In exercise of the powers conferred by sub section 1 of Section 16 of Indian Nursing Council Act,

रजिस्ट्री स.ं डी.एल.- 33004/99 REGD. No. D. L.-33004/99 सससससससससससससीीीीीीीीीीीीी.............जजजजजजजजजजजजजीीीीीीीीीीीीी.............-------------डडडडडडडडडडडडडीीीीीीीीीीीीी.............एएएएएएएएएएएएएललललललललललललल.............-------------अअअअअअअअअअअअअ.............-------------11111111111114444444444444000000000000033333333333332222222222222000000000000022222222222224444444444444-------------222222222222255555555555552222222222222999999999999944444444444441111111111111 xxxGIDHxxx CCCCCCCCCCCCCGGGGGGGGGGGGG-------------DDDDDDDDDDDDDLLLLLLLLLLLLL-------------EEEEEEEEEEEEE-------------11111111111114444444444444000000000000033333333333332222222222222000000000000022222222222224444444444444-------------222222222222255555555555552222222222222999999999999944444444444441111111111111 xxxGIDExxx असाधारण EXTRAORDINARY भाग III—खण् ड 4 PART III—Section 4 प्राजधकार स ेप्रकाजित PUBLISHED BY AUTHORITY स.ं 147] नई दिल्ली, बुधवार, मार् च6, 2024/फाल्ग नु 16, 1945 No. 147] NEW DELHI, WEDNESDAY, MARCH 6, 2024/PHALGUNA 16, 1945 I.— XLVIII i. ii. i. XLVIII 1584 GI/2024 (1)2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] ii. iii. iv. v. vi. vii. viii. ix. x. (LaQshya)' xi. xii. xiii. xiv. xv. xvi. xvii. xviii. xix. xx. xxi. xxii. xxiii. xxiv. xxv. xxvi. xxvii. xxviii. xxix. xxx. xxxi.[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 3 (LaQshya) 1;g vfHkys[k+ Hkkjr ljdkj ds LokLF; ,oa ifjokj dY;k.k e=a ky; vkSj Hkkjrh; mip;kZ ifj"kn~ }kjk varjkZ"Vªh; çlkfodk ifjla?k ds lg;ksx ls fodflr fd;k x;k gS vkSj jk"Vªh; feMokbQjh dk;Z cy dh ikBîØe milfefr ds vknkuksa ij vkèkkfjr gSA4 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] % 2https://www.internationalmidwives.org/assets/files/definitions-files/2018/06/eng-philosophy-and-model-of-midwifery-care.pdf[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 5 I:6 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] II: III: IV:[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 78 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] (i) (ii) (iii) (iv) (v) (vi) (vii) (i) (ii) (iii) (iv) (v)[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 9 (vi) (vii) (viii) (i) (ii) (iii) (iv) (v) (vi) VIII I II10 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4][भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 1112 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] I: II: III: IV:[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 13 I: II: III: IV: III • • •14 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • • • • • • • • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 15 • • - % - % • % %16 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] × × × × • × × × • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 17 II:18 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] III: IV:[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 1920 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • • • • • IV • • • • • • • • • • • • • • • • • • • • III *ETech BEmONC[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 21 • • • • • • • • • VII • % • • • • •22 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • i. ii. % iii. % I:[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 2324 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] I I • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 25 • • • II • • • • • • • • • • • • • • • • •26 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • • III • • • • • • IV • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 27 • • • • • • • • • • • • • • • o • o o o o • • • • • • • • •28 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • V • • • • • • • • • • • • • VI • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 29 • • • 'kSf{kd vè;;u bdkbZ le; ¼?kaV½s vè;;u ds urhts fo"k; fufgr dk; Z vkadyu fofèk xfrfofèk;ka I Vh&2 Lo;a ds Kku vkèkkj vH;kl ds fy, Kku fodflr • O;k[;ku] VîwVksfj;y] • vH;kl eas Kku • O;fDrxr vkSj fodkl {ks=ksa dk djuk vkSj Kku dks vH;kl eas Nk= dh vxqokbZ ds vuqç;ksx vè;;u vkadyu ykuk okyh lsfeukj ij fufgr dk; Z ;kstuk ds vkbZlh,e n{krkvks a • f'k{kk vkSj vH;kl dh rkdr • Lo&funsfZ'kr vè;;u rS;kj djuk] lkFk dh le> çnÆ'kr • n{krk,a D;k gSa] vkSj vè;;u] • vkbZlh,e n{krkvksa tSls] iksVZQksfy;ks djuk vkSj buds f'k{k.k dh fofHkUu fofèk;ka dk mi;ksx djrs gq, varxHZkkZ'k;h vkSj fo#) vkadyu djuk D;k gSa\ ifjn`'; fodkl n[s kHkky es a ykWx&cqd dk • bUgas fodflr djus ds fy, vkj,elh fodkl Çpru'khy vH;kl dh vuHqko rS;kj djuk O;k[;k djuk vkSj • feMokbQjh Kku] Çpru'khy bldk mi;ksx vH;kl vkSj fofHkUu n`f"Vdks.k vè;;u vkSj Kku dks ds ckjs es a D;k vuks[kk gS\ fodflr djus ds fy, dSl s fd;k tk ldrk gS30 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 'kSf{kd vè;;u bdkbZ le; ¼?kaV½s vè;;u ds urhts fo"k; fufgr dk; Z vkadyu fofèk xfrfofèk;ka II Vh&2 'kS{kf.kd fl)karksa dh feMokbQjh f'k{k.k ij ykxw gksus • dqN vkbZlh,e • fdlh Hkh {ks= • iksVZQksfy;ks le> çnÆ'kr djuk] okys 'kSf{kd fl)kar n{krkvks a vkSj es a vkbZlh,e dk fodkl ftles a vuHqkokRed • vuHqkokRed çKrk] MCY;w,pvks n{krkvks a ds • ikB ;kstuk çKrk] dkS'ky ifjn`';&vkèkkfjr vè;;u] feMokbQjh ,MwdsVj vkèkkj ij ikB dk vkadyu vè;;u] vè;;u dkS'ky] vH;kl es a daihVsla h Mksesla ds ;kstuk rS;kj ifjn`';&vkèkkfjr f'k{k.k vkSj vkadyu] oSpkfjd vkèkkj ij 'kSf{kd djuk vè;;u] vè;;u fMtkbu] f'k{k.k vH;kl&vkèkkfjr nf`"Vdks.k vkSj ikB vè;;u 'kkfey gSa] ;kstuk,a fodflr ysfdu bUgÈ rd djuk lhfer ugÈ gSa III Vh&2 vkbZlh,e n{krkvks a feMokbQjh vH;kl ds fy, • vkbZlh,e n{krkvks a • fyf[kr • vkbZlh,e vkSj MCY;w,pvks vuqHkokRed vkSj ds vkèkkj ij fofHkUu ifjn`'; vkSj n{krkvks a ds çf'k{kd n{krkvks a dks ifjn`';&vkèkkfjr vè;;u ifjn`';ksa dks fodflr d{kk es a f'k{k.k vkèkkj ij lh[ku s ds fy, vkèkkj • ifjn`';&vkèkkfjr vè;;u] djus vkSj MCY;w,pvks ds fy, ml ifjn`'; dk ds :i es a vH;kl ls vH;kl] i<+us ;k vkWuykbu çf'k{kd n{krkvks a dh ifjn`'; dk vkadyu ifjn`'; fodflr lla kèkuks a ls ifjn`'; dSls lhek ds fgLls dks mi;ksx djuk djuk fodflr fd;k tk, ,dhÑr djus okyh • iksVZQksfy;ks • vH;kl vkèkkfjr f'k{kk ftles a xgu dk;Z'kkyk,a fodflr djuk uSnkfud fu.kZ; yus k] O;ogkj • d{kk es a MCY;w,pvks es a lk{; dk mi;ksx djuk n{krkvks a dh lai.w kZ 'kkfey gS J`a[kyk dks 'kkfey • uSnkfud {ks= es a vH;kl gsrq fd;k tk,xk f'k{kk dks vkdkj nsuk • fleqys'ku dk mi;ksx djuk IV Vh&3 ifjoruZ dkjh vkSj 'kSf{kd nf`"Vdks.k • vH;kl% lca aèkijd çlkfodh; • lca aèkijd f'k{kk & lacèakijd Nk= vkSj f'k{kd ds n[s kHkky ds fy, çlkfodh; ns[kHkky ds fy, chp ldkjkRed 'kSf{kd n`f"Vdks.k dh çlkfodkvks a dks rS;kj djuk lca aèk cukuk le> dk çn'kZu ¼Nk=@f'k{kd@ • Hkwfedk fuoZgu% djuk vkSj vuqç;ksx efgyk@ifjokj½ ifjn`'; vkèkkfjr • Hkwfedk fuoZgu • ifjoruZ dkjh f'k{kk & vè;;u ds fy, fyf[kr ifjoruZ dkjh çlkfodh; vky[s k n[s kHkky ds fy, çlkfodkvks a dks rS;kj djuk • Nk= dsfaær vè;;u • ;ksX;rk vkèkkfjr f'k{kk@ çf'k{k.k V Vh&3 f'k{k.k vkSj uSnkfud f'k{k.k vkSj uSnkfud çf'k{k.k • ifjppkZ vkSj • vH;kl f'k{k.k% • fucaèk] laf{kIr ,l,y&2 çf'k{k.k ds fl)kar o dkS'ky vuHqkokRed çKrk fl)kar vkSj mÙkj vkSj lh,y&5 j.kuhfr;ksa@ dkS'kyks a • f'k{k.k&vè;;u çfØ;k • vH;kl f'k{k.k% fofHkUu f'k{k.k ,elhD;w dh O;k[;k djuk • o;Ld vè;;u fl)kar fl)kar vkSj dkS'ky i)fr;ks a dk • vH;kl • f'k{k.k ds rjhds & fleqys'ku] çn'kZu mi;ksx djds f'k{k.k Nk=&dsfaær vkSj ifj;kstuk,a] leL;k&vkèkkfjr • Çpru'khy vè;;u dkS'ky çn'kZu l=@lw{e lca aèkijd vè;;u ij vè;;u] vH;kl dk vH;kl djuk • ikB ;kstuk] f'k{k.k è;ku dsfaær djrs gq, • Çpru'khy vè;;u • Hkwfedk fuoZgu tkap lwph] fofHkUu f'k{k.k n'` ;&JO; • l{w e f'k{k.k i)fr;ks a dk mi;ksx lkèku ¼,oh • ikB ;kstuk vkSj dkS'ky tkap djuk ,M~l½ rS;kj lpw h rS;kj djuk djuk lgdeÊ leh{kk vkSj • ,oh ,M~l rS;kj djuk • ekeys dk vkRe&Çpru • ekeys dk vè;;u rS;kj vè;;u rS;kj xfrfofèk;ks a es a Hkkx djuk] ekeyk@fleyq s'ku djuk] ysuk ifjn`'; ekeyk@ • ekLVj vkSj uSnkfud jksVs'ku fleqys'ku ikjLifjd lapkj dks ;kstuk rS;kj djuk ifjn`'; c<k+ok nsuk • uSnkfud f'k{k.k fofèk;ka & • l{w e f'k{k.k nkSj s vkSj çfrosnu] csMlkbM[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 31 'kSf{kd vè;;u bdkbZ le; ¼?kaV½s vè;;u ds urhts fo"k; fufgr dk; Z vkadyu fofèk xfrfofèk;ka lQy çlkfodk& fDyfud] lEesyu efgyk lk>snkjh • uSnkfud çhlsIVjf'ki] esVa Çjx LFkkfir djus ds fy, vkSj jksy ekWMÇyx vko';d lapkj • lgdeÊ&leh{kk] vkRe&Çpru dkS'ky dh igpku • ikjLifjd lapkj djuk o lpa kj o nyh; lpa kj fofoèk lkaLÑfrd o Vdjko çcaèku leqnk;ksa ds chp • çlkfodk vkSj efgyk ds chp çHkkoh lapkj dh çHkkoh vkSj f'k"V lapkj pqukSfr;ksa dks • fofoèk lkaLÑfrd leqnk;ksa ds igpkuuk chp lapkj • ekxZn'kZu ,oa ijke'kZ VI Vh&3 Kku vkSj dkS'ky vkadyu@ewY;kadu ds rjhds • ifjppkZ vkSj • Kku vkadyu • fucaèk] ,l,y&2 vkadyu ds fofHkUu • Kku vkadyu% fuEufyf[kr vuHqkokRed çKrk ijh{k.k dh lfa{kIr mÙkj rjhdks a dh O;k[;k dh rS;kjh • Lo&funsfZ'kr vè;;u rS;kjh vkSj djuk o fucaèk • fleqys'ku • vks,llhbZ ,elhD;w o lfa{kIr mÙkj LVs'kuks a vkSj • vks,llhbZ o ,elhD;w fleqys'ku {ks=ksa vkadyu midj.k • dkS'ky vkadyu dh LFkkiuk fodflr djuk o fufgr dk; Z • vkadyu ds o i;Zos{k.k tkaplwph fy, psdfyLV o vks,llhbZ@vks,lihbZ rS;kj djuk o O;kogkfjd ijh{kk Lo&ewY;kadu@ o ekSf[kd ijh{kk leh{kk es a Hkkx ysuk • eukso`fÙk dk vkadyu% eukso`fÙk ds iSekus II II32 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4][भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 33 I • • • • • • • II • • • • • •34 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • • III • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 35 I • • • • • • • • • • • • • • • • • • • II • • • • • • • • • • • 3;gka ;g mYys[kuh; gS fd çlkfodk vkSj efgyk ds chp lk>snkjh lacaèk eas] nksuksa leku :i ls vko';d] ysfdu vyx&vyx] ;ksxnku nsr s gSaA efgyk ifjHkkf"kr djrh gS fd mldk ifjokj dkSu gS vkSj os Hkkxhnkj dSls cusaxsA tkudkjh lk>k dh tkrh gS] fu.kZ;ksa ij ckrphr dh tkrh gS vkSj efgyk ,sls fu.kZ; ysrh gS tks mlds fy, lgh gksr s gSaA çlkfodk efgyk ds fu.kZ;ksa dk leFkZu djrh gSA is;jeSu ,oa vU; ikBîiqLrd es a ^O;ogkj eas lk>snkjh* vè;k; ns[ksaA36 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • • • o • • • • • • • • • • • • • • • • o • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 37 • • • o • • • III • • • • • • • • • • • • o o •38 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • o o o o o o IV • • • • • • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 39 • • • • • • • • V • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •40 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • o o o o o VI • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 41 • • • • • • • VII • • • • • • • • • • • • • • • • • •42 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • VIII • • • • • • • • • • • • • • • • IX • • • • • • • • • • • • • • • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 43 • • • • • o o • • I • •44 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • II • • • • • • • • • • • • • • • • • • • III • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 45 • • • • • • • • • IV • • • • • • • • • • • • • • • • • •46 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] V • • • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 47 I • • • • • • • • • • • • • • • • o • ✓ ✓ ✓ o ✓ o o48 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] ✓ ✓ o o o o ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ o o o o o o • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 49 II • • • • • • • • • • • • • • • • • • • o o o • • o o o • o o o50 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] o o o o o • • o o • • • III • • • • • • • • • o • o • o o • o o o[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 51 o o • o o • o • • IV • • • • • • • • • • • • • • • • • o • • • • •52 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • • • • • • • • • V • • • • • • • • • • • • • • • o • • o[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 53 • o ✓ o • o o o o o o54 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] I • • • • • • • • • • • • • • • • • • • • • • • • • o o o • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 55 • II • • • • • • • • • o • o o o • o • o • • • • III • • • • • • • •56 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] o o o • • • • III:[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 57 I • • • • • • • • • • • • II • • • • • • • • III • • • • • o • o • o • o58 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • o o • o o • • o IV • • • • • • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 59 • IV: • • • •60 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • • o o • • • • • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 61 • •62 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • • • • • • • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 63 • • • • • • • • • • • • • • •64 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] [जवज्ञापन-III/4/असा./796/2023-24] I • • • • • II I:[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 65 II: III:66 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] IV: III[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 6768 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] MgSO 4[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 69 • • • •70 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4][भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 71 * • • • IV72 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 73 • V74 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] VI • • • • • • • • • • • • • • • • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 75 • • • • • • • • • • • • • • • • • • • https://www.who.int/maternal_child_adolescent/topics/quality-of-care/midwifery/strengthening- midwifery-education/en/ • https://www.who.int/hrh/nursing_midwifery/educator_competencies/en/ • https://www.internationalmidwives.org/our-work/policy-and-practice/essential-competencies-for- midwifery-practice.html • https://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-care-compared-other- models-care-women-during-pregnancy-birth-and-early • https://www.whiteribbonalliance.org/wp-content/uploads/2017/11/Final_RMC_Charter.pdf • https://transform.childbirthconnection.org/reports/physiology/ • https://www.whiteribbonalliance.org/whatwomenwant/ • •76 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • http://www.open.ac.uk/opencetl/files/opencetl/file/ecms/web- content/Finlay-(2008)-Reflecting-on-reflective-practice-PBPL-paper-52.pdf • • • • • • • • https://www.internationalmidwives.org/our-work/policy-and-practice/essential-competencies-for- midwifery-practice.html • CD004667. DOI: 10.1002/14651858.CD004667.pub5 • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 77 • • • • • • VII (i) (ii) (iii)78 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] (i) (ii) (iii) (i) • % • % • (ii) • % • % •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 79 (iii) • • • % • • % • * × • × • * • × × × • × • • • • • • * × ×80 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • A • • • B • • D • • • • •[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 81 • • • • • • • • • • • • (i) • • D • • • • E (ii)82 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • • • F • • B C i. ii. % % iii. % C VII A %[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 83 % % % % × = × = × = × +1× = I. × II. × III. × IV. × × ifjf'k"V&B% vda rkfydk dk çk:i B ijh{kk cksMZ dk uke jkT; çrhd@fpUg vad fooj.k & ,uih,e çf'k{kd dk;ZØe ikB~;Øe ,uih,e çf'k{kd iathdj.k la[;k84 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] C vH;FkÊ dk ijh{kk cksMZ dk uke vfHkçekf.kr çrhd@fpUg Nk;kfp= jkT; vkaf'kd iw.kZrk dk vufare çek.ki= ----------------------------------------------------------------------------------------------------------------------------------------- ijh{kk cksMZ ,rn~}kjk çekf.kr djrk gS fd -------- ----------------------------------------------------------- dks tUe s @ tUeh ------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------- dks ulZ çSfDV'kuj feMokbQjh ,MwdsVj ¼,uih,e ,MwdsVj½ dk;ZØe es a ços'k fn;k x;k gS vkSj iathdj.k la[;k ------------------------------------------------------- ds lkFk fnukad ------------------------------------------- dks vk;ksftr ijh{kk es a bls vkaf'kd :i ls iwjk djus ij fofèkor fu;qDr ijh{kdks a }kjk vuafre çek.ki= çkIr djus ds fy, ;ksX; çekf.kr fd;k x;k gSA cksMZ dh eqgj LFkku% frfFk% jftLVªkj lfpo@vè;{k[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 85 ijh{kk cksMZ dk uke çrhd@fpUg çrhd@fpUg ijh{kk cksMZ dk uke vH;FkÊ dk jkT; vfHkçekf.kr Nk;kfp= jkT; vkaf'kd iw.kZrk dk vufare çek.ki= ----------------------------------------------------------------------------------------v---k-af--'--k-d---- --i---w.--k-Z-r--k-- --d----k- --v---u---fa--r---e-- - çiejkh.{kkik =c ksMZ ,rn~}kjk çekf.kr djrk gS fd -------------- ----------------------------------------------------------------------------------------------------- --d----k-s ---t---U--e--- s--@----- --t----U-e---h-- ------------------------------------------------------------------------------------------------------- ---i--j---h-{--k-k- ---c--k--sM---Z --,---r---n---~}---k-j--k- ---ç--e---k--f-.--k-r--- ---d---j---r--k-- --g---S --f-d---- ------------------ ----------------------------------------------------------------------------------------- ---d----k-s ---u---l---Z dçSfkDs Vt'Ukeu sj@ fe MtoUekbh Q--j--h- ---,---M---wd----sV---j-- ---¼-,---u---i--h--,--e--- ---,---M---wd----sV--j---½- ---d----k-;---ZØ----e--- ---e--as ---ç---o--s'---k- ---f-n---;---k- ---x---;---k- ---g---S ---v---k--Sj- iat-h--d----j--.--k- ---l---a[---;---k- ------------------------------------------------------------------ ---d----k-s --u---l----Z --ç---Sf-D Vd's kuljkF kf efMnoukkbadQ j--h- ---,---M---wd----sV---j-- --¼--,---u--i---h-,---e--- --,- Mdwdks sVvj½k; dksftk;rZØ ei jhe{s akk çeos'as kb lfns ;vk kafx'k;dk :ig S lvs ikSjwj k idatjhdus ji.jk lfoa[fè;kok r- --f-u---;---qD---r-- ---i--j---h-{--k-d----k-s a--}---k--j--k- --v----u---af-r---e dçs elk.kkFik= fnçukIkrad d--j--u---s --d----s --f-y----,--- --;---k-sX--;--- --ç---e---k-f .kdrk s fdv;k;k ksfxt;rk giSAj h{kk es a bls vkaf'kd :i ls iwjk djus ij fofèkor fu;qDr ijh{kdks a }kjk vuafre çek.ki= çkIr djus ds fy, ;ksX; çekf.kr fd;k x;k gSA cksMZ dh eqgj LFkku% frfFk% jftLVªkj lfpo@vè;{k vH;FkÊ dk çrhd@fpUg vfHkçekf.kr Nk;kfp= LFkku% frfFk% jftLVªkj lfpo@vè;{k cksMZ dh eqgj86 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] ijh{kk cksMZ dk uke vH;FkÊ dk jkT; vfHkçekf.kr Nk;kfp= çrhd@fpUg fMIyksek çek.ki= ulZ çSfDV'kuj feMokbQjh çf'k{kd ----------------------------------------------------------------------------------------------------------------------------------------- ijh{kk cksMZ ,rn~}kjk çekf.kr djrk gS fd ------------------------------------------------------------------- dks tUe s @ tUeh ------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- dks ulZ çSfDV'kuj feMokbQjh ,MwdsVj ¼,uih,e ,MwdsVj½ dk;ZØe es a ços'k fn;k x;k gS vkSj iathdj.k la[;k ------------------------------------------------------- ds lkFk fnukad ---------------------------- ---------------------- dks vk;ksftr ijh{kk eas bls vgZrk çek.ki= çkIr djus ds fy, ;ksX; çekf.kr fd;k x;k gSA cksMZ dh eqgj LFkku% frfFk% jftLVªkj lfpo@vè;{k[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 87 D 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- 21- 22- 23- 24- 25-88 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 26- 27- 28- 29- 30- E[भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 8990 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4][भाग III—खण् ड 4] भारत का रािपत्र : असाधारण 91 VIII92 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] INDIAN NURSING COUNCIL NOTIFICATION New Delhi, the 16th February, 2024 Indian Nursing Council {Nurse Practitioner in Midwifery (NPM) Educator Program}, Regulations, 2023 F.No. 11-1/2022-INC(i).—In exercise of the powers conferred by sub-section (1) of Section 16 of Indian Nursing Council Act, 1947 (XLVIII of 1947), as amended from time to time, the Indian Nursing Council hereby makes the following regulations, namely:— 1. SHORT TITLE AND COMMENCEMENT i. These Regulations may be called the Indian Nursing Council {Nurse Practitioner in Midwifery (NPM) Educator Program}, Regulations, 2023. ii. These shall come into force on the date of notification of the same in the Official Gazette of India. 2. DEFINITIONS In these Regulations, unless the context otherwise requires i. ‘the Act’ means the Indian Nursing Council Act, 1947 (XLVIII of 1947) as amended from time to time; ii. ‘the Council’ means the Indian Nursing Council constituted under the Act; iii. ‘BEmONC’ means Basic Emergency Obstetric and Newborn Care; iv. ‘DOP’ means Directly Observed Practical; v. ‘GoI’ means Government of India; vi. ‘HDU’ means High Dependency Unit; vii. ‘ICM’ means International Confederation of Midwives; viii. ‘ICU’ means Intensive Care Unit; ix. ‘IMNCI’ means Integrated Management of Neonatal Childhood Illnesses; x. ‘LaQshya’ means Labor Room and Maternity Operation Theatre Quality Improvement Initiative; xi. ‘MCQ’ means Multiple Choice Questions; xii. ‘MLCC’ means Midwife-led Continuity of Care; xiii. ‘MLCUs’ means Midwife-led Care Units; xiv. ‘MMR’ means Maternal Mortality Rate; xv. ‘MoHFW’ means the Ministry of Health & Family Welfare, Government of India; xvi. ‘NMTI’ means National Midwifery Training Institute; xvii. ‘NPM’ means Nurse Practitioner in Midwifery; xviii. ‘OBG’ means Obstetrics and Gynecology; xix. ‘OPD’ means Out Patient Department; xx. ‘OT’ means Operation Theatre; xxi. ‘QMNC’ means Quality Maternal and Newborn Care; xxii. ‘RMNCH ’ means Reproductive, Maternal and Newborn Child Health; xxiii. ‘RN&RM’ means a Registered Nurse and Registered Midwife (RN&RM) and denotes a nurse who has completed successfully, recognised Bachelor of Nursing (B.Sc. Nursing) or Diploma in General Nursing and Midwifery (GNM) course, as prescribed by the Council and is registered in a SNRC as Registered Nurse and Registered Midwife; xxiv. ‘SBL’ means Scenario-based Learning; xxv. ‘SDA’ means Safe Delivery App; xxvi. ‘SDGs’ means Sustainable Development Goals; xxvii. ‘SMTI’ means State Midwifery Training Institute;[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 93 xxviii. ‘SNRC’ means the State Nurse and Midwives Registration Council, by whichever name constituted, by the respective State Governments; xxix. ‘UHC’ means Universal Health Coverage; xxx. ‘UNFPA’ means United Nations Population Fund; xxxi. ‘WHO’ means World Health Organisation. NURSE PRACTITIONER IN MIDWIFERY (NPM) EDUCATOR PROGRAM1 1. INTRODUCTION AND BACKGROUND 1.1 Introduction In 2015, India became one of the 193 countries to commit to the Sustainable Development Goals (SDGs), which aim to transform the world by 2030 to a more prosperous, more equal, and more secure planet for all. Needless to say, India’s responsibility is immense as these ambitious goals cannot be achieved without accelerating progress in one- sixth of the world that resides in our country. Health is central to commitments made by the Government of India. For us to be able to ensure healthy lives and promote wellbeing for all at all ages, it is critical to focus on improving our core health indicators, which include maternal and infant mortality. When a pregnant woman enters the health system, she puts her faith in the system to receive high quality services for herself and her newborn. Responding to this faith India has strengthened maternal and child health services in our country under the National Health Mission. India has made tremendous progress over the last few decades in increasing institutional deliveries through the National Health Mission and schemes like the Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram, and this has greatly reduced the maternal and infant mortality. India’s maternal mortality ratio has declined from 254 per lakh live births in 2004-06 to 130 per lakh live births in 2014-16 (Sample Registration System). India has shown impressive gains in reduction of maternal mortality evident from the fact that the compound annual rate of decline of MMR has increased significantly from 5.8% during (2007-09 to 2011-13) to 8.01% (2011-13 to 2014-16). Similar achievements are also visible in reduction of under-five and infant mortality rates. Investments on maternal and child health remain a key focus area under the National Health Mission. Operationalizing First Referral Units, new Maternal and Child Health Wings, Obstetric High Dependency Units and Intensive Care Units; capacity building initiatives such as Dakshata trainings; quality antenatal care strengthening programs such as the Pradhan Mantri Surakshit Matritva Abhiyan etc. continue to be a key priority. In addition to above, the Government of India has recently launched the LaQshya - Labor Room and Maternity Operation Theatre Quality Improvement Initiative. Substantial global evidence exists that addressing the time around and immediately after childbirth is critical for saving the lives of mothers and newborns. Studies conducted by White Ribbon Alliance have also highlighted the need to focus on respectful maternity care. The LaQshya program has thus been launched to provide quality intrapartum and immediate postpartum care and promote respectful maternity care. Despite the tremendous progress, nearly 32,000 pregnant women each year still lose their lives during pregnancy, childbirth and the postnatal period. In addition, 5,90,000 newborns die every year in the first month of life. Additional efforts are needed in India to increase Universal Health Coverage (UHC) and to achieve Sustainable Development Goals (SDGs) for maternal and newborn and child health. The National Health Policy 2017 aims at the reduction of maternal mortality ratio to 100 per lakh live births by 2020. The survival of women and newborns is closely correlated with the care and attention received during pregnancy and, most importantly, at the time of delivery. Delayed management of cases, due to lack of access to skilled care, is one of the major reasons for the deaths, particularly in the rural areas. Skilled and respectful care during childbirth is important because millions of women and newborns develop serious and hard to predict complications before, during or immediately after delivery. Evidence shows that quality midwifery care, provided by midwives educated to international standards, reduces maternal and newborn mortality and stillbirth rates by 83%. And with 56 improved maternal and newborn health outcomes, it is also evident that 87% services can be delivered by midwives educated to international standards. There also has been an increasing body of evidence globally that Midwife-led Care Units (MLCUs) can address maternal and neonatal mortality and morbidity by promoting quality and continuity of care through provision of women-centric care and promoting natural births. Where a model of Midwife-led Continuity of Care (MLCC) is introduced, this reduces preterm birth by 24%. Beyond survival, quality midwifery care improves breastfeeding rates and psychosocial 1This document has been developed by Ministry of Health & Family Welfare, Government of India and the Indian Nursing Council in collaboration with the International Confederation of Midwives and based on inputs from the curriculum sub-committee of the National Midwifery Task Force.94 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] outcomes, and reduces the use of unnecessary interventions, in particular caesarean sections and increases access to family planning (Lancet Series, 2014; UNFPA, 2014 & WHO, 2017). The International Confederation of Midwives outline the midwifery philosophy and model of care2. Midwifery has a unique body of knowledge, skills and professional attitudes drawn from disciplines shared by other health professions such as science and sociology, but practised by midwives within a professional framework of autonomy, partnership, ethics and accountability. Midwifery is an approach to care of women and their newborn infants whereby midwives optimise the normal biological, psychological, social and cultural processes of childbirth and early life of the newborn; work in partnership with women, respecting the individual circumstances and views of each woman; promote women’s personal capabilities to care for themselves and their families; and collaborate with midwives and other health professionals as necessary to provide holistic care that meets each woman’s individual needs. Midwifery care is provided by an autonomous midwife. 1.2 The ‘Midwifery Services Initiative’ of India Considering the need for trained human resources to provide quality care to 30 million pregnancies every year in India and at the same time recognizing the challenges earlier, Government of India has proposed an alternative model of service provision for strengthening reproductive, maternal and neonatal health services by nurse practitioners in midwifery through MLCUs. Quality maternity care provided by midwives through the MLCUs is vital to this transformation. The recognition that quality of care will not only save lives but will also provide a positive experience of childbirth means that the change required must be transformative. This will require making fundamental change to the way services are delivered, and the culture of care provided to women. The ‘Guidelines on Midwifery Services in India’ set transformative change must be at the heart of midwifery education. The ‘midwifery services initiative’ aims to create a new cadre of midwives titled “Nurse Practitioners in Midwifery” (NPM) who are skilled in accordance with ICM competencies, knowledgeable and capable of providing compassionate women centered, reproductive, maternal and newborn child health services (RMNCH) and to develop an enabling environment for integration of this cadre into the public health system in order to achieve the SDGs for maternal and newborn health (MoHFW, 2018). 1.3 Preparing Nurse Practitioners in Midwifery (NPM) and NPM Educators for the future of India Quality education is essential to prepare international-standard midwives with ICM competencies with the knowledge and skills to provide the full scope of care that women and newborns need. Evidence indicates that the optimum duration of training required to acquire needed midwifery skills and competencies is 18 months. The existing one-year Nurse Practitioner in Midwifery Post Basic Diploma Program of the Council is re-designed and upgraded to an 18-month intensive residency program to develop more NPMs for providing respectful, highest standards of quality and evidence-based care at the institutional and community levels with specific emphasis on providing safe and competent midwifery care. The essential components for quality midwifery based on the Quality Maternal and Newborn Care (QMNC) framework is also integrated in the curriculum. The Nurse Practitioner in Midwifery (NPM) will be responsible for promotion of health of women throughout their life cycle, with special focus on women during their childbearing years and their newborns. He/She will be responsible for care during preconception, pregnancy, childbirth, and post-natal period and care of newborn. He/She will be responsible and accountable for her practice. The NPM will practice independently and collaboratively with the doctors in the hospital and within the existing peripheral health system consisting of skilled birth attendants, auxiliary nurse midwives, nurses, doctors and specialists. Midwife-led Care Units would be established at high case load facilities. Midwives posted in these MLCUs would be expected to handle the low risk and normal births and will also be expected to ensure initial management and stabilization of women with complications before safely referring them to doctors for further collaborative management. The aspirations and plans for the quality of India’s midwives and their contribution to the transformation of RMNCH services in India, call for a midwifery education program that will combine the ability to practice autonomously to meet the emotional, social, geographical, physical, medical and personal needs of childbearing women, their newborns and families, while shifting the culture of care, learning continuously and working within a novel organization of midwife led care. Such education can only be provided by midwifery educators who have engaged in a curriculum based on international standards and that supports relationship building, critical thinking, reflection, creativity and a good understanding of theory from midwifery and health sciences and apply to judgment, problem solving, diagnostic, communication and clinical skills that are basic to midwifery. Therefore, it is necessary to train a pool of nurse practitioner in midwifery (NPM) educators with the ability to train nurse practitioners in midwifery as per the WHO/ICM competencies and regulations of the Council. It is essential that midwifery educators are well versed with these competencies before they take their role as educators in 2https://www.internationalmidwives.org/assets/files/definitions-files/2018/06/eng-philosophy-and-model-of-midwifery-care.pdf[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 95 order to bring about transformation in the midwifery services provided by the NPMs. The need for this transformative change and the paradigm shift of maternity care must be at the heart of education for midwife educators who will be leaders in the change and ensure the sustainability of education into practice. Responding to this urgent need, the NPM educator curriculum is designed in line with WHO midwifery educator core competencies alongside ICM competencies, that emphasize humanizing transformation and autonomous role of midwives. The curriculum is developed in four course modules, MODULE I: Preparing midwives for relationship based and transformative midwifery care, MODULE II: Preparing midwives for care during pregnancy, birth and puerperium, MODULE III: Preparing midwives to lead, manage and supervise quality midwifery care, MODULE IV: Preparing midwives for evidence-based midwifery practices. It aims to strengthen the technical knowledge, clinical skills and facilitation skills of the midwifery educators alongside role modeling the core values underpinning the midwifery practice. The midwifery educator program prepares competent NPM educators, who can effectively educate and train NPMs to provide quality, compassionate, women-centered, respectful care to woman, neonate and family. The program will also equip the NPM educators in leadership, supervision and management skills and enable them to understand and utilize the research end evidence relevant to midwifery practice. 2. PHILOSOPHY AND VISION 2.1 Philosophy The Council believes that registered nurses need to be given additional education and training to work as nurse practitioners in midwifery (NPMs) in clinical and community settings in the present context of emerging expanded and specialist roles of nurses and advances in technology. Strengthening midwifery education is fundamental to quality midwifery and that the NPM educators need to be trained to international standards before they take their role as educators in order to bring about transformation in terms of humanization and autonomous role in the midwifery services provided by the NPMs. The Council believes that competency-based training would enable the nurse practitioner in midwifery (NPM) educators to demonstrate knowledge, skills and behaviors based on sound evidence-based knowledge, focusing on the concept of ‘women-centered and respectful care’ that is central to midwifery practice. To achieve a respectful environment and to develop students’ knowledge and practice of the relationship-based care that is central to midwifery practice, there is also an emphasis on the student-teacher relationship, communication and attention to power relationships (Cranton, 2009) and emphasis on the role and responsibility of the educator to shape educational experiences for developing the next generation of practitioners (Biesta, 2015). The trained educators will be able to combine their knowledge, attitude and skills with interpersonal and cultural competencies to work independently as well as collaboratively with the inter-professional team. The curriculum for NPM educators, who will play a critical part in developing midwifery into the future and provide ongoing leadership, will therefore need to develop the ability to be responsive to this much-needed radical and complex transformative change, in educating and making fit for practice this new cadre of educated, skilled and compassionate midwives who are prepared for autonomous role in providing midwifery led care for the future of India. Therefore, the NPM educator curriculum philosophy is based on the idea of transformative learning centred on critical reflection, problem-posing and dialogue, as well as attention to praxis (reflection/action/dialectic). The teaching learning approaches will integrate adult learning principles, competency-based education, collaborative learning, experiential learning, mastery learning and self-directed learning. Teaching and learning will be led by midwifery educators supported by medical faculty from Obstetrics and Gynecology, Pediatrics and Public Health for collaborative and interdisciplinary learning as required. The Council believes that the NPM educators involved in training the nurse practitioners in midwifery should be competent in all midwifery skills (knowledge, attitude and practice), well qualified to lead by example in the clinical field and support the management and implementation of the NPM training across the country. The Council also believes that a variety of innovative educational strategies can be used in the clinical settings to provide best clinical learning experiences. It is hoped to facilitate developing policies towards creation of cadre positions for appropriate placement of these NPMs to function in midwifery lead care units. 2.2 Vision The program aims to prepare midwifery educators who are able to engage students in transformative education, with a vision for midwifery and midwifery education for India, who meet the WHO competencies for midwifery educators, and lead development of the midwifery practice and scholarship, through education and research.96 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 3. AIM & OBJECTIVES 3.1 Aim The aim of this educational program is to prepare competent NPM educators to function in the capacity of educators and trainers for nurse practitioners in midwifery, to provide quality and compassionate care to woman, newborn, and family, manage and supervise care of woman and newborn at all the three levels of care, teach NPMs in areas related to woman and newborn care using latest educational technology and prepare them to conduct or participate in research areas of woman and newborn care. 3.2 Objectives The program prepares NPM educators to - 1. Develop and provide transformational education and leadership. 2. Demonstrate achievement of the WHO Midwifery Educator Competencies (2013a). 3. Demonstrate achievement of the ICM Essential Competencies for Midwifery Practice and practice midwifery as per the Council regulations and MoHFW guidelines. 4. Role model skilled, woman-centered, compassionate, respectful midwifery care that meets the needs of women, their newborns and families, and the communities they live in. 5. Demonstrate the ability to use experiential learning methodologies to teach NPMs that prepare NPMs who will practice autonomously within the scope of practice in designated midwife-led services in India. 6. Show a commitment to humanization, professional development, lifelong learning, and leadership in the practice of midwifery. 4. CURRICULUM CONCEPTUAL MODEL The conceptual model places relationships (woman/newborn, educator/student) at the heart of the midwifery educator curriculum as the program seeks to equip educators who will drive the aspirations for a positive childbirth experience in India. The curriculum will reinforce or model woman-centered care by also placing the student at the center of learning. A transformative, competency-based experiential learning approach will equip midwives to become educators who will promote quality midwifery care to address the needs of women in India. Quality midwifery care and transformative midwifery education are underpinned by ICM essential midwifery competencies (ICM, 2019) and WHO Midwifery educator competencies (WHO, 2013). The content, values and philosophy that form this program are informed by current pedagogical best practice. Advancements in learning and teaching show that student learning is enhanced when students are immersed in an intensive experience based on experiential/theoretical learning, with support for professional and personal self- reflection. It is essential that NPM educator receive and provide respectful education, including role modeling respectful behavior while educating and communicating with students in both classroom and clinical practice settings, in order to teach respectful maternity care attitudes. The model is illustrated in Figure 1 below:[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 97 Figure 1. Curriculum Conceptual Model The curriculum focuses on preparing Midwifery Educators attuned to the core values, integrated concepts and maternity care priorities weaved into the curriculum for Nurse Practitioners in Midwifery so that the educators are empowered and capable of providing the transformational education to the upcoming Midwives. The core values, integrated concepts and maternity care priorities weaved into the NPM Educator and NPM curriculums are outlined below: 4.1 Core Values The core values provide a foundation to develop midwives who are committed to promoting a positive childbirth experience for all women and were derived from core government, WHO and ICM documents. These values include: (i) compassion, (ii) respect, (iii) woman, baby and family-centredness, (iv) equity and rights, (v) collaboration and teamwork, (vi) ethical practice, (vii) moral courage. 4.2 Integrated Concepts Within the curriculum there are seven concepts which represent key approaches that inform contemporary midwifery practice. These concepts include: (i) social inequities and midwives as primary health practitioners, (ii) evidence-based midwifery practice, (iii) cultural competence, (iv) quality maternity and newborn care, (v) continuity of midwifery care, (vi) midwifery as a relationship between a woman, baby, family and a midwife, (vii) optimizing physiological birth, (viii) community knowledge. 4.3 Maternity Care Priorities The program provides a strong focus on identified maternity care needs and priorities which are addressed across the curriculum, e.g., (i) improving maternity and newborn care for vulnerable and hard to reach women, (ii) reducing maternal and newborn mortality and morbidity, (iii) effective management of emergency care, (iv) Human rights and gender-based violence, (v) strengthening midwifery-led care, (vi) humanising and de- medicalising birth. 5. QUALITIES OF NPM EDUCATOR The NPM Educator graduating from this program will be an educator, leader and practitioner of midwifery, with an in-depth understanding of midwifery, its role in primary health care, how midwifery could/should evolve in India, the impact on midwifery on women and their families, and how education will enable this. The values of woman- centered care, student-centered teaching, equity and justice, human and reproductive rights, and compassion for others, will be foundational for practice. Midwife educators for the future of India will have vision, leadership qualities, the courage to question, and the ability to form collaborative working relationships to achieve change particularly in changing the existing paradigm of physician led midwifery care to a new paradigm of midwife led care.98 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 6. SCOPE OF PRACTICE On completion of the educational program, the NPM educator will be certified by the Examination Boards approved by the Council and get registered as additional qualification at the SNRC. The NPM educators will ensure the implementation of Nurse Practitioner in Midwifery (NPM) program and provide education and training to those who enroll for the course at the State Midwifery Training Institutes. The NPM educator will also practice midwifery in all settings including hospitals and health centers particularly in midwife led care units (MLCUs), utilizing the knowledge and clinical competencies acquired during the training, alongside mentorship support in strengthening the clinical midwifery competencies. The NPM educator will be able to perform full scope of practice as per education and training and the Council regulations and MoHFW guidelines (Annexure-VIII). The specific roles of the NPM educator and midwifery practitioner are listed in the Annexure-I. 7. COMPETENCIES The Council adapts WHO Core Competencies for Midwifery Educators (WHO, 2013) in educating and training midwifery educators for India with minor modifications in the competencies relevant to NPM program and the framework is given below: It also adapts ICM Essential competencies for midwifery practice (2019) found in Annexure-II. Figure 2. NPM Educator Competencies The competencies are organized under 8 competency domains with a total of 28 competencies for all the domains. Competency Domain 1: Ethical and legal principles of midwifery Midwifery educators incorporate and promote ethical and legal aspects of midwifery care in teaching/ learning activities and by consistent role modelling. Competencies: 1.1 Demonstrate professional accountability for the delivery of midwifery care as per the Council standards that are consistent with moral, altruistic and humanistic principles in midwifery practice. 1.2 Demonstrate understanding of the legal and regulatory principles in midwifery practice within the legal framework of India. 1.3 Demonstrate understanding of midwifery philosophy of care focused on respectful maternity care placing the woman’s sexual and reproductive health rights at the center of the care process.[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 99 Competency Domain 2: Midwifery practice Midwifery educators maintain current knowledge and skills in midwifery theory and practice based on the best evidence available. Competencies: 2.1 Demonstrate knowledge, attitude and skills as per the ICM competencies adopted by the Council to practice midwifery. 2.2 Provide care for normal birth and pregnancy. 2.3 Demonstrate skills in providing safe, competent and effective midwifery care to women and their neonates. 2.4 Practice midwifery that reflects evidence based and up-to-date knowledge. 2.5 Demonstrate respect and empathy towards mother, family and society at all levels of care. Competency Domain 3: Theoretical learning Midwifery educators create an environment that facilitates learning. Competencies: 3.1 Incorporate educational strategies to enhance active learning to develop students’ critical thinking, critical reasoning skills and innovative thinking. 3.2 Select and use effective and appropriate teaching and learning resources. 3.3 Demonstrate skill in providing competency-based skill training using simulation for the students of the NPM course. 3.4 Recognize and support the learning styles and unique learning needs of NPM students. Competency Domain 4: Learning in clinical area Midwifery educators maintain an environment for effective clinical teaching of midwifery care. Competencies: 4.1 Facilitate a safe and effective clinical learning environment. 4.2 Promote individualized experiential learning. 4.3 Demonstrate skills in clinical education and training. Competency Domain 5: Assessment and evaluation of students and program Midwifery educators conduct regular monitoring and evaluation of students and programs. Competencies: 5.1 Assess student competency using various assessment strategies, tools and maintain accurate records. 5.2 Monitor, assess and evaluate the effectiveness of the NPM program. Competency Domain 6: Organization, management and supervision Midwifery educators organize and implement the NPM curriculum effectively. Competencies: 6.1 Participate actively in planning and organizing the NPM curriculum. 6.2 Implement the NPM curriculum effectively and provide feedback for quality improvement. 6.3 Provide facility-based mentoring for the NPM’s after placement. Competency Domain 7: Communication, leadership and advocacy Midwifery educators communicate effectively and function as advocates, change agents and leaders. Competencies: 7.1 Demonstrate effective communication using variety of methods in diverse care delivery settings. 7.2 Demonstrate cultural competence in course design and development and teaching and midwifery practice. 7.3 Function as leaders and change agents to improve midwifery education and practice.100 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 7.4 Use a variety of advocacy strategies to promote midwifery education and practice. 7.5 Participate in professional development activities relevant to midwifery education. Competency Domain 8: Research Midwifery educators promote the use of research and use it to inform midwifery education and practice. Competencies: 8.1 Use research and inform teaching and practice. 8.2 Cultivate a culture supporting critical inquiry and evidence-based practice. 8.3 Train NPM’s to develop skills to conduct, communicate and utilize research. 8. PROGRAM DETAILS 8.1 Program Description The NPM educator training is a six month’s residency program with a main focus on competency-based training facilitated by mastery and experiential learning centered around transformational and relationship-based teaching and learning. The curriculum comprises of four course modules, MODULE 1: Preparing midwives for relationship based and transformative midwifery care, MODULE II: Preparing midwives for care during pregnancy, birth and puerperium, MODULE III: Preparing midwives to lead, manage and supervise quality midwifery care, MODULE IV: Preparing midwives for evidence-based midwifery practices. The curriculum encompasses hands on skill training and orientation to the treatment protocols and drugs permitted for use by NPMs trained to function in various health care settings. This will be followed by a 12-month structured mentorship program where the NPM educators would teach the NPM students as well as practice midwifery simultaneously. The NPM educators maintain the logbooks, keep their portfolio and reflect on experience during the interaction with the mentor individually or in groups, face to face or online. Peer support alongside mentor support is essential component of the mentorship program. A balance of clinical and classroom teaching using a variety of teaching methods will be maintained. As the program sets the standard of midwifery education in India, it is important that these students engage with a program that models contemporary experiential learning. As such the curriculum will be taught incorporating experiential and scenario-based learning approaches (Chorazy M. and Klinedinst K. 2019; Smith et al. 2018; Kolb 1984; Dewey 1938). The curriculum will also utilize a competency-based approach drawing on the eight competency domains from the WHO Midwifery Educator Core Competencies (2013a) and 28 competency statements formulated under these domains. It is expected that, upon completion of the course the midwifery educators of this program will incorporate the same approaches when they begin teaching the new generation of midwives through the 18-month NPM training. 8.2 Program Structure Practicum (Hours) Theory Course Modules (Hours) Skills Lab Clinical (Hours) (Hours) MODULE I: Preparing midwives for relationship based and transformative midwifery 30 5 10 care MODULE II: Preparing midwives for care during pregnancy, birth & puerperium 80 35 790 MODULE III: Preparing midwives to lead, manage and supervise quality midwifery 15 20 care MODULE IV: Preparing midwives for evidence-based midwifery practices 15 20 Total Hours 140 hours 40 hours 840 hours 8.3 Guidelines for Starting the Nurse Practitioner in Midwifery Educator Program 8.3.1 Staffing 1. Faculty Trainer (Teacher): M.Sc. OBG/Pediatrics/Community Health Nursing with minimum 2 years of clinical maternity experience and 5 years of teaching experience. (International Midwifery Educators would be engaged along with Indian midwifery faculty trainers for training initial batches). 2. Medical Preceptors: Medical faculty from Obstetrics and Gynecology, Pediatrics and Public Health with 3 years post PG experience/as a consultant.[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 101 3. Guest Faculty: NHM/MoHFW officials/Experts from other fields. Faculty student ratio: 1:5 Preceptor student ratio: 1:5 No. of seats: Maximum 30 per batch 8.3.2 Physical Facilities 1. Classroom - 1 2. Skills/simulation lab - 1 with necessary equipment and supplies (Annexure-III) 3. Library - Current nursing textbooks including midwifery, maternal, neonatal & journal (National and International publications), relevant GoI guidelines/modules 4. Teaching Aids • LCD projector • Screen for projection • Computer • Laptop • Tablet for IT applications (For ex. Safe Delivery App, e-Partograph and other apps) • Connectors to project tab screens to external screen • 4 Mbps internet leased line • Midwifery related equipment such as Gym balls, Floor mats, Rebose cloth etc. 5. Office facilities for educators 8.3.3 Clinical Facilities Minimum Bed strength and other Clinical Facilities: • 100-200 bedded Parent Hospital having minimum 50 maternity beds or 50 bedded maternity hospital with an established MLCU • Labour room as per the LaQshya guidelines of Government of India • Minimum 6 labour rooms/spaces • Maternal and neonatal units • Case load of minimum 6000 deliveries per year • Maternity OT and Obstetric HDU/ICU • Separate Kangaroo Mother Care Unit • 8-10 level II neonatal beds • Affiliated Heath Sub-Centre, Community Health Centre and Primary Health Centre • Referral links to tertiary care hospital • Affiliation to Tertiary Hospital - Medical College Hospital • Affiliation with level III neonatal beds 8.4 Admission Requirements 8.4.1 Eligibility for Admission The candidate seeking admission to this program should have the following qualifications: • Be a registered nurse and registered midwife (RN&RM). • M.Sc. Nursing with specialty in Obstetrics and Gynaecology, Pediatrics or community health with minimum 2 years of clinical maternity working experience. • B.Sc. Nursing with Nurse Practitioner in Midwifery with 2 years of clinical experience.102 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • Inservice candidates are also eligible for admission and will be receiving their regular salary. Being a residency program, the other students undergoing the program will be given salary/stipend equivalent to their counterparts in the respective organization. Note: • In the initial batches, any M.Sc./B.Sc. Nursing candidate with a minimum of 5 years of clinical maternity working experience, with passion towards midwifery, clinical/hands on experience of conducting deliveries and willingness to continue clinical practice and conduct deliveries. Candidates with teaching experience in OBG nursing will be given preference. Research experience is an added advantage. • The candidate in order to be trained and practicing in midwifery has to obtain registration to practice (RN&RM) in the State where enrolled in the NPM educator program. 8.4.2 Selection Process Selection Criteria and Process Overview for Recruitment of Midwifery Educators is outlined below: • The entrance will be conducted in two parts with certain percentage weightage for each component. The overall score for entrance examination is 100 marks (60 for written test & OSCE and 40 for interview). • Part 1: Written Test and OSCE - Written Test (40%): Multiple Choice Questions and two short essays (2 hours duration) covering the areas of antenatal, intrapartum, postnatal, complication management and neonatal care. Short essays will be screened for technical proficiency as well as fluency in written English. Some weightage should be given for proficiency in written English. - OSCE - Objectively Structured Clinical Examination (20%): An OSCE bank based on current protocols under LaQshya is annexed for reference. • Part 2: Interview (40%) Successful candidates who clear the written test and OSCE will be screened for the following at the interview: 1) Motivational Screening (20%) Based on the information provided in the personal statement of the candidate: a) Passion for woman’s health - to provide respectful care for a positive birthing experience. b) Willingness to undergo the 6-month residential course at the designated NMTI in a different State and 12 months mentorship at their home State in the designated training centre. c) Willingness to serve as individual practitioners of midwifery care - low-risk pregnancies and normal births as posted after the training. d) Willingness to continue with her clinical practice throughout her career, though the distribution between teaching and clinical practice may vary depending on the stage of her career. e) Commitment to program goals and GoI’s vision of providing quality of care around the time of birth. Candidates should have clear understanding of the 18-month training and midwifery-led-model of care. 2) Aptitude Assessment (20%) will be a part of interview process to ascertain spoken English language proficiency and communication, technical knowledge, leadership and advocacy for client’s rights, and team spirit. 8.5 Organization of the Program 8.5.1 Distribution of the program in weeks (26 weeks): 1. Teaching: Theory & Clinical Residency 23 weeks 2. Examination (including preparation) 1 weeks 3. AL + CL + Public holidays 2 weeks 26 weeks 8.5.2 Distribution of the courses for teaching: 23 weeks = 1020 hours Block Classes (Theory & Skill Lab): 3 weeks = 3 × 40 = 120 hours Clinical Residency (Clinical Practice, Theory & Skill Lab): 20 weeks = 20 × 45 = 900 hours[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 103 Details Full Theory Block Classes: 3 weeks × 40 hours per week = 120 hours (Theory 100 hours + Skill Lab 20 hours) Clinical Residency (20 weeks): 20 weeks × 45 hours per week = 900 hours (Theory 40 hours + Skills Lab 20 hours + Clinical 840 hours) • 40 hours of theory and 20 hours of skills lab to be integrated during clinical experience. They can be covered in the form of skill lab learning, faculty lecture, clinical rounds, clinical presentations, drug presentations etc. (3-4 hours per week for 18 weeks: First 10 weeks - 2 hours per week × 10 weeks = 20 hours for skill lab and 2 hours per week × 10 weeks = 20 hours of theory and Next 8 weeks - 3 hours per week × 8 weeks = 24 hours of theory). • The NPM educators would be posted in different shifts as per the duty roster of the clinical facility in maternity service areas only (ANC clinic, Triage, Labour room, Antenatal/postnatal ward, SNCU etc.). • Minimum 45 hours per week and on call duties every fortnight should be given. Total = 140 hours (theory) + 40 hours (skills lab) + 840 hours (clinical practice) = 1020 hours 8.6 Course of Instruction Practicum S.No. Courses Theory (Skills Lab + Areas of Clinical Postings Clinical) I MODULE I: Preparing midwives for relationship-based 30 SL-5 and transformative midwifery care CL-10 Section 1: Relational education: preparing midwives for 15 SL-2 Integrated clinical practices relationship-based midwifery care CL-5 Unit1: Introduction 1 Unit 2: Introduction to Midwifery and what women want 4 Unit 3: Universal rights of childbearing women 1 Unit 4: Respectful relationship-based care 5 SL-1 Unit 5: Maternal and newborn health scenarios 2 SL-1 Unit 6: Chain of Referral system 2 CL-5 Section 2: Transformative education: preparing 15 SL-3 Integrated clinical midwives for transformative midwifery care (Teaching CL-5 practices and Learning Approaches) Unit 1: Developing knowledge for practice and putting 2 knowledge into practice Unit 2: How we learn to be competent - knowledge, skills 2 and behaviour for practice Unit 3: Experiential and scenario-based learning for 2 practice Unit 4: Develop educational approaches based on principles 3 of adult learning Unit 5: Teaching and clinical training skills 3 CL-3 SL-3 Unit 6: Assessment/Evaluation Methods 3 CL-2 II. MODULE II: Preparing midwives for care during 80 SL-35 Pregnancy, Birth & Puerperium CL-790 A.1.1.1 Section 1: Maternal, Fetal and Newborn Physiology 6 SL-3 Unit 1: Review of anatomy and physiology 2 SL-2 Unit 2: Embryology and Fetal growth and development 2 SL-1 Unit 3: Physiological changes in pregnancy 2 Antenatal OPD/ward Section 2: Normal Pregnancy, Birth and Puerperium 22 SL-12 CL-450104 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Practicum S.No. Courses Theory (Skills Lab + Areas of Clinical Postings Clinical) Unit 1: Beginning the pregnancy journey 2 Unit 2: Pregnancy assessment and midwifery care during 1st 3 SL-1 Antenatal OPD/ward Trimester CL-40 Unit 3: Midwifery care during 2nd trimester of pregnancy 1 SL-1 Antenatal OPD/ward CL-40 Unit 4: Midwifery care during 3rd trimester of pregnancy 1 SL-1 Antenatal OPD/ward CL-40 Unit 5: Midwifery care during 1st stage of labour 4 SL-3 Labour room/casualty CL-70 Unit 6: Midwifery care during 2nd stage of labour 2 SL-3 Labour room CL-40 Unit 7: Midwifery care during 3rd stage of labour 2 SL-2 Labour room CL-70 Unit 8: Midwifery care during 4th stage of labour 2 SL-1 Labour room CL-70 Unit 9: Postnatal midwifery care 5 CL-80 Postnatal ward/OPD A.1.1.2 Section 3: Care of the Newborn 6 SL-2 CL-40 Unit 1: Family centered care 1 Postnatal ward Unit 2: Ongoing care of newborn 1 CL-10 Postnatal ward/OPD Unit 3: Risk identification and referral of newborn 2 CL-15 SNCU/NICU/Postnatal ward/OPD Unit 4: Nutritional needs of the newborn and establishing 1 SL-2 Postnatal ward/OPD breastfeeding CL-10 Unit 5: Disease prevention and immunization 1 CL-5 Postnatal OPD/Family Planning ward/ Immunization OPD B SECTION 4: COMPLEX CARE OF THE WOMEN 22 SL-16 AND NEWBORN, HEALTHY FAMILIES AND CL-300 COMMUNITIES Unit 1: Recognition and management of problems during 6 SL-2 ANC OPD/ANC Ward/ pregnancy CL-70 Obstetric HDU Unit 2: Recognition of deviations from the normal and 6 SL-4 Labour ward/Obstetric management during labour CL-70 HDU/Maternity OT Unit 3: Recognition and Management of postnatal problems 4 SL-4 Postnatal Ward/ Obstetric CL-70 HDU Unit 4: Recognition and Management of neonatal problems 4 SL-3 SNCU/NICU CL-50 Unit 5: Healthy families and communities 2 SL-3 Postnatal ward/ CL-40 Family Planning ward C SECTION 5: PHARMACOLOGY, INFECTION 24 SL-2 CONTROL & LEGAL AND ETHICAL ISSUES Unit 1: Applied pharmacology and fundamentals of 20 prescribing Unit 2: Infection Control 2 SL-2 Integrated clinical practice[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 105 Practicum S.No. Courses Theory (Skills Lab + Areas of Clinical Postings Clinical) Unit 3: Legal and ethical issue 2 III. MODULE III: Preparing midwives to lead, manage and 15 CL-20 supervise quality midwifery care Unit 1: Midwifery leadership 4 CL-5 All maternity areas/ MH/DH/CHC Unit 2: Change theories and transformative practice 4 CL-5 Unit 3: Management of MLCU’s 4 CL-5 Unit 4: Records and reports 3 CL-5 IV. MODULE IV: Preparing midwives for evidence-based 15 CL-20 midwifery practices Unit 1: Knowledge and utilization - research and evidence 15 CL-20 Total = 1020 hours 140 hours 40+840 hours 9. TEACHING AND LEARNING Teaching learning within the NPM Educator curriculum draws on Experiential Learning theories. Experiential learning recognizes that learning is an active process that occurs as students interact with authentic activities, experiences and social encounters. The educational process is underpinned by respect, with educators modelling the respectful care and communication that these graduates will engage in with women. The student is intentionally situated at the center of learning and becomes directly involved in the process of constructing knowledge. As such, experiential learning relies on experience, as the source material and thoughtful reflection to facilitate learning. Providing ‘real world’ context to activities and experiences aligns students learning to the types of practice and complexities they might encounter as midwifery graduates. Motivation and engagement increase as students work with real-life situations that require decision-making that reflect the nature of maternity care environments and promote autonomous roles that need to be assumed upon completion of the program and called to lead midwifery care in MLCUs. Experiential learning is also committed to minimizing the theory-practice gap that has been recognized as a challenge in contemporary tertiary health care education. Experiential learning integrates practice with theory, avoiding teaching and learning which occurs in silos. As part of the experiential learning pedagogy students will engage in significant practice experience through midwifery practicums. Practicums will be organized to reflect a diversity of clinical settings across the continuum of childbirth, pre-conception to postpartum and will include hospital and community settings. Students will also be required to engage in defined continuity of care experiences where they follow women through their pregnancy, labour, birth and puerperium. Complementing experiential learning in this program is scenario-based learning (SBL) and reflective practice. SBL uses scenarios which reflect realistic situations, for example they may be based on case studies, critical incidents or narratives, which provide contextual material and/or learning triggers and provide an ideal environment for exploring practice, complexities and encourage critical thinking, problem solving and decision-making skills. The learning processes in SBL moves through phases that requires students to engage in the scenario, analyze the situation, identify learning needs, construct knowledge, reflect and apply learning. Scenario based learning is best provided through tutorials and flipped classroom, where students can access pre-tutorial readings and recorded lectures to support the interactive nature of the learning. A dedicated simulated environment will be developed to provide a safe learning environment where students will have the opportunity through simulation workshops to develop midwifery skills, work in teams, explore scenarios and problems, and practice clinical decision-making. Carefully designed simulation activities will also provide the opportunity to develop communication skills relevant to the women’s needs and health problems, including interacting with scenarios representing families from different demographic and cultural backgrounds, which is vital considering India’s cultural and demographic diversity. Interprofessional learning may also be fostered through implementing team simulation scenarios.106 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Reflective practice assists students to learn from experience, both positive and negative and to gain new insights about themselves and practice. Gibbs cyclic model provides a six-stage approach to systematically reflect on an experience or activity; including description, feelings, evaluation, analysis, conclusion and an action plan. GIBBS CYCLE Experiential learning supported by scenario based learning and reflective practice will be integrated throughout the curriculum in both theoretical and practice components. Teaching and learning arrangements will be organized to encourage collaboration and interaction, examples of teaching modes include tutorials and group work, online resources and lectures, smart classrooms, personal research and reflection, experiential workshops, journal club, post clinical reviews. 9.1 Teaching and Learning Methods Classroom Skills Lab Clinical • Tutorials and workshops • Skill demonstration • Clinical practice under supervision • Lecture cum Discussion • Simulation • Independent clinical practice • Experiential learning • Scenario-based • Bed side clinics • Self-directed learning (Learning reflective learning • Reflective learning resources - Annexure-IV) • OSCE (plan and • Experiential learning • Problem based learning conduction) • Case presentation • Practice teaching • Role play • Case studies/discussions • Micro teaching • Drills • Health talk • Audio-video assisted teaching • Microteaching - skill • Clinical rounds/conference demonstrations • Virtual learning - virtual • Drug discussion and presentation classroom • Videos • Microteaching - theory/skill demonstrations • *Safe Delivery App/any other • Field visit/report apps as self-directed learning • Logbook (Annexure-III) Example: *ETech based learning may be incorporated throughout the curriculum by integration of Safe Delivery App into the various teaching methodologies. The Safe Delivery App is a smartphone application that provides direct and instant access to evidence-based and up-to-date clinical guidelines on BEmONC. The SDA can be used as a teaching and learning tool that covers 11 modules: Infection Prevention, Post Abortion Care, Hypertension, Active Management of Third Stage Labour, Prolonged Labour, Post Partum Haemorrhage, Manual Removal of Placenta, Maternal Sepsis, Neonatal Resuscitation, Newborn Management, Low Birth Weight.[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 107 9.2 Assessment Methods Continuous formative assessments • Self-assessment through reflective learning, as well as peer review • Group work • Objective Structured Clinical Examinations (OSCEs) • Essays, case discussions, literature review, written assignments • Written examinations • Practical assessments - teaching activities, simulation • Teaching observation assessment - direct observation of teaching practice (practice teaching) • Competency assessment • Clinical practice evaluation 10. EXAMINATION REGULATIONS EXAMINING AUTHORITY: Examination boards approved by the Council. The candidates are expected to undergo six months intensive residential training at the National Midwifery Training Institute. During the training, i.e., at the end of three months of training, the educators would be expected to undergo a competency-based examination. However, if the educator does not clear the examination, he/she would be given one chance to reappear for the examination failed either in theory or practical only within 2-4 weeks and if failed again and found unsuitable would be discontinued from the program. The educators who clear the examination at the end of three months would be re-assessed at the end of six months of training followed by final assessment at the end of 18 months. The examination pattern for the 3-month exam would be similar to the examination pattern for the final examination at the end of 18 months. (The examination guidelines are detailed and given separately in Annexure-VII.) 10.1 Eligibility for Admission to Examination • Percentage of attendance in theory and practical before appearing for final examination should be 90%. • Candidate who successfully completes all the requirements such as logbook and clinical requirements is eligible and can appear for the final exam. • Completion of 12-month mentorship experience is mandatory requirement for admission to final examination. • The details of eligibility to appear for first assessment after 3 months and second assessment after 6 months are outlined in the exam guidelines. 10.2 Supplementary Examination • Failed candidates can appear for the supplementary examination after 6 weeks in the final exam failed either theory or practical only. • Number of attempts - 3 10.3 Examination Pattern (One theory paper and one practical examination) Internal (formative assessment) External (summative assessment) Theory 25 marks (tests, assignments, presentations) 75 marks (10 marks - MCQ, 30 marks - short answers, 35 marks - essay/scenario) Practical 50 marks (10 for clinical performance + 10 for clinical 50 marks (20 in OCSE + 30 in DOP assignments + 10 for OSCE + 20 for DOP) 10.4 Practical Examination • A panel of three examiners - Faculty trainer - 2 (one internal and one external) and medical preceptor – 1 (the examiners as well as the medical preceptor who are involved in teaching the program and are familiar with the curriculum) 10.5 Qualification of Examiner • M.Sc. Nursing, OBG specialty with 5 years of teaching or clinical experience after PG with a dual role/M.Sc. OBG nursing with 5 years of experience as faculty with a minimum of 2 years midwifery clinical working experience. • Medical faculty from Obstetrics and Gynecology, Pediatrics and Public Health with 3 years post PG experience/consultant.108 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 11. CERTIFICATION A. Title - Nurse Practitioner in Midwifery (NPM) Educator B. The title is awarded upon successful completion of the prescribed study program, which will state that the candidate i. Has completed the prescribed course of Nurse Practitioner in Midwifery (NPM) Educator. ii. Has attended 90% of the theoretical and 100% of the practical instruction hours before awarding the certificate. iii. Has passed (70% marks both internal and external together) in the prescribed theory and practical examination. C. Certification will be done by the Examination Boards approved by the Council. The SNRC will be registering NPM Educator as an additional qualification. Midwifery Educators, who clear the examinations at the end of six months, should be posted at State Midwifery Training Institutes for training of Nurse Practitioners in Midwifery (NPMs). Six Month training of Midwifery Educators would be followed by one year of onsite mentorship to ensure proficiency of Midwifery Educators. The Examination Boards approved by the Council would provide a provisional certificate to the candidates who have successfully completed six months of training and would further provide a final certification after they have completed the 12 months of mentorship. 12. COURSE MODULES COURSE MODULE I PREPARING MIDWIVES FOR RELATIONSHIP BASED AND TRANSFORMATIVE MIDWIFERY CARE Theory (T): 30 hours Practicum: Skills Lab (SL): 5 hours, Clinical (CL): 10 hours Course Aim This course prepares the students to understand their role as an educator by building on their understanding of midwifery in Indian and global context, thus prepares future NPMs for relationship-based and transformative midwifery care. It aims to prepare educators who have imbibed the principles of midwifery philosophy and practice and are competent and skilled in the art of transformative teaching and learning practices. Course Description Central to this course are the dual concepts of woman-centered care and student-centered learning. The philosophy of midwifery practice based on the scope of practice, code of ethics, and essential competencies by the Council/ICM for the midwife will be explored. This will also enable the NPM educator to gain knowledge on adult learning principles and to develop the skills and attitude in effectively teaching and training nurse practitioners in midwifery. Course Objectives 1. Explore the midwifery educator’s competencies in tangent with the ICM midwives’ competencies in Indian context. 2. Demonstrate an understanding of the midwifery curriculum and key national & international documents and guidelines for midwifery and midwifery education. 3. Demonstrate skills in effective communication and providing respectful maternity and newborn care. 4. Describe current educational theories including experiential and scenario-based learning principles to create an environment to facilitate learning. 5. Identify own learning needs and apply student-directed study goals. 6. Describe group dynamics and the importance of peer review and self-reflection. 7. Develop effective learning, teaching practices and resources based on evidence. 8. Apply competency-based education in the context of midwifery practice across the continuum and the ICM essential competencies. 9. Demonstrate current midwifery knowledge and skills and recognize the role of continuing professional development.[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 109 Competencies (WHO educator competencies) 1. Demonstrate professional accountability for the delivery of midwifery care as per the Council standards that are consistent with moral, altruistic and humanistic principles in midwifery practice. (1.1) 2. Demonstrate understanding of midwifery philosophy of care focused on respectful maternity care placing the woman’s sexual and reproductive health rights at the center of the care process. (1.3) 3. Incorporate educational strategies to enhance active learning to develop students’ critical thinking, critical reasoning skills and innovative thinking. (3.1) 4. Select and use effective and appropriate teaching and learning resources. (3.2) 5. Demonstrate skill in providing competency-based skill training using simulation for the students of the NPM course. (3.3) 6. Recognize and support the learning styles and unique learning needs of NPM students. (3.4) 7. Facilitate a safe and effective clinical learning environment. (4.1) 8. Promote individualized experiential learning. (4.2) 9. Demonstrate skills in clinical evaluation and training. (4.3) 10. Assess student competency using various assessment strategies, tools and maintain accurate records. (5.1) 11. Monitor, assess and evaluate the effectiveness of the NPM program. (5.2) 12. Participate actively in planning and organizing the NPM curriculum. (6.1) 13. Implement the NPM curriculum effectively and provide feedback for quality improvement. (6.2) 14. Demonstrate effective communication using variety of methods in diverse care delivery settings. (7.1) The Course Module I is sub-divided into two Sections: Section 1 – Theory (T): 15 hours, Skill Lab (SL): 1 hour and Clinical (CL): 5 hours Section 2 – Theory (T): 15 hours, Skill Lab (SL): 4 hours and Clinical (CL): 5 hours Section 1: Relational education: preparing midwives for relationship-based midwifery care Drawing on the WHO educator competencies and ICM midwifery philosophy and core documents, this this section will introduce students to their role as an educator by building on their understanding of midwifery in a global context and situating it within the new midwifery initiative for India. Central to this are the dual concepts of woman- centred care and student-centred learning. Philosophy of midwifery practice based on the ICM definition of a midwife, scope of practice, code of ethics, and essential competencies for the midwife; LaQshya guidelines; WHO guidelines and recommendations on antenatal, intrapartum and postnatal care; mother, baby and family attachment and psychology; literature, frameworks and guidelines around humanizing birth, cultural competence, respectful care, sexual health and reproductive rights, gender-based violence and the ethical and legal aspects of the Council will be explored and applied to teaching and clinical practice. This section will introduce the WHO Midwifery educator core competencies in conjunction with the new guidelines for midwifery-led care and the curriculum for the NPM in India; introduction to learning and teaching pedagogy. There will be a specific focus on the role of the educator, positive human relationships, respectful compassionate communication, development of confident active listening and communication skills. Students will start to use group work, peer support and reflective practice and to incorporate these into their teaching practice; development of lifelong learning skills, including critical thinking skills, reflective practice and evidence-based policy and practice. SECTION 1: CONTENT OUTLINE Theory (T): 15 hours, Skill Lab (SL): 1 hour and Clinical (CL): 5 hours Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment I T-1 Build rapport Introduction • Icebreakers and • Development of • Assessment of with other ‘getting to know you’ self-portfolio portfolio students and • Vision of the midwifery activities educator educators training program • Overview of courses and Identify previous expectations experience of • Studying for success student peers110 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment working in • Accessing resources groups (online) • Seminar and tutorial Confidently expectations and working in begin journey as groups midwife • Role of self-directed educator student learning • Overview of course Articulate assessments, academic understanding of policies and procedures, becoming a group norms midwifery • WHO educator educator competencies • Developing your portfolio II T-4 Describe current Current scenario and status • Seminars (student • Journal • MCQ scenario and of midwifery in India and its led) reference and • Long Essays status of future • Self-directed learning presentation midwifery in • Current scenario and status • Talking with a India and its of midwifery in India and pregnant woman/new future its future mother about her • History of midwifery experience Describe the • Current scenario: philosophy of Midwifery in India midwifery • Introduction to practice and philosophy of midwifery ethics practice Apply the • The Council/ICM code midwifery model of ethics of care in clinical • Models of midwifery practice care - including distinction between midwives and Discuss other providers with autonomy and midwifery skills accountability within the • Midwife led care and continuity of care (MLCC) context of midwife led care • Autonomy and and continuity of accountability within the care context of midwife led care and continuity of care • Essential competencies for basic midwifery practice Contextualize (ICM) ICM midwifery practice • The Council practice standards standards • ICM global standards for midwifery practice • Trends in midwifery • Midwifery associations Describe the and its role concept of • Philosophy and practice of woman, newborn woman, newborn and and family family centred care for centred care India • ‘What women want’ - the expectations and experience of care • Building positive relationships • Key challenges in midwifery practice in India Describe and influence of midwifery relational education for education and transformation relationship- • Roles and scope of NPMs based midwifery in India[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 111 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment • Relational education and relationship-based midwifery III T-1 Describe Universal rights of • Lectures, tutorials • Develop a • Assignment on universal rights childbearing women and seminars scenario to scenario of childbearing • Observation in illuminate women and how • Universal rights of practice universal rights they might be childbearing women and in practice applied in India? how they can be applied in Explain how India? these might be • International studies of applied in human rights violations and practice their effects IV T-5 Respectful relationship-based • Discussion and • Writing role • Essay, short care: Respectful maternity experiential learning play script answers and and newborn care (RMNC) • Video - RMNC • Explore key MCQ • What is RMNC? • Integrated clinical challenges in • Assessment of Describe the • The nature of respectful practice in maternity midwifery clinical importance of care ward practice in performance RMNC • Type of care expected from • Clinical scenarios implementing with rating scale women and family and role plays - e.g., RMNC during • Feedback form • Importance of RMNC in domestic/ sexual antenatal care, from mothers improving quality of care abuse - students intra-natal care (Particularly • Clients’ rights for health respond and bring in and postnatal designed for care and examples of social the evidence care assessing accountability practices • Encourage respectful • Prepare a role delivery of • Behavior change strategy educator/ student play respectful care) for RMC services relationship • Assessment of • Creating Social and • Exercise: Build the scenario on Cultural Barrier Free positive relationships implementing Environment within the clinical RMNC during • RMC for women in environment and antenatal care, MLCU’s sensitize everyone to intra-natal care • RMC at all phases the new role of the and postnatal o Preconception midwife practitioner care o During ANC • Explore studies of o During labour relationship-based o During delivery continuity of care o During postpartum period • Newborn care integrated into RMC • Client privacy • Respectful communication: bereavement, maternal death, newborn death, IUD, Link the practice still birth of women • RMC in complication centered care to • RMC during psychological the provision of morbidity of women respectful postpartum maternity care • RMC for differently- abled woman • Effect of non-respectful care • Role of NPM in assuring RMNC in MNH service • Model respectful relationships in practice and Develop in education strategies to promote respectful and compassionate112 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment care V T-2 Maternal and newborn • Discussion and • Preparation & • Essay, short SL-1 health scenario in India experiential learning presentation of answers and • Public health for midwives scenarios vital statistics MCQ (Self Learning) • Self-directed learning records/Fact • Assessment of • Epidemiological aspects • Supervised practice sheet visit report Describe the and magnitude of maternal in HSC, PHC, CHC • Literature search epidemiology of and neonatal health in India on MNH care maternal and (Self Learning) neonatal health • Issues of maternal and in India neonatal health: age, gender, sexuality, psycho socio-cultural factors, gender disparities and women empowerment • Health care delivery system: National, State, District, and Village level Discuss various with reference to MCH national • National health programs RMNCH related to RMNCH programs • Quality of care in MNH including new midwifery service initiatives VI T-2 Identify and Chain of Referral system • Discussion and • Writing referral • Essay, short CL-5 implement the • Limitations and possibilities experiential learning slip/ note answers and chain of referral of other health care • Supervised clinical • Safe Delivery MCQ system providers practice App (SDA) • Policy and protocols for Identify and referral; range of strategies apply policies (Conditions requiring and protocols referral, when, where and required to how to refer for what stabilize women condition) for referral • Transport arrangements: community resources, advice to families and referral note • Follow up: feedback on cases referred • Records and reports on referrals Section 2: Transformative education: preparing midwives for transformative midwifery care (Teaching and Learning Approaches) Section 2 will introduce educational theories such as experiential and scenario-based learning and competency- based education in the context of midwifery practice across the continuum and in primary health care settings. Students will be taught the skills to create an environment that facilitates learning in both theoretic and clinical environments. It will also draw on the student’s midwifery knowledge and clinical experience across the continuum of pregnancy, birth and postpartum care of women and newborns. Use of evidence in facilitating informed decision- making, risk management/wellbeing support, working in community and primary health settings, midwifery education for women and role in public health. Highlight the need for continuing professional competence; the role of clinical supervision; provide opportunity to develop teaching materials and resources; introduce experiential and scenario- based learning, simulation technologies, consolidate learning and teaching approaches. SECTION 2: CONTENT OUTLINE Theory (T): 15 hours, Skill Lab (SL): 4 hours and Clinical (CL): 5 hours Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment I T-2 Assessment of own Developing knowledge • Lecture, tutorial, • Prepare • Development knowledge base for practice and putting student led seminar assignment on of portfolio and and areas for knowledge into practice • Self-directed study application of log-book with[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 113 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment development • Power in education • Development of a knowledge into plan for and in practice scenario using ICM practice, e.g., individual Demonstrate • What are competencies RMC in intra- learning understanding of competencies, and natal care ICM competencies different methods of and assess against learning, teaching? these • Creating experience for developing these Describe reflective • What is unique about practice and how midwifery knowledge, this might be used reflective practice and to develop learning different approaches? and knowledge II T-2 Demonstrate Educational theories • Develop educational • Prepare Lesson • Development understanding of applicable to midwifery design, teaching Plan based on of portfolio educational education approaches and ICM • Assessment of theories including • Experiential learning, lesson plans based on competencies in the Lesson Plan but not limited to scenario- based some of the ICM any area experiential learning, learning competencies and learning, skill skills, teaching and WHO midwifery learning, scenario- assessment in practice, educator competency based learning, conceptual learning domains practice-based education III T-2 Develop a scenario Experiential and • Intensive workshops • Written scenario • Assessment of from practice as a scenario-based learning developing different and using that the scenario basis for learning for midwifery practice scenarios, based on scenario for based on ICM ICM competencies ICM competencies teaching in the competencies and WHO and integrating part class • Scenario-based educators’ of the range of WHO • Development of learning, how to competencies educator portfolio develop a scenario competencies from practice, reading • The class will cover or online resources the whole range of • Practice based WHO competencies education including clinical decision making, using evidence in practice • Shaping education for practice in the clinical area • Using simulation IV T-3 Demonstrate Educational approaches • Exercise: Build understanding and • Relational positive relationship application of the education - Preparing between the student educational midwives for and teacher approaches for relationship-based • Role play: Scenario transformational midwifery care based learning and relationship- (student/teacher/ • Written script for based midwifery women/families) role play care • Transformative education - Preparing midwives for transformative midwifery care • Student centered learning • Competency based education/training V T-3 Describe principles Teaching and clinical • Discussion and • Practice • Essay, short SL-2 of teaching and training skills experiential learning teaching: theory answers and CL-5 clinical training and • Practice teaching: and skill MCQ strategies/ skills • Teaching-learning theory and skill demonstration • Practice114 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment process demonstration using various teaching Utilize different • Adult learning • Practice reflective teaching sessions/ teaching principles learning methodologies micro-teaching methodologies • Methods of • Role play • Preparation of focusing on student teaching - simulation, lesson plan, centered and projects, problem- checklists, AV relationship- based based learning, drills aids learning • Reflective • Preparation learning of case studies, • Microteaching case/ simulation • Preparation of scenarios lesson plans and skill • Microteaching checklist • Preparation of AV aids • Preparation of case studies, case/simulation scenarios • Preparation of master and clinical rotation plan • Clinical teaching methods - rounds and reports, bedside clinic, conferences Participate in peer • Clinical review and self- preceptorship, reflection activities mentoring and role modeling Promote • Peer-review, self- interpersonal reflection communication • Interpersonal Identify communication communication o Communication skills required to o Team establish successful communication midwife-woman o Conflict partnership management • Effective and Recognize respectful challenges to communication effective between midwife and communication woman within diverse • Communication within cultural diverse cultural communities communities • Guidance and counseling VI T-3 Explain various Assessment/ Evaluation • Discussion and • Preparation of • Essay, short SL-2 methods of Methods experiential learning knowledge answers and knowledge and • Assessment of • Self-directed learning assessment test MCQ skills assessment knowledge: • Simulation • Setting up of • OSCE Preparation of OSCE stations o Essay and simulation o Short answers areas Develop o MCQs • Prepare assessment tools • Assessment of checklists for skills evaluation o Assignments o Observation checklist o OSCE/OSPE o Practical Participate in self- examination[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 115 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment assessment/ o Viva voce appraisal • Assessment of attitude: Attitude scales COURSE MODULE II PREPARING MIDWIVES FOR CARE DURING PREGNANCY, BIRTH AND PUERPERIUM Theory (T): 80 hours Practicum: Skills Lab (SL): 35 hours, Clinical (CL): 790 hours The Course Module II is sub-divided into five Sections: Section 1 – Theory (T): 6 hours and Skill Lab (SL): 3 hours Section 2 - Theory (T): 22 hours, Skill Lab (SL): 12 hours and Clinical (CL): 450 hours Section 3 - Theory (T): 6 hours, Skill Lab (SL): 2 hours and Clinical (CL): 40 hours Section 4 - Theory (T): 22 hours, Skill Lab (SL): 16 hours and Clinical (CL): 300 hours Section 5 - Theory (T): 24 hours and Skill Lab (SL): 2 hours Course Aim This course will equip the NPM educators to upscale their knowledge, clinical skill and competencies and lead by example to prepare competent NPMs to deliver skilled, knowledgeable, compassionate and respectful midwifery care across the continuum of childbirth. Course Description This module is designed to enable the NPM educators to review the principles of related biological and behavioral sciences and midwifery to promote physiological birth and provide respectful quality care. The course comprises of review of anatomy and physiology, pre pregnancy care, antenatal care, intrapartum care, postpartum care and care of newborn and applied pharmacology including fundamentals of prescribing, legal & ethical issues, and infection control. It also includes recognition and management of problems/complications during pregnancy, labour, and postnatal period, and neonatal problems. Course Objectives 1. Discuss the anatomy and physiology of the female reproductive system and conception. 2. Assess and provide pre pregnancy care including counseling. 3. Assess and provide care for women in the antenatal, intra-natal and postnatal period including conduction of normal deliveries. 4. Assess and provide care for neonates. 5. Identify deviations from normalcy, stabilize and transport women and neonates to the higher health centers. 6. Demonstrate sound knowledge of applied pharmacology and principles of prescribing. 7. Identify and use medicines appropriately in midwifery, obstetric emergencies and complex situations as per GoI guidelines. 8. Demonstrate professional accountability for the delivery of midwifery care as per the Council standards that are consistent with moral, altruistic, legal and ethical and regulatory and humanistic principles in midwifery practice. 9. Implement infection control practices in maternal and newborn care facilities. 10. Collaborate with the health care team in providing midwifery care to women and their neonates. 11. Promote health of families and communities and provide family welfare services. Competencies (ICM) 1. Adhere to jurisdictional laws, regulatory requirements, code of conduct for midwifery practice. (1f) 2. Provide pre-pregnancy and antenatal care. (2a) 3. Determine health status of women. (2b)116 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 4. Assess the fetal wellbeing. (2c) 5. Monitor the progression of pregnancy. (2d) 6. Promote and support health behaviors that improve their wellbeing. (2e) 7. Provide anticipatory guidance related to pregnancy, birth, breastfeeding, parenthood, and change in the family. (2f) 8. Detect, manage, and refer women with complicated pregnancies. (2g) 9. Assist the woman and her family to plan for an appropriate place of birth. (2h) 10. Provide care to women with unintended or mistimed pregnancy. (2i) 11. Promote physiologic labour and birth. (3a) 12. Manage a safe spontaneous vaginal birth and prevent complications. (3b) 13. Provide care of the newborn immediately after birth. (3c) 14. Provide postnatal care for the healthy woman. (4a) 15. Provide care to healthy newborn infant. (4b) 16. Promote and support breast feeding. (4c) 17. Detect and treat or refer postnatal complications in woman. (4d) 18. Detect and manage health problems in newborn infant. (4e) 19. Provide family planning services. (4f) Section 1: Maternal, Fetal and Newborn Physiology This section will review the students’ knowledge of anatomy and physiology of reproduction and fetal development in order to support the facilitation of normal physiological birth. This section will include but not be limited to anatomy and physiology of reproductive system, conception, menstruation and ovulatory cycle; anatomy of maternal pelvis and fetal skull. It will provide an in-depth study of the normal physiological changes that occur in pregnancy. It will review placental physiology and fetal growth and development, fetal circulation. Content will be sequentially aligned with the normal pregnancy, providing the bio- science to support midwifery knowledge and application of practice skills. SECTION 1: CONTENT OUTLINE Theory (T): 6 hours and Skills Lab (SL): 3 hours Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment I T-2 Review the Review of anatomy • Self-directing • Presentations/ • Essay, short reproductive and physiology of learning seminars answers and SL-2 system human reproductive MCQ system • Discussion and • Demonstration - Understand the experiential learning female pelvis and female hormonal • Female pelvis and fetal skull cycle (ovarian and Fetal skull (with uterine) feto-pelvic relationships) • Hormonal cycles II T-2 Understand the Embryology and fetal • Tutorial • Foetal circulation • Evaluation of process of growth and - schematic the assignment SL-1 fertilization and development • Group work representation conception • Online lecture • Fertilization and Understand conception • Self-directed placental learning development and • Implantation function • Embryological Demonstrate development knowledge of fetal • Placental growth &[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 117 development in development early pregnancy • Placental function; Understand the blood brain barrier role of the placenta in fetal • Fetal growth and wellbeing and development nutrition • Fetal circulation • Fetal nutrition III T-2 Recognize Physiological changes • Tutorial • Formative quiz physiological in early pregnancy (final course changes in early • Group work exam) • Cardiovascular, pregnancy across the body systems hematological, • Online lecture • Educational endocrine, digestive, • Self-directed resource Understand the respiratory, uterine, learning development interaction of renal, immune pregnancy system hormones musculoskeletal, integumentary changes • Hormones of pregnancy • Ongoing signs of pregnancy Section 2: Normal Pregnancy, Birth and Puerperium This section will prepare the student to provide skilled, knowledgeable, compassionate and respectful midwifery care across the continuum of childbirth in both community and institution. It will include knowledge and skills to promote physiological birth and provide respectful quality maternal and newborn care. This will include but not limited to Antenatal care: assessment of pregnancy, comprehensive health history, physical assessment, screening, managing existing disease/pathology, support for pregnancy discomforts, assessment of fetal growth and wellbeing, health information and informed consent, antenatal education; Intrapartum care: 1st, 2nd, 3rd and 4th stage of labour, which includes the assessment of progress of labour, partograph, vaginal examination, observations and documentation, supporting women in labour and birth, promotion of physiological birth, non-pharmacological and pharmacological pain relief, assessment of perineal trauma, perineal suturing, observation and bleeding assessment, timely referral; Postnatal care: maternal care, transition to parenthood - mother, father and family, promoting attachment, skin-to-skin contact, establishing breastfeeding, managing breastfeeding challenges, documentation, reporting etc. Compassionate, woman centred midwifery care during normal pregnancy, labour, birth and postnatal period alongside evidence-based quality, holistic and continuity of midwifery care utilizing cultural competence and sensitivity are highly emphasized throughout. SECTION 2: CONTENT OUTLINE Theory (T): 22 hours, Skills Lab (SL): 12 hours and Clinical (CL): 450 hours Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment I T-2 Facilitate a Beginning the pregnancy • Discussion and • Pre- conception • Evaluation of partnership3 with journey experiential learning counseling skills using women through checklist continuity of care Pre-pregnancy Care • Demonstration • History taking and assessment • Assessment of 3Note that in a partnership relationship between a midwife and a woman, both make equally essential (but different) contributions. The woman defines who her family are and how they will be involved. Information is shared, decisions are negotiated, and the woman makes decisions that are right for her. The midwife upholds the woman’s decisions. See chapter on partnership in practice in Pairman et al textbook.118 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment • Review of sexual • Role play - of health status clinical development (Self counselling of women performance Explain the Learning) with using significance of pre • Tutorial, group work • Assessment of checklist pregnancy care • Socio-cultural aspects of nutritional status human sexuality (Self • Case study and screening of • Evidence based Learning) women essay Recognize birth as a • Evidence based screening normal life event for for health problems such women and their as diabetes, hypertension, families thyroid conditions, and chronic infections that impact pregnancy Provide preconception care • Pre-conception for eligible couples counseling (including awareness regarding normal births) Provide information • Genetic counseling (Self and develop skills to Learning) enable shared decision making in • Assess and confirm midwifery practice pregnancy • Shared decision making in midwifery practice Understand and advocate for planned • Planned parenthood parenthood II T-3 Respond effectively Pregnancy assessment and • Discussion and • Health education • Essay, short to women’s midwifery care during 1st experiential learning answers and SL-1 individuality, and trimester • Case MCQ CL-40 lack of knowledge • Demonstrations presentation about their social and Review of • Assess clinical • Bed side clinics • Bed side clinic cultural contexts • Normal pregnancy skills using • Case discussions • Clinical procedure • Maternal nutrition and Conference checklists malnutrition • Seminar Explain the • Antenatal history • Assess clinical significance of • Diagnosis of pregnancy - • Nursing rounds taking and performance a wn ote mn ea nta al nc da r fe a mfo ir l yth e s di ig ffn es r ea nn td ia s ly dm iap gt no om ss is, , • Supervised clinical assessment u scs ain leg rating practice in antenatal confirmatory tests OPD and ward • D bir ra thw p a l am n icro- • OSCE/ OSPE Demonstrate skills in • Definition, nature, • Self-directed learning providing antenatal objectives and • Laboratory care, health importance of antenatal • Skilled Birth investigations: education for care Attendant module perform and interpret - UPT, pregnant women and o Building partnership • Online lecture Hb estimation, continuity of care with women following HIV/Syphilis • Promote equity RMC protocol • Scenario-based testing; urine learning and access to care analysis for • Antenatal assessment: during pregnancy albumin and History taking, physical sugar • Recognize birth as examination, breast a normal life event examination, obstetrical • Assessment of for women and and pelvic examination fetal well-being their families (Leopold’s maneuvers), laboratory investigation • Antenatal • Describe the need counselling for documentation • Identification and and record keeping management of minor discomforts of pregnancy • Antenatal care and counseling (lifestyles in pregnancy, nutrition,[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 119 Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment shared decision making, risky behavior in pregnancy, counseling regarding sexual life during pregnancy etc.) • Screening for antenatal anxiety • Screening for family violence o Point of Care and One Stop Service during ANC • Danger signs during pregnancy • Birth preparedness and complication readiness (including promoting “Normalcy during pregnancy”) • Childbirth preparation • Respectful care and compassionate communication • Recording and reporting o Clinical procedures as per the GoI guidelines • Various models of ANC and their evolution • GoI current model of ANC provision • Role of Doula/ ASHA’s III T-1 Demonstrate Midwifery care during 2nd • Tutorial • Quiz, (end of knowledge of trimester of pregnancy course exam) SL-1 midwifery practice • Group work CL-40 throughout the 2nd • mEd anu ac gat ei mon e na tn d o f • Online lecture • C bao sm edp etency trimester physiological changes • Scenario based assessment and discomforts of 2nd learning trimester • OSCE Maintain woman • Case study centered • Rh negative and relationship-based prophylactic anti D • Simulation workshop care • Second trimester tests and health education Assess fetal growth o Interpreting screening and development results o Health education on IFA, calcium and Discuss management vitamin D for existing disease supplementation, or pathology glucose tolerance test, immunization etc. Facilitate ethical • Informed decision midwifery practice making promoting maternal120 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment autonomy and choice • Antenatal assessment: abdominal palpation, fetal assessment, auscultate fetal heart rate - Doppler and Pinnards • Assessment of fetal well- being: fetal pattern, DFMC, biophysical profile, non-stress test, cardiotocography, USG, vibro-acoustic stimulation • 2nd trimester antenatal care o Women centered care o Respectful care and compassionate communication o Referral and collaboration, empowerment o Ongoing risk assessment o Maternal Mental Health o Role of Doula/ ASHA’s IV T-1 Demonstrate Midwifery care during 3rd • Tutorial • Quiz, (end of knowledge of trimester of pregnancy course exam) SL-1 midwifery practice • Group work CL-40 t th rir mou esg th eo r ut the 3rd • dP ish cy os mio fl oog rti sc a dl u ring 3rd • Online lecture • C bao sm edp etency trimester • Scenario based assessment • Third trimester tests and learning Maintain woman screening • Case study centered relationship-based • Fetal engagement in late • Simulation workshop care to develop birth pregnancy plan • Demonstration of • 3rd trimester antenatal birthing position education classes Provide antenatal • Birth preparedness and care related to complication readiness preparation for birth • Health education on and breastfeeding exclusive breastfeeding education to build each woman’s • Danger signs of confidence pregnancy - recognition of ruptured membranes • Ongoing risk assessment • Cultural needs • Women centered care • Respectful and compassionate communication • Alternative birthing[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 121 Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment positions - women’s preferred choices • Role of Doula/ ASHA’s V T-4 Apply the physiology Midwifery care during 1st • Discussion and • Bed side clinic • Essay, short of labour stage of labour experiential learning answers and SL-3 • Health education MCQ Review of • Bed side clinics CL-70 • Case • OSCE/ OSPE Describe how a • Normal labour and birth • Case discussions presentation midwife builds a • Assessment of woman’s confidence • Onset of birth/labour • Seminar • Clinical skills using and provides • Per vaginal examination • Simulation Conference procedure respectful care for (if necessary) • Case study checklist the women during • Video labour • Stages of labour • Plotting and • Assess clinical • Demonstrations interpretation of performance • Organization of labor with rating room - Triage, • Supervised clinical partograph scale Encourage the role of preparation for birth practice in labour • Supervised birth companion ward clinical practice during labour • Positive birth environment • SBA, IMNCI, NSSK modules • Respectful care and Discuss the effect of communication • LaQshya the midwife’s (and guidelines other team members) 1st Stage language on the woman’s emotional • Physiology of normal well-being labour • Monitoring progress of labour Discuss how to maintain an • Using Partograph environment for • Pain relief in labour labour in which the (non-pharmacological woman feels safe and pharmacological) • Assessing and Work effectively monitoring fetal well with pain during being labour • Psychological support - managing fear • Activity and positioning for labour • Nutrition during labour • Care during 1st stage of normal labour o Positive childbirth experience for women o Birth companion for labour o Safe environment for mother and newborn to promote bonding o Role of Doula/ ASHA’s o Evidence based theories (e.g., becoming a mother)122 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment and practice in relation to labour interventions VI T-2 Apply knowledge of Midwifery care during 2nd the physiology of stage of labour SL-3 birth to midwifery Self-directed learning CL-40 care • Physiology (mechanism of labour) Discuss how the midwife provides • Signs of imminent labour care and support for • Intrapartum monitoring the women during birth to enhance • Birth position of choice physiology and • Warm compresses promote normal birth • Vaginal examination (if necessary) • Management - preparation and supporting birth • Psychological support • Non-directive coaching • Role of Doula/ ASHA’s VII T-2 Assessment and care Care during 3rd stage of • Tutorial • Case study • Quiz (end of of the newborn labour course exam) SL-2 immediately • Group work • Simulation • Physiology - placental CL-70 following birth separation and expulsion, • Online lecture homeostasis • Scenario based • Physiological learning management of third stage of labour • Active management of third stage of labour • Examination of placenta, membranes and vessels • Assess perineal, vaginal tear/injuries and suture if required • Immediate perineal care • Assessment and care of the newborn immediately following birth • Essential newborn care (ENBC) • Initiation of breast feeding • Skin to skin contact • Vitamin K prophylaxis • Newborn resuscitation VIII T-2 Discuss the impact of Care during 4th stage of • Tutorial • Quiz (end of labour and birth as a labour course exam) SL-1 transitional event in • Group work Observation, Critical • Competency[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 123 Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment CL-70 the woman’s life Analysis and Management • Online lecture based of mother and newborn assessment • Scenario based • Maternal assessment, learning Ensure initiation of observation of fundal breast feeding and height, urine output, • Case study adequate latching blood loss • Simulation • Documentation and Workshop Record of birth • Breastfeeding and latching • Managing uterine cramp • Alternative/ complementary therapies • Role of Doula/ ASHA’s • Various childbirth practices • Safe environment for mother and newborn to promote bonding IX T-5 Demonstrate Postpartum care/ Ongoing • Discussion and • Seminar • Essay, short integration of the care of women experiential learning answers and CL-80 role of midwife in • Case studies MCQ the care of woman Review of • Demonstration • Clinical • Assessment • Normal postpartum • Simulations presentation of skills with period Explore the maternal • Bedside rounds/ • Counseling procedure physiological • Physiology of clinics mothers for check list changes following puerperium • Case discussion breast feeding - • OSCE/ OSPE birth techniques and • Post-natal assessment and care - facility and • Role play position home-based care • Safe Delivery App • Health talk Understand the physiology of • Perineal hygiene and care video on feeding • Postnatal lactation and assessment • Bladder and bowel composition of breast function • Supervised milk clinical practice • Minor disorders of in postnatal ward puerperium and its and OPD Demonstrate skill in management caring for postnatal • Physiology of lactation women and lactation management Understand • Postnatal counseling and homeostasis and psychological support nutritional requirements of the • Normal postnatal baby newborn blues and recognition of postnatal depression • Transition to parenthood • Care for the mother from 72 hours to 6 weeks after the delivery o Cultural competence (Taboos related to postnatal diet and124 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment practices) o Evidence based practice in relation to postnatal and newborn care • Knowledge on postpartum family planning methods • Follow-up Section 3: Care of the Newborn This section will prepare the student to provide skilled, knowledgeable, respectful and compassionate midwifery care to the newborn in both community and institution. It will address the knowledge and skills required to provide quality care for the newborn and promote a healthy transition to life. This will include but not limited to: supporting the transition to extra uterine life; immediate care of the newborn, Apgar score, newborn assessment, essential newborn care; complete physical examination; newborn health needs; nutritional needs of the newborn, skin to skin contact; breastfeeding; maternal newborn bonding; growth and development of the infant; prophylactic measures; involve partner/support person; screening and immunization; provide evidence based information to parents; consideration of cultural norms; respectful care. It further equips the students to distinguish variations in normal development of the newborn and refer to the inter professional team. SECTION 3: CONTENT OUTLINE Theory (T): 6 hours, Skills Lab (SL): 2 hours and Clinical (CL): 40 hours Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment I T-1 Discuss the need for Family centered care • Tutorials and group • Formative compassionate, family work assessment, • Concept of family centered midwifery care competency of the newborn and how centered care • Scenarios based this is provided • Partnership and cultural Discuss how the woman competency and family’s views and • Respectful care and beliefs are respected communication Understand that actions • Informed consent and and interventions carried shared decision making out on baby need to be fully explained and informed consent obtained II T-1 Discuss preparation for Assessment and ongoing • Discussion and • Case • Essay, short newborn at birth care of normal neonates experiential learning presentation/ answers and CL-10 Case discussion MCQ Review of • Demonstrations • Health talk • OSCE/OSPE Explain the midwife’s • Normal neonate - • Self-directed learning role in observing and physiological adaptation • Newborn assessing the newborn • Seminar assessment immediately after birth • Newborn assessment and care • Case discussion • Screening for congenital • Safe Delivery App Explore the anomalies module on newborn physiological adaptions management and risk that the newborn • Care of newborn from management undergoes following 72 hours to 6 weeks birth after the delivery • Supervised clinical (routine care of practice in postnatal newborn) ward/NICU/ Nursery[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 125 Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment Demonstrate skills in • Skin to skin contact caring for normal newborns in the • Thermoregulation presence of mother • Infection prevention (asepsis and hand washing) III T-2 Identify the newborn at Risk identification and • Tutorials and group • Case study risk and give relevant referral work CL-15 immediate care • Risk Identification and • Scenarios Understand the process referrals to refer unwell • Simulation newborns • Minor disorders of newborn and their • Workshops Educate the mother and management • Online lecture family on prevention, recognition, and • Newborn screening management of common • Signs of distress and newborn problems risk assessment • Identification of complications, management and referral as per IMNCI protocol • Documentation and record • Health education to the mother and family about the management of common newborn problems IV T-1 Discuss the benefits of Nutritional needs of the • Tutorials and group • Formative breastfeeding for the newborn and establishing work quiz SL-2 baby and mother breastfeeding • Scenarios • Competency CL-10 • Breastfeeding based OSCE • Simulation Understand the • Breast milk • Summative composition of breast composition • Workshops exam milk • Benefits of • Online lecture breastfeeding for the newborn and mother Discuss the recommendation of • Lactation management: exclusive breastfeeding Breast feeding for six months techniques and positions, rest and nutrition for mother Explain how to help a during breastfeeding mother succeed with the first breastfeeding and • Exclusive breastfeeding recognize if the baby is • Expression and storage breastfeeding well of breast milk • Signs of hunger Explain and demonstrate • Supportive environment how to express breast for breastfeeding milk and storage • Baby Friendly Hospital Initiative (BFHI) Understand the BFHI guidelines • Health education to126 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Teaching Learning Methods of Unit Hours Learning Outcomes Content Assignments Activities Assessment mother and family on breastfeeding V T-1 Understand the Disease prevention and • Tutorials and group • Formative midwife’s role in immunization work quiz CL-5 immunization • Immunization • Scenarios • Summative exam • Importance of • Simulation Demonstrate skill in immunization immunization of the • Workshops newborn • Health education to family on current • Online lecture immunization schedule • Self-directed learning SECTION 4: COMPLEX CARE OF THE WOMEN AND NEWBORN, HEALTHY FAMILIES AND COMMUNITIES This section will develop students’ knowledge and skills in providing woman and family-centred, evidence-based midwifery care for women with complex needs across pregnancy, labour and birth and the puerperium, management of the compromised newborn. It further will provide student with a sound understanding of the midwifery role in primary health and optimising positive outcomes for the woman and her family. This will include but not limited to: assessment of risk; triaging, midwifery management and care of medical and obstetric complications and emergencies, provision of midwifery care in the event of poor maternal and/or neonatal outcomes or demise; law and ethics in relation to complex care; effective communication, collaboration, team work and referral; application and use of technology during complications of pregnancy, childbirth and the postpartum period, malpositions and abnormal presentations, cephalo-pelvic disproportion (CPD), preterm labour, disorders of uterine action; complications of third stage: obstetric emergencies, obstetric procedures induction of labour, basic life-saving skills - adult CPR; recognition and management of postnatal problems; identification of deviation from normal, puerperal pyrexia, puerperal sepsis, urinary complications, secondary postpartum haemorrhage, vulval haematoma, breast engorgement including mastitis/breast abscess, thrombophlebitis, DVT, uterine subinvolution, Vesico Vaginal Fistula (VVF), recto vaginal fistula (RVF), decision making about management and referral. Content on complex care of newborn will include but not limited to: Newborn mortality and major causes in India, care planning and midwifery management of the neonate with complex needs, use of technology; incorporation of family-focused care in the management of the compromised neonate; care in stillbirth and neonatal death, Models of newborn care in India - NBCC, SNCUs, NICU. Management of conditions include: prematurity, birth asphyxia, newborn sepsis, hypothermia, respiratory distress, hypoxia and asphyxia, jaundice, neonatal infections, high fever, convulsion neonatorum tetanus, low birth weight, congenital anomalies, haemorrahagic diseases, birth injuries, home based newborn care program - community facility integration in newborn care, calculation of fluid requirements, EBM/formula feeds/tube feeding, care of bereaved families, shared decision making about management and referral, Integrated Management of Neonatal Childhood Illnesses (IMNCI). This section will also include: health promotion; disease prevention; family planning and family planning counselling using Balanced Counselling Strategy (BCS), cultural norms and cultural competence; community knowledge and understanding; men’s engagement in maternity care; reproductive health and rights; adolescent pregnancy; unintended pregnancy; post-abortion care; ICM Bill of rights for women and midwives. Care includes: impact of early/frequent childbearing, MTP Act, methods of MTP, post abortion family planning methods, collaboration with other health workers, social welfare schemes of GoI. SECTION 4: CONTENT OUTLINE Theory (T): 22 hours, Skills Lab (SL): 16 hours and Clinical (CL): 300 hours Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment I T-6 Identify, provide Recognition and Management • Discussion and • Write on health • Essay, short initial of problems during Pregnancy experiential learning assessment, answers and SL-2 management and screening and MCQ CL-70 refer women with Review of • Bedside clinics management of problems during • High-risk pregnancy • Demonstration high-risk • OSCE pregnancy within • Evaluation of[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 127 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment the scope of • Triaging and risk stratification • Case presentation mothers case midwifery and discussion study/case practice • Performing and interpreting • Health education presentation fetal surveillance (CTG/NST) • Simulation plan • Review of complications • Safe Delivery App • Case study plan Support women during pregnancy (definition, modules on post and report with complicated causes, signs and symptoms, abortion care and pregnancy and diagnosis, management and hypertension facilitate safe and complications) positive birthing • Supervised clinical outcome o Bleeding in early practice in antenatal pregnancy: ward/ OPD/Obstetric IUC ✓ Abortion ✓ Ectopic pregnancy ✓ Hydatidiform mole o Bleeding in late pregnancy: ✓ Antepartum haemorrhage - placenta previa, abruption placenta o Hyperemesis gravidarum o Pregnancy induced hypertension ✓ Pre-eclampsia ✓ Eclampsia o Multiple pregnancy o Oligohydramnios o Polyhydramnios o Medical conditions in pregnancy ✓ Anemia in pregnancy ✓ Gestational diabetes mellitus ✓ Cardiac disease ✓ Pulmonary disease ✓ Thyrotoxicosis ✓ Sexually transmitted diseases ✓ HIV/AIDS ✓ Rh incompatibility o Infections in pregnancy - urinary tract infection, bacterial, viral, protozoal, fungal o Intrauterine growth restriction o Intrauterine fetal death o Gynecological disorders complicating pregnancy o Adolescent pregnancy128 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment o Elderly primi gravida and grand multipara • Management of conditions as per the protocol • Decision making for management and referral • Policy for the referral services • Role of NPM in management of the problems during pregnancy II T-6 Identify, provide Recognition of deviations from • Discussion and • Case • Essay, short initial the normal and management experiential learning Presentation plan answers and SL-4 management and during labour and report MCQ CL-70 refer women with • Bed side clinics problems during Review of • Simulations • Assessment of • Demonstration labour within the • Preterm labour: Prevention • Safe Delivery skills using scope of and management of preterm • Self-directed learning App modules on procedure check list midwifery labour (use of antenatal • Seminar PPH, Manual practice corticosteroids in preterm removal of • OSCE/ OSPE labour) • Case discussion Placenta and • Assessment of prolonged labour Facilitate • Premature rupture of case study communication membranes • Supervised link between the clinical practice • Malposition’s and abnormal midwife, women in labour room/ presentations (breech, brow, and families obstetric face) casualty/ • Cephalo Pelvic Disproportion Obstetric IUC, Collaborate with (CPD) operation theatre the obstetricians • Disorders of uterine action • Scenario based in the learning management of o Prolonged labour obstetric o Precipitate labour emergencies and complications o Dysfunctional labour • Complications of 3rd stage: o Retained placenta o Injuries to birth canal o Postpartum hemorrhage (bimanual compression of the uterus, aortic compression, uterine balloon tamponade) • Obstetric emergencies o Ruptured uterus o Obstetrical shock o Amniotic fluid embolism o Foetal distress o Cord prolapses o Shoulder dystocia o Uterine inversion o Vasa previa • Episiotomy and suturing with informed consent (types,[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 129 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment indication etc.) • Obstetric procedures o Forceps delivery o Vacuum delivery • Manual removal of the placenta • Induction of labour • Caesarean section: indications & preparation III T-4 Identify, provide Recognition and Management • Discussion and • Preparation of • Essay, short initial of postnatal problems experiential learning health talk answers and SL-4 management and MCQ CL-70 refer women with Review of • Bedside clinics • Clinical postnatal • Physical examination, presentation - • Assessment of problems within identification of deviation plan & report skills with the scope of from normal • Self-directed procedure midwifery check list learning practice. • Review of puerperal complications and its • Seminar management • Case discussion Develop rapport o Puerperal pyrexia with the women • Supervised and families for o Puerperal sepsis clinical practice continuity of care in postnatal o Urinary complications ward/ postnatal o Secondary Postpartum OPD/ obstetric hemorrhage casualty/ operation theatre o Vulval hematoma • Safe Delivery o Breast engorgement App module on including mastitis/ breast Sepsis abscess, feeding problem • Discussion on o Thrombophlebitis variety of case o DVT studies/ simulation o Uterine subinvolution scenarios to o Vesico vaginal fistula practice decision (VVF) making o Recto vaginal fistula (RVF) o Postpartum blues/ psychosis • Decision making about management and referral • Clinical procedures as per the guidelines IV T-4 Recognition and Management • Discussion and • Newborn • Essay, short of neonatal problems experiential learning assessment answers and SL-3 report MCQ • Newborn mortality and major • Demonstration CL-50 causes in India • Assessment of • Self-directed learning Identify, manage skills with • Models of newborn care in and refer high- India - NBCC; SNCUs • Seminar procedure risk newborn check list ▪ Case discussion • Screening of high-risk • Assessment of newborn ▪ Safe Delivery App clinical video on newborn130 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment • Review of conditions affecting resuscitation, performance newborns and their newborn with rating consequences management and low scale birth weight module • Prematurity ▪ OSCE/ OSPE ▪ Supervised clinical • Low birth weight practice in NICU/PN ward/well baby clinic o Kangaroo Mother Care ▪ Role play • Birth asphyxia/Hypoxic encephalopathy • Newborn sepsis • Hypothermia • Respiratory distress • Jaundice • Neonatal infections • High fever Encourage • Convulsions mother-infant bonding • Neonatorum tetanus • Congenital anomalies • Hemorrhagic diseases • Birth injuries • SIDS (sudden infant death syndrome) prevention, Compassionate care • Calculation of fluid requirements, EBM/ formula feeds/tube feeding • Home based newborn care program - community facility integration in newborn care • Decision making about management and referral • Integrated Management of Neonatal Childhood Illnesses (IMNCI) • Bereavement counseling Counsel women and families with situations requiring grief counseling V T-2 Healthy families and • Discussion and • FP counseling • Essay, short communities experiential learning report answers and SL-3 preparation MCQ • Health promotion & disease • Demonstration CL-40 Explain various prevention • Demonstration • OSCE family welfare • Role plays services available • Social and cultural norms and[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 131 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment to couples and competence • Self-directed learning • Role plays families • Father’s engagement in • Seminar • Self-directed maternity care learning • Supervised clinical Counsel couples • Family Welfare Services practice in PN • Seminar and provide ward/PN OPD/FP family welfare o Planned Parenthood ward/ • Supervised services o Impact of early/ frequent PHC/CHC/HSC clinical practice in PN ward/PN childbearing OPD/FP ward/ o Comprehensive range of PHC/CHC/ HSC family planning methods • Counselling on ✓ Action, effectiveness, Family planning advantages, management to disadvantages, myths, the couple misconception and medical eligibility criteria (MEC) for use of various family planning methods o Emergency contraceptives o Family planning counseling using Balanced Counseling Strategy (BCS) o Importance of follow up and recommended timing o Unintended or mistimed pregnancy o Post abortion counseling o Collaboration with other health workers (especially ASHAs and ANMs) o Role of NPM in family planning program/ family welfare services Support the women with abortion and provide post abortion care SECTION 5: PHARMACOLOGY, INFECTION CONTROL & LEGAL AND ETHICAL ISSUES This section will deepen students’ knowledge and understanding of pharmacology to ensure safe practice for the woman, fetus and newborn. The content will include but not be limited to: pharmacokinetics; pharmacodynamics; quality use of medicines, medication therapy in emergency and complex care; drug classification and legislation as well as environmental hazards and teratogens. Complementary therapies and supplementation. The legal, regulatory and ethical frameworks and requirements of midwifery practice, including code of ethic and professional conduct, jurisdictional laws (incl. legislation regarding abortion), local policy and guidelines, respectful behaviour, human rights, humanizing birth, autonomy and shared decision making, confidentiality and privacy. It will also support students to develop skills on infection prevention and control measures in maternal and newborn care facilities.132 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] SECTION 5: CONTENT OUTLINE Theory (T): 24 hours and Skills Lab (SL): 2 hours Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment I T-20 Applied pharmacology and ▪ Lecture • Drug dosage • MCQs fundamentals of prescribing calculation Describe the • Discussion and • Short pharmacology • Drugs used in obstetrics for experiential • Drug study/ answers and of drugs to be mothers and neonates learning presentation essay used in • Classification • Self-directed • Writing • Case study obstetrics for learning prescription analysis mothers and • Mechanism of action neonates • Review of • Case study • Drug • Dosage literature - laws analysis and presentation • Uses and regulations, discussion & Case Identify trends of nurse reports challenges and • Side effects prescribing promote practice • Role of NPMs - Advice to collaboration women and family (including • Integrated Clinical special precautions while practice in taking medicines) maternal-neonatal Identify areas teratogenicity • Teratogenic effect of drugs and its • Writing • Classification of drugs as prevention prescription pregnancy risk category • Documentation: accurate and complete records • Fundamentals of prescribing o Principles of prescribing and factors influencing it o Process and steps of prescribing o Prescribing competencies • Prescriptive role of Nurse Practitioners (National & International) • Professional, legal and ethical issues relevant to prescribing practice • Implications of wrong practices related to prescribing (using case studies) • Prescription of medicines as per protocols (national guidelines & regulations - the Council/MoHFW) • List of drugs that can be Prescribe administered by nurse permitted practitioner as approved by drugs for GoI women as per the protocols[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 133 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment II T-2 Infection Control • Discussion and • Review notes • OSCE/ experiential on national OSPE SL-2 Explain the • National guidelines and learning guidelines infection institutional policy control policies • Games • Draw from • Principles of prevention of clinical infection • Demonstration experience using IP materials Demonstrate • Standard precautions for and write skills in prevention of infections • Skill infection infection demonstrations - control o Hand washing control infection practices related practices o Use of protective attire to reach expert practice level in IP standards o Processing of used items/equipment • Videos o Proper handling and • Clinical practice disposal of sharps • Self-directed o Maintaining a clean learning Explore and environment reflect on the • Safe Delivery App role of NPM o Biomedical waste disposal module on IP and health • National infection control team in guidelines infection prevention • Role of NPM and health team in infection prevention/ control III T-2 Explain the Legal and ethical issues • Discussion and • Presentation • Essay, short code of ethics experiential - ethical and answers and • National legal framework for and legal learning legal issues MCQ Medical Practice including implications of in midwifery National Health Policy 2017 • Scenarios various aspects of midwifery • IMNC Act practice • The Council/ICM Code of ethics and its implications Identify key • Practice standards for legislation midwifery and its rationale governing the practice of o Policies and procedures midwives o Establishing standing orders and protocols o Informed consent • Legal framework for midwifery practice and its implications Reflect on the • Ethical issues in maternal and nature of ethics neonatal care and diverse moral and • Adoption laws, MTP Act, Pre- ethical Natal Diagnostic Test (PNDT) outlooks of Act, Surrogate mothers people • Scope and specifics of national MNH Guidelines of the MoHFW134 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment COURSE MODULE III PREPARING MIDWIVES TO LEAD, MANAGE AND SUPERVISE QUALITY MIDWIFERY CARE Theory (T): 15 hours; Clinical (CL): 20 hours Course Aim The NPM educator will demonstrate skills of leadership, supervision and management for provision of quality midwifery education and practice. Course Description This module is designed to enable the NPM educators to develop an understanding of the principles of leadership, supervision and management. It also focuses on management of MLCUs, quality assurance of MNH services and continued professional development. Course Objectives 1. Describe the importance of leadership, supervision, management and advocacy for midwifery. 2. Demonstrate current midwifery knowledge and skills and recognize the role of continuing professional development. Competencies (WHO educator competencies) 1. Provide facility-based mentoring for the NPM’s after placement. (6.3) 2. Demonstrate effective communication using variety of methods in diverse care delivery settings. (7.1) 3. Demonstrate cultural competence in course design and development and teaching and midwifery practice. (7.2) 4. Function as leaders and change agents to improve midwifery education and practice. (7.3) 5. Use a variety of advocacy strategies to promote midwifery education and practice. (7.4) 6. Participate in professional development activities relevant to midwifery education. (7.5) CONTENT OUTLINE Theory (T): 15 hours and Clinical (CL): 20 hours Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment I T-4 Demonstrate an Midwifery leadership • Tutorial, group work • Summative understanding of continuous CL-5 • Leadership and styles • Scenario-based contemporary assessment - (transformational leadership) learning leadership community Identify elements • Personality styles • Online resources development plan underpinning • Myer Briggs personality style • Personality quiz effective team building and • Team building, Negotiation negotiation skills • Conflict resolution Identify strategies to respond to • Respectful communication community needs • Emergency response, community development II T-4 Identify key theories Change theories and • Tutorial, group work • Summative of change transformative practice report on CL-5 • Scenario-based leadership styles Describe • Change theories learning transformative midwifery practice • Agents of change • Online resources • Transformative care • Innovation[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 135 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment III T-4 Describe role of Management including • Discussion and • Exercises/ • Essay, short NPM in management of MLCU’s experiential learning case studies answers and CL-5 management and MCQ supervision of • Management • Scenarios maternal and o Definition, principles and • Case studies neonatal care in elements various health care • Role play settings including o Management of (time, MLCUs material and personnel) • Observation MLCU o Team management o Material management - equipment and supplies • Supervision o Definition, objectives and types of supervision o Mentoring - facility based mentoring for NPMs • Quality Assurance o Nursing and midwifery Utilize advocacy audit skills and cultural competence for o Quality assurance of MNH promoting services midwifery education • Quality assurance of and MLCC midwifery training • Advocacy o Definition, principles, type/level of advocacy, advocacy skills for midwives IV T-3 Describe and utilize Records and Reports • Discussion and • List of • Essay, short the different types experiential learning records and answers and CL-5 • Importance of records of records and reports in MCQ reports in midwifery keeping • Seminar MLCU care and their • Various records and reporting • Orientation on importance formats to be maintained in various records and MLCU reporting formats in MNH area Perform clinical • Record storage systems audits based on the • Supervised clinical • Retrieval of records role of nurse practice in midwives • E-records PHC/CHC/ HSC/DH/ MCH • Role of nurse midwives in clinical audits - MPDSR; Newborn death audit; Caesarean audits; maternal and newborn service audits • Practical utility of regular records and reporting • MoHFW Clinical Case Sheets for MNH including safe childbirth checklist • Role of NPM in reviewing and reporting the data in terms of indicators and136 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment discussion how that impacts care being provided COURSE MODULE IV PREPARING MIDWIVES FOR EVIDENCE-BASED MIDWIFERY PRACTICES Theory (T): 15 hours, Clinical (CL): 20 hours Course Aim The NPM educator will identify and utilize evidence in the practice of midwifery. Course Description This module is designed to enable the NPM educators to develop an understanding of research process and utilization of evidence in daily midwifery practice. Course Objectives 1. Develop effective learning and teaching practice and resources based on evidence. 2. Utilize the assessment and evaluation data to critically analyze and enhance midwifery practice. 3. Demonstrate an understanding of quality indicators in education and as they relate to midwifery practice. Competencies (WHO educator competencies) 1. Use research and inform teaching and practice (8.1) 2. Cultivate a culture supporting critical inquiry and evidence-based practice. (8.2) 3. Train NPM’s to develop skills to conduct, communicate and utilize research. (8.3) CONTENT OUTLINE Theory (T): 15 hours and Clinical (CL): 20 hours Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment I T-15 Knowledge and utilization of • Discussion and • Literature • Essay/short research and evidence experiential search on answers and CL-20 learning MNH care MCQ Qualitative & Quantitative Research • Portfolio, reflection • Research • Assessment activities and report of • Overview of qualitative and planned modules assignments Describe the quantitative research paradigms research process, • A research study • Assessment • Research questions in quantitative and based on area of of completed quantitative and qualitative qualitative methods work (e.g., WHO research research Intrapartum study - • Research approaches and designs recommendations presentation or LAQSHYA and report • Methodology indicators) Discuss the value of evidence in the o Sampling • EBMP - Journal context of best o Data collection - tools and club (discussion of practices in techniques evidence on maternity care midwifery • Analysis and interpretation of practices) data • Communication, dissemination Demonstrate and utilization of research - application of academic integrity, correct academic integrity referencing principles and • Research critique correct use of[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 137 Learning Teaching Learning Methods of Unit Hours Content Assignments Outcomes Activities Assessment referencing • Literature search strategies - selection of relevant literature • Critical appraisal, analysis and synthesis Identify and utilize • Writing literature review evidence through review of literature • Statistics and valid recommendations • Sources and presentation of data for midwifery • Statistical packages and its practice application • Preparing research proposal Evidence based midwifery Identify and select practice (EBMP) relevant literature • Recommended sources of data/evidence - Facility/District/State - available registers, HMIS, DLHS, Indian - Analyze and NFHS, RHS, SRS, HMIS, synthesise research DLHS, AHS, Census, MoHFW literature GoI guidelines • Global standards – WHO recommendations; ICM recommendations; Demonstrate CONCHRANE; State of Worlds understanding of Midwifery different levels of • Research priorities in midwifery evidence • Utilization of facility data for improvement in health services; health outcomes Describe the use of evidence in practice 13. STRUCTURED MENTORSHIP The clinical residency program is of 6 months duration to develop educational abilities as well as to ensure clinical skills are up to date. This can be made more effective by integrating the 12-month mentorship and a portfolio approach, which is seen as an extension of the residency program. A portfolio is a collection of experiences and reflections which the student gathers across the mentorship period and includes continuity of care experiences and provides a competency-based approach to learning and assessment. The portfolio provides evidence of learning and competence, contextualizing the learning and linking it with theory and practice. Students are required to develop their learning plan having identified learning needs and objectives for their clinical practice experience. The portfolio helps the student develop self-directed learning and critical reflection. It provides personal and professional evidence of the student’s learning and is used as a means to promote interactions between students and preceptors, mentors and/or teachers. Students receive feedback based on competencies achieved and documented reflective practice. The portfolio will be paper based initially but with the development of an e-portfolio anticipated. The structure may include a title page (giving student’s name, year of training and name of the mentor), contents page, a list of learning objectives, clinical experience records and a short reflection on each experience. A competency assessment will be collected during clinical placements and specific skills will be assessed for competency according to the ICM essential competencies. A final reflective overview will summarize the learning that has taken place since the last portfolio review. Preceptorship and mentoring are crucial for competency-based learning and assessment, as it enhances the feedback process and stimulates students’ reflections in relation to the ICM competencies. Students will have individual mentors allocated for their mentorship experience. The aims of mentoring are to: provide feedback; stimulate reflection; support students in compiling the portfolio; monitor students’ competency development; support students in developing a better awareness and understanding of their strengths and weaknesses; support students in138 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] creating a learning plan for the placement; and motivate/inspire students. The mentors will be required to complete a competency assessment of general and specific practice skills. If the organisation and logistics permit students should be brought together for at least 1, 2 or 3 workshop intensives in which they share experience, what went well, what was difficult, with tutor support. The students will bring with them teaching material they have prepared. They will use their log books, keep their portfolio, and reflect on experience. During this period students should be encouraged to have peer support of each other. Mentorship Plan Month - 1 Objective: Onsite orientation of local stakeholders, gap analysis and support for initiating midwifery service • Baseline assessment - Training infrastructure, clinical practice site and midwifery services. • Unlearning of practices and encompassing the normal physiological aspects of births. • Clinical mentoring - Focus on organizing ANC clinic, triaging area, childbirth education area, labor room. • Clinical mentoring - Support in running antenatal clinic, triaging area and childbirth education area. • Handholding support for antepartum and intrapartum care. • Clinical mentoring - Support in running antenatal clinic, triaging area and childbirth education area. • Handholding support for antepartum and intrapartum care. • Reflections with educators. Month - 2 Objective: Clinical handholding, competency assessment and training on PPH • Reflections with educators, NPM trainees and obstetric champions to identify challenges. • Clinical mentoring - Support in running antenatal clinic, triaging area and childbirth education area. • Handholding support for antepartum and intrapartum care. • Competency assessment for antenatal health education, abdominal examination, vaginal examination. • Obstetric emergency drill - PPH. • Clinical Mentoring - Support in running antenatal clinic, triaging area and childbirth education area. Month - 3 Objective: Clinical handholding, clinical training on CTG, Pre-eclampsia and eclampsia identification and management, competency assessments • Clinical teaching on CTG monitoring and interpretation. • Obstetric emergency drill - Pre-Eclampsia/Eclampsia. • Competency assessment - Management of first stage of labor, care of 2nd Stage, physiological third stage of labour and AMTSL. • Clinical Mentoring - Support in running antenatal clinic, triaging area and childbirth education area. Month - 4 Objective: Clinical handholding, clinical training on induction of labor, NBR and competency assessments • Clinical teaching on induction of labor.[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 139 • Obstetric emergency drill – NBR. • Competency assessment of clinical skills - CTG monitoring, new born care and assessment, post-natal care. • Clinical Mentoring- Support in running antenatal clinic, triaging area and childbirth education area. Month - 5 Objective: Clinical handholding, clinical training, family planning and competency assessments • Reflections with educators, NPM trainees and obstetric champions to identify challenges. • Clinical teaching - Family planning counselling and IUCD insertion (Interval and PPIUCD). • Competency assessment of clinical skills - Episiotomy, perineal assessment and suturing. • Clinical Mentoring - Support in running antenatal clinic, triaging area and childbirth education area. • Handholding support for antepartum and intrapartum care. Month - 6 Objective: Clinical handholding and clinical teaching on Midwifery care - abortion related services • Competency assessment - consolidating skills. • Clinical teaching - Midwifery care - abortion related services (Bereavement counselling, advice in terms of safe abortion). • Clinical Mentoring - Support in organizing competency assessments for NPM trainees. Month - 7 Objective: Clinical handholding, competency assessments and support for preparation of research protocol • Competency assessment - Consolidating skills. • Teaching - Research proposal development. Month - 8 Objective: Clinical handholding, competency assessments and review on IMNCI protocols • Competency assessment - consolidating skills. • Teaching - IMNCI protocols. Month - 9 Objective: Clinical handholding, competency assessments and review on Facility Based New-born Care protocols • Competency assessment - consolidating skills. • Teaching - Facility Based New-born Care protocols. Month - 10 Objective: Clinical handholding, competency assessments Month - 11 Objective: Clinical handholding, competency assessments Month - 12140 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Objective: Competency based assessments of midwifery educators and appraisal of research study Dr. T. DILEEP KUMAR, President [ADVT.-III/4/Exty./796/2023-24] 14. ANNEXURES ANNEXURE-I ROLES AND RESPONSIBILITIES OF THE NPM EDUCATOR The NPM Educator will ensure the implementation of Nurse Practitioner in Midwifery (NPM) program and train those who enroll for the course at the State Midwifery Training Institutes. • The NPM Educator will ensure that trainee NPM’s who enroll for NPM course are adequately exposed to theory and practice during the entire program. • The NPM Educator will follow the curriculum prescribed by the Council to provide details of content in theory, practice, and internship along with lesson plans for standardized training. • The NPM Educator will also be in charge of keeping a record for every NPM student (logbook). A copy of the same will remain with the NPM student as well. This will be managed as a joint responsibility to ensure participatory learning. • The NPM Educator would be required to continuously update their knowledge and participate in professional development activities relevant to midwifery education. • To maintain competency, the NPM Educator will also practice in the clinical facility of the training institute and provide comprehensive midwifery care to the women under her care. He/She would focus on the care of women with low-risk pregnancies for whom he/she provides antenatal care and offers support to women during labour and childbirth. After birth he/she focuses on ensuring that the mother and baby are well, develops close bonding and makes sure that the baby has the best start in life. He/She also utilizes her knowledge and competencies to identify deviations from normal pregnancy, labour and postpartum care, provide initial management and obtain appropriate medical help as indicated. ANNEXURE-II ICM ESSENTIAL COMPETENCIES FOR MIDWIFERY PRACTICE (2019) COMPETENCY CATEGORY I: GENERAL COMPETENCIES NPMs demonstrate professional accountability as an autonomous practitioner in the delivery of midwifery care as per ICM standards adopted by the Council that are consistent with moral, altruistic and humanistic principles in midwifery practice. Competencies 1a. Assume responsibility for own decisions and actions as an autonomous practitioner. 1b. Assume responsibility for self-care including personal safety and self-development as a midwife. 1c. Appropriately delegate aspects of care and provide supervision. 1d. Utilize research to informed practice. 1e. Uphold the fundamental human rights of individuals when providing midwifery care. 1f. Adhere to jurisdictional laws, ethical, regulatory requirements, codes of conduct for midwifery practice. 1g. Facilitate women to make individual choices about care. 1h. Demonstrate effective interpersonal communication with women and families, health care teams, and community groups. 1i. Facilitate normal birth processes in institutional and community settings, including women’s homes. 1j. Assess the health status, screen for health risks, and promote general health and well-being of women and infants. 1k. Prevent and treat common health problems related to reproduction and early life. 1l. Recognize conditions outside midwifery scope of practice and refer appropriately. 1m. Care for women who experience physical and sexual violence and abuse.[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 141 COMPETENCY CATEGORY II: PRE-PREGNANCY AND ANTENATAL NPMs perform health assessment of woman and fetus, promote their health and well-being, detect complications during pregnancy, and provide care to women with unexpected pregnancy. Competencies 2a. Provide pre-pregnancy and antenatal care. 2b. Determine health status of women. 2c. Assess the fetal wellbeing. 2d. Monitor the progression of pregnancy. 2e. Promote and support health behaviors that improve their wellbeing. 2f. Provide anticipatory guidance related to pregnancy, birth, breastfeeding, parenthood, and change in the family. 2g. Detect, manage, and refer women with complicated pregnancies. 2h. Assist the woman and her family to plan for an appropriate place of birth. 2i. Provide care to women with unintended or mistimed pregnancy. COMPETENCY CATEGORY III: CARE DURING LABOUR AND CHILDBIRTH The NPMs continue to monitor and provide care to woman during labour that facilitates physiological processes and a safe birth, immediate care to newborn infant and detect complications in mother and infant. Competencies 3a. Promote physiologic labour and birth. 3b. Manage a safe spontaneous vaginal birth and prevent complications. 3c. Provide care of the newborn immediately after birth. COMPETENCY CATEGORY IV: ONGOING CARE OF WOMEN AND NEWBORNS The NPMs continue to perform health assessment of mother and infant, provide health education and support for breast feeding, detect complications, and initiate family planning services. Competencies 4a. Provide postnatal care for the healthy woman. 4b. Provide care to healthy newborn infant. 4c. Promote and support breast feeding. 4d. Detect and treat or refer postnatal complications in woman. 4e. Detect and manage health problems in newborn infant. 4f. Provide family planning services. ANNEXURE-III CLINICAL LOGBOOK FOR NPM EDUCATORS (PROCEDURAL COMPETENCIES/SKILLS) Performs independently/ Date & Performs collaboratively S.No. Specific Procedural Competencies/Skills Signature of with doctor/Assists in the Faculty procedures (P/PC/A) * 1 ANTENATAL CARE 1.1 Health assessment of antenatal woman: History taking, P physical examination and obstetrical examination 1.2 Urine pregnancy test P142 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Performs independently/ Date & Performs collaboratively S.No. Specific Procedural Competencies/Skills Signature of with doctor/Assists in the Faculty procedures (P/PC/A) * 1.3 Estimation of hemoglobin using Sahli’s hemoglobinometer/ true P Hb-P 1.4 Preparation of peripheral smear for malaria P 1.5 Urine testing for albumin and sugar P 1.6 Point of care HIV test P 1.7 Point of care syphilis test P 1.8 Preparation of mother for USG P 1.9 Perform USG PC 1.10 Fetal patterns/Kick chart/DFMC (Daily Fetal Movement Count) P 1.11 Preparation and recording of Cardiotocography (CTG)/ P Non-Stress Test (NST)/Contraction Stress Test (CST) 1.12 Preparation/assisting woman for antenatal investigations - A amniocentesis, cordocentesis, chorionic villus sampling 1.13 Antenatal counseling - diet & exercise P 1.14 Administration of TT/Td-P P 1.15 Prescription of iron and folic acid tablets 1.16 Prenatal counseling and care of general and vulnerable groups P such as adolescent pregnant mothers 2 INTRANATAL CARE 2.1 Identification, assessment and admission of woman in labour P 2.2 Perform CTG PC 2.3 Vaginal examination during labour including clinical pelvimetry P 2.4 Plotting and interpretation of partograph P 2.5 Preparation for birthing - physical and psychological P 2.6 Setting up of the birthing room/unit P 2.7 Pain management during labour - non-pharmacological P 2.8 Supporting normal births P 2.9 Episiotomy only if required and repair P 2.10 Essential newborn care P 2.11 Active management of third stage of labour P 2.12 Examination of placenta P 2.13 Care during fourth stage of labour P 2.14 Initiation of breast feeding and lactation management P[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 143 Performs independently/ Date & Performs collaboratively S.No. Specific Procedural Competencies/Skills Signature of with doctor/Assists in the Faculty procedures (P/PC/A) * 2.15 Assessment and weighing of newborn P 2.16 Administration of Vitamin K P 3 POSTNATAL CARE 3.1 Postnatal assessment and care P 3.2 Perineal/episiotomy care P 3.3 Breast care P 3.4 Postnatal counseling - diet, exercise & breast feeding P 3.5 Postpartum family planning P 4 NEWBORN CARE 4.1 Assessment of newborn including gestational age P 4.2 Baby bath P 4.3 Kangaroo Mother Care P 4.4 Identification of minor disorders of newborn and their P management 4.5 Neonatal immunization - Administration of BCG, Hepatitis B P vaccine 5 CARE OF WOMAN WITH COMPLICATIONS/HIGH RISK MOTHER 5.1 Identification of antenatal complications - pre-eclampsia, anemia, P antepartum hemorrhage 5.2 Glucose challenge test/Glucose Tolerance test P 5.3 Administration of MgSO P 4 5.4 Identification of fetal distress and its management P 5.5 Preparation of woman for emergency/elective caesarean section A and assisting in caesarean 5.6 Prepare the mother and perform vacuum delivery when P&PC favourable 5.7 Diagnosis of malpresentations and malpositions P 5.8 Diagnosis and management of cord presentation/cord prolapse P & PC 5.9 Early diagnosis of preterm labor P 5.10 Prepare, assess suitability and support the mother during breech P delivery when favorable 5.11 Conduct Breech delivery PC 5.12 Infection prevention during labor and newborn care P 5.13 Diagnosis and management of prolonged labour P144 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Performs independently/ Date & Performs collaboratively S.No. Specific Procedural Competencies/Skills Signature of with doctor/Assists in the Faculty procedures (P/PC/A) * 5.14 Prepare and perform low forceps operation A 5.15 Manual removal of the placenta PC 5.16 Diagnosis and initial management of PPH P & PC • Bimanual compression of uterus • Balloon tamponade for atonic uterus • Aortic compression for PPH • Prescription and administration of fluids and electrolytes through intravenous 5.17 Repair of perineal and vaginal tears (upto II degree) P 5.18 Repair of perineal and vaginal tears (above II degree) PC 5.19 Identification and first aid management of obstetric shock P 5.20 Manage obstetric shock PC 5.21 Diagnosis and management of puerperal sepsis P & PC 5.22 Management of breast engorgement P 5.23 Management of thrombophlebitis P & PC 6 HIGH RISK NEWBORN 6.1 Identification of high-risk newborn P 6.2 Neonatal resuscitation P 6.3 Assisting in neonatal diagnostic procedures A 6.4 Feeding of high-risk newborn - EBM (spoon/paladai) P 6.5 Insertion/removal/feeding - Naso/orogastric tube P 6.6 Administration of medication - oral/parenteral PC 6.7 Neonatal drug calculation P 6.8 Oxygen administration P 6.9 Care of neonate in incubator/warmer/ventilator P 6.10 Neonatal intubation/ventilator PC 6.11 Care of neonate on phototherapy P 6.12 Assist in exchange transfusion A 6.13 Organizes different levels of neonatal care P 6.14 Transportation of high-risk newborn P 7 FAMILY WELFARE 7.1 Family planning counseling P[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 145 Performs independently/ Date & Performs collaboratively S.No. Specific Procedural Competencies/Skills Signature of with doctor/Assists in the Faculty procedures (P/PC/A) * 7.2 Distribution of temporary contraceptives - condoms, OCP’s, P emergency contraception 7.3 Insertion and removal of Interval IUCD P 7.4 Insertion and removal of PPIUCD/PAIUCD P 7.5 Counselling of the woman for Postpartum sterilization P 7.6 Prepare and assist in tubectomy A 8 OTHER PROCEDURES 8.1 Prepare and assist for D&C/D&E operations A 8.2 Perform Manual Vacuum Aspiration P & PC 8.3 Post abortion care P 8.4 Post abortion family planning services P 8.5 Post abortion counseling P 8.6 Pre-conception nutritional assessment, screening HIV, Cervical P cancer 8.7 Preconception counseling and care P 8.8 Pap smear P 8.9 Visual inspection with acetic acid/iodine P 8.10 Counseling on breast self-examination P 8.11 Conduction of maternal and perinatal death audit PC 8.12 Maintenance of registers P 8.13 Maintenance of records P * When the learner is found competent to perform the skill, the faculty/trainer will sign it. Learners: are expected to perform the listed skills/competencies many times until they reach level 3 competency, after which the faculty signs against each competency. Faculty/Trainers: Must ensure that the signature is given for each competency only after they reach level 3. • Level 3: competency denotes that the leaner is able to perform that competency without supervision • Level 2: Competency denotes that the learner is able to perform each competency with supervision • Level 1: competency denotes that the learner is not able to perform that competency/skill even with supervision PORTFOLIO The skills that require collaborative performance and that are only assisted can be followed up even during mentorship and maintained through portfolio. However, the skills that need to be performed independently and the learners are able to reach level 3 performance have to be completed before appearing for the final examination at the end of 6 months. ANNEXURE-IV NPM EDUCATOR TRAINING PROGRAM: CLINICAL REQUIREMENTS146 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Signature of the S.No. Clinical Requirement Date Faculty/Preceptor 1 Antenatal assessment and care - 40 2 Postnatal assessment and care - 40 3 Assessment of labour using partograph - 40 4 Per vaginal examination - 20 5 Observing normal births - 5 Facilitating normal births from 1st stage (independent) - 40 6 Assisting instrumental births - 10 7 Placental examination - 10 8 Episiotomy and suturing only if indicated - 10 9 Insertion of Interval IUCD - 5 10 Insertion of PPIUCD/PPIUCD - 5 11 Newborn assessment - 40 12 ENBC - 40 13 Newborn Resuscitation - 20 14 Kangaroo Mother care - 5 15 Antenatal care study - 2 (normal - 1, high risk - 1) Diagnosis: Intrapartum care study - 2 (normal - 1, high risk - 1) 16 Postnatal care study - 2 (normal - 1, high risk - 1) Diagnosis: 17 Newborn care study - 1 Diagnosis: 18 Clinical presentation - 4 • Antenatal: • Intra natal: • Postnatal: • Newborn: 19 Health talk • Antenatal - Topic: • Postnatal - Topic • Newborn - Topic: • Family Welfare - Topic: 20 Counseling mothers & family members 1.[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 147 Signature of the S.No. Clinical Requirement Date Faculty/Preceptor 2. 21 Antenatal in-patient reviews - 2 1. 2. 22 Clinical Seminar/Clinical Conference Topic: 23 Drug study, presentation and report - 1 Drug: 24 Visits - report • Peripheral health facility 25 Project: Evidence based midwifery practice (Individual/Group) - 1 Topic: 26 Microteaching sessions - Theory - 4 1. 2. 3. 4. Microteaching - Skill demonstration - 4 1. 2. 3. 4. Signature of the Program Coordinator ANNEXURE-V NPM EDUCATOR TRAINING PROGRAM: CLINICAL EXPERIENCE DETAILS Number of days Signature of Area of Posting Clinical Condition care given Faculty/Preceptor148 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Signature of the Program Coordinator ANNEXURE-VI LEARNING RESOURCES List of GoI Guidelines (RMNCH) • Guideline on Midwifery Services in India (2018) • LaQshya: Labour Room Quality Improvement Initiative Guideline • Guidelines for Standardization of Labour Rooms at Delivery Point • Dakshata: Empowering Providers for Improved MNH Care during Institutional Deliveries • SBA: Guidelines for Antenatal Care and Skilled Attendance at Birth by ANMs/LHVs/SNs, Handbook and Trainers Guide • IMNCI Training Modules, Photo and Chart Booklets • Navjat Shishu Suraksha Karyakram Guidelines • Routine Immunization Handbook for Health Workers • Postpartum Family Planning Handbook for Service Providers • IUCD Reference Manual for Medical Officers and Nursing Personnel • PPIUCD Reference Manual • Operational Guidelines: Introduction of Haemophilus influenza b (Hib) as Pentavalent Vaccine in Universal Immunization Program of India • Use of Antenatal Corticosteroids in preterm Labour • Facility based IMNCI (F-IMNCI) (Participants Manual and Chart Booklet) • Guidance Note on use of Uterotonics during labour • Vitamin K Prophylaxis at Birth (in facilities) • National Guideline for Calcium Supplementation during Pregnancy • National Guideline on Management of Hypothyroidism during Pregnancy • National Guidelines for Diagnosis & Management of Gestational Diabetes Mellitus[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 149 • Screening for Syphilis during Pregnancy • National Guidelines Respectful Newborn Care - Child Health Division, MoHFW • Guidance for Mentoring and Support Visit - DAKSHATA • Assessment Guidelines for Selection of NPM Educators - MoHFW Guidelines Other Resources • WHO Report on Strengthening Quality Midwifery Care and Midwifery Education • The Lancet Series 2014, 2018 - Midwifery Quality Maternal and Newborn Care (QMNC) Framework • ICM Essential Competencies for Midwifery Practice (2018 update) Framework Structure • WHO Midwifery Educator Competencies • Safe Delivery App • Pairman et al, Midwifery Preparation for Practice (2019) • Downe and Byrom, Squaring the Circle (2019) • Downe and Byrom, ROAR Compassionate Care • Midwifery Continuity of Care, 2nd Edition • Caroline Homer, Pat Brodie, Jane Sandall and Nicky Leap • Empowering Decision-making in Midwifery: A Global Perspective, 1st Edition by Elaine Jefford (Editor), Julie Jomeen (Editor) • Dahlen H., Schmied V., Hazard B., Birthing Outside the System: The Canary in the Coalmine (2019) • Visaria L., Midwifery and Maternal Health in India (2010) • WHO, Midwives Voices, Midwives Realities (2016) • UNFPA. State of World’s Midwifery (2014) E- Resources • https://www.who.int/maternal_child_adolescent/topics/quality-of-care/midwifery/strengthening-midwifery- education/en/ • https://www.who.int/hrh/nursing_midwifery/educator_competencies/en/ • https://www.internationalmidwives.org/our-work/policy-and-practice/essential-competencies-for-midwifery- practice.html • https://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-care-compared-other-models-care- women-during-pregnancy-birth-and-early • https://www.whiteribbonalliance.org/wp-content/uploads/2017/11/Final_RMC_Charter.pdf • https://transform.childbirthconnection.org/reports/physiology/ • https://www.whiteribbonalliance.org/whatwomenwant/ References • Biesta G. (2015) What is education for? On Good Education, Teacher Judgement and Educational Professionalism, European Journal of Education, 50(1), 75-87 • Cranton P. (2009) Understanding and Promoting Transformative Education: A Guide for Educators of Adults, Canadian Journal of University Continuing Education, 35(1) • Chorazy M. and Klinedinst K. (2019) Learning by doing: A model for incorporating high-impact experiential learning into an undergraduate public health curriculum. Frontiers in Public Health Journal, 7(31), 1-6 • Dewey J. (1938) Experience and Education. New York, NY: Collier Books • Finlay L. (2008) Reflecting on 'Reflective Practice'. 1st ed. [ebook] The Open University, Accessed on 12th July 2019 at http://www.open.ac.uk/opencetl/files/opencetl/file/ecms/web-content/Finlay-(2008)-Reflecting- on-reflective-practice-PBPL-paper-52.pdf150 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • Friere P. (1972) Pedagogy of the Oppressed, Penguin Books, Hammondsworth, UK • Gibbs G. (1988) Learning by Doing: A guide to teaching and learning methods, Further Education Unit, Oxford Polytechnic: Oxford • Homer C.S.E., Friberg I.K., Dias M.A.B., ten Hoope-Bender P., Sandall J., Speciale A.M. & Bartlett L.A. (2014) The projected effect of scaling up midwifery. The Lancet, 384 (9948), 1146-1157 • Kolb D.A. (1984) Experiential Learning: Experience as the Source of Learning and Development, Englewood Cliffs, NJ: Prentice-Hall • Mezirow J. (1991) Transformative dimensions of adult learning, Jossey-Bass, San Francisco • Renfrew M.J., Mcfadden A., Bastos M.H., Campbell J., Channon A.A., Cheung N.F., Silva D.R.A.D., Downe S., Kennedy H.P., Malata A., Mccormick F., Wick L. & Declercq E. (2014) Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care, The Lancet, 384, 1129-1145 • Miller S., Abalos E., Chamillard M., Ciapponi A., Colaci D., Comandé D., Diaz V., Geller S., Hanson C., Langer A., Manuelli V., Millar K., Morhason-Bello I., Castro C.P., Pileggi, V.N., Robinson N., Skaer M., Souza J.P., Vogel J.P. & Althabe F. (2016) ‘Beyond too little, too late and too much, too soon: a pathway towards evidence- based, respectful maternity care worldwide’, The Lancet, 388 (10056), 2176-2192. • ICM Essential Competency Standards for the Midwife (ICM 2018) accessed on July 12th July 2019 at https://www.internationalmidwives.org/our-work/policy-and-practice/essential-competencies-for- midwifery-practice.html • Sandall J., Soltani H., Gates S., Shennan A., Devane D. (2016) Midwife-led continuity models versus other models of care for childbearing women, Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5 • Smith M., Warnes S. & Vanhoestenberghe A (2018) Scenario-based learning in Teaching and Learning in Higher Education: Perspectives from UCL, Ch. 10 Ed Davies J and Pachler N., UCL Institute of Education Press, University College, London • Tracy S K., Welsh A., Hall B., Hartz D., Lainchbury A., Bisits A., White J. & Tracy M.B. (2014) Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes. BMC Pregnancy and Childbirth, 14, 46 • United Nations Population Fund (UNFPA) 2014. The State of the World’s Midwifery, A Universal Pathway. A Woman’s Right to Health • World Health Organization (WHO) 2013a. Midwifery educator core competencies, Geneva. • World Health Organization (WHO) 2013b. WHO recommendations on postnatal care of the mother and newborn, Geneva • World Health Organization (WHO) 2014a. Midwifery educator core competencies adaptation tool, Geneva • World Health Organization (WHO) 2014b. WHO midwifery educator core competencies: building capacities of midwifery educators, Geneva • World Health Organization (WHO) 2016. WHO recommendations on antenatal care for a positive pregnancy experience, Geneva • World Health Organization (WHO) 2018. WHO recommendation: intrapartum care for a positive childbirth experience, Geneva • World Health Organization (WHO) 2019. Strengthening quality midwifery education for Universal Health Coverage 2030: Framework for action, Geneva ANNEXURE-VII EXAMINATION GUIDELINES FOR NURSE PRACTITIONER MIDWIFERY EDUCATOR PROGRAM Indian Nursing Council INTRODUCTION The Government of India (GoI) is implementing the ‘Midwifery initiative’ in India to bring about a transformation in the quality of care given to women and their families during pregnancy, labour, childbirth and postpartum period. This initiative has brought about the setting up of a new cadre of Nurse Practitioners in Midwifery[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 151 (NPM) who would be functioning under the title ‘Nurse Practitioner Midwife’ providing compassionate, respectful, competent and women centered midwifery care. These NPMs are trained by the NPM educators at the State Midwifery Training Institutes (SMTI). The knowledge and skills of the NPM educators are standardized through a specialized NPM educator program which includes 6 months of intensive residential training in the national midwifery training institute (NMTI) followed by onsite mentoring for 12 months. The NPM educators would receive their certification at the end of 18 months on successful completion of the program. This training program is conducted by a group of 6 international trainers and 6 national trainers who are the faculty trainers for this program. During their training program, the NPM educators undergo 3 assessments/examinations: (i) First assessment after 3 months of training (ii) Second assessment after 6 months of residential training for provisional certification (iii) Final assessment/examination for certification at the end of 18 months, that is after 12 months of onsite training with mentorship. This document gives a complete description of the preparation and process of conduction of examination and certification. EXAMINING AUTHORITY The examining authority for the NPM educator program will be the state examination boards approved by the Council. The examination as per the Council curriculum guidelines, will be designed, conducted and evaluated by the board and certificates would be issued by the same authority. Three examinations/assessments will be conducted at specified intervals for final certification. Registration numbers are allotted to the candidates at the time of admission. TYPE OF EXAMINATIONS Considering the transformative nature of the NPM program, the NPM educators should be highly efficient, competent and motivated to teach and train NPMs to bring about change in the delivery of compassionate and respectful midwifery care. The process of evaluation and certification is made robust to meet this demand. (i) First assessment At the end of 3 months, the NPM educators will undergo examination in one theory paper and one practical examination to assess the suitability to continue the course. However, if the NPM educator does not clear the examination, she may be given one more chance and if still does not clear, she would be discontinued from the program. (Module 1 and Module 2: Section 1-3 would be covered in this examination. (ii) Second assessment At the end of 6 months, the candidates would undergo Second assessment in theory and practical examination. On passing the examination, a provisional certificate of partial completion of the program would be issued. All modules are included for the examination. (iii) Final assessment After completion of 12 months onsite mentorship experience, the NPM educators would appear for their final examination in theory and practical conducted at the respective NMTI. All modules are included for the examination. On successful completion, the candidates would be certified as NPM educators. Note: For all the three examinations, the same pattern of examination will be followed. ELIGIBILITY FOR ADMISSION TO EXAMINATION The candidates who fulfill the following criteria only would be eligible to appear for the examinations. (i) First assessment • Completion of at least 90% of prescribed attendance (3 months) for both theory and clinical practice. • Completion of 40% of logbook and clinical requirements. • Certificate of completion of attendance and requirements by the Principal of College of Nursing/Program coordinator (faculty trainer). (ii) Second assessment • Completion of at least 90% of prescribed attendance (6 months) for both theory and clinical practice. • Completion of 80% of logbook and clinical requirements.152 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • Certificate of completion of attendance and requirements by the Principal of College of Nursing/Program coordinator (faculty trainer). (iii) Final examination • Completion of at least 90% of prescribed attendance (6 months) for both theory and clinical practice. • Completion of 12 months of mentorship experience in the SMTI according to the plan. • Completion of 100% of logbook and clinical requirements. • Certification of completion of logbook and clinical requirements by the principal college of Nursing/Program coordinator (Faculty trainer) based on the records maintained by the respective faculty trainer who mentored the NPM educator during the 12 months of onsite training. • Successful conduction of trainings for the NPMs in the SMTI. PASS: 70% both internal and external together in prescribed theory and practical examination SUPPLEMENTARY EXAMINATION Candidates who fail in the first assessment would be given one more chance to appear for the examination within 2-4 weeks in the examination failed, either in theory or practical only and if they fail again and are not found suitable, would be discontinued from the program. Candidates who fail in the Second assessment at the end of 6 months, can appear for the examination after 6 weeks in the examination failed, either in theory or practical only. The provisional certificate of partial completion of the program would be given only after passing the Second assessment. However, the candidates can proceed for onsite training under mentorship. EXAMINATION PATTERN The pattern of examination is the same for all three assessments/examinations. There will be one theory paper and one practical examination Theory Internal assessment External examination Theory Total = 25 marks Total = 75 marks; Duration = 3 hours Internal (25 marks) + • *Tests: 3 tests × 5 marks = 15 marks • Multiple choice questions: External (75 marks) 10 × 1 = 10 marks • *Assignments/presentations: = 100 marks 5 × 2 marks = 10 marks • Short answers: 5 × 2 = 10 marks Short notes: 5 × 5 = 25 marks • Essay/Scenario: 30 marks 2 × 15 = 30 marks Practical Total = 50 marks Total = 50 marks Internal (50 marks) + • Clinical performance = 10 marks • OSCE (5 stations) = 20 marks External (50 marks) • Clinical assignments/presentations = 10 • Direct observed practical =30 marks = 100 marks marks • OSCE = 10 marks • Direct observed practical = 20 marks *Tests should be conducted for 25 marks (MCQ - 3 marks, Short answers - 1 × 2 = 2 marks, Short answers 2 × 5 = 10 marks and essay/scenario type - 10 marks) and converted to 5 marks for consolidation. Assignments/ presentations can be scored for 10 marks and converted to 2 marks for consolidation. EXAMINERS Theory • Question paper setting - The board assigns a panel of 2 examiners to set 2 sets of question papers each examiner as per the blue-print (Annexure-A). Question papers should be set by the faculty trainers of the NPM educators. Questions from these 4 question papers as per the blue-print and question paper pattern are selected and the final[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 153 question paper is prepared by the examination board. Confidentiality should be maintained and each faculty who is setting the question paper should sign an undertaking of confidentiality. • Invigilation - The invigilation of the examination should be done by an external faculty appointed by the board. The Principal of the nursing college/Program coordinator (faculty trainer) in which the NMTI is located will be the chief superintendent of the examination. • Evaluation - The theory papers should be evaluated at the examination board or the center allotted by the examination board by the faculty trainers under the supervision of the secretary/chairperson of the examination board. • Mark sheet – The sample of the mark sheet is enclosed in Annexure-B. Practical Examination • Practical examination should be conducted for 2 to 3 days – on day one OSCE is conducted followed by directly observed practical on the subsequent days. • OSCE – For the conduction of OSCE, a team of 5 evaluators for 5 stations should be appointed by the board from the NMTI along with the Principal of the college of nursing/Program coordinator (Faculty trainer) who will be the chief superintendent for the examination. An external examiner (faculty trainer) is appointed by the board to observe and moderate the conduction of the OSCE sessions. List of the OSCE stations for examination is selected by the board and sent to the examination center in a sealed cover – 3 basic skills and 2 advanced skills (List enclosed in Annexure-D). • Directly Observed Practical – This is conducted by a team of 3 examiners. 2 faculty trainers - one internal and one external and 1 medical preceptor who were involved in the teaching program of the NPM educators. • Qualification of Examiners: M.Sc. nursing, OBG specialty with 5 years of teaching or clinical experience after PG with a dual role/M.Sc. OBG nursing with 5 years of experience as faculty with a minimum of 2 years midwifery clinical working experience. Medical preceptor should be medical faculty from Obstetrics and Gynecology, Pediatrics and Public Health with 3 years post PG experience/consultant. CONDUCTION OF EXAMINATION • The examination schedule for both theory and practical examination is given at least 2 weeks prior to the examination by the board. • Hall tickets are sent from the examination board to the examination center. • The center for examination is allotted by the examination board. • The invigilators and practical examiners are appointed by the examination board. • Question papers are sealed and sent to the examination center or may be done online. The chief superintendent who is either the principal/program coordinator (faculty trainer) is responsible for the security of the papers. • The candidates should use only their registration numbers. Names should not be written anywhere in the answer scripts. Theory • The examination hall is arranged with adequate lighting and ventilation. Seating is arranged as per the registration number. • Candidates can be permitted into the hall 15 minutes before commencement of the examination on producing the hall ticket. • Duration of examination is 3 hours. • No candidates should enter the examination hall after the expiry of thirty minutes from the commencement of examination and leave the examination hall before the expiry of sixty minutes from the commencement of the examination. • No electronic devices should be permitted in the examination hall. • The answer scripts should be signed by the invigilator before commencement of the examination. • The question paper pack should be opened by the chief superintendent and the invigilators in the presence of the candidates 15 minutes prior to commencement. (If online, downloaded in the same manner)154 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • A bell should be given every half an hour of the examination to alert the candidates. • On completion of the examination, the answer scripts are collected in order, packed, sealed, signed by the chief superintendent and sent to the examination board on the day of examination by registered post or speed post. Practical Examination (i) Objective Structured Clinical Examination (OSCE) • OSCE is done on day 1 of the examination. • The OSCE station list is given by the examination board which can be opened 60 minutes prior to the commencement of the examination. 5 stations are selected - 3 basic skills and 2 advanced skills (list of skills - Annexure-D). • Each station should be set up with the necessary articles and checklist. • Each candidate can be allowed 10 minutes for each station. • The time allotted for 1 OSCE session is 50 minutes. There can be a maximum of 6 rounds of OSCE in a day. 30 candidates can be assessed on the same day. The candidates who complete the OSCE should not be allowed to meet the other candidates waiting for the examination. If the number of candidates is more, the examination can be done on the next day with a different set of skill stations. • The scores for the OSCE are done for each station by the individual evaluators and the final scoring sheet is compiled and consolidated jointly by the external evaluator and chief superintendent. OSCE Score sheet is enclosed in Annexure-E. (ii) Directly Observed Practical (DOP) • DOP is done on day 2 of the examination. • Each candidate is allotted a mother for examination - antenatal, intranatal or postnatal by lottery method. They would be given 3-4 hours for assessment and care of the mothers and newborn (if postnatal). • The care given is evaluated by the internal examiner, external examiner and medical preceptor individually and their scores are combined for the final score. Viva voce is conducted in the bedside/ conference room in the clinical area. The DOP assessment form is enclosed in Annexure-F. • A maximum of 15-20 students can be examined on the same day. • The score is compiled with the OSCE scores and signed by the examiners and the chief superintendent. The score sheet is sent to the examination board on the day of examination by registered post or speed post. RESULTS The results of the examination are declared by the examination board within a period of 15 days up to one month from the conduction of the examinations. The paper evaluation center can be decided by the board. A candidate successfully clears the examination if she has scored at least 70% of marks in both theory and practical papers together which is Pass. Format of mark sheet and certificate (provisional & Final) is enclosed in Annexure-B & C. CERTIFICATION A. Title - Nurse Practitioner Midwifery Educator (NPM Educator) B. The title is awarded upon successful completion of the prescribed study program, which will state that the candidate[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 155 i. Has completed the prescribed course of nurse practitioner midwifery educator ii. Has attended 90% of the theoretical and 100% of the practical instruction hours before awarding the certificate. iii. Has passed (70% marks both internal and external together) in the prescribed theory and practical examination. C. SNRC will register NPM educator as additional qualification. On passing the second examination at the end of 6 months, a provisional certificate of partial completion of the program would be issued. On successful completion of the final examination, the candidates would be awarded the certificate of NPM educator. Model of the certificates are enclosed in Annexure-C. SUB-ANNEXURES IN ANNEXURE-VII ANNEXURE-A: Blueprint of Question Paper Exam : Preliminary/interim/final examination Marks : 75 Date : Time : 3 hours MCQ Short Short Essay/ Situation S.No. Type of questions answers notes Marks Percentage 1 mark 2 marks 5 marks 15 marks 1 Remembering (knowledge based simple recall questions, facts, terms, 2 1 1 - 9 12% concepts, principles, theories, identify, define information) 2 Understanding (comprehension, understand conceptually, interpret, 3 1 1 1(10) 20 26% compare, contrast, explain, paraphrase, interpret information) 3 Application (use abstract information in concrete situation, apply knowledge 2 1 1 1(10) 19 25% to new situation, solve problems) 4 Analysis and synthesis (classify, compare, contrast, differentiate, organize and 1 1 1(15) 18 24% integrate new pieces of information) 5 Evaluation (appraise, judge, justify the value or worth of a decision or outcome, 2 1 1 - 9 12% predict outcomes based on values)156 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] TOTAL 10×1=10 5×2=10 4×5=20 2×10+1×15=35 100 100 *Question Paper Pattern Name of the Examination Board: ________________________ State: ________________________________ Name of the Theory Examination - First/Second/Final Examination Date: Maximum marks: 75 marks Duration: 3 hours Answer all the questions in the answer booklet given I. Multiple choice question: choose the best answer 10 × 1 = 10 marks (A question stem with 4 options) II. Short answers: answer in one or two sentences 5 × 2 = 10 marks (definitions, meanings, application, differences, list etc.) III. Short notes: 4 × 5 = 20 marks (analyze, interpret, comprehend, brief, explain) IV. Essay/situation: (2 × 10) + (1 × 15) = 35 marks (Discuss, apply, narrate, evaluate, compare and contrast) ANNEXURE-B: Sample Mark Statement NAME OF EXAMINATION BOARD STATE STATEMENT OF MARKS – NPM EDUCATOR PROGRAM Course NPM Educator Registration Number[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 157 ANNXURE-C: Sample Certificates (Provisional & Final) NAME OF EXAMINATION BOARD Photo of EMBLEM candidate (to be STATE attested) PROVISIONAL CERTIFICATE OF PARTIAL COMPLETION The _________________________________________________________ Examination Board hereby makes known that _____________________________________________________________, born on158 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Sample of Certificate - Final Certificate NAME OF EXAMINATION BOARD Photo of candidate STATE EMBLEM (To be attested) AWARD OF DIPLOMA Nurse Practitioner Midwifery Educator The _________________________________________________________ Examination Board hereby makes known that _____________________________________________________________, born on[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 159 Seal of the Board ANNEXURE-D: List of Skills for OSCE Basic Skills Advanced Skills 1. Antenatal assessment: calculation of EDD 1. Management of antenatal complications: pre- eclampsia and eclampsia 2. Antenatal assessment: detecting pregnancy using pregnancy testing kit 2. Administration of Inj. MgSO 4 3. Antenatal examination: measuring blood pressure 3. Identification and management of hemorrhage in pregnancy 4. Antenatal examination: measuring pulse 4. Preparation and recording of Cardiotocography160 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 5. Abdominal examination during pregnancy (CTG)/Non-Stress Test (NST)/Contraction Stress Test (CST) 6. Laboratory investigation: Testing blood - hemoglobin 5. Assessment during first stage of labor: plotting of 7. Laboratory investigation: Testing urine for sugar partograph 8. Laboratory investigation: Testing urine for protein 6. Intrapartum complications: Identify and manage 9. Laboratory investigation: RDT for malaria 7. Newborn resuscitation 10. Glucose challenge test/Glucose Tolerance test 8. Kangaroo mother care 11. Antenatal general examination 9. Prepare and perform low forceps operation 12. Administration of Inj. TT 10. Conduct Breech delivery 13. Counseling of antenatal woman 11. Initial management of PPH: preparation and 14. Setting up of the birthing room/unit administration of oxytocin drip 15. Assessment during first stage of labor: PV 12. Initial Management of PPH: Bimanual compression examination including clinical pelvimetry of uterus 16. Pain management during labour - non- 13. Balloon tamponade for atonic uterus pharmacological 14. Aortic compression for PPH 17. Assessment and care during second stage of labor: 15. Prescription and administration of fluids and conducting normal delivery electrolytes through intravenous 18. Assessment and care during third stage of labor: 16. Manual removal of the placenta active management 17. Catheterization - Plain catheter 19. Essential newborn care 18. Catheterization - Indwelling catheter 20. Examination of placenta 19. Starting up of IV line 21. Assessment and weighing of newborn 20. Repair of perineal and vaginal tears (upto II degree) 22. Neonatal immunization - Administration of BCG, Hepatitis B vaccine 21. Identification and first aid management of obstetric shock 23. Care during fourth stage of labour 22. Management of postnatal complications 24. Baby bath 23. Oxygen administration 25. Perineal/episiotomy care 24. Care of neonate on phototherapy and ventilator 26. Breast care 25. Insertion and removal of PPIUCD/PAIUCD 27. Counseling postnatal woman 26. Perform Manual Vacuum Aspiration 28. Distribution of oral contraceptive pills 27. Post abortion care 29. Counseling on postpartum family planning 28. IUCD insertion - Interval 30. Counseling on family planning - method specific 29. Pap smear 31. Post abortion counseling 30. Visual inspection with acetic acid/iodine 32. Counseling on breast self-examination *A total of 5 skills – 3 basic and 2 advanced skills are selected for each OSCE session. ANNEXURE-E: OSCE SCORE SHEET Plan for OSCE Examination and Compilation Sheet (External Examination) Name of the Examination Centre : Name of the Examination : First/Second/Final Examination Date : Total Number of Students : 30[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 161 Time per Station : 10 minutes Total duration : 6 hours (4 hours morning, 2 hours evening) Evaluators : 1. 2. 3. 4. 5. Moderator : Chief Superintendent : S.No. Station Category Skill Assessed Marks 1 I Basic 20 2 II Advanced 20 3 III Basic 20 4 IV Advanced 20 5 V Basic 20 Total marks 100/5 = 20 marks OSCE Compilation sheet Name of the Examination Center : Name of the Examination : First/Second/Final Examination Date : Roll Number of Students allotted : From ____________ to _____________ Total Number of Students : Allotted: Attended: Total Number of OSCE Station : Basic Skills - 03 Advanced Skills - 02 OSCE Score Summary Sheet : Name of OSCE Station Stations Total Marks Total Marks Registration Number 1 2 3 4 5 (out of 100) (out of 20)162 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Signature of Moderator Signature of Chief Superintendent ANNEXURE-F: Assessment Form for Directly Observed Practical NAME OF THE EXAMINATION CENTER NPM Educator Program Evaluation form for Practical Examination - First/Second/Final Examination (Same but separate forms for internal examiner, external examiner and medical preceptor) Examiner: Internal/External/Medical Preceptor o N .S n o it a r t s ig e Rr e b m u N n o it c e llo c y r o t s iH la c is y h p la r e n e Gn o it a n im a x e d e s u c o F /c if ic e p St n e m s s e s s a e r a c f o n a lP e v it c e j b o /la o G e r a c y r e f iw d iMd e d iv o r p f o n o it a c ilp p As e lp ic n ir p c if it n e ic e r a c f o n o it a u la v E n o it a c in u m m o C & n o it a c u d Eg n ile s n u o C k c a b d e e f s r e h t o M a v iV la t o T s Max marks 2 2 4 2 2 6 2 2 2 2 2 2 30 1 2 3 4 5 6 7 8 9[भाग III—खण्‍ड 4] भारत‍का‍राजपत्र‍:‍असाधारण 163 10 11 12 13 14 15 Signature of the Examiner External Practical Examination Consolidation Sheet Name of the Examination Center : Name of the Examination : First/Second/Final Examination Dates of the Examination : OSCE - DOP - Roll Number of Students allotted : From to Total Number of Students : Allotted: Attended: Registration Internal External Medical Total Grand S.No Total DOP Number Examiner Examiner Preceptor OSCE total Maximum Marks 30 30 30 90/3=30 20 50 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15164 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Internal Examiner External Examiner Medical Preceptor Place: Date: Seal: Signature of Chief Superintendent (Principal/Program Coordinator/Faculty Trainer) ANNEXURE-VIII SCOPE OF PRACTICE For Nurse Practitioner in Midwifery (NPM) Educator & Nurse Practitioner Midwife Document Prepared by MoHFW and Indian Nursing Council (June 2021) Reference: Available at MoHFW and INC websites Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.