Saturday, January 24, 2009

Should nurses & midwives be allowed to work as a health professional once they have committed a criminal offence?

Nine msn reported on an interesting story in Victoria, regarding nurses found guilty of serious offences. This information was found through The Freedom of Information,the offences included manslaughter, sex offences and torturing animals.
Nurses in Victoria found guilty of serious offences including manslaughter, sex offences and torturing animals have been given approval to care for sick and vulnerable patients.

Nursing authorities in Victoria have in the past three years approved registration of more than 100 nurses who had admitted being found guilty of crimes including stalking, drug trafficking, possessing child pornography and manslaughter, News Limited newspapers said.

This raises several questions, what was the crime? have they repaid society for the crime? and are they now trustworthy?

Have they by the very nature of the crime, forfeited the right to work as a nurse? one could also argue,that the nurse has bought the profession into disrepute therefore should not be allowed to work as a nurse again.
Would you like this person looking after your mother, father, son, brother etc.

Off course there is the other side of the coin - they have paid the price to society for the crime, whether it be a fine or goal time and they have proven to be trustworthy. Is it then unreasonable to allow them to work as a health professional again? However, It does seem bizarre that a nurse convicted of sex offences and torturing animals would be allowed to work as a nurse again?

Do we allow policeman who have been convicted of a crime and gaoled to be re-employed as a policeman?

What do you think? should nurses & midwives who have committed a serious criminal offence be allowed to re-register and work as a nurse?

Out of action

Well it’s that time of year as a lecturer, preparing for the new semester to begin, changing unit outlines and assessments to correlate with the student’s evaluations from the previous year. I am very excited about the semester beginning a whole new group of students all eager to share and learn experiences.

However it’s also a good time to have some urgent minor hand surgery. It really is difficult being the recipient of care especially me being Ms Independent. It’s about giving up your control, trusting and letting others do things for you and for me this is a difficult lesson. I feel sorry for my husband and family trying to keep me down – however ‘pain’ is a good indicator, it certainly makes you stop!
I am usually a touch typist, but alas now with bandaged hands I’m afraid it’s finger typing, I am grateful that I am able to do that, otherwise I think I would go nuts.
Funny enough I had not heard of Trigger Thumb until 16 weeks ago when I developed incredible pain in the soft pad and left thumb area eventually not being able to bend it or use my thumb. I wore a splint hoping that would resolve the issue, alas it only got worse, driving me to go to the doctors and the diagnosis being trigger thumb.
After being referred to a specialist, ultra sound then the cortisone injection – I would not recommend the injection, it was the most painful experience and would not do it again, especially as it only lasted six weeks. The pain was back with vengeance, now my thumb would lock at the joint and had to be manually manipulated back into place – wow the pain. To make matters worse the right thumb was following suit, it was now very painful. Both thumbs are now splinted. It's surprising how important your thumbs are, no opening bottles, jars, door handles the list is endless.
It’s time for a ‘Google’ search to see what the cause & treatment options are: causes are repetitive use, which I can’t think of anything I have done, other causes are rheumatoid arthritis, diabetes, or simply being between the ages of 50-60, damn! getting older. Also pre-disposing factors are, suffering from carpel tunnel syndrome – which I have. Women are 4 times more likely to get than men. Treatment is, splinting, steroids and surgery, once the finger starts locking.
So it was time for surgery, now I am out of action for about a week or two.

Thank goodness I can still use my fingers. I now also have time to finish my book “How are we to live” by Peter Singer. Speaking of Peter Singer he is coming to Perth Writers Festival in February.

Thursday, January 15, 2009

Baby Confiscation in Bali - Midwife in question

This is a very interesting story, one I had not thought of before. It just goes to show you that anything is possible in the name of money. We are very fortunate here in Australia.

This story was reported in the "Jakarta Post" "Baby Confiscation goes to police"

A couple whose baby was reportedly "confiscated" because they were unable to pay for its delivery have reported their midwife to the Bali Police, accusing her of human trafficking.
The couple have accused their midwife of "confiscating" their baby for financial purposes. The couple also felt that the midwife was not displaying ‘goodwill’ over the issue.
The parents could not afford to pay their bill of 1.5 million rupee (Rp) after the delivery so the father left the mother and baby at the clinic until he could return with the money to pay his debts.
He returned three weeks later with 1.Million rupee and hoped that this would be enough for his family to return home with him. However the midwife had added a further 4.5 million to the bill for expenses totaling 6 million Rp. He was forced to sign an agreement stipulating that he must leave one of his sons at the clinic to assure he would return to pay his debt or in order to be released from all his debts.

The midwife is defending the charges and disputed the amount of fees charged as only 2.5 million, and has a lawyer representing her.

The midwife is under investigation for Human Trafficking, possible adoption issues and child protection laws.
The human trafficking laws carries a penalty of between 3 and 15 years in prison and a fine of between Rp 60 million and Rp 300 million (US$27,000).

This is a sad story and certainly contravenes any Code of Ethics throughout the world.
I am thankful that I work in Australia as a midwife and do not have to deal with these issues.
What do you think?

Tuesday, January 13, 2009

Why is it so hard for Doctors to accept working in partnership with Midwives

January 10 The Australian published a story "Doctors firm against role of midwives".
We are all eagerly waiting for the release of the federal health minister Nicola Roxon's report on Maternity Services in Australia. During the process of review the obstetricians have stepped up their campaign against the MIDWIFE.
Lets look at the facts: Midwives want to look after low risk women - Midwives want to offer midwifery-led-care, which is a midwife-focused, woman-focused model of care for low-risk-women.
Women with medical problems, or in a higher risk category will see an obstetrician or the midwife will refer the women if it is required.
Is this so hard to understand?

Why are obstetricians so determined not to work collaboratively with midwives?
Dahlen (Australian College of Midwives) says obstetricians are incorrectly claiming or implying that midwives are seeking to be in sole charge of births.

‘‘We are not asking for midwives to be out there on their own — we don’t want that,’’ Dahlen said.

‘‘What we want, what we have always wanted, is collaborative models of care, where women can have a midwife who cares for her through her pregnancy and postnatal period.

‘‘It’s not about being ‘independent’ — this is about doing what midwives are best at, caring for women, particularly low-risk women, and having support from obstetric colleagues when that’s needed.

‘‘Part of the reason we have such a high intervention rate is because normal, low-risk women are being cared for by highly specialised surgeons trained in surgery.

‘‘We are not saying midwives are not going to work with obstetricians — we are asking for more choice, not less.’’ Dahlen says women are ‘‘marching with their feet’’ to seek better access to midwifery services, based on the number of women prepared to attend rallies and on the number of submissions from individual women to the federal Government’s review.

In December the Government revealed over 900 submissions to the review had been received, most of them from individual consumers.

It is about time someone started listening to what women want.....our maternity services are failing women and this is evident by the number of women who freebirth.
Also the submissions from women indicate that our maternity system has become to focused on medical intervention.

It will be very interesting to see the outcome of Nicola Roxon's report.....we are waiting with baited breath.

Saturday, January 10, 2009

Antenatal information - be mindful to always give updated relevant information to women.

The antenatal period is a time when as midwives we are continuously giving women information relating to their pregnancy and birth. It is a known fact that women have identified that good communication during the antenatal period is vital and most importantly that women are listened to. Page1 identifies that “listening is a fundamental skill since it is a foundation for good communication and will give the best idea of what a woman wants and needs to know”. It is vital during this period that we give evidenced based, non biased, informed, and relevant information. The midwife (Australia) is bound by legislation that is the Nurses and Midwives Act 2006 to abide by the ANMC Code of Conduct 2008, Competency Standards 2006 and Code of Ethics 2008. The Code of Ethics in value statement 5, states that “Midwives value informed decision making”. This therefore means that the midwife ensures their decision making is based on contemporary, relevant and well-founded knowledge and practice, which includes the woman’s knowledge of herself and her infant. The Code of Conduct, states that “Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products”. Finally the ANMC Competency Standards state “ Communicates effectively with the women, her family and friends” and “Promotes safe and effective midwifery care”, these two competencies particularly pertain to communication, knowledge, skills and listening to the women’s needs.
You might ask how this refers to the Nurses and Midwives Act 2006, well in breaching these Codes you are breaching the Act by
- Acting carelessly, Acting improperly and or
- Acting incompetently
- Therefor leading to disciplinary action, section 49 of the above Act.

This leads on to an interesting case in Virginia US (Written By: Dawn Collins, JD -2) where a woman delivered her first child in 1997 with brain damage and later developed cerebral palsy. In 2000 the same woman was considering a second child and sort advice from her physician. During this consult it was discovered that she had in fact got “lupus, migraine headaches and supraventricular tachycardia that was treated with Beta-blockers. The woman was informed that the risk of a brain hemorrhage like the one that caused her first child's damage could be reduced by regular monitoring for fetal growth, tracking of fetal movements, and FHR testing. The woman was asked about the results from those tests in her first pregnancy, she informed them she had no such studies done. She said her physicians involved with the first delivery told her the child's problems were due to a placental abruption.”
The woman then made some enquires and learned this type of testing was standard of care for women with her medical conditions, she discovered further that a specialist had been consulted during her first pregnancy who did recommend testing, but these suggestions were not discussed with her nor were the tests performed.
The woman sued those involved with the first pregnancy care and “claimed that IUGR had occurred due to her lupus and the beta-blocker she took and that additional fetal monitoring was required when this was recognized. The child was born about a month early due to fetal distress and at age 9 had an IQ of 48 and functioned at the level of a child less than 3-years-old. A $28 million award was granted. “

This case is an example of how the incorrect information can lead to possible unnecessary harm to both the mother and the fetus. Also that if women are not informed correctly in the first instance, the chances are the second time around they will want more information especially if they have had a poor outcome or their expectations have not been met.

Where would you stand, if you were the midwife who provided the care in the first pregnancy?

It is very important to document the discussions you have with the women you care for, this is not only for your own protection, but for the women that you care for, so that they know you are accountable for these discussions.


1.Page, L,. The New Midwifery Science and Sensitivity in Practice. Churchill Livingstone,2004.
2. Collins, D. No antepartum testing in first pregnancy results in CP. Risk management in obstetrics and gynaecology. 2009. Contemporary OB/GYN

Sunday, January 4, 2009

Rating your GP online?

Happy New Year to all - best of health, happiness and love for 2009.

I was checking and responding to blogs when I came across this article in the Mail Online (UK)
Patients will be able to rate and review performance of their GPs on new NHS website By Rebecca Camber
It's this a good idea, to be able to rate your GP online. The NHS has created a website which will be under Government control. The idea is that this will boost doctors' performance - or will it?
Off course I can see potential problems with confidentially and truthfulness - however legal action can be taken against writers for defamation if they write untruths.

The NHS already does something similar with the NHS Choices (types of treatment or hospital) website -
from this analysis of the first 6,500 comments showed, 24 per cent were positive, 27 per cent negative and the rest were balanced.

that's not bad odds!

We must remember people that who are dissatisfied will complain more, tend to be more negative and may also be more malicious.

Also website staff will be able to moderate reviews to exclude comments that could identify a GP or staff member.

What do you think? do we need to go down this road? Do you think it will make a difference?

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