Lecture 4 - Legal and Ethical issues in midwifery practice (1).pdf

Dr EnasMohamed Lofty Associated Professor In Nursing Administration College Of Nursing, PNU Lecture 3 1  Learning objectives On completion of this lecture, the student will be able to: 1. Describe the common legal issues in midwifery....

Dr EnasMohamed Lofty Associated Professor In Nursing Administration College Of Nursing, PNU Lecture 3 1  Learning objectives On completion of this lecture, the student will be able to: 1. Describe the common legal issues in midwifery. 2. Outline the common ethical issues and challenges in midwifery practice. Introduction Many legal issues are involved in case of mother and her infant. The common causes of law suits against the nurse include: 1. Problems of medication 2. Failure in adequate client monitoring 3. Failure to adequate assess the client 4. Failure to report changes in client 5. Nursing care of the newborn 1- Problems of medication Problems may occur while administering medication to patients which can result in allegation against the midwife in regard to: 1. improper patient identification, 2. wrong medication dosages, route or time 3. failure to monitor side effects E.g. Nurses are involved in administration of oxytocin in augment of the labour How to reduce medication error Minimize verbal order or telephone order 1. Repeat order to prescriber 2. Spell drug name aloud 3. Speak slowly and clearly Avoid abbreviations and acronyms Never assume anything about an item in the order ‫ (ال تخمن‬route) Never use trailing zero ‫(الصفر الزائد‬ex: do not use 1.0 mg , use 1 mg. Document immediately. 2- Failure in adequate client monitoring The delivering mother must be adequately monitor to prevent maternal complications during: 1. Prenatal period: antenatal assessment 2. Intranatal period: monitoring the fetal heart rate, uterine contractions and progression of labor 3. Post natal period: continuous observation of mother and foetus during first 24 hours after delivery. 3- Failure to adequate assess the client Midwives is responsible for assessing and reporting any minute change in the client’s condition. Higher levels of assessment skills have to be maintained by the midwives. Ex: obtaining appropriate health histories and performing physical examinations 4-Failure to report changes in client Midwives During assessment , she may notice any change in the client’s condition. This has to be brought to the notice of the physician. Failure of notification may lead to loss of life. Ex: changes in blood pressure/ blood glucose levels, changes in fetal heart rate.. 5-Nursing care to the new-born The legal requirements in providing nursing care of new-born, such as: - Properly identify the infant mother pair as soon as possible with foot print, and wrist band - Standard of practice includes: - Providing clear airways - Clamping the umbilical cord - Cord care - Keeping infant warm. Ethical issues and challenges 1. Substance abuse 2. Refusal of medical treatment 3. Informed consent 4. Female sterilization 5. Forced caesarean birth 6. Abortion 7. In vitro fertilization and embryo transfer 8. Surrogacy ‫تأجي األرحام‬‫ر‬ Ethical issues and challenges-contd… 9-Selective reduction in multifetal pregnancy 10-Intrauterine treatment of fetal conditions 11Contraceptives 12-Infertility and ART (assisted reproductive technology) 13Human reproductive cloning  1. Substance Abuse Substance abuse is the use of illegal drugs or the use of prescription or over-the- counter drugs Substance abuse for any person is a problem, but when it involves a pregnant woman, substance abuse can cause fetal injury and thus has legal and ethical implications. 2. Refusal of medical treatment All clients have the right to refuse medical treatment. Refusal of treatment may occur when the treatment conflicts with religious or cultural beliefs. In these cases, it is important to educate the client and family about the importance of the recommended treatment without forcing the client to agree. 3. Informed consent Informed consent is a principle in medical ethics and medical law that a patient should have sufficient information before making their own free decisions about their medical care. Key components of informed consent Informed consent has four key components: A- Disclosure - health care provider must give to patients enough information that would be expected by a reasonable person to make a decision (include the risks and the benefits- explained in language patient understand) B- Comprehension – understanding of information Key components of informed consent C- Competency - person has the ability to make and be held responsible for decisions. D- Voluntariness – the patient is free from coercion, a choice being made of a person's free will. Informed consent - when and who ? - when It occurs prior to initiation of the procedure or specific care and addresses the legal and ethical requirement of informing the client about the procedure. who The physician or advanced practice nurse is responsible for informing the client about the procedure and obtaining consent. 4. Forced caesarean birth Refusal of CS-birth by mother lead to conflict. If refusal occur try identify reason and convince about benefits but not to forced. When it necessary to save life , the health care provider, take help of court and do surgery after legal notice