UNIVERSITY OF FLORIDA - College of Nursing



UNIVERSITY OF FLORIDA

COLLEGE OF NURSING

COURSE SYLLABUS

SPRING 2013

COURSE NUMBER NGR 6360C (section 0704)

COURSE TITLE Nurse-Midwifery Care I

CREDITS 7 (3 credits didactic, 4 credits laboratory)

PLACEMENT First Course in Nurse-Midwifery Clinical Track

PREREQUISITES NGR 6002C: Advanced Health Assessment and Diagnostic Reasoning

NGR 6140: Physiology and Pathophysiology for Advanced Nursing Practice

NGR 6636: Health Promotion and Role Development

PRE/COREQUISITES NGR 6172: Pharmacotherapeutics for Advanced Practice Nursing

NGR 6240: Primary Care for Adults

FACULTY

|Jane F Houston DNP, CNM |(Office) 352/273-6411 |Office Hours: Fridays 10am-12pm |

|Clinical Assistant Professor |(Cell) 352/871-0151 | |

|houstonj@ufl.edu | | |

|Jane Gannon, DNP, CNM, CNL |(Office) 904-244-5166 |Office hours: Tuesday 1-3 pm |

|Clinical Assistant Professor | | |

|jgannon@ufl.edu | | |

|MaryAnn Smith MSN, CNM |Cell 352/316-5516 |Office Hours: Tuesday 4-6 pm |

|Clinical Assistant Professor | | |

|nursemas@ufl.edu | | |

|DEPARTMENT CHAIR | | |

|Susan Schaffer, PhD, ARNP, BC (Gainesville) |352/273-6366 |Office Hours: Mondays 1130am-1:30pm |

|sdschaf@ufl.edu | | |

|JACKSONVILLE CAMPUS DIRECTOR | | |

|Andrea Gregg, RN, DSN (Jacksonville) |904/244-5172 |Office Hours: By appointment |

|greggac@ufl.edu | | |

COURSE DESCRIPTION This course presents specialized knowledge of current theories and techniques in nurse-midwifery care. The emphasis is on the development of nurse-midwifery management skills in the care of women from diverse backgrounds who are at low risk for complications of pregnancy. The focus is on primary care, gynecological, antepartal, intrapartal, or postpartal care and the care of newborns. An additional focus of this course is on well woman care throughout the lifespan.

COURSE OBJECTIVES Upon completion of this course, the student will be able to:

1. Integrate scientific theories and research findings from nursing and other disciplines into nurse-midwifery practice to provide primary care, gynecological, antepartal, intrapartal, postpartal and neonatal care.

2. Synthesize and apply knowledge of normal physiologic and psychosocial aspects to women and neonates receiving nurse-midwifery care.

3. Provide culturally sensitive care to the low risk woman and neonate through the use of the nurse-midwifery management process.

4. Utilize international, national, state, and local administrative agencies concerned with health care of families, women and neonates to provide comprehensive care.

5. Collaborate with other health care providers to ensure continuity of care and optimal health care delivery for nurse-midwifery clients.

6. Demonstrate the nurse-midwifery professional role in the provision of care to women and neonates, including consultation and collaboration when appropriate.

7. Integrate primary care knowledge into clinical practice.

8. Utilize legal and ethical principles in the provision of care and the promotion of informed decision making with clients.

COURSE SCHEDULE

Online lectures weekly with two hours of Elluminate discussion

CLINICAL SCHEDULE

Individually determined (minimum of 192 clinical hours).

ATTENDANCE

Students are expected to listen to all online classes, attend other learning experiences and examinations. Students are expected to be present for all scheduled clinical practice experiences and seminars. Students may be expected to attend on-campus or synchronous classes periodically. Students are expected to participate in the activities and discussions as listed in the course syllabus and on the course web-site. Timeframes for the posting and receiving of materials are listed in the course materials on the course web-site. Students who have extraordinary circumstances preventing attendance should explain these circumstances to the course instructor prior to the scheduled examination or clinical lab, or as soon as possible thereafter. Instructors will make an effort to accommodate reasonable requests. A grade penalty may be assigned for late assignments or make-up exams. Make-up exams may not be available in all courses.

This course will use one of UF’s web hosted collaborative software applications (Adobe

Connect and or Voice Thread) for lecture presentation and or assignments.  These collaborative applications have the functionality of recording your text, audio and or video comments.   If you do not want to be recorded please notify assigned faculty member prior to the first class.  You do not need to provide a photo or use the video comment option, this is your choice.  The recordings are accessed through web links provided by your faculty member and should not be share with anyone not enrolled in the course. The recordings are available to the class during the semester.  The recordings will not be used in another course.

ProctorU Information for Graduate Online Courses ONLY:

o Major course examinations will be administered via ProctorU, a live proctoring service, to ensure a secure testing environment.

o Each student computer must be in compliance with Policy S1.04, Student Computer Policy and must contain a web cam, microphone, and speakers.

o Each examination will cost $22.50 per exam.

o Students go to the website and click on “How To Get Started”. This will permit students to create an account and test out their system.

o Once an instructor makes an exam available, students go online to ProctorU to schedule and pay for the exam session. Students must provide a valid email address and phone number where they can be reached during an exam.

o CON IT Support office will oversee this process and provide technical assistance.

Downloading the exam from Sakai is prohibited, as is printing the exam.

Graduate students are required to submit a written calendar of planned clinical practice dates and times to the course faculty member prior to beginning the clinical rotation. Any changes to the calendar (dates and times) must be submitted in writing to the course faculty member before the change is planned to occur. Clinical hours accrued without prior knowledge of the faculty member will not be counted toward the total number of clinical hours required for the course.

For clinical courses, students are expected to be present for all labs and scheduled clinical dates and times. Students who have extraordinary circumstances preventing attendance would explain those circumstances to the clinical instructor prior to the scheduled seminar or clinical date. The clinical instructor will make an effort to accommodate reasonable requests. The clinical component is pass/fail. The minimum number of hours must be achieved to pass.

ACCOMMODATIONS DUE TO DISABILITY

• Each semester, students are responsible for requesting a memorandum from the Disability Resource Center to notify faculty of their requested individual accommodations. This should be done at the start of the semester.

COUNSELING AND STUDENT HEALTH

Students may occasionally have personal issues that arise on the course of pursuing higher education or that may interfere with their academic performance. If you find yourself facing problems affecting your coursework, you are encouraged to talk with an instructor and to seek confidential assistance at the University of Florida Counseling Center, 352-392-1575, or Student Mental Health Services, 352-392-1171. Visit their web sites for more information: or

STUDENT HANDBOOK

Students are to refer to the College of Nursing Student Handbook for information about College of Nursing student policies, honor code, and professional behavior. Of particular importance for this course are the sections on appearance in clinical practice areas, personal liability insurance, and student safety.

TOPICAL OUTLINE

1. National, state and local agencies involved in providing primary care, gynecologic, antepartal, intrapartal, postpartal, neonatal and family services

2. Anatomy and physiology associated with gynecology, pregnancy, labor and birth, and the puerperium; fetal growth and development

3. Anatomy, physiology and care of the neonate; in adaptation to extrauterine life and stabilization

4. Common laboratory and diagnostic tests specific to fertility, perinatal and neonatal care

5. Patient education: Family planning, well-woman gynecology, pregnancy, birth, postpartum, neonatal and preparation for childbirth

6. Human sexual response; sexual problems; PLSSIT counseling, referral and resources

7. Undesired pregnancies; counseling, referral and resources

8. Fertility problems issues; preconception, family planning methods, assisted fertility methods, resources for counseling and referral

9. Management of common breast problems, vaginitis and sexually transmitted infections

10. Nurse-midwifery care of low-risk women and neonates

11. Diagnosis and evaluation of the normal course of women’s health, pregnancy, labor and birth, and the pueperium

12. Nutritional needs associated with the well woman, pregnancy, the puerperium and the neonate

13. Emotional and psychosocial changes across the lifespan and those associated with pregnancy and the puerperium

14. Etiology and use of; pharmacologic and non-pharmacologic methods of pain/discomfort relief in women’s health and during pregnancy, birth, and postpartum

15. Maternal/infant/family grief and attachment processes

16. Methods for assessing normal neonatal status and gestational age

17. Antepartal and intrapartal management issues: Assessment of maternal/fetal well-being, stripping membranes, STIs, UTIs, labor status, hydration, nutrition, labor initiation, ambulation, pain management, position for labor/delivery; episiotomy/ laceration and repair, delivery, and facilitating neonatal adaptation

18. Lactation and methods for facilitation and suppression

19. Peri-menopausal and post menopausal physiology, psychosocial considerations, and methods/options for health care needs

20. Legal and ethical perspectives of nurse-midwifery care

TEACHING METHODS

Online lecture via Voice Thread, case studies, discussion via Adobe Connect (Tuesdays 7-9pm), demonstration, electronic sources, audiovisual materials, supervised clinical practice, and readings.

LEARNING ACTIVITIES

Clinical simulations and laboratory; written papers; oral presentations (online).

CLINICAL EVALUATION

Clinical experience will be evaluated through faculty observation, verbal communication with the student, written work, and agency staff reports using a College of Nursing Clinical Evaluation Form. Faculty reserve the right to alter clinical experiences, including removal from client care areas, of any student to maintain patient safety and to provide instructional experiences to support student learning.

Clinical evaluation will be based on achievement of course and program objectives using a College of Nursing Clinical Evaluation Form. All areas are to be rated. A rating of Satisfactory represents satisfactory performance and a rating of Unsatisfactory represents unsatisfactory performance. The student must achieve a rating of Satisfactory in each area by completion of the

semester in order to achieve a passing grade for the course. A rating of less than satisfactory in any of the areas at semester end will constitute a course grade of E. Satisfactory achievement of clinical competency is a requirement to receiving a course grade. Regardless of the classroom grade, a student receiving an Unsatisfactory evaluation in the clinical component of the course will be assigned a course grade of E.

The faculty member will hold evaluation conferences with the student and clinical preceptor at each site visit. The faculty will write a summary of each conference in an advisement note. This summary will be signed by the faculty member and student. Final evaluation conferences with the faculty member are mandatory and will be held during the last week of each semester. A student may request additional conferences at any time by contacting the clinical faculty member.

Students enrolled in advanced practice courses with a clinical component will use Clinical Experience Form F to document clinical experience including hours, practice location and preceptor for their personal records. Students also assess their learning experience using Clinical Site Assessment Form G. Completed Form G is collected by the faculty member and submitted to the Coordinator of Clinical Laboratories at the College. At the end of the clinical experience the student completes a self-evaluation and the faculty completes a student evaluation using the College of Nursing Clinical Evaluation Form.

CLASSROOM EVALUATION

For students who achieve a satisfactory clinical grade, the letter grade for the course will be based upon the following:

GRADING SCALE

A 95-100 (4.0) C 74-79* (2.0)

A- 93-94 (3.67) C- 72-73 (1.67)

B+ 91-92 (3.33) D+ 70-71 (1.33)

B 84-90 (3.0) D 64-69 (1.0)

B- 82-83 (2.67) D- 62-63 (0.67)

C+ 80-81 (2.33) E 61 or below (0.0)

* 74 is the minimal passing grade

Exam I 20%

Exam II 20%

Exam III 20%

Paper 25%

Case Study Presentation 15%

Clinical Practice Pass/Fail (minimum of 192 clinical hours)

Late Work: Students are expected to turn in assignments when they are due. If advance arrangements are made with the faculty for due cause (e.g. extended illness, death in the family), an assignment may be turned in at a later date without penalty. Otherwise, assignments turned in late will be assessed a penalty of five (10) percentage points the first 24 hours, plus (5) percentage point per day after the first 24 hours, including weekends. This is deducted from the final percentage grade.

Clinical Evaluation: Clinical experience will be evaluated through faculty/preceptor observation, self-evaluation, agency staff reports, and written work. Ongoing clinical evaluation will occur each clinical day, and will be summarized at midterm and at the end of the course. Evaluation will be based on achievement of objectives using the Midterm & Final Evaluation Tool and the Daily Clinical Evaluation Tool. The student must practice at a safe level in all categories of practice to pass the course. Categories of clinical include preconception, antepartum, intrapartum, postpartum, newborn, family planning/gynecology, well-woman, and primary care. Students should complete both a midterm and final evaluation. At the midterm evaluation, any areas of difficulty should be identified and a plan to resolve the difficulty established in writing with the student, the preceptor (if any), the faculty advisor, and the course instructor. If the student is unable to practice safely in all categories at the end of the course, a failing grade will be given. As stated in the nurse-midwifery guidelines and discussed during the orientation session, failure in any area of the clinical component results in the inability of the student to progress to the next clinical course regardless of the didactic component of the grade.

Satisfactory achievement of clinical competency is a requirement to receive a course grade. Regardless of theory grade, a student receiving an unsatisfactory evaluation in the clinical component of the course will be assigned a course grade of E.

REQUIRED

REQUIRED: All texts from previous MSN courses

American College of Nurse-Midwives (ACNM) 

        Core Competencies for Nurse-Midwifery Practice (2007)

        The Standards for the Practice of Nurse-Midwifery (2003)

        The ACNM Code of Ethics (2008)

REQUIRED TEXTS

Beckmann, C., Ling, F., Smith, R. & Barzansky, B. (2009) Obstetrics and Gynecology (6th ed).

Philadelphia, PA: Lippincott Williams & Wilkins

Gabbe, S., Simpson, J. L., Niebyl, J. R., Galan, H., Goetzl, L., Jauniaux, E.R. & Landon, M (2012)

Obstetrics: Normal and Problem Pregnancies (6th ed). Philadelphia, PA: Churchill Livingstone

Hatcher, R. A., Trussell, J., Nelson, A.L., Cates, W., Stewart, F., & Kowal, D. (2011).  Contraceptive

technology (20th ed.). New York, NY: Ardent Media.

Oxorn, H. (1986). Oxorn-Foote: Human labor and birth (5th sub ed.). Norwalk, CT: Appleton & Lange.

Varney, H.  (2004). Varney’s midwifery (4th ed.).  Sudbury, ME: Jones and Bartlett.

RECOMMENDED TEXTS

Briggs, G.G, Freeman, R.K., & Yaffe, S.J.  (2011). Drugs in pregnancy and lactation (9th ed.). 

Philadelphia, PA: Lippincott Williams & Wilkins.

Cunningham, F. G.,  Leveno, K. J., Bloom, S.L., Hauth, J.C., Gilstrap, L. C., & Wenstrom, K.D.  (2009).

Williams Obstetrics (23rd ed.). Columbus OH: McGraw-Hill.

Gordon, J. D., Rydfors, J., Druzin, M.L., Tadir, Y., El-Saved, Y., Chan, J., Lebovic, D., Langen, E. & Fuh,

K. (2007). Obstetrics, Gynecology and Infertility: Handbook for Clinicians; Pocket Edition. Arlington,

VA: Scrub Hill Press

Varney, H.  (2009). Varney’s Pocket Midwife (2nd ed).  Sudbury, ME: Jones and Bartlett.

Youngkin, E. Q., Davis, M. S., Schadewald, D.M., & Juve, C. (2013). Women’s Health: a primary

health guide. (4th ed.). Upper Saddle River, NJ: Pearson Education Inc.

Approved: Academic Affairs Committee: 2/01; 1/02

Faculty: 3/01; 2/02

UF Curriculum: 10/97; 11/01

WEEKLY SCHEDULE

|Date |Lecture |Readings |

|1/7/13 |Introduction to Spring semester and simulation lab work, role of the | |

|Monday |midwife DVDs (CON classroom, Jacksonville) | |

| | | |

|CON Jacksonville LAB |Suture Lab |See SAKAI website |

| | |Handouts online |

| | |V pp 1275-1289 |

| | |G pp 472-474 |

|1/8/13 |IUPC, IFSE, local infiltration, other procedures |See SAKAI website |

|Tuesday |L&D Lab (Normal birth, fetal monitoring, vaginal examination) |Handouts online |

|CON Jacksonville LAB |Mock clinical encounter |V Ch 27, 64, 65, 68, 69 |

| | |B Ch 1 |

|1/7/13- 1/11/13 |Menstrual Cycle / Ovulation |CT Ch 2 |

| |A & P of Labor |G pp 303-314 |

| |Normal Labor Stage I |V Ch 26; OF Ch 11 |

| |Normal Labor Stage II |V Ch 28 |

|l/14/13 |A& P Of Pregnancy/Fetal development/pelvimetry/fetopelvic relationships |V Ch 21; OF 1, 5, 7, 8 & 9 |

| |Mechanisms of Labor | |

| | |V pp 823-827; OF pp 94-106 |

| |Prenatal Care |V Ch 22 |

| | |G Ch 5 |

|1/22/13 |Antepartum Lab Interpretation |V Ch 22 |

|(1/21/13 MLK birthday observed) | | |

| |Pain relief |OF Ch 31 |

|1/28/13 |EXAM I | |

| |Grief; Attachment and Loss |Article on SAKAI |

| | |V pp 1048-1052 |

| | |G pp 580-581 |

| |3rd & 4th stage |V Ch 31, 33 |

WEEKLY SCHEDULE

|Week of February 4 |Newborn exam, transition to extrauterine life; hyperbilirubinemia |Newborn handouts online |

| | |B Ch 10 |

| | |G Ch 20 |

|February 11 |Newborn infections / Social high risk |G Ch 20 |

| |Common discomforts |V Ch 5, 21 & 22 |

| | |B Ch 2, 14 |

|February 18 |Lactation, breastfeeding, and mastitis |B Ch 11 V Ch 43 |

| | |G Ch 22 |

|February 25 |EXAM II | |

| |Menopause, HRT/ well woman exam |B Ch 1 & 37 |

| | |

|March 4-8 SPRING BREAK – NO CLASS | |

|March 11 |Nutrition / weight management |V ch 22, pp 599-608 |

| | |B pp 68-69 |

| |Teratogens |G Ch 8 |

| |Jill Hendrickson, MS MSSW |handouts |

| | | |

| |PAPER DUE | |

|March 18 |Undesired pregnancy / fertility and options |handouts |

|March 25 |Cord blood gas analysis | |

| |Postpartum depression |V ch 44 |

|April 1 & 8 |Evidence-based care and international aspects of midwifery | |

|April 15 |EXAM III | |

| April 22 |PRESENTATIONS online | |

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