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Islamic University Islamic University Midwifery Department Women issue & Ethics in Midwifery Prepared by Dr. Areefa Said Al-Bahri 2015 Table Of Content Chapter 1 Introduction Chapter 2 definition of Ethics &Ethical Principles Chapter 3 International Midwifery code (ICM) Chapter 4 Ethical decisions& reproductive health of women Chapter 5 Consent Form Chapter 6 Patient rights Chapter7 Character of moslem nurse Chapter 8 Ethical dilemmas Chapter 9 Palestine council of health Chapter 10 the most topics regarding women's health Chapter 11 counseling & topics of counseling. Chapter 12 family planning methods . Chapter 13 breast feeding . Chapter 14 cancer Chapter 15 infertility. Chapter 16 Menopause and old women Chapter 17 -violence against woman 1 Women’s health Care Chapter 1 Introduction What is a Midwife? Most midwives are health care providers who offer services to women of all ages and stages of life with their advanced education and their focus on research and partnering with women. Today’s woman expects the best care. She expects her provider to understand the value & individual needs. She wants a provider who will partner with her to make health decisions. Midwives focus on what is most important to each woman’s unique situation and values and often work with other members of the health care team. It’s time to think about whether a midwife might be the right choice for you. Midwifery Fields and places of Job Many midwives focus not only on maternity care, but also on the full range of a woman’s health needs. Certified nurse-midwives (CNMs) and certified midwives (CMs) provide care starting with a woman’s first period until after menopause, plus all the important health events in between, such as: General health care services Annual gynecologic exams Family planning needs Treatment of sexually transmitted infections Care during teenage years Care for pregnancy, labor, and birth Menopause care CNMs and CMs are independent health care providers. They also work with other members of the health care team, such as physicians and nurses, to provide the highest quality care. They work in a variety of settings, such as hospitals, medical offices, clinics, birth centers, and homes. They provide general health care services, gynecology care, family planning, as well as maternity care (before, during, and after childbirth). They are covered by most insurance. Types of Midwives Certified Nurse-Midwife (CNM) CNMs are registered nurses with graduate education in midwifery. They have graduated from a nurse-midwifery education program. This education includes a university degree as well as hands-on clinical training by practicing CNMs. 2 CNMs provide general women’s health care throughout a woman’s lifespan. These services include general health check-ups and physical exams; pregnancy, birth, and postpartum care; well woman gynecologic care; and treatment of sexually transmitted infections. CNMs are able to prescribe a full range of substances, medications, and treatments, including pain control medications. CNMs work in many different settings, such as hospitals, health centers, private practices, birth centers, and homes. Certified Midwife (CM) CMs are midwives with a bachelor’s degree in a field other than nursing who have graduated from a graduate-level midwifery education program accredited by the midwifery education program for CMs includes health-related skills and training in addition to midwifery education, which is the same as that of CNMs. They have passed the national certification exam. CMs provide the same services as CNMs, practice in the same settings, and receive the same preparation as CNMs to safely prescribe a full range of substances, medications, and treatments, including pain control medications. Certified Professional Midwife (CPM) CPMs prepare for a national certification exam administered by the North American Registry of Midwives (NARM) in different ways. There are two primary pathways for CPM education with differing requirements: The health care services provided by CPMs are not as broad as those of CNMs and CMs. CPMs provide pregnancy, birth, and postpartum care for women outside of the hospital—often in birth centers and homes. CPMs are not able to prescribe most medications. Other Midwife These midwives may or may not have formal education and have not passed a national certification exam. They may or may not be licensed. Their services are usually focused on pregnancy and birth, and they are unable to prescribe most medications. Role as Midwives Unfortunately, many people don’t really know what role midwives play in women’s health care today. The truth is that midwives approach health care using science and evidence. They base their expert, personalized service for women and newborns on their education and experience. In fact, certified-nurse midwives (CNMs) and certified midwives (CMs) can offer services beyond maternity care, including women’s and general health care services from the teenage years through adulthood and into the elder years. A Midwife’s Approach to Health Care When seeking a partner for your women’s health care, it’s important to understand how different kinds of providers will have a different approach to care. Midwives are skilled in creating a health care experience that is modified to your personal preferences and health care needs. They will work with you to decide on important decisions such as where and 3 how you want to give birth or how you want to approach your changing needs as you move into menopause. Why Choose a Midwife? Choosing a midwife offers you a chance for expert personalized care based on research and evidence. Midwifery care does not rely on providing a specific set of childbirth procedures or practices for all women. Instead, midwives tailor care to meet the wants and needs of each woman and her baby. In this way, midwives maintain the best conditions possible for a safe and healthy outcome for all involved. 4 Chapter 2 * Definition of Ethics: Ethics came from the Greek word {Ethos} which means: (custom, habit, conduct). And also ethics defined as "the science that approaches human actions in forms of Right or wrong" and these actions are {Voluntary actions}. Principles of ethics Beneficence: Beneficence is to act in the best interests of the patient, and to balance benefits against risks. The benefits that medicine is competent to seek for patients are the prevention and management of disease, injury, handicap, and unnecessary pain and suffering and the prevention of permature or unnecessary death. Autonomy Autonomy means to respect the tight of the individual. Respect for autonomy enters the clinical practice by the informed consent. This process usually understood to have 3 elements, disclosure by the physician to the patient's condition and its management, understanding of that information by the patient and a voluntary decision by the patient to authorize or refurs treatment. Respect: you must respect pt's autonomy, dignity& liberty. Non maleficence It means that a health personnel should prevent causing harm and is best understood as expressing the limits of beneficence. This is commonly known as "primum non nocere" or first to do on harm. Confidentiality Confidentiality is the basis of trust between health personnel and patient. By acting against this principle one destroys the patient trust. The right not to be restrainted, neglected or discharged from care without an opportunity to find other health provider. The right to absolute privacy The right to accept or to refuse treatment. The right to full disclosure of financial factors involved in her care. The right to know who will participate in her care and obtain additional consultation of her choice. Altruism: Is to protect the community by supporting actions, to meat the health and social need of the public. Paternalism: Is to protect the weak person. Veracity: Is the obligation to tell the truth. Fidelity: Is the obligation to loyal to the pt. community and profession. 5 Justice: Is to be fair, and equitable to all pts Regardless of any service you want to give. Egoism: Is the right to maximize personal benefits. Utilitarianism: Is the greatest good for the greatest members. legal and ethical principles in the provision of health services 1. Informed decision making. Patients or individuals who require health care services have right to make their own decision about the opinions for treatment or other related issues. The process of obtaining premission is called informed consent. The health care provider should disclose the following details: The individuals is currently assessed health. Reasonably accessible medical, social, and other means of response of the individual's conditions including predictable success rates, side effects and risks. The implications for the individual's general, sexual and reproductive health and lifestyle deteriorating any of the options or suggestions. The health provider's reasoned recommendation for particular treatment option or suggestion. 2.Surrogate decision makers: Surrogate decision makers [parents, caregivers, guardians] may take the decision if the affected individual's ability to make a choice is diminished by factors such as extreme youth, mental processing difficulties, extreme medical illness or loss of awareness. 2. Privacy and confidentiality A patient's family, friend or spiritual guide has no right to medical information regarding the patient unless authorized by the patients. The following points of confidentiality are to be kept in mind: Health care providers duties to protect patient's infromation against unauthorized disclosures. Patient's right to know what their health care providers think about them. Health care provider's duties to ensure that patients who authorize releases of their confidential health related information to other. Exercise an adequately informed and free choice. 3. Competent delivery services: Every individaul has a right ot receive treatment by a competent health care provider who knows to handle such situations quite well. According to the laws, medical negligence is shown when the following 4 elements are all established by a complainig party.
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