| Module Code: NURM053 |
Module Title: ADVANCED ASSESSMENT OF THE NEWBORN FOR MIDWIVES |
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Module Provider: Health & Social Care
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Short Name: ADVASSFORMID
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Level: M
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Module Co-ordinator: BROWN A Dr (HSC)
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Number of credits: 30
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Number of ECTS credits: 15
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| Module Availability |
| Semester 1 |
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| Assessment Pattern |
A portfolio of evidence to demonstrate a record of learning in and through practice which should demonstrate the achievement of the module learning outcomes.
Clinical Practice
Up to nine months to complete practice component.
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| Module Overview |
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| Prerequisites/Co-requisites |
Registered Midwife with three years post registration experience
A relevant degree or demonstrate academic ability
• Evidence of sound knowledge of anatomy, physiology, pathophysiology applied to newborn assessment
• Normally three years’ recent experience in a relevant area of clinical practice
• Evidence of clinical skills, writing skills and reasoning at level 3
• Prior to starting the module students are advised to prepare by reading one of the essential texts
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| Module Aims |
This module is delivered in two parts.
Part 1:
To carry out structured systems-based physical examinations and health assessments within their professional practice context.
To focus on the complex skill of assessing undifferentiated problems, to devise differential diagnoses, develop management plans and make appropriate referrals.
To examine knowledge and understanding of normal physiology and pathophysiology and abnormalities using a body systems approach linking this to assessment of the newborn.
To define assessment and examine the purposes of assessment.
To examine clinical judgement by identifying clinical phenomena that manifest in the newborn, examining clinical data that refer to clinical phenomena (including assessment data), considering the outcome of assessment (the condition, clinical or health state), and exploring the diagnostic reasoning process.
To critically analyse the evidence base for the assessment and treatment, to critically analyse current assessment frameworks, and to evaluate the implications for care.
Part 2:
The second part of this module aims to prepare midwives to undertake the complete physical examination of the healthy newborn, between 37-42 completed gestational weeks. This examination will replace that which has traditionally been undertaken by a paediatrician or a GP. The rationale for the neonatal examination conducted within the first 24 hours and days after delivery will be to detect any signs of acute illness or abnormalities, to allow prompt diagnosis and intervention without which many of the acute conditions which afflict newborn babies can lead to serious consequences.
The midwife as the lead professional is increasingly expected to manage a caseload, diagnose and refer appropriately and communicate effectively with a variety of other disciplines and the multidisciplinary team.
However, in the interest of clients, this constantly changing and expanding role requires midwives to develop new skills and competencies, which necessitate appropriate education. This module seeks to develop such skills, underpinned by a sound knowledge base to support clinical practice. Skills development is within the context of holistic care and therefore the emphasis is on recognition of the theory and practice to develop and expand these new skills, which are based on evidence based practice.
This new role undertaken will enhance independent and autonomous practice whilst improving continuity of care and facilitate more timely discharge of babies from the postnatal area, reducing paediatric workload. In addition such a role will enable birth at home to be easily facilitated where the GP has not been contacted to provide neonatal examination.
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| Learning Outcomes |
By the end of the module the student will be able to:
Subject Knowledge and Understanding
Demonstrate understanding of generic consultation skills and application of clinical frameworks within the newborn assessment
Recognise professional boundaries and conduct, accountability of the advanced practitioner, referral pathways, safe practice, and understands the issues relating to parental/ guardian consent and newborn dignity
Use knowledge of body systems and related problems and associated signs and symptoms to make accurate differential diagnoses
• Assess the physiological adaptation of each system in the fetus-neonate and relate these to the examination of the newborn
• Determine risk factors in relation to neonatal well-being and identify deviations from the norm in the newborn
• Assess the neonatal condition to determine the involvement of the multidisciplinary team, through referral to a paediatrician and the need for any urgent intervention through locally agreed channels
• Consider critically the ethical and moral dilemmas parents may encounter when faced with a deviation from the normal in the newborn and to improve skills of the midwife in breaking bad news
Cognitive Skills
• Critically evaluate the evidence and research base of new approaches to judgement and decision-making in relation to care of the newborn
• Analyse and evaluate contemporary issues in the field of neonatology using appropriate evidence.
• Critically evaluate the relevant research studies to underpin best practice in the care of the newborn
• Critically evaluate and reflect on own learning
Analyse clinical data in the context of health and disease and assess their probable significance
Use a structured and systematic approach in assessment, linking clinical data to clinical knowledge within a holistic framework, to arrive at a differential diagnosis of certain conditions such as heart sounds, hip assessment and respiratory condition
Evaluate the evidence in support of diagnostic theories
Evaluate the evidence in support of clinical decisions and the management plan
Evaluate the effectiveness of approaches to the diagnosis of the condition, and to the promotion of health and management of the condition
Key/Transferable Skills
• Engage in effective communication with the parents and members of the multi-disciplinary team whilst developing the skills of history taking
• Critically reflect on own practice as a means of improving care for newborn babies
• Determine the professional, moral, legal and ethical issues in relation to midwifery practice.
• Carry out the examination of the newborn competently
Draw on research evidence to support clinical judgements about clinical conditions and related interventions
Practical skills
Demonstrate systematic newborn assessment and physical examinations within clinical settings
Apply complex skills of systematic and holistic assessment of undifferentiated newborn problems to make accurate differential diagnoses, safe management plans and appropriate referrals
Act autonomously, using skills acquired, within guidelines of
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| Module Content |
Indicative content:
Part 1:
• Assessment: Principles, definitions, purposes. Clinical Judgement / clinical reasoning (includes identification of clinical phenomena, types of clinical data, identifying the clinical condition, the clinical reasoning process and differential diagnosis).
• The Health History: Communication skills and interviewing techniques in health assessment. Legal and ethical aspects of the newborn assessment. Review of body systems, application of communication skills, and documentation of findings.
• Advanced clinical assessment: Development of skills for complex assessment of altered health states for the main body systems. These systems would include the central nervous system, respiratory system, cardiovascular system, gastrointestinal system, genitourinary system, skin, musculoskeletal system and the special senses: (eyes/ vision, ears/ auditory, vestibular/ equilibrium).
• Differential diagnosis: Analysis of clinical cases to develop differential diagnosis skills focusing on undifferentiated health problems for the above body systems.
• Evaluation: Critical analysis of current frameworks for assessment. Critical analysis and reflection on the practitioner’s role and evidence of contribution to the development of the role. Evidence of autonomous and advanced practice and critical analysis of the evidence for practice.
Part 2:
Theoretical input of:
• embryology and fetal development of a specific system
• adaptation of this system to extra-uterine life
• the abnormalities that can be detected on examination in relation to this system
• the common problems in relation to the well neonate for this system
• the explanations and information that is given to parents
• the information from maternal history that is required to relate findings to management
• choice of a specific problem related to this system and outline the management and the short and long term care and prognosis for that neonate
• exploration of the processes involved in integrating parental and professional model of care
Repeated as above for each of the systems indicated below:
Cardiovascular system
Respiratory
Neurological
Gastrointestinal
Urogenital/ chromosomal sexual differentiation
Musculo-skeletal
Sensory organs – including skin
Metabolic and Endocrine system
Immune system – infection
Genetics/Embryogenesis- dysmorphology
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| Methods of Teaching/Learning |
Contact hours: 80 hours
Workbased/ self directed 300 hours
Teaching will be by interactive lectures/discussions/seminar presentations and practical experience.
Students will be enrolled through U learn for blended learning using e-learning technology.
Study Days
Part 1: 1 to 3 days per week for 4 weeks in theory on assessment strategy, history taking, peer evaluation, accountability in advanced practice, clinical reasoning and differential diagnosis in certain conditions of a number of body systems as applicable to the newborn eg heart sounds, hip assessment and respiratory conditions
Part 2: One day a week attendance at the University of Surrey for 8 weeks in theory
Facilitated by module leader, paediatricians, other contributing tutors
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| Selected Texts/Journals |
ESSENTIAL READING LEVEL
Bickley L S (2003) Bates’ guide to physical examination and history taking, 8th edn. Lippincott Williams and Wilkins, Philadelphia
(Pocket companion also available)
Or
Epstein O, Perkin D G et al. (2003) Clinical examination 3rd edn. Mosby, Edinburgh
Or
Douglas G Nicol F Robertson C eds. (2005) Macleod’s clinical examination 11th edn. Elsevier Churchill Livingstone, Edinburgh
Or
Talley N J, O’Connor S (2006) Clinical examination A systematic guide to physical diagnosis 5th edn. Elsevier Churchill Livingstone, Edinburgh
Recommended Reading:
Ballinger A Patchett (2003) Saunders’ pocket essentials of clinical medicine 3rd ed. Saunders Elsevier, Edinburgh
Baston H & Durward H (2001) Examination of the New Born : A practical guide Routledge, London
Blackburn (2003) (2nd edition) Fetal & Neonatal Physiology
Bloomfield L, Townsend J & Rogers C (2003) Qualitative study exploring junior paediatricians, midwives, GPs and mothers’ experiences and views of the examination of the newborn Midwifery 19 (1) pp37-45
Coad J, Dunstall M (2001) Anatomy & Physiology for Midwives Mosby Woolfe, London
Firth L (1996) Ethics and Midwifery : Butterworth Heinemann, Oxford
Gaedeke MK (1998) Paediatric and Neonatal Critical Care Mosby, London
Hopcroft K Forte V (2003) Symptom sorter 2nd edn. Radcliffe Medical Press Ltd., Abdingdon
Jarvis C (2004) Physical examination & health assessment 4th ed. Saunders, St Louis (Pocket companion also available)
Kelnar C, Harvey D, Simpson C (1995) The Sick Newborn Baby Balliere Tindall, London
Klaus M, Fanaroff A (1993) Care of the High Risk Neonate Philadelphia WB Saunders USA
Kumar P Clarke M (2005) eds. Clinical medicine 6th edn. Elsevier Saunders, Edinburgh
Leone Ta, Finer NR (2006) Fetal adaptation at birth Current Paediatrics [online] 16(4) pp 269-274
Levene M et al (1993) Essentials of Neonatal Medicine Blackwell, London
Longmore M Wilkinson I B et al (2004) Oxford handbook of clinical medicine 6th edn. Oxford University Press, Oxford
Lumsden H (2005) Midwives experience of examination of the newborn as an additional aspect of their role: a qualitative study MIDIRS Midwifery Digest 15 (4) pp450-457
Marieb E N (2004) Human anatomy and physiology 6th ed. Pearson Benjamin Cummings, London
Mc Sherry R Johnson S (2005) eds. Demystifying the nurse/therapist consultant. A foundation text Nelson Thornes, Cheltenham
Milner RDG & Herber T (1984) A colour atlas of the newborn Oxford University Press, Oxford
Moon G, Gould M et al. (2000) Epidemiology: an introduction. Open University Press, Buckingham
Porth C M (2004) Essentials of pathophysiology. Concepts of altered health states Lippincott Williams & Wilkins, Philadelphia
Raftery A T (2005) Differential diagnosis 2nd ed. Elsevier Churchill Livingstone, Edinburgh
Robertson NRC (1992) Textbook of Neonatology Churchill Livingstone, London
Rogers C, Bloomfield L & Townsend J (2003) A qualitative study exploring midwives perceptions and views of extending their role to the examination of the newborn baby Midwifery 19 (1) pp 55-68
Silverman J Kurtz S Draper J (2005) Skills for communicating with patients 2nd edn. Radcliffe publishing, Oxford
Stables D (1999) Physiology of Childbearing Balliere Tindall, London
Tappero & Honeyfield (2003) (3rd edition) Physical Examination of the Newborn
Thompson A Dowding D (2002) Clinical decision making and judgement in nursing Churchill Livingstone, Edinburgh
Townsend J et al (2004) Routine examination of the newborn EMREN study Research findings register – summary minutes 1380 www.refer.nhs.uk/view record
Wulff H R Gøtzsche P C (2000) Rational diagnosis and treatment. Evidence-based clinical decision-making 3rd edn. Blackwell Science, Oxford
JOURNALS
Journal of Neonatal & Gynaecological Nursing
USEFUL WEBSITES
neonatal.peds.washington.edu\NICU-WEB\
http//:rms.nelh.nhs.uk\childhealth
Cochrane: The Cochrane database can be accessed through the UNIS website.
University of Surrey; htpp://www.surrey.ac.uk/library
York Centre for Systematic Reviews and Dissemination;
htpp://www.york.ac.uk/inst/crd
C.H.A.I.N (Contact, help, advice, information network); Chain@doh.gov.uk
Health Development Agency; http://www.hda-online.org.uk
NELH (The National Electronic Library for Health); http://www.nelh.nhs.uk
Department of Health; htpp://www.doh.gov.uk
Becher J 2004 Insight into early fetal development [on line] Royal College of Physicians of Edinburgh, Edinburgh. Available from http://www.behindthemedicalheadlines.com/articles/fetal development.shtml
www.bmj.com
http://bmj.bmjjournals.com/cgi/content/full/331/7511/0?etoc&eaf
www.dh.gov.uk
http://www.emedicine.com/
http://www.emedicine.com/emerg/topic490.htm
www.etu.sgul.ac.uk/cso/
http://www.medicine.ucsd.edu/clinicalmed/lung.htm
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| Last Updated |
| 3RD AUGUST 2010 |
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