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.
History and comptemporary perspectives in midwiferyarchana bhatti
The document provides a history of obstetrics from ancient times to the present. It discusses how obstetrics originated from the Latin word for midwife and evolved from being the domain of village dais to the involvement of male physicians. Key developments included the first textbook on obstetrics in the 18th century, the introduction of forceps and anesthesia in childbirth, and advances in antenatal care, ultrasound, and cesarean sections. Contemporary perspectives emphasize reducing maternal mortality through early prenatal care, risk identification, clean delivery practices, and expanding health services. Future practices may involve genetic research, intrauterine techniques, and improved infection control.
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.
National, state, and institutional standards and policies provide the legal and ethical framework that governs midwifery practice. Midwives must be licensed by the state where they practice and follow both national standards of practice and policies of the institutions where they work. Professional negligence and malpractice issues can arise if a midwife breaches her duty of care or causes injury through improper care. The ethical principles of beneficence, non-maleficence, respect for autonomy, and justice guide midwives in providing care and making decisions. Preparing for parenthood involves addressing lifestyle, health, financial, and psychological factors before conception to help ensure a healthy pregnancy and baby.
Legislation, clinical rights, and professional responsibility regarding abortionKanchan Mehra
This document discusses abortion law and policy in India. It provides context on the history of abortion legislation in India from the 1960s onwards. Key events discussed include the 1971 Medical Termination of Pregnancy Act, amendments in 2002 and 2003 to expand access, and proposed amendments in 2014. The document also reviews research on abortion service delivery in India and ongoing issues that restrict access, such as a limited provider base and poor regulation of services.
Historical perspective, trends, role of midwife in midwifery (1)Amandeep Jhinjar
A midwife is a person who has completed an accredited midwifery education program and is licensed to provide care to women during pregnancy, childbirth, and the postpartum period. Midwives provide antenatal care, assist with normal deliveries, conduct postnatal care visits, and provide general health information and counseling to women and families. They work to ensure safe outcomes for both mothers and newborns by detecting complications, providing emergency care when needed, and referring more complex cases to medical professionals when required. The role of the midwife is to support women's health and the normal physiologic process of pregnancy and childbirth.
Menopause is the permanent cessation of menstruation that occurs naturally as part of aging when the ovaries stop producing estrogen and progesterone, and a woman can no longer get pregnant. Counseling women about menopause aims to address questions/concerns, provide education, facilitate informed decision making, and enhance confidence. The counseling process involves building rapport, exploring issues, and committing to actions. A survey found that over 75% of postmenopausal women received counseling on hormone replacement therapy, with no differences found between managed care and other insurance types. More efforts are needed to educate underserved women.
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
Management of ailment during puerperiumPRANATI PATRA
This document discusses the management of common minor ailments that can occur during the postpartum period, known as the puerperium. It describes treatments for after pains, breast engorgement, increased urination, constipation, and suppressed lactation. For breast engorgement, it recommends expressing milk, applying hot/ice packs, supportive bras, pain medication, and regular breastfeeding. Increased urination is managed by keeping the mother hydrated and changing clothes frequently. Constipation is addressed through diet and mild laxatives if needed. Lactation suppression involves breast binding and avoiding stimulation. Thorough checkups and discharge advice include postnatal exercises, self-care, breastfeeding guidance, and contra
Maternal and child health issues can be influenced by several factors such as lifestyle, socio-cultural aspects, nutrition, psychology, gender, sexuality, and maternal age. Key issues include maternal age increasing risks of pregnancy complications; gender discrimination affecting care for female babies; and nutrition playing a critical role in pregnancy outcomes but being impacted by poverty and busy schedules. Socio-cultural factors like religious beliefs, views of pregnancy, and concerns for modesty also influence maternal health behaviors and utilization of prenatal care services.
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.
This document discusses various career opportunities in nursing. It outlines different nursing specialties including hospital care nurses, cardiac nurses, pediatric nurses, ICU nurses, psychiatric nurses, home health nurses, hospice nurses, labor and delivery nurses, dialysis nurses, emergency room nurses, neurological nurses, oncology nurses, school nurses, and operating room nurses. For each specialty, it provides a brief description of the role and opportunities for certification in that specialty through various nursing organizations. The document promotes nursing as a career with many opportunities and specialization options.
Standing orders and protocols of obstetric emergencies approved by MOHFWjagadeeswari jayaseelan
The document discusses standing orders, which are written orders signed by a licensed practitioner that allow nurses to provide specific care for symptoms or clinical problems without a new direct order. Examples of situations where standing orders may be used include administration of immunizations, treatment of common health issues, screening activities, and orders for lab tests. The document also provides several examples of specific standing orders related to obstetric care, postpartum care, and newborn care.
The document outlines 16 hallmarks that characterize the art and science of midwifery. Key hallmarks include recognizing important female life stages as normal physiological processes, advocating for non-intervention during normal processes absent complications, and promoting woman-centered care, empowerment, and continuity of care. Midwifery also focuses on health promotion, education, advocacy for informed choice, and collaboration with other healthcare professionals.
This document discusses various childbirth practices including natural birth methods like the Bradley method, Lamaze method, home births, and water births as well as assisted births like hospital births, C-sections, vacuum extraction, and forceps delivery. The Bradley and Lamaze methods focus on preparing mothers for unmedicated vaginal births through coaching and relaxation techniques. Home and water births allow laboring at home or in water but carry risks if complications arise. Hospital births provide medical interventions but higher infection risks. C-sections, vacuum extraction, and forceps are assisted options used when natural birth poses risks but also carry their own risks.
MODELS AND THEORIES INFLUENCING MIDWIFERY CARE full.pptxBayengJosephine
The document discusses models and theories that influence midwifery care. It begins by identifying disciplines like sociology, physiology, and anthropology that form midwifery's foundation. It then examines the medical model in depth, noting its focus on disease treatment and practitioner control. While useful for addressing illness, the medical model is criticized for neglecting holism and empowerment. The document also discusses models of participation in care, emphasizing patient-centeredness, shared decision-making, and community involvement at various levels from receiving services to planning programs.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
Screening and assessment of high-risk pregnancies involves identifying women at increased risk of complications through non-invasive tests like ultrasounds, NSTs and CSTs. Diagnostic tests then establish or rule out conditions and include invasive procedures like amniocentesis and cord blood sampling. Ultrasounds provide fetal images and assess growth while NSTs and CSTs monitor the fetal heart rate during rest and contractions. Amniocentesis analyzes amniotic fluid for genetic disorders while cord blood sampling draws fetal blood for similar tests when earlier methods were inconclusive. Both invasive procedures have a risk of miscarriage but can diagnose many conditions affecting the developing baby.
This document presents 5 potential problem statements for research studies related to maternal and infant health. The first study would evaluate the effectiveness of teaching antenatal mothers about TORCH infections and prevention during pregnancy. The second would assess knowledge of warning signs in pregnancy among first-time mothers. The third would examine the effect of birthing position on labor pain. The fourth would assess teaching breastfeeding initiation using breast crawl. And the fifth would determine if allowing family with the woman reduces labor pain.
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.
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 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.
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.
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.
3-code of ethics11111111.@@24 ppt.ppt.pdfssusere01cf5
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.
Factors influencing growth & development:
Growth & development depend upon multiple factors or determinants. They influence directly or indirectly by promoting or hindering the process.
The determinants can be grouped as Heredity & environment..
Heredity or genetic factors are also related to sex, race, & nationality. Environment includes both pre natal & post natal factors.
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn J...rightmanforbloodline
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn Jarvis, All Chapters 1 - 32 Full Complete.pdf
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn Jarvis, All Chapters 1 - 32 Full Complete.pdf
Introduction of mental health nursing, Perspective of mental health and mental health nursing, Evolution of mental health services, treatment and nursing practices Mental health team, Nature and scope of mental health nursing, Role & function of mental health nurse inn various settings and factors affecting the level of nursing practice, concept of normal and abnormal behavior
Report Back from ASCO 2024: Latest Updates on Metastatic Breast Cancer (MBC)....bkling
Join Dr. Kevin Kalinsky, breast oncologist and researcher from Emory Winship Cancer Institute, to learn about the latest updates from The American Society of Clinical Oncology (ASCO) annual meeting 2024.
General Endocrinology and mechanism of action of hormonesMedicoseAcademics
This presentation, given by Dr. Faiza, Assistant Professor of Physiology, delves into the foundational concepts of general endocrinology. It covers the various types of chemical messengers in the body, including neuroendocrine hormones, neurotransmitters, cytokines, and traditional hormones. Dr. Faiza explains how these messengers are secreted and their modes of action, distinguishing between autocrine, paracrine, and endocrine effects.
The presentation provides detailed examples of glands and specialized cells involved in hormone secretion, such as the pituitary gland, pancreas, parathyroid gland, adrenal medulla, thyroid gland, adrenal cortex, ovaries, and testis. It outlines the special features of hormones, differentiating between peptides and proteins based on their amino acid composition.
Key principles of endocrinology are discussed, including hormone secretion in response to stimuli, the duration of hormone action, hormone concentrations in the blood, and secretion rates. Dr. Faiza highlights the importance of feedback control in hormone secretion, the occurrence of hormonal surges due to positive feedback, and the role of the suprachiasmatic nucleus (SCN) of the hypothalamus as the master clock regulating rhythmic patterns in biological clocks of neuroendocrine cells and endocrine glands.
The presentation also addresses the metabolic clearance of hormones from the blood, explaining the mechanisms involved, such as metabolic destruction by tissues, binding with tissues, and excretion by the liver and kidneys. The differences in half-life between hydrophilic and hydrophobic hormones are explored.
The mechanism of hormone action is thoroughly covered, detailing hormone receptors located on the cell membrane, in the cell cytoplasm, and in the cell nucleus. The processes of upregulation and downregulation of receptors are explained, along with various types of hormone receptors, including ligand-gated ion channels, G protein–linked hormone receptors, and enzyme-linked hormone receptors. The presentation elaborates on second messenger systems such as adenylyl cyclase, cell membrane phospholipid systems, and calcium-calmodulin linked systems.
Finally, the methods for measuring hormone concentrations in the blood, such as radioimmunoassay and enzyme-linked immunosorbent assays (ELISA), are discussed, providing a comprehensive understanding of the tools used in endocrinology research and clinical practice.
- Video recording of this lecture in English language: https://youtu.be/AWaobASkZM4
- Video recording of this lecture in Arabic language: https://youtu.be/1cQRmJ3SKWc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lymphoma Made Easy , New Teaching LecturesMiadAlsulami
This lecture was presented today as part of our local Saudi Fellowship program. After three years of direct interaction with trainees and hematologists, I have started to develop an understanding of what needs to be covered. This lecture might serve as a roadmap for approaching and reporting lymphoma cases.
This document contains an overview of different types of ocular neoplastic disorders or ocular tumors among pediatric patients. you can have a quick basic concept about ocular tumors among children and a basic management strategy. You will have perfect idea about almost 8 ocular tumors among pediatric patients .
Introduction to Dental Implant for undergraduate studentShamsuddin Mahmud
Introduction to Dental Implant
Dr Shamsuddin Mahmud
Assistant Professor, Department of Prosthodontics
Nortth East Medical College (Dental Unit)
Definition of Dental Implant
A prosthetic device
made of alloplastic material(s)
implanted into the oral tissues beneath the mucosal and/or periosteal layer and
on or within the bone
to provide retention and support for a fixed or removable dental prosthesis.
Classification of Dental Implant
According to placement within the tissue
Blade/Plate form implant
According to Material Used
A) METALLIC IMPLANTS
Commercially pure Titanium
Cobalt chromium molybdenum
Titanium aluminum vanadium
Stainless steel
B) NON-METALLIC IMPLANT
Zirconium
Ceramic
Carbon
According to the ability of implant to stimulate bone formation
A) Bio active
Hydroxyapatite
Tri Calcium Phosphate
B) Bio inert
Metals
Parts of Dental Implant
Implant fixture
Implant mount
Cover screw
Gingival former/healing screw/healing abutment/permucosal extension
Impression post/impression transfer abutment
Implant analogue
Abutment
Fixation screw
Implant Fixture
Implant Mount
Connected to the fixture
Function: used to carry implant from its vital to the prepared osteotomy site either by hand or with a ratchet/ handpiece adaption
Cover Screw
component that is used to cover the implant connection during the submerged healing of the implant
Function: preserves the patency of the connection by preventing any soft tissue ingrowth in the connection
Gingival former/ Healing Abutment/ Healing screw
Screw/ abutment used to create the soft tissue emergence profile around the implant.
Time of placement:
During 1st surgery – One step surgery
After Osseointegration – Two step/stage surgery
Gingival former/ Healing Abutment/ Healing screw
Placed in the site 2-3 weeks for soft tissue healing
Function:
Create gingival emergence profile
Formation of biological width
Impression post/impression transfer abutment
component that is used to trans- fer the implant Hex position and orientation from the mouth to the working cast.
Types
Closed tray
Open tray
Implant analogue/
component which has a different body but its platform and connection are exactly similar to the implant. The analogue is used to replicate the implant platform and connection in the laboratory mode.
Abutment
Abutments
Advantages of Dental Implant Retained Prosthesis
Maintain bone height and width by preventing bone resorption
Maintain facial esthetics
Improve masticatory performance
Improve stability and retention of prosthesis
More esthetics
Increase survival times of prostheses
There is no need to alter adjacent teeth
Improve psychological health
Disadvantages of Dental Implant Retained Prosthesis
Very expensive.
Cannot be used in medically compromised patients who cannot undergo surgery.
Longer duration of treatment
Requires a lot of patient co-operation because of repeated recall visits are essential
INDICATION OF DENTAL IMPLANT
Dental implants can successfully restore all
Formulation of Buccal Drug Delivery SystemKHimani2
Buccal drug delivery system is an advanced type of drug delivery system where the drug is passed into the specific site without must wastage ! It is a novel drug delivery system where the medicament avoids 1st pass metabolism, which increases its bio availability !
* Types include matrix type and reservoir type in which 2nd type is more advanced and shows quick absorption of the drug .
* I have mentioned it's advantages and disadvantages.
* Factors effecting the drug delivery system
*Formulation of the BDDS
* Evaluation parameters
Regenerative Medicine in Chronic Pain ManagementReza Aminnejad
Regenerative technologies are the future of medicine. The current clinical strategy focuses primarily on treating the symptoms but regenerative medicine seeks to replace tissue or organs that have been damaged by age, disease, trauma, or congenital issues.
CASE PRESENTATION ON ACUTE GASTROENTERITIS.Bhavana
This is a case presentation of a 72 year old female patient who was admitted in the hospital with the chief complaints of loose stools since 6 Days and generalised weakness and history of one episode of vomiting (one day back).
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