THE INFLUENCE OF MODULE AND PRECEPTORSHIP METHOD ON

MIDWIFERY CARE II TOWARDS THE SKILL IMPROVEMENT OF THE

DIII MIDWIFERY STUDENTS

ABSTRACT

NUR ZAHRA. The influence of preceptorship method towards the skill

improvement of the Diploma III midwifery students (Adviced by Prastawa
Budi and Mardiana Ahmad)
Aim: This research is aimed to analyze the influence of giving module and
preceptorship learning method towards the second stage of childbirth care
skills on the Diploma III midwifery students at the Pelamonia Kesdam VII/
Makassar’s Midwifery Academy.
Method: the type of research method applied is experimental method
which classified on Quasi Experimental study designed by “pre-post test”.
The sample is some of students in level II who are still studying actively on
semester III in Institute of Health Science on Midwifery Study Program in
Diploma III at the Pelamonia Kesdam VII Wirabuanan Makassar totally 48
respondents. The implementation of research is started on November until
December 2019.
Result: the analyzing data of this research is conducted by using Wilcoxon
test with applying SPSS 24, then the result shows that the students’ skill
before giving module and preceptorship learning method is classified on
less skilled category (100%), and after giving module, it shows that 81,5%
(skilled) of them have capabality to execute the second stage of childbirth
care, then the statistical test shows that there is a different skill before and
after giving modul (p<0.05). Thus, it can be assumed that the giving
module and preceptorship learning method can improve the second stage
of childbirth skill.
Keywords: Module, Preceptorship, Second Stage of Childbirth Skill,
Student
INTRODUCTION
The further Subtainable Development Goals (SDGs) in 2030
becomes the crucial point in case of improving the quality of education
system. (UNDP 2015). The competency standard of the midwifery
graduated students can provide the treatments as appropriate as their
competences. (Kementrian-Kesehatan-RI 2011). The Midwifery Care II
Subject is one of structural study subjects of midwifery study program in
Diploma III. This learning matter is important in building the students as
the professional midwife in giving the high quality healthcare (Suwisi
2015).
The learning process of the second stage of childbirth care
requires the students to acquire the capability in applying the basic
concept of arranging the bookkeeping process appropriately. (Agus Susilo,
Siswandari 2016).
The curriculum of Diploma III in Midwifery Program is totally 39
SKS which consist of 36 SKS in practical subjects and 23 SKS in clinical
subjects (Lisa, Hernowo & Anwar 2016). The midwifery education is a high
vocational education which its learning target is decided on certain
proportion like as 60% including on practical lesson and 40 % including on
theoretical lesson in classroom (Nurmala 2018).
The previous study which have been conducted by (Murphy 2016)
shows that the skill which will be achieved by students is capability on
practicing the second stage of the childbirth, skilled on clinical practice,
and assisting students more effective in Clinical intructur guiding process.
Module is an innovative and creative learning that becomes a necessity,
so it can attract the learning want of students (Wahyuningsih et al. 2017).
Thus, it can be assumed that module can improve the students skill in
designing the learning material which encourage them more independent
and creative in learning (Sawyer, 2019).
Module in education is developed based the need in order to
increasing the interpersonal collaboration among students and lecturers to
achieve the target in education program from Antwerp University
Association (AUHA). The teaching which using module provides the
opportunity for students to learn through various different techniques, able
to solve the problem based on the background, knowledge, and the habits
of each student. Therefore, the good modul must be designed
systematically, interesting, and clearly so it can be used everytime
everywhere based on the need (Tsakitzidis et al. 2015).
The clinical education in midwifery, nursing, and medical field
involves the preceptorship learning model to improve the knowledge,
confidence of students in the clinic (Pujiastuti, 2018). Then, the midwifery
competency is the combination of evaluation that comes from skill,
behaviour and attitude to apply the midwifery care safely and responsible
(Kemenkes RI, 2015).
Therefore, the improvement of clinical learning by preceptorship
needs to be increased and able to apply its contribution and function which
being the responsibility together among the midwifery institution and the
hospital including as an unit so this act can bridge the gap theoretical and
practical cases and able to improve the students skill (Susanti et al, 2014).
Preceptor holds the crucial role in facilitating the clinical learning
experiences and student’s professionalism (Kurniati Ulfa et.al . 2015).
For fixing these problem, it needs to create the learning
management, in case of the role of preceptorship which is influenced for
increasing the skill improvement and professionalism, so it is very
important to give knowledge and building the psychomotor skill of students
(Susanti,et al 2014). The related literatures show that presenting
discussion in preceptorship method is very recommended to deal the
change.(Traynor, Wasike dan Caldwell, 2017).
The competency owned by a midwife nowadays, is very influenced
towards the service that given to people. One of factors which influences
the low competency of midwifes is caused by the requirement of
curriculum which rather priorities on result than process and there is no
standardization on evaluation tool (Nurmala, 2018). It is expected to
students that they have to able to provide the care for mothers as
appropriate with its procedure and authority, so the midwife can contribute
in decreasing AKI and AKB for the further (Kemenkes RI, 2010).
Therefore, the improvement of clinical learning by preceptorship
needs to be increased and able to apply its contribution and function which
being the responsibility together among the midwifery institution and the
hospital including as an unit so this act can bridge the gap theoretical and
practical cases and able to improve the students skill (Susanti et al, 2014).
The experienced midwife (preceptor) with the new midwife
(preceptee) can adapt as good with operating new tasks as a professional
midwife (Mccallian et al. 2014). The previous studies that have been
conducted yet by (Traynor, Wasike & Caldwell 2017) show that
preceptorship method can attract a discussion so it is very well to do to
deal the change when practicing on the field.
The obstacle found in the field when practicing is the lack of
preparation by students before doing practical act. They should
understand about the way to execute the second stage of the childbirth.
Similarly, the habit that often applied by the advisor through face to face,
absolutely spend much time. There is not enough time for interacting with
students, so the advisors feel difficult to give the assessment for them.
In facing certain obstacles in the field, it needs the practical and
clinical learning management through module with preceptorship method.
This treatment is expected to be able create the educational collaboration
in the clinic which involves the advisors in institution and clinic. Besides,
students can use the preceptorship process so they get the guidance
directly and the goal of learning can be reached.
The existence of the second stage of childbirth care modul is
expected to make the students getting motivation in developing the
learning independently, able to handle by themselves, able to solve the
problem as appropriate with procedure standard, able to optimize the
health of mothers and babies, and capable to give the useful lessons for
students to live in their environment with people (Sinatra, Gale M.
Taasoobshirazi, 2019).
Based on the descriptions above, the researcher deals to know the
influence of giving module with the preceptorship learning about second
stage of childbirth care towards the skill of the Diploma III midwifery
students.

METHOD
Method that used in this research was quasi experimental study
designed by “pre test post test design”. The researcher compared and
analyzed the skill before and after intervention of giving care module and
preceptorship learning method of the second stage of the childbirth for
Diploma III midwifery students of its module. The research was started
from November until Desember 2019. The sample was the second level
students on semester III in Diploma III midwifery study program. The
sampling technique was conducted by purposing sampling, the total
sample for the class of the second stage of the childbirth care module was
about 46 respondents which consist of the students who resigned as
subject of research, students who did not join for guidance, and the
students who did not exist on the pre-test and post-test. The independent
variable of this research was module and the second stage of the
childbirth care preceptorship, while the dependent variable was the skill of
the second stage of childbirth. The data analysis applied bivariat analysis
on the parameter scale such as category (ordinal and nominal) with using
Wilcoxon test.

THE RESULT
This research was conducted in STIKES Pelamonia Kesdam VII
Wirabuana Makassar started from November until Desember 2019 based
on the recommendation of the ethic agreement number:
1045/UN4.6.4.5.31/PP36/2019 on November 4th 2019 had been released
by the the ethic commission of Hasanuddin University of Makassar and
the data analysis used Wilcoxon test with rank signed test.
Tabel 1. Respondents’ Characteristics
, Modul and Preceptorship
Characteristic n=47 p value*
n(%)
IPK
less 2 (4.3) 0.103
Good 45 (95.7)
Age
<19 years old 40 (85.1) 0.862
≥19 years old 7 (14.9)
Income
<1.8 millions 25 (53.2) 0.835
≥1.8 millions 22 (46.8)
Anxiety
unworried 16 (34.0) 0.326
Worry 31 (66.0)
Confidence
Unconfident 25 (53.2) 0.126
Confident 22 (46.8)

*homogenetr Test of variance

The table above showed that the Commulative Achievement Index of
the Diploma III midwifery students in Pelamonia Kesdam VII Wirabuana
Makassar Midwifery Academy was dominantly very satisfying with the
scale of IPK 2.76 – 3.50 and tend to be <19 years old. Based on the
anxiety felt, it could be seen that the respondents did not feel unworried
with the skill that owned by them, otherwise their motivation for assisting
other was dominantly less which made the respondents felt confident in
helping the childbirth and sometimes they felt less confident too.
Table 2. Module and Preceptorship of the childbirth care towards the skill
of Diploma III midwifery students in Pelamonia Kesdam VII
Wirabuana Makassar Academy

Modul and Preceptorship

Variable/ sub n=47
Criteria
variable n(%)
Pre Post
Skill of Unskilled 47 (100.0) 7 (14.9)
second stage
of the Skilled - 40 (85.1)
childbirth care
1. Identifying 0 10 (21.3) -
the 1 - -
symptoms
and signs 2 37 (78.7) 47 (100.0)

4. Preparing 0 46 (97.9) -
helps 1 1 (2.1) 1 (2.1)
2 - 46 (97.9)
7. Ensuring 0 27 (57.4) 0 (0.0)
the 1 20 (42.6) 6 (12.8)
completed
Opening
and fetus 2 - 41 (87.2)
condition
10.Preserving 0 47 (100.0) 0 (0.0)
the mother 1 0 (0.0) 5 (10.6)
and her
family 2 - 42 (89.4)

13.Preparatio 0 47 (100.0) -
n of the 1 - 8 (17.0)
childbirth
process 2 - 39 (83.0)

16.Childbirth 0 47 (100.0) -
aid 1 - 9 (19.1)
2 - 38 (80.9)

The table of the statistics test above showed that the score of the
second stage of the childbirth care skill before and after given intervention
was referring to unskilled in doing the childbirth care to module and
preceptorship. While after given intervention, it showed that the
increasement of skill score. After given learning module and
preceptorship, the students were dominantly skilled and doing the sixth
skill part perfectly and it showed 85.1% with the score of p value < 0,001,
then the skilled and the sixth skill part were conducted nearly perfect.
DISCUSSION
In this research, the media and learning method used in improving
the second stage of the childbirth skill are the use of module and
preceptorship learning of the second stage of the childbirth care. From the
table 1, it describes that there is a difference of the learning result of the
second stage of the childbirth skill on the both groups which show that the
module and preceptorship of the second stage of the childbirth care are
influenced to the improvement of students’ skill in giving the childbirth care
especially for second stage. By using the module and preceptorship, it can
decrease the overweight of case in education, offering and increasing the
students competency towards the learning (Yankey et al. 2017). It means
that giving module and preceptorship is able to improve the students skill
and all parts of skill conducted perfectly too. Besides, it can give the
feedback to students’ learning being more structured, able to be designed
more interesting, easy to fulfil the need so it will encourage the students
motivation to do learning, then when the mistakes occurs, they will do
reconstruction soon. (Sinatra, Gale M. Taasoobshirazi, 2019).
The use of preceptorship method can facilitate students through
experience, learning outcome, and creating the comfortable learning
environment, so that they are free to call preceptor when they need some
helps in learning and they can interact with others politely (Nur
mukarromah, 2016). The preceptorship which conducted in practical field
can increase the learning outcome clinically. (Phuma-ngaiyaye et al.
2017).
Practical Learning in Laboratory emphasized more in tasking of
mastering skill aspect, both of basic or health technical skills. By mastering
skill aspect in laboratory, it will give the preparation for students to be
involved learning in a clinic. (Nurmala, 2018)
Based on the researcher’s assumption, the preceptorship learning
method can increase the effectiveness of teaching and creating the
effective learning environment, so the students can do practice to improve
the skill. Supported by giving module of the second stage of the childbirth,
it gives the access for students to learn the module contents, so they
become more active and able to do show the skill of the second stage of
the childbirth practically. The skill improvement that obtained by students
is cannot be undone from the effective teaching and the good learning
relation that based on the module of the second stage of the childbirth
care with students, in consequence, the learning is running well. By the
existence of module, the students will be more active in asking questions
related to the lessons that have been understood yet.
This case means that the module of the second stage of the child
birth care is good for improving the students’ skill in applying the midwifery
care especially for second stage of childbirth.

CONCLUSION
Based on the result of this research and data analysis which have
been conducted by researcher, it can be assumed that the difference of
average score on the second stage of childbirth care at module class and
preceptorship before and after intervention increasing significantly
compared to the demonstration class is on pre-test which describes that
module and preceptorship method in second stage of childbirth care is
better in improving its skill.

ACKNOWLEDGEMENT
The researcher expresses thankful to all persons who involved in
assisting the research process. Then, she also thanks to all students who
contributed as the respondents of this research. Furthermore, she also
says much thanks to all advisors who have given the guidance and
suggestion so this project can be finished on time.

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