Monday, January 27, 2020

Negligence in Midwifery

Negligence in Midwifery Christine Borg After a spontaneous vaginal delivery a woman suffered a severe haemorrhage leading to hypovolaeima and severe adult respiratory distress. She was admitted to an Intensive Care Unit but had recurrent bleeding, than collapsed. After resuscitation in theatre, a substantial piece of placental tissue was removed under general anaesthesia. Upon routine checking the staff midwife was initially doubtful about the placenta, but then she documented that the placenta was complete. Discuss. Introduction A practising registered midwife is an accountable person who ensures that health and safety laws are implemented in her care provided (Dimond, 2002 pg.312). The registered midwife puts into priority the safety of the mother and her baby. The competent midwife is knowledgeable, understanding, skilled, and accountable. Unfortunately any behaviour that the research based professional carries out or fails to carry out, that result in harm to the mother or the child will have legal implications (Dimond, 2002). Postpartum haemorrhage Uncontrolled bleeding of more than 500mls from the women’s genital tract, at any time following delivery to 12 weeks postpartum is described as postpartum haemorrhage (Williams, 2011 pg.113). Blood lost can be either evident or concealed, resulting in shock (Tiran, 2012). Postpartum haemorrhage is the most common cause of maternal death occurring worldwide (Fraser Cooper, 2009). Optimum management of the third and fourth stage of labour is a matter of great concern towards preserving maternal health. Postpartum haemorrhage is most often a case of inappropriate management of the third stage of labour, along with an unprofessional inspection of the placenta (Fraser Cooper, 2009). Examination of the placenta Inspection of the placenta is a practical examination done in the labouring room by a fully qualified midwife. This exam includes the assessment of both the fetal and maternal membranes. Evaluation of the placenta is part of the duty of care of the midwife in the first hour following birth. On the delivery of the placenta, either by expectant or active management of the third stage, the midwife holds up the placenta from the umbilical cord with the fetal surfaces being examined first. The membranes are examined for integrity, completeness and any present abnormalities. Membranes; the amnion and the chorion should be made sure to be present and complete (De Kock, 2004). This assessment is usually done in the presence of the mother. The maternal surface is examined for completeness, so as to make sure that no cotyledons have been left inside the uterus. If a cotyledon is found to be missing, or if the midwife is uncertain with regards to placental findings, help from other health professionals should be sought and the placenta kept for further examination. Of utmost importance is to include the mother in the examination, describing reasons for the examination procedure, while explaining the possible risks of an incomplete placenta (De Kock, 2004). Women’s right for information The mother has the right to be informed of both the normal and abnormal findings. Communication is a necessary tool in midwifery. While being close to the woman, the midwife should have explained the situation and kept the mother calm, while talking her through the necessary procedures that were to take place (ICM, 2011) The midwife The title ‘midwife’ can only be used by the ’’person who has successfully completed a midwifery educational programme, that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of ICM Global Standards for Midwifery Education : who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery’’ (Midwives code of practice, 2005). The core competencies of the midwife The midwife is fit to practise if she has the necessary knowledge and skills, has a good professional behaviour, character and a good health status, meeting the standards and competencies required (ICM, 2011). Competencies are set up as a guide for midwives to fulfil their profession. The guidelines provided by the code of practise in midwifery, aims to put in priority the safety of the mother and the child. The competencies of the expert of normality include her ability to work with the women and provide constant care and support. Being competent means, that a high quality care and a cultural sensitive assistance is given to the mother during birth. Such event is the monitoring of the fetal and maternal wellbeing and providing the assistance towards performing a safe birth. The midwife must be aware of the possible risks occurring during labour being able to observe, recognize and act when warning signs present (ICM, 2011). Being competent and accountable- the case scenario The skills and abilities allow the midwife to inspect the placenta for integrity and completeness, however, in such a case as described above, having a midwife not sure of herself, referral to other health care professionals should have been considered while assisting the latter if possible. Having the mother notified of the findings and given consent with relation to the procedures that needed to take place, appropriate analgesia should have been administered. Once the doctor confirms that a part of the placenta is missing, a vaginal exam followed by an examination of the uterus under sterile conditions is usually performed. Should the midwife acted as a responsible professional, she must have been in control to take the necessary urgent measures if help from other health professionals was not accessible, keeping in mind the risk against the benefits. In such a case the priority of the midwife should have been managing postpartum bleeding so as to avoid the incidence of haemorrhage (ICM, 2011). The skills and abilities of the midwife allow her to perform a fundal massage in order to stimulate a contraction and help any remaining clots left in the uterine or vaginal cavity to be delivered (De Kock, 2004). Of utmost importance in the delivering the appropriate care, was the monitoring and estimation of the maternal blood loss. Oxytocic drugs should have been administered while regularly assessing vital signs of the mother, in addition to the recording of concise and accurate data of the events (ICM, 2011). In such a case were haemorrhage occurred, lifesaving drugs could have been administered to the woman in order for shock and respiratory distress to be avoided. The midwife shall have the skill to identify shock and be able to manage it. An intravenous line should have been inserted in such case and while administering the appropriate fluids and drugs, drawing of blood for laboratory testing could have been made possible. The woman with serious complication needed to be transferred to a higher level of care so as for emergency care to be given as required. In extreme cases the midwife must be able to perform cardio pulmonary resuscitation (De Kock, 2004). Furthermore, following such care, the midwife must have given great importance to the postnatal period of the woman. Observations of the woman’s progress and monitoring of the vital signs should have taken place (ICM, 2011). Record Keeping- A professional tool Accurate documentation of the process of labour and birth is a responsible role of the midwife. Appropriate written information about the progress of labour and the on-going care provided during this experience, gives out relative information about the mother and the fetal well-being during the birth events. The midwife must ensure that all the records are filled appropriately before transferring the woman to the future health care professionals (De Kock, 2004). The purpose of documentation is to provide a written evidence of events as they take place (Dimond, 2002). Appropriate written communication in the event of labour shall be factual, well dictated, concise, consistent, accurate, clear, legible, relevant and signed. Writing shall include detailed information of the care provided, the plan, actions, observations and the events occurring during labour (Dimond, 2002) All the information being documented is to be written as a contemporaneous manner of events. Documenting childbirth is a description of the birthing process. Relative information shall include data of the estimated blood loss during labour, the findings from the placenta examination as well as the results of the mother’s vital signs, whenever taken during the mother’s stay. Assessment of the perineum and vagina along with identification of necessary repairs, type and quantity of sutures required should also be noted (Dimond, 2002). The midwife must preserve all information recorded. Keeping all the records provides guidance to the health professional (Dimond, 2002). Documentation is a tool in the experts practise and it shall be considered as an essential part of care and not as additional to the care offered (Dimond, 2002) When writing out records one is to eliminate abbreviations and write in a manner that is easily understood by others. Records shall be clear so as to serve as a tool to facilitate an investigation. If any mistake is present in the recording of information, this should be corrected by cutting out neatly the mistake, while making sure that a signature and a date is presented. All information recorded by students is to be seen and signed by the midwife assigned. Information is to be written in a consecutive manner, having problems arising during the birth identified, and the actions and plans noted (Dimond, 2002). Regular training on documentation shall be proposed especially in situations where pressure is present especially at the time of the delivery where time is limited and record keeping is given a low priority. Written information shall reflect a clear evidence of the care being constantly provided to the mother and the baby (Dimond, 2002) ‘’A record becomes a legal document whenever it is required as an evidence of events occurred and is relevant in a court of law’’ (Dimond, 2002). Tools of documentation are necessary in the court of law, as although they are not always a proof of truth; records are an instrument of evidence and are tool for criticism by the judge. All written records are to be accurately dated timed, and signed. Negligence ‘Negligence may be best defined as actionable harm where a patient claims compensation caused by the carelessness of a midwife in breach of their duty of care’’ (Griffith, 2008). Negligence is the failure to take care of someone or something. This is the most brought up action in health services for compensation (Dimond, 2002 pg.182). Compensation can only be given when the midwife infracted the law in her duty of care, when harm has been recognised, or in the presence of a negative result that had been led to by the disrupted duty of care. The midwife has the responsibility of the duty of care towards all her clients. The duty of care involves: caring safely for the women and family, being able to communicate effectively, sharing evidence based information, giving advice, notifying the women of risks and acting in a way to promote health (Dimond, 2002 pg.184). The duty of care does not only relate to the care and treatment, but includes also the act of recording factual information and storing records. Duty of care involves all actions and activities that ensure safety. The midwife must aim to avoid acts that put the person at risk of harm. The person described is one who is directly affected by the midwife act. The aim is to have a positive effect on the mother, new-born, family and the overall experience (Dimond, 2002 pg.185). When a midwife is found guilty of putting the mother close to death a custodial sentence is most likely to be received by midwife (Griffith, 2010). Legislation of care This case scenario is a typical example of a dispute in the legal duty of care. In this case the midwife must have first understood the present standards of care (Dimond, 2002). The midwife described here has failed to understand and follow the protocols, guidelines and procedures drawn up nationally and locally. The midwife has also failed to understand the importance of accurate record keeping. The midwife is challenged on her inappropriate actions. Her records, if written precisely can also aid in defending her actions (Griffith, 2010). As a general rule, midwives who are not certain about the changing and revised standards of care, being practised in the area, are to make sure that all necessary information is gathered, understood and followed, so as to enhance safety in the care given to the mother and the family (Griffith, 2008). All midwives are responsible to obey to all policies. Trained and competent midwives are trusted and the element of trust in a qualified midwife reflects her level of competencies (Dimond, 2002). The government aims to increase the standard of the registered professionals and makes sure that all practioners listed on the registration list are safe and protective towards the public. Legislation aims to protect the mothers from dangerous professional staff. When a professional staff identifies that she has made a mistake, she shall not be complacent. It is the role of the midwife to communicate effectively with the woman and give all the acknowledgment, explanations and apologies, so as to act in the best way to correct her behaviour towards safeguarding the women and her family (Dimond, 2002 pg. 220). Although health professionals are to be knowledgeable and assertive, being over confident with their behaviour might put the mother and child at risk. With regard to this case scenario, having the midwife not seeking help from other professionals signifies, that her over confidence has led her to reduce the quality of care provided. Furthermore, a competent midwife would not only make sure that the placenta is examined correctly, but would also ensure that the placenta is examined in the presence of the mother, having findings continuously being communicated and explained. Any competent assessment of the risk would have to take in account the post birth vital signs of the women. The midwife’s failure to document correctly, take action and evaluate the mother’s vital signs was a direct cause towards the deterioration of the mother (Dimond, 2002). Conclusion The professional care provided by the midwife should be based on research and be within the law. As the claims for compensation continue to rise, the need for midwives to understand and reflect on the cases of negligence is important; so as to minimize the risk of negligence and increase the levels of standards of care (Dimond, 2002 pg.226). It is the midwives’ duty to understand the elements of negligence and take care of their actions and behaviours. A holistic approach of care provided by the midwife includes ’’leadership; clinical knowledge and skills; documentation; guideline development; risk management and debrief; audit; and education’’ (De Kock, 2004). References The core competencies for basic midwifery practice. (2002). Journal of Midwifery and Womens Health, 47(5), 403-404-406. De Kock, J. (2004). Second and third stages of labour. In J. De Kock, C. Van der Walt (Eds.), Maternal and newborn care: A complete guide for midwives and other health professionals (1st ed., pp. 14-1-14-7). Lansdowne: Juta and Company. Dimond, B. (Ed.). (2002). Legal aspects of midwifery (2nd ed.). China: Elsevier Science Limited. Fraser, D. M., Cooper, M. A. (Eds.). (2009). Myles textbook for midwives (15th ed.). Edinburgh: Elsevier. Griffith, R. (2008). Negligence and the standard of midwifery practice. British Journal of Midwifery, 16(10), 676-677. Griffith, R. (2010). Understanding negligence as a crime in midwifery. British Journal of Midwifery, 18(7), 449-450. International Confederation of Midwives. (2011). Essential competencies for basic midwifery practice 2010. (). International confideration of midwives. (2015). Retrieved from http://www.internationalmidwives.org/ Medfort, J., Battersby, S., Evan, M., Marsh, B., Walker, A. (Eds.). (2011). Oxford handbook of midwifery (2nd ed.). New York: Oxford University Press. Midwives code of practice. (2005, July). Retrieved from https://ehealth.gov.mt/download.aspx?id=908 Tiran, D. (Ed.). (2012). Baillieres midwives dictionary (12th ed.). London: Elsevier.

Sunday, January 19, 2020

Tuesdays with Morrie TEST Prep

Why does Mitch feel guilty about his brother, Peter? A. He wasn't there for him when he was dying. B. Peter had cancer, but Mitch thought he should've been the one to get cancer. C. Mitch was Jealous of Peter. D. Mitch stole something from him before he died. 2. Why does Memoir feel it is important to accept our death early in life? A. So we can appreciate life and our loved ones B. So we can live life to the fullest C. It will minimize having regrets in life D. All of the above 3.During Match's first visit with Memoir, What does he realize about his own life? A. He's too caught up in work and making money. B. Memoir wasn't a good influence on him. C. He is enjoying life and doesn't like to work. D. He shouldn't concern himself on everything 4. What does Memoir mean by the quote, â€Å"love each other or die†? A. In life it helps if you love someone. B. Memoir would be dead with his wife. C. If we do not have love, we have nothing D. Love isn't important. 5. What does the pink hibiscus plant symbolize? A. The natural human life cycle B. Morris's diseaseC. Match's life D. Eve's death 6. What does Memoir tell Mitch it is K to do? A. Cry B. Eat dinner without him C. Leave early D. Stay late 7. Why did it bother Memoir that one day someone else would have to wipe his behind? A. Because it made him sick B. He saw it as a sign of weakness C. He saw it as the ultimate sign of dependency D. Because it smells 8. In â€Å"Tuesdays with Memoir†, who was Morris's first interview with? A. Katie Court B. Barbara Walters C. Ted Copper D. Hugh Downs 9. In â€Å"Tuesdays with Memoir,† what did Mitch think he would die of? A. CancerB. Loneliness C. ALLS D. Heart disease 10. What condition did Memoir have? B. Heart disease D. A stroke 11 . How did Memoir entertain visitors? A. By sitting outside B. Leading discussion groups on dying C. Looking at old photos D. Reading through books 12. What was Morris's favorite thing to do? A. Going to the movies B. Dancing C. Puzzles D. Writing novels 13. What instrument did Mitch play? A. Guitar B. Violin C. Tuba D. Piano 14. What were the words used by Memoir some mornings, when he felt bitter and angry? A. I want to live B. My life is done already C.Why do I bother trying D. I'm giving up today 15. How would you describe Memoir? A. Strong B. Reluctant C. Bitter D. Mean 16. This story would be considered a A. Autobiography B. Biography C. Short-story D. Narrative 17. What were Match's overwhelming desires for Memoir during his college years? A. Hug him B. Get out of his class C. Give him a napkin D. Both a and b 18. Who was the first person to ever interview Memoir? A. Ted Copper B. A Boston Globe Reporter C. Michelle D. Morris's Close Friend 19. How many â€Å"aphorisms† did Memoir have? A. 50+ B. 100+ c. 90 D. 78 20.What character trait would most fit Michelle? A. Hard-working B. Determined C. Lazy D. Ambitious 21 . Who was asked to watch over someone's kids? A. A cousin B. Memoir C. The un cle D. Michelle 22. What university did Memoir teach at? A. Stanford B. Brandeis C. Princeton D. Berkeley 23. In what month did Memoir die? A. December B. November C. October D. January 24. What allowed Mitch to spend time with Memoir? A. He got ALLS B. A new Job C. A newspaper strike D. He was fired 25. What item did Mitch give to Memoir at his college graduation? A. A book B. A picture of them togetherC. Food D. A briefcase 26. What college subject did Memoir teach? A. Sociology B. Global Studies C. Veterinary D. Philosophy 27. What newspaper did Memoir work for? A. Detroit Free Press B. Memoir didn't work for a newspaper C. Nightline D. Michigan Times 28. Memoir appeared on what TV show? A. 60 Minutes B. Nightline C. The Collect Report D. The Ted Copper Show 29. What was Morris's father's, Charlie, occupation? A. Newspaper writer B. Architect C. Waiter D. Factory worker 30. If Memoir could be reincarnated into any animal of choice, his choice would be A. Fish B. HyenaC. Gazelle D . Crane 31 . What was Morris's final course about? A. How to Dance B. Political Science C. Acceptance of Following Whatever Culture Tells You D. The Meaning of Life 32. Eva was A. Morris's mother B. Match's step-mother C. Morris's step-mother D. Match's uncle Part B: True/False 33. The book reflected from present to past. A. True B. False 34. Everything Memoir did made him cry. 35. Memoir wanted pity from his friends and family. 36. Memoir and Michelle called each other â€Å"Tuesday People† because they always met on Tuesdays during Michelle college years. 37.Michelle didn't feel sorry for Memoir. 38. Michelle called Memoir â€Å"coach† as a nickname. 39. Memoir was okay with his professor/friend dying? 40. Memoir always showed great passion when explaining how to face the end of life. 41 . Michelle was influenced a lot by Memoir. Part C: Short Answers 42. Describe your overall opinion and or view of how Memoir accepted his diagnosis. Use at least 3 examples from the story. 43. Would you have the strength and mind to live the same way as Memoir did? 44. Would you describe Memoir as weak or strong about his situation? Why or why not? Explain.

Saturday, January 11, 2020

Of mice and men theme power Essay

By examining the relationship between the protagonist geroge and lennie , and the relationship between curly and his wife, this response will attempt to argue that indeed the only power others have over us , is the power we give them. this response will also attempt to examine techniques and description to make and shape meaning in the world of this novel. How Power is Presented in Of Mice and Men The theme of power in Of Mice and Men is presented by Steinbeck in a variety of ways, including characterisation, dialogue and imagery. The main themes of power in the novella include physical power, seduction and the power of hierarchy. The theme of physical power is mainly represented through the character Lennie. The power of seduction is shown through Curley’s wife. Whereas the power of hierarchy is portrayed through the Boss, Slim and Curly. In the novella Of Mice and Men, Steinbeck presents physical power through the character Lennie Small. Lennie is a huge character, with immense physical strength. We can deduce this, from the opening description â€Å"A huge man† . The description here has foreshadowed Lennie’s physical stature and strength. His physical power, is a recurring theme throughout the novella. It is again shown, when George talks to Slim about his previous life with Lennie, â€Å"coulda bust every bone in my body†. Here through the use of dialogue, the reader is shown the physical power Lennie has over George. It is ironic, that even though Lennie has the advantage of physical power. George is the more dominant one. We can see this, by the way George reprimands Lennie for disobeying instructions, â€Å"you wasn’t gonna say a word†. This dialogue, foreshadows Lennie’s lack of mental power, to follow George’s instructions. Curley, The Boss and George are all connected because they have power over someone. In the Novella, The boss is in control of everything. Also he answers to no one. â€Å"Hey, what’s your stake in this guy†. This dialogue is between George and The Boss, he is questioning George on his power over Lennie. This quote shows that he can control who works for him and who doesn’t. He can fire someone just be cause he doesn’t  like them.

Thursday, January 2, 2020

Strengths And Limitations Of Qualitative Research

Introduction Research is crucial to understand various issues and in order to resolve them. It can be done either quantitatively or qualitatively depending on the type of research paradigm and the requirements of the researcher. Qualitative research particularly doesn’t involve numerical data but studies and collects data in an empirical form. Kerlinger’s view (1966) completely rejected the idea of qualitative research whereas Campbell’s idea (Mile Huberman, 1994) stated all research has a qualitative basis. However, it becomes important to be aware of the major advantages and disadvantages of qualitative research in order to answer the research question thoroughly. My concern in this essay is to critically assess the strengths and the†¦show more content†¦The data was collected using semi-structured informal interviews and showed considerable variation in the women’s approach to answer some of the questions. Hence, it reveals that some women like to discuss their viewpoints among themselves which could not have been known through numerical data. Qualitative research makes use of rigorous procedures and multiple methods for data collection which make the data real, rich and deep (Cohen, 2007). Moreover, qualitative analysis rigorously focuses on the functioning of the social processes. It investigates individual experiences and helps to build a detailed account of people’s feelings and why they act in a particular way. Most of the research done focuses on psychology individuals rather than their social processes which is a major limitation of quantitative research, overcome by qualitative research. This was clearly visible in a study (Riley, 1983) where she predicted that most of the developmental psychology treats mothers and infants as if they are on a â€Å"desert island† and are not in touch with daily real-life problems. Relating to this study, Walkerdine and Lucey (1989) clearly showed in their study that everyday concerns are essential in influencing a mother’s and her four-year-old daughterâ€℠¢s conversation. In a longitudinal study, Discourse analysis has particularly beenShow MoreRelatedEssay On Risk Assessment1649 Words   |  7 PagesTo Review the Lived Experience of Nurses, when Carrying Out Risk Assessments on Patients who have Developed a Pressure Ulcer      Future Research:   This assignment has two parts, part one reviewed pressure ulcer prevention, and the gaps that were identified were: it lacked research on pressure ulcer management, individuals did not having enough knowledge on methods to reduce pressure ulcers, there was a low sample size and selection and there was a gap between the risk assessment process, and pressureRead MoreExamine the Fields of Qualitative and Quantitative Research and the Advantages and Limitation of Each Paradigm.1089 Words   |  5 Pagesprobably been more energy spent on debating the difference, advantages and limitations between qualitative and quantitative research methods, it can be said that this issue has been debated to death with many spending years proving which methods is the best. 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