuss on-going learning experiences. The mentor must involve the link lecturer and/or the practice education facilitator (PEF) at an early stage when there are concerns about a student’s standard of practice or behaviour. In this instance any action plan and follow-up review must be clearly documented in the Competency Assessment Book.Initial Meeting / OrientationAt the beginning of a placement (within two days), the sign-off mentor must meet with the student to complete the orientation checklist and discuss the student’s previous learning. At this initial meeting, the sign-off mentor will discuss learning needs and prepare a development plan for learning opportunities to be facilitated during the placement. The outline of the plan must be documented and signed.

Mid-point MeetingBoth mentor and student should meet at the mid-point of the placement to discuss progress. This is a valuable time for the student and mentor to review the initial developmental plan. Students must be given objective feedback on their progress at this point; and where concerns have been raised that a student may not achieve the required level of competence, an action plan must be developed. Where appropriate the link lecturer and/or PEF will be involved at this meeting. It would be good practice to sign individual competencies throughout the placement to monitor the students’ progress.

Final MeetingAt the end of the placement, the student and mentor must meet to discuss and complete all the documentation in the Competency Assessment Book. The mentor enters a grade and completes the individual competencies that are left to sign. It is the responsibility of the sign-off mentor to document the rationale for the overall mark awarded. This should be

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documented as a summary during the final meeting. It would be beneficial to also include feedback from the wider team, women and their families.

What to do IF an experience/competency is not available during the placement

When there is no opportunity for the student to demonstrate a competency, such as an obstetric emergency, the student midwife must be able to discuss and demonstrate accurate understanding of the situation and the implications. Simulation can be used to assess competence. The mentor will then verify that the competency is achieved by signing it off as “Explanation Verified” (EV). When a student is unable to explain, the competency is recorded as ‘FAIL’. The mentor must also document the EV or Fail in the Student’s Ongoing Record of Attainment (ORA).Apart from ‘EV’, the assessment outcome of each competency outcome must be written P for pass or write FAIL in full for clarity.

On-going Record of Achievement (ORA)

The NMC Standard 16 (NMC, 2009) states that an on-going record of achievement (ORA) is a required component of the assessment of practice.The ORA allows information about overall student performance to be passed from one placement mentor to the next, enabling the mentors to judge student progress. All three years of practice learning are evidenced in this document providing mentors with an overview that will support mentors and students to plan the learning outcome and complete the assessment process.

LINK LECTURER AND PEF’S RESPONSIBILITIES

A midwife lecturer is identified as the link lecturer for each approved midwifery practice placement area. They discuss changes, developments and review students’ allocations and suitability of the placements by conducting practice placement audits and completing placement profiles every 18 to 24 months.

The link lecturer updates the mentors of any regulatory and programme changes such as assessment processes to ensure that the practice marking tools are used effectively. The link lecturer (and where appropriate the midwife PEF) will be involved in supporting and guiding both mentors and students when issues arise, for example, if the sign-off mentor is concerned about a student’s lack of progress or unacceptable behaviour, the link lecturer will be involved in discussions and give guidance of the marking and moderation of practice. Any decisions or action points must be documented in the Competency Assessment Book.PEF’s support mentors in the practice learning environment and they are responsible for a range of placements.

MODULE LEADER’S RESPONSIBILITIES

The module leader is responsible for issuing the Competency Assessment Book to students and prepares the students for the learning outcomes of each practice module. The module leader must give students information about the submission date and how/where to submit the completed documents. The module leader is responsible for ensuring fairness and equity of the assessment process and will moderate and ensure due process has been applied. The module leader ensures that the external examiner is able to scrutinise completed Competency Assessment Books, discussing the marking/moderation and any issues with them. It is also the module leader’s responsibility to present the results to the Module Board of Examiners.

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Practice learning process

The student to make initial contact with the practice placement area 2 weeks prior to commencement date.

Initial meeting within 2 days of commencing the practice placement You and your sign-off mentor must compete the induction sheet. Review progress to date. Identify learning outcomes and write a plan. Set dates for your mid-point and final assessments and book these in the

ward diary.Mid-point meeting

You are expected to complete your own self-assessment prior to meeting your mentor to highlight your learning needs.

You and your sign-off mentor meet to review your progress. If there are no concerns raised, then continue with the original plan. If concerns are raised then a plan needs to be devised and documented to facilitate the achievement of outstanding competencies. The link lecturer, module leader, PDT or PEF should be contacted to support this process.

End of placement meeting You and your sign-off mentor meet to evaluate the placement, sign the

competencies, allocate a grade, demonstrate the rationale for the grade, complete the time sheets and complete the ORA. You also need to evaluate the placement and write a summary of your experience.

Submission of assessment documentationYou must submit all your documentation together by the set date and time given by the module leader which for Practice 7 (MID09120) is Gail Norris. Non-submission will result in a fail for the module regardless of the grade awarded by the practice placement sign-off mentor.

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PLACEMENT: POSTNATAL

RIE ST JOHN’S BORDERS FORTH VALLEY FIFE Please circle the applicable

DATE OF PLACEMENT FROM TO

PLEASE PRINT NAME OF MENTORS INVOLVED IN THE

ASSESSMENT

SIGNATURES & INITIALS OF MENTORS

DATE OF LASTMENTOR UPDATE

ORIENTATION AT INITIAL MEETING

The orientation to practice area must be completed during the first shift of the placement. Please indicate if you have provided the orientation

information to the practice placement in relation to the following with a tick: √

Yes NoPreliminary discussion of skills previously achieved and the learning opportunities availableIntroduction to other team members

Orientation to placement philosophy and client groupLocation of equipment and stores

Fire and safety procedures

Emergency procedures

Specific policies/ legal frameworks/ confidentiality issuesMoving and handling policies and proceduresOthers –

Date & Signature of student

Date & Signature of mentor

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POSTNATAL WARD PLACEMENT SUMMARYPRACTICE PLACEMENT AREA: DATES:

I have received and discussed student’s previous placement records Sign-off mentor’s signature:

RECORD OF DEVELOPMENTAL PLAN AT INITIAL MEETING To be completed by the student prior to initial meetingStudent’s goals and expectations

Student’s signature: Date:Print Name

To be completed by the mentor at the initial meetingAgreement of learning opportunities during the placement

Sign-off mentor’s signature: Date:Print Name

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RECORD OF MID-POINT MEETING AND COMMENTS:Student’s self-assessment of progress:

Students’ signature: ………………………………… Date:

Sign-off mentor’s comments:

Sign-off mentor’s signature: ………………………….. Date:

Use this section only if necessary. Sign-off mentor’s action plan for areas of concern if required. ACTION PLAN: REVIEW OF OUTCOMES:

Print Name Sign and Date Sign and DateStudentSign-off mentorLink lecturer/PEF

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FINAL MEETING AND COMMENTS:Student’s evaluation of achievement:

Student’s signature: ……………………………………Date:

Sign-off mentor’s rationale for mark awarded:

COMPETENCIES: PASS/FAIL OVERALL MARK ……. Sign-off mentor’s signature: ……………………………Date:

Module Leader’s Comments:

Signature, Print Name and Date:

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Assessment Criteria – Clinical Score-Directions for use: Level 9The scoring system is based on the assessment of each element of practice. Each box has the same 4 criteria which identify progress according to performance. Based on your experience and comments from other sign-off mentors you need to decide whether the student is excellent, pass or fail. Once you have decided which box best describes your student’s performance; you should mark according to the box you have chosen. For example, if you feel that the student is a pass this automatically means that the student will receive a mark of 40% with additional scoring increasing it to a maximum of 64%.

Overall Judgement

Domain criteria Available Score

Actual Score

Overall score

Excellent (merit)

100-65%

Domain 1Effective midwifery practice

Excellent care and clinical skills achieved at level 9, at all times with exceptionally effective practice

0-9

Domain 2Professional and ethical practice

Consistently critically reflects on professional practice and is fully aware of the ethical issues within midwifery practice

0-9

Domain 3Developing the individual midwife and others

Can clearly evaluate own learning requirements in practice in relation to the need for life long teaching and learning for themselves and others: Principles and processes relating to revalidation

0-9

Domain 4Achieving quality care through evaluation and research

Excellent ability to apply research and the evidence to practice 0-8

Pass64-40%

Domain 1 Good care and clinical skills achieved at level 9, with good effective practice 0-6Domain 2 Regularly critically reflects on professional practice and is aware of the ethical

issues within midwifery and midwifery practice0-6

Domain 3 Can evaluate some of her own learning requirements in practice in relation to the need for life long teaching and learning for themselves and others: Principles and processes relating to revalidation

0-6

Domain 4 Ability to apply research and the evidence to practice 0-6Fail

39-0%Domain 1 Care and clinical skills not achieved at level 9 0-10

Domain 2 Minimal or no critical reflection on professional practice and does not indicate awareness of the ethical issues within midwifery

0-10

Domain 3 Is unable to or has limited ability to evaluate her own learning requirements in practice in relation to the need for life long teaching and learning for themselves and others: Principles and processes relating to revalidation

0-10

Domain 4 Limited or no ability to apply research and the evidence to practice 0-9

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POSTNATAL PLACEMENTP or Fail If there is no opportunity for the student to demonstrate a competency, enter “EV” to denote that she/he

has the underpinning theoretical knowledgeP or Fail Sign-off mentors

signature DateStudent MentorCommunicationDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: Communication

Demonstrates effective communication skills with women and their families and always seeks to confirm understanding and gain informed consent.Is proactive and creative when encouraging women to think about their own health and the health of their babies and families, and how this can be improved.Utilises appropriate communication skills to deal with difficult and challenging circumstances, including situations where women have physical, cognitive or sensory disabilities. Engages in multidisciplinary communication: face to face, telephone, in writing and electronically ensuring the woman’s needs and wishes are clear.Plans and provides health education during the postnatal period for women, families and juniors.

DiagnosisDomain: Effective midwifery practiceProfessional and ethical practiceESC: CommunicationInitial consultation between the woman and the midwifeMedicines management

Can admit a women and her baby into the postnatal ward utilising the principles of SBAR.Initiates the holistic assessment and monitoring of women throughout the postnatal period. Considers the following through the assessment of cultural and emotional wellbeing: History taking, observation, physical examination and Including social factors for example; substance misuse, domestic violence. Can provide information relating to 2 specific postnatal investigations and demonstrate an understanding of their indications:1.2.

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POSTNATAL PLACEMENT P or Fail If there is no opportunity for the student to demonstrate a competency, enter “EV” to denote that she/he


signature DateStudent MentorDiagnosis (cont.…)

Applies evidence based knowledge when sharing information and performing assessments/tests/investigations and screening tests such as:

Blood glucose monitoring. Blood testing. Urine samples. Infection screening.

Initiates maternal observations: temperature, pulse, blood pressure, respirations, urinalysis, fluid balance and Per Vaginum (PV) loss.Demonstrates awareness and critical understanding of the following signs and symptoms in postnatal women:

Pain. Bradycardia, tachycardia, pyrexia, hypo/hypertension,

dyspnoea, tachypnoea. Headaches. Offensive PV loss. Abnormal urinary function. Abnormal bowel function.

Recognises, monitors and discusses the normal maternal postnatal physiological adaptations and can refer as appropriate when deviation occurs.Prepares women for discharge home including appropriate documentation, discharge prescriptions/medications and follow up appointments.

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signature DateStudent Mentor

Care planningDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwife

Initiates care planning, made in partnership with women and other health care professionals, which is evidence based and respects her culture, choice and individual context.Evaluates care plans: making and documenting amendments to enhance care and improve outcomes.Critically discusses the need for individualised postnatal support for families.Provides examples of national and local policy/guidelines that support best practice and promotes women centred care:

Care provisionDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeMedicines management

Is proactive in promoting care environments that are diversity sensitive and free from exploitation, discrimination and harassment.

Can take an accurate social, medical, surgical and obstetric history in order to determine pathway of care, including consideration for women with disabilities.Recognises and critically explores the role of the midwife in ‘normal’ postnatal care and assess the needs of women.Provides a critical rationale for the midwifery care offered to women who have had an antenatal/intrapartum complication; for example: APH, instrumental delivery or caesarean section. Demonstrates an understanding of the role of the midwife and actively participates when caring for women with complex needs such as: pregnancy loss, still birth neonatal death.Understands and evaluates the processes of monitoring and supporting women who have postnatal mental health issues.Ensures the comfort needs of women are met such as: bladder care, hydration, nutrition, hygiene, infection prevention and assessment of skin integrity.

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signature DateStudent MentorCare provision (cont.…)

Supports women to become independent and self-caring by providing advice on: bladder control, recuperation and contraceptive choices.

Applies knowledge to assess, plan, care and provide support for women and their family with babies who are ill/pre-term or have a disabilityWith minimal supervision, manages and prioritises competing demands, include identification of who is most appropriate to provide particular interventions.

ReferralDomain: Effective midwifery practiceProfessional and ethical practiceESC: CommunicationInitial consultation between the woman and the midwifeInitiation and continuance of breastfeedingMedicines management

Initiates appropriate and timely referrals for women who would benefit from the skills and knowledge of other professionals: acting within the law when disclosing information without consent.Discusses the rationale for referrals such as: health, social and psychological issues, maternal obesity, child protection, financial issues and the law.Recognises and critically discusses the importance of team working to support the best interests of individual women.

Emergency proceduresDomain: Effective midwifery practiceProfessional and ethical practiceESC: CommunicationMedicines management

Discusses and evaluates the role of the midwife when participating in emergency procedures that meet the needs of women and their babies:

Adult resuscitation. Postpartum haemorrhage. Severe pre-eclampsia/eclampsia. Neonatal resuscitation. The use of medicinal products.

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Examination and care for babiesDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitiation and continuance of breastfeedingMedicines management

Performs and completes the documentation of a full assessment/ physical examination of the baby recognising normal growth and development.Provides a rationale when assessing the following signs and symptoms in the baby:

Colour/skin profusion. Behaviour/alertness. Cry. Muscle tone/movements. Feeding patterns. Elimination patterns. Weight loss. Signs of infection. Tachycardia, bradycardia, pyrexia and dyspnoea.

Provides advice and support for parents on hygiene, safety, protection, security and child development.As appropriate, assists women to administer medicines to their babies.Discusses and evaluates referral pathways for babies with child protection issues. Initiates and justifies the care and referral, as necessary, for babies with specific health needs such a low birth weight. Under supervision, evaluates the care required for babies with pathological conditions, such as babies affected by maternal substance misuse. Prepares a baby for discharge home including appropriate documentation, follow-up and discharge medication.

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Infant nutritionDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeInitiation and continuance of breastfeeding

Supports and advises women as they start to feed and care for their baby, recognising the woman’s existing attitude, knowledge and skills.Applies knowledge and skills when advising women over the telephone, when contacted for advice on breast feeding issues.Encourages and supports mothers to keep their baby close so that they can tune into each other and learn early feeding cues (skin to skin and baby holding). Facilitates and encourages the development of the parent(s)/baby relationship.Critically discusses the principles underpinning responsive feeding, bed sharing and the use of dummies with an awareness of your own thoughts and feelings about infant feeding. Ensures that information shared is ethical and non-judgemental. Applies in-depth knowledge of the physiology of lactation with women on effective positioning, attachment using the ‘see’ ‘hear’ ‘feel’ principles.Supports women to hand express breastmilk and feed their baby using a cup or syringe as appropriate. Provide supports when early feeding challenges occur; such as the baby who is slow to initiate and maintain feeding or the baby with specific health needs.Critically appraises and evaluates the strength of research evidence in relation to breast feeding practices, promotion and support interventions.Recognises and discusses pathways for referral to appropriate health care professionals such as the infant feeding advisor.

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PartnershipDomain: Professional and ethical practiceAchieving quality care through evaluation and researchESC: CommunicationMedicines management

Initiates partnership working with women that facilitates the provision of seamless care. Discussions should include women centred care, promotion of health and management of health needs.Provides culturally sensitive support for women regarding future reproductive choices; for example: contraception and family planning.

Medicine administration Domain: Effective midwifery practice & Professional and ethical practice ESC: CommunicationInitiation and continuance of breast feedingMedicines management

(ENU Guidance for Student Midwives and Medicine Administration p37)

Takes a medicine history and accesses evidence based sources of information relating to the safe and effective management of medicinal products utilising the British National Formulary.Can identify the manner in which medicines are absorbed, metabolised and excreted (principles of pharmaco-kinetics); and how medicine doses are determined by dynamics/systems in the bodyCan correctly calculate and discuss 3 common medicines and dosages used in postnatal midwifery practice at the first attempt (100% accuracy).1.2.3.Ensures an individual, women centred focus when sharing information, alleviating fear and anxiety of the women in relation to medicine administration, if appropriate, utilise medicine information leaflets.Safely administers oral, intramuscular and subcutaneous medication under direct supervision and disposes of all equipment needed during preparation and administration. Demonstrates an understanding of and participates in the administration and management of blood and blood products.Participates in the siting of intravenous cannulae and subsequent care of the intravenous site.

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signature DateStudent MentorMedicine administration (cont.…)

Participates in involving women in the administration and/or self-administration of medicines (over the counter or prescribed).Interprets and maintains prescription charts accurately as per The Code (NMC, 2015), national/local policies for the administration of medicines with an understanding of professional responsibilities such as midwives exemption list (MEL). Demonstrates an awareness of how to report contraindications, side effects and adverse reactions.Initiates, with support, referral to an appropriate practitioner for medicine review such as pain relief.Demonstrates the ability to maintain the stock control/storage of medicinal products including: ward stock and take-home medications.Demonstrates an awareness of the role and function of bodies that regulate and ensure the safety and effectiveness of medicinal products; for example: the Standards for Medicines Management (NMC, 2007) & the Medicines and Healthcare Products Regulatory Agency (UK Government).

Record keepingDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationMedicines management

Completes accurate, legible and continuous records which include the rationale behind actions taken.Utilises the appropriate information technology systems available to facilitate data analysis and evaluation.Adheres to the data protection laws around women’s records.

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signature DateStudent MentorPublic healthDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: Communication

Critically discusses public health policies which influence maternity care provision; for example: infant hearing screening and Anti-D programmes. Discusses and justifies health promotion strategies which target specific groups with particular health needs; for example: smoking cessation, obesity and infant nutrition. Demonstrates the application of evidence based practice in relation to the reduction of maternal and perinatal morbidity and mortality.

Respecting the individualDomain: Effective midwifery practiceProfessional and ethical practiceESC: Communication

Recognises and discusses the different roles and relationships in families, reflecting religious and cultural beliefs, preferences and experiences particularly around family planning advice. Challenges situations/others where the dignity of women may be compromised.Respects women’s autonomy and rights when making a decision, even where choice may result in harm to themselves or their unborn baby, unless a court of law orders the contrary.

Professional practiceDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeNormal labour and birthInitiation and continuance of breastfeedingMedicines management

Practices in accordance with The Code (NMC, 2015) and within the limitations of the individuals’ own competence, knowledge and sphere of professional practice.Demonstrates knowledge and application of legislation relating to human rights, equal opportunities and equality & diversity; for example: informed choice. Acts professionally to ensure that personal judgements, prejudices values and beliefs do not compromise the care provided.

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signature DateStudent MentorProfessional practice (cont.…)

Maintains confidentiality and security of written and verbal information acquired in a professional capacity.Critically reflects upon the need to disclose information about individuals and organisations only to those who have a right and need to know.Through reflection and evaluation demonstrates commitment to personal and professional development. Contributes to individual, organisational and national audits in order to optimise care of women, babies and their families; for example: the completion of Peripheral Vascular Catheter (PVC) documentation.Acts as an effective role model in decision making, taking action and supporting more junior staff.Maintains midwifery standards by adhering to local uniform policies, practising good time keeping, conducting yourself in a professional manner and adhering to infection control policies.Undertakes universal precautions when handling blood and body fluids.Applies safe moving and handling principles to practice.

Collaborative workingDomain:Effective midwifery practiceProfessional and ethical practiceESC: CommunicationMedicines management

Actively participates in collaborative working with the wider health care team and sharing skills with other agencies, such as: social policy, nursery nurses and paediatricians.

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COMMUNITY PLACEMENT: _________________

RIE ST JOHN’S BORDERS FORTH VALLEY FIFE Please circle the applicable

DATE OF PLACEMENT FROM TO

PLEASE PRINT NAME OF MENTORS INVOLVED IN THE

ASSESSMENT

SIGNATURES & INITIALS OF MENTORS

DATE OF LASTMENTOR UPDATE

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ORIENTATION AT INITIAL MEETING

The orientation to practice area must be completed during the first shift of the placement. Please indicate if you have provided the orientation

information to the practice placement in relation to the following with a tick: √

Yes NoPreliminary discussion of skills previously achieved and the learning opportunities availableIntroduction to other team members

Orientation to placement philosophy and client groupLocation of equipment and stores

Fire and safety procedures

Emergency procedures

Specific policies/ legal frameworks/ confidentiality issuesMoving and handling policies and proceduresOthers –

Date & Signature of student

Date & Signature of mentor

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COMMUNITY PLACEMENT SUMMARYPRACTICE PLACEMENT AREA: DATES:

I have received and discussed student’s previous placement records Sign-off mentor’s signature:

RECORD OF DEVELOPMENTAL PLAN AT INITIAL MEETING To be completed by the student prior to initial meetingStudent’s goals and expectations

Student’s signature:…………………………………….. Date:Print Name

To be completed by the mentor at the initial meetingAgreement of learning opportunities during the placement

Sign-off mentor’s signature: Date:Print Name

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RECORD OF MID-POINT MEETING AND COMMENTS:Student’s self-assessment of progress:

Students’ signature: ………………………………… Date:

Sign-off mentor’s comments:

Sign-off mentor’s signature: ………………………….. Date:

USE THIS SECTION ONLY IF NECESSARY. Sign-off mentor’s action plan for areas of concern if required.

ACTION PLAN: REVIEW OF OUTCOMES:

Print Name Sign and Date Sign and DateStudentSign-off mentorLink lecturer/PEF

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RECORD OF FINAL MEETING AND COMMENTS:Student’s evaluation of achievement:

Student’s signature: ……………………………………Date:

Sign-off mentor’s rationale for mark awarded:

COMPETENCIES: PASS/FAIL OVERALL MARK ……. Sign-off mentor’s signature: ……………………………Date:

Module Leader’s Comments:

Signature, Print Name and Date:

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Assessment Criteria – Clinical Score-Directions for use: Level 9The scoring system is based on the assessment of each element of practice. Each box has the same 4 criteria which identify progress according to performance. Based on your experience and comments from other sign-off mentors you need to decide whether the student is excellent, pass or fail. Once you have decided which box best describes your student’s performance; you should mark according to the box you have chosen. For example, if you feel that the student is a pass this automatically means that the student will receive a mark of 40% with additional scoring increasing it to a maximum of 64%.

Overall Judgement

Domain criteria Available Score

Actual Score

Overall score

Excellent (merit)

100-65%

Domain 1Effective midwifery practice

Excellent care and clinical skills achieved at level 9, at all times with exceptionally effective practice

0-9

Domain 2Professional and ethical practice

Consistently critically reflects on professional practice and is fully aware of the ethical issues within midwifery practice

0-9

Domain 3Developing the individual midwife and others

Can clearly evaluate own learning requirements in practice in relation to the need for life long teaching and learning for themselves and others: Principles and processes relating to revalidation

0-9

Domain 4Achieving quality care through evaluation and research

Excellent ability to apply research and the evidence to practice 0-8

Pass64-40%

Domain 1 Good care and clinical skills achieved at level 9, with good effective practice 0-6Domain 2 Regularly critically reflects on professional practice and is aware of the ethical

issues within midwifery and midwifery practice0-6

Domain 3 Can evaluate some of her own learning requirements in practice in relation to the need for life long teaching and learning for themselves and others: Principles and processes relating to revalidation

0-6

Domain 4 Ability to apply research and the evidence to practice 0-6Fail

39-0%Domain 1 Care and clinical skills not achieved at level 9 0-10

Domain 2 Minimal or no critical reflection on professional practice and does not indicate awareness of the ethical issues within midwifery

0-10

Domain 3 Is unable to or has limited ability to evaluate her own learning requirements in practice in relation to the need for life long teaching and learning for themselves and others: Principles and processes relating to revalidation

0-10

Domain 4 Limited or no ability to apply research and the evidence to practice 0-9

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COMMUNITY PLACEMENTP or Fail If there is no opportunity for the student to demonstrate a competency, enter “EV” to denote that she/he has the

underpinning theoretical knowledgeP or Fail Sign-off mentors


Communication Domain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeNormal labour and birthInitiation and continuance of breastfeedingMedicines management

Demonstrates effective communication skills with women throughout their pregnancy and postnatal periods; developing supportive relationships with women and their families. Utilise active listening strategies with women and their families, enabling them to make informed choices about their health and health care including gaining informed consent.Provide opportunities for women to disclose domestic abuse and can respond appropriately.Identifies and justifies health promotion strategies available in the community which are women and family focused. Discusses with women local/national information to assist with making choices, including national and local voluntary agencies and websites.Initiates and engages in multidisciplinary communication. Competently provides information about the pregnancy care services and options available, such as: lifestyle considerations, dietary information and screening tests.

DiagnosisDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeNormal labour and birthInitiation and continuance of breastfeedingMedicines management

Practices and evaluates the holistic assessment and monitoring of women throughout the preconception, antenatal and postnatal period.Include the following: History taking, observation, physical examination and biophysical tests, social, cultural and emotional assessments.Initiates and justifies the monitoring of fetal wellbeing which includes assessment of the fetal heart rate through auscultation using a pinard stethoscope/sonicaid and noting fetal movements. Interprets data/results accurately and shares this information sensitively with women and families considering any further action/consequences. Demonstrates the ability to seek out required information about less common or specialised antenatal screening tests.

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COMMUNITY PLACEMENTP or Fail If there is no opportunity for the student to demonstrate a competency, enter “EV” to denote that she/he


signature DateStudent MentorCare planningDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersESC: CommunicationInitial consultation between the woman and the midwifeInitiation and continuance of breastfeeding

Initiates appropriate care planning made in partnership with women and other health care professionals which is evidence based and respects culture, choice and individual context.Demonstrates a critical understanding of plans for birth, infant nutrition, preparation for parenthood and postnatal support. Actively facilitates women’s choice for place of birth, supporting health, safety and wellbeing outwith the acute hospital environment. Offers and/or delivers parent education or group sessions to share information in a variety of forums/multimedia activities, which empower women to recognise normal pregnancy and when to seek advice.Evaluates care plans: making and documenting amendments to improve outcomes.

Care provision Domain: Effective midwifery practiceProfessional and ethical practiceAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeInitiation and continuance of breastfeedingMedicines management

Critically discusses the variety of models and environments where midwifery care is delivered, consider non-traditional NHS care settings.Creates and maintains an environment which promotes health, safety and security where care is provided.Provides women centred, evidence based care in partnership with women and other care providers to promote continuing health and wellbeing.Takes an accurate social, medical, surgical and obstetric history in order to determine the woman’s pathway of care. Supports choice and gives the woman an opportunity to ask questions.

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signature DateStudent MentorCare provision (cont.…)

Discusses and critically reflects upon the role of the midwife in normal pregnancy. Undertakes the assessment of risk and the needs of women by determining maternal and fetal wellbeing relevant to their stage of pregnancy.With minimal supervision balances competing/conflicting priorities. Practices and reflects on midwifery care for women with complex needs; for example; pregnancy loss, stillbirth, neonatal death, previous operative or assisted deliveries.

ReferralDomain: Effective midwifery practiceProfessional and ethical practiceESC: CommunicationInitial consultation between the woman and the midwife

Identifies and initiates appropriate and timely referral for women who would benefit from the skills and knowledge of other professionals.Can justify the reasons for referral such as: women’s choice, health, social and psychological issues, child protection, financial issues and the law.Recognises and evaluates the importance of team working to support the best interests of individual women.

Community, care in labour and birth (if home birth available)Domain: Professional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeNormal labour and birth

Discusses and justifies the care of women labouring at home including how midwives monitor and support the wellbeing of the mother and fetus.

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signature DateStudent Mentor Emergency proceduresDomain: Effective midwifery practiceProfessional and ethical practiceESC: CommunicationMedicines management

Initiates and participates, when appropriate, in emergency procedures that meet the needs of women and their babies such as sudden collapse requiring resuscitation.

Examination and care for babiesDomain: Effective midwifery practiceProfessional and ethical practiceESC: CommunicationInitiation and continuance of breastfeeding

Performs a full daily physical examination of the baby using communication, observation and assessment of wellbeing.Initiates referral pathways for babies with child protection issues.Initiates the referral as necessary for babies with specific health needs.

Infant nutrition Domain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitiation and continuance of breastfeeding

Supports and advises women as they start to feed and care for their baby, recognising the woman’s existing knowledge and skills.Communicates effectively and sensitively the importance of breast feeding to empower women to sustain breastfeeding for the first 6 months. Participates in a variety of forums where information is shared in respect of the advantages and disadvantages of different infant feeding methods. Discusses and justifies the principles of responsive feeding with an awareness of personal thoughts and feelings about infant feeding. Ensures that information shared is ethical and non-judgemental. Actively supports and empowers women to recognise the growth and development of her baby and how to seek advice if concerned.Critically reflects upon the role of the midwife in referral when there is a deviation from expected growth and development and/or feeding difficulties.

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signature DateStudent MentorInfant nutrition (cont.…)

Shares information about national and local agencies/networks that are available to support women in the continuation of breast feeding such as NCT & lactation consultants.Demonstrates a working knowledge of the local demographic area including community breastfeeding support networks and initiatives within the locality.Critically discusses with women the importance of exclusive breast feeding for 6 months and the timely introduction of complimentary foods during the weaning period, into the second year of life and beyond.

Partnership Domain: Effective midwifery practiceProfessional and ethical practiceESC: CommunicationMedicines management

Works in partnership with women to facilitate the provision of seamless care. Discussions should include women centred care, promotion of health and management of risk.Offers care and provides a rationale for the midwifery support available for women regarding future reproductive choices for example contraceptive choices and family planning.

Medicine administrationDomain:Effective midwifery practiceProfessional and ethical practiceESC: CommunicationInitial consultation between the woman and the midwifeMedicines management

(ENU Guidance for Student Midwives and Medicine Administration p37)

Takes an accurate medicine history.Supports women to self-administer medicinal products such as analgesia and iron therapy.

Initiates referral to appropriate practitioners for example pain relief if necessary.Provides a rationale for the safe supply, administration and transportation of medicinal products such as: nitrous oxide, oxygen and controlled drugs (legal and professional regulations).

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COMMUNITY PLACEMENT P or Fail If there is no opportunity for the student to demonstrate a competency, enter “EV” to denote that she/he


signature DateStudent MentorRecord keepingDomain: Professional and ethical practiceAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwife

Completes accurate, legible and continuous records which include the reasoning behind actions taken.Utilises the appropriate information technology systems available to facilitate data analysis and evaluation. Adheres to the data protection laws around maternal and infant records.

Public healthDomain: Effective midwifery practiceProfessional and ethical practiceAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeInitiation and continuance of breastfeedingMedicines management

Shares information with women about public health policies which influence maternity care provision; for example: vitamin D supplementation, antenatal screening tests and immunisation programmes.Discusses and justifies health strategies which target specific groups with particular health needs; for example: smoking cessation. Utilises evidence based practice in relation to the reduction of maternal and perinatal morbidity and mortality for example: Sepsis, Sudden Infant Death.

Respecting the individualDomain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersESC: CommunicationInitial consultation between the woman and the midwifeInitiation and continuance of breastfeeding

Recognises and discusses the different roles and relationships in families, reflecting traditions, religious and cultural beliefs, preferences and experiences and the right to decline services or treatment. Critically reflects on the role of the midwife as an advocate for women and challenges situations/others where the dignity of women may be compromised.Respects women’s autonomy and rights when making a decision even where choice may result in harm to themselves or their unborn baby, unless a court of law orders the contrary.

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Professional practice Domain: Effective midwifery practiceProfessional and ethical practiceDeveloping the individual midwife and othersAchieving quality care through evaluation and researchESC: CommunicationInitial consultation between the woman and the midwifeMedicines management

Practices in accordance with The Code (NMC, 2015) and within the limitations of the individuals’ own competence, knowledge and sphere of professional practice.Contributes to individual, organisational and national audits in order to optimise care of women, babies and their families; for example: the completion of the Newborn Blood Spot Screening documentation.Demonstrates knowledge of legislation relating to human rights, equal opportunities and equality and diversity.Demonstrates understanding of ethical issues which impact on their own midwifery practice.Maintains confidentiality and security of written and verbal information acquired in a professional capacity.Demonstrates awareness and understanding of the need to act within the law when disclosing information about individuals and organisations. Demonstrates understanding of the process of NMC revalidation for midwives in relation to reflection, continuous professional development and practice standards.Maintains midwifery standards by adhering to local uniform policies, practising good time keeping, conducting yourself in a professional manner and adhering to infection control policies.Applies safe moving and handling principles to practice.

Collaborative workingDomain: Effective midwifery practiceProfessional and ethical practiceESC: CommunicationInitial consultation between the woman and the midwife

Practices collaborative working with other health care professionals, the wider health care team and other agencies, such as: social security, benefits and housing.

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ENU Guidance for Student Midwives and Medicine Administration

Please note that within individual NHS Trusts there is variation in practice therefore local unit policies must be consulted to determine the specific roles and responsibilities for students and medicine administration.

Medication which has been prescribed and is not being administered via the intravenous (IV) route may be checked and administered by student midwives under the direct supervision of a registered midwife. All student signatures must be clearly countersigned when supervision of medicine administration has occurred.

Midwives exemption list (MEL) and Patient Group Directions (PGD)

Patient Group Directions (PGDs) should only be used once a registered midwife has been assessed as competent and their name is identified and recorded within documentation retained at ward level. The administration of drugs via a PGD may not be delegated. Students cannot supply or administer under a PGD but would be expected to understand the principles and be involved in the process. Where medication is already subject to exemption order legislation there is no requirement for a PGD. As per guidance from the Nursing and Midwifery Council (NMC) (2011) student midwives may administer, under direct supervision of a sign-off mentor, the medicines found on the MEL except controlled drugs.

For example if Cyclizine Lactate was required this may be administered as a MEL. The student must be under direct supervision during all stages of the administration process. The drug should be checked by the student and the sign-off mentor, the medication is prepared for administration and then the midwife and sign-off mentor must go to the bedside and complete the patient identification checks following which the student may administer the medication and complete the required documentation. For the administration of Phytomenadione (Konakion) found on the MEL, this must be checked by two registered midwives (as it is a paediatric medicine two registered staff are needed) then checked by the student midwife – the student midwife may administer the medicine under direct supervision of that sign-off mentor. When documenting check local policies and guidelines but if required ‘(MEL)’ should be written next to the medicine and all practitioners involved in checking and administration must sign the drug prescription / administration record or Scottish Women Handheld Maternity Record (SWHMR) if used.“Standard 18: Nursing and midwifery students

1. Students must never administer or supply medicinal products without direct supervision.

GuidanceIn order to achieve the outcomes and standards required for registration, students must be given opportunities to participate in the administration of medication but this must always be under direct supervision. Where this is done, both the student and registrant must sign the patient or woman’s medication chart or document in the notes. The registrant is responsible for delegating to a student, and where it is considered the student is not yet ready to undertake administration in whatever form, this should be delayed until such time that the student is ready. Equally a student may decline to undertake a task if they do not feel confident enough to do so. The relationship between the registrant and the student is a partnership and the registrant should support the student in gaining competence in order to prepare for registration. As a student progresses through their training, their supervision may become increasingly indirect to reflect their competence level.”(NMC, 2010) 37

Controlled Drugs

Student Midwives may not administer controlled drugs when they are provided as a MEL or if the controlled drug is to be administered IV. If however the controlled drug is prescribed by medical staff and is not being administered IV then a student midwife may check the medication with a registered midwife and administer the drug under direct supervision.“When controlled drugs are prescribed the second signatory should be another registered health care professional (for example doctor, pharmacist, and dentist) or student nurse or midwife, in the interest of patient care, where this is not possible a second suitable person who has been assessed as competent may sign. It is good practice that the second signatory witnesses the whole administration process. For guidance, go to www.dh.gov.uk and search for Safer Management of Controlled Drugs: Guidance on Standard Operating Procedures.” (NMC, 2010)

Please note that within NHS Lothian the second signatory cannot be a student midwife or nurse - two registered health care professionals must check and witness the administration of a controlled drug. A student midwife may carry out the administration if they have been involved in the whole process of collection and checking of the drug in addition to the two registered midwives.

Within NHS Forth Valley from second year onwards a student midwife may be the second signatory.

Within NHS Fife the second signatory may be a student midwife with no restriction upon the year of study.

Controlled Drug Stock ChecksTwo registered nurses or midwives should perform this check. A student midwife may be the second checker provided they have the necessary knowledge to carry this out.

IV Fluids and MedicationStudent midwives may check and administer under direct supervision prescribed IV fluids with no additives such as Sodium Chloride 0.9% and Plasmalyte or equivalent as per the MEL. Student midwives cannot prepare or administer any IV drug therapy which includes antibiotics, Syntocinon infusions or boluses. However they must observe and understand the process involved. When electronic /medical devices are utilised e.g. infusion pumps or syringe drivers student midwives may only observe.

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References and Resources

Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ (Eds.) (2015) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13.Oxford: National Perinatal Epidemiology Unit, University of Oxford. Accessed 14th March 2016 from: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202015.pdf

National Health Service (NHS) Education for Scotland (NES). (2012) Midwives and Medicines 3rd Edition Interactive Version. Scotland: NES. Accessed 6th February 2015 from: http://www.nes.scot.nhs.uk/media/14194/Midwives_and_Medicines_Third_Edition_Nov2012.pdf

National Institute for Health and Care Excellence (NICE) (2014). Intrapartum care for healthy women and babies (CG190). Accessed 18th March 2016 from: https://www.nice.org.uk/guidance/cg190

Nursing and Midwifery Council (2009). Standards for Pre-registration Midwifery Education. London; NMC. Accessed 14th March 2016 from: https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-preregistration-midwifery-education.pdf

Nursing and Midwifery Council. (2010) Standards for Medicine Management. London: NMC. Accessed 14th March 2016 from: https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-medicines-management.pdf

Nursing and Midwifery Council. (2011). NMC Circular – Changes to Midwives Exemptions. Accessed 5th December 2014 from: http://www.nmc-uk.org/documents/circulars/2011circulars/nmccircular07-2011-midwives-exemptions.pdf

Nursing and Midwifery Council (2015). The Code. London: NMC. Accessed 14th March 2016 from: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

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https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-medicines-management.pdf

https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-medicines-management.pdf

https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-preregistration-midwifery-education.pdf

https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-preregistration-midwifery-education.pdf

https://www.nice.org.uk/guidance/cg190

https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202015.pdf

https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202015.pdf

Edinburgh Napier UniversitySchool of Nursing, Midwifery and Social Care

Midwifery Practice Placement Record of Hours

NameMatriculation number

IntakeTrimester

Placement area/s include all 1.

Date Placement commenced

Date placement was completed

Total Hours worked

Total hours sickness/Absent

Occasions Absent

1.2.Mentor’s Name

Mentor Signature/s all areas (if required)

NMC requirements Number of births Number of Assisted Deliveries

Total number of births at the beginning of the trimesterTotal number of births at the end of the trimester

On completion of each trimester this form must be submitted for checking to: THE PRACTICE MODULE LEADER along with your Competency Assessment Book, Ongoing Record of Achievement (ORA) and your Student audit forms. Remember, it is your responsibility to:

1. Accurately record the hours worked each week on placement.2. You complete an average of 37.5 hours per week in this Practice 7 Module. This will include

reflection hours however study time.is excluded and is provided in programmed blocks.3. To calculate hours worked per day, from the total hours per shift on a long day deduct 60 minutes

for meal breaks e.g., (12.5 hours – 1, record 11.5 hours worked) and 30 minutes from short shifts e.g., (8 hours – 30 minutes, record 7.5 hours).

4. Ensure your mentor signs the practice placement record of hours work card daily and at the end of each week after the hours are completed. Mentor must sign off any changes to this document.

5. Sick leave is noted as ‘S/L’. Sick leave is to be signed off by your mentor and academic staff will sign off UNI time.

6. Submit Practice Placement Record of Hours card along with your Competency Assessment Book and placement audit forms to the designated person/sign-in box on the date/time indicated by the Practice Module Leader. Do not separate any of the documents.

7. Never falsify Practice Placement records or assessments in any way. This would be considered non-academic misconduct and will affect your fitness to practise (see regulations).

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Week 1 Commencing: ……………………Mon Tues Wed Thu Fri Sat Sun

TotalStartFinish Hours workedDaily signature

Mentor’s signature ____________________________________________________














TotalStartFinish

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Hours workedDaily signature


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