MDWY20 NOTES.pdf

History of Midwifery A good midwife (Soranus of Esphesus) EGYPT - Literate with her wis about her Midwifery was a recognized female - Possessed of a good memory...

History of Midwifery A good midwife (Soranus of Esphesus) EGYPT - Literate with her wis about her Midwifery was a recognized female - Possessed of a good memory occupation based on Ebbers Papyrus - Loving work (1550 BC) - Respectable - Not handicapped as regard her senses Included in the Papyrus are five - Sound limb column topics that deal with obstetrics - Robust and gynecology, process of giving birth - Long slim fingers and short nails and the birth prognosis of the - Hands so soft to comfort both mother newborn. and child. Egypt (1770 BCE) 3 grades of midwives present The Westor Papyrus was introduced Technically proficient and this includes instructions for Read some of the text on OB-GYN calculating the expected date of Highly trained and reasonably confinement and describes different considered a medical specialist with concern in midwifery. Midwives were known by many different titles: Latrine (nurse) Mala (midwife) Obstetrix (obstetrician) Medica (Doctor) styles of birth chair. MODERN HISTORY Conflict between the surgeons and midwives arose in the 15th century. Medical men began Presence of Royal Birth rooms at to assert that their scientific techniques were Luxor and other temples better for mothers and infants than the folk medicine practiced by midwives. GRECO-ROMAN Old women who continue folk medical As doctors and medical associations pushed traditions in the village of roman empire, train for a legal monopoly on obstetric care, midwives who garnered their knowledge from midwifery became outlawed or heavily a variety of sources and highly trained women regulated throughout the US and Canada. who were considered physicians. (Flemming,2000) In Northern Europe and Russia, Prof. Christian Friedrich Deutsh established a midwifery school for women in university of The Normal and Health process of labor and Dorpat in 1811, which existed until WWII. delivery plays a larger role in Sweden, Netherlands than the rest of Europe. It was the predecessor for Tartu Health Care College. Training lasted for 7 months and in Swedish midwives stand out as they provide the end a certificate for practice was issued to 80% prenatal and 80% FP services to the the female students. people. Accusations on the capacity of midwives and HISTORY OF MIDWIFERY IN THE trained surgeons rose up. Arguments included PHILIPPINES these health workers until the study of bacteriology became popular in the early Establishment of Midwifery and Midwifery 1900s. (1901-1940) German social scientist Gunnar Heinsohn and On November 8, 1920, Dr. Jose Otto Steiger theorized that midwifery became Fabella founded the Maternity House a target of persecution and repression by and later on the Maternity and public authorities because midwives Children’s Hospital now known as Dr. possessed highly specialized knowledge and Jose Fabella Memorial Hospital. skills regarding not only assisting birth, but Dr. Fabella spearheaded the also contraception and abortion. organization of the premier school of midwifery in the country. CONTEMPORARY Highschool, graduates were accepted In the late 20th century, midwives were to train in midwifery for one year. already recognized as highly trained and Dr. Fabella opened the School of Midwifery on specialized professionals in obstetrics. Dr. Jose Fabella Memorial Hospital in 1922 with 3 objectives. In the beginning of the 21st century the - Train young women in midwifery to medical perception of pregnancy and gradually supplant unlicensed childbirth as potentially pathological and midwives. dangerous still dominates in Western Culture. - Train doctors and nurses for provincial work Midwives play a larger role in health care of - Give health service and education with pregnant women in Europe than in America. emphasis on maternal and child care. The objectives of Fabella Hospital SOM A medicalized model of birth still influences became more defined after producing the first these countries despite the WHO mandate of ten graduates of Midwifery. a natural. Normal and humanized birth.  - Train students of the school in modern RA7392 technique of attending to normal - The Philippine Midwifery Act of 1992 deliveries was enacted to revise RA2644. This - Give practical education to mothers in act established the functions of the the modern procedure of delivery Board of Midwifery for the profession. including pre and postnatal care of the - The law also promotes the academic babies. preparation of midwives as the Later that year another SOM was opened in expanded ro;e of midwife. Cebu followed by Bacolod and Negros on the BOARD OF MIDWIFERY following year. Chairman - Obstetrician 4 members (3 midwives, 1 1965 - The DJFMHSOM offered the nurse-midwife) Nurse-Midwifery course which aimed to bring midwifery education in the Philippines to the Development of Midwifery Education in the level comparable to the advanced countries in Philippines the world. 6 months course - 1 year course (which highlights midwives in MCH) Organizations In the early years, students were 1. Liga Nacional Para La Protection de la supported by the government. Primera Infancia and Circula Feme nil These students are called Manila “pensionados” 2. Gatas de Leche Dat Nurseries in 1996 - CMO No. 24 s. 1992 - Manila integrated competencies in PHC. 2000 - CMO No. 36 s. 2000 - REGULATION FOR MIDWIFERY PRACTICE inclusion of expanded role of (1941-1980) Midwives. The regulation of midwifery was 2007 - CMO No. 33 s. 2007 - separated from medicine, when RA ladderized BSM 2382 (Medical Act of 1959) was 2023 - CMO No. 3 s. 2023 - BSM enacted in 1959. Straight Program The separation of midwifery from Midwife medicine gave birth to RA 2644 (Act of A health professional whose primary Regulating Midwifery Training and work is instituting preventive Practice) on June 18, 1960. measures, promotion of normal birth, detection of complications in mother BOARD EXAMINERS FOR MIDWIVES and child, the accessing of medical or Chairman - Obstetrician appropriate assistance and the 2 members (1 midwife, 1 carrying out of emergency measures. nurse-midwife) Midwife (Medical Code of Practice) Midwifery Practice - As a person who, have been regularly Health education to individuals, family admitted to a midwifery educational and community. program, duly recognized in the Primary health care services country in which it is located, has Antenatal, intra-natal-post care of a successfully completed the prescribed normal pregnant mother course of studies in midwifery and has Immunization acquired the requisite qualifications to Oral and parenteral dispensing of be registered and/or legally licensed to oxytoxic drugs after the delivery of the practice midwifery,. placenta. Suturing perineal laceration to control Midwifery Schools Recognized bleeding Member and Certified by APSOM- Intravenous fluid during OB principal and SOM emergencies CHED ACCREDITED - with CHED Vitamin K injection to the newborn Certificate of Program Compliance Sphere of Midwifery Practice Hospital/Domiciliary Prescribed Hours Community Health Complete Academic Units - 180 units Academe Complete Number of Clinical Entrepreneurs Practicum Hours - 2,703 hours Administrative Complete Cases for PRC Filing Skills and Abilities of a Professional Midwife 20 actual deliveries 1. Technical Skills - skills that a midwife 20 internal examination should apply in performing procedures 5 suturing assigned to them. 5 Intravenous Insertion 2. Communication Skills - skills in expressing their thoughts either by Legally Licensed to Practice writing or orally. Passed the Midwifery Licensure Exam 3. Analytical Skills - decision making Licensed to practice within the legally scope of Midwifery (RA7392) Essential Competencies of Midwives RA7392 (ICM,2019) Independent Functions of Midwives RA7392 1. General Competencies - this Insertion of IV fluids during obstetric category are about the midwife’s emergencies accountabilities as a health Internal examination during labor professional, the relationship with Suturing of perineal lacerations women and other care providers and Injection of oxytocin after delivery of care activities to all aspects of a the placenta. midwifery practice.  2. Pre-pregnancy and Antenatal - endowed with the capacity to love, to about the health assessment of the like, to know, to respond, and to woman and fetus, promotion of health appreciate the uniqueness of others. and well being, detection of Social Being - Man is like some other complications during pregnancy, and men. Group of people have some care of women with an unexpected common attributes. pregnancy. Spiritual Being - Man’s intellect give 3. Care during labor and birth - him the ability to understand the assessment and care during labor that meaning of events as they relate to facilitates physiological; process and a him or to his loved ones. safe birth, the immediate care of the - It is the intellect that helps him newborn of the infants and the accept these events as “God’s detection of complications in mother or will” infant. 4. Ongoing care of women and Man is a whole complete and independent newborns - address the continuing who has 14 fundamental needs (Henderson) health assessment of mother and infant and health education, support Breath Keep Clean for breastfeeding, detection of Eat and Drink Avoid danger complications and provision of family Eliminate Communicate planning services. Move and maintain Worship Posture Work The Concepts of a Man Sleep and rest Play Dress and undress Learn Man - the concept of a man forms from the first foundation component of Nursing. To be Man and His Environment able to provide individualized, holistic, humane, ethical and quality nursing care. The environment comprises the overall surroundings of any object. Characteristics of a Man In ecology, the environment means all factors Biological Being - he is composed of which affect the survival and reproduction of cells, tissues, organs and organ living organisms. system functioning as one whole organism. Building and energy-supplying components Psychosocial Being - is capable or and regulatory components. Thus the rational, logical thinking but he can be environment comprises material factors irrational and illogical when provoked. whose presence is decisive for survival and Joyce Travelbee states that man is development of living organisms (sugar, carbon, hydrogen) and other factors - All humans need oxygen, water, food, regulating the living process. safety, security, love and self-esteem Both man and environment are altered by the in order to maintain his well-being. process of urbanization and migration. - All people strive to meet their basic human needs. At any given time, an Some of the innumerable stress to which individual’s needs may be met, responses occur: partially met or unmet. Human beings live in the kingdom of - A person whose needs are met may nature and interact with it constantly. be considered as healthy and a person The influence of nature in the form of with one or more unmet needs may be the air he breathes, the water he considered as a risk for illness. drinks, the food he eats, and the flow of energy and information. Abraham Maslow’s Hierarchy of Needs Any change in the environment can Abraham Maslow (1908 - 1970) not only result in devastating effects, - The father of humanistic psychology but he can also pose a threat to the and creator of Maslow’s Hierarchy of human race. Needs. The relationship between man and the - According to his theory certain human environment has been established in needs are more basic than the others, the early periods itself. that is, there are some needs which Changes in population structure and must be met first before the individual characteristics of population. turns his attention to the other needs. Changes in social and cultural 1. Physiological Needs organization. - These needs are located at the Responses at physiological and base of hierarchy. developmental level - They are life-saving and Changes in genetic composition and life-sustaining, they are given structure, partly as a result of social the highest priority. Without factors. them, a person will not survive. 2. Safety and Security Needs Needs - are those which are necessary or - These basics are involved with desirable to maintain life and well-being. self-preservation. - Those things which an individual must - This means that a person must have in order to survive. be protected from harm and Characteristics of basic human needs. danger. - Human needs are universal although a. Physical Safety - implies that threats to some needs are modified by cultural health and life must be eliminated. influences. b. Emotional Security - implies that to be emotionally and psychologically  secure, a person must know what to - Generally permanent [male and expect from others. female] 3. Love and Belongingness - Attributes are equally valued - These are needs in which a person expects the understanding and Primary Sex characteristics acceptance of others, especially his - Sexual and reproductive family or significant others, peers and organs his community. Secondary Sex Characteristics - These needs arise only after the - Body changes over time physiological and safety needs have {example: breast, pelvic been met. widens, deep voice} 4. Self - Esteem Needs Sex Roles - These are the needs of a person to - A function on which a male or female feel good about himself, to believe that assumes because of the basic other people hold him in high regard. physiological or anatomical between 5. Self - Actualization the sexes. - These are the needs of a person to be - A role in which can be performed by able to control himself and his destiny only one sexes. and to develop his full potential. - The highest level need in Maslow’s Male Female hierarchy. Ovum Child Bearing Basic Rights of Man Fertilization 1. Right to life Spermatozoa Gestation 2. Right to privacy determines the 3. Rights to freedom child’s sex. 4. Rights to free exercise of religious worship Lactation 5. Rights to due process of law in case of lawsuits Gender - The characteristics of women, men, girls and boys that are socially GENDER AND DEVELOPMENT constructed. Sex - It varies from society to society and - Biological characteristics of being a can change overtime. female or a male. Gender Role - Physical attributes pertaining to a - Learned behaviors in given society or person’s body contours. community of social groups  - Influences by perceptions and Discrimination Against Women expectations. (CEDAW), which it signed on July 15, - Arising from cultural, economic, 1980 and ratified on August 05, 1981, environmental, social, and religious is obligated to pursue and implement factors. programs, projects and activities that will contribute to the achievement of women’s empowerment and gender Men Women equality. Leader Cooking - Know as the international bill of rights of women, the CEDAW was adopted Providing Child Care by the UN General Assembly in 1979 income for the and entered into force as an family International Treaty on September 03., Housekeeping 1981, consisting of PREAMBLE and 30 articles. It defines what constitutes discrimination against women and sets Legal Basis For Gender and Development up an agenda for national action to end such discrimination. CHED MEMORANDUM ORDER NO. 1 - The CEDAW defines discrimination SERIES OF 2015 against women as “any distinction, - Establishing the policies and exclusion or restriction made of the guidelines on GAD in the CHED and basis of sex which has the effect or Higher Education Institutions (HEIS) purpose of impairing or nullifying the specifies the oversight and monitoring recognition, enjoyment or exercise by functions of CHED to recognize and women, irrespective of their marital assess GRCS among HEIS with status, on a basis of equality of men expertise in GAD. and women, of human rights and Purpose of the Memorandum fundamental freedoms in the political, - The purpose of this is to establish economic, socio-cultural, civil or any policies and guidelines on Gender and other field.” (CEDAW PART 1, Development (GAD) in the CHED and ARTICLE 1) HEIS. The Memorandum aims to GENDER promote gender equality and to The Basics mainstream gender perspectives in all - The word “trans” come from a Latin aspects of higher education. word meaning “across” Rationale and Mandates - “Transgender means “across gender”. - The Philippine being a state party to The use of “trans” as an umbrella term the United Nations (UN) Convention to describe those who identify differs on the Elimination of all forms of  somehow from the gender they were - It is not outwardly visible compared to given birth to.. gender expression. - The word “cis” comes from a Latin - It aligns with the sex assigned at birth word meaning “the same side” but transgender people, it differs in Cisgender varying degrees from the sex assigned - used to describe someone who’s at birth. gender has not changed from the one Gender Expression they were given birth to. - How a person presents their gender Gender Binary outwardly, through behavior, clothing, - “Binary” comes from a latin word voice or other perceived “consisting of two” characteristics. - Referring to the common categories of - Feminine or masculine gender: man and woman. Agender Gender Spectrum and non- binary - Describes a person who does not - Gender is a spectrum with male and identify as any gender. female at either end. Gender-expansive Non-Binary - Describe when someone with a more - Describe when their gender falls flexible gender identity than might be outside the gender binary system. associated with a typical gender - Have gender identity crisis binary. Gender Socialization Gender transition - The process through which a culture’s - A process a person may take to bring gender-related rules, norms, and themselves and/or their bodies into expectations are learnt. alignment with their gender identity. - Thought that children are aware of Gender Bias their gender at the age of 3- before - Often form of unconscious or implicit they came to recognize any other type bias of group they belong to. - Happens when someone - Through this, people will develop their unintentionally attributes certain own beliefs about gender and attitudes and stereotypes to someone ultimately form from their gender. else. Agents of Gender Socialization - Results in sexism and can create Parent Socialization structural barriers that perpetuate Peer Socialization workplace under gender inequality. School Socialization Gender Discrimination Media Socialization - Any exclusion or restriction made on Gender Identity the basis of gender that creates - One’s own internal sense of self and barriers for girls, boys, women, and/or their gender.  men in recognizing their full and equal social location and different gender human rights. roles. Gender Inequality Gender Responsiveness - The discrimination on the basis of sex - Recognizing and accounting for the or gender causing one sex or gender important differences between men to be routinely privileged or prioritized and women in psychological over another. development , socialization, culture, Gender equality exposure to trauma and life - A fundamental human right. experiences. Inequities - providing solutions on most Principles needed. 1. Go beyond featuring women. 2. Ensure fair visibility for men and RA 9710 or Magna Carta of Women women. - Fulfills the commitment of the 3. Don’t diminish women’s contributions government to the Convention on the 4. Don’t reinforce gender stereotypes Elimination of all forms of 5. Portray Diversity Discrimination Against Women 6. Use gender-responsive language (CEDAW) which the Philippines ratified 7. Don’t victimize in 1981. 8. Don’t patronize - This act categorically defines 9. Present facts, not judgements discrimination against women. 10. Be open 1987 Constitution of the Republic of the Philippines Culture in Health Care The principle of equality between and INTRODUCTION ON HISTORICAL AND women is ensured in the Philippine FOUNDATIONS OF TRANSCULTURAL Constitution to with: NURSING States recognize the female role of women in nation building and shall CULTURE IN NURSING ensure the fundamental equality Culture is defined as the totality of socially before the law of women and men. transmitted behavior patterns, arts, beliefs, Causes of Gender Inequality is the Gender values, customs, lifeways, and all other Prejudice that begins in childhood. The Effect products of human work and thought of gender inequality is to face discrimination. characteristics of a population of people that guide their worldview and decision making. Gender Sensitivity - The ability to recognize gender issues, IMPORTANT TERMS RELATED TO women’s different perceptions and CULTURE interests arising from their different Attitude is a state of mind or feeling about some aspect of a culture. Attitudes are learned; for example, some people think that on how to deal with patients of different one culture is better than another. culture and cultural background. A Belief is something that is accepted as true, In her classic, groundbreaking book titled especially as a tenet or a body of tenets "Nursing and Anthropology: Two Worlds to accepted by people in an ethnocultural group. Blend,"Leininger (1970) analyzed the ways in ldeology consists of the thoughts and beliefs which the fields of anthropology and nursing that reflect the social needs and aspirations of are interwoven and interconnected. an individual or an ethnocultural group. Cultural knowledge is all we know that Transcultural Nursing is a humanistic and characterizes a particular culture. It can scientific study and practice that focuses on include descriptions such as those known as how patterns of behavior in health, illness, cultural dimensions and can also include other and caring are influenced by the values and information that may explain why people beliefs of specific cultural groups. it applies conduct themselves in a particular way. this knowledge in the planning and provision Cultural awareness has to do with an of culturally appropriate care. appreciation of the external signs of diversity, such as the arts, music, dress, foods, and TCN is sometimes used interchangeably with physical characteristics. cross-cultural, intercultural, and multicultural Cultural sensitivity has to do with personal nursing. attitudes and not saying things that might be offensive to someone from a cultural or ethnic HISTORY background different from that of the health The foundations of transcultural care provider's cultural or ethnic background. nursing were laid in the mid-1950s. Peplau Cultural competence in health care is having first mentioned in 1950 that the cultures were the knowledge, abilities, and skills to deliver an important variable affecting mental health. care more congruent with the patient's cultural The growing interest in Leininger's beliefs and practices. Increasing one's transcultural nursing model has begun with consciousness of cultural diversity improves population changes and migration. Leininger the possibilities for health-care practitioners to tried to promote transcultural nursing provide culturally competent care. movements. Much more attention was paid to the TRANSCULTURAL NURSING (NATURE) care of individuals from different cultures in the 1960s. Since the 1960s, nurses have MADELEINE LEININGER (July 13, 1925- been carrying out studies aimed at providing August 10, 2012) was an internationally particularly cultural care to people from all known educator, author, theorist, communities/cultures. In 1962, King stated administrator, researcher, consultant, public that psychopathological behaviors differ from speaker, and the developer of the concept of culture to culture. transcultural nursing that has a great impact  In 1969, the International Council of RATIONALE FOR CULTURALLY Nursing (1CN) began using cultural content in COMPETENT CARE nursing. The Transcultural Nursing Society Multiple factors are converging at this (TCNS) was established in 1974 to train time in history to heighten societal nurses in this area. This organization aims to awareness of cultural similarities and provide the nurses and other health care differences among people. In many professionals with the basic knowledge parts of the world, there is growing necessary to develop cultural skills in awareness of social injustice for culturally sensitive practice, education, people from diverse backgrounds and research and management. the moral imperative to safeguard the Since 1989, "Journal of Transcultural civil and health care rights of Nursing" has been published, aiming to train vulnerable populations. nurses about transcultural care and improve Immigration and migration result in their practice. Evidence-based studies have growing numbers of immigrants, been conducted in this area. Today, there are people who move from one country or about 25 books and over 800 articles covering region to another for economic, research, theory and applications related to political, religious, social, and personal transcultural nursing. reasons. This is a promising field of study with Health workers respond to global which Turkish nurses have recently started to health care needs become familiar. Now that globalization is Responds to natural and human-made inevitable, studies on transcultural care disasters around the world and provide practices will broaden the horizons of Turkish care for refugees nurses and others all around the world. expected to demonstrate effective Cross-cultural communication and In addition to Leininger,a pioneer model of deliver culturally congruent and transcultural nursing many nurses worked in culturally competent nursing care to the field of cultural care including Boyle, people from diverse countries and Campinha-Bacote, Yahle Langenkamp, Giger cultures. and Davidhizar, Juntunen, Leuning. Swiggum Interprofessional collaborative practice et al., Purnell, Ryan, Carlton and Ali. refers to multiple health providers from Among these, there are researchers arguing different professional backgrounds that the models and theories of two modelists working together with patients, (Giger and Davidhizar and Purnell) who do families, caregivers, and communities myriads of studies on cultural care are to deliver the highest quality care extremely simple, comprehensible and (World Health Organization WHO, suitable for use in many different fields and 2010), cultures. WHAT HEALTH PROFESSIONALS CAN DO?  enjoyment of the highest attainable standard The following suggestions may help you care of health is one of the fundamental rights of for and communicate with patients every human being, without distinction of Consider how your own cultural beliefs race, religion, political beliefs or economic and values and behaviors may affect social conditions. “ (WHO, 1948) interactions with patients Respect, understand and work with Physical differing cultural perceptions of Manifests physical abnormalities but effective or appropriate treatment do not feel ill Recognize that families may use Does not demonstrate any physical complementary and alternative changes but may feel ill therapies, For appropriate, specific Mental conditions, remind them that Candidates for Maintain psychiatric complementary and alternative examination and possible treatment of medicine use can delay biomedical but nevertheless, are able to live well testing or treatment and potentially in their community and do not see the cause harm. need to ask nor receive medical and Try to locate the patient. Assess their Psychiatric care. support system, What are their Maintain optimal level of functioning language skills? Social Negotiate a treatment plan based on Diagnosed with disease yet shared understanding and agreement. Cxperience no problems in performing Find out whether a patient or family their task would benefit from spoken or visual Illness messaging for reasons of culture or A condition of being unhealthy in your body or limited literacy. mind; a condition in which the body or mind is Where needed, arrange for an harmed because an organ or part 1s unable appropriate interpreter. to work as it usually does a disease or Listen carefully to your patients and sickness. Illness can be a perceived notion of confirm that you have understood their unwellness or derive from self-diagnosis. messages. Causes: Make sure you understand how the Supernatural Causes - Gods and patient understands his or her own malevolent spirits Displeasing divine health or illness. beings. Imbalance of Humors - Health and Illness Blood - Source of energy of "Health is a state of complete physical, social, body and soul. and mental well-being and not merely the Yellow Bile - Emotional absence of disease or infirmity. The Irregularities  Black Bile - Cancer God, in which the patient, family Phlegm- Associated with the brain members and even the physician Miasma Theory ( "bad air" ) - Noxious should not interfere. vapors emanating from decaying Conceding to the wishes of the organic matter collective (Pakikisama) to maintain Astrological Influences - Celestial group harmony body influence human health CULTURAL INFLUENCE ON CULTURE ON PERCEPTION OF ILLNESS PRESENTATION OF AND REACTION TO AND PRESENTATION OF SYMPTOMS PAIN RESPONSE TO ILLNESS Culture and Pain Filipino older adults tend to cope with Culture plays an important role in the way we illness with the help of family and experience, and express, pain. friends, and by faith in God. Complete cure or even the slightest PAIN AS SACRIFICE improvement in a malady or illness is In terms of religion, Catholicism in viewed as a miracle. particular (which is the major religion Filipino older adults tend tò manage in the Philippines), emphasizes pain their illnesses by self-monítoring of as sacrifice. symptoms, ascertaining the possible The panata, where we negotiate for a causes, determining the severity and favor (including healing for oneself or a threat to functional capacity, and close relative), often involves an offer considering the financial and of pain, whether through a pilgrimage. emotional burden to the family. These Filipino beliefs and practices also include refusing to take pain COPING STYLES medications, or on their own will Coping styles common among elderly FIlipino reduce the dose, because they want to in times of illness or crisis include: offer their pain. Patience and Endurance (Tiyaga): the ability to tolerate uncertain situations PAIN AS A RESPONSE Flexibility (Lakas ng Loob): being Patient's will often express their pain through respectful and honest with oneself groans that often turn into wails. Humor (Tatawanan ang problema); the capacity to laugh at oneself in times of CULTURAL INFLUENCE ON THE adversity EPIDEMIOLOGY OF DISEASE Fatalistic Resignation (Bahala Na): the view that illness and suffering are the FILIPINO TRADITIONS THAT AFFECT unavoidable and predestined will of HEALTH DIETARY PATTERNS  The “Bahala Na” Mentality It is believed that fulfilling these - the bahala na mentality can cravings will promote the health of the extend to how we eat or plan mother and the baby. our meals Traditional Filipino medicine also plays - The result: not being fully in a role in pregnancy and childbirth. control of what goes inside Traditional healers, known as "hilot," your body. may be consulted for THE I-E-EXERCISE KO NALANG" pregnancy-related concerns. EXCUSE to give birth at home with the - The quality of food matters if assistance of traditional birth you want to stay healthy. attendants, while others may prefer to - Make sure you are eating give birth in a hospital setting with the healthy food and exercise only assistance of medical professionals. to complement your food CONTRACEPTIVE PATTERN intake. The Philippines is a predominantly THE KAILANGAN NG PANULAK Catholic country with deeply ingrained PROBLEM religious and cultural values that - The incessant need to pair the influence people's attitudes towards meals with sugary beverages contraception. THE AYOKO NG RICE LIFE The country's high fertility rate and THE MAG-DI-DIET NALANG AKO high incidence of unintended ULIT CYCLE pregnancies have led to a greater - Filipinos are prone to yo-yo awareness of the importance of family dieting putting the body planning and contraception. through cycles of feast and Filipino cultural influence on famine. contraceptive pattern is primarily SABI SA TV, HEALTHY YAN ISSUE characterized by a preference for - Most Filipinos are still slaves to natural methods such as withdrawal, marketing claims. fertility awareness methods, and - People must learn to read breastfeeding as a means of spacing labels and figure out the truth births PREGNANCY AND CHILDBIRTH This preference for natural methods is Pregnancy is viewed as a family affair, and rooted in cultural beliefs that see the family members are expected to provide use of artificial contraception as a support and assistance throughout the violation of the natural order of things pregnancy and childbirth process. HOUSING ARRANGEMENT the traditional concept of "paglilihi," The prevalence of extended families which refers to the cravings or desires living together in one household, as of the pregnant woman. well as the importance placed on  communal living spaces, can increase increased risk of depression and the risk of infectious disease anxiety. transmission within households and HEALTH TRADITIONS MODELS communities. Rooted in cultural values and beliefs The prevalence of informal Practices related to health settlements, such as slums and Physical, Mental, Emotional, and shantytowns, in urban areas of the Social Aspects Philippines can exacerbate the risk of Emphasize prevention, balance, and disease transmission. harmony in oneself The emphasis on communal living Often used alongside or integrated spaces can promote social support with Modern Medical practices and provide opportunities for health Biomedical Model education and promotion. Based on principles of evidence-based MARRIAGE AND KINSHIP medicine. The provision of healthcare services, Diagnosis and treatment through with family members often being the pharmaceuticals, surgery, and other primary caregivers for sick relatives. medical interventions. CHILD REARING PRACTICES Health as physical absence of Filipino cultural influence on child disease. rearing practices is characterized by Utilized by assessing symptoms, strong emphasis on respect, discipline, medical history, díagnostics, and and the importance of family values. formulating treatment plans. BODILY IMAGE ALTERATIONS Traditional Chinese Medicine (TCM) ACCULTURATION Concept of Q1/Chi Vital force of life Acculturation is a process that can be surges in the body. influenced by various factors, including Illness is caused by imbalances of age of migration, length of residence in Q1/Chi the is composed of alternating a new country, social support forces of Yin and Yang networks, and exposure to and Yin and Yang - opposing forces that engagement with the dominant culture. exist in all aspects of Life The process of acculturation can lead TCM aims to restore balance between to changes in health behaviors, such health and diseases. as changes in diet and physical Internal body organs and External activity, that can contribute to the environment development of chronic diseases. Acupuncture, Moxibustion Massage, Acculturation can also lead to changes Movement and Concentration in mental health outcomes, such as Exercíse (Tai Chi) Acupuncture Traditional Herbal Medicine (Hilot) Insertion of thin needles into specific - massage, herbal remedies, points on the body stimulate energy and spiritual rituals ow and restore balance within the - medicinal plant and body's system bulong/orasyon whispered or Restore proper flow of Qi/Chi written prayers. Pain Management, Musculoskeletal, - National Certification Digestive, Respiratory, Stress and Committee for Hilot (NCCH) Insomnia - Traditional and Alternative Complementary therapy alongside Medicine Act (RA 8423) conventional Medical treatment. integrate alternative health care into the National Ayurveda Healthcare Delivery System Individual's Constitution or Prakriti Traditional Birth Attendants Vata - Movement - Support women during Pitta pregnancy Metabolism/Digestion Kapha- Structure - Communities where access to Stability - Lubrication of the body professional medical care is Diet (food affects 3 doshas) limited Therapies and Treatment - massage. herbal - Cultural knowledge - steams etc. understanding of local Yoga and Medication - improve flexibility and customs, beliefs, and calm the mind traditional birthing practices. Naturopathy - Knowledge on Traditional Combines natural healing techniques with Remedies (Massage, modern Manipulation, Cord Cutting, scientific knowledge. and Care Principles Arbularyo/Albularyo Healing of Nature - A traditional healer in the Treating the Cause not the Symptom Philippines who uses a Do No Harm combination of herbal Treat the whole person medicine, spiritual practices, Educate and Empower and folk remedies to address Indigenous Healing Traditions various ailments. UNIQUE HEALING TRADITIONS BASED Traditional Medicine Systems ON INDIGENOUS CULTURES AROUND Traditional Nutrition and Dietary THE WORLD. Practices - The concept of “pagkain ng IN THE PHILIPPINES: gulay at prutas”  - Dietary remedy practices by Continuous Learning and Mental Filipinos Stimulation - Foods have healing properties often used to address common Communication ailments or promote general - Any means of exchanging thoughts, well-being. feelings and other information between - Fermented Foods promotes two or more people. gut health and aid digestion - The intent of any communication is to (Beresford et al. 2022) elicit a response. - Bitter melon has medicinal properties associated with Two main purposes of therapeutic several health conditions. communication: - Food sharing and Community 1. To influence others meals fosters social 2. To obtain information connections and promotes a sense of belonging. Components of Communication "Bentusa" or "Cupping” 1. Sender - initiate the process of - placing heated cups onto the communication by generating a skin to create suction, message who wishes to convey a promoting blood flow and message to another. easing muscle pain or 2. Referent - motivates one person to congestion. communicate with another. These are cues that initiate communication like Healthy Lifestyle sight, sounds, colors, time, schedules, - encompasses a range of practices and object, emotions, etc. choices that contributes to overall 3. Encoding - involves the selection of well-being and promotes optimal specific signs or symbols (codes) to physical, mental and social health. transmit the message such as which Adopting a healthy lifestyle is crucial language & words to use, tone & for preventing various health issues gestures of the voice, etc… and improving the quality of life. 4. Message - derives from the sender's internal and external experiences. It is Elements of Healthy Lifestyle what is actually said or written, the Balanced Nutrition body language that accompanies the Regular Physical Activity words. Adequate Sleep 5. Channel - the medium through which Stress Management the sender transmit the message Personal Hygiene Visual Channel - visual clue Mindful Technology Use that may support, contradict, or  disguise the verbal message 2. Intrapersonal Communication- the (facial expression) interaction that occurs between two Auditory Channel - spoken people or with a small group. words and other verbal cues 3. Public communication - the interaction Kinesthetic Channel - physical of one individual with a large group of sensations mediated by touch. people. 6. Receiver (decoder) - individual who Cohesiveness - bonding receives and interprets the message between two members of the from the sender. group. Decode - to relate the message Group Dynamics - the study of perceived to the receiver's events that occur in the context storehouse of knowledge and of group interactions. experience and to sort out the meaning of the message. Verbal Communication 7. Response (feedback) - the receiver's - Uses spoken or written word reaction to the sender's message. Environment - the physical and CRITERIA FOR VERBAL COMMUNICATION emotional climate in which the 1. Pacing - talking rapidly, using awkward interaction takes place. pauses, or speaking slowly and deliberately conveys an unintended Characteristics of Effective Feedback message. Long pauses and a rapid Specific rather than general shift to another subject give the Descriptive impression that you are hiding the Provided in a supportive truth. non-threatening manner. 2. Intonation - tone of the voice Give in a timely manner dramatically affects a message's Practical and appropriate for the meaning and emotions directly individual client influences tone of voice. Clear and unambiguous 3. Clarity & Brevity - a message that is Direct and honest direct and simple will be more effective. Avoid using phrases such as 3 Different Kinds of Communication " you know " 1. Interpersonal Communication - a 4. Simplicity - includes the use of powerful form of communication that commonly understood words. occurs within an individual. Also called 5. Personal appearance - physical self talk, self-verbalization, and inner characteristics, manner of dress and thought. grooming, and jewelry are indicators of well-being, How a person dresses is  often an indicator of how the person midwife-client relationship, but it must feels. be used with care. 6. Artifact - items in the client's environment, grooming, clothing, Non- Verbal Communication jewelry that may convey important - also called body language. It conveys nonverbal messages. meaning in human communication. 7. Posture and Gait - the way people Perhaps the majority of walk and carry themselves are often communication occurs via nonverbal reliable indicators of self-concept, messages. current mood and health. (ex. Erect posture & active suggest feeling well) CRITERIA FOR NON-VERBAL 8. Jargon Technical - language that may COMMUNICATION be perfectly appropriate when 1. Gestures - a salute, a thumbs-up, and communicating with other care a tapping foot are types of gestures. providers, but is confusing and 2. Territoriality & personal space - is a potentially frightening to the client. concept of the space and the things 9. Timing and relevance - this involves that an individual considers as sensitivity to the client's needs and belonging to the self which is concerns. (es. Do not begin teaching separated and made visible to others. when the patient is in pain. Do not ask 3. Personal space - is invisible, questions at once. individual, and travels with person 10. Adaptability - spoken messages need to be altered/adjusted in accordance FACTORS INFLUENCING THE with behavioral cues from the client. ( COMMUNICATION PROCESS ex. A Midwife who usually smiles, Development- Knowledge of a client's appears cheerful, greets his client Hi, developmental stage will allow the Mrs. Norman!," notices that the client midwife to modify the message is not Smiling and appears distressed. accordingly. It is important for the Midwife to then Gender- This difference makes the modify his tone of speech and express same communication be interpreted concern in her facial expression. differently by a man and a woman. 11. Credibility - means worthiness of Values - are the standards that belief, trustworthiness, reliability. It influence behavior. may be the most important criterion of Perceptions- are the personal view of effective communícatíon. Midwives an event. An individual's subjective foster credibility by being consistent, sense of the world around her or him. dependable, and honest. (es. A midwife draws the curtain around a 12. Humor - the use of humor can be a crying woman and leaves her alone). Why do positive and powerful tool in the you think the midwife did that? The midwife thinks that I may upset others so Respect- is an attitude that she draws the curtain. Or The midwife emphasizes the other person's worth respects my need to be alone. and individuality. Roles and Relationships - the nature Acceptance- the midwife willingly of relationship between the receives the clients honest feelings. participants. Touch - is a powerful vehicle for Personal space - is the distance communication, and is arguably people prefer in interactions with underutilized in today's modern world, others which is invisible and travels where machines and medications are with the person. the order of the day. Touch can be Proxemics - is the study of distance used to soothe, comfort and establish between people in their interactions. rapport and therapeutic bond between Territoriality- concept of the space and midwife and client. things that an individual considers as Touching someone is an old age belonging to the self; human tendency demonstration of caring, as in case to claim territory must be recognized. when a midwife holds a client's hands Roles and relationship - the roles and during labor, painful procedure or relationship between the sender and when delivering the baby. the receivers affect content and Touch can also be perceived as responses in the communication intrusive or hostile. process. Environment - people usually 3 DIFFERENT KINDS OF SPACE/ communicate most effective in a DISTANCE comfortable environment. 2. 1. Intimate distance - is characterized by Congruence- the verbal and nonverbal body contact, heightened sensations aspects of the message match. of body heat and smell, and Interpersonal attitudes - attitudes vocalizations. Vision is intense, convey beliefs, thoughts, feelings restricted to a small body part, and about people and Events. maybe distorted. Caring and Warmth - convey a feeling 2. Personal distance - is less of emotional closeness. overwhelming that intimate distance. Caring - conveys deep and genuine Voice tones are moderate, body heat concern for the person and involves and smell are noticed less. More of the giving feelings, thoughts, skills and person is perceived at this distance so knowledge, more intense than warmth. less distortions on facial and body Warmth- conveys friendliness and expressions. consideration as shown by acts of 3. Social distance - is characterized by smiling and attention 7 to phỳ'sical clear visual perception of the whole comforts. person. Body heat and odor are  imperceptible, eye contact is show the client's needs in mind. The increased, and vocalizations are loud client must be assured of enough to be overheard by others. It is confidentiality in order to feel safe in more formal. sharing information of a very private 4. Public distance - Requires loud, clear nature. vocalizations with careful enunciation. 2. Setting the Stage - the stage for Although faces and forms of people therapeutic communication is are seen at public distance, important. Establishing an appropriate individuality is lost. time and place, the midwife should introduce him/herself and clarify the THERAPEUTIC COMMUNICATION purpose of interaction and the Therapeutic Communication - using expected duration. Setting the stage in communication for the purpose of this vay allows the client to begin the creating a beneficial outcome for the interaction on a more equal footing client; the hallımark of the with the midwife; each knows who the midwife-client relationship other is, as well as how long they will Therapeutic Relationship - a be there. relationship established by the midwife 3. Accepting the client - accepting the that benefits the client's health status, client "as is" is important in therapeutic also called as helping relationship, communication. A judgmental interpersonal relationship, midwife- approach to any interactions will limit client relationship the ability for mutual understanding. It Aphasia - absence or impairment of is essential for every midwife to remain the ability to communicate through aware of his/her biases and to speech, writing, or signs because of approach each client from a brain dysfunction; considered prospective acceptance. Often it is complete or total when both sensory difficult for midwives to understand and motor areas are involved. why, especially when this behavior endangers the clients health. PRINCIPLES OF THERAPEUTIC 4. Active listening - a method of listening COMMUNICATION where you reflect back your understanding of what a person says 1. Time and Place - are important to you: More important, active listening elements of therapeutic communicates your acceptance of the communication. Not only the amount person's thoughts and emotions. of time the midwife spends with each client, but also the timing of PHASES OF THERAPEUTIC interaction. Taking into consideration RELATIONSHIP the timing of the interaction will also  1. Pre-interaction phase - is similar to the Confrontation planning stage before an interview. b. Facilitating and taking actions The midwife collects information - The client must make decisions before the first face-to-face meeting and take action to be more such as the client's name, address, effective age, medical history, etc. 4. Termination Phase - if often expected to be 2. Introductory phase - also referred to as difficult and filled with ambivalence. the orientation phase or the pre Methods: helping phase, is important because it - Summarizing or reviewing the process sets the tone for the rest of the can produce a sense of relationship. accomplishment a. opening the relationship - Referrals are necessary in some b. clarifying the problems situations s Follow-up phone calls or c. Structuring & formulating the e-mails contract DEVELOPING HELPING RELATIONSHIP At the end of introductory phase, the client 1. Listen actively should begin to: 2. Help to identify what the person is Develop trust in the midwife. feeling View the midwife competent 3. Put yourself in the other person's professional shoes (empathize) Believe that the midwife will respect 4. Be honest client confidentiality 5. Be Genuine and Credible Understand the purpose of the 6. Use your ingenuity relationship and the roles 7. Be aware of cultural differences that Feel that they are active participants in may affect the meaning and the plan. understanding 8. Maintain client confidentiality 3. Working phase - the Midwife & the client 9. Know your role and your limitations begin to view each other as unique individuals, appreciate this uniqueness and LISTENING AND RESPONDING care about each other. S - sit facing the patients a. Exploring & understanding B. O - offer an open posture Facilitating and taking actions L - lean toward the patient Skills required: E - establish and maintain intermittent eye Empathy contact Respect R - Relax Genuineness Concreteness  COMMUNICATION WITH PEOPLE WHO This is disastrous if you're in a HAS DISABILITIES customer facing role. Physically Challenge - remember that the By responding well to angry people, person's personal space can include the you can build a positive relationship wheelchair and crutches. with them, and you'll experience less Do not touch or push a person's stress and unhappiness as a result of wheelchair or move their crutches or dealing with them. walking stick without their permission. When speaking with a person who COMMUNICATING WITH PEOPLE WITH uses a wheelchair, try to find VISION IMPAIRMENT something to sit on in order to be at eye level with them. When you meet people who have a vision impairment, always address GENERAL TIPS FOR COMMUNICATING them by name and introduce yourself WITH PEOPLE WITH A DISABILITY by name. Speak clearly and in a Speak to a person with a disability as normal voice you would speak to anyone else. Remember that people with a vision Speak in an age-appropriate tone. impairment cannot rely on the visual Treat adults as adults. cues as people who do not have a If a person with disability is vision impairment. Make sure you accompanied by another person such verbalize any thought or feelings. as a carer, address your question If a person is accompanied by a guide directly to the persons with disability. dog, do not pet it, feed it or otherwise Put the person first, not their disability. distract it while it is in a harness. A dog (ex. Use the term a person with in a harness is working. disability rather that a disabled person Try to avoid negative phrases such as COMMUNICATING WITH PEOPLE WITH "suffers from"' and "crippled'". Use the HEARING IMPAIRMENT phrase "people who use a wheelchair" Gain the person's attention before rather than wheelchair bound". speaking, Try a gentle tap on the shoulder, a wave or some other visual COMMUNICATION WITH PEOPLE WHO signal to gain attention. ARE AGGRESSIVE/ ANGRY PERSON: Face the person directly and maintain You can calm them down, so that they cyc contact don't take any actions that harm you or Make sure your mouth is visible. others either physically or emotionally. Remember do not cover your mouth If you respond angrily to someone with your hands or any object while ełse's anger, you can easily end up talking, being seen as the aggressor yourself.  Look directly at the person while 5. Understand that the respect/or the speaking and speak evenly, not too client and communicated needs is fast or slow. Don't exaggerate your contrary to the therapeutic mouth movements, as this will make it relationship. more difficult to lip-read 6. Communicative in a nonthreatening Use short sentence manner. Keep your volume up and natural, But 7. Use validating techniques in don't shout. communication. COMMUNICATING WITH PEOPLE WITH AN 8. Be considerate of reluctance to talk INTELLECTUAL DISABILITY/COGNITIVELY when the subject involves sexual CHALLENGE matters. Before talking ensure you have a 9. Adopt special approaches when the person's attention. Try using their patient speaks a different language. name or eye contact to make sure you 10. Use interpreters to improve have their attention. communication. Keep your question simple and your answer easy to understand. PASSIVE- AGGRESSIVE ANGER IS Remember that your body language is COMMON IN THE WORKPLACE, AND SIGN important, as people with an OF IT INCLUDE THE FOLLOWING: intellectual disability often rely on Pretending not to hear or understand visual cues requests. Avoiding involvement, or Be prepared to use visual information acting "distantly" or to receive visual information from Spreading gossip or rumors or telling people with an intellectual disability. hurtful jokes to retaliate. Be specific and direct. Avoid talking Obsessing using abstracts, acronyms, metaphors Sulking or withdrawing or puns. Engaging in self-defeating behaviors, or setting others up for failure GENERAL GUIDELINES FOR Behaving secretively TRANSCULTURAL THERAPEUTIC Ignoring others COMMUNICATION Demonstrating an "angry smile” 1. Assess personal beliefs of culturally diverse STRATEGIES FOR DEALING WITH ANGRY 2. Assess communication variables from PEOPLE a cultural perspective. It's useful to know how to calm angry people 3. Plan care based on communication down. When you can defuse someone's needs an arid culture background. anger, it can enhance your professional 4. Modify communication approaches to reputation, and it can help you deal with meet cultural needs. people who struggle to manage their important to communicate on how you emotions. feel during that time. 1. Stay safe and involve others - if you GENERAL GUIDELINES FOR feel threatened by an angry person, TRANSCULTURAL THERAPEUTIC trust your judgment. Leave the room COMMUNICATION immediately if you feel unsafe. 1. Assess personal beliefs of culturally 2. Don't respond with anger - do your diverse best to respond calmly and intelligently 2. Assess communication variables from when facing angry people. a cultural perspective. 3. Distance yourself emotionally - 3. Plan care based on communication sometimes another person's anger has needs an arid culture background. nothing to do with you. It can have a 4. Modify communication approaches to major influence on how you cope in meet cultural needs. situations. 5. Understand that the respect/or the 4. Identify the cause- you need to identify client and communicated needs is why the person you're dealing with contrary to the therapeutic feels angry, relationship. 5. Pursue solutions and ideally 6. Communicative in a nonthreatening apologize- once you understand the manner. situation try to avoid making excuses 7. Use validating techniques in or dependıng your actions. Instead try communication. to ask what you can do to resolve the 8. Be considerate of reluctance to talk issue. when the subject involves sexual 6. Distract them- one way to defuse a matters. person's anger is to focus his attention 9. Adopt special approaches when the to something else. patient speaks a different language. 7. Help them control their Anger- angry 10. Use interpreters to improve outbursts from someone on your team communication. can affect the whole group's productivity and morale. Standard Precautions 8. Practice Defusing Anger- use Elements of Standard Precaution roleplaying so that team members can 1. Hand Hygiene practice dealıng with angry and upset 2. Gown customers, 3. Mask 9. Communicate how you feel- you may 4. Face Protection work with a patient who frequently 5. Gloves experiences angry outbursts. If so, 6. Safe injection practices once the anger has passed, it's 7. Patient Care Equipment  8. Environmental Control They are the basic level of infection 9. Textile and laundry control precaution. 10. Worker Safety Hospital Infection is the result of a 11. Patient Placement and Transport combination of factors: Microbial 12. Respiratory Hygiene/ Cough Etiquette source + Transmission + Susceptible 13. Infection Control Patient Care host = Infection Practices for Lumbar Puncture History of Infection Control Precautions What are Universal Precautions Year Infection Control Precautions Universal precaution are control guidelines designed to 1877, Separates facilities, Antisepsis protect workers from exposure to diseases 1910 and disinfections spread by blood and other Body fluids. 1985 UNIVERSAL PRECAUTIONS (guidelines for protecting Universal Precautions healthcare worker because the Applied universally in caring for all emergence of HIV and other patients bloodborne pathogen) Hand washing Decontamination of equipment and 1987 BODY SUBSTANCE devices ISOLATION ( focused on Use and disposal of needles and protecting patients and health sharps safely (no recapping) personnel from all moist body Wearing protective items fluids not just blood: semen, Prompt cleaning up of blood and body vaginal secretions, wound fluid spills. drainage, sputum, saliva, etc. Systems for safe collection of waste 1996 STANDARD PRECAUTIONS: and disposal two level approach: (1) Standard Why Universal Precautions Precaution which apply to all Any unsafe contact can pass on the clients and patients attending infections and lead to dangeroUs diseases healthcare facilities. Standard Precautions (2) Transmission-based Previously known by various names Precautions which apply only to including "universal precautions" hospitalized patients. Standard precautions are designed to reduce the risk of transmission of 2007 ISOLATION PRECAUTIONS bloodborne and other pathogens from (new pathogens, SARS, Avian both recognized and unrecognized Influenzae HSN1, H1N1) sources to a susceptible host. Why Universal Health Precautions. Washing with simple toilet soap - The concept of Universal Health Precautions reduces the rate of transmission of emphasizes that all our patients should be common infections including HIV. treated as though they have potential bloodborne infections, and can infect the Indications for Hand Washing caring health care workers. ( CDC) In prolonged contact with patients. Before taking care of Human materials/Tissues considered Highly Immunosuppressed, Newborn infants, Infectious patients in ICU /ICCU, Dialysis Units, Blood Burn's Units. Semen Before and after touching wounds. Vaginal secretions Microbial contamination of Hands, 4CSF likely to occur when in contact with 5 Synovial fluids mucous membranes, body fluids, and 6 Amniotic fluid other secretions contaminated with 7 All other body fluids Blood, and serous fluids. Not Infectious unless contaminated with Blood Use of Gloves or Body fluids. Use of a pair of disposable plastic gloves can Feces, protect if chances of contact with Blood or Nasal secretions, Body fluid is anticipated/inevitable. Sputum, Sweat, Use of Mask, Cap, Eye Wear Tears, Will certainly protect us from splashes Urine /Vomitus, of Blood or Body fluids. Saliva unless blood stained. Don't underestimate the importance of using a Cap and Mask. Hand washing is the most important method It equally protects our patients. of disease prevention. Bacteria and bacteria can be spread via dirty hands and they are Uses of Cap and Mask too small to see with the human etc. You must Stringent use of Mask and Cap can wash your hands properly in order to remove save several Lives in the Hospital them. Use of Foot wear HAND WASHING