An integrative review of defining characteristic of the nursing diagnosis "spiritual distress".

AIM: The aim of this study was to identify the defining characteristics of spiritual distress (00066). DESIGN: This study was conducted by integrated review method using Broom method. METHODS: PubMed, ProQuest, Web of Science, Embase, Scopus, and Cochran Library, and Persian scientific databases were searched from January 2010 to December 2020. RESULTS: Twenty-one article and 74 defining characteristics were identified. 33 of these defining characteristics was mentioned in NANDA. The criteria with the highest frequency and repetition in articles were lack of peace, lack of hope, change in anger behaviour, lack of meaning in life, change in fear and crying behaviour, Concern about belief and values system and/or God. CONCLUSION: Some of the spiritual distress defining characteristics overlap with other nursing diagnoses, including anxiety and hopelessness. Clinical and content validation studies need to be conducted and the main criteria for diagnosing spiritual distress in different cultures and religions need to be identified.

"Spiritual distress (00066)" in patients under fertility treatment: Clinical validation study.

PURPOSE: This study aimed to clinically validate the NANDA-I nursing diagnosis of "Spiritual distress (00066)" in people under assisted reproductive technologies, and to determine the sensitivity, specificity, and predictive value of the defining characteristics. METHODS: Cross-sectional study that was conducted between September 2019 and June 2020. Recruitment happened by invitation posted in fertility-related websites. Those who accepted to participate were asked to fill the consent form and the online questionnaire. Statistical analysis was based on Rasch's model. The study was approved by the Ethics Committee. FINDINGS: The sample comprised 104 Portuguese individuals undergoing assisted reproductive techniques. The "Spiritual distress (00066)" was validated and 22 defining characteristics were confirmed as representative. No item showed differential item functioning. "Perceived suffering" was the most sensitive defining characteristic and had the highest negative predictive value. "Insufficient courage" had the highest positive predictive value, and "Anger toward power greater than self" was the most specific. CONCLUSIONS: Results validated the presence of the NANDA-I nursing diagnosis of "Spiritual distress (00066)" in a sample going through assisted reproductive technologies, improving accuracy of this nursing diagnosis in such population. IMPLICATIONS FOR NURSING PRACTICE: This is a crucial step to raise the level of evidence of such nursing diagnosis and to increase the level of evidence on NANDA-I terminology. Furthermore, this study has contributed to raising the quality of nurse's critical judgement and clinical reasoning and allow an early spiritual and a more holistic and personalized patient-centered intervention in the reproductive field.

OBJETIVO: O presente estudo teve como objetivo analisar a validade clínica do diagnóstico de "angústia espiritual (00066)" em pessoas a realizar técnicas de reprodução assistida e determinar a sensibilidade, especificidade e valor preditivo das características definidoras. MÉTODOS: Este é um estudo transversal que decorreu entre Setembro de 2019 e Junho de 2020. O recrutamento ocorreu por meio de convite lançado em sítios afetos ao tema da fertilidade. As pessoas interessadas em participar preencheram um formulário de consentimento informado e um questionário online. A análise estatística primou pelo emprego do modelo Rasch. O estudo foi aprovado pela Comissão de Ética. RESULTADOS: A amostra final incluiu 104 portugueses submetidos a técnicas de reprodução medicamente assistida. O diagnóstico de "angústia espiritual (00066)" foi validado e 22 características definidoras foram confirmadas pelos dados. "Sofrimento percebido" foi a característica definidora mais sensível e com o maior valor negativo preditivo. "Coragem insuficiente" destacou-se no valor positivo preditivo, e "Raiva relativa a Poder Maior do que o próprio" foi a mais específica. CONCLUSÕES: Os resultados obtidos validaram a presença do diagnóstico de "angústia espiritual (00066)" em pessoas a realizar técnicas de reprodução assistida, contribuindo, desta forma para melhorar a acurácia deste diagnóstico de enfermagem nesta população. IMPLICAÇÕES PARA A PRÁTICA: Este é um passo crucial para elevar o nível de evidência deste diagnóstico de enfermagem e aumentar o corpo do conhecimento da terminologia NANDA-I. O seu contributo passa também por elevar a qualidade do julgamento crítico dos enfermeiros e o seu poder de decisão clínica permitindo uma intervenção precoce mais holística, centrada na espiritualidade e no paciente em contexto reprodutivo.

Experiencia de diagnóstico comunitario bajo el modelo de enfermería de Elizabeth Anderson / Community diagnosis experience on the model of nursing

RESUMEN Introducción: Trabajar con y para la comunidad permite integrar la perspectiva de las personas respecto a su estado de salud, los beneficios que otorga su entorno, el gobierno y los sistemas de salud, identificar problemas que afectan el bienestar integral de las personas que la forman. Objetivo: Describir la experiencia de aplicar un diagnóstico comunitario bajo el modelo de enfermería de Elizabeth Anderson. Métodos: Estudio descriptivo de corte transversal, con una muestra de 285 personas de 63 familias en la comunidad "Los Microbuseros" de Peñalolén, Santiago de Chile. Para obtener la información se aplicó una encuesta que se procesó en el programa SPSS. Las variables estudiadas fueron los 8 subsistemas del modelo Elizabeth Anderson. Resultados: De la muestra, padecían diabetes mellitus II el 34,92 por ciento, hipertensión arterial el 42,85 por ciento, sedentarismo el 67,36 por ciento y tabaquismo el 31,22 por ciento; el 55,55 por ciento no participaba en organizaciones comunitarias; el 96,82 por ciento no usaba programas municipales, el 80,95 por ciento de las familias no recibía información sobre programas gubernamentales de salud, el 95,23 por ciento aumentó el consumo de alcohol y drogas en la vía pública en el último año, el 74,60 por ciento desconocía el número de seguridad policial del sector. El 80,85 por ciento no conocía el programa de salud cardiovascular, el 96,82 por ciento no acudía al Centro de salud. Conclusión: El modelo de Anderson permite valorar la comunidad de manera holística, evidenciar que la salud puede ser influenciada por otros sistemas como la economía, la seguridad, la educación, entre otros. Por ello surge la necesidad de fortalecer los factores protectores e intervenir sobre los riesgos para mejorar la calidad de vida de la comunidad(AU)

ABSTRACT Introduction: Working with and for the community allows integrating the perspective of people regarding their health status, the benefits of their environment, government and health systems, identify problems that affect the well-being of the people who form it . Objective: To describe the experience of applying a community diagnosis under the nursing model of Elizabeth Anderson in community "Los Microbuseros" of Peñalolén, Santiago de Chile. Methods: Descriptive cross-sectional study with a sample of 285 people from 63 families. To obtain the information a survey was applied and processed in the SPSS program. The variables studied were the 8 subsystems of the Elizabeth Anderson model. Results: Diabetes Mellitus II presents 34.92 percent, arterial hypertension 42.85 percent, sedentarism 67.36 percent, smoking 31.22 percent, does not participate in community organizations 55.55 percent, does not use municipal programs 96.82 percent Does not receive information on government health programs, 80,95 percent of families increased alcohol and drug consumption on public roads in the last year 95.23 percent, did not know the number of police security in the sector 74,60 percent. 80.85 percent did not know the cardiovascular health program, 96.82 percent did not go to the Health Center. Conclusion: The Anderson model allows valuing the community in a holistic way, showing that health can be influenced by other systems such as economy, safety, education, among others. Therefore, the need to strengthen the protective factors and intervene on the risks to improve the quality of life of the community arises(AU)

From linear care plan through concept map to Concepto-Plan: The creation of an innovative and holistic care plan.

Linear care plans have traditionally been used in nursing education to support nursing students in identifying potential and actual health care problems, and to follow up on those issues with nursing interventions. However, the linear care plan does not support the nursing student with learning in-depth critical thinking, clinical reasoning, creative thinking, and other ways of thinking. Concept mapping was introduced as a way to support the nursing student to improve upon critical thinking and clinical reasoning and to identify relationships among the patient's health care problems. The present manuscript features the development and evaluation of the Concepto-Plan (C-P), an innovative, holistic care plan that moves away from the linear care plan and improves upon the concept map care plan. The C-P focuses on the relationships among the data clusters and the nursing diagnoses and can be used to enhance the therapeutic relationship between the patient and the nursing student. Quality improvement data supports the effectiveness of the C-P for nursing students to organize and prioritize client-centred care while experiencing meaningful learning, professional self-reflection, clinical reasoning, creative and critical thinking skills and the ability to provide an individualized holistic care plan. As a result, the C-P has been integrated into the curriculum in two different nursing programs in two Canadian provinces.

Midwifery Management of Pregnant Women Who Are Obese.

INTRODUCTION: Obesity is associated with increased risks for adverse health outcomes during and after pregnancy in both the woman with obesity and her infant. This study was designed to investigate midwifery management of pregnant women with obesity. METHODS: Certified midwives and certified nurse-midwives who were members of the American College of Nurse-Midwives were sent a survey. The survey instrument was divided into 4 sections: demographic characteristics; practice guidelines and protocols; the role of the 2015 Levels of Maternal Care guidelines for referral, including transfer to a higher level of care; and factors that influence management of pregnant women with obesity. Descriptive statistics were used to analyze data. RESULTS: In a sample of 546 midwives, 87% of respondents reported observing an increase in perinatal complications associated with obesity. Midwives reported increasing discomfort with the care of pregnant women with obesity as body mass index (BMI) increased. For pregnant women with extreme obesity, the respondents reported less frequent use of physiologic birth guidelines only and increased use of interventions, referral to physician care, and transfer to a higher level of care. Approximately half (270, 49.5%) reported having a guideline that addressed the care of women with obesity. Of these, 145 midwives (53.7%) reported that extreme obesity was the BMI threshold for identifying an increased or high risk for perinatal complications. Sixty percent (339) of midwives who participated requested guidance for management of laboring women who are obese. DISCUSSION: This study provides a greater understanding of midwifery management practices when caring for women with obesity and opportunities to improve care. The results suggest that midwifery management alters with increased BMI, specifically in the care of women with extreme obesity. Suggestions for future study include research on management of pregnant women with obesity and extreme obesity with outcome data examining management strategies that provide safe, satisfying care.

Calidad de vida y diagnósticos de enfermería de mujeres con AIDS / Qualidade de vida e diagnósticos de enfermagem de mulheres com AIDS / Quality of life and nursing diagnoses of women with AIDS

Objetivo: Evaluar la calidad de vida y los diagnósticos de enfermería de mujeres con sida. Métodos: Estudio transversal, involucrando a 70 mujeres con sida en seguimiento ambulatorial. Para la recolección de datos, se utilizó el formulario sociodemográfico y clínico y la versión brasileña del instrumento World Health Organization Quality of Life - VIH. Los diagnósticos de enfermería se determinaron de acuerdo con la Taxonomía II de la NANDA-I. Se realizó análisis a través del software Statistical Package for Social Sciences(R) (SPSS) versión 18. Resultados: La mayoría de las mujeres tenían entre 18 y 59 años (98,6%), era heterosexual (97,2%) y con carga viral indetectable (54,3%). Presentaron calidad de vida intermedia en todos los campos de la escala y se encontraron 14 diagnósticos de enfermería, destacándose el Patrón de Sexualidad Ineficaz, Miedo y la Ansiedad Relacionada con la Muerte. Conclusión: Mujeres con sida presentaron calidad de vida intermedia, necesitando de atención de enfermería integral y holística (AU)

Objetivo: Avaliar a qualidade de vida e os diagnósticos de enfermagem de mulheres com aids. Métodos: Estudo transversal, envolvendo 70 mulheres com aids em acompanhamento ambulatorial. Para coleta de dados utilizaram-se o formulário sociodemográfico e clínico e a versão brasileira do instrumento World Health Organization Quality of Life - HIV. Os diagnósticos de enfermagem foram determinados de acordo com a Taxonomia II da NANDA-I. Realizou-se análise através do Software Statistical Package for Social Sciences(R) (SPSS) versão 18. Resultados: A maioria das mulheres tinha de 18 a 59 anos (98,6%), era heterossexual (97,2%) e com carga viral indetectável (54,3%). Apresentaram qualidade de vida intermediária em todos os domínios da escala e foram encontrados 14 diagnósticos de enfermagem, destacando-se o Padrão de Sexualidade Ineficaz, Medo e a Ansiedade Relacionada à Morte. Conclusão: Mulheres com aids apresentaram qualidade de vida intermediária, necessitando de cuidado de enfermagem integral e holístico (AU)

Aim: To evaluate the quality of life and the nursing diagnoses of women with AIDS. Methods: Cross-sectional study involving 70 women with AIDS in outpatient follow-up. The sociodemographic and clinical form and the Brazilian version of the World Health Organization Quality of Life - HIV instrument were used for data collection. Nursing diagnoses were determined according to NANDA-I Taxonomy II. The analysis was performed using the Software Statistical Package for Social Sciences (SPSS) version 18. Results: The majority of women were 18 to 59 years old (98.6%), heterosexual (97.2%) and had an undetectable viral load (54.3%). They presented intermediate quality of life in all domains of the scale and 14 nursing diagnoses were found, especially the Pattern of Ineffective Sexuality, Fear and Death Related Anxiety. Conclusion: Women with AIDS presented intermediate quality of life, requiring integral and holistic nursing care (AU)

Plan de cuidados a un paciente portador de una sonda de gastrostomía / Plan of care for a patient with a gastrostomy catheter

Se expone el caso de un paciente portador de sonda de gastrostomía por presentar neoplasia del seno piriforme que impide la deglución. Cuando el paciente fue derivado a la consulta presentaba irritación importante de la piel que rodeaba la sonda de gastrostomía debido a la emisión continua de jugos gástricos, así como por pérdidas de alimentación provocadas por la holgura excesiva del estoma y dolor continuo en la zona. Dicha situación no permitía descansar al paciente, generándole sentimientos de preocupación y desánimo. Utilizando los patrones de Marjory Gordon se valoró al sujeto, identificando los diagnósticos enfermeros según la taxonomía de la North American Nursing Diagnosis Association (NANDA), los resultados según la Nursing Outcomes Classification (NOC) y las intervenciones enfermeras oportunas, siguiendo la Nursing Intervention Classification (NIC), para que el paciente adquiriera las habilidades necesarias para el manejo de su sonda de gastrostomía, supiera cómo administrar adecuadamente la alimentación y los medicamentos a través de la misma y mantuviera la integridad de la piel periestomal (AU)

We present the case of a patient with gastrostomy due to neoplasia in the pyriform sinus that prevented swallowing. When the patient was referred, he presented a major irritation of the skin around the gastrostomy catheter, due to the continuous production of gastric juices, as well as food losses caused by the excessive width of the ostomy and continuous pain in the area. Said situation prevented the patient from resting, and generated feelings of concern and discouragement. The patient was assessed using Marjory Gordon's patterns, identifying nursing diagnoses according to the taxonomy by the North American Nursing Diagnosis Association (NANDA), outcomes according to the Nursing Outcomes Classification (NOC), and the adequate nursing interventions, following the Nursing Intervention Classification (NIC), so that the patient acquired the skills needed to manage his gastrostomy catheter, learning how to administer adequately food and medications through it, and maintaining the integrity of peristomal skin (AU)

Spiritual Well-Being and Spiritual Distress in Cancer Patients Undergoing Chemotherapy: Utilizing the SWBQ as Component of Holistic Nursing Diagnosis.

Holistic nursing care requires attention to the spiritual dimension. This is particularly important when caring for patients with cancer. This research presents the results of the assessment of spiritual well-being using the Spiritual Well-Being Questionnaire (SWBQ) to validate the nursing diagnosis of spiritual distress. Structured interviews were conducted with 169 patients in one hospital in Portugal. We concluded that the SWBQ is a useful and reliable instrument to assess spiritual distress, which highlights the importance of listening to patients and questioning them about spiritual needs as well as the importance of differential diagnosis aimed at effective interventions.

¿Cómo ayuda la aplicación del proceso enfermero a las mujeres con diagnóstico ansiedad? / How can the application of the nursing process help to women with anxiety nursing diagnosis?

Objetivo: Evaluar las intervenciones grupales de enfermería en mujeres con diagnóstico enfermero ansiedad mediante el resultado NOC autocontrol de la ansiedad. Material y método: Estudio pre-experimental del tipo pretest-postest de un solo grupo realizado en un Centro de Salud Mental de la Región de Murcia a un grupo de 12 mujeres en edad adulta que presentan el diagnóstico enfermero ansiedad. Se realizó a cada paciente la valoración de enfermería por Patrones Funcionales de Salud (PFS) antes y después de la asistencia a las 8 sesiones de intervenciones enfermeras grupales. Al comenzar y al finalizar el grupo, se cumplimentó el criterio de resultado NOC autocontrol de la ansiedad. Las intervenciones enfermeras fueron a) disminución de la ansiedad (5820), terapia de relajación simple (6040), educación sanitaria (5510), enseñanza grupo (5604) y grupo de apoyo (5430). Se tomó como variable independiente las intervenciones enfermeras y como variable dependiente las puntuaciones del resultado NOC, empleándose como instrumento de evaluación. Resultados: El análisis del resultado NOC autocontrol de la ansiedad nos muestra diferencias significativas. Antes de las intervenciones, la media presenta el valor 22.5 y tras las mismas de 37.8 con una desviación típica de 3.22 y 7.11 respectivamente. La mediana antes y después de las intervenciones corresponde con los valores 21 y 37.5. El parámetro del test de los rangos de Wilcoxon corresponde con un valor de Z igual a -2.98 con una p igual a 0.003. Conclusiones: El estado, conducta y percepciones de las pacientes del grupo medido con el resultado autocontrol de la ansiedad, mejora tras recibir las intervenciones enfermeras. La puntuación global de los indicadores empleados en este resultado ha sido apropiada como medida de los efectos de las intervenciones (AU)

Purpose: To evaluate nursing group interventions in women with anxiety nursing diagnosis by self NOC result of anxiety. Methodology: Pre-experimental pretest-posttest study composed by a single group of twelve women in a Mental Health Center of the Region of Murcia. The participants were a group of women in adulthood presenting the nursing diagnosis anxiety. Each patient received 8 group nursing interventions. Before and after the group intervention, a nursing outcome criteria is filled for each patient. The following nursing interventions were used: Anxiety reduction (5820), simple relaxation therapy (6040), health education (5510), group education (5604) and support group (5430). The independent variable was nursing interventions and the dependent variable was NOC punctuations, being used as an assessment tool. Results: The analysis of the NOC result anxiety self-control shows significant differences. Before the intervention, the mean was 22.5 and 37.8 after it with standard deviations of 3.22 and 7.11 for each one. The median was 21 before interventions and 37.5 after them. The Wilcoxon test shows a Z value of -2.98 with p 0.003. Conclusion: The state, behaviour and perception of patients improve with nursing interventions received. The global punctuation of used clinical indicators is a good tool to measure nursing intervention effects (AU)

Paciente con síndrome de Charles Bonnet: propuesta de cuidados / Charles Bonnet syndrome patient-care proposal

Objetivo: El objetivo de este trabajo es mejorar la comprensión de las experiencias de los pacientes con síndrome de Charles Bonnet (SBC) y proponer un plan de cuidados de enfermería. Profundizar sobre la propia experiencia del enfermo puede aportar conocimientos, que orienten a las enfermeras, en la detección de estos pacientes y a establecer un cuidado integral de la persona con SCB, aplicando la metodología de la disciplina, con el objetivo de mejorar la calidad de vida de los pacientes. Método: Revisión y análisis del caso de una mujer de 87 años de edad, con diagnóstico de degeneración macular asociada a la edad (DMAE), que causó baja visión en ambos ojos y se diagnostica con SCB en el servicio de oftalmología. Se realiza un abordaje cualitativo y se elige el relato biográfico, válido para conocer el significado de estar enfermo e incorporar la perspectiva del paciente en las intervenciones de salud. Resultados: La paciente fue diagnosticada de SCB secundario a la DMAE. Ella describe las siguientes unidades temáticas: las alucinaciones, las emociones asociadas, el diagnóstico y atención de la salud y, por último, el afrontamiento. Conclusiones: Se hace hincapié en la importancia de la ayuda profesional desde el comienzo de las alucinaciones, para evitar temores infundados y el adecuado seguimiento de su evolución

Purpose: Improve understanding of the experiences of patients with Charles Bonnet syndrome (SBC) and progress in planning nursing care. Deepen the experience of the patient can provide knowledge to guide nurses in the detection of patients and the needs perceived by them, in order to establish a comprehensive care of the person applying the methodology of the discipline, focus to improve the quality of life of patients. Method: Review and analysis of the case of a woman of 87 years old, diagnosed with Macular Degeneration Age-related (AMD), which caused low vision in both eyes and is diagnosed with CBS at the Department of Ophthalmology. A qualitative approach of descriptive characteristics performed and the biographical account is chosen because it provides valid for knowing the meaning of being sick / healthy and incorporate the perspective of the patient in health interventions. Findings: The patient was diagnosed as CBS secondary to AMD. She describes the following thematic units: hallucinations, associated emotions (experiences), diagnostic and health care and lastly, coping. Conclusions: She stresses the importance of professional help, from the beginning of the hallucinations to avoid unfounded fears and proper monitoring of its evolution

Nursing Diagnosis of "Spiritual Distress" in Women With Breast Cancer: Prevalence and Major Defining Characteristics.

BACKGROUND: Spirituality and spiritual needs of cancer patients are frequently mentioned in the nursing literature, but the most significant defining characteristics of spiritual distress in the context of clinical reasoning and nursing diagnosis are rarely explored. Understanding of these is important for effective spiritual intervention. OBJECTIVE: The aim of this study was to identify the prevalence and the defining characteristics of the nursing diagnosis "spiritual distress," as classified according to NANDA International, among women with breast cancer. METHODS: This was a quantitative and cross-sectional study, comprising the third phase of a larger study investigating the clinical validation of spiritual distress in cancer patients undergoing chemotherapy. Fehring's clinical diagnostic validation model was used to identify the prevalence and the major defining characteristics of the diagnosis. A convenience sample was used, and data were collected by structured interview. RESULTS: A total of 70 women participated; most were married (62.9%) and had a mean age of 54 years, and 55.7% reported having at least 1 person depending on them. The average length of time since the cancer diagnosis was 30.9 months. Twenty-seven participants were experiencing spiritual distress (38.6%). Eleven defining characteristics were classified as major. CONCLUSIONS: The prevalence of spiritual distress and the major defining characteristics give clinical evidence about the nurse's role in providing spiritual care. The results are useful for the improved use of the NANDA International diagnoses within this domain. IMPLICATIONS FOR PRACTICE: The findings highlight the importance of assessing the defining characteristics of the diagnosis as an objective strategy to improve clinical reasoning related to spirituality and to facilitate more effective interventions.

Women's lived experiences of domestic violence during pregnancy (2).

This paper is a follow up paper to a study which explored women's experiences of domestic violence before, during and after pregnancy. Findings from this study suggested that women would like midwives to be able to recognise the signs of domestic violence and to be able to offer them an appropriate response and support. Midwives are well placed to recognise the signs of domestic violence and provide appropriate support. This paper addresses some of the challenges and dilemmas for midwives when identifying and supporting women who have experienced domestic violence and provides some key messages for midwifery practice.

Atrial electrogram interpretation improves after an innovative education program.

BACKGROUND: To avoid adverse patient outcomes from inappropriate treatment, it is recommended that an atrial electrogram (AEG) be recorded whenever atrial arrhythmias develop in patients after cardiac surgery. However, AEGs are not commonly performed because nurses lack knowledge about differentiating atrial rhythms on AEGs. OBJECTIVE: To investigate whether completing a novel online evidence-based education program on interpreting AEGs would improve critical care nurses' AEG interpretation. METHODS: Specialized critical care nurses were taught about obtaining and interpreting atrial rhythms on AEGs using a 42-minute online mini-movie. AEG interpretation was assessed pre and two and eight weeks post-intervention. RESULTS: AEG interpretation increased two weeks post intervention and was retained at eight weeks. Some participants used this newly acquired knowledge to interpret arrhythmias that were not taught during the education program. CONCLUSION: Accurate interpretation of AEGs is an easy skill for specialized critical care nurses to learn via an online education program.

Women's lived experiences of domestic violence during pregnancy (1).

This paper reports on a qualitative study, which explored women's experiences of domestic violence before, during and after pregnancy. During pregnancy the women were physically attacked, including blows and kicks to the pregnant abdomen; they were punched, slapped, kicked, bitten, pushed around, held by the throat and attempts at strangulation occurred for two of the women. The women were sexually abused, experienced enforced isolation and financial hardship. They experienced extreme psychological distress, including depression before, during and after pregnancy. Feelings of vulnerability about themselves and their unborn babies were intensified by their partners' continuing violence and abuse. The findings from this research will support midwives to recognise the warning signs of domestic violence and abuse during pregnancy and to be able to offer an appropriate response.

3. Undiagnosed breech--part of midwifery practice.

This article discusses the background to undiagnosed breech and what a midwife can do to support a woman who is giving birth to a baby in an undiagnosed breech presentation. There is no evidence to support the use of emergency caesarean section when a breech is diagnosed in labour and it is a requirement of the Nursing and Midwifery Council rules and standards that registered midwives should have been taught, pre-registration, how to assist an undiagnosed breech presenting baby to be born.

Pregnancy nausea and vomiting--the role of the midwife.

Seventy five-80 per cent of pregnant women get some degree of nausea and vomiting of pregnancy (NVP) and it becomes severe in about 30 per cent of women with symptoms. Calling it 'morning sickness' is both inaccurate and damaging as it can be seen to trivialise the condition. Severe NVP can cause depression, feelings of inadequacy, loss of time at work, admission to hospital and termination of pregnancy. It is important for midwives to treat women with NVP with understanding and empathy, and for midwives to be able to assess women with NVP and refer for admission those developing hyperemesis gravidarm.

Blood tests for investigating maternal wellbeing.

It is the midwife's role to assess the client's general health, explore her medical, surgical, menstrual, gynaecological, obstetric, psycho-emotional, social and family history thoroughly to ascertain if there are indicators of potential complications in her pregnancy, labour and birth and puerperium. In this article we examine the case of Carla; as there is history of thyroid dysfunction in her family, this could be an indicator towards a diagnosis of thyroid pathology.