Research on Integrated “Curriculum – Certification” Model for 1+X Postpartum Recovery: Midwifery Education

Research on Integrated “Curriculum – Certification” Model for 1+X Postpartum Recovery: Midwifery Education | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Research on Integrated “Curriculum – Certification” Model for 1+X Postpartum Recovery: Midwifery Education Siyun Wang, Zhen Zhang, Li Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5927398/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In China, the “1 + X certification” policy has significantly reformed vocational education since 2019. This research integrates the “1 + X Postpartum Recovery” teaching content into midwifery education. It develops the “curriculum –certification” course model for midwifery majors, improves nursing skills in the “1 + X Postpartum Recovery” area, and expands the professional value of midwifery in maternal and infant care. Methods Using content analysis, we discussed and formulated a curriculum for credit integration. This study comprehensively evaluates the curriculum credit integration in teaching programs. SPSS Windows software version 22.0 was used to analyze the data, χ 2 test, t-test or ANOVA for quantitative data, α = 0.05, and the subjective evaluation using a structured questionnaire and present keywords by the word cloud diagram. Results The passing rate of students' certificate examinations was significantly increased through course certificate accommodation. Furthermore, the students’ evaluation of the course, teaching resources, and teachers' teaching process were higher. Conclusion The new course model integrates students' content in relevant professional courses. The combination of online teaching resources and the optimization of teaching mode promotes the organic integration of professional and practical skills, helping students complete the requirements of a “1 + X Postpartum Recovery” certificate with less time cost while enhancing career development skills and career competitive advantages. Postpartum care nursing professional education certificate education traditional medical treatment Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction In 2019, the Ministry of Education of the People’s Republic of China [1] proposed that the “1+X” certificate education began in vocational colleges and applied to undergraduate colleges and universities in the National Vocational Education Reform Implementation Plan. “1” means diploma, and “X” means vocational skill level certificate. “X” certificates represent competency requirements for new positions in modern society, including knowledge, literacy, and skills, and are divided into three levels (primary, intermediate, and advanced) by each certificate. A third-party industry organization selected and authorized by the Ministry of Education of the People’s Republic of China conducts standards and certificate assessment of the “X” certificates. China has a large population, and with the rapid development of the social economy in recent years, health needs have undergone tremendous changes. An increasing number of women have begun to pay attention to the potential harm caused by childbirth and the need to "healthy childbirth" actively. Postpartum recovery centers are becoming important institutions for fulfilling these. Therefore, the Ministry of Education selected a third-party industry organization to offer a postpartum recovery certificate in 2021 [2]. The X certificates are related to nursing majors, such as maternal and infant care, older adult care, and children's care, among others. The teaching content is highly consistent with the nursing or midwifery major. It only needs to add a course to train the “X” certificate skills and achieve certificate requirements. However, the “X” of certificates for postpartum recovery contains three fields: rehabilitation medicine, nursing, and traditional Chinese medicine (TCM). This is a significant learning challenge for midwifery students. The requirement cannot be achieved by simply adding a course. Students must be trained for certification, as the diploma education curriculum framework that has passed the national certification cannot be changed. Therefore, constructing a “curriculum – certificate” integration model is the best solution. Background “1 + X” Certification Policy is a Reform in Chinese Vocational Education The Chinese government attaches great importance to vocational education and has proposed to improve comprehensive skills in vocational education. With the "1 + X" vocational education certificate system implemented in 2019, vocational education trends shift to "one specialty, multiple abilities, and one person with multiple positions" educational goals. Thus, interprofessional education may become a developmental trend in vocational education. It is more suitable for interprofessional education in modern society's jobs and professions and has the same status as education in health professions [ 3 ]. The "X" certificate of education is an essential reform of Chinese vocational education and is a product that integrates industry and education [ 4 ]. Until 2020, the national Ministry of Education authorized 393 Vocational Education and Training Evaluation Organization and 447 “X” certificates [ 5 ]. The "X" certificate comprises government, training evaluation organizations, colleges, or universities. The government is responsible for selecting excellent enterprises, training evaluation organizations for developing vocational standards, and colleges and universities for training or teaching implementation and examinations. The collaboration benefits the curriculum through certification integration, reform teaching evaluation, and improvement of education qualifications. Chinese Unique Fertility Culture and the Needs of Postpartum Nursing “Zuo Yue Zi” is a unique Chinese fertility culture. The earliest documented records can be traced back to the "Liji Neize" of the Western Han Dynasty. It is a lifestyle performed after childbirth and has more than 2,000 years of history. The concept is similar to the "puerperal period" in modern medicine. TCM plays a vital role in the culture and holds that pregnancy and childbirth will weaken the body of women. They must take certain precautions regarding diet and the care environment to protect the mother's body. For thousands of years, with the development of TCM theories and practice, the specific ideas and opinions about postpartum time we call “Yue Zi taboo” it is well known in China, and this custom and culture have also spread in areas where Chinese people live around the world. In other words, "Zuo Yue Zi" is a fertility culture in which Chinese people spend their puerperium in a unique lifestyle that is different from usual to pursue maximum health benefits. The customs and culture determine why Chinese people need postpartum nursing services. Therefore, “Zuo Yue Zi” is a medical and cultural care need with vital social, cultural, and life attributes. In recent years, postpartum health care has gradually become a manifestation of Chinese women's emphasis on health, and perinatal medicine and midwifery, which are directly related to female fertility, have naturally become a vital force. In the past, graduated midwifery students became midwives responsible for childbirth. However, nowadays, midwives need to be accountable for breastfeeding, nursing babies, and taking care of mothers’ postpartum recovery. The workplace extends community and family, meaning that care contains society, culture, and physical and mental health. Meanwhile, graduate midwifery students must be competent as general midwives or nurses in hospitals and maternal and infant healthcare in communities and other health institutions. This has deeply impacted midwifery students regarding their professional identity, professional values, and career planning. Thus, the need for postpartum recovery certification and why the certification is complex. Description of Research Problems “1 + X” certification can promote the deep integration of schools and enterprises, achieve "dual" education, and create a unique education model for vocational education in China. It benefits creating a teaching ecological chain that integrates industry-college-research [ 6 ]. This certification represents a significant reform for diploma education and vocational training, as its implementation necessitates changes for students, teachers, and educational institutions. These changes include modifying the curriculum and instruction, training new teacher faculty, updating training equipment, and constructing a new curriculum framework. However, over many years of vocational education development in China, under the requirements and guidance of the National Ministry of Education standards, many majors, especially traditional ones, have reached a ceiling regarding course categories, hours, and credits, among others. In such circumstances, adding the content of the "1 + X" certificate, which typically requires over 100 hours, will make it difficult for colleges to formulate teaching plans, curriculum standards, and implementation strategies. The "1 + X" certificate is oriented based on vocational job requirements, and it is common for the content of these certificates to overlap with professional learning courses partially. It is reasonable to integrate vocational skills training into professional courses [ 7 ]. This integration is the theoretical foundation for designing the “curriculum – certification” integrated model. This study aims to construct and modify a new curriculum based on the midwifery diploma education and integrated “1 + X Postpartum Recovery” content and achieving the “X” certification to help students improve their professional values and broaden their vocational road. Aims Focus on vocational educational midwifery students, based on the midwifery curriculum framework, modify the course content and semester, and construct a suitable “1 + X Postpartum Recovery Certification” curriculum – certification integrated model. Method Design “Curriculum – Certification Integrated” Course Model Design of Integrated “1 + X Postpartum Recovery” Certificate into Midwifery Curriculum Framework Midwifery diploma education is 3 years, comprising 6 semesters. The last year includes Semesters 5 and 6 of clinical practice. The theory learning plan is in Semesters 1–4, and all the certification learning and exams must be finished before Semester 4. The “1 + X Postpartum Recovery” certificate has three levels: primary, intermediate, and advanced. The intermediate level comprises six modules and 60 core skills. The requirement is that students have professional knowledge and skills for physical and mental health during pregnancy, puerperium, lactation, neonatal period, and infant period. Implementing the “X” certification is challenging because of the teaching content in interprofessional nursing science, rehabilitation medicine, and TCM areas. Almost 50% of content and skills are not in the midwifery curriculum framework (Fig. 1 ). Consequently, faculty leaders and course group teachers analyze and break up all the knowledge and skills needed to integrate the curriculum framework to ensure students learn from current courses. Therefore, we modified the course content in the midwifery curriculum framework, not adding or deleting courses; that is, we did not change the midwifery curriculum framework. Next, we added a course named “1 + X Postpartum Recovery” in the third semester to present the “X” certification course in the curriculum framework, which is the National Ministry of Education requirement. The added course allowed us to review related knowledge and intensive training skills for the certification exam. At the end of the third semester, the certification examination is arranged, and the credit is calculated (intermediate level is 112 hours, 7 credits), which means the certification exam is the course's final exam. Design Teaching Implementation Plan Clarify Teaching Objectives Based on Postpartum Recovery Nursing Job Requirements According to National Ministry of Education requirements, midwifery students must be competent in clinical nursing, midwife, community nursing, and postpartum recovery nursing. Based on these roles, the teaching objectives of the “1 + X Postpartum Recovery” certification are: (1) to understand the theoretical knowledge related to postpartum recovery; (2) to apply this knowledge to recovery-related assessment and skills; (3) to provide health services to mothers and babies (including daily direct care); and (4) to provide health education to mothers and their families. Additionally, students should develop good professional ethics, a high sense of work responsibility, strong interpersonal communication skills, adaptability, and teamwork ability. Strengthen the Training of Course Group Teachers Choose teachers with a nursing background to form a course group and send them to the “1 + X” teacher training center. Eight teachers with clinical nursing experience in maternal and infant care or community nursing will qualify for “1 + X Postpartum Recovery” teaching and examination. Moreover, the nursing faculty should connect with related industries, such as confinement centers or maternal and infant health care clubs, to invite the staff to teach and help construct a fundamental training base. Analysis of Theoretical and Practical Knowledge Modifies the Curriculum Framework Analyzing the “1 + X Postpartum Recovery” certification (intermediate) teaching content and requirements, course group teachers integrated this knowledge into the midwifery curriculum framework. Nine courses are highly related to the certification. One course, “Nursing of TCM,” contains substantial knowledge and numerous skill points, making it challenging to cover all the content in one semester. Therefore, we divided it into three courses: Introduction to TCM Nursing, TCM Herbal and Chinese Medicinal Formulas and TCM Dietary Care, and Skills and Practice of Nursing TCM, which will be covered over three semesters. After modifying the curriculum framework, there are now 11 related courses (Table 1 ). Table 1 “1 + X” Postpartum Recovery (Intermediate) Certificate Integration Curriculum Schedule Task Core Knowledge and Skills Integrated Related Courses Recommended Class Hours Semester Basic Knowledge 8 Tasks Include 24 Units Task 1 Introduce 1 + X policy background New Student Orientation 2 1 Task 2 Professional ethics and Professional literacy Humanistic Cultivation in Nursing 1 1 Task 3 Female reproductive system and structure and function of the breast Anatomy 0.5 1 Task 4 Care during pregnancy, childbirth, and puerperal Obstetrics and Gynecology Nursing 40 3 Task 5 Fundamentals care of postpartum recovery Body recovery Rehabilitation Nursing of TCM Health-Cultivation 8 2 Nutrition and diet TCM Herbal & Chinese Medicinal Formulas and TCM Dietary Care 24 2 Pelvic floor recovery guidance Rehabilitation Nursing of TCM Health-Cultivation 8 2 Feeding and breast care Health Education of Nursing 2 3 Task 6 Psychological characteristics of pregnant women Maternal and Child Psychology 12 2 Task 7 TCM Constitution identification and recovery conditioning Types and characteristics of TCM constitutions Introduction of TCM Nursing 2 1 Conditioning methods for TCM constitution types 4 Commonly used acupuncture points in postpartum recovery 24 Task 8 Employment and entrepreneurship Postpartum Recovery 2 3 Professional skills 6 modules include 60 contents Module 1 Breast care Physiological changes in the breast during pregnancy Obstetrics and Gynecology Nursing 2 3 Assessment of breast abnormalities Surgical Care 2 3 Postpartum breastfeeding guidance Health Education of Nursing 0.5 3 Treatment of difficulty latching 0.5 Treatment of inadequate breastfeeding 0.5 Weaning guidance 0.5 Massage techniques for mothers to block milk Skills and Practice of Nursing TCM 4 3 Prevention and treatment of breast engorgement 4 Treatment of nipple damage Health Education of Nursing 0.5 3 Prevention and treatment of nipple confusion 0.5 Recognition and prevention of mastitis Surgical Care 1 3 Module 2 TCM Constitution recuperation Identification of maternal TCM constitution Introduction of TCM Nursing 1 1 Health education for pregnant women with different TCM constitutions 1 Identification of data collected by primary postnatal restorers Postpartum Recovery Self-learning 3 Instrument use 2 Maternal Chinese herb fumigation Skills and Practice of Nursing TCM 1 3 Maternal herbal bathing 1 Maternal body health massage 4 Maternal exercise plan Rehabilitation Nursing of TCM Health-Cultivation 0.5 2 Guidance on daily life Introduction of TCM Nursing 0.5 3 Precautions for maternal Recovery TCM constitution 0.5 Module 3 Body recovery Assessment of diastasis rectus abdominis Rehabilitation Nursing of TCM Health-Cultivation 2 2 Assessment of postpartum pubic symphysis separation Assessment of postpartum pelvic rotation Assessment of postpartum gait Massage of the rectus abdominis muscle Rehabilitation Nursing of TCM Health-Cultivation 2 2 Massage of separation of the pubic symphysis Massage of sacroiliac joint dysfunction Pelvic correction Exercise instruction for diastasis recti Rehabilitation Nursing of TCM Health-Cultivation 4 2 Exercise instruction for pelvic rotation Exercise instruction for hip laxity Exercise instruction for sagging breasts Yoga exercise instruction Puerperal dietary guidance TCM Herbal & Chinese Medicinal Formulas and TCM Dietary Care 2 2 Dietary guidance during lactation 2 Module 4 Reproductive health care Perineal cleansing care after normal delivery Obstetrics and Gynecology Nursing 0.5 3 Care of wounds after cesarean section Self-learning Identification of puerperal infections 10 Identification of abnormal lochia 4 Analysis of the causes of abnormal lochia 10 The model was used to explain the anatomy of the pelvic floor to the mother Health Education of Nursing Anatomy Self-learning 3、1 A common symptom of pelvic floor dysfunction Rehabilitation Nursing of TCM Health-Cultivation 2 2 Postpartum pelvic floor muscle test report analysis Postpartum Recovery 2 3 The use of postpartum pelvic floor muscle conditioning equipment Postpartum Recovery 2 3 Postpartum pelvic floor muscle function exercises Postpartum Recovery 3 3 Module 5 Psychological and emotion care Guidance on early mother-infant bond building Health Education of Nursing 1 3 Influencing factors of postpartum psychological factors Maternal and Child Psychology 0.5 2 Manifestations of postpartum psychological abnormalities 0.5 Adjustment of postpartum psychological abnormalities Module 6 Service management Service evaluation Postpartum Recovery 2 3 Service implementation Service feedback Design the New Course, “1 + X Postpartum Recovery” According to the National Ministry of Education requirements, a new course named “1 + X Postpartum Recovery” after the certification has been added. The course content is designed to review and strengthen skills, ensuring students can easily pass the final exam and obtain the certificate. The detailed design of this course is provided in Table 2 . Table 2 Postpartum Recovery Course Design (3rd Semester) Professional Skills Module Teaching Content Class Hour Breast care Health education on breastfeeding (Theoretical review) 4 Prevention and treatment of breast health care, maternal milk blockage, breast engorgement, etc. (Practical training) 8 TCM constitution recuperation Maternal TCM Constitution assessment and conditioning plan (Practical training) 6 Body recovery Postpartum rehabilitation care (review) 4 A common symptom of pelvic floor dysfunction (review) 1 Postpartum pelvic floor muscle test report analysis (Practical training) 2 Postpartum pelvic floor muscle function exercise guidance (Practical training) 3 Using instrument practice (Practical training) 2 Diastasis rectus abdominis assessment and conditioning (Practical training) 2 Massage of sacroiliac joint dysfunction (Practical training) 1 Postpartum physical recovery and exercise guidance (Practical training) 8 Reproductive health care Identification of Postpartum lochia and infection (review) 3 Postpartum vulvar cleaning care, post-cesarean section wound care (Practical training) 8 Service management Resume store operations and service management after childbirth (Visit and study at the training base) 2 pre-exam training 8 exam simulation 2 Total hours 64 Implementation of “Curriculum – Certification Integrated” Course Teaching Students Participants are midwifery students who have participated in the “curriculum – certification integrated” course model from 2021 to 2023. These students were recruited through the Chinese Nationwide Unified Examination for Admissions to General Universities and Colleges. Teachers Group A total of 11 teachers have participated in the midwifery integrated curriculum teaching, including eight nursing teachers and three industry staff teachers. Four teachers have master’s degrees, three are professors or assistant professors, and the rest are senior lecturers. All industry staff teachers have over five years of experience and hold bachelor’s degrees. Each teacher has undergone teaching skill training and participated in lesson preparation before teaching students. Implementation of “1 + X Postpartum Recovery” All the core knowledge and skills for the “1 + X Postpartum Recovery” certification are covered in the 11 courses, with the final “1 + X Postpartum Recovery” course only to review and strengthen this knowledge. We used a blended teaching method in the course, which includes three parts: Pre-class Preview and Post-Class Review . In the first class, teachers introduce course modules and practical training projects, distribute course learning maps and arrangements to the class learning group, and clarify teaching objectives, learning content, and practical training projects. Before the course, students are required to preview the practical training items in the "Postpartum Recovery Core Operational Skills (Intermediate)" online course, which was developed by the “X” third-party industry organization. After the course, students independently review and practice test exercises in the training base. Teaching in Class. During the class sessions, teachers conduct reviews of the knowledge points covered in the certificate examination. In practical training, teachers employ a case-teaching method to reinforce theoretical knowledge and guide students on its application. Pre-exam Training and Exam Simulation . After completing all the reviews and skill training, 10 hours are dedicated to summarizing and conducting exam simulations to familiarize students with the exam process. Examination A third-party industry organization arranges the “1 + X” postpartum recovery certificate examination and comprises theoretical and practical tests. The theoretical test assesses students’ knowledge using multiple-choice questions randomly selected by computer, each receiving a unique test paper. The total score is 100 points, and a score of over 60 is considered passing. The practical test requires students to select items and perform two randomly selected tasks on-site: one long-answer question and one short-answer question. The total score for the practical test is also 100 points. Evaluation of “Curriculum – Certification Integrated” Course Evaluation of Content and Methods Examination Pass Rate Both theoretical and practical scores must be 60 points or above to obtain the certificate. Therefore, the examination pass rate is a part of the course teaching evaluation. The examination pass rate is calculated as the number of students who obtained the certification divided by the number of students who participated in the course (The examination pass rate = obtain certification students or participated course students). Student Evaluation for Curriculum and Teaching The questionnaire was developed based on Bush’s evaluation of the teaching form [ 8 ] combined with the CIPP model [ 9 ]. It includes two parts: course and teachers (12 items for the course and 9 items for teachers), including teaching environment and resources (6 items). It is a five-point Likert scale questionnaire: strongly agree = 5, agree = 4, neither A nor D = 3, disagree = 2, strongly disagree = 1. Apart from this, open-ended questions are placed in a separate section at the end of the form [ 10 ]. For the course evaluation, the questions include: What was the most valuable aspect of this course regarding your learning? What aspects of the course would you revise? For the teacher evaluation, the questions might be: What were the strengths of this teacher? What are areas for improvement for this teacher? The course and teacher’s questionnaire reliability Cronbach’α is 0.985, the validity Cronbach’α is 0.862, the teaching environment and resource questionnaire reliability Cronbach’α is 0.979, and the validity Cronbach’α 0.810. These results indicate that the evaluation tools have good validity and reliability. Data Collection Questionnaire surveys were conducted within one week after the end of the course and exam, and all students who participated in the curriculum framework were required to complete the questionnaire. Scores and passing rates were calculated on the day of the exam. Data collection includes the years 2021, 2022, and 2023. The 2021 data applied to the old curriculum framework, while the 2022 and 2023 data applied to the modified curriculum framework. Data Analysis Statistics were analyzed using SPSS Windows software version 26.0. The exam scores were presented by. Examination pass rates were compared across the years using ANOVA and chi-square tests. Open-ended questions were analyzed to form a word cloud diagram using Nvivo 12 Plus. Results Demographic Profile of Participants and Examination Score In 2021, 4 men and 54 women participated in the exam. In 2022, there were 3 men and 57 women; in 2023, there were 40 women. The examination pass rates for the three years showed significant differences by the chi-square test, P < 0.001. The exam scores also showed significant differences over the three years as tested by ANOVA, P < 0.000. Details are provided in Tables 3 and 4 . Notably, there is no significant difference between 2022 and 2023, as shown in Table 5 . Table 3 Examination Details for the 3 Years Table 4 Students Examination Scores for the 3 Years Year Theory Exam Score Practice Exam Score 2021年 49.38 ± 35.09 62.89 ± 44.37 2022年 71.20 ± 14.91 90.38 ± 17.06 2023年 81.64 ± 1.70 94.04 ± 3.04 F 25.407 19.126 P 0.000 0.000 Table 5 Between-Group Comparison of the Three-Year Test Scores Exam Score Year Mean Difference Std. Error P Practice exam score 2021 2022 -27.48603 * 5.32294 < .001 2023 -31.97978 * 5.94113 < .001 2022 2021 27.48603 * 5.32294 < .001 2023 -4.49375 5.90058 .447 Theory exam score 2021 2022 -21.82069 * 4.27642 < .001 2023 -32.24569 * 4.77307 < .001 2022 2021 21.82069 * 4.27642 < .001 2023 -10.42500 * 4.74049 .029 Table 6 Student Evaluation of the Course Students’ Evaluation of Teaching Environments and Resource The students evaluated the teaching environment and resources with a more than 4.0 score; the 2023 score was milder than the 2022 score (Table 7). Furthermore, students' open-ended evaluation keywords were analyzed in Nvivo 12 plus software, and the word cloud diagram is shown in Figure 3. The keywords are training room too small, insufficient variety of training materials. Table 7 Student Evaluation of the Teaching Environment and Resources Student Evaluations of Teachers The course group teachers who have participated in teaching the "1+X Postpartum Recovery" course were also professional course teachers within the curriculum – integrated framework. In maintaining consistency in the curriculum framework, no changes were made to the teaching staff over the three years, ensuring the effectiveness of the integrated curriculum framework in midwifery education. These teachers taught the students for three semesters, meaning they were familiar with each. The students evaluated teachers (Table 8) and commented on their strengths and suggestions for improvement. Word cloud diagrams were created for the four teachers who received the most student evaluations. The prominent keywords were "earnest," "responsible," "diligent," and "humorous," among others (Figure 4). Table 8 Student Evaluation of the Teachers Items Teachers A B C D E F G H The teacher was well-prepared for class. 4.52±0.544 4.60±0.495 4.76±0.431 4.48±0.544 4.72±0.454 4.68±0.471 4.56±0.541 4.66±0.479 The teacher was enthusiastic about the content and teaching in the course. 4.58±0.575 4.58±0.575 4.78±0.418 4.52±0.544 4.68±0.471 4.68±0.471 4.60±0.571 4.64±0.485 The teacher gave clear explanations. 4.64±0.485 4.60±0.495 4.78±0.418 4.50±0.544 4.72±0.454 4.66±0.519 4.62±0.530 4.66±0.519 The teacher encouraged student participation and discussion. 4.64±0.485 4.66±0.519 4.74±0.443 4.52±0.614 4.66±0.519 4.68±0.513 4.60±0.571 4.62±0.530 The teacher showed respect for students’ views and opinions. 4.58±0.499 4.66±0.479 4.76±0.431 4.46±0.579 4.64±0.485 4.68±0.513 4.58±0.575 4.64±0.525 The teacher provided prompt and valuable feedback. 4.60±0.535 4.66±0.479 4.74±0.487 4.52±0.580 4.68±0.513 4.68±0.513 4.56±0.577 4.62±0.530 The teacher was readily available to students (e.g., questions after class, by email, by appointment, after clinical practicum). 4.58±0.499 4.62±0.490 4.76±0.431 4.48±0.580 4.68±0.471 4.66±0.519 4.56±0.577 4.64±0.525 Overall, this teacher was an effective teacher. 4.60±0.535 4.62±0.490 4.78±0.418 4.56±0.577 4.68±0.471 4.70±0.463 4.56±0.577 4.62±0.530 Discussion Curriculum – certification Integrated Course Model Can Help Students Learning Interprofessional Knowledge Figure 1 illustrates the core knowledge and skills required for the "1 + X" postpartum recovery certificate, encompassing three main areas: TCM, midwifery and nursing, and rehabilitation, which cover a wide range. Specifically, rehabilitation and TCM nursing are introductory courses in the curriculum framework, emphasizing foundational rather than advanced professional knowledge and skills. However, the “1 + X” postpartum recovery certificate necessitates comprehensive and specialized expertise in these areas, particularly in TCM nursing—an interdisciplinary field bridging TCM and nursing science. In China, TCM nursing emerged as a new discipline after the 1950s and gradually integrated into the nursing curriculum of some colleges from the 1980s onwards. However, it is not part of the national teaching standard framework the National Ministry of Education requires. It indicates that not all nursing educators possess the necessary knowledge and skills in TCM nursing. This specialization is primarily taught in TCM universities and colleges, underscoring the specialized nature of TCM nursing education. In China, TCM has over 2000 years of history and a unique theoretical system that is very different from modern medicine. For the Chinese, TCM is not only a traditional medicine but also a traditional culture. Nursing science is based on modern medicine theory, originally from the United Kingdom, and compared with modern nursing, TCM nursing is a particular discipline in nursing science. TCM pays attention to holistic concepts and treatments based on pattern identification. It is different from modern medicine, which is divided into disciplines and professions based on human system diseases, and it is challenging to correspond directly with the departments of modern hospitals. With the influence of modern medicine and decades of development, the teaching of TCM nursing can be categorized into three main parts: (1) Fundamentals of TCM: this includes theories such as Yin-Yang theory, five-elements theory, Zang–Xiang theory, theory of essence, qi, blood and body fluids, theory of meridians and collaterals, eight-principle pattern identification, Chinese herbal and Chinese medicinal formulas, Four qi and five flavors, contraindicated combination, inspection, auscultation, inquiry, and palpation-four diagnostic methods, among others. (2) TCM Clinical Nursing: This covers nursing practices in Chinese internal medicine, Chinese gynecology, Chinese pediatrics, and other specialized areas. (3) TCM Nursing Skills: This involves practical techniques such as moxibustion, cupping, tuina (Chinese therapeutic massage), and others. The Chinese government allows nursing practitioners with an educational background from TCM institutions to perform 18 TCM nursing skills, including Tuina and cupping [ 11 ]. In clinical practice, due to the complexity and specialized nature of TCM theories, diagnosis and treatment are typically the domain of TCM physicians. Simultaneously, nurses mainly carry out skill-based tasks. There is inadequate research on the theoretical foundations and clinical applications of TCM nursing. This gap makes it challenging for clinical nurses to comprehend TCM prescriptions and treatment plans devised by TCM doctors. This deficiency is particularly pronounced in the context of the postpartum recovery certificate, which demands more profound TCM theoretical knowledge. The “X” certificate requires nurses to possess advanced TCM knowledge, such as identifying TCM diet based on body constitution, evaluating breastfeeding using TCM principles, performing TCM Tuina techniques to stimulate lactation by clearing meridians and guiding postpartum mothers to adjust their lifestyles using TCM health preservation theories to facilitate recovery, among other responsibilities. Moreover, nurses must possess enhanced competencies to independently assess and provide services in settings like confinement centers, communities, or family homes where TCM doctors may not be available. The training curriculum framework needs to provide adequate support in these areas. Therefore, the course group has reformed the TCM nursing course. Previously offered as a single course over one semester, it is now divided into three courses: Introduction of TCM Nursing, TCM Herbal and Chinese Medicinal Formulas and TCM Dietary Care, and Skills and Practice of Nursing TCM. The Introduction of TCM Nursing covers fundamentals of TCM theories, including the Yin-Yang theory, five-elements theory, Zang–Xiang theory, theory of essence, qi, blood and body fluids, theory of meridians and collaterals, eight-principle pattern identification, body constitution identification, and etiological factors and pathogenesis. The TCM Herbal and Chinese Medicinal Formulas and TCM Dietary Care course focus on teaching typical Chinese herbal and classical formulas in postpartum recovery and dietary considerations for maternity during the postpartum period, including tailored diets for body constitution recuperation. The Skills and Practice of the Nursing TCM course instructs students on acupoints relevant to postpartum recovery, techniques such as Tuina and cupping for maternity recuperate for maternity, and addressing breastfeeding issues such as acute mastitis breast engorgement. The redesign of the TCM nursing curriculum aims to provide a more scientific foundation, formulating a comprehensive knowledge framework for students before they proceed to the "X" certification course. This approach facilitates a deeper understanding of the certification's requirements and enhances students' self-efficacy in learning. The “curriculum-certification integrity” course model integrates certification knowledge and skills into the current curriculum framework without altering the curriculum certified by the Ministry of Education, thereby meeting the "X" certification requirements. The model aims to improve student learning outcomes and pass rates, as confirmed by assessing its learning outcomes. Curriculum – Certification, Integrated Course Model, Can Help Students Pass the Certification Examination easier In China, students typically pay an additional fee to participate in certification examinations they want to achieve before graduating from either high education or vocational education, which can be costly. However, the Chinese government fully funds the “1 + X” certification and is available only to non-graduating students. The National Ministry of Education allocates funds annually to cover the costs of "X" certification training and education for eligible students. Each educational institution must ensure that a specified number of students successfully pass the certification examination, and government funding is based on the number of students who achieve certification. This funding mechanism necessitates institutions to guarantee the successful certification of the allocated number of students. Otherwise, the funds earmarked for those students may be considered wasted. Repeated failures to meet certification targets could result in the institution losing its qualification to offer the certification or losing government funding altogether. Therefore, achieving a high pass rate in the certification examination is critically important. The postpartum recovery certification conducted its first examination in 2020, but it was unsuccessful due to insufficient theoretical knowledge in TCM and rehabilitation among midwifery students. The “curriculum – certification integrate” course model has not yet been implemented, making it challenging for students to grasp the material, leading to a high dropout rate of 30% and a significant waste of government funds. The students expressed that they lacked sufficient foundational knowledge in TCM nursing and rehabilitation nursing to complete the certification within the 64-class-hour "X" course alone. Subsequently, the course group revised the curriculum framework to ensure students acquire adequate basic knowledge and skills before beginning the "X" course. Over the following three years, the participation rate in the examination improved from 67–100%, and the pass rate increased from 65.5–100%. These results demonstrate that the model effectively utilizes government funds and enhances students' learning self-efficacy, thereby benefiting professional education. Teacher as a Modeling Role for Students to Be Good Learners Owing to the interdisciplinary nature and complexity of integrating disciplinary knowledge and skills within the "1 + X" postpartum recovery certificate, this challenges students and imposes higher preparation requirements on teachers who deliver this course. While nursing teachers with relevant experience have been selected, there is a shortage of teachers with a TCM education background. TCM nursing and rehabilitation nursing are not part of the standard teaching system in Chinese nursing education. In our course group, only one teacher possesses the TCM educational background and experience, while the remaining seven do not. This poses significant challenges in delivering coursework that is based on TCM theories. All teachers in the course group undergo professional training and must attain teaching and examination qualifications for the "X" certification to address this. Furthermore, the course group enhances professional competence through collaborative lesson preparation, team-based learning activities, and practical visits and learning experiences in practice settings. Throughout the entire process, teachers and students learn and grow together. Clinical teachers and nursing educators serve as role models for nursing students, with their role modeling significantly influencing students' learning outcomes [ 12 ]. Teachers who demonstrate hard work, diligence, earnestness, and a commitment to lifelong learning inspire students' professional enthusiasm and foster their professional identity during teaching practice [ 13 ]. During the three-semester learning process, the invisible pressures and constraints are critical hidden aspects of the classroom environment, positively influencing nursing undergraduate education. Declarations Ethics approval and consent to participate The research was approved by the “IRB of the Mianyang Hospital of TCM” ethics committee and was carried out per the Ethical Guidelines for Social Science Research, ensuring that the rights, dignity, and privacy of participants were respected throughout the research process. Prior to participation, all individuals were provided with comprehensive information about the research objectives, procedures, potential risks, and benefits. Participation was entirely voluntary, and participants retained the right to withdraw at any stage without consequences. Confidentiality and anonymity were strictly upheld, with all data securely stored and used solely for research purposes. Approval No. 2024-104. Consent for publication Wang Siyun, Zhang Zhen and Li Li, hereby give our consent for the publication of my article in BMC Pregnancy and Childbirth. We confirm that: The content is original and does not infringe upon any copyright, privacy, or other legal rights. We have reviewed the final version of the material and agree to its publication. Availability of data and materials The datasets and materials generated and/or analyzed during the current study are not publicly available due to confidentiality agreements. However, further information may be available from the corresponding author upon reasonable request, subject to applicable restrictions. Competing interests No potential conflicts of interest exist concerning this article's research, authorship, and publication. Funding The study was funded by the Sichuan College of Tradition Chinese Medicine (Funding No. 22SHYB0) and Mianyang Vocational Education Research Center (Funding No. MZY22C19) Authors' contributions Wang Siyun: Conceptualization, Methodology, Investigation, Resources, Formal analysis, Writing- Review & Editing Zhang Zhen: Resources, Project administration, Funding acquisition Li Li: Supervision, Writing - Review & Editing Acknowledgements Thank you for all students participated the research and teachers engaging in the course: Lin Lin, Dong Min, Wang Jinyu, He Yan, Yang Dan, Ye Jing. We would like to thank Editage (www.editage.com) for English language editing. References Ministry of Education of the Peoples Republic of China. (2019). National vocational education reform implementation plan, no , 4 . http://www.moe.gov.cn/jyb_xxgk/moe_1777/moe_1778/201904/t20190404_376701.html List of the fourth batch of "1+X" vocational education and training evaluation organizations and vocational skill level certificates . (2021). https://pvc-e7031f9b-6522-11e9-883f-fa163e9e2c22.obs.cn-north-1.myhuaweicloud.com/prod%2Fimage%2F2020-12-31%2F062095dbc9a34d648d7bdcaef35cab0b.pdf Thibault, G. E. (2020). The future of health professions education: Emerging trends in the United States. FASEB Bioadvances , 2 (12), 685–694. doi:10.1096/fba.2020-00061 Cai, L. (2021). Survey and analysis of the first batch of nursing students who participated in the "1+X" geriatric care grade examination's perception of geriatric care work. Fujian Medical Journal , 43 (1), 3. doi:10.3969/j.issn.1002-2600.2021.01.047 https://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_fjyyzz202101047 Central Institute for Vocational and Technical Education. (2023). Central Institute for Vocational and Technical Education . http://www.civte.edu.cn/j/xxx.htm Zhang, Y., & Liu, J. (2019). Exploration and research on the teaching model of embedding "1+X certificate" in higher vocational education courses. Journal of Commercial Economics , 21 , 179–182. Duan, L., & Shen, W. (2020). Exploration of the talent training model of Chinese vocational education 1+X certificate system. China Journal of Multimedia Network Teaching , 03 , 132–133. https://www.cnki.net/KCMS/detail/detail.aspx? dbcode=CJFD&dbname=CJFDLAST2020&filename=DMWJ202003063&uniplatform=OVERSEA&v= 3lwqNCZmxSUJaRvEHtXNdqSYy6 as2WR5RoUBVHPNA698q9qsEqv9mxfy-KhNqdxc Bush, M. A., Rushton, S., Conklin, J. L., & Oermann, M. H. (2018). Considerations for developing a student evaluation of teaching form. Teaching and Learning in Nursing , 13 (2), 125–128. doi:10.1016/j.teln.2017.10.002 Jun, L., Junling, Z., & Chun, L. (2013). Implementation and evaluation on CIPP evaluation pattern in project teaching in vocational colleges. Chinese Nursing Research , 10 , 3292–3294. https://www.cnki.net/KCMS/detail/detail.aspx?dbcode=CJFD&dbname=CJFDHIS2&filename=SXHZ201329051&uniplatform=OVERSEA&v=Fko0dwvwm-X6fenbmCjhpDSr_v999knTLXtJOK8et7OgDXfLkvP4tIhTYrGqDL6E Chulkov, D. V., & Van Alstine, J. (2012). Challenges in designing student teaching evaluations in a business program. International Journal of Educational Management , 26 (2), 162–174. doi:10.1108/09513541211201979 https://www.cnki.net/KCMS/detail/detail.aspx? dbcode=CJFD&dbname=CJFDLAST2019&filename=SYJJ2 01921052&uniplatform=OVERSEA&v=JJnaC6D7zBNA5skTuEcBJV9oln8pv2oGe0C8AmgLjdb5n09G- B4cFpi9u4pOHc06 National Administration of Traditional Chinese Medicine. (2015). Notice on the issuance of the "Handbook of Traditional Chinese Medicine Techniques for Nursing Staff" . http://www.natcm.gov.cn/yizhengsi/gongzuodongtai/2018-03-24/2691.html Ahn, J. N., Hu, D., & Vega, M. (2020). “Do as I do, not as I say”: Using social learning theory to unpack the impact of role models on students' outcomes in education. Social and Personality Psychology Compass , 14(2), e12517. https://compass.onlinelibrary.wiley.com/doi/abs/10.1111/spc3.12517 Van, I. K. (2014). The Impact of a Nursing Program on the Formation of Nursing Students' Professional Identity (Doctoral dissertation, The Chinese University of Hong Kong (Hong Kong)). The Impact of a Nursing Program on the Formation of Nursing Students' Professional Identity - ProQuest Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5927398","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":409482359,"identity":"478e338b-3bbe-4493-8e6c-aa9a08274975","order_by":0,"name":"Siyun Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYFACNgaJDz8keNiY2Q8+AHJ5GBuI0CI5s8dGjp+dJ9kApIWZGC3SPGxpxpL9DGYSID47IS3yM9ISb/DwHE7ccJghrfJHRa0M74wE1s08eLQY3Eg7bCFhAdLCeOw2z5njPJIzEthu49Uikd4mYQC15TZj2zEeQ0Ja5GcAtSSwgbWYFf78d4zH/gYBLQw30o5JHAB5v5nBjIG3oYaHkaDDzjxLtmwEBTIzT7I0z7EDPIw9D9tuzsHnsPY0w9t/QFHJf/zgxx81dfaM7cnHbrzB5zA0cBiIGRuY8PoFDdSBScYfJGgZBaNgFIyCYQ8AG5JRPz1jlOYAAAAASUVORK5CYII=","orcid":"","institution":"Sichuan College of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Siyun","middleName":"","lastName":"Wang","suffix":""},{"id":409482360,"identity":"e06094e3-ca5b-4ba7-acab-31c8a1c51cdf","order_by":1,"name":"Zhen Zhang","email":"","orcid":"","institution":"Sichuan College of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Zhang","suffix":""},{"id":409482361,"identity":"de87ebd6-6b9b-4c38-b5be-521f70502744","order_by":2,"name":"Li Li","email":"","orcid":"","institution":"Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-01-30 03:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5927398/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5927398/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75407523,"identity":"62da90ab-ac34-45b0-aa18-61be16c831f3","added_by":"auto","created_at":"2025-02-04 08:54:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70746,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e1+X Postpartum recovery 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13:33:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1918553,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5927398/v1/47723b16-5a22-4838-b906-c3cc6fa39622.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Research on Integrated “Curriculum – Certification” Model for 1+X Postpartum Recovery: Midwifery Education","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2019, the Ministry of Education of the People\u0026rsquo;s Republic of China [1] proposed that the \u0026ldquo;1+X\u0026rdquo; certificate education began in vocational colleges and applied to undergraduate colleges and universities in the National Vocational Education Reform Implementation Plan. \u0026ldquo;1\u0026rdquo; means diploma, and \u0026ldquo;X\u0026rdquo; means vocational skill level certificate. \u0026ldquo;X\u0026rdquo; certificates represent competency requirements for new positions in modern society, including knowledge, literacy, and skills, and are divided into three levels (primary, intermediate, and advanced) by each certificate. A third-party industry organization selected and authorized by the Ministry of Education of the People\u0026rsquo;s Republic of China conducts standards and certificate assessment of the \u0026ldquo;X\u0026rdquo; certificates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChina has a large population, and with the rapid development of the social economy in recent years, health needs have undergone tremendous changes. An increasing number of women have begun to pay attention to the potential harm caused by childbirth and the need to \u0026quot;healthy childbirth\u0026quot; actively. Postpartum recovery centers are becoming important institutions for fulfilling these. Therefore, the Ministry of Education selected a third-party industry organization to offer a postpartum recovery certificate in 2021 [2]. The X certificates are related to nursing majors, such as maternal and infant care, older adult care, and children\u0026apos;s care, among others. The teaching content is highly consistent with the nursing or midwifery major. It only needs to add a course to train the \u0026ldquo;X\u0026rdquo; certificate skills and achieve certificate requirements. However, the \u0026ldquo;X\u0026rdquo; of certificates for postpartum recovery contains three fields: rehabilitation medicine, nursing, and traditional Chinese medicine (TCM). This is a significant learning challenge for midwifery students. The requirement cannot be achieved by simply adding a course. Students must be trained for certification, as the diploma education curriculum framework that has passed the national certification cannot be changed. Therefore, constructing a \u0026ldquo;curriculum \u0026ndash; certificate\u0026rdquo; integration model is the best solution.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003e \u003cb\u003e\u0026ldquo;1\u0026thinsp;+\u0026thinsp;X\u0026rdquo; Certification Policy is a Reform in Chinese Vocational Education\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe Chinese government attaches great importance to vocational education and has proposed to improve comprehensive skills in vocational education. With the \"1\u0026thinsp;+\u0026thinsp;X\" vocational education certificate system implemented in 2019, vocational education trends shift to \"one specialty, multiple abilities, and one person with multiple positions\" educational goals. Thus, interprofessional education may become a developmental trend in vocational education. It is more suitable for interprofessional education in modern society's jobs and professions and has the same status as education in health professions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The \"X\" certificate of education is an essential reform of Chinese vocational education and is a product that integrates industry and education [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Until 2020, the national Ministry of Education authorized 393 Vocational Education and Training Evaluation Organization and 447 \u0026ldquo;X\u0026rdquo; certificates [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The \"X\" certificate comprises government, training evaluation organizations, colleges, or universities. The government is responsible for selecting excellent enterprises, training evaluation organizations for developing vocational standards, and colleges and universities for training or teaching implementation and examinations. The collaboration benefits the curriculum through certification integration, reform teaching evaluation, and improvement of education qualifications.\u003c/p\u003e\n\u003ch3\u003eChinese Unique Fertility Culture and the Needs of Postpartum Nursing\u003c/h3\u003e\n\u003cp\u003e\u0026ldquo;Zuo Yue Zi\u0026rdquo; is a unique Chinese fertility culture. The earliest documented records can be traced back to the \"Liji Neize\" of the Western Han Dynasty. It is a lifestyle performed after childbirth and has more than 2,000 years of history. The concept is similar to the \"puerperal period\" in modern medicine. TCM plays a vital role in the culture and holds that pregnancy and childbirth will weaken the body of women. They must take certain precautions regarding diet and the care environment to protect the mother's body. For thousands of years, with the development of TCM theories and practice, the specific ideas and opinions about postpartum time we call \u0026ldquo;Yue Zi taboo\u0026rdquo; it is well known in China, and this custom and culture have also spread in areas where Chinese people live around the world. In other words, \"Zuo Yue Zi\" is a fertility culture in which Chinese people spend their puerperium in a unique lifestyle that is different from usual to pursue maximum health benefits. The customs and culture determine why Chinese people need postpartum nursing services. Therefore, \u0026ldquo;Zuo Yue Zi\u0026rdquo; is a medical and cultural care need with vital social, cultural, and life attributes. In recent years, postpartum health care has gradually become a manifestation of Chinese women's emphasis on health, and perinatal medicine and midwifery, which are directly related to female fertility, have naturally become a vital force. In the past, graduated midwifery students became midwives responsible for childbirth. However, nowadays, midwives need to be accountable for breastfeeding, nursing babies, and taking care of mothers\u0026rsquo; postpartum recovery. The workplace extends community and family, meaning that care contains society, culture, and physical and mental health. Meanwhile, graduate midwifery students must be competent as general midwives or nurses in hospitals and maternal and infant healthcare in communities and other health institutions. This has deeply impacted midwifery students regarding their professional identity, professional values, and career planning. Thus, the need for postpartum recovery certification and why the certification is complex.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDescription of Research Problems\u003c/h2\u003e \u003cp\u003e\u0026ldquo;1\u0026thinsp;+\u0026thinsp;X\u0026rdquo; certification can promote the deep integration of schools and enterprises, achieve \"dual\" education, and create a unique education model for vocational education in China. It benefits creating a teaching ecological chain that integrates industry-college-research [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This certification represents a significant reform for diploma education and vocational training, as its implementation necessitates changes for students, teachers, and educational institutions. These changes include modifying the curriculum and instruction, training new teacher faculty, updating training equipment, and constructing a new curriculum framework.\u003c/p\u003e \u003cp\u003eHowever, over many years of vocational education development in China, under the requirements and guidance of the National Ministry of Education standards, many majors, especially traditional ones, have reached a ceiling regarding course categories, hours, and credits, among others. In such circumstances, adding the content of the \"1\u0026thinsp;+\u0026thinsp;X\" certificate, which typically requires over 100 hours, will make it difficult for colleges to formulate teaching plans, curriculum standards, and implementation strategies. The \"1\u0026thinsp;+\u0026thinsp;X\" certificate is oriented based on vocational job requirements, and it is common for the content of these certificates to overlap with professional learning courses partially. It is reasonable to integrate vocational skills training into professional courses [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This integration is the theoretical foundation for designing the \u0026ldquo;curriculum \u0026ndash; certification\u0026rdquo; integrated model.\u003c/p\u003e \u003cp\u003eThis study aims to construct and modify a new curriculum based on the midwifery diploma education and integrated \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; content and achieving the \u0026ldquo;X\u0026rdquo; certification to help students improve their professional values and broaden their vocational road.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAims\u003c/h3\u003e\n\u003cp\u003eFocus on vocational educational midwifery students, based on the midwifery curriculum framework, modify the course content and semester, and construct a suitable \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery Certification\u0026rdquo; curriculum \u0026ndash; certification integrated model.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDesign \u0026ldquo;Curriculum \u0026ndash; Certification Integrated\u0026rdquo; Course Model\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eDesign of Integrated \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; Certificate into Midwifery Curriculum Framework\u003c/h2\u003e \u003cp\u003eMidwifery diploma education is 3 years, comprising 6 semesters. The last year includes Semesters 5 and 6 of clinical practice. The theory learning plan is in Semesters 1\u0026ndash;4, and all the certification learning and exams must be finished before Semester 4. The \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; certificate has three levels: primary, intermediate, and advanced. The intermediate level comprises six modules and 60 core skills. The requirement is that students have professional knowledge and skills for physical and mental health during pregnancy, puerperium, lactation, neonatal period, and infant period. Implementing the \u0026ldquo;X\u0026rdquo; certification is challenging because of the teaching content in interprofessional nursing science, rehabilitation medicine, and TCM areas. Almost 50% of content and skills are not in the midwifery curriculum framework (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Consequently, faculty leaders and course group teachers analyze and break up all the knowledge and skills needed to integrate the curriculum framework to ensure students learn from current courses. Therefore, we modified the course content in the midwifery curriculum framework, not adding or deleting courses; that is, we did not change the midwifery curriculum framework. Next, we added a course named \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; in the third semester to present the \u0026ldquo;X\u0026rdquo; certification course in the curriculum framework, which is the National Ministry of Education requirement. The added course allowed us to review related knowledge and intensive training skills for the certification exam. At the end of the third semester, the certification examination is arranged, and the credit is calculated (intermediate level is 112 hours, 7 credits), which means the certification exam is the course's final exam.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDesign Teaching Implementation Plan\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eClarify Teaching Objectives Based on Postpartum Recovery Nursing Job Requirements\u003c/h2\u003e \u003cp\u003eAccording to National Ministry of Education requirements, midwifery students must be competent in clinical nursing, midwife, community nursing, and postpartum recovery nursing. Based on these roles, the teaching objectives of the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; certification are: (1) to understand the theoretical knowledge related to postpartum recovery; (2) to apply this knowledge to recovery-related assessment and skills; (3) to provide health services to mothers and babies (including daily direct care); and (4) to provide health education to mothers and their families. Additionally, students should develop good professional ethics, a high sense of work responsibility, strong interpersonal communication skills, adaptability, and teamwork ability.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eStrengthen the Training of Course Group Teachers\u003c/h3\u003e\n\u003cp\u003eChoose teachers with a nursing background to form a course group and send them to the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X\u0026rdquo; teacher training center. Eight teachers with clinical nursing experience in maternal and infant care or community nursing will qualify for \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; teaching and examination. Moreover, the nursing faculty should connect with related industries, such as confinement centers or maternal and infant health care clubs, to invite the staff to teach and help construct a fundamental training base.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of Theoretical and Practical Knowledge Modifies the Curriculum Framework\u003c/h2\u003e \u003cp\u003eAnalyzing the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; certification (intermediate) teaching content and requirements, course group teachers integrated this knowledge into the midwifery curriculum framework. Nine courses are highly related to the certification. One course, \u0026ldquo;Nursing of TCM,\u0026rdquo; contains substantial knowledge and numerous skill points, making it challenging to cover all the content in one semester. Therefore, we divided it into three courses: Introduction to TCM Nursing, TCM Herbal and Chinese Medicinal Formulas and TCM Dietary Care, and Skills and Practice of Nursing TCM, which will be covered over three semesters. After modifying the curriculum framework, there are now 11 related courses (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;1\u0026thinsp;+\u0026thinsp;X\u0026rdquo; Postpartum Recovery (Intermediate) Certificate Integration Curriculum Schedule\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTask\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCore Knowledge and Skills\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntegrated Related Courses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRecommended Class Hours\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSemester\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasic Knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e8 Tasks Include 24 Units\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTask 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIntroduce 1\u0026thinsp;+\u0026thinsp;X policy background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNew Student Orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTask 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eProfessional ethics and Professional literacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHumanistic Cultivation in Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTask 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale reproductive system and structure and function of the breast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnatomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTask 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCare during pregnancy, childbirth, and puerperal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetrics and Gynecology Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTask 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eFundamentals care of postpartum recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBody recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRehabilitation Nursing of TCM Health-Cultivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNutrition and diet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTCM Herbal \u0026amp; Chinese Medicinal Formulas and TCM Dietary Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePelvic floor recovery guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRehabilitation Nursing of TCM Health-Cultivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFeeding and breast care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealth Education of Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTask 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePsychological characteristics of pregnant women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaternal and Child Psychology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTask 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTCM Constitution identification and recovery conditioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTypes and characteristics of TCM constitutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntroduction of TCM Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConditioning methods for TCM constitution types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommonly used acupuncture points in postpartum recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTask 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEmployment and entrepreneurship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostpartum Recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6 modules include 60 contents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003eModule 1\u003c/p\u003e \u003cp\u003eBreast care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePhysiological changes in the breast during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetrics and Gynecology Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAssessment of breast abnormalities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePostpartum breastfeeding guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHealth Education of Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTreatment of difficulty latching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTreatment of inadequate breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWeaning guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMassage techniques for mothers to block milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSkills and Practice of Nursing TCM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePrevention and treatment of breast engorgement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTreatment of nipple damage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealth Education of Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePrevention and treatment of nipple confusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eRecognition and prevention of mastitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eModule 2\u003c/p\u003e \u003cp\u003eTCM Constitution recuperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIdentification of maternal TCM constitution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIntroduction of TCM Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHealth education for pregnant women with different TCM constitutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIdentification of data collected by primary postnatal restorers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePostpartum Recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSelf-learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInstrument use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMaternal Chinese herb fumigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSkills and Practice of Nursing TCM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMaternal herbal bathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMaternal body health massage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMaternal exercise plan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRehabilitation Nursing of TCM Health-Cultivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGuidance on daily life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIntroduction of TCM Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePrecautions for maternal\u003c/p\u003e \u003cp\u003eRecovery TCM constitution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e \u003cp\u003eModule 3\u003c/p\u003e \u003cp\u003eBody recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAssessment of diastasis rectus abdominis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eRehabilitation Nursing of TCM Health-Cultivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAssessment of postpartum pubic symphysis separation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAssessment of postpartum pelvic rotation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAssessment of postpartum gait\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMassage of the rectus abdominis muscle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eRehabilitation Nursing of TCM Health-Cultivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMassage of separation of the pubic symphysis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMassage of sacroiliac joint dysfunction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePelvic correction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eExercise instruction for diastasis recti\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eRehabilitation Nursing of TCM Health-Cultivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eExercise instruction for pelvic rotation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eExercise instruction for hip laxity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eExercise instruction for sagging breasts\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYoga exercise instruction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePuerperal dietary guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTCM Herbal \u0026amp; Chinese Medicinal Formulas and TCM Dietary Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDietary guidance during lactation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eModule 4\u003c/p\u003e \u003cp\u003eReproductive health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePerineal cleansing care after normal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eObstetrics and Gynecology Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCare of wounds after cesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSelf-learning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIdentification of puerperal infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIdentification of abnormal lochia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAnalysis of the causes of abnormal lochia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eThe model was used to explain the anatomy of the pelvic floor to the mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealth Education of Nursing Anatomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSelf-learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3、1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eA common symptom of pelvic floor dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRehabilitation Nursing of TCM Health-Cultivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePostpartum pelvic floor muscle test report analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostpartum Recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eThe use of postpartum pelvic floor muscle conditioning equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostpartum Recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePostpartum pelvic floor muscle function exercises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostpartum Recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eModule 5\u003c/p\u003e \u003cp\u003ePsychological and emotion care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGuidance on early mother-infant bond building\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealth Education of Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInfluencing factors of postpartum psychological factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMaternal and Child Psychology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eManifestations of postpartum psychological abnormalities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdjustment of postpartum psychological abnormalities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eModule 6\u003c/p\u003e \u003cp\u003eService management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eService evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePostpartum Recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eService implementation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eService feedback\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDesign the New Course, \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo;\u003c/h2\u003e \u003cp\u003eAccording to the National Ministry of Education requirements, a new course named \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; after the certification has been added. The course content is designed to review and strengthen skills, ensuring students can easily pass the final exam and obtain the certificate. The detailed design of this course is provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePostpartum Recovery Course Design (3rd Semester)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional Skills Module\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeaching Content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClass Hour\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreast care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth education on breastfeeding (Theoretical review)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevention and treatment of breast health care, maternal milk blockage, breast engorgement, etc. (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTCM constitution recuperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal TCM Constitution assessment and conditioning plan (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eBody recovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostpartum rehabilitation care (review)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA common symptom of pelvic floor dysfunction (review)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostpartum pelvic floor muscle test report analysis (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostpartum pelvic floor muscle function exercise guidance (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsing instrument practice (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiastasis rectus abdominis assessment and conditioning (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMassage of sacroiliac joint dysfunction (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostpartum physical recovery and exercise guidance (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReproductive health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdentification of Postpartum lochia and infection (review)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostpartum vulvar cleaning care, post-cesarean section wound care (Practical training)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eService management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResume store operations and service management after childbirth (Visit and study at the training base)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003epre-exam training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eexam simulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImplementation of \u0026ldquo;Curriculum \u0026ndash; Certification Integrated\u0026rdquo; Course\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eTeaching Students\u003c/h2\u003e \u003cp\u003eParticipants are midwifery students who have participated in the \u0026ldquo;curriculum \u0026ndash; certification integrated\u0026rdquo; course model from 2021 to 2023. These students were recruited through the Chinese Nationwide Unified Examination for Admissions to General Universities and Colleges.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTeachers Group\u003c/h2\u003e \u003cp\u003eA total of 11 teachers have participated in the midwifery integrated curriculum teaching, including eight nursing teachers and three industry staff teachers. Four teachers have master\u0026rsquo;s degrees, three are professors or assistant professors, and the rest are senior lecturers. All industry staff teachers have over five years of experience and hold bachelor\u0026rsquo;s degrees. Each teacher has undergone teaching skill training and participated in lesson preparation before teaching students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eImplementation of \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo;\u003c/h2\u003e \u003cp\u003eAll the core knowledge and skills for the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; certification are covered in the 11 courses, with the final \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; course only to review and strengthen this knowledge. We used a blended teaching method in the course, which includes three parts:\u003c/p\u003e \u003cp\u003e \u003cb\u003ePre-class Preview and Post-Class Review\u003c/b\u003e. In the first class, teachers introduce course modules and practical training projects, distribute course learning maps and arrangements to the class learning group, and clarify teaching objectives, learning content, and practical training projects. Before the course, students are required to preview the practical training items in the \"Postpartum Recovery Core Operational Skills (Intermediate)\" online course, which was developed by the \u0026ldquo;X\u0026rdquo; third-party industry organization. After the course, students independently review and practice test exercises in the training base.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTeaching in Class.\u003c/b\u003e During the class sessions, teachers conduct reviews of the knowledge points covered in the certificate examination. In practical training, teachers employ a case-teaching method to reinforce theoretical knowledge and guide students on its application.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePre-exam Training and Exam Simulation\u003c/b\u003e. After completing all the reviews and skill training, 10 hours are dedicated to summarizing and conducting exam simulations to familiarize students with the exam process.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eExamination\u003c/h2\u003e \u003cp\u003eA third-party industry organization arranges the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X\u0026rdquo; postpartum recovery certificate examination and comprises theoretical and practical tests. The theoretical test assesses students\u0026rsquo; knowledge using multiple-choice questions randomly selected by computer, each receiving a unique test paper. The total score is 100 points, and a score of over 60 is considered passing.\u003c/p\u003e \u003cp\u003eThe practical test requires students to select items and perform two randomly selected tasks on-site: one long-answer question and one short-answer question. The total score for the practical test is also 100 points.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of \u0026ldquo;Curriculum \u0026ndash; Certification Integrated\u0026rdquo; Course\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003eEvaluation of Content and Methods\u003c/h2\u003e \u003cdiv id=\"Sec20\" class=\"Section4\"\u003e \u003ch2\u003eExamination Pass Rate\u003c/h2\u003e \u003cp\u003eBoth theoretical and practical scores must be 60 points or above to obtain the certificate. Therefore, the examination pass rate is a part of the course teaching evaluation. The examination pass rate is calculated as the number of students who obtained the certification divided by the number of students who participated in the course (The examination pass rate\u0026thinsp;=\u0026thinsp;obtain certification students or participated course students).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStudent Evaluation for Curriculum and Teaching\u003c/h2\u003e \u003cp\u003eThe questionnaire was developed based on Bush\u0026rsquo;s evaluation of the teaching form [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] combined with the CIPP model [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It includes two parts: course and teachers (12 items for the course and 9 items for teachers), including teaching environment and resources (6 items). It is a five-point Likert scale questionnaire: strongly agree\u0026thinsp;=\u0026thinsp;5, agree\u0026thinsp;=\u0026thinsp;4, neither A nor D\u0026thinsp;=\u0026thinsp;3, disagree\u0026thinsp;=\u0026thinsp;2, strongly disagree\u0026thinsp;=\u0026thinsp;1.\u003c/p\u003e \u003cp\u003eApart from this, open-ended questions are placed in a separate section at the end of the form [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. For the course evaluation, the questions include: What was the most valuable aspect of this course regarding your learning? What aspects of the course would you revise? For the teacher evaluation, the questions might be: What were the strengths of this teacher? What are areas for improvement for this teacher?\u003c/p\u003e \u003cp\u003eThe course and teacher\u0026rsquo;s questionnaire reliability Cronbach\u0026rsquo;α is 0.985, the validity Cronbach\u0026rsquo;α is 0.862, the teaching environment and resource questionnaire reliability Cronbach\u0026rsquo;α is 0.979, and the validity Cronbach\u0026rsquo;α 0.810. These results indicate that the evaluation tools have good validity and reliability.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eQuestionnaire surveys were conducted within one week after the end of the course and exam, and all students who participated in the curriculum framework were required to complete the questionnaire. Scores and passing rates were calculated on the day of the exam. Data collection includes the years 2021, 2022, and 2023. The 2021 data applied to the old curriculum framework, while the 2022 and 2023 data applied to the modified curriculum framework.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eStatistics were analyzed using SPSS Windows software version 26.0. The exam scores were presented by. Examination pass rates were compared across the years using ANOVA and chi-square tests. Open-ended questions were analyzed to form a word cloud diagram using Nvivo 12 Plus.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Profile of Participants and Examination Score\u003c/h2\u003e \u003cp\u003eIn 2021, 4 men and 54 women participated in the exam. In 2022, there were 3 men and 57 women; in 2023, there were 40 women. The examination pass rates for the three years showed significant differences by the chi-square test, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001. The exam scores also showed significant differences over the three years as tested by ANOVA, P\u0026thinsp;\u0026lt;\u0026thinsp;0.000. Details are provided in Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Notably, there is no significant difference between 2022 and 2023, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003e\u003cem\u003eExamination Details for the 3 Years\u003c/em\u003e\u003cem\u003e\u003cbr\u003e\u003cimg 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\"\u003e\u003c/em\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eStudents Examination Scores for the 3 Years\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTheory Exam Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePractice Exam Score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2021年\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.38\u0026thinsp;\u0026plusmn;\u0026thinsp;35.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.89\u0026thinsp;\u0026plusmn;\u0026thinsp;44.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2022年\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.20\u0026thinsp;\u0026plusmn;\u0026thinsp;14.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.38\u0026thinsp;\u0026plusmn;\u0026thinsp;17.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2023年\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cem\u003eBetween-Group Comparison of the Three-Year Test Scores\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExam Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean Difference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003ePractice exam score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-27.48603\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.32294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-31.97978\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.94113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.48603\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.32294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.49375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.90058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eTheory exam score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-21.82069\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.27642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-32.24569\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.77307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.82069\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.27642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-10.42500\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.74049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudent Evaluation of the Course\u003c/em\u003e\u003cem\u003e\u003cbr\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1738600573.png\"\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudents\u0026rsquo; Evaluation of Teaching Environments and Resource\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe students evaluated the teaching environment and resources with a more than 4.0 score; the 2023 score was milder than the 2022 score (Table 7). Furthermore, students\u0026apos; open-ended evaluation keywords were analyzed in Nvivo 12 plus software, and the word cloud diagram is shown in Figure 3. The keywords are training room too small, insufficient variety of training materials.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cem\u003eStudent Evaluation of the Teaching Environment and Resources\u003c/em\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cem\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1738600571.png\"\u003e\u003c/em\u003e\u003cbr\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudent Evaluations of Teachers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eThe course group teachers who have participated in teaching the \u0026quot;1+X Postpartum Recovery\u0026quot; course were also professional course teachers within the curriculum \u0026ndash; integrated framework. In maintaining consistency in the curriculum framework, no changes were made to the teaching staff over the three years, ensuring the effectiveness of the integrated curriculum framework in midwifery education. These teachers taught the students for three semesters, meaning they were familiar with each. The students evaluated teachers (Table 8) and commented on their strengths and suggestions for improvement. Word cloud diagrams were created for the four teachers who received the most student evaluations. The prominent keywords were \u0026quot;earnest,\u0026quot; \u0026quot;responsible,\u0026quot; \u0026quot;diligent,\u0026quot; and \u0026quot;humorous,\u0026quot; among others (Figure 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudent Evaluation of the Teachers\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 224px;\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" style=\"width: 407px;\"\u003e\n \u003cp\u003eTeachers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eThe teacher was well-prepared for class.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.52\u0026plusmn;0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.60\u0026plusmn;0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.76\u0026plusmn;0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.48\u0026plusmn;0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.72\u0026plusmn;0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4.66\u0026plusmn;0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eThe teacher was enthusiastic about the content and teaching in the course.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.58\u0026plusmn;0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.58\u0026plusmn;0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.78\u0026plusmn;0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.52\u0026plusmn;0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.60\u0026plusmn;0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eThe teacher gave clear explanations.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.60\u0026plusmn;0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.78\u0026plusmn;0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.50\u0026plusmn;0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.72\u0026plusmn;0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.66\u0026plusmn;0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.62\u0026plusmn;0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4.66\u0026plusmn;0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eThe teacher encouraged student participation and discussion.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.66\u0026plusmn;0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.74\u0026plusmn;0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.52\u0026plusmn;0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.66\u0026plusmn;0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.60\u0026plusmn;0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4.62\u0026plusmn;0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eThe teacher showed respect for students\u0026rsquo; views and opinions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.58\u0026plusmn;0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.66\u0026plusmn;0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.76\u0026plusmn;0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.46\u0026plusmn;0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.58\u0026plusmn;0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eThe teacher provided prompt and valuable feedback.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.60\u0026plusmn;0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.66\u0026plusmn;0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.74\u0026plusmn;0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.52\u0026plusmn;0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4.62\u0026plusmn;0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eThe teacher was readily available to students (e.g., questions after class, by email, by appointment, after clinical practicum).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.58\u0026plusmn;0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.62\u0026plusmn;0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.76\u0026plusmn;0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.48\u0026plusmn;0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.66\u0026plusmn;0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eOverall, this teacher was an effective teacher.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.60\u0026plusmn;0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.62\u0026plusmn;0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.78\u0026plusmn;0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.68\u0026plusmn;0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.70\u0026plusmn;0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.56\u0026plusmn;0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4.62\u0026plusmn;0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003eCurriculum \u0026ndash; certification Integrated Course Model Can Help Students Learning Interprofessional Knowledge\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the core knowledge and skills required for the \"1\u0026thinsp;+\u0026thinsp;X\" postpartum recovery certificate, encompassing three main areas: TCM, midwifery and nursing, and rehabilitation, which cover a wide range. Specifically, rehabilitation and TCM nursing are introductory courses in the curriculum framework, emphasizing foundational rather than advanced professional knowledge and skills. However, the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X\u0026rdquo; postpartum recovery certificate necessitates comprehensive and specialized expertise in these areas, particularly in TCM nursing\u0026mdash;an interdisciplinary field bridging TCM and nursing science.\u003c/p\u003e \u003cp\u003eIn China, TCM nursing emerged as a new discipline after the 1950s and gradually integrated into the nursing curriculum of some colleges from the 1980s onwards. However, it is not part of the national teaching standard framework the National Ministry of Education requires. It indicates that not all nursing educators possess the necessary knowledge and skills in TCM nursing. This specialization is primarily taught in TCM universities and colleges, underscoring the specialized nature of TCM nursing education.\u003c/p\u003e \u003cp\u003eIn China, TCM has over 2000 years of history and a unique theoretical system that is very different from modern medicine. For the Chinese, TCM is not only a traditional medicine but also a traditional culture. Nursing science is based on modern medicine theory, originally from the United Kingdom, and compared with modern nursing, TCM nursing is a particular discipline in nursing science. TCM pays attention to holistic concepts and treatments based on pattern identification. It is different from modern medicine, which is divided into disciplines and professions based on human system diseases, and it is challenging to correspond directly with the departments of modern hospitals.\u003c/p\u003e \u003cp\u003eWith the influence of modern medicine and decades of development, the teaching of TCM nursing can be categorized into three main parts: (1) Fundamentals of TCM: this includes theories such as Yin-Yang theory, five-elements theory, Zang\u0026ndash;Xiang theory, theory of essence, qi, blood and body fluids, theory of meridians and collaterals, eight-principle pattern identification, Chinese herbal and Chinese medicinal formulas, Four qi and five flavors, contraindicated combination, inspection, auscultation, inquiry, and palpation-four diagnostic methods, among others. (2) TCM Clinical Nursing: This covers nursing practices in Chinese internal medicine, Chinese gynecology, Chinese pediatrics, and other specialized areas. (3) TCM Nursing Skills: This involves practical techniques such as moxibustion, cupping, tuina (Chinese therapeutic massage), and others.\u003c/p\u003e \u003cp\u003eThe Chinese government allows nursing practitioners with an educational background from TCM institutions to perform 18 TCM nursing skills, including Tuina and cupping [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In clinical practice, due to the complexity and specialized nature of TCM theories, diagnosis and treatment are typically the domain of TCM physicians. Simultaneously, nurses mainly carry out skill-based tasks. There is inadequate research on the theoretical foundations and clinical applications of TCM nursing. This gap makes it challenging for clinical nurses to comprehend TCM prescriptions and treatment plans devised by TCM doctors. This deficiency is particularly pronounced in the context of the postpartum recovery certificate, which demands more profound TCM theoretical knowledge.\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;X\u0026rdquo; certificate requires nurses to possess advanced TCM knowledge, such as identifying TCM diet based on body constitution, evaluating breastfeeding using TCM principles, performing TCM Tuina techniques to stimulate lactation by clearing meridians and guiding postpartum mothers to adjust their lifestyles using TCM health preservation theories to facilitate recovery, among other responsibilities. Moreover, nurses must possess enhanced competencies to independently assess and provide services in settings like confinement centers, communities, or family homes where TCM doctors may not be available. The training curriculum framework needs to provide adequate support in these areas.\u003c/p\u003e \u003cp\u003eTherefore, the course group has reformed the TCM nursing course. Previously offered as a single course over one semester, it is now divided into three courses: Introduction of TCM Nursing, TCM Herbal and Chinese Medicinal Formulas and TCM Dietary Care, and Skills and Practice of Nursing TCM. The Introduction of TCM Nursing covers fundamentals of TCM theories, including the Yin-Yang theory, five-elements theory, Zang\u0026ndash;Xiang theory, theory of essence, qi, blood and body fluids, theory of meridians and collaterals, eight-principle pattern identification, body constitution identification, and etiological factors and pathogenesis. The TCM Herbal and Chinese Medicinal Formulas and TCM Dietary Care course focus on teaching typical Chinese herbal and classical formulas in postpartum recovery and dietary considerations for maternity during the postpartum period, including tailored diets for body constitution recuperation.\u003c/p\u003e \u003cp\u003eThe Skills and Practice of the Nursing TCM course instructs students on acupoints relevant to postpartum recovery, techniques such as Tuina and cupping for maternity recuperate for maternity, and addressing breastfeeding issues such as acute mastitis breast engorgement. The redesign of the TCM nursing curriculum aims to provide a more scientific foundation, formulating a comprehensive knowledge framework for students before they proceed to the \"X\" certification course. This approach facilitates a deeper understanding of the certification's requirements and enhances students' self-efficacy in learning.\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;curriculum-certification integrity\u0026rdquo; course model integrates certification knowledge and skills into the current curriculum framework without altering the curriculum certified by the Ministry of Education, thereby meeting the \"X\" certification requirements. The model aims to improve student learning outcomes and pass rates, as confirmed by assessing its learning outcomes.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section3\"\u003e \u003ch2\u003eCurriculum \u0026ndash; Certification, Integrated Course Model, Can Help Students Pass the Certification Examination easier\u003c/h2\u003e \u003cp\u003eIn China, students typically pay an additional fee to participate in certification examinations they want to achieve before graduating from either high education or vocational education, which can be costly. However, the Chinese government fully funds the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X\u0026rdquo; certification and is available only to non-graduating students. The National Ministry of Education allocates funds annually to cover the costs of \"X\" certification training and education for eligible students. Each educational institution must ensure that a specified number of students successfully pass the certification examination, and government funding is based on the number of students who achieve certification. This funding mechanism necessitates institutions to guarantee the successful certification of the allocated number of students. Otherwise, the funds earmarked for those students may be considered wasted. Repeated failures to meet certification targets could result in the institution losing its qualification to offer the certification or losing government funding altogether. Therefore, achieving a high pass rate in the certification examination is critically important.\u003c/p\u003e \u003cp\u003eThe postpartum recovery certification conducted its first examination in 2020, but it was unsuccessful due to insufficient theoretical knowledge in TCM and rehabilitation among midwifery students. The \u0026ldquo;curriculum \u0026ndash; certification integrate\u0026rdquo; course model has not yet been implemented, making it challenging for students to grasp the material, leading to a high dropout rate of 30% and a significant waste of government funds. The students expressed that they lacked sufficient foundational knowledge in TCM nursing and rehabilitation nursing to complete the certification within the 64-class-hour \"X\" course alone. Subsequently, the course group revised the curriculum framework to ensure students acquire adequate basic knowledge and skills before beginning the \"X\" course. Over the following three years, the participation rate in the examination improved from 67\u0026ndash;100%, and the pass rate increased from 65.5\u0026ndash;100%. These results demonstrate that the model effectively utilizes government funds and enhances students' learning self-efficacy, thereby benefiting professional education.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eTeacher as a Modeling Role for Students to Be Good Learners\u003c/h2\u003e \u003cp\u003eOwing to the interdisciplinary nature and complexity of integrating disciplinary knowledge and skills within the \"1\u0026thinsp;+\u0026thinsp;X\" postpartum recovery certificate, this challenges students and imposes higher preparation requirements on teachers who deliver this course. While nursing teachers with relevant experience have been selected, there is a shortage of teachers with a TCM education background. TCM nursing and rehabilitation nursing are not part of the standard teaching system in Chinese nursing education. In our course group, only one teacher possesses the TCM educational background and experience, while the remaining seven do not. This poses significant challenges in delivering coursework that is based on TCM theories. All teachers in the course group undergo professional training and must attain teaching and examination qualifications for the \"X\" certification to address this. Furthermore, the course group enhances professional competence through collaborative lesson preparation, team-based learning activities, and practical visits and learning experiences in practice settings.\u003c/p\u003e \u003cp\u003eThroughout the entire process, teachers and students learn and grow together. Clinical teachers and nursing educators serve as role models for nursing students, with their role modeling significantly influencing students' learning outcomes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Teachers who demonstrate hard work, diligence, earnestness, and a commitment to lifelong learning inspire students' professional enthusiasm and foster their professional identity during teaching practice [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. During the three-semester learning process, the invisible pressures and constraints are critical hidden aspects of the classroom environment, positively influencing nursing undergraduate education.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved by the \u0026ldquo;IRB of the Mianyang Hospital of TCM\u0026rdquo; ethics committee and was carried out per the Ethical Guidelines for Social Science Research, ensuring that the rights, dignity, and privacy of participants were respected throughout the research process. Prior to participation, all individuals were provided with comprehensive information about the research objectives, procedures, potential risks, and benefits. Participation was entirely voluntary, and participants retained the right to withdraw at any stage without consequences. Confidentiality and anonymity were strictly upheld, with all data securely stored and used solely for research purposes. Approval No. 2024-104.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWang Siyun, Zhang Zhen and Li Li, hereby give our consent for the publication of my article in BMC Pregnancy and Childbirth. We confirm that: The content is original and does not infringe upon any copyright, privacy, or other legal rights.\u003c/p\u003e\n\u003cp\u003eWe have reviewed the final version of the material and agree to its publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets and materials generated and/or analyzed during the current study are not publicly available due to confidentiality agreements. However, further information may be available from the corresponding author upon reasonable request, subject to applicable restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflicts of interest exist concerning this article\u0026apos;s research, authorship, and publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by the Sichuan College of Tradition Chinese Medicine (Funding No. 22SHYB0) and Mianyang Vocational Education Research Center (Funding No. MZY22C19)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWang Siyun: Conceptualization, Methodology, Investigation, Resources, Formal analysis, Writing- Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eZhang Zhen: Resources, Project administration, Funding acquisition\u003c/p\u003e\n\u003cp\u003eLi Li: Supervision, Writing - Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThank you for all students participated the research and teachers engaging in the course: Lin Lin, Dong Min, Wang Jinyu, He Yan, Yang Dan, Ye Jing.\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.com) for English language editing.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMinistry of Education of the Peoples Republic of China. 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Survey and analysis of the first batch of nursing students who participated in the \u0026quot;1+X\u0026quot; geriatric care grade examination\u0026apos;s perception of geriatric care work. \u003cem\u003eFujian Medical Journal\u003c/em\u003e,\u003cem\u003e 43\u003c/em\u003e(1), 3. doi:10.3969/j.issn.1002-2600.2021.01.047 https://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_fjyyzz202101047\u003c/li\u003e\n\u003cli\u003eCentral Institute for Vocational and Technical Education. (2023). \u003cem\u003eCentral Institute for Vocational and Technical Education\u003c/em\u003e. http://www.civte.edu.cn/j/xxx.htm \u003c/li\u003e\n\u003cli\u003eZhang, Y., \u0026amp; Liu, J. (2019). Exploration and research on the teaching model of embedding \u0026quot;1+X certificate\u0026quot; in higher vocational education courses. \u003cem\u003eJournal of Commercial Economics\u003c/em\u003e,\u003cem\u003e 21\u003c/em\u003e, 179\u0026ndash;182. \u003c/li\u003e\n\u003cli\u003eDuan, L., \u0026amp; Shen, W. 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Challenges in designing student teaching evaluations in a business program. \u003cem\u003eInternational Journal of Educational Management\u003c/em\u003e,\u003cem\u003e 26\u003c/em\u003e(2), 162\u0026ndash;174. doi:10.1108/09513541211201979 https://www.cnki.net/KCMS/detail/detail.aspx?\u003cbr\u003edbcode=CJFD\u0026amp;dbname=CJFDLAST2019\u0026amp;filename=SYJJ2\u003cbr\u003e01921052\u0026amp;uniplatform=OVERSEA\u0026amp;v=JJnaC6D7zBNA5skTuEcBJV9oln8pv2oGe0C8AmgLjdb5n09G-\u003cbr\u003eB4cFpi9u4pOHc06\u003c/li\u003e\n\u003cli\u003eNational Administration of Traditional Chinese Medicine. (2015). \u003cem\u003eNotice on the issuance of the \u0026quot;Handbook of Traditional Chinese Medicine Techniques for Nursing Staff\u0026quot;\u003c/em\u003e. http://www.natcm.gov.cn/yizhengsi/gongzuodongtai/2018-03-24/2691.html\u003c/li\u003e\n\u003cli\u003eAhn, J. N., Hu, D., \u0026amp; Vega, M. (2020). \u0026ldquo;Do as I do, not as I say\u0026rdquo;: Using social learning theory to unpack the impact of role models on students\u0026apos; outcomes in education. \u003cem\u003eSocial and Personality Psychology Compass\u003c/em\u003e, 14(2), e12517. https://compass.onlinelibrary.wiley.com/doi/abs/10.1111/spc3.12517\u003c/li\u003e\n\u003cli\u003eVan, I. K. (2014). \u003cem\u003eThe Impact of a Nursing Program on the Formation of Nursing Students\u0026apos; Professional Identity\u003c/em\u003e (Doctoral dissertation, The Chinese University of Hong Kong (Hong Kong)). The Impact of a Nursing Program on the Formation of Nursing Students\u0026apos; Professional Identity - ProQuest\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Postpartum care, nursing professional education, certificate education, traditional medical treatment","lastPublishedDoi":"10.21203/rs.3.rs-5927398/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5927398/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn China, the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X certification\u0026rdquo; policy has significantly reformed vocational education since 2019. This research integrates the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; teaching content into midwifery education. It develops the \u0026ldquo;curriculum \u0026ndash;certification\u0026rdquo; course model for midwifery majors, improves nursing skills in the \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; area, and expands the professional value of midwifery in maternal and infant care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing content analysis, we discussed and formulated a curriculum for credit integration. This study comprehensively evaluates the curriculum credit integration in teaching programs. SPSS Windows software version 22.0 was used to analyze the data, χ\u003csup\u003e2\u003c/sup\u003e test, t-test or ANOVA for quantitative data, α\u0026thinsp;=\u0026thinsp;0.05, and the subjective evaluation using a structured questionnaire and present keywords by the word cloud diagram.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe passing rate of students' certificate examinations was significantly increased through course certificate accommodation. Furthermore, the students\u0026rsquo; evaluation of the course, teaching resources, and teachers' teaching process were higher.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe new course model integrates students' content in relevant professional courses. The combination of online teaching resources and the optimization of teaching mode promotes the organic integration of professional and practical skills, helping students complete the requirements of a \u0026ldquo;1\u0026thinsp;+\u0026thinsp;X Postpartum Recovery\u0026rdquo; certificate with less time cost while enhancing career development skills and career competitive advantages.\u003c/p\u003e","manuscriptTitle":"Research on Integrated “Curriculum – Certification” Model for 1+X Postpartum Recovery: Midwifery Education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-04 08:54:14","doi":"10.21203/rs.3.rs-5927398/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b87b59c6-1704-49e8-b3a3-d8edae780e6b","owner":[],"postedDate":"February 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-17T13:24:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-04 08:54:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5927398","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5927398","identity":"rs-5927398","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}