Scope of Practice for Registered Midwife (RM

)

Health Regulation Department Dubai Health Authority (DHA)

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Introduction Health Regulation Department in DHA is responsible for regulating midwifery practice in the Emirate of Dubai, United Arab Emirates. Scope of Practice (SOP) refers to the activities that registered midwives are educated, authorized and competent to perform as well as their decision making capacity. Such activities are established through the legislated definition of licensed midwifery practice, complemented by standards, limits, conditions and education and influenced by setting, environment and health needs of the population. The Eastern Mediterranean Region (EMRO) of the World Health Organization (WHO) in its Global Advisory Group Meeting in 2000 identified lack of legislation as the most prevailing reason for nurses and midwives not working to their full potential. The primary purpose of this document is to guide and direct midwives practice within this environment. Through this framework DHA health regulation meets its responsibility to regulate midwifery practice in the public interest and address incompetent, impaired or unethical practice amongst midwives. DHA health regulation in recognising its further responsibilities to ensure public safety and in line with its published expectations of the registered nurse, equally expects that registered midwives must self assess their competence and make individual decisions about their practice within unique circumstances and settings. Furthermore midwives retain accountability for their own practice and are accountable to the woman and her newborn, the public, their employer and the regulatory authority. To ensure consistency in midwifery standards throughout the UAE the following Midwifery Competency Framework has drawn largely on the work undertaken in 2007 to develop the Scope of Practice (SOP) for the Midwife, which was endorsed by the Health Authority of Abu Dhabi (HAAD) Nursing and Midwifery Advisory Committee in December 2007 and the Federal Department of Nursing (FDON) Midwifery Committee in January 2008. During the collaborative development of the SOP by midwifery representatives throughout the UAE, the International Confederation of Midwives (ICM) Essential Competencies for Basic Midwifery Practice (2002) provided an international guide and benchmark. In order to provide more detailed evidence guidelines for midwifery practice in Dubai the Midwifery Competence Framework has been modified and expanded. The Scope of Practice for the Licensed Midwife is endorsed by DHA health regulation and should be read in conjunction with DHA health regulation Code of Conduct and Ethics for Nurses and Midwives. DHA health regulation upholds that no midwife should be directed or compelled to undertake any practice that falls short of DHA health regulation standards or code of conduct requirements.

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labour and postpartum period. The sphere of practice: She must be able to give the necessary supervision. FIGO. health units. has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. She has an important task in counseling and education. domiciliary conditions or any other service. having been regularly admitted to a midwifery educational program. family planning. 2. WH0 A midwife is a person who. Midwifery Practice and Comprehensive Care Professional. duly recognized in the country in which it is located. to conduct deliveries on her own responsibility. the detection of abnormal condition in mother and child. and the execution of emergency measures in the absence of medical help.International Definition of a Midwife As accepted by the ICM Membership and Joint Study Group on Maternity Care. but also within the family and community. Core midwifery competency standards and associated performance criteria are located within these domains of practice which are guided by the ICM/WHO/FIGO (1992) and ICM (2005) Definitions of the Midwife and the ICM essential competency standards for the Midwife (2002). The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynecology. the procurement of medical assistance. not only for the women. Legal and Ethical Practice Professional Development Quality Improvement and Collaborative Healthcare Page 3 of 27 . 3. and to care for the newborn and the infant. care and advice to women during pregnancy. Competency Standards Four Domains of Practice have been identified. clinics. Domains of Practice 1. She may practice in hospitals. and child care. 4. This care includes preventive measures.

NB: For the purpose of this document she may mean he in specific circumstances Page 4 of 27 . The indicators and evidence guides are neither comprehensive nor exhaustive but rather provide examples of evidence of competence. Evidence of safety to practice is demonstrated when the registered midwife meets the competency criteria within the domains.Competency Statements Each Domain of Practice has competency statements and associated performance criteria that a midwife must demonstrate to fulfil regulatory requirements.

1.3 Supports the woman and her family to promote health and wellbeing birth spacing and positive parenting.1.Domain 1 Midwifery Practice and Comprehensive Care Competency 1.1 Promotes health and provides education to the woman and her family Indicator Sub Indicator Evidence Guide Examples Knowledge of: • Communication in establishing and maintaining helpful relationships • • Healthy life style behaviours Positive parenting strategies 1.1 Midwives provide high 1. culturally sensitive health education and services to the woman and her family in 1. planned pregnancies and 1.1 Identifies.1.1.1. Page 5 of 27 .1.2 Provides the woman and her family with accurate information order to promote healthy family life. participates in and contributes to the development of health education programs in the community quality.1.

4 Actively listens to the woman and her family and responds to their needs 1.2.3 Communicate relevant information effectively.2. 1. symbols and images Theories that inform and enhance understanding of communication and the effective use of relationship and interpersonal skills 1.Competency 1. using language that is readily understood care.1. including verbal and non-verbal communication.2.5 Facilitates learning opportunities through sharing of information 1. touch.1.1.5 Advocates informed choice and shared decision-making • Page 6 of 27 .2.1 Midwives provide 1.2.1 Offers advice and midwifery care that respects the cultural and social needs of each woman evidence-based information to and her family the woman and her family facilitating them to make informed choices regarding their 1.1.2.1.2 Facilitates decision-making by the woman and her family Indicator Sub Indicator Evidence Guide Examples Knowledge of: • The effect of culture on communication. such as when physical contact is appropriate and when it is not and how to address people • The different forms and range of effective communication.

5 1.1. assessment frameworks and maternity care guidelines.3.3.3.3 1.1 well-being of the pregnant woman and the fetus 1.Competency 1.7 Page 7 of 27 .3.3.1.2 Evidence Guide Examples Knowledge of: Plan. Educates the woman and families about normal physiological changes of pregnancy and advise on strategies to relieve • The importance of giving constructive.3. Care for the pregnant woman from conception to birth Care for the normal newborn Potential risk pregnancy. The physiological changes that occur during pregnancy & their impact on health.6 1. factors during Sub Indicator 1. collaboration with the woman and her family pathways.3 Provides safe and effective antenatal care Indicator 1.1.4 1.1.3. implement and evaluate holistic antenatal care in • Commonly used clinical protocols.1. common discomforts positive feedback to others Assesses the growth and well-being of the fetus Provides nutritional advice for pregnancy and lactation Interprets and acts upon information from antenatal assessments Interprets and analyses basic screening laboratory/ultrasound studies Identifies health risk factors and refers care as necessary • • • • • Factors that impact positively and negatively on women’s during pregnancy and well-being.1 Promotes the health and 1.1.3.1.

3 Protects.3 Provides safe and effective antenatal care Sub Indicator Evidence Guide Examples Evidence Guide Examples Knowledge of: 1.2. birth and parenting 1.2.2 Prepares the woman for 1.2.3.Competency 1.3. promotes and supports breastfeeding in alignment with current WHO/UNICEF guidelines • • • Care of the woman during labour Pain relief during labour Baby Friendly Accreditation guidelines Page 8 of 27 .3.2 Provides information about pain relief.3.1 Educates the woman about the onset and process of labour labour. birth positions and delivery options to facilitate informed choices 1.

1.2 Identifies the signs which indicate onset and progress of labour 1.1.1.3 Identifies the measures to assess fetal and maternal well-being in labour 1.4.4 Identifies the signs normal/complications and indicators of deviations from • • The physiology of normal labour Evidenced based midwifery skills for appropriate interventions Page 9 of 27 .4.4 Provides safe and effective intrapartum care Indicator Sub Indicator Evidence Guide Examples Knowledge of: 1.4.4.1 Recognizes the relevant critical diameters and landmarks of the maternal reproductive anatomy 1.1.1 Demonstrates an understanding of the physiology of labour 1.Competency 1.4.

2.2 Demonstrates competency 1.4.2.4.4.2 Identifies complications or deviations from normal the woman during childbirth 1.1 Promotes normal physiological childbirth in the skills needed to support 1.4 Encourages and respects the woman’s preferences • throughout labour and delivery.4.4 Provides safe and effective intrapartum care Indicator Sub Indicator Evidence Guide Examples Knowledge of: 1.5 Recognizes emergency situations and intervenes in an appropriate and timely manner.3 Implements midwifery care which reduces risk and harm to the woman and fetus 1.4.2.Competency 1. • • Support for the woman during labour and delivery Evidenced based midwifery skills for appropriate interventions during emergency situations Advocacy Informed consent Page 10 of 27 .2.2.4. within safe parameters of practice or safe delivery in an environment conducive to well being of • mother and newborn as requested 1.

1.5: Provides safe and effective postnatal care Evidence Guide Examples Knowledge of: 1.Competency 1.1 Demonstrates an 1.1.5. supporting the post partum.5.3 Recognizes maternal nutritional.4 Educates the woman about discomforts of the puerperium and advises on strategies to relieve them 1.1.1 Identifies the normal process of involution and healing following • Physiology of the post natal period childbirth understanding of the physiology of the post natal period • Care of the mother and new born 1.5. mother-newborn dyad • Evidenced based midwifery skills for 1.1.2 Facilitates the process of lactation and bonding. physiological and emotional appropriate interventions needs and acts accordingly 1.5.5.5 Recognizes deviations from normal and acts accordingly Indicator Sub Indicator Page 11 of 27 .5.1.

6.Competency 1.1.1.1.6.6.6: Provides safe and effective care of the newborn Indicator Sub Indicator Evidence Guide Examples Knowledge of: • Physiology and needs of the new born • 1.3 Identifies variations in the normal newborn and acts accordingly appropriately 1.1 Recognizes signs of newborn adaptation to extra-uterine life knowledge of the physiology 1.1 Demonstrates a 1.1.6.6.2 Identifies factors relevant to growth and development and needs of the newborn Page 12 of 27 .4 Implements health promotion and disease prevention strategies Infection Control 1.

2 Demonstrates competency 1.6.2.1 Immediately assesses the newborn’s condition in the skills needed to safely care 1.2.4 Performs interventions to facilitate adaptation to extra-uterine life 1.6.2.2.6.5 Recognizes deviations from normal and acts accordingly 1.3 Promotes early breastfeeding Page 13 of 27 .2.6.6: Provides safe and effective care of the newborn Indicator Sub Indicator Evidence Guide Examples Knowledge of: • Newborn assessment and care • • 1.2.6.6.6.Competency 1.6 Initiates emergency measures when necessary • • Infection control Health and safety and environmental control Evidenced based midwifery skills for appropriate interventions Neonatal resuscitation 1.2 Performs a detailed physical examination of the newborn for the newborn 1.

7. Formula for calculating drug dosages (all routes) Pain management 1.3 Accurately calculates medication doses for administration • • 1.7.7.1.1.5 Recognizes contra-indications and side effects and acts accordingly 1. birth and lactation 1.1.1.6 Documents medication administration accurately Page 14 of 27 .7.7. birth and lactation based practice in use of pharmacological preparations 1.Competency 1.1.1.7.7.4 Safely administers medications during pregnancy.1 Educates the woman about the potential effects of medication during pregnancy.2 Educates the woman about any medications required by the relevant to midwifery practice newborn 1.7 Performs safe and effective pharmacological interventions Indicator Sub Indicator Evidence Guide Examples Knowledge of: • Medication administration and management protocols (the rights of drug administration).1 Demonstrates evidence 1.

1. supervised and supported to perform 2.1.1.1.Domain 2: Professional.1 To practice within a 2.6 Contributes to policy development impacting on midwifery practice 2.1.1.1 Functions in accordance with legislative and policy guidelines relevant to midwifery practice Indicator Sub Indicator Evidence Guide Examples Knowledge of: • • • • • • Regulatory and licensing requirement and self regulation Legislation governing midwifery practice Scope of Practice and scope of practice decision making tool Code of conduct and ethics for nurses and midwives Organisation policies Practice setting standards 2.1.1.1 Maintains current license to practice as an outcome of selfscope of competency and an regulation ability to work independently and in collaboration with others.1.1.1.4 Practices only to the level for which s/he is adequately prepared.7 Interacts with policy makers and legislators to influence legislation and regulation pertaining to midwifery practice Page 15 of 27 .1.1.2 Identifies unsafe practice and intervenes accordingly . legal and ethical practice Competency 2. 2.5 Utilizes relevant codes of conduct as a guide to midwifery practice 2.3 Functions within a set midwifery scope of practice as delineated by this document 2.1. 2.1.

3 Assumes responsibility for delegation and supervision of midwifery care (direct and indirect).1.2 Assumes responsibility and accountability for own actions and clinical decision making Indicator Sub Indicator Evidence Guide Examples Knowledge of: • • 2.2.2.1. which is relevant to the context and the competence of the person to whom care is delegated 2.1.4 Accepts responsibility for delegated activities relevant to the context and own level of competence 2.6 Advocates for the woman and families to ensure promotion of a healthy and safe birth • • Appropriate delegation Woman and family rights Differences in cultural and religious practices/needs Self assessment techniques Referral process/s 2.2.2 Consults and performs referrals as necessary • 2.5 Works collaboratively with other health care professionals to improve the delivery of services to the woman and her family 2.Competency 2.1.1.2.2.1.1 Performs ongoing self-evaluation to determine strengths and limitations in knowledge and skills Page 16 of 27 .2.

1.1.3.3.5 Communicates effectively with the woman.3.3 Works in partnership with the woman to support them in making informed choices about their health 2.1 Implements midwifery care in a culturally respectful and non-judgmental manner Page 17 of 27 . significant others and health care professionals to optimize care 2.1.1.3.3 Delivers care and practices midwifery within an ethical framework and social context Indicator Sub Indicator Evidence Guide Examples Knowledge of: • • 2.Competency 2.4 Acts to strengthen the woman in promoting health of self and others 2.6 Advocates to protect rights of the woman and families in relation to midwifery care • Advocacy Code of Conduct and Ethics for nurses and midwives Woman and family rights 2.2 Bases midwifery practice on ethical decision making 2.3.1.3.1.

1.4 Maintains record of all learning and professional development activities attended Evidence Guide Examples Knowledge of: • • • • • Technological and scientific advances Life long learning Reflective practice Sources of evidence based research Professional practice portfolio Page 18 of 27 .1.1 Demonstrates a commitment to development of self Indicator 3.1 The midwife is accountable for establishing.1 Maintains knowledge and skills through actively participating in continuing professional development programs 3.1. Sub Indicator 3.1.3 Actively engages in continuous self-assessment to evaluate and enhance own practice 3.1.1.1.1.Domain 3: Professional development Competency 3. maintaining and evaluating her own life long learning needs to ensure continuing competence to practice.2 Uses valid research to inform midwifery practice 3.1.

2 Demonstrates a commitment to development of others and the profession Indicator Sub Indicator Evidence Guide Examples Knowledge of: • • • • 3.6 Refers to and disseminates current research to guide midwifery practice Page 19 of 27 . Research and midwifery knowledge 3.2.3 Participates in facilitating and co-coordinating learning opportunities for others 3.2.2.4 Contributes to health care policy as relevant to midwifery practice Preceptor ship Mentoring Maternity care policies and standards.2.1.2.1. 3.1.2 Supports others less experienced or new to the profession professional development through formal and informal preceptor and mentor programs 3.1 Collaborates and shares professional knowledge with others direction and teaching of colleagues to enhance 3.5 Identifies opportunities and contributes to nursing research 3.Competency 3.1.1 Contributes to the support.2.1.2.1.

1.1.1.1.1 Recognizes that quality improvement involves ongoing consideration.1 Participates in improvement activities. quality Sub Indicator 4.2 Participates in case review activities 4.1.1. the midwife evaluates the effectiveness of care and promotes a midwifery perspective within the inter-professional activities of the team Competency 4.4 Uses appropriate risk assessment tools to identify actual and potential risks Evidence Guide Examples Knowledge of: • Safe administration of therapeutic substances • • • Risk assessment tools Quality Management Performance indicators (key quality characteristics) Page 20 of 27 .1 Recognizes and values quality improvement activities to monitor and improve standards of midwifery Indicator 4. use and review of practice in relation to practice outcomes.1. as a member of the healthcare team. standards and guidelines and new developments 4.3 Participates in clinical audits 4.1.Domain 4: Quality Improvement and Collaborative Healthcare: This domain contains competencies to demonstrate that.1.

2 on an individual’s/groups needs and healthcare setting 4.2.2 Recognizes that the 4.2.1.3 Demonstrates knowledge 4.1 membership and roles of healthcare teams and service providers will vary depending 4.2.3.Competency 4.2 members of the health team Recognizes when to negotiate with.2.2.2.2 Demonstrates accountability for communication.2 on an individual’s/groups needs and healthcare setting Sub Indicator Recognizes when to negotiate with.3. implementation and evaluation of care Indicator 4.2.• Decision making frameworks making • Processes for referrals Reviews and evaluates care with members of the healthcare team Page 21 of 27 .2.1.2. or refer to other healthcare or service providers Establish positive and productive working relationships with colleagues Evidence Guide Examples Knowledge of: • • Health care systems Roles and responsibilities of various models of interdisciplinary health teams Knowledge of: 4. consulting and collaborating with other health professionals and health providers regarding activities of care planning.1 of effective inter-professional work practices which respect and utilize the contributions of 4.1 membership and roles of healthcare teams and service providers will vary depending 4. or refer to other healthcare or service providers Establish positive and productive working relationships with colleagues • • Health care systems Roles and responsibilities of various models of interdisciplinary health teams Knowledge of: Participates with members of the healthcare team in decision.1 Recognizes that the 4.2.2.

The Midwife should use the following steps to assist in making appropriate and accountable decisions.SCOPE OF PRACTICE DECISION MAKING Decision making in midwifery practice is complex and relies on a number of factors. Is the function within the individual’s scope of practice? It is the responsibility of every midwife to understand and apply the relevant standards of professional practice within their own scope of practice. skill and experience to perform the function? • Are these skills and abilities documented in my employment file? • Do I have required authorization to perform this activity? • Do I require the expert assistance of other health professionals? • Have I met the requirements for delegation? • Have I met the requirements for supervision? Page 22 of 27 . Is the function within the scope of practice of the registered midwife? Midwifery practice in Dubai is guided by contemporary standards and policy endorsed by DHA HEALTH REGULATION and benchmarked against standards and procedures endorsed by national and international associations. training. IDENTIFY • Do I possess the current knowledge. Step 1. is it supported by policy and is it supported by research/evidence based practice for this situation? Are there other standards or regulatory policy that I must consider and will the practice comply with these? Do I require regulatory authorization to perform this activity? • • Step 2. IDENTIFY • • Is the activity within the scope of practice of the registered midwife? Does the practice comply with midwifery standards. In making decisions in relation to their scope of practice midwives must actively engage in continuous self assessment and self regulation to ensure continuing competence to practice.

IDENTIFY • Is there a legitimate need by the woman for this service? • Will the woman benefit from my performing this service? • Has the woman been consulted in the decision process? Step 4. Does the employing facility support this function? Midwives have the responsibility to practice within professional standards and guidelines which are supported by appropriate policies and procedures provided by employers.Step 3. Am I willing to accept accountability and responsibility for my decision? Page 23 of 27 . • • • Is this function identified within my role/job description? Do I have the support of my supervisor to perform this function? Is there organizational policy or procedure in place? Step 5. Is there an identified client/patient need or benefit? Midwifery care should occur in consultation with the woman and her family.

SCOPE OF PRACTICE DECISION MAKING STEPS Question: How do I know what my current Scope of Midwifery Practice is? ASK Step 1 Is the function within licensed midwifery practice? EVALUATE • Is the activity within the licensed midwifery practice? • Does the practice complies with midwifery standards and supported by policy and is it supported by research/evidence based practice for this situation? No YES Step 2 Is the function within the individual's scope of practice? YES • Do I possess the current knowledge. skill and experience to perform the function? • Are these skills and abilities documented in my employment file? • Do I have required authorized to perform this No activity? • Do I require the expert assistance of other health professionals? • Have I met the requirements for delegation? • Have I met the requirements for supervision? • Is there a legitimate need by the woman for this service? No • Will the woman benefit from my performing this service? • Has the woman been consulted in the decision process? • Is this function identified within my role/job No description? • Do I have the support of my supervisor to perform this function? • Do I accept responsibility for the performance and No outcome of this function in this context and mindful of any competence? DO NOT PROCEED Review & consult resources & seek Step 3 Is there an identified need by the woman or identified benefit? YES Step 4 Does the employing facility support this function? Yes Step 5 Am I willing to accept accountability for my decision? YES PROCEED Page 24 of 27 . training.

DELEGATION must not be given in circumstances which involve a compromise to the woman or new born safety or a breach of legislation or professional standards. The decision to delegate is based on the midwife’s professional judgment and determination that the person to whom the delegation is to be given is competent to perform the function. Supervision can be direct where the Registered Midwife works with the Registered Nurse. Processes which are the shared responsibility of the licensed midwife as well as the employer must be in place to support the Registered Nurse. direction. to a person whose role/job description and training allows them to perform such functions but does not have the authority to perform such functions without supervision. SUPERVISION Supervision is defined as the activities of oversight. Supervision can be indirect where the Registered Midwife is not present and supervision is provided other than by direct observation. Registered Midwives who delegate health care tasks retain accountability for the decision to delegate and the subsequent performance of the delegated task. guidance. Page 25 of 27 . Assistant Nurse or Health Care Assistant or Student Midwife in this situation. It is not permitted for Registered Nurses or Assistant Nurses to delegate tasks that are the domain of the qualified midwife. Supervision can be of the individual or a group of persons and is usually for a defined time as determined by the licensed nurse depending on the situation and activity. Assistant Nurse or Health Care Assistant or Student Midwife and can provide observation and intervention where necessary. Only REGISTERED MIDWIVES are able to delegate. monitoring or evaluating. support. advice.DELEGATION WITHIN THE SCOPE OF PRACTICE OF THE REGISTERED MIDWIFE DELEGATION BY REGISTERED MIDWIVES For the purpose of this document delegation is the conferring of authority to perform specific functions or tasks/activities in a specific situation.

ASSISTANT NURSE A Person registered under the registered assistant nurse scope of practice COMPETENT Having the required abilities or qualities COMPETENCE The combination of skills. values and abilities that underpin effective performance as a nurse DUTY OF CARE A duty to use care toward others that would be exercised by an ordinarily reasonable and prudent person in order to protect them from unnecessary risk of harm PUBLIC The community of the Emirate of Dubai. Page 26 of 27 .GLOSSARY OF TERMS ACCOUNTABILITY A Registered Midwife is answerable to the woman and her newborn. actions and behaviours. The focus should be on improvement. actions and behaviours and for the consequences of those decisions. The midwife has the responsibility to maintain and further develop the competence necessary for their area of practice. SELF REGULATION Self regulation is a dynamic process for the health professional which involves accountable practice and sound decision making. attitudes. United Arab Emirates REGISTERED NURSE A person registered under the registered nurse scope of practice SELF ASSESSMENT Self assessment of competence is a continuous process of examination against professional standards and guidelines. Critical continuous self assessment of competence to practice and actions to maintain and enhance competence is its foundation. the regulator and the public for her decisions. the employer. knowledge.

Department of Health & Medical Services (2008). Job Description/ Performance 5. L.. Australian Nursing & Midwifery Council (2006) National Competency Standards for the Registered Midwife. The Hague International Confederation of Midwives (2002) Essential Competencies for Basic Midwifery Practice http://www. ACMI (2001) Australian College of Midwives Incorporated Competency Standards for Midwives http://www.euro. Appraisal Midwife 6. Scope of practice for the Midwife 8. A.au 2.References 1.int/document/e86640.who.internationalmidwives. Health Authority Abu Dhabi (2007). Australian Nursing and Midwifery Council (2006) National Competency standards for the Midwife 4.pdf 7.acmi. (2004) Munich Declaration: nurses and midwives: A force for health. Wagner.org. Ministry of Health United Arab Emirates (2007). A Scope of Practice Decision – Making Tool Page 27 of 27 .org. Federal Department of Nursing. Nurses Board South Australia (2006). ICM/WHO/FIGO International Definition of the Midwife. An Analysis of implementation of the Munich Declaration 2004 (WHO publication) http://www.ae 9. Scope of Practice for the Midwife. ICM.anmc.haad.au 3.org/modules. Buscher.php?op=modload&name=News& file=article&sid=27 10. www. www.

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