Assessment of clinical competency of nurse-midwives : implications for maternal and neonatal health care at the national level/

Date of Award


Document Type


Degree Name

Master of Science in Nursing (MScN)


School of Nursing and Midwifery, Pakistan


The study purpose: To establish the extent to which the TNMC standard guidelines for midwifery practice are utilized in the facilities, explore and describe the level of clinical competence of nurse-midwives as well as identify the existing knowledge and skills gaps. Methods: An explorative descriptive study design was conducted at two public health care facilities in the Ilala district, on the practicing nurse-midwives. Systematic sampling technique was utilized in recruitment of participants. A sample of 55 nurse-midwives was involved in the study. The eligibility was: practicing midwife, work experience; length of stay at the facility, and willingness to participate. Data were collected in June, 2010, through test of knowledge of nurse-midwives, through a structured objective examination, and direct observation of participants in the actual performance of their duties using a structured skill check list. The data were analysed, and expressed in frequencies and percentages. Results: The findings, revealed that of the respondents' 52.9% had sufficient level of competency to provide care. Out of the 52.9% respondents, 43.5% had score between 65% - 95% in the knowledge test, and 80 - 94% in skills, and 9.4% had scored above 86% in the knowledge lest and 95% in skills and fell in highly sufficient category. The remaining, 47.1% of the respondents had low score in both the knowledge, and skills. Low levels were revealed on; monitoring of the mother and the babies condition; use of partograph, and infection prevention and control. Discussion: These findings call for the urgent attention of hospital management to improve the level of clinical competency of nurse-midwives. The nurse-midwives should be provided comprehensive training and refresher courses for effective and up to date knowledge and skills; the working should take place in also an enabling environment to in order to enhance competence. Implications: The findings of this study have created a platform that could be used to inform nurse/midwives leaders, other decision makers, and nurse-midwives working in maternity care units about what are the issues in midwifery practice; hence, plan for strategies that may contribute to improve the midwifery practices. Thus, findings of this study may have significance for nurse-midwife clinicians, nursing and midwifery teachers in the clinical and class room settings, and hospital administrators, working in facilities with characteristic similar to the two study sites.

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