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MIDWIFE
MIDWIFE



Midwifery is a health care profession in which providers offer care to childbearing women during their pregnancy, labour and birth, and during the postpartum period. They also care for the newborn through to six weeks of age, including assisting the mother with breastfeeding. Midwives may also offer interconceptional care including well-woman care.

A practitioner of midwifery is known as a midwife, a term used in reference to both women and men. (The etymology of midwife is Middle English: mid = with and Old English: wif = woman). In the United States, nurse-midwives are advance practice nurses (nurse practitioners]). In addition to giving care to women in connection with pregnancy and birth, they also provide primary care to women, well-woman care (gynecological annual exams), family planning, and menopause care.

Midwives are autonomous practitioners who are specialists in low-risk pregnancy, childbirth, and postpartum. They generally strive to help women to have a healthy pregnancy and natural birth experience. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions can be complementary, but often are at odds because obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.

Midwives refer women to general practitioners or obstetricians when a pregnant woman requires care beyond the midwives' area of expertise. In many jurisdictions, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain situations that may be described as normal variations or may be considered abnormal, including breech births, twin births and births where the baby is in a posterior position, using non-invasive techniques.

Definition

According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics):

A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to womens health, sexual or reproductive health and childcare, and to gain the knowledge to counteract the lack of pain relivers and antiseptics.

A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.

Early historical perspective

In ancient Egypt, midwifery was a recognized female occupation, as attested by the Ebers papyrus which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology, especially concerning the acceleration of parturition and the birth prognosis of the newborn. The Westcar papyrus, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.

Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians. However, there were certain characteristics desired in a “good” midwife, as described by the physician Soranus of Ephesus in the second century. He states in his work, Gynecology, that “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.” Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child. Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife. A woman who possessed this combination of physique, virtue, skill, and education must have been difficult to find in antiquity. Consequently, there appears to have been three “grades” of midwives present in ancient times. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery.

Midwives were known by many different titles in antiquity, ranging from iatrinē, maia, obstetrix, and medica. It appears as though midwifery was treated differently in the Eastern end of the Mediterranean basin as opposed to the West. In the East, some women advanced beyond the profession of midwife (maia) to that of obstetrician (iatros gynaikeios), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors. One example of such a midwife is Salpe of Lemnos, who wrote on women’s diseases and was mentioned several times in the works of Pliny.

However, in the Roman West, our knowledge of practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives. Slave girls may have been apprenticed, and it is most likely that mothers taught their daughters.

The actual duties of the midwife in antiquity consisted mainly of assisting in the birthing process, although they may also have helped with other medical problems relating to women when needed. Often, the midwife would call for the assistance of a physician when a more difficult birth was anticipated. In many cases the midwife brought along two or three assistants. In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the birthstool was a crescent-shaped hole through which the baby would be delivered. The birthstool or chair often had armrests for the mother to grasp during the delivery. Most birthstools or chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant would stand behind the mother to support her. The midwife sat facing the mother, encouraging and supporting her through the birth, perhaps offering instruction on breathing and pushing, sometimes massaging her vaginal opening, and supporting her perineum during the delivery of the baby. The assistants may have helped by pushing downwards on the top of the mother's abdomen. Finally, the midwife received the infant, placed it in pieces of cloth, cut the umbilical cord, and cleansed the baby. The child was sprinkled with “fine and powdery salt, or natron or aphronitre” to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put olive oil in the baby’s eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for congenital deformities and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant’s survival and likely recommended that a newborn with any severe deformities be exposed.

A second-century terracotta relief from the Ostian tomb of Scribonia Attice, wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birthing chair, gripping the handles and the midwife’s assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the vagina, as encouraged by Soranus.

The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives. They may have been highly trained or only possessed a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine or the newer methods of professional parturition. Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.

During the Christian era in Europe, midwives became important to the church due to their role in emergency baptisms, and found themselves regulated by Roman Catholic canon law. In Medieval times, childbirth was considered so deadly that the Christian Church told pregnant women to prepare their shrouds and confess their sins in case of death. The Church pointed to Genesis 3:16 as the basis for pain in childbirth, where Eve's punishment for her role in disobeying God was that he would "multiply thy sorrows, and thy conceptions: in sorrow shalt thou bring forth children." A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.

Later historical perspective

In the 18th century, a division between surgeons and midwives arose, as medical men began to assert that their modern scientific processes were better for mothers and infants than the folk-medical midwives.

At the outset of the 18th century in England, most babies were caught by a midwife, but by the onset of the 19th century, the majority of those babies born to persons of means had a surgeon involved. A number of excellent full length studies of this historical shift have been written.

German social scientists Gunnar Heinsohn and Otto Steiger have put forward the theory that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion. According to Heinsohn and Steiger's theory, the modern state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague (also known as the black death) which had swept over the continent in waves, starting in 1348.

They thus interpret the witch hunts as attacking midwifery and knowledge about birth control with a demographic goal in mind. Indeed, after the witch hunts, the number of children per mother rose sharply, giving rise to what has been called the "European population explosion" of modern times, producing an enormous youth bulge that enabled Europe to colonize large parts of the rest of the world.

While historians specializing in the history of the witch hunts have generally remained critical of this macroeconomic approach and continue to favor micro level perspectives and explanations, prominent historian of birth control John M. Riddle has expressed agreement.

United States

There are two main divisions of modern midwifery in the US: nurse-midwives and direct-entry midwives.

Nurse-midwives

Nurse-midwives were introduced in the United States in 1925 by Mary Breckinridge for use in the Frontier Nursing Service (FNS). Mrs. Breckinridge chose the nurse-midwifery model used in England and Scotland because she expected these nurse-midwives on horseback to serve the health care needs of the families living in the remote hills of eastern Kentucky. This combination of nurse and midwife was very successful. The Metropolitan Life Insurance Company studied the first seven years of the FNS, and reported a substantially lower maternal and infant mortality rate than for the rest of the country. The report concluded that if this type of care was available to other women in the USA thousands of lives would be saved, and suggested nurse-midwife training should be done in the USA. Mrs. Breckinridge opened the Frontier Graduate School of Midwifery in 1939 the first nurse-midwifery education program in the USA. The Frontier School is still educating nurse-midwives today but in a new way. In 1989 the program became the first distance option for nurses to become nurse-midwives without leaving their home communities. The students do their academic work on-line with the Frontier School of Midwifery and Family Nursing faculty members and they do their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member. This community based model has graduated over 1200 nurse-midwives.
In the United States, nurse-midwives are variably licenced depending on the state as advanced practice nurses, midwives or nurse-midwives. Certified Nurse-Midwives are educated in both nursing and midwifery and provide gynecological and midwifery care of relatively healthy women. In addition to licensure, many nurse-midwives have a master's degree in nursing, public health, or midwifery. Nurse-midwives practice in hospitals, medical clinics and private offices and may deliver babies in hospitals, birth centers and at home. They are able to prescribe medications in all 50 states. Nurse-midwives provide care to women from puberty through menopause. Nurse-midwives may work closely with obstetricians, who provide consultation and assistance to patients who develop complications. Often, women with high risk pregnancies can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently, 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. Upon graduation from these programs, graduates sit for a certification exam administered by the American Midwifery Certification Board.

Direct-entry midwives

A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not require prior education as a nurse. Direct-entry midwives learn midwifery through self-study, apprenticeship, a private midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.

Under the umbrella of "direct-entry midwife" are several types of midwives:

A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only US credential that requires knowledge about and experience in out-of-hospital settings. At present, there are approximately 900 CPMs practicing in the US.

A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 24 states.

The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife (CPM) credential was available).

The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges that graduate nurse-midwives. This credential, called the Certified Midwife, is currently recognized in only three states (New York, New Jersey, and Rhode Island). All CMs must pass the same certifying exam administered by the American Midwifery Certification Board for CNMs.

The North American Registry of Midwives (NARM) is a certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). The CPM certification process validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university-based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery.

Practice

Midwives work with women and their families in any number of settings. While the majority of nurse-midwives work in hospitals, some nurse-midwives and many non-nurse-midwives work within the community or home. In many states, midwives form birthing centers where a group of midwives work together. Midwives generally support and encourage natural childbirth in all practice settings. Laws regarding who can practice midwifery and in what circumstances vary from state to state.

United Kingdom

Midwives are practitioners in their own right in the United Kingdom, and take responsibility for the antenatal, intrapartum and postnatal care of women, up until 28 days after the birth, or as required thereafter. Midwives are the lead health care professional attending the majority of births, mostly in a hospital setting, although home birth is a perfectly safe option for many births. There are a variety of routes to qualifying as a midwife. Most midwives now qualify via a direct entry course, which refers to a three- or four-year course undertaken at university that leads to either a degree or a diploma of higher education in midwifery and entitles them to apply for admission to the register. Following completion of nurse training, a nurse may become a registered midwife by completing an eighteen-month post-registration course (leading to a degree qualification), however this route is only available to adult branch nurses, and any child, mental health, or learning disability branch nurse must complete the full three-year course to qualify as a midwife. Midwifery students do not pay tuition fees and are eligible for financial support for living costs while training. Funding varies depending on which country within the UK the student is located and whether they are taking a degree or diploma course. Midwifery degrees are paid for by the National Health Service (NHS). Some students may also be eligible for NHS bursaries.

All practising midwives must be registered with the Nursing and Midwifery Council and also must have a Supervisor of Midwives through their local supervising authority. Most midwives work within the National Health Service, providing both hospital and community care, but a significant proportion work independently, providing total care for their clients within a community setting. However, recent government proposals to require insurance for all health professionals is threatening independent midwifery in England.

Midwives are at all times responsible for the woman for whom they are caring, to know when to refer complications to medical staff, to act as the woman's advocate, and to ensure the mother retains choice and control over her childbirth experience. Many midwives are opposed to the "medicalisation" of childbirth, preferring a more approach to care, ensuring a satisfactory outcome for mother and baby.

Midwifery Training

Midwifery training is considered one of the most challenging and competitive courses amongst other healthcare subjects. Most midwives undergo a 32 month vocational training program, or an 18 month nurse conversion course (on top of the 32 month nurse training course). Thus midwives potentially could have had up to 5 years of total training. Midwifery training consists of classroom based learning provided by select Universities in conjunction with hospital and community based training placements at NHS Trusts.

Midwives may train to be community Health Visitors (as may Nurses).

Community Midwives

Many midwives also work in the community. The role of community midwives include the initial appointments with pregnant women, managingclinics, postnatal care in the home, and attending home births.

Diposkan oleh Catatanku di 23:18 0 komentar
Minggu, 21 Maret 2010
HOSPITAL


A hospital is an institution for health care providing patient treatment by specialized staff and equipment, and often, but not always providing for longer-term patient stays.

Today, hospitals usually are funded by the public sector, by health organizations, (for profit or nonprofit), health insurance companies or charities, including by direct charitable donations. In history, however, hospitals often were founded and funded by religious orders or charitable individuals and leaders. Similarly, modern-day hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in history, this work usually was performed by the founding religious orders or by volunteers.

Etymology

During the Middle Ages the hospital could serve other functions, such as almshouse for the poor, hostel for pilgrims, or hospital school. The name comes from Latin hospes (host), which also is the root for the English words hospice, hotel, hostel, and hospitality. The modern word hotel derives from the French word hostel, which featured a silent s, eventually removed from the word to leave a circumflex on modern French hôtel. The word also is related to the German word 'Spital'.

Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usually requires an article; in Britain and elsewhere, the word normally is used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both uses are found.

Types

Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ('outpatients') without staying overnight; while others are 'admitted' and stay overnight or for several weeks or months ('inpatients'). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients and the others often are described as a clinic.

General

The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and typically has an emergency department to deal with immediate and urgent threats to health. A general hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States, have their own ambulance service.

Specialized

Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories, and so forth.

A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre-twentieth-century origins began as one building and evolved into campuses. Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. Within the United States, most hospitals are nonprofit.

Teaching

A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school or nursing school. Some of these are associated with universities

Clinics

A medical facility smaller than a hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.

Departments

Resuscitation room bed after a trauma intervention, showing the highly technical equipment of modern hospitals

See also: Category:Hospital departments

Hospitals vary widely in the services they offer and therefore, in the departments they have. They may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as cardiology or coronary care unit, intensive care unit, neurology, cancer center, and obstetrics and gynecology.

Some hospitals will have outpatient departments and some will have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy.

Common support units include a dispensary or pharmacy, pathology, and radiology, and on the non-medical side, there often are medical records departments and/or release of information department.

History

Early examples

In ancient cultures, religion and medicine were linked. The earliest documented institutions aiming to provide cures were Egyptian temples. In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (Greek: Ασκληπιεία, sing. Asclepieion Ασκληπιείον), functioned as centers of medical advice, prognosis, and healing.[1] At these shrines, patients would enter a dream-like state of induced sleep known as "enkoimesis" (Greek: ενκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery.[2] Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing.[3] In the Asclepieion of Epidaurus, three large marble boards dated to 350 BC preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium.[4] The worship of Asclepius was adopted by the Romans. Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed.

According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century A.D., King Pandukabhaya (fourth century B.C.) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world.[6][7] Mihintale Hospital is the oldest in the world.[8] Ruins of ancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura, and Medirigiriya.

Institutions created specifically to care for the ill also appeared early in India. King Ashoka is said to have founded at least eighteen hospitals ca. 230 B.C., with physicians and nursing staff, the expense being borne by the royal treasury.[10] Stanley Finger (2001) in his book, Origins of Neuroscience: A History of Explorations Into Brain Function, cites an Ashokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds of hospitals, hospitals for people and hospitals for animals. Where there were no healing herbs for people and animals, he ordered that they be bought and planted."[11] However Dominik Wujastyk of the University College London disputes this, arguing that the edict indicates that Ashoka built rest houses (for travellers) instead of hospitals, and that this was misinterpreted due to the reference to medical herbs.

The first teaching hospital where students were authorized to practice methodically on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia".

Roman Empire

The Romans created valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C., and many were identified by later archeology. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools.

The adoption of Christianity as the state religion of the Roman Empire drove an expansion of the provision of care. The First Council of Nicaea in 325 A.D. urged the church to provide for the poor, sick, widows, and strangers. It ordered the construction of a hospital in every cathedral town. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea. The latter was attached to a monastery and provided lodgings for poor and travelers, as well as treating the sick and infirm. There was a separate section for lepers.

Medieval Islamic world

Main article: Bimaristan

Further information: Medicine in medieval Islam

In the medieval Islamic world, the word "bimaristan" was used to indicate a hospital establishment where the ill were welcomed, cared for and treated by qualified staff. In this way medieval Islamic physicians distinguished between a hospital and earlier ancient establishments such as a healing temple, sleep temple, hospice, asylum, lazaret, or leper-house, all of which were common in antiquity and more concerned with isolating the sick and the mad (insane) from society than offering them a true cure. Some thus consider the medieval Bimaristan hospitals as "the first hospitals" in the modern sense of the word.

The first free public hospital in Baghdad was opened during the Abbasid Caliphate of Harun al-Rashid in the 8th century.[17] The first hospital in Egypt was opened in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia. As the system developed, physicians and surgeons were appointed who gave lectures to medical students and issued diplomas to those who were considered qualified to practice, an early parallel to modern medical schools.[18][17] The first psychiatric hospital was built in Baghdad in 705. Many other Islamic hospitals also often had their own wards dedicated to mental health.

Between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care. Hospitals in Baghdad in the ninth and tenth centuries employed up to twenty-five staff physicians and had separate wards for different conditions. Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 CE and was simple, but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The hospital employed female nurses, including nurses from Sudan.[20] In addition to regular physicians who attended the sick, there were Fuqaha al-Badan, a kind of religious physio-therapists, group of religious scholars whose medical services included bloodletting, bone setting, and cauterisation. During Ottoman rule, when hospitals reached a particular distinction, Sultan Bayazid II built a psychiatric hospital and medical madrasa in Edirne, and a number of other early hospitals also were built in Turkey.

Medieval Europe

Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580 at Mérida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.

Colonial America

The first hospital founded in the Americas was the Hospital San Nicolás de Bari [Calle Hostos] in Santo Domingo, Distrito Nacional Dominican Republic. Fray Nicolas de Ovando, Spanish governor and colonial administrator from 1502–1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552.[22] Abandoned in the mid-eighteenth century, the hospital now lies in ruins near the Cathedral in Santo Domingo.

Conquistador Hernán Cortés founded the two earliest hospitals in North America: the Immaculate Conception Hospital and the Saint Lazarus Hospital. The oldest was the Immaculate Conception, now the Hospital de Jesús Nazareno in Mexico City, founded in 1524 to care for the poor.

The first hospital north of Mexico was the Hôtel-Dieu de Québec. It was established in New France in 1639 by three Augustinians from l'Hôtel-Dieu de Dieppe in France. The project, begun by the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by colonial physician Robert Giffard de Moncel.

Modern era

In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charité (founded in Berlin in 1710) is an early example.

Guy's Hospital was founded in London in 1724 from a bequest by the wealthy merchant, Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751, after £2,000 from private subscription was matched by funds from the Assembly.

When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important research center. During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialized medicine.

By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In continental Europe the new hospitals generally were built and run from public funds. The National Health Service, the principle provider of health care in the United Kingdom, was founded in 1948.

In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. One of the earliest of these "almshouses" in what would become the United States was started by William Penn in Philadelphia in 1713. These hospitals are tax-exempt due to their charitable purpose, but provide only a minimum of charitable medical care. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. The largest public hospital system in America is the New York City Health and Hospitals Corporation, which includes Bellevue Hospital, the oldest U.S. hospital, affiliated with New York University Medical School. In the late twentieth century, chains of for-profit hospitals arose in the USA.

Criticism

While hospitals, by concentrating equipment, skilled staff and other resources in one place, clearly provide important help to patients with serious or rare health problems, hospitals also are criticised for a number of faults, some of which are endemic to the system, others which develop from what some consider wrong approaches to health care.

One criticism often voiced is the 'industrialised' nature of care, with constantly shifting treatment staff, which dehumanises the patient and prevents more effective care as doctors and nurses rarely are intimately familiar with the patient. The high working pressures often put on the staff exacerbate such rushed and impersonal treatment. The architecture and setup of modern hospitals often is voiced as a contributing factor to the feelings of faceless treatment many people complain about.

Another criticism is that hospitals are in themselves dangerous places for patients, who are often suffering from weakened immune systems - either due to their body having to undergo substantial surgery or because of the illness which placed them in the hospital itself. Most of these criticisms stem from the pre-Listerian era. However, even in modern hospitals, hospital-acquired infections can be an important cause of hospital related morbidity, and sometimes mortality.

Funding

In the modern era, hospitals are, broadly, either funded by the government of the country in which they are situated, or survive financially by competing in the private sector (a number of hospitals also are still supported by the historical type of charitable or religious associations).

In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health care system exists, funded by the state. Hospital care is thus relatively easily available to all legal residents (although as hospitals prioritize their limited resources, there is a tendency for 'waiting lists' for non-emergency treatment in countries with such systems, and those who can afford it, often take out private health care to get treatment more quickly). On the other hand, many countries, including for example the USA, have in the twentieth century followed a largely private-based, for-profit-approach to providing hospital care, with few state-money supported 'charity' hospitals remaining today.[26] Where for-profit hospitals in such countries admit uninsured patients in emergency situations (such as during and after Hurricane Katrina in the USA), they incur direct financial losses, ensuring that there is a clear disincentive to admit such patients.

As quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this. Independent external assessment of quality is one of the most powerful ways of assessing the quality of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international health care accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the USA, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France.

Buildings

Architecture

Modern hospital buildings are designed to minimize the effort of medical personnel and the possibility of contamination while maximizing the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimized. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design.

However, the reality is that many hospitals, even those considered 'modern', are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:

"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety."



Some newer hospital designs now try to reestablish design that takes the patient's psychological needs into account, such as providing for more air, better views, and more pleasant color schemes. These ideas hearken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings.

Another major change which is still ongoing in many parts of the world is the change from a ward-based system (where patients are treated and accommodated in communal rooms, separated at best by movable partitions) to a room-based environment, where patients are accommodated in private rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital, which causes some hospitals to charge for the privilege of private rooms.

Ninewells Hospital, Dundee, Scotland is currently one of the largest hospitals in the world, it also is one of the largest teaching hospitals. Ninewells also contains the first building in Britain designed by architect Frank Gehry, in conjunction with James F Stephen. The design was commissioned by Maggie's centres, the cancer support organisation, for their third centre at the hospital and was officially opened on 25 September 2003 by Bob Geldof. Also Ten million pounds has been spent redesigning and overhauling the paediatric department of the hospital and, in June 2006, it was opened officially under the name Tayside Children's Hospital.

Department of hospital:
1.Acute assessment unit
2.Coronary care unit
3.Emergency department
4.Geriatric intensive-care unit
5.Intensive-care unit
6.Neonatal intensive-care unit
7.Norfolk Regional Center
8.Nursing unit
9.On-call room
10.Pediatric intensive-care unit
11.Physical therapy
12.P cont.
13.Post anesthesia care unit
14.Psychiatric hospital
15.Release of information department
16.Trauma center
17.Urgent care

Some vocabularies for giving direction:
1.Go ahead = Jalan terus
2.Turn right = Belok kanan
3.Turn left = Belok kiri
4.Go upstair = Naik tangga
5.Go downstair = Turun tangga
6.Way = Jalan
7.Junction = Pertigaan
8.Crossway/road = Perempatan
9.Turning = Belokan
10.Sign = Tanda
Diposkan oleh Catatanku di 22:03 0 komentar
Kamis, 18 Maret 2010
nurse
Nurse


A nurse is a healthcare professional who, in collaboration with other members of a health care team, is responsible for: treatment, safety, and recovery of acutely or chronically ill individuals; health promotion and maintenance within families, communities and populations; and, treatment of life-threatening emergencies in a wide range of health care settings. Nurses perform a wide range of clinical and non-clinical functions necessary to the delivery of health care, and may also be involved in medical and nursing research.
Both Nursing roles and education were first defined by Florence Nightingale, following her experiences caring for the wounded in the Crimean War. Prior to this, nursing was thought to be a trade with few common practices or documented standards. Nightingale's concepts were used as a guide for establishing nursing schools at the beginning of the twentieth century, which were mostly hospital-based training programs emphasizing the development of a set of clinical skills. The profession's early utilization of a general, hospital-based education is sometimes credited for the wide range of roles nurses have assumed within health care, and this is contrasted with present-day nursing education, which is increasingly specialized and typically offered at post-secondary institutions.
Practice as a nurse is often defined by state, provincial or territorial governments. As an example, the province of Ontario classifies nurses into the roles of Registered Practical Nurse, Registered Nurse (general class), and Registered Nurse (extended class).In this respect, the title "nurse" is protected by law within the province, and regulated by legislative statute.Some regions have legislated different or expanded roles for nurses, generating many potential nurse careers.
Around the world, nurses are often female. However, in Francophone Africa, which includes the countries of Benin, Burkino Faso, Cameroon, Chad, Congo, Côte d'Ivoire, the Democratic Republic of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, and Togo, there are more male than female nurses.In Europe, in countries such as Spain, Portugal, Czechoslovakia, and Italy, over 20% of nurses are male.
Currently, a nursing shortage exists within the United Kingdom, United States, Canada, and a number of other developed countries. The majority of analysis refers to a shortage of Registered Nurse staff. The Canadian Registered Nurse shortage has been linked to longer wait times for hospital-based procedures, increased adverse events for patients, and more stressful work environments. As the shortage of Registered Nurses increases, it is expected that there will be an increasing move towards utilizing unregulated healthcare workers to meet demands for basic nursing care within hospitals and the community.

Etymology
The English word nurse also refers to the act of breastfeeding. A wet nurse is considered someone who provides her own breast-milk to infants. In other languages, the word for nurse comes from the same etymology as the word infirmary, such as in French (infirmier), or Italian (infermiere).

Education
Typically, nurses are distinguished from one another by the area they work in (critical care, perioperative, oncology, nephrology, pediatrics, adult acute care, geriatrics, psychiatric, community, occupational health, etc.). Bodies such as the American Nurses Association and the Canadian Nurses Association have both supported a move towards the creation of national specialty certifications, in order to support more specialized nursing roles. As nursing roles and specialties are continually changing, the International Council of Nurses states that nursing education should always include continuing education activities; while educational preparation is expected to vary between countries, all nursing jurisdictions are encouraged to promote continuing education as an important form of professional education.

Nursing education varies widely, and continues to produce an array of options as nursing roles evolve and also expand in scope. Educational preparation as a nurse may include certificate, diploma, associates, bachelors, masters or doctoral preparation.

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