Adjustment: An educational process referring to changes in behavior towards better

life, better relationships and better contribution to society

 
Profession: A calling by which members profess to have special knowledge by
training, by experience or both on that they may guide or advice or serve other in
that field.

CRITERIA OF A PROFESSION
 
 Mastery of the Craft- the profession must possess the necessary skills and
attitude.
 Service orientation-Hall mark of the profession
 Autonomy-reasonable independent being (self-regulated)
 Accountability-the essence of profession
 Political Power- Adhere own sets of values
 Professional Organization- Must be a member of an accredited Organization (e.g
IMAP)
 
 EVOLUTION OF MIDWIFERY IN THE
PHILIPPINES
Care of the sick in Primitive times
•Animism. Babaylan, catalonan,
•Superstitious and mystical beliefs: wind theory, natural Order and forces (mangkukulam or
manggagaway)
Spanish period
•Individual sin (Gaba or Bad Karrma), poot and Aswang
•Materia medica (MOrga. Governador-General in 1595-1596 noted used of wine as medicine:
Lambanog and Tuba)
•Fore runner of Filipino Red Cross
American Period
•Separation of Producers, distributors, and consumers of health
•Exchange calue
•Iloilo Mission Hospitals School of Nursing (1906)
Contemporary
Dr. Jose Fabella, first secretary of the department of health founded the first midwifery school in
the 1922 as a response to high infant mortality rate.
 Objectives of the First Midwifery Schools:
 Train young women to replace hilots

(traditional birth attendant)

 Train doctors and nurses for Rural

assignments and
 Provide health service and education with

emphasis on maternal and child health (MCH)

 Is the performance or offer to perform or render for a fee, salary, or
other reward or compensation of service recurring an understanding of
the principles and application of procedures and techniques in the
supervision of and care of women during pregnancy, delivery and
puerperium.
 Management of Normal Delivery
 Performance of Internal examination during Labor, except when patient
has antenatal bleeding.
 Health education of patient family and community, including nutrition
and family Planning
 Carrying out the written order of the physician with regards to ante-
natal, intra natal and post natal care of the normal pregnant women
 Giving Immunization
 Oral and parenteral dispensing of oxytocic after the delivery of the
placenta.
 Suturing perineal laceration to control bleeding
 Giving intravenous fluid during obstetrical emergencies provided they
were trained for that purpose
 May inject vitamin K to new born
Characteristic of Profession
 There is especial preparation and training
 With clearly defined permanent membership
 Acceptance of the service motive

Determinants of Professional Practice

 Problems and needs by the people
 Policies and regulation
 Current socio-economic political and cultural
system
Traditional Function of the Midwife (R.A No. 7392). The
Philippine Midwifery Act of 1992 provides the
midwife:

 Gives supervision care and advice to women during

pregnancy, labor and post-partum period.
 Conduct deliveries on her own responsibility
 Cares of the newborn including the detection of
abnormalities and counseling of parents or couple.
 Gives health Education
 Executive emergencies measures
 Procures medical supplies
Expanded Function of the Midwifes
 Oral and parenteral dispensing of oxytocic

drugs after delivery of the placenta

 Suturing perineal lacerations to control

bleeding
 Giving of intravenous fluids during obstetrical

emergencies
 Injecting of vitamin K. to the Newborn
  
IMAP
Brief History:
 In the 1961 two organization were founded the
Philippine Midwives association of the Philippines or the
PHIMIDAS with Atty. Angelina Fonce as first president and
the National Federation of Filipino Midwives or the NFFM
with Mrs. Leoncia Chuatoco as first president.
 
 In 1974, the two were integrated to become IMAP with Ms.
Juana Reyes as its first president. It is presently the only
professional midwives association recognized by the
Philippine Regulatory Commission (PRC)

Letter of Instruction 1980

 Compulsory membership to professional association
accredited by the professional regulations commission
Ethics – part of philosophy that deals with systematic
approaches to questions of morality.
 A term for the study of how we make judgments regarding
right and wrong.
 A system of MORAL PRINCIPLES or moral standards
governing conduct.
 
Morals- Human conduct in the application of ethics.
Concerned with JUDGMENT PRINCIPLES of right and wrong
in relation to human actions and character.

CODE OF ETHICS
 Fundamental responsibilities of midwife
 Render medical services regardless of the religious belief ,
political belief or creed
FREEDOM OF RELIGION
 No law shall be made respecting the establishment of a
religion or to prohibit the free exercise there of. The fee
exercise and enjoyment of religious profession and
worship without discrimination shall forever be allowed.
 
Two aspects of freedom of Religion
a. Freedom to Believe - Absolute
b. Freedom to Act – Relative (It must be in conformity to the
law, morals, customs and traditions)
 Render medical services on the ground medical neutrality –
don’t take the background of pt.
 Protect life and respect the dignity of man

Trained Worker
 Dignity – respect Bill of Rights
 One who perform lethal injection to the person found
guilty
1. The patient has the right to considerate and respectful care, irrespective
of socioeconomic status
2. The patient has the right to obtain from his physician complete current
information concerning his diagnosis, treatment and prognosis in terms
the patient can reasonably be expected and understand. When it is not
medically advisable to give such information to the patient, the
information should be made available to an appropriate person in his
behalf. He has the right to know by name and in person, the physician
and nurse responsible in coordinating his care.
3. The patient has the right to receive from his physician information
necessary to give informed consent prior to the start of any procedure
and/or treatment. Except in emergencies, such information for informed
consent should include but not necessarily limited to the specific
procedure and/or treatment, the medically significant risks involved, and
the probable duration of incapacitation. Where medically significant
alternatives for care or treatment exist, or when the patient requests
information concerning medical alternatives, the patient has the right to
such information. The patient has also the right to know the name of the
person responsible for the procedures and/or treatment.
4.The patient has the right to refuse
treatment/lifegiving measures, to the extent
permitted by law, and to be informed of the
medical consequences of his action.
5. The patient has the right to every consideration
of his privacy concerning his own medical care
program. Case discussion, consultation,
examination and treatment are confidential and
should be conducted discreetly. Those not
directly involved in his care must have the
permission of the patient to be present.
6. The patient has the right to expect that all
communication and records pertaining to his
care should be treated confidential.
7. The patient has the right to expect that within its capacity,
a hospital must make reasonable response to the request
of patient for services. The hospital must provide
evaluation, service and/or referral as indicated by the
urgency of care. When medically permissible a patient may
be transferred to another facility only after he has received
complete information concerning the needs and the
alternatives to such transfer. The institution to which the
patient is to be transferred must first have accepted the
patient for transfer.
8. The patient has the right to obtain information as to any
relationship of the hospital to other health care and
educational institutions in so far as his care is concerned.
The patient has the right to obtain information as to the
existence of any professional relationship among
individuals, by name, who are treating him.
9. The patient has the right to be advised if the hospital
proposes to engage in or perform human experimentation
affecting his care or treatment. The patient has the right to
refuse or participate in such research project.
10. The patient has the right to expect reasonable continuity
of care; he has the right to know in advance what
appointment times the physicians are available and where.
The patient has the right to expect that the hospital will
provide a mechanism whereby his physicians or a delegate
of the physician of the patient’s continuing health care
requirements following discharge informs him.
11. The patient has the right to examine and receive an
explanation of his bill regardless of source of payment.
12. The patient has the right to know what hospital rules
and regulations apply to his conduct as a patient.
Bill of Rights of Patients
1. Right to informed consent
2. Right to refuse and/or withdrawal from
participation or autonomy
3. Right to privacy
4. Right to confidentiality
5. Right to quality care
1. Right to Informed Consent
Conscious – all medical practice are not
authorized ŝ consent
Unconscious – all medical practice are
authorized as if consent is given to you
 
Rule in Giving Consent
 Patient her/himself
 If the Pt. is married the consent of the spouse
is not necessary, provided of sound mind and
legal age.
2. Right to Make Decisions Or Autonomy
- Right to Self Determination
- Justice Cardozo
 
“A Person who is of a sound mind and of legal
age shall have the right to determine what is
supposed to be done to his body.”
PERSONS TO MAKE DECISIONS IN CONSCIOUS PATIENT
 parents
 grandparents
◦ paternal
◦ maternal
 eldest brother/sister
 relatives/guardians
 Teachers

Telephone – overheard by two credible witnesses

 Fiancé – authorize to give consent for conscious if no
parents, grandparents, brother/sister, guardians.
Q: How do you respect the dignity of patient?
A: By respecting the bill of rights of patient.

Note:Between the conflict of pt. and doctor,

loyalty will always be on the patient
3. Right to Privacy and Confidentiality
Privacy of Communication
“It shall be inviolable except upon the lawful
order of the court and when public safety,
public health requires it.”
*Cannot be violated at all – SECRECY ACT LAW
Q: Who owns the medical chart?
A: Hospital
 
Q: Who owns the communication in the
medical chart?
A: Doctor and Patient
*Duty: Keeps in proper place (medical chart rack)
with honesty, confidentiality, and integrity

Relative Privacy Absolute Privacy

Doctor – Patient Midwife – Spouse
Midwife – Patient Midwife – lawyer
(case) Midwife – Priest
(religion)

 
Husband – wife = absolute privacy; order from
court, no order to divulge/ reveal or right not to
tell

Q: What is Privacy?
A: Privacy is any not related to health condition.
 
Q: What is Confidentiality?
A: Confidentiality is any related to health
condition.

Breach – Violation of right, e.g. breach of

confidentiality
Autonomy – “Freedom to CHOOSE”
Beneficence – “Do only what’s GOOD”, respect,
privacy
Nonmaleficience – “Do NO harm”, e.g. side rails
up
Veracity – “Tell the TRUTH”
Justice – “Be FAIR”
Fidelity – “Keep your word”, keeping promises
“LOYALTY”
MIDWIFERY ETHICS – the code governing the
NURSE’S BEHAVIOR, especially towards patients,
employing authority and to the profession.
 
Beneficence - any action that would BENEFIT
others. The principle that imposes upon the
practitioner to seek the good for the patients
under all circumstances. Beneficence connotes
positive action toward preventing or removing
harm and promoting good such as:
 One ought to prevent evil or harm
 One ought to remove evil or harm
 One ought to do or promote good.
Nonmaleficence – states the idea to REFRAIN from inflicting
harm. “one ought NOT to inflict evil or harm. The admonition
of nonmaleficence is stated in the negative manner while the
beneficence is in the positive.
 
Justice – The basic principle that deals with FAIRNESS, just
deserts, and entitlements in the distribution of goods and
services.
 
Some methods of distributing goods and services in our
society are as follows:
To each, an equal share
To each, according to need
To each, according to effort
To each, according to contribution
To each, according to merit
To each, according to ability to pay
 Autonomy - In health care, it means the form of
personal LIBERTY, where the individual is free to
choose and implement ones’ own decisions, free
from deceit, duress, constraint, or coercion.
Three Basic elements involved:
 
1.ability to decide
2.power to act upon your decisions
3.a respect for the individual autonomy of others.