The document outlines international standards and codes of ethics for midwifery practice. It discusses establishing a midwifery-specific regulatory authority to effectively regulate midwives and support autonomous midwifery practice. It also covers protecting the title of midwife, governance structures for regulatory authorities, and the importance of national regulation and collaboration between regulatory bodies.
Current trends in midwifery &; obstetrical nursingAbhilasha verma
The document discusses current trends in midwifery and obstetrical nursing. It outlines goals to reduce maternal mortality, fetal and infant death, preterm birth, and cesarean sections among low-risk women. New trends discussed include the WHO near-miss approach, maternal waiting homes, postpartum butterfly device, transvaginal Bakri balloon, wireless fetal monitoring, non-invasive prenatal testing, vaginal seeding, cervical cerclage, treating intrauterine infections, and improving nutrition. The document also discusses robotic gynecological surgery, the Vita HEAT device during labor, using virtual reality to relieve labor pains, Clearblue digital pregnancy tests, My Peri Tens devices, and an
This topic contains Meaning and definitions of midwifery, obstetrics, obstetrical nursing, midwife, scope of midwifery, basic competencies of a midwife, history of midwifery in nursing and development of maternity services in India.
High-risk approach with screening and assessmentAnamika Ramawat
High risk pregnancies require screening and assessment to identify risks and provide extra care. Around 20-30% of pregnancies are considered high risk due to factors that could adversely affect the pregnancy outcome for the mother or baby. Assessment involves evaluating the health history and risk factors, while screening identifies apparently healthy people who may be at increased risk. Various diagnostic tests can then be used to further evaluate any risks found during screening. These include noninvasive tests like ultrasound, CTG, NST and CST as well as invasive tests like CVS and amniocentesis. Proper screening, assessment and diagnosis of high risk pregnancies allows for improved monitoring and outcomes.
Role of nurse midwifery and obstetric careSujata Sahu
The document discusses the roles of a nurse midwife throughout the four stages of childbearing: adolescence, antenatal, intranatal, and postnatal. In each stage, the nurse midwife acts as a caregiver, counselor, teacher, and clinician. During adolescence, the midwife provides education on puberty, sexuality, and marriage. In the antenatal stage, the midwife provides prenatal care, screening for risk factors, and education. In labor and delivery, the midwife supports the mother, monitors labor, and teaches about the birthing process. After birth, the midwife assesses mother and baby, counsels on parenting and family planning, and teaches about newborn and
Recent advancement in infertility final pptLalitaSharma39
This document provides an overview of recent advancements in infertility management. It begins with definitions of infertility and its types. It then discusses various causes of female infertility including age, smoking, STIs, weight, chemotherapy, genetic factors, and issues with the fallopian tubes, uterus, cervix, and vagina. Tests for infertility and treatment options like laparoscopy, medication, and assisted reproductive technologies are also outlined. Specific ART procedures described in detail include IUI, IVF, GIFT, ZIFT, ICSI, and ovary transplants.
HISTORICAL AND CONTEMPORARY PERSPECTIVES,ISSUES OF MATERNAL AND CHILD HEALTH kirukki
This document discusses historical and contemporary perspectives on maternal and child health. It provides background on midwifery and nursing practices over time in India and Kerala. It outlines key national programs in India related to maternal and child health. It also discusses issues such as malnutrition, infection, uncontrolled reproduction, and gender-based violence that impact maternal and child health in India. Additionally, it summarizes perspectives and goals from the International Conference on Population and Development and Millennium Development Goals related to improving reproductive and sexual health worldwide.
The document discusses adolescent pregnancy, unwed mothers, causes and risks. It defines adolescent pregnancy as affecting girls aged 19 or younger. Rates have declined due to increased condom use. Younger teens aged 12-14 are more at risk of unplanned sex. Unwed mothers face social stigma and economic hardship without family support. Preventive measures include education, easy access to contraceptives, and banning prostitution. Nurses can educate youth and advocate for the rights of unwed mothers.
Community midwifery aims to promote maternal and child health through antenatal, intranatal, and postnatal care. Antenatal care includes regular checkups to monitor the health of the mother and baby, identify high-risk pregnancies, provide education on nutrition and hygiene, and begin postpartum family planning. Intranatal care focuses on a clean delivery to prevent infections. Postnatal care supports breastfeeding and family planning education while checking for postpartum complications over 10 days of visits. The overall goals are a healthy mother and baby as well as promoting reproductive health.
This document discusses induction of labour, which is defined as artificially stimulating uterine contractions before the onset of natural labour. It outlines the goals, indications, methods, and nursing responsibilities for labour induction. The main methods discussed are medical induction using prostaglandins or oxytocin, and surgical induction through membrane stripping or artificial rupture of membranes. The nursing responsibilities involve properly administering induction medications and procedures, monitoring the woman and fetus during labour induction, and providing general care and support to the woman and newborn.
LAW: THE SUM TOTAL OF RULES AND REGULATIONS BY WHICH THE SOCIETY IS GOVERNED
ETHICS: Ethics is the systematic study of What a persons conduct ought to be with regard to him or herself, other human beings and the environment, it is the justification of what is right or good and the study of what a person’s life and relationship ought to be, not necessarily what they are.
This document discusses trends in midwifery and obstetrical nursing. It begins by defining midwifery and obstetrics. It then outlines several trends, including economic issues like rising costs of childcare; technological advances in fertility treatments and testing; demographic shifts to urban areas; changes in healthcare settings like managed care and shorter hospital stays. It also discusses trends toward patient involvement and self-care. Current problems discussed are shorter hospital stays, higher patient acuity, lack of rural facilities, and changes to maternal-newborn nursing models.
Labour is initiated by various biochemical and physiological changes that occur in late pregnancy. These include increased production of uterotonins like oxytocin, prostaglandins, and CRH by the fetus and placenta. There is also a withdrawal of progesterone's inhibitory effects and an increase in oxytocin receptors in the uterus. Together, these changes make the uterus more sensitive and responsive to contractions. The cervix simultaneously undergoes ripening, becoming softer, shorter, and more dilated in preparation for labour and delivery.
This document discusses several topics related to single mothers and teenage pregnancy. It provides reasons why women may become single mothers such as being unmarried, widowed, or divorced. It outlines counseling needs for single mothers and risks of teenage pregnancy for both mothers and infants. Risk factors for domestic violence and its physical effects on pregnancy are described. Prevention of teen pregnancy, signs of pregnancy, and diagnosis methods are also summarized.
Level of neonatal care, Level I,Level II, Level III whole nursing care of Bab...sonal patel
The document categorizes 4 levels of neonatal care provided by hospitals and facilities based on the therapies and services available. Level I provides basic care for healthy newborns. Level II (special care nursery) cares for preterm or ill infants needing limited care. Level III (NICU) provides intensive care for critically ill infants. The highest level, Level IV (regional NICU), provides specialty surgical care and the most advanced therapies.
Alternative & complementary therapies in midwiferyManu Aravind
Traditional Chinese Medicine originated in China 4000 years ago and is based on the concept of qi (vital energy) and the balance of yin and yang in the body. Acupuncture and acupressure involve stimulating points along meridian pathways to restore balance. Herbal medicine, massage, tai chi, and meditation are also components of Traditional Chinese Medicine.
Respectful maternity care (RMC) is a universal human right that encompasses respect for women's autonomy, dignity, feelings, choices, and preferences during childbirth. RMC outlines seven rights of childbearing women: 1) freedom from harm and ill treatment; 2) informed consent and respect for choices; 3) privacy and confidentiality; 4) dignity and respect; 5) equality and freedom from discrimination; 6) health care and the highest attainable level of care; and 7) liberty, autonomy, and freedom from coercion. Benefits of RMC include respect for beliefs and cultures, empowerment of women, continuous support during labor, and freedom of choice and movement.
Physiological changes during third stage of laborsonisht
The document discusses the physiological changes that occur during the third stage of labor. It defines the third stage as beginning with the birth of the baby and ending with delivery of the placenta and membranes. It describes the two main methods of placental separation - the Schultze method where separation begins centrally, and the Matthew's Duncan method where separation occurs at the margins. The key events of the third stage include placental separation facilitated by uterine contractions, formation of a retroplacental clot, descent and expulsion of the placenta, and control of bleeding through uterine retraction.
A registered midwife is someone who has completed an approved midwifery education program, is registered to practice midwifery, and maintains competency. The scope of midwifery practice includes providing care during pregnancy, labor, birth and postpartum, as well as family planning advice and newborn care. Midwifery practice is underpinned by values of empowering women and respecting their decisions, and sees birth as a normal process where midwives are the primary caregivers. An individual midwife's scope may change based on their experience and training, practice guidelines, and the needs of the woman and baby.
Nepal legalized abortion in 2002 and further expanded access through its 2018 law. The law allows abortion up to 12 weeks with consent, up to 28 weeks in cases of rape/incest or health risks, and the government aims to make safe abortion services widely available. However, challenges remain due to stigma and some sex-selective abortions. National policies focus on training health workers and expanding comprehensive abortion care, including counseling, at health facilities across the country.
THESE SLIDES ARE PREPAREED TO UNDERSTAND about nursing IN EASY WAY Important links- NOTES- https://mynursingstudents.blogspot.com/ youtube channel https://www.youtube.com/c/MYSTUDENTSU... CHANEL PLAYLIST- ANATOMY AND PHYSIOLOGY-https://www.youtube.com/playlist?list=PL93S13oM2gAPM3VTGVUXIeswKJ3XGaD2p COMMUNITY HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPyslPNdIJoVjiXEDTVEDzs CHILD HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gANcslmv0DXg6BWmWN359Gvg FIRST AID- https://www.youtube.com/playlist?list=PL93S13oM2gAMvGqeqH2ZTklzFAZhOrvgP HCM- https://www.youtube.com/playlist?list=PL93S13oM2gAM7mZ1vZhQBHWbdLnLb-cH9 FUNDAMENTALS OF NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPFxu78NDLpGPaxEmK1fTao COMMUNICABLE DISEASES- https://www.youtube.com/playlist?list=PL93S13oM2gAOWo4IwNjLU_LCuhRN0ZLeb ENVIRONMENTAL HEALTH- https://www.youtube.com/playlist?list=PL93S13oM2gAPkI6LvfS8Zu1nm6mZi9FK6 MSN- https://www.youtube.com/playlist?list=PL93S13oM2gAOdyoHnDLAoR_o8M6ccqYBm HINDI ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAN4L-FJ3s_IEXgZCijGUA1A ENGLISH ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAMYv2a1hFcq4W1nBjTnRkHP facebook profile- https://www.facebook.com/suresh.kr.lrhs/ FACEBOOK PAGE- https://www.facebook.com/My-Student-S... facebook group NURSING NOTES- https://www.facebook.com/groups/24139... FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG – BLOGGER- https://mynursingstudents.blogspot.com/ Instagram- https://www.instagram.com/mystudentsu... Twitter- https://twitter.com/student_system?s=08 #PEM, #codeofethics,#for ,#nurses,#ASSESSMENT, #APPEARENCE,#PULSE,#GRIMACE,#REFLEX,#RESPIRATION,#RESUSCITATION,#NEWBORN,#BABY,#VIRGINIA, #CHILD, #OXYGEN,#CYANOSIS,#OPTICNERVE, #SARACHNA,#MYSTUDENTSUPPORTSYSTEM, #rashes,#nursingclasses, #communityhealthnursing,#ANM, #GNM, #BSCNURING,#NURSINGSTUDENTS, #WHO,#NURSINGINSTITUTION,#COLLEGEOFNURSING,#nursingofficer,#COMMUNITYHEALTHOFFICER
The document discusses the International Code of Ethics for Nurses developed by the International Council of Nurses (ICN) in 1953. It provides an overview of the code, which outlines ethical standards of conduct for nurses in four elements: nurses and people, nurses and practice, nurses and the profession, and nurses and co-workers. The document emphasizes that while international codes provide guidance, national codes tailored to each country's context can further assist nurses in navigating complex ethical situations. It concludes nurses must be accountable to ethical obligations, as nursing is one of society's most trusted professions.
Professional organizations play an important role in establishing standards for nursing practice and education. They regulate nursing education programs and certification, provide professional development opportunities, advocate for nurses' interests, and give guidance on ethics. Membership in these organizations allows nurses to stay updated in their field, network with colleagues, and receive career support and resources.
The document discusses various nursing regulatory bodies and their roles in accreditation, renewal, registration, and patient rights. It defines key terms like regulation, accreditation, and licensure. The main regulatory bodies discussed are the International Council of Nurses, Indian Nursing Council, Trained Nurses Association of India, and State Nursing Councils. The goals of regulation are to define the nursing profession, determine scope of practice, set education and ethical standards, and establish accountability. Regulatory bodies work to protect public safety by ensuring qualified practitioners through standards, registration, and monitoring of nursing education and practice.
A registered midwife is someone who has completed an approved midwifery education program, is registered to practice midwifery, and maintains competency. Their scope of practice includes providing care during pregnancy, labor, birth and postpartum as well as family planning advice and newborn care. Midwifery practice is underpinned by values of empowering women and respecting their decisions, and sees birth as a normal process supported by midwives through a holistic model combining art and science.
A registered midwife is someone who has completed an approved midwifery education program, is registered to practice midwifery, and maintains competency. Their scope of practice includes providing care during pregnancy, labor, birth and postpartum as well as family planning advice and newborn care. Midwifery practice is underpinned by values of empowering women and respecting their decisions, and sees birth as a normal process supported by midwives through a holistic model combining art and science.
This document summarizes key issues related to independent nursing and midwifery practice. It discusses nurse practitioners, who have graduate nursing education and provide comprehensive patient assessments. It also outlines areas of independent nursing practice like consultancy and various medical specialties. Responsibilities of independent nurses are described, including documentation and emergency procedures. Independent midwifery practice is also covered, defining midwives and outlining standards of care and challenges faced by midwives in India, such as gaining recognition as independent practitioners and developing educational programs.
This document discusses nursing as a profession and provides information on various topics related to nursing. It begins by defining the unique function of nurses in assisting individuals with health-related activities. It then discusses nursing as a profession, the basic principles and roles of nurses, qualities of good nurses, and codes of ethics. Specific principles from the International Council of Nurses code of ethics and the Indian Nursing Council code of ethics are outlined. The document also discusses torts related to nursing practice, the Indian Nursing Council, State Nursing Councils, and current trends in nursing.
Nursing administration in India faces several challenges including a shortage of nurses, low nurse-to-population ratios, and underpaid nursing staff. Current trends in nursing administration include increasing population diversity, rapid technological advances, globalization, a focus on quality care and evidence-based practices, and expanding telehealth. Nursing education must also adapt to these changes by offering more online courses and strengthening nursing research. Addressing issues like staffing, salaries, harassment, and providing continuing education can help overcome challenges in nursing administration in India.
This document outlines the Code of Nursing Ethics according to the American Nurses Association (ANA). It discusses 9 main provisions that define the ethical obligations and duties of nurses. The provisions address respecting human dignity, the nurse's primary commitment to patients, advocating for patient safety and rights, accountability in nursing practice, maintaining competence and integrity, advancing the nursing profession, and collaborating with others to promote community health. The code aims to establish ethical standards and values to guide nurses in upholding their professional responsibilities.
This document discusses advanced nursing practice, the definition of nursing practice, characteristics of advanced practice nursing, development and implementation of a professional nursing practice framework, and the scope of nursing practice in different settings. It defines advanced nursing practice as utilizing graduate education and expertise to meet patient health needs. Nursing practice is providing patient care based on their condition and nursing theories. Characteristics of advanced practice include autonomy, leadership, expertise, and influence on policy. The framework was created with input from nurses to define practice and guide nurses. Evaluation examines how it affects practice and outcomes. The scope of nursing is broad and affects many roles across settings.
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The document discusses the code of ethics for nursing. It begins by outlining the learning objectives, which are to define the code of ethics, explain its purposes and regulatory bodies, and discuss the role of nurses in applying it. It then defines a code of ethics as a set of principles that guide ethical decision making. The key purposes of the code are to ensure quality care, create standards for professional conduct, and protect patient rights. The American Nurses Association code establishes standards around patient confidentiality and informed consent. The code addresses nurses' responsibilities to patients, nursing practice, their profession, coworkers, and society.
HEALTH AND NURSING SERCICE ADMINISTRATION.pptxjummaiwennie1
Nursing has evolved significantly from 60 years ago and will continue to change in the next 60 years. Nursing developed from apprenticeship to a unique profession based on its own body of knowledge gained through research. Contemporary nursing fulfills 8 criteria of a profession: it provides essential services; utilizes a specialized body of knowledge; involves intellectual activities and accountability; requires university education; allows relative independence and autonomy; is motivated by altruism; follows a code of ethics; and has organizations that support high standards. A hospital nursing department recognizes its role is to provide high-quality, cost-effective care by promoting health, maintaining an educational environment, and allowing career development while respecting all individuals.
The document discusses the extended and expanded roles of nurses beyond traditional nursing roles. It defines key terms like nursing, nurse, and discusses the need for expanded roles in areas like community health, research, and more specialized roles. It also describes various advanced practice nurse roles like nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, and more. These roles require additional education and certification but allow nurses to assess, diagnose, treat and manage some conditions autonomously or under physician supervision.
This document discusses nurses' individual liability within the ethical scope of nursing practice. It begins by outlining the ICN Code of Ethics for Nurses, which establishes four principal standards for nurses regarding their responsibilities to people requiring care, nursing practice, the nursing profession, and co-workers. It then defines nursing liability and the types of liability nurses may face, including personal, supervisor, and employer liability. The document provides steps nurses can take to avoid liability, such as practicing within legal standards, using established practice guidelines, and thoroughly documenting all care. It concludes by examining how nurses can maintain appropriate boundaries and ethical conduct within their scope of practice to prevent liability issues.
The document discusses independent nurse practitioners, specifically independent nurse midwifery practitioners. It defines independent nurse practitioners as advanced practice nurses with a master's degree who are licensed to practice independently. It outlines the philosophy, historical development, standards, key practices, and issues of independent midwifery practice. It also discusses the development of independent nurse practitioners in India to address shortages and reduce maternal and infant mortality rates.
This document discusses breastfeeding, including its benefits, anatomy, physiology, and techniques. Some key points include:
- Exclusive breastfeeding is recommended for the first six months due to complete nutrition, immunity benefits, and bonding effects.
- Breast anatomy includes glandular tissue, ducts, and sinuses that secrete and store milk under stimulation from prolactin and oxytocin hormones.
- Common issues like sore nipples and engorgement can be prevented or treated to ensure successful breastfeeding.
- Frequent feeding on demand is recommended, assessing urine output and weight gain of the baby.
The document discusses innovations in nursing education, clinical practice, administration/management, and research. It provides examples of innovations such as handheld computers, e-learning, telehealth, evidence-based practice, computerized records, and new nursing roles. The need for innovation is driven by demands for improved healthcare quality and access despite workforce shortages. Nurses must be open to new ideas and changing practices to continuously advance the nursing profession.
This document discusses anemia in pregnancy. It defines anemia as having insufficient red blood cells or hemoglobin. Anemia is common in pregnancy, affecting 18-75% of pregnant women globally. Anemia is classified as mild, moderate or severe based on hemoglobin levels. Common causes of anemia in pregnancy include iron deficiency, folic acid deficiency, vitamin B12 deficiency, and genetic disorders like sickle cell anemia. Left untreated, anemia can negatively impact both mother and baby by increasing risks of infection, hemorrhage, low birth weight, and other complications. Routine screening and treatment with iron, folic acid and other supplements can help prevent and manage anemia during pregnancy.
This document discusses nursing care of women with reproductive tract malignancies. It covers cancers of the cervix, ovaries, uterus, and other reproductive organs. It defines female reproductive tract cancers and discusses risk factors, signs and symptoms, diagnostic tests, stages of disease, and treatment methods like chemotherapy, radiation, and surgery. The document also outlines the nursing responsibilities in managing these patients, which include educating women on screening and risk factors, managing side effects of treatment, and providing care during recovery.
This document outlines a presentation on strategic planning. It defines strategic planning as a disciplined effort to produce fundamental decisions and actions that shape an organization's goals and strategy. The key points are:
- Strategic planning involves determining long-term goals, objectives, and allocating resources to achieve them.
- It is a participatory process to develop a shared vision and hold people accountable.
- Developing a strategic plan follows steps like assessing the situation, creating a mission/vision, developing strategies/goals/objectives, and implementing and evaluating the plan.
- Strategic planning in nursing helps set formal plans, improve communication, and focus on quality outputs to enhance nurse performance.
This document provides information on various obstetrical emergencies presented in a seminar, including definitions, symptoms, diagnosis, management, and nursing considerations. Vasa previa is defined as blood vessels from the umbilical cord or placenta crossing the cervix without Wharton's jelly covering. Symptoms include vaginal bleeding. Diagnosis is via color Doppler and emergency c-section is required if membranes rupture. Amniotic fluid embolism causes pulmonary vasospasm and coagulopathies. Symptoms include respiratory distress and hemorrhage. Management focuses on hemodynamic support and delivery. Other emergencies discussed include obstetric shock, cord prolapse, and uterine inversion.
The document summarizes Ida Jean Orlando's nursing theory. Some key points:
- Orlando believed the nurse's role is to discover and meet the patient's immediate need for help. However, the patient's presenting behavior may not represent their true need.
- The theory involves the nurse assessing the patient through perception of verbal and non-verbal cues, thoughts about the perception, and feelings engendered. This helps identify the patient's distress and needed help.
- Nursing actions should be deliberative, directly exploring needs with the patient, or automatic, not focused on the patient's needs. The nurse must evaluate if actions met the patient's needs by observing outcomes like relief from distress.
- Orlando
This document summarizes ethical issues in obstetrics and neonatal care. It discusses three types of autonomy, divides issues into maternal, fetal and other categories, and provides examples like surrogacy, fetal monitoring, and fetal tissue research. Ethical principles guide professionalism in nursing. Issues are further explored around colostrum feeding, hymen reconstruction, the role of men in labor, and transsexualism. Sources cited include a nursing textbook and PubMed.
This document discusses drugs used in pregnancy, labor, and the postpartum period. It provides information on folic acid, iron, calcium, antihypertensive drugs, diuretics, tocolytic agents, and oxytocics. Key drugs discussed include labetalol, nifedipine, methyldopa, hydralazine, furosemide, isoxsuprine, ritodrine, and oxytocin. Dosages, indications, contraindications, and nursing considerations are provided for many of the drugs.
Problem-based learning (PBL) is introduced as an alternative to traditional lecture-based teaching. PBL engages students in structuring real-life problems and aims to develop problem-solving skills. It was refined in the 1960s and adopted by medical schools in the 1980s. PBL is defined as individualized learning that results from working towards problem solutions. Key principles are that understanding comes from interaction, cognitive conflicts stimulate learning, and knowledge evolves through social processes. PBL is student-centered, uses small groups, and faculty act as facilitators. Students work in groups to identify learning issues and design plans to solve problems. Recent studies show PBL improved nursing students' scores and self-efficacy in applying
This document discusses antenatal fetal surveillance, which involves assessing fetal well-being during pregnancy to ensure delivery of a healthy newborn. It outlines various indications for surveillance including maternal conditions like hypertension and diabetes, as well as fetal conditions like growth restriction. Methods of surveillance discussed include biochemical tests of maternal serum, ultrasound, MRI, amniocentesis, and clinical assessment of fetal growth through maternal weight gain and abdominal exams. The goal of surveillance is to monitor high-risk pregnancies and detect issues that could impact the fetus.
The document discusses the formation and composition of blood. It begins by introducing the cardiovascular and lymphatic systems that make up the circulatory system. It then covers the components, functions, and production of blood. The key components of blood are plasma and formed elements like red blood cells, white blood cells, and platelets. Blood functions to transport nutrients and gases, protect the body, and regulate pH and temperature. Blood cells are produced through hematopoiesis in the bone marrow from stem cells.
This document discusses various topics related to thermoregulation including types of temperature, factors affecting thermoregulation, fever, hyperthermia, hypothermia, and frostbite. It defines these conditions and discusses their causes, signs and symptoms, diagnosis, and management. Nursing considerations are provided for assessment and care of patients experiencing fever, hyperthermia, and hypothermia. Current trends in cooling techniques for hyperthermia are also reviewed.
There are six links in the chain of infection: 1) the infectious agent, 2) the reservoir host, 3) the portal of exit, 4) the route of transmission, 5) the portal of entry, and 6) the susceptible host. Breaking the chain of infection is important for healthcare professionals by identifying pathogens, practicing asepsis and hygiene, controlling portals of exit, preventing transmission, protecting portals of entry, and recognizing susceptible hosts.
Pharmacotherapy of Asthma and Chronic Obstructive Pulmonary Disease (COPD)HRITHIK DEY
This PowerPoint presentation provides an in-depth overview of the pharmacotherapy approaches for managing asthma and Chronic Obstructive Pulmonary Disease (COPD). It covers the pathophysiology of these respiratory conditions, the various classes of medications used, their mechanisms of action, indications, side effects, and the latest treatment guidelines. Designed for students, healthcare professionals, and anyone interested in respiratory pharmacology, this presentation offers a comprehensive understanding of current therapeutic strategies and advancements in the field.
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptxsouravpaul769171
Theoretically, gene therapy is the permanent solution for genetic diseases. But it has several complexities. At its current stage, it is not accessible to most people due to its huge cost. A breakthrough may come anytime and a day may come when almost every disease will have a gene therapy Gene therapy have the potential to revolutionize the practice of medicine.
JMML is a rare cancer of blood that affects young children. There is a sustained abnormal and excessive production of myeloid progenitors and monocytes.
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, discuss NSCLC in this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Exploring Alternatives- Why Laparoscopy Isn't Always Best for Hydrosalpinx.pptxFFragrant
Not all women with hydrosalpinx should choose laparoscopy. Natural medicine Fuyan Pill can also be a nice option for patients, especially when they have fertility needs.
A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
Ontotext’s Clinical Trials Eligibility Design Assistant helps with one of the most challenging tasks in study design: selecting the proper patient population.
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Ventilation Perfusion Ratio, Physiological dead space and physiological shuntMedicoseAcademics
In this insightful lecture, Dr. Faiza, an esteemed Assistant Professor of Physiology, delves into the essential concept of the ventilation-perfusion ratio (V˙/Q˙), which is fundamental to understanding pulmonary physiology. Dr. Faiza brings a wealth of knowledge and experience to the table, with qualifications including MBBS, FCPS in Physiology, and multiple postgraduate degrees in public health and healthcare education.
The lecture begins by laying the groundwork with basic concepts, explaining the definitions of ventilation (V˙) and perfusion (Q˙), and highlighting the significance of the ventilation-perfusion ratio (V˙/Q˙). Dr. Faiza explains the normal value of this ratio and its critical role in ensuring efficient gas exchange in the lungs.
Next, the discussion moves to the impact of different V˙/Q˙ ratios on alveolar gas concentrations. Participants will learn how a normal, zero, or infinite V˙/Q˙ ratio affects the partial pressures of oxygen and carbon dioxide in the alveoli. Dr. Faiza provides a detailed comparison of alveolar gas concentrations in these varying scenarios, offering a clear understanding of the physiological changes that occur.
The lecture also covers the concepts of physiological shunt and dead space. Dr. Faiza defines physiological shunt and explains its causes and effects on gas exchange, distinguishing it from anatomical dead space. She also discusses physiological dead space in detail, including how it is calculated using the Bohr equation. The components and significance of the Bohr equation are thoroughly explained, and practical examples of its application are provided.
Further, the lecture examines the variations in V˙/Q˙ ratios in different regions of the lung and under different conditions, such as lying versus supine and resting versus exercise. Dr. Faiza analyzes how these variations affect pulmonary function and discusses the abnormal V˙/Q˙ ratios seen in chronic obstructive lung disease (COPD) and their clinical implications.
Finally, Dr. Faiza explores the clinical implications of abnormal V˙/Q˙ ratios. She identifies clinical conditions associated with these abnormalities, such as COPD and emphysema, and discusses the physiological and clinical consequences on respiratory function. The lecture emphasizes the importance of understanding these concepts for medical professionals and students, highlighting their relevance in diagnosing and managing respiratory conditions.
This comprehensive lecture provides valuable insights for medical students, healthcare professionals, and anyone interested in respiratory physiology. Participants will gain a deep understanding of how ventilation and perfusion work together to optimize gas exchange in the lungs and how deviations from the norm can lead to significant clinical issues.
Hepatocarcinoma today between guidelines and medical therapy. The role of sur...Gian Luca Grazi
Today more than ever, hepatocellular carcinoma therapy is experiencing profound and substantial changes.
The association atezolizumab (ATEZO) plus bevacizumab (BEVA) has demonstrated its effectiveness in the post-operative treatment of patients, improving the results that can be achieved with liver resections. This after the failure of the use of sorafenib in the already historic STORM study.
On the other hand, the prognostic classification of BCLC is now widely questioned. It is now well recognized that the indications for surgery for patients with hepatocellular carcinoma are certainly narrow in BCLC and no longer reflect what is common everyday clinical practice.
Today, the concept of multiparametric therapeutic hierarchy, which makes the management of patients with hepatocellular carcinoma much more flexible and allows the best therapy for the individual patient to be identified based on their clinical characteristics, is gaining more and more importance.
The presentation traces these profound changes that are taking place in recent years and offers a modern vision of the management of patients with hepatocellular carcinoma.
Embyonal Stem Cells - Properties and Classification
Standing orders in obstetrics
1. CODE OF ETHICS AND
STANDARDS OF MIDWIFERY
PRACTICE AND STANDING
ORDERS IN OBSTETRICS
PRESENTED BY:-
MS LISA CHADHA
F. Y MSC NURSING
BVCON, PUNE
2. CODE OF ETHICS
A written set of guidelines issued by an
organization to its workers and
management to help them conduct their
actions in accordance with its primary
values and ethical standards.
3. International Code of Ethics for
Midwives
• The aim of the International Confederation of
Midwives (ICM) is to improve the standard of
care provided to women, babies and families
throughout the world through the
development, education and appropriate
utilization of the professional midwife
4. • Such care may encompass the
reproductive life cycle of the woman
from the pre-pregnancy stage right
through to the menopause and to the
end of life.
6. The Code of ethics
• I. Midwifery Relationships
• a. Midwives develop a partnership with individual women in
which they share relevant information that leads to informed
decision-making, consent to an evolving plan of care, and
acceptance of responsibility for the outcomes of their
choices.
• b. Midwives support the right of women/families to participate
actively in decisions about their care.
• c. Midwives empower women/families to speak for
themselves on issues affecting the health of women and
families within their culture/society.
• .
7. • d. Midwives, together with women, work with policy and funding
agencies to define women’s needs for health services and to
ensure that resources are fairly allocated considering priorities
and availability
• f. Midwives respectfully work with other health professionals,
consulting and referring as necessary when the woman’s need
for care exceeds the competencies of the midwife.
• g. Midwives recognize the human interdependence within their
field of practice and actively seek to resolve inherent conflicts.
• h. Midwives have responsibilities to themselves as persons of
moral worth, including duties of moral self-respect and the
preservation of integrity
8. • II. Practice of Midwifery
• a. Midwives provide care for women and childbearing families
with respect for cultural diversity while also working to eliminate
harmful practices within those same cultures.
• b. Midwives encourage the minimum expectation that no woman
or girl should be harmed by conception or childbearing.
• c. Midwives use up-to-date, evidence-based professional
knowledge to maintain competence in safe midwifery practices
in all environments and cultures.
9. • d. Midwives respond to the psychological, physical,
emotional and spiritual needs of women seeking
health care, whatever their circumstances (non-
discrimination).
• e. Midwives act as effective role models of health
promotion for women throughout their life cycle, for
families and for other health professionals.
• f. Midwives actively seek personal, intellectual and
professional growth throughout their midwifery
career, integrating this growth into their practice.
10. • III. The Professional Responsibilities of Midwives
• a. Midwives hold in confidence client information in order to
protect the right to privacy, and use judgment in sharing this
information except when mandated by law.
• b. Midwives are responsible for their decisions and actions,
and are accountable for the related outcomes in their care of
women.
• c. Midwives may decide not to participate in activities for which
they hold deep moral opposition; however, the emphasis on
individual conscience should not deprive women of essential
health services.
11. • d. Midwives with conscientious objection to a given
service request will refer the woman to another
provider where such a service can be provided.
• e. Midwives understand the adverse consequences
that ethical and human rights violations have on the
health of women and infants, and will work to
eliminate these violations.
• f. Midwives participate in the development and
implementation of health policies that promote the
health of all women and childbearing families.
12. • IV. Advancement of Midwifery Knowledge and
Practice
• a. Midwives ensure that the advancement of
midwifery knowledge is based on activities that
protect the rights of women as persons.
• b. Midwives develop and share midwifery knowledge
through a variety of processes, such as peer review
and research.
• c. Midwives contribute to the formal education of
midwifery students and ongoing education of
midwives.
14. International Standards for
Midwife
• The International Confederation of
Midwives (ICM) has developed the ICM
Global Standards for Midwifery
Regulation (2011) in response to
requests from midwives, midwifery
associations, governments, UN
Agencies and other stakeholders.
15. • GOAL
• The goal of these standards is to promote regulatory
mechanisms that protect the public (women and
families) by ensuring that safe and competent
midwives provide high standards of midwifery care to
every woman and baby.
• AIM
• The aim of regulation is to support midwives to work
autonomously within their full scope of practice. By
raising the status of midwives through regulation the
standard of maternity care and the health of mothers
and babies will be improved.
16. ICM Global Standards for Midwifery
Regulation
• 1. Model of regulation
• 1.1 Regulation is midwifery specific
• Midwifery requires legislation that establishes a
midwifery-specific regulatory authority with adequate
statutory powers to effectively regulate midwives,
• support autonomous midwifery practice and enable
the midwifery profession to be recognized as an
autonomous profession.
• Midwifery-specific legislation protects the health of
mothers and babies by ensuring safe and competent
midwifery practice
17. • 1.2 Regulation should be at a national level
• Where possible regulation should be at a national
level. However, if this is not possible there must be a
mechanism for collaboration and communication
between the midwifery regulatory authorities.
• National regulation enables uniformity of practice
standards and facilitates freedom of movement of
midwives between jurisdictions
18. • 2. Protection of title
• 2.1 Only those authorised under relevant legislation
may use the title ‘midwife’ endowed by that legislation
• Mothers and their families receiving care from a midwife
have a right to know that they are being cared for by a
legally qualified practitioner.
• A legally qualified practitioner is individually
responsible and accountable for her actions and is
required to adhere to professional codes and standards.
• Reserving the title ‘midwife’ for legally qualified
midwives identifies legally qualified midwives from
others who provide aspects of maternity care.
19. • 3. Governance
• 3.1 The legislation sets a transparent process for nomination,
selection and appointment of members to the regulatory authority
and identifies roles and terms of appointment.
• Because there is no evidence for any specific model of selection of
members for regulatory authorities
• The ICM recommends a combination of appointment and election
for all members of the midwifery regulatory authority. The choice
will depend on feasibility and local acceptance.
• All members of the regulatory authority should demonstrate
experience and expertise against predetermined selection criteria
such as broad experience in the midwifery profession; business
and finance expertise; education expertise and legal expertise.
20. • 3.2 The majority of members of the midwifery
regulatory authority are midwives who reflect the
diversity of midwifery practice in the country.
• Midwife members should be appointed or elected
from nominees put forward by the midwifery
profession.
• The midwife members need to reflect the diversity of
midwives and of midwifery practice in the country,
have credibility within the profession and be
authorized to practice in the jurisdiction
21. • 3.3 There must be provision for lay
members
• Lay members of the midwifery
regulatory authority should reflect the
diversity of the country including
ethnicity. Ideally lay members will
provide perspectives that reflect those
of childbearing women.
22. • 3.4 The governance structures of the midwifery
regulatory authority should be set out by the
legislation.
• The midwifery regulatory authority has systems and
processes in place to specify roles and
responsibilities of board or council members;
powers of the council; process of appointment of
chairperson.
• Such processes must be transparent to the public
through publication of an annual report and other
mechanisms for publicly reporting on activities and
decisions.
23. • 3.5 The chairperson of the midwifery
regulatory authority must be a midwife.
• The members of the midwifery
regulatory authority should select the
chairperson from amongst the midwife
members.
24. • 3.6 The midwifery regulatory authority is funded by members of
the profession
• Payment of fees is a professional responsibility that entitles
midwives to obtain registration or a license to practice if that
midwife meets the required standards.
• Ideally the midwifery regulatory authority is entirely funded by
the profession. However, in countries where the midwifery
workforce is small or poorly paid some government support may
be required.
• Government funding has the potential to limit the autonomy of
the midwifery regulatory authority and therefore needs to be
provided through a mechanism that minimizes such a
consequence.
25. • 3.7 The midwifery regulatory authority works in
collaboration with the midwifery
• Professional associations.
• The midwifery regulatory authority’s processes
should be based on principles of collaboration and
consultation.
• The midwifery regulatory authority needs to work in
partnership with other midwifery organizations that
also have a role in public safety and standard setting
such as the midwifery association.
•
26. • 3.8 The midwifery regulatory authority works
in collaboration with other regulatory
authorities both nationally and internationally.
• Collaboration with other regulatory authorities, both
nationally and internationally, promotes
understanding of the role of regulation and more
consistent standards globally.
• Collaboration can provide economies of scale for
developing shared systems and processes that
improve quality.
27. • 4. Functions
• 4.1. Scope of practice
• 4.1.1 The midwifery regulatory authority defines the
scope of practice of the midwife that is consistent
with the ICM definition and scope of practice of a
midwife.
• The midwifery profession determines its own scope of
practice rather than employers, government, other
health professions, the private health sector or other
commercial interests.
• The scope of practice provides the legal definition of
what a midwife may do on her own professional
responsibility.
• The primary focus of the midwifery profession is the
provision of normal childbirth and maternity care.
28. • The scope of practice must support and enable
autonomous midwifery practice and should therefore
include prescribing rights, access to
laboratory/screening services and admitting and
discharge rights.
• As autonomous primary health practitioners midwives
must be able to consult with and refer to specialists
and have access to back up emergency services in all
maternity settings.
• Associated non-midwifery legislation may need to be
amended to give midwives the necessary authorities
to practice in their full scope. For example, other
legislation that controls the prescription of
narcotics/medicines or access to lab/diagnostic
29. • 4.2. Preregistration midwifery education
• 4.2.1. The midwifery regulatory authority sets the
minimum standards for preregistration midwifery
education and accreditation of midwifery education
institutions that are consistent with the ICM education
standards.
• The midwifery profession defines the minimum standards
for education and competence required for midwifery
registration.
• The ICM definition and scope of practice of a midwife,
essential competencies for basic midwifery practice and
standards for midwifery registration should provide the
framework for pre-registration midwifery education
programmes
30. • 4.2.2. The midwifery regulatory authority
approves preregistration midwifery education
programmes leading to the qualification
prescribed for midwifery registration.
• The midwifery regulatory authority
establishes the processes to approve
midwifery education programmes and
accredit midwifery education organisations in
order to ensure that the programmes and
graduates meet the approved education and
registration standards and the ICM Global
Standards for Midwifery Education.
31. • 4.2.3. The midwifery regulatory authority accredits the
midwifery education institutions providing the
approved preregistration midwifery education
programme.
• In countries where national accreditation
organizations exist the midwifery regulatory authority
collaborates in the processes of approval and
accreditation.
• In these situations each organization may focus on its
own specific standards and area of expertise and
accept the assessment of the other.
32. • 4.2.4. The midwifery regulatory authority audits
preregistration midwifery education programmes and
midwifery education institutions.
• The midwifery regulatory authority establishes the
processes for ongoing monitoring and audit
mechanisms of pre-registration midwifery education
programmes and the midwifery education institutions
providing the programmes in order to ensure that
appropriate standards are maintained
• While it establishes the processes the midwifery
regulatory authority may employ external auditors to
carry out this work.
33. 4.3. Registration
• 4.3.1. The legislation sets the criteria for
midwifery registration and/or licensure.
•4.3.2. The midwifery regulatory authority
develops standards and processes for
•registration and/or licensure meet specific
standards set by profession (via the
•midwifery regulatory authority).
34. • 4.3.3. The midwifery regulatory authority develops
processes for assessing equivalence of applicants
from other countries for entry to the midwifery
register/or licensure.
• Midwifery registrants from other countries must meet the same
registration standards as local midwifery registrants.
• The assessment process should be comprehensive and may
include:
Sighting and assessing original qualifications and post-
registration midwifery experience of applicants and comparing
these with the educational preparation of local new graduate
midwives.
Assessing the competence of applicants against the
competencies for entry to the register;
35. Assessment methods may include examinations and
clinical assessment of competence.
Midwives from other countries who meet registration
standards should be required to complete an
adaptation programme to orientate to local society and
culture, health system, maternity system and
midwifery profession.
Midwives can hold provisional registration until these
requirements are met within the designated timeframe.
36. • 4.3.4. Mechanisms exist for a range of registration
and/or licensure status.
• From time to time midwifery regulatory authorities
need flexibility to temporarily limit the practice of a
midwife, for example, while a midwife is having her
competence reviewed or is undertaking a
competence programme or has a serious health issue
that may compromise safe practice.
• Legislation should include categories of registration
to provide for particular circumstances. For example
provisional, temporary, conditional, suspended and
full midwifery registration/licensure.
37. • 4.3.5. The midwifery regulatory authority maintains a
register of midwives and makes it publicly available.
• The midwifery regulatory authority demonstrates
public accountability and transparency of its
registration processes by making the register of
midwives available to the public. This may be
electronically through a website or by allowing
members of the public to examine the register.
• Women and their families have a right to know that
their midwife is registered/licensed and has no
conditions on her practice. Therefore this information
needs to be accessible to the public.
38. 4.3.6. The midwifery regulatory authority establishes
criteria, pathways and processes leading to
registration/licensure for midwives from other countries
who do not meet registration requirements.
•Where midwives from other countries do not meet the
registration standards a range of options can be
considered including examination, education
programmes, clinical assessment.
•Some midwives may not be able to meet the registration
standards without first completing another pre-
registration midwifery education programme.
39. • 4.3.7. The midwifery regulatory authority
collects information about midwives and
• their practice to contribute to workforce
planning and research.
• The midwifery regulatory authority has a role
in supporting workforce planning. Information
collected can inform planning for pre-
registration and post registration midwifery
education and inform governments about
workforce needs and strategies
40. • 4.4. Continuing competence
• 4.4.1. The midwifery regulatory authority implements a
mechanism through which midwives regularly demonstrate
their continuing competence to practice.
• Midwifery competence involves lifelong learning and the
demonstration of continuing competence for
registration/licensure.
• Eligibility to continue to hold a licence to practice midwifery is
dependent upon the individual midwife’s ability to demonstrate
continuing competence.
• Assessment and demonstration of continuing competence is
facilitated by a recertification or relicensing policy and process
that includes such things as continuing education, minimum
practice requirements, competence review (assessment) and
professional activities.
41. • 4.4.2. The legislation sets out separate requirements
for entry to the midwifery register and/or first license
and relicensing on a regular basis.
• A requirement for regular relicensing separates the
registration/first licensing process from the
subsequent application to practice process.
• Historically in many countries relicensing required
only the payment of a fee. Internationally there is an
increasing requirement for demonstration of ongoing
competence (including updating knowledge) as a
requirement for relicensure of health professionals.
42. • 4.4.3. A mechanism exists for regular relicensing of
the midwife’s practice.
Midwives may be on the midwifery register for life
(unless removed through disciplinary means or by
death). However, the establishment of separate
processes to approve the ongoing practice of midwives
will enable the midwifery regulatory authority to
monitor the continuing competence of each midwife.
.
43. • 4.4.4. Mechanisms exist for return to practice
programmes for midwives who have
• been out of practice for a defined period.
• The midwifery regulatory authority is responsible for
ensuring that all midwives are competent.
• As part of a continuing competence framework the
midwifery regulatory authority ensures that standards
and guidelines are set that identify the timeframes and
pathways for midwives returning to practice after a
period out of practice.
44. • 4.5. Complaints and discipline
• 4.5.1. The legislation authorises the midwifery
regulatory authority to define expected standards of
conduct and to define what constitutes
unprofessional conduct or professional misconduct.
• The midwifery regulatory authority has a public
protection role and increasingly there is a public
expectation that all professions are transparent and
effective in setting standards for practice that protect
the public.
• The midwifery regulatory authority sets the standards
of professional conduct and ethics and judges when
midwives fall below expected standards.
45. • 4.5.2. The legislation authorises the midwifery
regulatory authority to impose, review and
remove penalties, sanctions and conditions on
practice
• The midwifery regulatory authority requires a
range of penalties, sanctions and conditions
including censure; suspension; midwifery
supervision; requirement to undertake an
education programme; requirement to undergo
medical assessment; restricted practice;
conditional practice; and removal from the
register
46. • 4.5.3. The legislation sets out the powers and
processes for receipt, investigation, determination and
resolution of complaints.
• Appropriate mechanisms must be in place to
effectively manage issues of competence, health and
conduct. The mechanisms must ensure natural justice.
• The detail in the legislation will depend on the judicial
system and cultural context in place in any country.
Very prescriptive legislation may restrict the
development of a flexible and responsive midwifery
workforce.
•
47. •
• 4.5.4. The midwifery regulatory body has
policy and processes to manage complaints
in relation to competence, conduct or health
impairment in a timely manner.
• Complaint processes enable anyone to make
a complaint about a midwife
(consumer/service user, other health
professional, employer, another midwife, or
regulator can initiate a complaint).
48. • 4.5.5. The legislation should provide for the
separation of powers between the investigation of
complaints and the hearing and determining of
charges of professional misconduct.
• Separation of investigation and hearing and
determination allows for fairness to the midwife and
transparency to the public.
• Separation of powers prevents a conflict for the
midwifery regulatory authority between protecting
the interests of the midwifery profession and
ensuring public safety.
•
• The decision is made in the public interest, rather
than that of the profession
49. • 4.5.6. Complaints management processes are
transparent and afford natural justice to all parties.
• A freely available and accessible appeal process
should be in place.
•
• 4.6. Code of conduct and ethics
• 4.6.1. The midwifery regulatory authority sets the
standards of conduct and ethics.
• The codes of conduct and ethics are a baseline for the
practice and professional behaviour expected from a
midwife and the midwifery profession. The profession
sets these standards via the midwifery regulatory
authority.
51. Definition
• Standing Orders are orders in which
the nurse may act to carry out specific
orders for a patient who presents with
symptoms or needs addressed in the
standing orders. They must be in
written form and signed and dated by
the Licensed Independent Practitioner
52. • Standing orders are approved and signed by the
physician in charge of care before their
implementation.
• They are commonly found in critical care setting and
other specialized practice setting where client’s needs
can change rapidly and require immediate attention.
• Standing orders are also common in the community
health setting, in which the nurse encounters
situations that do not permit immediate contact with a
physician.
53. • Examples of situations in which standing orders may
be utilized can include,
• Administration of immunizations (e.g. influenza,
pneumococcal, and other vaccines)
• Nursing treatment of common health problems
• Health screening activities
• Occupational health services
• Public health clinical services
• Telephone triage and advice services
• Orders for lab tests.
• School health
• During labor
54. • Objectives
• To maintain the continuity of the treatment of the
patient.
• To protect the life of the patient.
• To create feeling of responsibility In the members of
health team.
55. • Uses
• Providing treatment during emergency
• Enhance the quality and activity of health
service.
• Developing the feeling of confidence and
responsibility in nurses and other health
workers.
• Protecting the general public from troubles.
• Enhancing the faith of general public in
medical institution.
56. List of standing orders
• The Expert Advisory Group Meeting held on
140.10.2004 as a follow up the meeting held
on the 19th
of July 2004 was to suggest
recommendations on various issues which
needed policy decisions related to the use of
selected life saving drugs and interventions
in obstetric emergencies by Staff Nurses
LHVs and ANMS.
57. • 1. Administration of Inj. Oxytocin and
Misoprostol
• It was decided that Tab. Misoprostol would be used as
prophylaxis against PPH, in all deliveries, as a part of
active management of the third stage of labour.
• Tab. Misoprostol should be given, sublingually or
orally, 600mg (3 tablets of 200 mg each), immediately
after the delivery of the baby.
• If a woman bleeds for more than 10 minutes after
deliver, she should be given 10U Inj. Oxytocin
preferably by the IV route (when the ANM is trained to
give the same)
58. • 2 . Administration of Inj. Magnesium sulphate for
prevention and management of Eclampsia
• Inj. MGSO4 is the drug of choice for controlling eclamptic fits.
• The first does should be given by the ANM/staff nurse/Medical
Officer at the PHC.
• The woman should immediately be referred to a CHC/FRU and not
a PHC. This is because in these cases termination of pregnancy
will be required, and a PHC may not be equipped for the same.
• This first dose should be given as a 50% solution (this preparation
is available in the market). 8cc need to be given to make a total
dose of 4 gms.
59. • 3 Administration of IV infusions to treat shock
• It was universally felt that the administration of IV
infusions was a life saving procedure. As
haemorrhage was the commonest cause of maternal
mortality, the administration of 3ml of fluid for every
ml of blood lost could keep the woman alive during
the time it took to transport her to the nearest
CHC/FRU where blood transfusion facility was
available.
• As of now, the ANMs are neither trained nor allowed
by the regulatory authorities to establish an IV line.
After the discussion, it was decided that:
60. – If the ANM is trained to give IV infusion, she should
administer wherever feasible, even at home.
– The ANM should start infusion with Ringer Lactate or
Dextrose Saline.
– If an IV infusion was being started incases of PPH, it was
recommended the IV fluid should be augmented with 20U of
Oxytocin for every 500 ml bottle of fluid. This could be
continued throughout transportation.
– However, the logistics and feasibility of the ANM being able to
carry IV infusion sets and IV fluids to homes need to be
explored, and ensured.
61. • 4 Administration of antibiotics:
• The indications for which antibiotic therapy is
recommended are:
– Premature rupture of membranes
– Prolonged labour
– Anything requiring manual intervention
– UTI
• Puerperal sepsis There should be instructions
for the ANM that after starting the woman on
antibiotics, she should inform the PHC
Medical Officer
62. • 5 Administration of antihypertensive:
• There was a universal consensus that
only the Medical Officer should be
allowed to administer anti-
hypertensives to a woman with
hypertension in pregnancy.
63. • 6 Removal of retained products of
conception:
• For incomplete abortion, if bleeding
continues, the ANM and staff nurse can
perform only digital evacuation of products of
conception. However the staff nurse can use
MVA under the supervision of the Medical
Officer.
64. • 7 Manual removal of placenta (MRP):
•
• MRP should be carried out only by the Medical Officer
in a health facility (PHC/CHC) setting.
• If the placenta was partially separated (as could be
diagnosed by the presence of vaginal bleeding), the
ANM should try and see if a part of the placenta could
be seen coming out from the os. Then she could
assist the removal of the placenta .
• The ANM should be trained in the active management
of the third stage of labour.
65. • 8 Conduction of an Assisted Vaginal Delivery (forceps
& vacuum extraction):
• Conduction of an assisted vaginal delivery was not
possible at the community level due to obvious
reasons. Hence it was universally felt that:
• Assisted vaginal deliveries (i.e. the use of obstetric
forceps or vacuum extraction) should be carried out
by the Medical Officer only.
• The ANMs and the staff nurse need to be trained in
the use of a partograph, for diagnostic purpose only.
This will help her in taking a decision for referral in a
case of prolonged labour.
66. • 9 Repair of vaginal and perineal tears:
• Scientific evidence proved that superficial tears do
not require any repair, because the outcome was the
same whether or not such a tear was sutured. The
ANM should be able to recognize a superficial tear,
and should be able to distinguish it from deeper
tears. She should simply apply pad and pressure on
the tear.
• For second and third degree tears which require
repair, the ANM should refer the woman to a higher
facility.
67. • The Staff Nurse should be allowed to repair a second
degree tear at the PHC setting, under the supervision
of the Medical Officer. But she too should refer third
degree tears after vaginal packing.
• It was decided that the medical officer and the staff
nurse require to be trained in repairing tears, and the
ANM requires training in recognizing the degree of
tear.
• No additional material/items thus need to be added to
the ANM kit for the repair of vaginal/perineal tears.
68. RECENT STUDY
• Facilitators and barriers to the use of
standing orders for vaccination in
obstetrics and gynecology settings
• JANUARY 2017
• American Journal of Obstetrics &
Gynecology
69. STUDY DESIGN: At 6 safety-net and private obstetrician gynecology
practices, 51 semi structured interviews were completed by trained
qualitative researchers over 2 years with clinical staff and vaccination
program personnel. Standardized qualitative research methods were
used during data collection and team-based data analysis to identify
major themes and subthemes within the
interview data.
RESULTS: All study practices achieved partial to full implementation of
vaccine standing orders for human papillomavirus, tetanus diphtheria
pertussis, and influenza vaccines. Facilitating factors for vaccine
standing order adoption included process standardization, acceptance
of a continual modification process, and staff training. Barriers to vaccine
standing order adoption included practice- and staff-level competing
demands, pregnant women’s preference for medical providers to
discuss vaccine information with them, and staff hesitation in
determining HPV vaccine eligibility.
70. CONCLUSIONS:
With guidance and commitment to integration of new
processes, obstetrician-gynecology practices are able to
establish vaccine standing orders for pregnant and non
pregnant women. Attention to certain process barriers can
aid the adoption of processes to support the delivery
of vaccinations in obstetrician-gynecology practice setting,
and provide access to preventive health care for many
women.
72. BIBLIOGRAPHY
• Kamini Rao, textbook of midwifery and obstetrics for
nurses, Elsevier publication, 1st
edition .
• Annamma Jacob, text book of midwifery, 1st
edition,
jaypee publication 2005.
• Adele pillitteri, child health nursing care of the child and
family, 1st
edition Lippincott publication.
• Potter & perry , fundamentals of nursing,5 th edition,
Elsevier publication.
• www.drugs2004rn.com.
• www.pubmed.com