Japanese Nursing Association

Introduction

Background for the Formulation of the Guidelines for Applying Clinical Ladder of Competencies for
Midwifery Practice (CLoCMiP) ............................................................................................ P.2 (orig.P.2)

Message to readers

Message to Midwives Going Up the Ladder ........................................................no translation (orig.P.6)

Chapter 1

Career Development and Career Enhancement of Midwives ........................................................... P.7 (orig.P.7)
 What is a midwife? ........................................................................................................ no translation (orig.P.7)
 Career paths of midwives ................................................................................................................ P.7 (orig.P.9)
 Midwife’s portfolio .................................................................................................................... P.11 (orig.P.13)
 The CLoCMiP and the significance of this guideline .................................................. no translation (orig.P.25)

Chapter 2

What Is the CLoCMiP? ................................................................................................................. P.14 (orig. P.29)
 Background for the development of the CLoCMiP ....................................................no translation (orig. P.29)
 The CLoCMiP from Level Novice to Level IV ........................................................................ P.14 (orig. P.36)

Chapter 3

Education Programs Based on the CLoCMiP ............................................................................. P.24 (orig. P.42)
 Education items that correspond to the CLoCMiP from Level Novice to Level IV ................. P.24 (orig. P.42)
 Education programs that correspond to each level of the CLoCMiP ........................................ P.24 (orig. P.42)

Chapter 4

Comprehensive Evaluation of the CLoCMiP ............................................................................... P.30 (orig. P.60)
 What is the comprehensive evaluation of the CLoCMiP? ........................................................ P.30 (orig. P.60)

Chapter 5

Training for the CLoCMiP .............................................................................................. no translation (orig. P.68)
 Creative efforts in the implementation of training ...................................................... no translation (orig. P.68)
 Examples of training plans .......................................................................................... no translation (orig. P.70)

Chapter 6

Questions and Answers concerning the CLoCMiP ........................................................ no translation (orig. P.75)

Chapter 7

Glossary of Terms ............................................................................................................. no translation (orig. P.82)

1

Introduction

Background for the Formulation of the Guidelines for Applying Clinical Ladder of Competencies for
Midwifery Practice (CLoCMiP)

Training midwives capable of satisfying expectations for the roles from pregnant and puerperal women and thesocietyIn the era of changing demographic structure, particularly with the rapidly declining birthrate, what roles are expected of midwives in the perinatal
medical care service system? It is time we thoroughly examined this matter.
At the same time, not only individuals but also organizations are required to review what career paths should be drawn for midwives to fulfill their
expected roles, and what support is required to realize such career paths.
At present, expectations are high for the “training of novice nursing staff, following the establishment of educational systems to enable organizedtraining for novice nursing staff. On the other hand, it is deemed indispensable to review, mature and further develop the systems on an ongoingbasis, in response to unavoidable changes in the environment and social circumstances that surround medical care. The case is especially the samewith the training of newly graduated midwives that has just started.
In the meantime, similar review and the establishment of systems are required for continuing education, targeted at midwives who have been in thepractice for one year. However, such review and the establishment of systems are limited within the individual facilities where midwives work.
Furthermore, it is urgently required to promote the career development of midwives, as a part of measures to develop professional abilities, while thenationwide workforce of midwives is far from sufficient.
In career development, the philosophy of the nursing department is established based on the philosophy of the hospital. Educational philosophy andeducational targets are defined based on the philosophy of the nursing department. Subsequently, the philosophy for midwifery, the philosophy for
midwifery education, and the targets for midwifery education should be formulated as required for individual hospitals to perform their roles andfunctions. While it is required to determine midwifery philosophy and targets as specialists who take care of the two lives, of mother and child, rather
than as a subcategory of nursing staff, it seems that, in the present status, ongoing education for midwives is undertaken under the education
philosophy and educational targets for the nursing staff in general.
However, it is necessary to support the professional life of midwives to enable their development in midwifery throughout their life, and to train andsupport, in particular, midwives who are capable of satisfying expectations from pregnant and puerperal women and the society.
To continuously strengthen the practical ability of midwives following basic midwifery education as its ground and the education of newly graduatedmidwives as its basis, it is required to establish a standardized strategy at an ALL-Japan level, crossing over the borders of facilities.

2

Initiatives at the Japanese Nursing Association based on national measures and projects
Here, look at the table below describing the activities of midwives that have been expected in national measures and projects over the ten years from2001 to 2010.
In response to these national measures and projects, and to the conditions of clinical midwifery practice, we at the Japanese Nursing Association(“JNA”) have undertaken diverse initiatives.
In 2003, the Professional Committee on Midwifery of JNA created “Evaluation of the Quality of Midwifery Care at Medical Facilities: Self
Evaluation Criteria” as a self-evaluation tool aimed to improve the quality of midwifery care. Two years later, a nationwide status survey was
conducted using these evaluation criteria.

3[TableActivities of Midwives Expected in National Measures and Projects]

 The environment that surrounds medical care has been substantially changing, including the declining birthrate and super-aging society, as well as
limited medical facilities, equipment and human resources.
 On a national scale, plans have been made toward the promotion of team approach for improving medical services, childrearing support
measures, and so on. In this context, recognition has been renewed concerning the utilization and necessity of midwives, and their expecteddevelopment.
Sukoyaka Oyako 21 (Healthy
Parents and Children 21)
Challenge 2: Ensuring ofa safe and comfortable pregnancy/
childbirth, and assistance forinfertility(MHLW, 2001 to 2014)
HPB Director-General’sNotification“Division of Roles andCollaboration, etc. among
Physicians, Midwives and Nurses
in Delivery”(MHLW, 2007)
HPB Notification“Promotion of the Division of
Roles between Physicians andMedical Professionals and Clerical
Staff”(MHLW, December 2007)
Vision for Securing Safe andDesired Medical Care
(MHLW, 2008)“Promotion of Team Approach”(MHLW, 2010)

 Promoted the “introduction of team approach through the utilization of midwives”
 First interim evaluation (2005): Midwives increased, but their distribution was uneven among facilities.
 Second interim evaluation (2010): Midwives were continuously increasing, but on-site perceived shortage remains,because important problems that are not represented in the indicators (e.g. uneven distribution among regions andfacilities) have yet to be resolved.
 As specified in the Act on Public Health Nurses, Midwives and Nurses, midwives are in charge of midwifery practice,and should play the role of comprehensively protecting midwifery in normal delivery and the health of the mother andchild. Because childbirth involves unexpected risks, midwives should ensure adequate daily collaboration withphysicians.
 Measures to secure midwives should be taken in collaboration and cooperation with local related persons.
 Under close collaboration and cooperation with physicians, the proactive utilization of midwives in the healthmanagement of the mother and child, and in delivery management when the pregnant woman takes a normal course,
enables to reduce the workload of physicians in obstetric medical institutions. Such reduction in the workload ofphysicians in obstetric medical institutions enables physicians to concentrate on matters that can only be handled byphysicians, thereby exercising the specialty of physicians more effectively, while relieving obstetricians of excessive
burden at medical institutions that handle local critical emergency care.
 Measures should be taken to promote the dissemination of in-hospital midwifery cares and midwife outpatient wards,
so that midwives can handle normal deliveries by themselves in collaboration with physicians. At the same time, toexercise specialties and provide efficient medical care, collaboration through team approach should be promoted. In
this process, midwives engaged in the midwifery practice should be increased, while measures should also be taken to
improve their ability.
 Aim at the further utilization of the specialty of midwives, under collaboration, cooperation and the division of roles
with obstetricians.
 It is adequate to take into consideration that the suture of perineal laceration is a highly required procedure for safe andappropriate midwifery, and to conduct trial implementation and verification in the clinical practice concerning theextent of laceration that can be handled by midwives and the desired collaboration with obstetricians, based on which
results final conclusion should be drawn.
(Partially modified p.14 of the Training Guidelines for Newly Graduated Midwives, Japanese Nursing Association (2012))

4

Furthermore, a reviewing subcommittee for improving the quality of midwives was established to resolve problems identified in this survey, and thesecond edition was published in 2007. In the compilation of the second edition, the content of the evaluation criteria was summarized and subdivided
to improve the accuracy and validity of the criteria, referring to the minimum requirements of midwife education, and to the Essential Competencies
established by the International Confederation of Midwives (ICM).
The expressions for Evaluation Levels I to IV are determined by domain, referring to clinical ladders, nursing management of various facilities, andthe Framework for Evaluation of Hospital Functions by the Japan Council for Quality Health Care. Because caring is the basic attitude of midwives,
it is placed at the top of the evaluation criteria, followed by diagnosis and care for pregnant, puerperal and postpartum women and newborns; home
visits to the mother and child, and the functions of institutions and facilities for midwifery care (for managers). These evaluation criteria wereprepared from a standard perspective, and we have promoted their use at obstetric medical institutions across Japan.
Starting fiscal 2004, another subcommittee was established under the Professional Committee on Midwifery of JNA, to examine “systems forautonomous midwifery care by midwives” (referred to as “in-hospital midwifery cares” at the beginning), as a way to provide new maternal careutilizing the specialty of midwives. The subcommittee submitted a report in 2006. We disseminated the booklet under a strong message that “systems
for autonomous midwifery care by midwives” could be started with possible sections, such as midwife outpatient wards, in accordance with thephilosophy and conditions of establishment of the hospital or clinic, and subsequently expanded in steps.
In 2011, the subcommittee also prepared “Guidelines of the Utilization of Indicators for the Evaluation of Functions of In-Hospital Midwife-Led
Care System*”, as a reference for obstetric medical institutions with effective in-hospital midwife-led care system, and for those that plan to establish
such systems.
* A system for effectively utilizing midwives where “in-hospital midwifery clinic” and “in-hospital midwifery care unit” are established, in which midwives take the initiative in providing
nursing and midwifery care including antenatal health checkups, childbirth support, and health guidance (consultation service and education) at hospitals and clinics, in accordance withthe range of activities specified by the Act on Public Health Nurses, Midwives and Nurses

While midwifery outpatient wards and in-hospital midwife-led care system gradually increased owing to these activities, new challenges havebecome clear in recent years.
Firstly, obstetric wards are increasingly shifting to combined wards, due to the declining birthrate and the shortage of obstetricians. The proceeding
increase of combined obstetric wards may interfere with the promotion of in-hospital midwife-led care system. This problem results from manpower
shortage on one hand, and from the enfeebled environment for acquiring the practical ability of midwives on the other hand, where midwives are
required to take care of other patients during work shifts while providing care to high-risk pregnant and puerperal women.
Another problem is the uneven distribution of employed midwives, caused by the lack of standards for the adequate allocation of midwives. These
factors are interrelated to produce an environment that retards practical midwifery ability.

Necessity of career paths and a clinical ladder for midwives that can be utilized on an ALL-Japan basis
In this context, it is expected that midwives should autonomously acquire necessary abilities, by promoting in-hospital midwife-led care systemreferring to the “systems for autonomous midwifery care by midwives” as described above, and by utilizing the “Evaluation of the Quality of5Midwifery Care at Medical Facilities: Self Evaluation Criteria”.
At the same time, it is critical to provide midwives not only with standardized novice education, but also with systematized ongoing education, taking
into account that the stagnant acquisition of practical midwifery ability is caused by external environmental factors in the perinatal medical careservice systems, and by the resultant internal environmental factors.
Also taking into consideration the expected roles of functional associations, as indicated in the “Report concerning Recurrence Prevention under theJapan Obstetric Compensation System (the Japan Council for Quality Health Care)”, it is considered strongly necessary to visualize “standardized
practical ability that midwives should have.”
Therefore, JNA positioned support to the enhancement of practical midwifery ability as a midwifery-related project in 2011, and started
consideration. In 2012, JNA linked the training of newly graduated midwives with the subsequent ongoing education, and published the “Training
Guidelines for Newly Graduated Midwives”, the “Career Paths for Midwives”, and the “Clinical Ladder of Competencies for Midwifery Practice(CLoCMiP)” as tools that could be used across Japan.
This guideline has been summarized based on the continued review of systems for enhancing the practical ability of midwives (i.e. careerdevelopment), integrating the tools as described above.
This guideline depends on the management system of respective obstetric medical institutions. It may not be effective to directly apply this guidelineto the existing management system to introduce CLoCMiP. It is recommended to prepare a portfolio at first, as part of education based on the
education philosophy for midwives at each facility, and the roles and functions expected of the facility, and then modify and apply the clinical ladderas suitable for the conditions of the facility.
The Clinical Ladder Levels indicated herein are under ongoing review by the Japanese Promotional Council for Practical Midwifery Capability,
toward the planned establishment of a system for certification based on nationally integrated standards in the near future. This initiative is aimed at
visualizing practical midwifery ability toward other professionals related to care for pregnant and puerperal women, thereby further encouraging
midwives themselves.
We hope to upgrade this guideline with appropriate modification based on inputs from its users. JNA requests for open and honest opinions.
Toshiko Fukui
Executive Officer, Japanese Nursing Association
July 2013

6

Chapter 2

Concepts of career and career development

There are several viewpoints for the deliberation of careers. While “career” refers to promotion atwork or a specialized profession in some cases, this guideline regards career as “a variety ofcontinuous experience related to various roles throughout one’s life”, and not as mere
occupational background.

Chapter 7

Chapter 6

Career development can be seen from two perspectives as described on the right.
Here, it is required to harmonize and integrate the needs of individuals with the needs of theorganization, thereby aligning and interrelating the growth of individuals with the development of
the organization. Mutual confirmation will be required, referring to the time for career counseling,
as indicated in “Career Paths of Midwives” (Table 1-1) below.

1) Career development as seen from the viewpoint of
individuals:
Individuals design their own careers and pursue theirown growth, toward the attainment of their own goals.
2) Career development and ability development asseen from the viewpoint of the organization:
The organization manages the careers of its members,
and contributes to its development, in order to attainits goals.

Chapter 3

1Career paths of midwives

Chapter 42Career Development and Career Enhancement of Midwives

Chapter 5

Chapter 1

Career Development and Career Enhancement of Midwives

Chapter 1

Chapter 1

7

2

Significance of career paths

What are the requirements for harmonizing and integrating the needs of individuals with theneeds of the organization, thereby aligning the growth of individuals with the development of theorganization?
One of the useful tools is a “career path.” To harmonize and integrate the needs of individuals
with the needs of the organization, it is necessary to clarify their mutual needs. Because a career
path can visualize their respective needs, it is useful for individuals to understand the needs of theorganization, and for the organization to understand the needs of individuals.
The respective needs that must be clarified are as listed on the top right.
It is assumed that most people hope to live a better life. Designing one’s own career is one of theways toward that goal. One’s occupational life is fulfilled when they adequately exercise theirabilities and skills that they have acquired as midwives, and recognize their contribution tosociety through such exercise. To enable this, persons are required to deepen theirself-understanding and identify their more specific goals. When their goals become more specific,
detailed experience and learning required to attain those goals are clarified, thereby enabling themto design their own careers.
The organization presents career paths as indicated on the bottom right. Individuals can examine
them, and review the feasibility of their own career designs, thereby pursuing fulfilled careers thatincorporate their own intensions.
Not all persons have a clear image of their individual career needs. In most cases, career needs
become clearer as they have various experiences and relate with many people. A rough and vague
design at an early occupational stage becomes clearer and more specific as people become moreexperienced. At an early stage, it is recommended that people should design their career inaccordance with their life cycle plans, referring to the career paths presented by the organization,
examining how they can develop their careers in the organization to which they belong.

81) Points that individuals should clarify
 Self-recognition: Understanding yourself
 What are your strengths and characteristics?
 What pleases you and what matters most to you?
 What is your future goal?
 Your needs in the career: What do you think about yourown career, and what is your future goal?
 Specific goals
 Experience and learning that are considerednecessary for attaining those goals
2) Points that the organization should clarify
 The mission and vision of the organization
 Human resources and abilities that are required for theorganization to realize its mission and vision

Career path items presented by the organization
 Outlook for the possible career development in theorganization
 Opportunities for experience and learning that can beprovided to the members of the organization
 Roles and abilities that are expected of the membersof the organization based on the years of experience Job descriptions and requirements for the membersof the organization to play the assigned roles Resources for career development that can be utilized
by the individual members of the organization

Chapter 1

This career path indicates the essential skills and knowledge that must be acquired for midwives to play their roles. At the same time, the table clarifies criticalexperience for acquiring those skills and knowledge, as well as learning items required for midwives to develop their own abilities. For midwives to fulfill theirroles as specialists, it is important to continue self-improvement throughout their life, making use of various opportunities for learning and other resources that areprovided by their organization and professional associations.

4

Design your career! - Incorporating your personality into the career design

What made you hope or decide to become a midwife at the beginning?
People may want to become midwives for various reasons, but are required to fulfill the same roles and expectations of midwives. The career path (Table 1-1)
mentioned above is considered to indicate the process for acquiring abilities required to fulfill those roles and expectations.
In the meantime, just as people want to become midwives for various reasons, their future vision and outlook differ from each other, regarding what types of
midwives they want to become, what working styles and employers they seek, and so on. This variety reflects the personality of each person, and generates thewidth and depth of midwifery careers in Japan. Society also needs diversity in midwives, so that they can satisfy diverse social expectations, rather than all
midwives take the uniform course of career development.

Chapter 7

The true and desirable course for midwives is that individual midwives play the roles required by society, while they develop themselves by satisfying their own
career needs. This should be the style of human resource development to support perinatal care service in the coming age. For this purpose, each midwife shouldcarefully examine what type of midwife they want to become, and what their preferable working style is, thereby pursuing their own growth and specialty.
Why not re-confirm your goal and design your future career, referring to the career path?

Chapter 2

This career path visualizes how midwives can develop themselves through their work, and is an epoch-making table that clearly describes, for the first time, thecareer path of midwives as specialists in Japan.

Chapter 3

In general, career paths differ by organization. Table 1-1 has been formulated by JNA, reviewing and incorporating social expectations for the function of
midwives, and the mission and roles of midwives.

Chapter 4

Career paths of midwives

Chapter 53Career Development and Career Enhancement of Midwives

Chapter 6

Chapter 1

9

Table 1-1 Career Paths of Midwives
Specify what should be the goal of your career as a midwife, and design your career utilizing the resources of the organization, based on experience required to attain thespecified goal.
Years of experience

From the first
employment

To Year 3

From Year 4

From Year 6Age

23 or 24 years

27 years

28 or 29 years

Around 30 years

Lifecycle event

Acquire the qualification of midwife andfind a job

Marriage

Acquisition of basic practical ability
A---First childbirthSecond childbirth

To Year 10

From Year 11

From Year 16

34 years

35 years

40 years

From Year 25
45 years

50 years

From Year 35
60 years and older
Mandatory
retirement

Third childbirthSecond career

Fulfillment of the career

Enhancement and expansion of practical ability andharmonization with life events

Career stages
Acquisition of practicalability

Time for career
counseling

Setting directions
for careerdevelopment

1st counselingPurposes: Sharing the development
plan (adjusting the goals of theindividual with the goals of theorganization)

2nd counselingPurposes: Continuing the career,
expanding the roles, and strengthening
the practical ability

 Maternity ward
Career rotation
 Assisting at least 30 cases of delivery(continued observation and assistanceInternal medicine,
through first to fourth stages of delivery)
Maternity outpatient
operating room,
Pediatrics, NICU
 Checkup of at least 100 pregnant
unit
emergency room,
women
etc.
 Checkup of at least 50 puerperal and Experience working in wards, an in-hospital midwifery clinic,
postpartum women (respectively 50
and an in-hospital midwifery carewomen on Postpartum Day 0 through Participate in local social contribution activities
Day 5)

Requirements forfunctional
development

 Acquire basic
knowledge andskillsViewpoints forsupporting theperson Identify andsupport theperson’s
adaptation to theworkplace and theoccupation
 Utilize OJT Case summaryand presentation

Preparations for the second career
Additional life events

Expansion of roles and perspectives

3rd counselingPurposes: Confirming the career
direction and examining possible
career changes

 Maternity ward Chief of the
in-hospital
midwifery clinic

 Long-term
training (at ahospital with an
in-hospital
midwifery care Activities as a
Professional
Committee on
Midwiferymember

4th counselingPurposes: Strengthening and developing
specialties, and developing junior midwives Chief of the
in-hospital
midwifery care

Function as an excellent generalist

Prepare for entrepreneurship

Path to an executive manager, teacher,researcher, or government official(alternatives at a crossroads)

 Acquire knowledge and skillsconcerning the management and nursingof high-risk newborns (and theirfamilies), and enhance learning for
upgrading practical ability

 Become a rolemodel

 Supportexperience at a
new department
 Provide
opportunities forlearning, andupgrade theperson’s practicalability Utilize the power  Preparations for  Support theof skilled
the second career
person’s second
midwives
careerMotivate theperson inaccordance withthe expanding
areas of work

Learn
 Narrow the Enhance
management anddirection to bepersonality andnursing ofheaded as asociability todiseases, andspecialist, andsupport the teampractice thestart preparations
approachknowledge in care
 Upgrade andfor pregnant
enhance thewomen withspecialty
complications
 Support the Confirm and Utilize external Identify andperson’s
support thetraining andprovide advice
experience inperson’s selection
educatingconcerning theareas other thanopportunities
conditions of
the specialty
management andoperation

5th counselingPurposes: Supporting the second career so thatmidwives can continue working throughout theirlife

 Exercise ability inaccordance with
one’s own healthand physicalstrength Train lessexperienced
midwives

Work Life Harmony (Harmonization of work, life and learning)(Partially modified based on MATSUDA Kenji (1989), “Career Development Programs at Private Companies - From Job Management to Career Management”, Kango Tenbo, p. 37, 14(8))

10Career Development and Career Enhancement of Midwives

Chapter 1

Chapter 1

What is a portfolio?

Chapter 4
Chapter 5

Utilizing portfolios in the career development of midwives(1) Visualizing the career development process of individuals
As mentioned above, career development may be seen from the viewpoint of individuals and from the viewpoint of the organization. Portfolios can be used
for examining the career development process of individuals. Through a portfolio, one can find out what experience and learning the person has had, in a
relatively short time. One may even identify the person’s future possibilities.
For the organization, portfolios are valuable tools to understand individuals, and also important tools to provide support to individuals, taking into accounttheir respective career needs. Portfolios can also be utilized during interviews with individuals that are held by the organization for their career development
through target management.

11

Chapter 62Chapter 3

The term “portfolio” comes from Italian words “port (to bring)” + “folio (a sheet of paper)”, andsignifies a document folder/holder, a paper folder containing drawings, etc. A portfolio cancontain the past achievements and performances of a person, just like a file of works owned by anartist or a cameraman. By browsing through a portfolio, people can know the personality of theowner.
A portfolio is not a mere archive of a person’s history, but visualizes the course of development of
the person. In career development, a portfolio can be utilized as a record of various experienceand learning through to the attainment of goals, and as a tool for managing one’s own experienceand learning.
Nursing professionals may use a portfolio for “having themselves known/understood by others”,
and “reviewing themselves and identifying new challenges”, among other purposes. In this way, aportfolio enables evaluation that cannot be represented by academic background or qualification,or that cannot be quantified. Therefore, it is effective to use a portfolio in annual reviews, during
interviews with the manager, and at other milestones in a person’s career.

Chapter 7

1

Midwife’s portfolio
Chapter 2

3

Portfolios visualize the process of experience and learning, and therefore enable individuals
to look back at their past achievements, clarify their career direction, and notice newchallenges and underdeveloped areas of learning. In this way, people can find out new goals
and feel motivated to take new challenges.
To begin with, a career belongs to each person, and it matters most that the person takes
ownership of the person’s career development. The utilization of portfolios enable
individuals to review themselves, and to make self-decision as to how they would like toarrange their experience and learning. This helps each person take true ownership of theirown career, and leads to their satisfaction at work.
(2) How supporting persons should relate with individuals in the utilization of portfolios
In the actual use of a portfolio, it matters most that each midwife takes ownership of its
utilization. For more effective utilization, it is also important how supporting persons relatewith individual midwives.
As supporters of career development, managers and more experienced midwives should
provide explanation concerning the significance and usage of portfolios at the introductionof portfolios or during orientation to newly employed midwives. This is the first step to help
midwives understand how to utilize portfolios, and how they are related to the growth (orcareer development) of individual midwives. Supporting persons should subsequently check
how portfolios are maintained, and utilize them on various occasions for supporting careerdevelopment.
During career-related interviews, supporting persons can refer to portfolios when theyevaluate the efforts of interviewees and recognize their growth, and crystallize
underdeveloped areas comparing the targeted goals with the present conditions. Once suchareas are identified, supporting persons can also suggest seminars, academic conferences
and other opportunities for learning related to the required experience and knowledge.
When there are midwives who are at a loss and cannot find their goals, supporting persons
can utilize portfolios to help them recognize smaller targets until they have a clear vision of
their ultimate goals.
For each midwife, as the subject of career development, the first step is to understand the significance of a portfolio and to prepare one. Subsequently, a
midwife should take the portfolio to each interview with the manager or more experienced midwives, and utilize it to share the midwife’s own information
with the interviewers for evaluation. It is also recommended to review the portfolio periodically and/or occasionally, because it enables persons to confirm
their own growth and to identify new challenges.

12Let’s make a portfolio!

Chapter 2
Chapter 5
Chapter 6

First, prepare a folder. In principle, the folder should consist of elements listed on the right. This
portfolio should be a tool to centralize and overview the process of your own career development.
For this purpose, the following points should be needed careful consideration, so that the portfolio
will be easy to use and be readily accessed.
 All filed materials should be dated with the indication of source.
 All materials should be filed in chronological order.
 All materials to be included in the folder should be arranged in the same size. (When it isdifficult to arrange the materials in the same size, you can archive them in clear files of thesame size or otherwise sort them neatly.)
Materials that can be used for a midwife’s portfolio are suggested on the following pages.

Elements of a portfolio
1) Written goal and targets
Written vision, goal, targets, action plans, etc.
2) All documents that indicate your process toward the goal
Records of deliveries that you have assisted, records of yourindividual activities (e.g. records of participation in academic
conferences and seminars, records of assigned duties in theward), description of learning, notes of your findings andobservations, seminar materials and articles fromnewspapers/magazines, advice from others, description ofself-evaluation, etc.
3) Summaries
Reviews concerning the attainment of your goal, newchallenges identified through reviews, hints that inspire you
toward the future, etc.

Chapter 7

3

Chapter 3(3) Examples of utilization of portfolios
At Hospital A in Tokyo, each newly employed midwife is provided with an “individual
training folder” and “clear files for archiving materials” designed for individual use. In
addition, newly employed midwives are briefed concerning how to utilize the individual
training folder, as a part of education at the nursing department. The briefing contains 1) the
purpose of the folder, 2) its utilization, 3) how to use it, 4) instructions for entering eachdocument, and 5) others (how to keep records of training, etc.).
Newly employed midwives start using “training records” during their orientation, andaccumulate their individual learning activities as specialized professionals. They share thetraining records with trainers for effectively implementing the learning process. The
individual training folder is also utilized in target management interviews, evaluation basedon the career development ladder, promotion, and on other occasions.
The hospital has prepared separate portfolio forms specialized for midwives, including1) departments that the person has experienced as a midwife, 2) the number of deliveries
that the midwife has assisted, and 3) a checklist of completed programs of career ladder.
It is assumed the many facilities utilize portfolios as a common tool for nursing professionals. It would become easier to draw career designs that feature thespecialty of midwifery, when portfolios are used with ideas to visualize the vision of organization and roles that are specialized for midwives.

Chapter 1

Career Development and Career Enhancement of Midwives

Chapter 4

Chapter 1

13

Chapter 1
Chapter 2
Chapter 7

Table 2-2 indicates the CLoCMiP from Level Novice to Level IV.
The items of practical midwifery ability in the clinical ladder are detailed below.
‘Ethical understanding’ refers to the caring attitude, and consists of explanation about caring theories, application thereof to practice, and review at the practice.
‘Maternity care ability’ comprises diagnosis and care during the pregnancy, delivery, postpartum and newborn periods that are required in clinical midwifery
practice, in addition to viewpoints for considerations during the delivery period. It is targeted that midwives acquire the items of maternity care ability from Level
Novice to Level III. “NCPR (Course B), CTG”, “physical assessment, transfusion pumps and midwifery records are designated as essential courses.
‘Professional autonomy’ signifies the basic approach and attitude required for midwives. It consists of education (education/guidance and self-development),
research, communication (interpersonal relationship), ethics (sociability and midwifery ethics), and managerial aspects in midwifery practice (safety, economy andleadership).
The clinical ladder indicates the practical midwifery ability of each midwife. Progress is not certified in accordance with the years of experience, but depends onwhether or not the midwife is capable of undertaking the targeted activity. Even so, it is required to indicate a rough guidance for the years of experience required
for each level, both for the purpose of visualizing the standard development of midwives, and for motivating midwives to proceed and set targets along the clinicalladder.
JNA considers that new midwives should be certified as Level Novice after six months to one year in practice, as Level I in two to three years, as Level II in four tofive years, and as Level III in approximately seven years. Of course, it is recommended that each midwife is upgraded in accordance with their respective practicalability.

Chapter 3

The CLoCMiP from Level Novice to Level IV

Chapter 42What Is the CLoCMiP?

Chapter 5

Chapter 2

What Is the CLoCMiP?

Chapter 6

Chapter 2

14

Level IV
1. Able to provide creative
midwifery care.
2. Able to play an instructive rolein the in-hospital midwifery
clinic.
3. Able to play an instructive rolein the in-hospital midwiferycare.
4. Able to provide educational
communication to staff in both
low and high risk cases.

Chapter 1

Level III
1. Able to responsibly provide
midwifery care for the pregnant/puerperant woman and thenewborn throughout thehospitalization period.
2. Able to autonomously provide
individualized care in thein-hospital midwifery clinic.
3. Able to play an instructive rolein the in-hospital midwifery
clinic.
4. Able to autonomously provide
care in the in-hospital midwiferycare unit.
5. Able to detect transition fromlow risk to high risk symptoms
in the early stage and tointervene when necessary.
i) Able to self-evaluate the attitude as a midwife, reviewing specific casesof care to persons who suit the ladder level(Able to clarify self-requirements for the practice of caring).

Chapter 4i) Able to understand the meaning, key concepts and theories of caring.
ii) Able to understand the importance of caring.
iii) Able to act based on the key concepts of caring (to know, to be together,to act for another person, to have power for enabling, and to maintainfaith).

Level II
1. Able to provide individualizedcare based on the child delivery
process.
2. Able to provide care in thein-hospital midwifery clinic withsupport.
3. Able to provide midwifery care
together with the senior
midwives in the in-hospital
midwifery care unit.
4. Able to judge whether thesymptom is low or high risk andprovide the initial intervention.

ii) Able to explain the meaning,key concepts and theories tojunior midwives and colleagues.
iii) Able to play educational andinstructive roles for practicebased on the meaning, key
concepts and theories of caring
to junior midwives andcolleagues.

Chapter 5

Level I
1. Able to provide midwifery caresafely and surely, having
acquired knowledge, skills, and aproper attitude to assist healthyliving .
2. Able to understand operations of
the in-hospital midwifery clinic
service and the in-hospital
midwifery care .
3. Able to understand thepathological conditions of highrisk examples and proper way tocope with them.

Chapter 6

Caring attitude

Ethical understanding

Goals

Level Novice
1. Able to provide midwifery caresafely and surely in accordancewith instructions, the procedure,
and the guideline.

Chapter 2

CLoCMiP

Chapter 7

Table 2-2

What Is CLoCMiP?

Chapter 3

Chapter 2

15

Information collection
Assessment/Clarification of problems (needs)

Diagnosis and care during the pregnancy, delivery, postpartum and newborn periods; Viewpoints for considerations during
the delivery period

Maternity care ability

16

Level Novicei) Able to understand information
required for healthy living
behavior diagnosis andpregnancy progress diagnosis inpregnancy/child delivery/
puerperium/newborn period withsupport.
ii) Able to collect information using
the fixed form.
iii) Able to know the lacking
information and able to collect
the additional information withguidance.
iv) Able to make records using
correct terms and appropriate
expressions based on criteria andprocedures of midwifery care.

Level Ii) Able to autonomously collectinformation required for healthyliving behavior diagnosis andpregnancy progress diagnosis inpregnancy/ child delivery/
puerperium/newborn periodii) Able to know the lacking
information and be able tocollect the additional
information.
iii) Able to sort out information
required for assessment withguidance.
iv) Able to make records using thecorrect terms and appropriate
expressions.

Level IIi) Able to collect all information
required for implementing
individualized midwifery careamong the information requiredfor healthy living behavior
diagnosis and pregnancy
progress diagnosis in pregnancy/
child delivery/ puerperium/
newborn period.
ii) Able to sort out information
required for assessment.

Low riski) Able to know the normal valuesof vital signs, various
examinations and various
physical measurements ofpregnant/puerperant women andnewborns.
ii) Able to understand anatomicaland physiology concerningobstetrics.
iii) Able to understand the meaningsof measured values with support.
iv) Able to analyze collected
information of healthy living
behavior and the pregnancy
progress diagnosis with support.
v) Able to understand thepathological conditions of major
perinatal disorders.

Low riski) Able to know
pregnant/puerperant women’s
normal chronological course,
and able to understandnewborns’ physiology.
ii) Able to analyze collected
information of healthy living
behavior and pregnancy progress
diagnosis with support.
High riski) Able to understandpathophysiology andexaminations of major perinatal
disorders (threatened
miscarriage/premature labor,
hyperemesis, pregnancy
hypertension syndromes,
gestational diabetes mellitus, andplacenta previa) and the risks ofmultiple pregnancies.
ii) Able to understand the proper
response to abnormality ofpregnant/puerperant women andnewborns, and how to assist
them.

Low riski) Able to analyze the collected
information of healthy living
behavior and the pregnancy
progress diagnosis.
ii) Able to clarify the needs ofpregnant/puerperant women andnewborns.
iii) Able to decide the priority orderof the needs.
High riski) Able to clarify problems
occurring to the pregnant/puerperant woman and thenewborn.
ii) Able to determine the prioritiesof the problems.

Level IIIi) Able to collect information
required for healthy living
behavior diagnosis andpregnancy progress diagnosis inpregnancy/ child delivery/
puerperium/ newborn period
based on theoretical reasons.
ii) Able to collect information inorder to conduct assessment
taking mental/ social aspects andfamily backgrounds into
consideration.
iii) Able to sort out the information
described in ii) consideringneeds and priority.
iv) Able to collect information
intentionally from the relevant
persons from different job types.
Low riski) Able to clarify the potential
needs.
High riski) Able to clarify potential
midwifery problems.
ii) Able to clearly distinguish the
midwifery problems from thegeneral problems.

Level IVi) Able to get the picture of overallsituation concerning the target
including individuality,
mental/social aspects, family
background, and selectively
collect information focused on
the required area.

Low /high riski) Able to give a correct diagnosis
considering the risks of thetarget following the diagnosing
process (Able to sort women
eligible for in-hospital
midwifery care).
ii) Able to explain the reasons forthe given diagnosis to othermidwives and the medical careteam members.
iii) Able to instruct junior midwives
so that they can make adiagnosis based on the
diagnostic process.

i) Able to make a midwifery planconsidering mental, social, andfamily conditions of thepregnant/ puerperant women andthe newborns.
ii) Able to make a plan and revise it
depending on the conditions.
iii) Able to make a midwifery planwith the participation of thepregnant/ puerperant women andtheir family members, and reviseit.
iv) Able to make a plan including
the collaboration with otherrelated health/ medical care staff
and revise it.

Planning

Chapter 1i) Able to make a midwifery planconsidering the individuality ofthe pregnant/ puerperant womenand the newborns.
ii) Able to assess and revise theformulated midwifery plan.
iii) Able to make a midwifery planwith the participation of thepregnant/ puerperant women andtheir family members.

Chapter 2i) Able to set goals according to
the needs of the pregnant/puerperant women and thenewborns.
ii) Able to make a consistent plan interms of the conditions of thepregnant/ puerperant women andthe newborns, the list of theirproblems, and the goals.
iii) Able to make a specific planusing the 5W1H approach.
iv) Able to make a midwifery planwith the participation of thepregnant/puerperant women andtheir family members withsupport.

Chapter 3i) Able to understand theconditions and needs of thepregnant/ puerperant woman andthe newborn at that time.
ii) Able to set goals according to
the needs of the pregnant/puerperant women and thenewborns with support.
iii) Able to make a consistent planin terms of the conditions of thepregnant/ puerperant women andthe newborns, the list of theirproblems, and the goals withsupport.
iv) Able to make a specific planusing the 5W1H approach.
v) Able to utilize the midwiferycare criteria/ standard midwifery
plan.

Level IVi) Able to share the given detailsof the diagnosis with othermembers of the medical careteam including the pregnant/puerperant woman.
ii) Able to give guidance on thedetails of the diagnosis given
and the priorities of the
problems.
iii) Able to collect required
information, conduct
assessment, make a diagnosis,
and decide about the priorities ina short time during an
emergency.
i) Able to make a plan using anappropriate method considering
the priorities of the pregnant/puerperant women and thenewborns and their midwifery
problems.
ii) Able to set appropriate goals(which can be reached/measured/ assessed) in order tosolve the target’s problems.
iii) Able to play an educational/
instructive role in the process ofmaking a midwifery plan.

Chapter 4

Level IIIi) Able to make an appropriate
diagnosis by analyzing
information on healthy living
behavior and pregnancy
progress.
ii) Able to judge the priorities whileconsidering whether providing
only midwifery care is enough,or medical intervention by thephysician is required based on
the details of the diagnosis.

Chapter 6

Level IIi) Able to make an appropriate
diagnosis by analyzing
information on healthy living
behavior and pregnancy
progress.
ii) Able to consider the priority ofproblems based on the details of
the diagnosis.

Chapter 7

Level Ii) Able to make an appropriate
diagnosis by analyzing
information on healthy living
behavior and pregnancy progresswith support as needed.

Diagnosis

Level Novicei) Able to make an appropriate
diagnosis by analyzing
information on healthy living
behavior and pregnancy progresswith support.

What Is CLoCMiP?

Chapter 5

Chapter 2

17

Practice
Evaluation

18

Level Novicei) Able to explain the midwifery
practice without fail before
applying the care.
ii) Able to carry out the items to beacquired during the novice
midwife training.
iii) Able to provide the pregnant/puerperant woman and thenewborn with care services
according to the midwifery careplan with support.
iv) Able to conduct the observations
required for treatment anddiagnosis and to appropriately
report it.
v) Able to conduct the indicatedtasks correctly and safely
following the midwifery carestandards and procedures.
vi) Able to correctly record theactivities carried out following
the midwifery recording
procedures.
vii) Understand how to respond toan emergency.
viii) Able to call others for help inan emergency.
ix) Able to know what items are
required in an emergency andprepare them according to theprocedures.
x) Able to understand the clinicalpathway when using it.
i) Able to accurately report theresult of the midwifery careprovided by the midwife herself.
ii) Able to present questions during
her midwifery practice.

Level Ii) Able to explain the midwifery
activities without fail before
starting it.
ii) Able to use the basic midwifery
techniques with support.
iii) Able to provide the targets withmidwifery care safely and surely
following the standards andprocedures according to the
midwifery care plan.
iv) Able to make records using
correct terms and appropriate
expressions following midwiferycare standards and procedures.
v) Able to provide Basic Life
Support and Advanced Life
Support in an emergency(including neonatal
resuscitation).
vi) Able to conduct activities
following the clinical pathway
when using it.

Level IIi) Able to carry out midwifery
activities according to the
midwifery care plan.
ii) Able to provide the necessary
care judging conditions andresponses of the pregnant/puerperant women and thenewborns.
iii) Able to add new items to theplan or revise the plan
immediately by recording othernew information than the needs
and problems recognized at thetime.
iv) Able to act properly as amember of the team in an
emergency.

Level IIIi) Able to conduct activities
according to the plan while
monitoring the responses of thepregnant/puerperant woman andher family members.
ii) Able to play a central role inproviding care to the pregnant/puerperant women and newborns
in the facility/ department
overall.
iii) Able to play a central role in an
emergency.
iv) Able to play an educational/
instructive role in the in-hospital
midwifery clinic.
v) Able to conduct activities
properly in collaboration withother related health/medical care
professionals.

Level IVi) Able to exercise creativity andinnovativeness in providing
midwifery activities.
ii) Able to provide
nursing/midwifery care applying
combinations of various
approaches.
iii) Able to respond to an
emergency, and take theleadership.
iv) Able to play an educational/
instructive role at all times.
v) Able to support the staff playing
an educational/ instructive role.

i) Able to ask questions regarding
her midwifery practice and solve
them.
ii) Able to assess the midwife’s
own midwifery practice on abasis with support.
iii) Able to revise the plan when
there is a continuing problem.
iv) Able to record the outline of theperformed midwifery practice.

i) Able to assess the result of the
midwifery care provided byherself on reasonable grounds.
ii) Able to assess the extent towhich the goal was achieved,
and to revise the plan.
iii) Able to explain and record thesummary of the care provided byherself.
iv) Able to assess the variances
when using clinical pathways.

i) Able to assess if the midwiferycare provided by herself met theneeds of the pregnant/ puerperant
woman and the newborn.
ii) Able to make self- evaluation
concerning whether she is a goodrole model for junior midwives
and students.

i) Able to make qualitative/
quantitative evaluation of the
midwifery care provided byherself.
ii) Able to evaluate the midwiferycare provided by other staff andgive guidance.

i) Able to participate in internaland external continuing
educational programs andtraining in a planned mannerbased on the midwife’s own
career and specialty,.
ii) Able to clarify and tackle themidwife’s own requirements toenhance her specialty.
iii) Able to utilize achievements
through such requirements inpractice.

i) Able to examine the reasons foreveryday actions.
ii) Able to participate in internaland external researchpresentation meetings inaccordance with the midwife’s
own interest.

i) Able to find out researchable
questions in everyday practice.
ii) Able to participate in research asa member of research.

i) Able to plan a research initiativeand promote it together withstaff.
ii) Able to present the results of a
research initiative.

Self-development

Education
Research

Professional autonomy

Chapter 1i) Able to clarify the midwife’s
own requirements.
ii) Able to autonomously collectnecessary information and act
toward the resolution ofproblems.
iii) Able to utilize learning in the
midwifery practice of the
midwife’s own and in thefacility.

Chapter 2i) Able to identify the midwife’s
own learning requirements basedon self-evaluation and evaluation
by others.
ii) Able to collect necessary
information and act toward theresolution of problems.
iii) Able to utilize learning in
midwifery practice of the
midwife’s own.

Chapter 3i) Able to review and sort out
everyday behavior.
ii) Able to openly accept advice
from others.
iii) Able to identify the midwife’s
own learning requirements basedon self-evaluation and evaluation
by others with support.
iv) Able to collect necessary
information and act toward theresolution of problems .withsupport,v) Able to utilize learning in
midwifery practice of the
midwife’s own with support.
i) Able to participate in internaland external researchpresentation meetings, and findinterest in research activities.

Level IVi) Able to participate in internaland external continuing
educational programs andtraining in a planned manner,
based on the midwife’s own
career and specialty.
ii) Able to play a central role in theplanning and operation of
education (to junior midwives
and students) in the facility.
iii) Able to undertake planning andoperation consideringcollaboration with otherdepartments in ii).
iv) Able to attain the targets of theward, able to support specificactions by junior midwives.
v) Able to utilize knowledge
concerning education, able tohelp junior midwives exercise
their abilities.
vi) Able to play educational andinstructive roles in healthguidance.
i) Able to formulate the midwife’s
own career plan (education,
management and practice).
ii) Able to formulate and takespecific steps for implementing
the plan.

Chapter 4

Level IIIi) Able to play a central role inguidance to junior midwives andstudents.
ii) Able to play a central role instudy meetings in the ward.
iii) Able to participate in planningand operation concerning
education (to junior midwives
and students) in the facility.
iv) Able to understand basic mattersconcerning the progress of adultlearning.
v) Able to provide health guidance
to all targets.

Chapter 6

Level IIi) Able to autonomously
participate in the continuing
educational program and internaland external training withpurpose.
ii) Able to participate in educationand guidance at the facility(guidance to new midwives,
junior midwives, and students)iii) Able to provide health guidance
to low-risk targets (individuals
and small groups).
iv) Able to understand evaluation in
education.

i) Able to apply the results of a
research initiative in clinicalpractice.
ii) Able to promote a research
initiative, and disseminate theresults internally and externally.

19

Chapter 7

Level Ii) Able to autonomously
participate in the continuing
educational program.
ii) Able to proactively participate ininternal and external training andstudy meetings that suit the
midwife’s level.
iii) Able to provide health guidance
to low-risk targets with support(individuals and small groups).
iv) Able to understand basic mattersconcerning education andguidance.

Education/guidance

Level Novicei) Able to understand the meaningof the continuing educational
program.
ii) Able to proactively participate ininternal and external training andstudy meetings that suit the
midwife’s level.

What Is CLoCMiP?

Chapter 5

Chapter 2

Communication (interpersonal relationship)Sociability

Ethics20

Level Novice
Level I
Level IIi) Able to take efforts to identifyi) Able to identify the needs of thei) Able to identify and understandthe needs of the care target fromcare target from physical,
potential needs and problems
physical, psychological andpsychological and social
based on the behavior ofsocial perspectives.
perspectives.
pregnant, puerperal andii) Able to respect the care target as ii) Able to recognize that the
postpartum women.
a person, and listen to andmidwifery service should startii) Able to autonomously provide
empathize with the person (withwith the care target, and treat her
explanation that satisfies the caresmiles, greetings,
accordingly (taking efforts totarget and her family, and obtainself-introduction, appropriate
avoid starting with the midwife’s
their consent when a midwifery
language, keeping promises,
own busy schedule andplan is modified or added.
etc.).
operations).
iii) Able to take efforts to recognize iii) Able to apply verbal andthat the midwifery service
non-verbal communication
should start with the care target,
skills.
and treat her accordingly.
iv) Able to provide explanation thativ) Able to understand verbal andsatisfies the care target, andnon-verbal communication
obtain her consent.
skills.
v) Able to provide explanation thatsatisfies the care target, andobtain her consent with support.
vi) Able to strictly protect
confidentiality and privacy.
vii) Able to take notes andaccurately communicate basedon 5W1H.
i) Able to understand the code of practice, and comply with it at work (e.g. refrain from coming late, leaving early,or unauthorized absence).
ii) Able to be capable of prompt reporting, notification and consultation, based on specified rules.
iii) Able to understand that the midwife must be responsible for her own actions speech and behavior, as a working
person and midwife.
iv) Able to recognize the necessity of her own health management as a midwife, and act accordingly.
v) Able to have the identity as a midwife, and understands and practices the specialty and autonomy as one.

Level IIIi) Able to act while forecasting
how it may affect others.
ii) Able to notice and accept
changes in the reaction ofpregnant, puerperal andpostpartum women and theirfamilies.
iii) Able to take assertive
communication in accordancewith the situation.
iv) Also able to maintain favorable
relationship with other related
professionals.

Level IVi) Able to establish a better
partnership with the care target
and her family.
ii) Able to identify the response of
the care target and her family,
and the surrounding conditions,and to take appropriate
communication with respect tothe care target and her family
while providing direct
midwifery care.
iii) Able to play an educational andinstructive role concerning
communication.

i) Able to understand the code ofpractice, and guides staff tocomply with it at work (e.g.
refrain from coming late, leaving
early, or unauthorized absence).
ii) Able to guide staff for prompt
reporting, notification andconsultation, based on specified
rules.
iii) Able to guide the entire staff tomaintain adequate appearance.
iv) Able to guide staff to takeresponsible actions as working
persons and as team members.

i) Able to recognize theimportance of the code ofpractice, practices it, and guidejunior midwives based on it.

Chapter 1
Chapter 2

Level IVi) Able to function as acoordinator in the ethicaldecision-making process.
ii) Able to take actions forenhancing the ethicalunderstanding of thedepartment.
iii) Able to play an educational andinstructive role concerning thelegal ground in guidance tostudents and exercise of
trainees.

Chapter 3

Level IIIi) Able to participate in the processof ethical decision-making.
ii) Able to understand theviewpoints of the care target andher family, and provide
necessary information and othersupport in doing i).
iii) Able to act toward the optimal
selection, through dialog withthe care target, her family andother related professionals withrespect to ethical requirements,.
iv) Able to be capable of practicebased on the legal ground.
v) Able to understand and fulfill thelegal responsibility of midwives
and nurses in guidance tostudents and exercise of trainees.

Chapter 4

Level IIi) Able to understand the values ofthe pregnant, puerperal andpostpartum women and theirfamilies.
ii) Able to understand theimportance of respecting diverseand mutual values, and acts
accordingly.
iii) Able to be capable of practicebased on the legal ground withsupport.

Chapter 5

Level Ii) Able to understand the ICM
Code of Ethics for Midwives,
ICN Code of Ethics for Nurses,
and JNA Code of Ethics for
Nurses, in association witheveryday midwifery practice.
ii) Able to understand ethicalprinciples.
iii) Able to understand thatmidwifery practice must be
based on the legal ground.

Chapter 6

Level Novicei) Able to understand the ICM
Code of Ethics for Midwives,
ICN Code of Ethics for Nurses,
and JNA Code of Ethics for
Nurses.
ii) Able to recognize the bioethics
related to midwifery operations.
iii) Able to have awareness as aprofessional and acts based on
ethics.

What Is CLoCMiP?

Chapter 7

Midwifery ethics

Chapter 221

Safety
EconomyManagement

22

Level Novice
Level I
Safety management and assurancei) Able to understand the medical safety management system in thefacility.
ii) Able to promptly report an incident or accident.
iii) Able to review the process of an incident or accident with support.
iv) Able to know how to report and record an incident or accident.
v) Able to predict and take measures against an accident that may occur inperinatal care (e.g. mistaking a newborn as another, abduction of anewborn, suffocation, fall or drop, burn, theft) with support.
vi) Able to handle medical devices and instruments in accordance with therules adequately.
vii) Able to understand and implement the basic rules for providing drugs.
Prevention of infectioni) Able to understand the infection prevention and management system inthe facility.
ii) Able to act in accordance with understanding of i) (e.g. standard
precautions, selecting necessary protective equipment, hygienic handwashing, aseptic manipulation, separating clean items from dirty items,
adequately handling medical waste based on the relevant code).
Disaster and disaster preparedness managementi) Able to understand the disaster and accident management system in thefacility.
ii) Able to know the management system in the department (firefighting
equipment, evaluation routes).
iii) Able to take everyday actions based on (ii) (e.g. locking the ward
entrance, checking visitors).
iv) Able to know early response in the event of disaster.
v) Able to act according to iv) under instructions in the event of disaster.
vi) Able to participate in periodic disaster drills.
Information managementi) Able to understand the information management system in the facility.
ii) Able to act based on i) (e.g. handling records, PCs, passwords andpatient information).
i) Able to appropriately select,i) Able to appropriately select,
prepare and use goods, taking
prepare and use goods, taking
into account cost
into account cost effectiveness.
effectiveness .with support.
ii) Able to appropriately use goods,ii) Able to appropriately use goods,
taking into account burden on
taking into account burden on
the care target.
iii) Able to provide necessary
the care target with support.
midwifery care within specifiediii) Able to consider how totime with support.
allocate time with support.

Level II
Safety management andassurancei) Able to review the process of anincident or accident.
ii) Able to learn lessons for the
future from an incident or
accident with support,iii) Able to predict and takemeasures against an accident
that may occur in perinatal care(e.g. mistaking a newborn asanother, abduction of a newborn,
suffocation, fall or drop, burn,theft).
iv) Able to make decision and act
with priority on the life of thecare target when an accident
occurs.
Prevention of infectioni) Able to act in accordance withthe facility’s system.
Disaster and disaster
preparedness managementi) Able to autonomously take early
response in the event of disaster,.
Information managementi) Able to act in accordance withthe facility’s system.

Level IIIi) Able to mind and adjust safety inthe care environment always.
ii) Able to play a central role inmeasures against accidents andincidents, infection prevention,and disaster preparedness.
iii) Able to take measures toestablish a workplaceenvironment that assures thesafety of staff.
iv) Able to adjust the workplaceenvironment to ensure the safe
handling of medical devices.
v) Able to find interest in laws andregulations concerning
equipment and medical materials(e.g. Product Liability Act).

Level IVi) Able to minds safety in the careenvironment, and provide
relevant advice to junior
midwives always.
ii) Able to identify problems in thenursing unit based onincident/accident reports.
iii) Able to formulate solutions
together with the
manager/supervisor in response
to problems identified in ii).
iv) Able to take improvement
measures, and evaluate andincorporate the results thereof.

i) Able to appropriately select,
prepare and use goods, taking
into account cost effectiveness,
and with the midwife’s own
ideas for improvement.
ii) Able to appropriately use goods,
taking into account burden on
the care target, listening to thetarget, and with the midwife’s
own ideas for improvement.
iii) Able to provide necessary
midwifery care within specified
time, and make necessary
adjustments.

i) Able to understand the logistics
system in the facility.
ii) Able to find interest in the
medical fee system and othermedical policies.

i) Able to be capable of proactive
goods management in thedepartment.
ii) Able to understand the flow ofbudget in the nursing unit.
iii) Able to understand the medical
fee system.

Chapter 1
Chapter 2

Level IVi) Able to promote activities
toward the goals of the nursing
department/unit.
ii) Able to promote committees,
assignments and meetings in thenursing unit.
iii) Able to take a leading positionin the improvement ofoperations at the nursing unit.
iv) Able to function as a liaison
between junior midwives andthe head nurse or the supervisor.
v) Able to distinguish decisions
that can be made by herself
from those that cannot.

Chapter 3

Level IIIi) Able to exercise a coordinating
function in midwifery
operations.
ii) Able to collaborate andcoordinate with otherdepartments.
iii) Able to provide consultation andsupport to junior midwives.

Chapter 4

Level IIi) Able to act adequately toward
better teamwork.
ii) Able to understand the conceptof leadership.
iii) Able to provide instructions toteam members to enable theefficient and effective operationsof the midwifery team.

Chapter 5

Level Ii) Able to understand thephilosophies of the facility andof the nursing department, andacts accordingly.
ii) Able to understand theorganization and functions of the
facility and of the nursing
department, and acts
accordingly.
iii) Able to understand the midwife’srole as a member of teamapproach, and collaborates
accordingly (capable ofreporting, notification andconsultation, and able to reportaccurate facts).
iv) Able to take necessarycommunication with colleagues
and other related professionals.
v) Able to understand different
ways of thinking by job type.
vi) Able to understand the role ofleader.

Chapter 6

Level Novicei) Able to understand thephilosophies of the facility andof the nursing department.
ii) Able to understand theorganization and functions of the
facility and of the nursing
department.
iii) Able to understand the
midwife’s role as a member ofteam approach, and collaborates
accordingly (capable ofreporting, notification andconsultation, and able to reportaccurate facts).
iv) Able to take communication
with colleagues and other related
professionals.

What Is CLoCMiP?

Chapter 7

Leadership

Chapter 2

23

Educational items that correspond to the CLoCMiP from Level Novice to Level IV

Chapter 1
Chapter 5

Regardless of the size and characteristics of the facility, it is required to implement educational programs linked to the clinical ladder, for individual midwives toattain the goals specified for each level. Table 3-1, “List of Training Items That Correspond to Each Level” provides an overview of educational items required todevelop the abilities specified as goals.
In the List of Educational Items That Correspond to Each Level, the horizontal axis indicates the development stages from Level Novice to Level IV, while thevertical axis lists goals, together with knowledge and skills required for midwifery practice. Users can check knowledge and skills required for a given level byreading the table vertically in the relevant development stage. They can also confirm how a given ability for midwifery practice can be accumulated throughlearning by reading the table horizontally along that ability.
Knowledge and skills required for midwifery practice are categorized into ‘ethical understanding’, ‘maternity care ability’, and ‘professional autonomy’, andrequired educational items are listed for each category.

Chapter 2

1

Educational Programs Based on the CLoCMiP

Chapter 3

Chapter 3

Educational Programs Based on the CLoCMiP

Chapter 4

Chapter 3

We have prepared educational programs linked with the clinical ladder, respectively from Level Novice to Level IV (Tables 3-2 to 3-6). For ‘ethicalunderstanding’, ‘maternity care ability’, and ‘professional autonomy’, the tables indicate specific educational methods, educational items, and evaluation points toreach the educational goal (targets of the ladder).

24

Chapter 6

Educational Programs that correspond to each level of the CLoCMiP

Chapter 72

Goals Midwifery practice and caring(Apply theories to practice) Criteria for selecting targets forthe in-hospital midwifery careunit
 Determination of deviationfrom the criteria for in-hospital
midwifery care targets duringhospitalization for delivery
 Guidance concerningassessment and planning

Chapter 7

For the evaluation of maternity care ability(practical midwifery ability), self-check should be
performed based on the Training Guidelines for
Newly Graduated Midwives (Table 3-7) for Level
Novice, and based on the checklist in the
Evaluation of the Quality of Midwifery Care atMedical Facilities, 2nd Edition (Japanese Nursing
Association) (Table 3-8) for Levels I to III. The
manager should confirm the results of theself-check.

[Knowledge part] Psychology of low-risk to high-risk women in the pregnancy, delivery and postpartum periods
 Course of and care for normal pregnancy, delivery and postpartum periods
 High-risk pregnancy, delivery, puerperal and postpartum: Pathological conditions and care for major diseases(threatened miscarriage/premature labor, PIH, placenta previa, multiple pregnancies, GDM, FGR) Anatomical and physiological characteristics of newborns and appropriate care
 Characteristics of and care to high-risk newborns
 Care to the families of high-risk newborns
 Midwifery records: Basic recording principles, the significance and approach of family-participative records, etc.
 Reading heartbeat monitoring of fetuses (basic/applied) How to read laboratory data
 Clinical pharmacology (including labor inducing drugs)
 Breastfeeding[Practice part] NCPR (B course): Hold periodic training Maternity emergency care
 Physical assessment (cerebral neurology, respiratory circulation, metabolism, newborns)
 Intravenous injection
 Delivery in a non-supine position

Chapter 1

Level III
Level IV
1. Able to responsibly provide
1. Able to provide creative
midwifery care for the pregnant/midwifery care.
puerperant woman and the
2. Able to play an instructive
newborn throughout therole in the in-hospital
hospitalization period.
midwifery clinic.
2. Able to autonomously provide
3. Able to play an instructive
individualized care in therole in the in-hospital
in-hospital midwifery clinic.
midwifery care unit.
3. Able to play an instructive role in
4. Able to provide educational
the in-hospital midwifery clinic.
communication to staff in
4. Able to autonomously provide
both low and high-risk cases.
care in the in-hospital care unit.
5. Able to detect transition from low
risk to high risk symptoms in theearly stage and to intervene whennecessary.
 Review oneself (OJT) Perform self-evaluation concerning your attitude as a midwife, reviewing
specific cases of care.
 Share the cases by several persons, and exchange opinions.

Chapter 2

Level II
1. Able to provide individualizedcare based on the midwifery
process.
2. Able to provide care in thein-hospital midwifery clinic withsupport.
3. Able to provide midwifery care
together with the senior midwives
in the in-hospital care unit.
4. Able to judge whether thesymptom is high or low risk andprovide the initial intervention.

Caring attitude
Practical midwifery ability(Diagnosis and care during the pregnancy, delivery,
postpartum and newborn periods; Viewpoints forconsiderations during the delivery period)

Ethicalunderstandings
Maternity care ability

Knowledge and skills required for midwifery practice- What is caring? (Understand key theories)

Level I
1. Able to provide midwifery caresafely and surely, having acquired
knowledge, skills, and a proper
attitude to assist healthy living.
2. Able to understand operations of
the in-hospital midwifery clinic
and the in-hospital midwifery careunit.
3. Able to understand thepathological conditions of highrisk patients and how to handle
them.

Chapter 3

Level Novice
1. Able to provide midwifery care safely and surely inaccordance with instructions, the procedure, and theguideline.

Chapter 4

List of Educational Items That Correspond to Each Level

Chapter 5

Table 3-1

Educational Programs Based on the CLoCMiP

Chapter 6

Chapter 325

Conditions for accomplishment
Education/guidance
Selfdevelopment

Education

Research
Midwifery
ethicsSociability

Communication(interpersonal
relationship)
EthicsProfessional autonomy

26

Level Novice
Level I
Level II
Level III
Delivery assistance ------------------------------------------------------------------------------------------------------------------------------------------------------  At least 100 cases of delivery assistance
Health checkup for newborns ------------------------------------------------------------------------------------------------------------------------------At least 100 cases of health checkup for newborns
Health checkup in the pregnancy period ---------------------------------------------------------------------------------------------------- At least 200 cases of health checkup in the pregnancy period
Health checkup in the postpartum period ------------------------------------------------------------------------------------------------------------ At least 200 health checkup in the postpartum period
Primary (the pregnancy, delivery and postpartum period) case----------------------------------------------- At least 20 cases of primary (the pregnancy, delivery and postpartum periods) caseGroup guidance (including small-group guidance) ---------------------------------------------------------------------------------------------------------------------------- Able to practice / Able to guide
Mother’s class / parents’ class ----------------------------------------------------------------------------------------------------------------------------------------------------- Able to practice / Able to guide
Emergency response (BLS, massive bleeding, etc.) --------------------------------------------------------------------------------------------------------------------------- Able to practice / Able to guide[Mandatory training] NCPR (B Course) --------------------------------------------------------------------------------------------------------------------------------------------------------------- Completed
CTG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Completed
Physical assessment ------------------------------------------------------------------------------------------------------------------------------------------------------------ Completed
Transfusion pump --------------------------------------------------------------------------------------------------------------------------------------------------------------- Completed
Midwifery records -------------------------------------------------------------------------------------------------------------------------------------------------------------- Completed
Continuing education and post-graduation education for
Education and guidance (guidance to
Education and guidance (educating to Education and guidance (training
midwives
patients and small-group education)
staff)
evaluation)

Level IV

Education and guidance (casestudies)

Career paths / clinical ladder
Career counseling Information concerning internal and external academic
conferences and study meetings
 Information concerning research activities in thedepartment

 Significance of research in theclinical practice Methods for nursing research(basics: literature retrieval(including implementation) andutilization, data collecting andanalysis methods, etc.)

 Examination of assigned cases from delivery assistanceto hospitalization and health checkup one month afterchildbirth, and OJT Communication at the time of emergency

 Examination of continuing assigned
cases from the pregnancy period tothe health checkup one month afterchildbirth, and OJT

Career counseling Methods for nursing research(practice) Methods for formulating researchplans Participation in academic
conferences Formulating plans for high-risk
pregnancy, delivery andpostpartum, and providing care
 Manners (appearance) Code of practice Manners (OJT) ICM -Code of Ethics for Midwives
 JNA -Code of Ethics for Nurses

 Ethical principles

 Bioethics

Career counseling Preparing research plans Presentations
 Making presentations at academic
conferences Continuing assignment from theearly to medium stages ofpregnancy, through to the healthcheckup one month after childbirth Central role in communication at
the time of emergency

 Case examination based oncontinuing assigned cases fromthe early to medium stages ofpregnancy, through to thehealth checkup one month afterchildbirth, and OJT Central role in communication
at the time of emergency
 Guidance in case examination

 Ethical decision-making (subjects)
 Case studies

 Ethical decision-making(medical service team) Case studies

Level IV

 Disaster preparedness (planning,
implementation and evaluation ofdisaster drills)

 Disaster preparedness(planning, implementation andevaluation of theoreticaltraining)

Goods management and costmanagement

Medical service systems concerningperinatal care

Health service systems and medical
fees in Japan

Midwifery and economy In-hospital midwifery care system and the roles of
midwives
 The organization where midwives belong to, its role andmedical service systems
 Membership Target-based management
 Roles of midwives in the team approach, and preferable
collaboration and alignment

 Membership (OJT)

 Leadership Technologies for problem
resolution

 Basics of midwifery management
 Leadership in a nursing unit Management of quality in
midwifery care / management of
midwifery operations

 Evaluation of quality based ondata Leadership in a medical service
team

Chapter 3

Level III
 Analysis of includes/accidents(examples)

Chapter 4

Level II
 Methods for analyzing incidents
and accidents
 Prevention of infection (OJT) Disaster preparedness (OJT)

Chapter 7

Chapter 6

Chapter 5

Level I Basic actions to prevent infection
 Disaster preparedness (OJT) Drug management (including themanagement of poisons, dangerous
drugs, narcotics, and blood
products)

Chapter 2

Chapter 1

Educational Programs Based on the CLoCMiP

Level Novice
 Laws applicable to midwives
 Obstetric medical compensation system Liability insurance for nursing professionals
 Utilization of various guidelines
 Basics of risk management Basic knowledge of infection (including maternal
infection)
 Basic knowledge for disaster preparedness
 Information management (information management rulesin the facility, handling of medical information,
information provision to service targets, etc.)
Operation management and time management

EconomyLeadership

Control(Management)

SafetyChapter 327

1

Establishing the environment to support education

For individual midwives to attain the goals of each stage in the clinical ladder, and proceed to a higher level, it is extremely important that the managers of theorganization establish an environment to support education, understanding the purpose of the clinical ladder, while midwives improve themselves through learningand the acquisition of skills. Specific measures for establishing such an environment are described below.
(1) Formulating annual educational plans
At a facility that does not have a clear internal educational plan, it is recommended to present an educational program for midwives at the same time as
introducing this ladder. Even a facility that already has its educational plan is also recommended to review its existing plan. While the process for formulating
educational (training) plans is detailed in Chapter 5, it is expected to be difficult at some facilities that midwives acquire midwifery practice, experience items, andessential training required at Level III of the clinical ladder. In such cases, it is preferable that the facility should group educational items, in advance, into thosethat are internally available and those that can be outsourced, and indicate the respective groups in the educational plan.
Each facility is requested to present its own educational plan, and to establish an environment to continuously support midwifery education, making use of study
meetings, seminars and other opportunities provided by organizations and functional associations that the facility belongs to.
(2) Establishing systems for enhancing midwifery practice
For midwives to acquire practical ability, they must also learn through experience, apart from participation in training sessions as described above. To enhance
opportunities for learning through experience, it is important that the managers of the facility establish systems for collaboration and cooperation both internallyand externally.
Specific measures include the integration of the outpatient unit with the inpatient ward. When nursing units are divided respectively or partially for pregnancy,
delivery, postpartum and newborn, opportunities are increased for midwives to experience care in the pregnancy, postpartum, and newborn periods in a moreconsecutive manner, by streamlining rotation and information exchange among the stages. Strengths of each facility should be bolstered by enhancing
collaboration among local facilities, and establishing short- to long-term training and expatriation systems.
In this way, each facility can make up for the areas that are difficult for midwives to accumulate experience. At the same time, this also enhances collaboration
between inside and outside the facility in training as mentioned above.
(3) Identifying and supporting the targets of individual midwives
Individual midwives should formulate specific action plans concerning learning items and the acquisition of skills toward the goals they would like to attain in thepresent ladder level, and have an initial interview with their manager, as part of the annual goal management (see Q3, Chapter 6). The manager should confirm
that the individually presented goals are aligned with the attainment of the present ladder level, provide advice, and support the midwife to proceed as planned.
During an interim interview, each midwife should update the manager on the implementation of their plan and progress to date, for evaluation by the manager. The
midwife should modify the goals when necessary, and continue to proactively strive for attaining goals in the second half. At the end of the term, the midwife
should have an interview with the manager concerning efforts throughout the year for evaluation, and clarify requirements for the next business year.
Daily midwifery practice should be recorded in the experience log (e.g. delivery assistance, checkup of pregnant women). The midwife should also archive
checklists concerning education, review of cases, reports, certificates of participation in academic conferences and seminars, certificates of training, certificates ofqualification, etc. in the portfolio, and utilize them for evaluation and during interviews.

28

3

Evaluation of education

Chapter 7

The evaluation of education is aimed at assessing the effect of education, and reviewing and improving the educational plan. Therefore, evaluation should be
conducted based on the educational goal (targets in the ladder). Care must be taken to avoid common confusion with the comprehensive evaluation of the clinicalladder for each midwife (see page 60).
Methods for evaluation include “test”, “skill check”, “report”, “review”, and “portfolio.” It is possible to evaluate several items at the same time. Conduct a testfor educational items that require the secure acquisition of knowledge or practical skills (e.g. reading CTGs). Implement a test or skill check to evaluate skill
exercise. Perform a review based on prepared reports to evaluate specific points in OJT.
Based on the results of evaluation, it also becomes necessary to modify the educational plan and/or to supplement educational items in underdeveloped areas.
For the evaluation of ‘Maternity care ability’, each midwife should perform self-check in accordance with the checklist provided in the “Training Guidelines for
Newly Graduated Midwives”, Japanese Nursing Association (Table 3-7) for Level Novice, and according to the checklist in the “Evaluation of the Quality of
Midwifery Care at Medical Facilities, 2nd Edition”, Japanese Nursing Association (Table 3-8) for Levels I through III. The manager of the midwife should
confirm the results of the self-check.

Chapter 2

Methods for education include “lecture”, “exercise”, “simulation”, “OJT”, and “review.” Lecture is effective when the acquisition of knowledge is required.
Exercise is effective for acquiring skills, and simulation is effective for training aimed at practice. OJT can be used when it is effective to learn throughexperience, and review can be utilized for the education of professional autonomy. In this way, methods should be selected according to the educational item.
Efficient and effective education becomes possible by holding sessions where midwives of different ladder levels can learn at the same time (e.g. a simulated
training with Level I midwives as puerperal woman, Level II as midwives, and Level III as leaders).
When a facility formulates its educational plan, the plan should be based on the assessment concerning items that are internally available and those that are
difficult to implement. To cover all necessary items, it is also possible to utilize collaboration among several facilities, temporary transfer systems, and external
training (see Chapter 5).

Chapter 3

Methods for education

Chapter 42Chapter 5(4) Presenting opportunities for learning
While identifying the ladder level and interest of each midwife, and presenting information concerning suitable internal and external study meetings, it is also
critical to encourage all midwives to participate in such sessions, in an impartial manner.

Chapter 1

Educational Programs Based on the CLoCMiP

Chapter 6

Chapter 329

1

Purpose of evaluation“Evaluation” in this chapter means to evaluate the attainment of each level in theclinical ladder.
Based on the acquisition of abilities and the attainment of goals specified for eachlevel of the clinical ladder, progress in the knowledge and skills of the midwife to beevaluated should be confirmed, and the midwife, a third person, and the manager
should mutually share the accomplishment level based on objective indicators.
Evaluation also helps the midwife to be evaluated formulate a specific action plan
toward the next challenges.

2Time for evaluation

The time for evaluation differs by the ladder level (recommended times are indicatedon the right).

30

Recommended times for evaluation
1) In Level Novice, evaluation is recommended at the time of employment,
and three months, six months, nine months, and eleven or twelve months
after employment.
 Evaluation at the time of employment is aimed at identifying thereadiness of each midwife.
 By identifying and sharing progress in detail over the first year, clarify
the targets of each midwife to proceed to higher levels.
 Conduct annual evaluation at the end of the business year, to confirm
that each midwife has attained the targets in Level Novice, and sharethat they should proceed to challenges in Level I.
2) In Level I, interim evaluation should be conducted in around September,and annual evaluation at the end of the business year.
 Each midwife to be evaluated should understand how to utilize theclinical ladder, and undertake planning, practice and evaluation along
their targets.
3) In Levels II, III and IV, annual evaluation should be conducted at the endof the business year.
 Clarify progress in the attainment of goals based on the annual
performance. The midwife to be evaluated should specify nextchallenges, and share them with the manager and other related persons.

Chapter 1
Chapter 2
Chapter 3

Chapter 3 detailed educational programs for midwives to proceed to higher levels as professionals, and also indicated the necessity and details of careful evaluation
concerning the incorporation of educational items into everyday midwifery practice.
Chapter 4 describes “comprehensive evaluation” for confirming and sharing that midwives have attained their goals and cleared each ladder level, through learningand experience accumulated along the educational program. The following sections indicate who conducts comprehensive evaluation, time for evaluation, methods
for evaluation, tools to be utilized, and other details.

Chapter 4

What is the comprehensive evaluation of the CLoCMiP?

Chapter 51Comprehensive Evaluation of the CLoCMiP

Chapter 6

Chapter 4

Comprehensive Evaluation of the CLoCMiP

Chapter 7

Chapter 4

4Chapter 3
Chapter 4

It is important to maintain objectivity by more than one person evaluating each
midwife. This requires two points: 1) that the midwife to be evaluated should also
perform self-evaluation, and 2) that a person who is able to adequately evaluate thetargeted practice should undertake evaluation by a third person.
Refer to notes on the right for evaluation by a third person and evaluation by the
manager. It is also suitable to determine primary persons in charge for each category(‘ethical understanding’, ‘maternity care ability’, and ‘professional autonomy’),specifying who should primarily evaluate each item in the clinical ladder. The
conditions, educational systems and other factors of each facility should also be taken
into account in the determination of evaluators.

Notes about evaluators
1) “A third person” should be: A person who is requested by the midwife to be evaluated; A person who can directly observe nursing practice by the midwife to beevaluated; A colleague, a more experienced midwife, or a less experienced midwife
around the midwife to be evaluated; or In Level Novice or Level I, a trainer, preceptor or the like who wellunderstands the midwife to be evaluated and who can observe
midwifery work by the midwife, or a person who is in a position to
guide the midwife to be evaluated.
2) “The manager” should be: The head nurse; or The deputy head nurse, a chief, a nurse in charge of educating or the like
who is regarded as adequate for evaluation by the head nurse.

Duration of an evaluation session and required preparations

The preferable duration of an interview session for evaluation is approximately 30 minutes. Evaluation may be completed in a day, or last two or three days. Whenan evaluation session takes more than one day, items to be evaluated should be divided and handled in a planned manner.
To ensure that adequate evaluation should be performed based on the clinical ladder, the date and time for the evaluation session should be adjusted at least twodays beforehand, so that the midwife to be evaluated, the third person and the manager can make necessary preparations. The midwife to be evaluated should be
notified of persons who will participate in the evaluation session.

5

Place for the evaluation session

For entering the checklist or holding an interview, select a place (private room) where privacy can be protected. A similar place should also be selected when athird person or the manager collects information concerning the practical level of operating knowledge and skills of the midwife to be evaluated, from thepreceptor, trainer, etc.
To enable the evaluation of knowledge, skills and determination in daily midwifery operations, the third person and the manager must intentionally observe theconditions of practice, the level of autonomy in actions, and other factors of the midwife to be evaluated.

31

Chapter 5

Evaluators

Chapter 6

3Chapter 2

In Level Novice, evaluation should be conducted in a focused manner at adequately short intervals. As the midwife proceeds to higher levels, the frequency ofevaluation may be reduced to once or twice a year.

Chapter 1

Comprehensive Evaluation of the CLoCMiP

Chapter 7

Chapter 4

6

Evaluation tools

Use 1) to 3) below as evaluation tools. In Level Novice, 4) should also be utilized.
When all facilities utilize these tools, more objective evaluation becomes possible
from a standardized perspective, and the recognition of each level can be integrated
across facilities.
1) Comprehensive Evaluation Sheet (Table 4-1)
2) Educating programs that correspond to each level of the clinical ladder (Chapter
3, Tables 3-2 through 3-6)3) Evaluation of the Quality of Midwifery Care at Medical Facilities, 2nd Edition(Chapter 3, Table 3-8)
4) Training Guidelines for Newly Graduated Midwives (Chapter 3, Table 3-7)
There also exist tools that are created at each facility for training their employees. It
is necessary that each facility should also utilize such tools, and play its role based on
the characteristics of the facility.
Examples of other evaluation tools are listed on the right.

7

 Examples of tools that can be utilized for evaluation
 ICM Code of Ethics for Midwives; Code of Ethics for Nurses
 Philosophy of the facility (hospital); philosophy of the nursing
department; declaration on the rights of patients, etc.
 HR information (portfolio, etc.)
 Educating information
 Materials that indicate the status of participation in training (certificatesof training, certificates of completion, etc.)
 OJT checklist
 Target management sheet Midwifery operating standard, midwifery standard, midwifery protocol,
midwifery recording standard
 Code of practice, employment regulations
 Accident/incident reports
 Case reports
 Midwifery plans formulated by the midwife to be evaluated Research presentations, publications and papers
 Qualifications (NCPR, aroma therapy, maternity yoga, etc.)
And other evaluation tools that suit the conditions of the facility

Methods for evaluation

Methods for evaluation include “submission of reports”, “review at operations and actions”, “participative observation”. Appropriate methods should be selected
and used in accordance with the conditions.
It is preferable that an interview session is held as part of evaluation at the end of the business year, where the midwife to be evaluated can exchange views withthe third person and the manager, so that evaluation can be performed with mutual understanding and satisfaction.
To evaluate the autonomy of the midwife in everyday operations in Level Novice and Level I, “review at operations and actions” and “participative observation”
should be utilized. “Participative observation” signifies evaluation through the observation of the midwife’s actions in everyday operations. It is also possible thatthe third person and the manager perform evaluation based on information collected from persons who relate with or adequately observe the midwife to beevaluated.
To confirm development methods in the midwifery process as part of ‘Maternity care ability’ in the clinical ladder, the scope of evaluation should include casestudies, case reports and other reports.

32

Professional autonomy

A
B
C
D[Research]
Evaluation criteria

Chapter 1

 Evaluate midwifery carethrough midwifery practice,conference, etc., confirmingthat creative midwifery
practice is undertaken. Also
refer to evaluation by thecared person.

 Confirm that the status ofparticipation in internal andexternal seminars and study
meetings is suitable for the
midwife’s level.

 Confirm the status ofparticipation in continuing
education programs, andverify the learning status,
progress in assignments, andachievements.

 Confirm the status ofparticipation in continuing
educational programs, andevaluate the learning status.

 Confirm the status ofparticipation in internal andexternal nursing researchpresentation meetings.

 Confirm that the midwife canstate the ground for eacheveryday action.

 Evaluate whether the midwife  Evaluate whether the midwife  Evaluate whether the midwife
can identify and express
has presented the results of a
has encouraged ward staff toquestions in everyday practicestudy or research in theapply research results tofrom a researching viewpoint.
hospital.
clinical practice, thereby
leading to improvement in

Chapter 2

 Evaluate midwifery care
 Evaluate midwifery care
 Evaluate midwifery carethrough midwifery practice.
through midwifery practice,through midwifery practice, Look back at the midwifery
conference, etc.
conference, etc., confirming
process, and evaluate remarks  Look back at the midwiferythat care is provided in an
made and the details ofprocess, and evaluate remarks
individualized andassessment and planning,
made and the details of
autonomous manner. Also
based on the formulated
assessment and planning, as
refer to evaluation by the
midwifery plan, records andwell as individualized carecared person.
other materials. Also refer topractice, based on theevaluation by the cared
formulated midwifery plan,
person.
records and other materials.
Also refer to evaluation by thecared person.

Chapter 4

 Evaluate midwifery carethrough midwifery practice.
 As for practical midwifery
ability, look back at the
midwifery process, andevaluate remarks made andthe details of assessment andplanning, based on theformulated midwifery plan,
records and other materials.

 Evaluate whether the midwife  Evaluate whether the midwife
is performing the role as aeffectively incorporates
clinical guide to newinternal education into
midwives, junior midwives
practice inside and outside theand students, and whether theward, from a leading
midwife utilizes midwifery
standpoint including thepractice to the midwife’splanning and operation of the
career and contributes to thetraining.
ward.
 Evaluate whether the
midwife’s self-careerplanning and specificmeasures are appropriate.

33

Chapter 5A
BCD[Education]
Evaluation criteria

Level Novice
Level I
Level II
Level III
Level IV
 Caring attitude is a common attitude and essential ability for all items under maternity care ability and professional autonomy.
 In comprehensive evaluation, evaluate this item not by caring itself, but based on the incorporation of caring attitude in everyday midwifery practice.

Chapter 6[Caring]
Evaluation criteria
A
B
CD[Practical midwifery ability]
Evaluation criteria

Chapter 3

Comprehensive Evaluation Sheet

Maternity care ability

Ethicalunderstanding

Table 4-1

Comprehensive Evaluation of the CLoCMiP

Chapter 7

Chapter 4

Level Novice

A
B
C
D[Communication]
Evaluation criteria

A
B
CD[Ethics]
Evaluation criteria

Management

A
B
C
D[Safety]
Evaluation
criteria

34

Level I

Level II

Level III

Level IV
operations and the resolutionof problems.

 Evaluate whether the midwife  Evaluate whether the midwife  Evaluate whether the midwife
practices actions that respect
practices actions that respectadequately understands thethe dignity of the caredthe dignity of the caredneeds and problems of theperson, through language andperson, and utilizes
cared person, and utilizes
attitude in everyday nursing
communication skills.
communication skills incare.
explanation to the caredperson and the obtainment of
the person’s consent.

 Evaluate whether the midwife  Evaluate whether the midwife
appropriately identifies
effectively utilizes
ongoing conditions in thecommunication skills, andeveryday practice of nursing
maintains favorable
care, and takes assertive
relationship with the cared
response.
person.

 Evaluate whether the midwife can practice responsible actions as a working person, and perform
appropriate reporting, notification and consultation, with the recognition and responsibility as a
medical professional.
 Midwifery ethics is a common mindset for all items under maternity care ability and professional
autonomy, and is also essential ability as a professional. In comprehensive evaluation, evaluate thisitem not by ethics itself, but based on the incorporation of ethical attitude in everyday midwifery
practice.

 Evaluate whether the midwife understands the necessity oforganizational actions and discipline in the workplace, and takes
responsible actions.

[Safety management] Evaluate whether the midwife practices safe midwifery carebased on the midwifery standard and the midwifery protocol.
 Evaluate whether the midwife’s indication in the incident reportfollowing an incident is appropriate.
[Prevention of infection]
 Evaluate whether the midwife’s preventive actions against
infection are appropriate.
[Disaster (prevention) management] Evaluate whether disaster (prevention) management andresponse to disaster by the midwife are appropriate.
[Information management] Evaluate whether the midwife understands the information
management system, and acts in accordance with the system.

 Evaluate whether the midwife  Evaluate whether the midwife
practices care from thecan play a leading role inviewpoint of safety
safety management.
management.
 Evaluate whether the midwife
 Evaluate whether the midwife
plays a leading role, together
can play a leading role inwith the manager, bysafety management.
identifying problems in the Confirm and evaluate theworkplace, and formulating,midwife’s understanding ofdisseminating andlaws and regulations
implementing solutions, whenregarding equipment andan incident/accident occurs.
medical materials (Product
Liability Act, etc.).
 Evaluate the midwife’s statusof participation in disaster
drills, actions in the event ofan accident, andunderstanding of the[Safety management] Evaluate whether the midwife
can review, analyze, andformulate actions for, actual
incidents.
 Evaluate whether the midwife
can take appropriate responsewhen an accident occurs.
[Prevention of infection]
 Evaluate whether the
midwife’s preventive actions
against infection areappropriate.
[Disaster (prevention)
management] Evaluate the midwife’s early
response in disaster drills.
[Information management]

A
B
C
D
[Leadership]
Evaluation criteria

 Evaluate whether the midwife  Evaluate whether the midwife  Evaluate whether the midwife  Confirm and evaluate that theacts without causing waste inacts without causing waste inacts without causing waste in
midwife understands the
goods and time.
goods and time.
goods and time using thelogistic system of the facility.
 Evaluate whether the midwife
midwife’s own ideas.
 Confirm and evaluate theacts considering how to Evaluate whether the midwife
midwife’s knowledge
allocate the midwife’s work
can undertake midwifery care
concerning medical service
hours.
within the specified time using
systems (medical fee system,
the midwife’s own ideas andetc.).
adjustments.

Chapter 1

Level III
midwife’s role andresponsibility.

Level IV

 Confirm and evaluate that the
midwife takes proactive
measures for goods
management in thedepartment.
 Confirm and evaluate that the
midwife is seeking to apply,
or is applying, knowledge
concerning medical service
systems (medical fee system,etc.) to the facility.

 Evaluate whether the midwife  Evaluate whether the midwife  Evaluate whether the midwife  Evaluate whether the midwife  Based on the philosophy ofis collaboratively
is playing roles as a member
is exercising leadership tois efficiently aligning andthe nursing department,
communicating withof team approach.
ensure the efficient operations
coordinating with otherevaluate whether the midwife
colleagues and otherof the nursing team.
departments.
is promoting activities toward
professionals.
the attainment of nursing
goals in a leading position,and is incorporating thephilosophy into practice.

Chapter 7

Chapter 6

A
B
C
D
A
B
Comprehensive
evaluation
C
D* Comprehensive evaluation of the clinical ladder: In principle, the same items should be evaluated by the midwife to be evaluated, a third person, and the manager (head nurse).

Chapter 2

Level II
 Evaluate whether the midwife
understands the information
management system, and acts
in accordance with the system.

Chapter 3A
BCD[Economy]
Evaluation
criteria

Level I

Chapter 4

Level Novice

Comprehensive Evaluation of the CLoCMiP

Chapter 5

Chapter 435

Guidelines for Applying Clinical Ladder of Competencies for Midwifery Practice(CLoCMiP)
1st education, 1st impression published on August 2, 2013
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Produced by:

Japanese Nursing Association
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Tel: +81-3-5778-8831
URL: http://www.nurse.or.jp/
Midwives Division
Department of Health Promotion Policy, Japanese Nursing Association
Tel: +81-3-5778-8843
Japanese Nursing Association Publishing Company

 Japanese Nursing Association 2013
It is prohibited to copy or reproduce this guideline without authorization.

Japanese Nursing Association