s ward rotation manual may 2011

8/3/2019 s Ward Rotation Manual May 2011

http://slidepdf.com/reader/full/s-ward-rotation-manual-may-2011 1/41

DIVINE WORD UNIVERSITY

Health Extension Department

CLINICAL SURGERY 2

UNIT: HE313

WARD ROTATION

HAND BOOK

Bob Simon

Clinical Lecturer

2011



Contents Page

Introduction ……………………………………………………………………………… 2

Clinical Performance Assessment ………………………………………….….. 5

Weekly Program ……………………………………………………………………..… 10

Clinical Attachment Grouping …………………………………………………… 11

Ward Duty Roster …………………………………………………………..………… 12

Unit Outline …………………………………………………………………..………… 13

Clinical Supervisor Weekly Program ………………………………..……… 16

Attendance record ………………………………………………………..……….. 16

History Taking & Clinical Exam (guide) …………………………..………. 17

Assessment Task ……………………………………………………………..…….. 22

Referencing Procedures …………………………………………………..…….. 23

Assessment Cover Sheet ................................................ 26


http://slidepdf.com/reader/full/s-ward-rotation-manual-may-2011 3/41 2

Introduction

Students cover surgical unit by doing eight weeks of fulltime clinical practical. This means that

students will work during working hours, from 8am to 4pm, some roosted on duty after hours from

6pm to 10pm, night duty from 10pm to 7am and weekends). You are expected to do clinical

observations and perform clinical practical and procedures under supervision in surgical Departmentof Modilon Hospital. This is supplemented with teaching ward rounds, bedside tutorials, case

presentations by hospital Medical Officers and tutorial sessions with a clinical supervisor on the

university campus. This unit is designed to equip Rural Health students the knowledge and skills in

the triaging and the fundamental basics in managing surgical conditions in a competent manner in

rural Papua New Guinea..

WARD DUTIES

Please read before starting Ward Clinical Rotation.

While you are attached to Surgical Unit (Ward 3), you will become part of the health team caring forall patients in this ward.

1. ADMISSIONS:

You will be responsible for admitting all patients. Each student should have approximately

equal numbers of patients to care for, once you admit a patient, that patient becomes you

responsibility until he is discharged or you change rotations. You must give any stat

treatment and sign the treatment sheet for new admission.

2. DISCHARGE:

When a patient is discharge, you must:

(a) Write a discharge form.

(b) Write a summary in the clinic book.

(c) Write a letter to the referring centre (if the patient was referred) and tick the

appropriate space on the front of the chart

(d) Arrange any necessary follow up.

(e) Make sure discharge medications are supplied and that the parent/guardian knows

how to give them.

3. WEIGHT:

All patients should be weighed on admission.

4. LABORATORY TESTS

You must chase up all of your patients results.

5. BLOOD SLIDE:



3

Blood slide should be taken on patients who are sick or have fever.

6. HAEMOGLOBIN AND FULL BLOOD COUNT:

Routinely haemoglobin should be done to all new admissions. HB and FBC on all cancerpatients weekly.

7. OTHER TEST: May be ordered as necessary.

8. WARD ROUNDS:

Ward rounds begin at 8:00am Mondays, Wednesdays, and Fridays. You are expected to have

seen your patients before this round begins. During the round you will present a summary of

each patient’s history and examination that you are caring for and your management plan.

After discussion with the Medical Officer or your clinical tutor, you will then be expected to

make sure that all treatment, tests, etc, are carried out.

9. OPERATING THEATRE

Tuesdays and Thursdays are operating days. Those students who are listed to observe

surgical procedures must be in the theatre by 8am. There should be no more than four

students at any one time. Theatre rules must be followed. Priority to year three & four HE

students.

10 PROCEDURES:

When you carry out the procedure, e.g. Put up I.V. drip, do I & D, you are responsible forcleaning up after words and repacking any tray you may have used and return it to CSD.

11. AFTER HOURS DUTY:

A roster needs to be made to cover this and you should each have a turn at making up a

roster. When you are on after normal working hours, you are responsible for all admissions,

and any other sick patients in the ward. If there are problems you are not sure how to

handle, you need to discuss these with Medical Officer on call to cover the ward for that

time, (see roster on notice board).

12. WARDS:

Ward three A is where all new admissions go. (Clean cases)

Ward three B & C is where all dirty cases are admitted (dirty cases)

13. INPATIENT EDUCATION:

While patient is in the hospital, you need to educate him about:



(a) His disease and its likely outcome.

(b) The treatment for that disease and how long he is likely to be in hospital.

(c) Nutrition, if the patient is malnourished.

14. HANDOVER:

When leaving this ward rotation, you must write a summary in the chard for the person who

will be caring for the patient next and tell them about your patients before you leave.

When you are handing over to someone else for after hour’s duties, you must tell them of

all problems in the ward.

15. DURATION:

Your ward rotation begins at 8:00am on the first Monday and ceases at 10.30pm on the

Sunday eight weeks later, except for those students whose rotation ceases at term break

when the rotation ceases at 4.00pm on the Friday.

16. ASSISTANCE IN WARD.

Do not hesitate to ask your RHEO, RMO, surgical registrar or SMO if you need assistance in

clinical practice. Ask the nursing officers for any general nursing procedures.

17. ILLNESS:

If you are sick, you must contact one of the Medical Officers or clinical lecturer. You should

arrange for someone else to care for your patients and do your on call while you remain ill.Make sure to obtain Medical Certificate from the medical officer or registrar if you are too

sick to attend duties.

18. STAFF RELATIONSHIP:

You will be part of a team while working in this ward. If you help others on the team, they

will help you. If you make it hard for others, they will probably do the same to you. Make

the most of your time in the ward, and in the long run it will be you who gain most benefit.

19. DRESSINGS

Make sure that you have your clinical shirt on, name tag/ID Card, good foot wear, hand

watch with second hand and finally neat dressing before you go to the ward for practical.

20. STAT DOSES OF MEDICATION

Stat dose must be given by you to all patients that you admit.

21. ASSESSMENT:



5

The SMO, Registrar, Clinical lecturer and Nursing Officers will assess you during your ward

practical. Three areas will be assessed.

(a) Knowledge

(b) Practical skills

(c) Attitude

NB: Final clinical Examination is at the end of the rotation.

..............................................................................................................



6

YEAR THREE

CLINICAL PERFORMANCE ASSESSMENT FORM

ATTITUDE ASSESSMENT:

CRITERIA LOW RATING SCALE HIGH RATING

Attitude to work Lazy, not interested 1 2 3 4 5 Industrious, very interested

Desire to learn Not willing to learn 1 2 3 4 5 Very willing to learn

Initiative Not shown at all 1 2 3 4 5 Takes the initiative often

Punctuality Not punctual or constantly

late

1 2 3 4 5 Punctual, on time

Appearance Not appropriately dressed 1 2 3 4 5 Appropriately dressed

Organising ability Either he cannot or will not

motivate and organise others

1 2 3 4 5 Demonstrated ability to

motivate and organise others

Reliability Fails to carry out requests

and instructions

1 2 3 4 5 Intelligently completes all

requests and instructions

Relationship to

patients and

guardians

Arrogant and insensitive 1 2 3 4 5 Cooperative, warm

approachable.

Relationship to

other staff

Arrogant, insensitive does

accept criticism.

1 2 3 4 5 Cooperative approachable.

Use of guide books

and referencebooks.

Fails to use the guide books

in the correct way.

1 2 3 4 5 Intelligently carries out the

management as shown in theguide books and notes.

TOTAL MARKS: …. /50

Signed: ……………………

Doctor/Tutor Date: ………………….



TOTAL MARKS: …. /55

Signed: …………………… Date: …………………….

CRITERIA LOW RATING SCALE HIGH RATING

Medical Subject Knowledge.

• Is there clear evidence of appropriate

reading? (This might ask whether enough

reading has been done, or whether the

reading is up to date!)

• Does he/she understand the subject-matter

and does an in-depth knowledge shines

through?

Ignorant of many

basic facts

0 1 2 3 4 5 Sound/good knowledge of

basic facts.

History taking.

• Is the information obtained precise, accurate

and of a high standard?

Incomplete

superficial history

taking

0 1 2 3 4 5 Practice, reliable and

comprehensive histories.

Physical examination.

• Is the information obtained precise, accurate

and of a high standard?

• Does he know how to do physical

examination?

• Is he/she able to explain the clinical findings?

Important

omission

saporous

abnormalities

reported.

0 1 2 3 4 5 Important physical finding

noted

Laboratory Test

• Has he ordered appropriate laboratory test?

• Has he able to interpret the Lab result?

• Has he/she able to perform laboratory test?

Incorrect

laboratory test

Difficulty

interpreting

Difficulty

performing

laboratory test

0 1 2 3 4 5

Important basic laboratory tes

ordered and be able to

interpret.

Diagnosis Incorrect

diagnosis

0 1 2 3 4 5 Correct diagnosis

Management plan.

• Is the presenter able to explain the difference

between live saving measures and long term

treatments?• Does he understand the importance of each

management plan

Incorrect

management

0 1 2 3 4 5 Correct management

Practical (clinical skill procedure.

• Has the right material & equipments been

identified and selected for the procedure and

used appropriately?

• Has the procedure done in sequential

manner?

• Has the procedure done confidently?

Clumsy, not

motivated, could

not do required

procedure.

0 1 2 3 4 5 Skilfully, consistently carries

out practical procedures.

Explain and educate the patients, eg treatment of

surgery.

• Are explanations clear?

Did not explain

and educate the

patients

0 1 2 3 4 5 Did explain and educate the

patients.

Pre-operative examination Incomplete

examination

0 1 2 3 4 5 Did complete examination

Post-operative management Did not manage

and care for

under anaesthetic

0 1 2 3 4 5 Did mange and cared for until

fully recovered from

anaesthetic.

Standard of total patient care received at the hands of

this student.

POOR 0 1 2 3 4 5 EXCELLENT



KEYS:

0. = The student consistently demonstrates an inadequate level of ability with maximum

supervision from staff required (0 marks).

1. = The student usually demonstrates an inadequate level of ability with maximum

supervision from staff required (1 mark).

2. = The student usually demonstrates an adequate level of ability, with moderate

supervision from staff (2 marks).

3. = The student consistently demonstrates a good level of ability, with minimum to

moderate supervision from staff (3 marks)

4. = The student consistently demonstrates an outstanding level of ability, with minimum

supervision from staff (4 marks).

5. = Excellent student with minimal supervision (5 marks)

KNOWLEDGE ASSESSMENT

All marks will be given as a percentage and the final theory mark is also given as a percentage:

TYPE OF ASSESSMENT

No Types Marks %

1 Clinical case write up & Presentation 20%

2

3

Case presentation( Bedside)K & S)

Attitude & Behaviour

30%

10

Total Marks 60

FINAL MARKS:

1. Attitude & Behaviour ________________10%

2. Knowledge & Skills: ________________30%

3. Clinical case write up & Presentation ________________20%

Final Exam; _______________40%

COMMENTS: (if applicable)

_______________________________________________________________________________

Signed: ……………………

Doctor/Tutor Date: …………………….

60%

40%



9

CLINICAL

PRESENTATION ASSESSMENT FORM

Students Name: _____________________________

Year: ________________________

Presentation Skills 0 1 2 3 4

Has the presenter gained the audience’s attention?

Are the objectives clearly stated, and achieved?

Is the presentation carefully planned, well

structured and organised, including the timing?

Is the communication well paced, clear and

effective?

Could notes be taken easily?Are explanations clear?

Is the presenter verbally ¯ uent? Is intonation

varied?

Is the presenter simply reading the information in a

manner suggesting poor preparation?

Is eye contact maintained with the audience?

Are they simplied to illustrate the point or are they

too complex?

Are they left up for long enough to be

interpreted/used?

Is the presenter confident with the material?Are questions confidently answered or is the

presenter uncertain?

Is the presenter enthusiastic?

TOTAL MARKS 52

Academic Content

Has the right material been selected for the

presentation?

Is it all relevant?

Is the vocabulary appropriate and pitched at thecorrect level?

Is there clear evidence of appropriate reading? (This

might ask whether enough reading has been done,

or whether the reading is up to date!)

Are the main issues made clear?

Is the information given precise, accurate and of

a high standard?

Is the information put into a broader context?

Does the presenter understand the subject-matter



10

and does an in-depth knowledge shines through?

Are examples used sensibly to illustrate the points?

If relevant, are areas of contention identified?

Is there evidence of an analytical approach to the

information presented?

TOTAL MARKS 40CLINICAL PRESENTATION Presenting skills

Has he/she taken precise history

Has he done good physical examination?

Has he missed important clinical features?

Does he know how to do physical examination?

Has he ordered appropriate laboratory test?

Has he able to interpret the Lab result?

Are differential diagnoses correct?

Has he made the correct provincial diagnosis?

Has he prescribed correct management plan? Useof STD treatment books

Is the presenter able to explain the difference

between live saving measures and long term

treatments?

Does he understand the importance of each

management plan

Does he know the indications for referral to

hospital?

Any reference to any text books?

Has the presenter used correct terminology

appropriately?Has he presented the case in sequential order?

Does the presenter understand the clinical

problem?

Is there evidence of an analytical approach to the

information presented?

Are teaching Aids used skilfully?

Are they large enough to be seen properly?

Do they clarify the point and reduce confusion?

Over all presentation?

TOTAL MARKS 80

OVERALL MARKS……../172

LECTURER: ______________________________ Date: ______________________

KEYS:

0. = The student consistently demonstrates an inadequate level of ability with maximum

supervision from staff required (0 marks).

1. = The student usually demonstrates an inadequate level of ability with

maximum supervision from staff required (1 mark).



11

2. = The student usually demonstrates an adequate level of ability, with moderate

supervision from staff ( 2 marks).

3. = The student consistently demonstrates a good level of ability, with minimum to

moderate supervision from staff (3 marks).

4. = The student consistently demonstrates an outstanding level of ability, with

minimum supervision from staff (4 marks).

...................................................................................................................................................

Weekly Program

DAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

TIME

8am – 10am

Ward round

& Work

Operating

Theatre(G1)

Ward round

& Work

Operating

Theatre(G1)

Ward round

& Work

10am – 11am

Bedside tutorial

Post

Operative

care (G2)

Bedside tutorial

Post Operative

care (G2)11am-12.30pm Dr Kuzma

(Tutorial)LUNCH BREAK

1.30-2.30pm Ward

tutorial/Ward

work

Operating

Theatre

Dr Kuzma

(Tutorial)

Operating

Theatre Tutorial

2.30-4.00pm Lecture HE213

Main Campus

Lecture HE213

Main Campus

Lecture HE213

Main Campus

NB: 1. All patients admitted to the Surgical Ward to be seen by R.H,

students for case studies.

2. Full history and clinical examination must be done on

admission.

3. All treatment ordered by R.H Trainee must be double check

by Clinical Tutor, or Medical Officer.

4. All admission after 4.06pm must be notified to M.O. on

call. This includes weekends.

5. Contact Medical Officers or SMO for any seriously ill patients on admission

immediately.

Dr. Kuzma MR.BOB SIMONSSMO Surgery Clinical Supervisor



12

HE3 CLINICAL ATTACHMENT GROUPING

Accident & Emergency (A) Medicine (B)

NO REG NO FIRST NAME SURE NAME NO REGNO

FIRST NAME SURE NAME

1 4894 Amenda NAWAK 1 4879 Anniephine MARKRAWA

2 5131 Budsy BILIMO 2 4904 Emmanuel TOBIAS

3 5203 Clodia MANORH 3 4874 Cedrick YUWORONONG

4 4898 Hariet TOPA,A 4 5133 Harry JOBBIE

5 5173 Jack WANTUM 5 4902 Jill YOPO

6 4886 Julianne VEOLI 6 5132 Julie YASEPSA

7 4895 Keren KOVE 7 5134 Keroline KOLAPEN

8 4892 Mellonson JOHN 8 5238 Ripson MURA

9 5166 Peter TOWANLOGO 9 5186 Petronella DAVID

10 5152 Renate ZUVANI 10 5184 Samson YATENG

11 5245 Tandam YAMO 11 4875 Tekla JACOB

O & G C Peadiatrics DNO REG NO FIRST NAME SURE NAME NO REG

NO

FIRST NAME SURE NAME

1 4887 Bathseba KEANGA 1 4882 Br.Geoffery LIRIA

2 4925 Christopher APIYEP 2 4893 Clerisa ANALUVA

3 5146 Emsop LUNICA 3 4876 Ezekkial ROKA

4 5163 Helen MIAG 4 4889 Ismael ERI

5 4901 Joe PUTT 5 4881 Jonathan BOMAI

6 4905 Junior KILUWA 6 4884 Keren MIUL

7 4908 Konia FRANCIS 7 Mathew OKSAP

8 5168 Nathan KAWA 8 4897 Nellie AKAI

9 4890 Philomena TATIRETA 9 4896 Pison JAKAWA

10 4885 Sharol ROKENTUO 10 4891 Sharon MAULUDU

11 4872 Verolyne KAVANAMUR 11 5171 Yapi OPI

Surgery (E) NO REG NO FIRST NAME SURE NAME

1 4878 Carolyne HEMO

2 5280 Cliford KOSU

3 4903 Gladlyn MALAK

4 5286 Jacenold PUKEHUN

5 5273 Judith PUGA6 5153 Kenning DABANG

7 4871 Mathilda WALOM

8 5156 Paul DISIN

9 5206 Rachel TUTANA

10 4899 Shirlyna LOWAGIPO

11 5172 Zuaru THEROW



13

NB: EIGHT WEEKS ROTATION IN EACH UNIT

..........................................................................................................................................

WARD DUTY ROSTER

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

8am

To

4pm

NB: After hours and weekend students are not allowed in the hospital wards.

.....................................................................................................................

UNIT TITLE: CLINICAL SURGERY 2

UNIT CODE: HE313

CREDIT POINTS 8 (seven week block rotation at Modilon hospital)

PREREQUISITES: HE221 Surgery I and Anesthetics.

DESCRIPTIONStudents cover this unit by doing seven weeks of fulltime clinical practical (working hours, after

hours and weekends) clinical observations and supervised practical experiences in the accidents and

emergency section of Modilon Hospital. This is supplemented with tutorial sessions with a lecturer

on the university campus. This unit will teach practical skills in diagnosis and management of the

most common surgical problems in Papua New Guinea. Stress will be placed on developing critical

clinical thinking, assessment of patients’ condition and formulating management plan. Studentsreceive theoretical and practical instruction regarding performing basic minor surgical procedures.

LEARNING OUTCOMES

Students are able to:

1. Describe characteristic clinical features of the commonest surgical diseases

2. Collect and critically analyze clinical data and assess patients condition

3. Arrive at most probable diagnosis

4. Formulate therapeutic plan for surgical patients

5. Outline preventive plan for the commonest surgical problems

DATE A & E MEDICINE O & G PEDIATRICS SURGERY COMMENTS

A B C D E

B C D E A

C D E A B

SEMESTER BREAK

D E A B CE A B C D



14

6. Demonstrate understanding and application of basic minor surgical procedures and perform

some of minor surgical procedures

CONTENT Week 1

Ward rounds, in bed teachingPresentation and discussion:

• Assessment and primary management of head trauma

• Management of patients with spinal injury

• Diagnosis and primary management of chest trauma

History taking and characteristic of surgical examination

Tasks: Admit a surgical patient, report findings from history taking and examination history,

Performing surgical nursing procedures: insertion of I.V. cannula, parenteral drugapplication,

NGT insertion, dressing etc.

Week 2

Ward rounds, in bed teachingPresentation and discussion:

• Abdominal trauma, post spleenectomy after care

• Burns management, skin graft

• Diagnosis and primary management of limb-threatening injuries


formulating management plan

Performing surgical nursing procedures: insertion of I.V. cannula, parenteral drug application,

NGT insertion, dressing etc.

Week 3Ward rounds, in bed teaching

Presentation and discussion:

• Reduction of commonest dislocations

• Fractures of the upper limb, Hand injuries

• Fractures of the lower limb, prevention and management of complications associated with

POP

Tasks: Admit a surgical patient, report findings from history taking and examination history,\

writing discharges, formulating management plan

Performing surgical minor procedures: application of skin traction, application of POP.

Practical test: Write a surgical patient history, differential diagnosis and management plan

Week 4Ward rounds, in bed teaching


• Hernias – differential diagnosis, strangulation, aftercare

• • Acute appendicitis – differential diagnosis

• Bowel obstruction





15

Performing surgical procedures: insertion of I.V. cannula, parenteral drug application, NGT

insertion, dressing etc.

Week 5

Ward rounds, in bed teaching

Presentation and discussion:• Urological emergencies

• Rectal diseases, haemorrhoids

• Breast cancer



Performing surgical minor procedures and nursing procedures: insertion of I.V. cannula,

parenteral drug application, NGT insertion, dressing etc.

Week 6


Presentation and discussion:• Prevention of Hospital cross-infections, aseptic technique

• Rehabilitation of surgical patients



Practical exam:

Collect clinical data

Conduct differential diagnosis with formulating most likely diagnosis

Formulate management plan including discharge instruction and possible preventive measures

Comment on the outcome

During this practical placement a student should

• Assist surgeon working in the surgical clinic (at least twice)

• Observe and assist work at the Operating Theatre (at least 6 times)

Week 7



• Prevention of Hospital cross-infections, aseptic technique

• Rehabilitation of surgical patients

Tasks: Admit a surgical patient, report findings from history taking and examination

history, writing discharges, formulating management plan

Practical exam:Collect clinical data

Conduct differential diagnosis with formulating most likely diagnosis

Formulate management plan including discharge instruction and possible preventive

measures

Comment on the outcome

During this practical placement a student should

• Assist surgeon working in the surgical clinic (at least twice)

• Observe and assist work at the Operating Theatre (at least 6 times)



16

ASSESSMENTS

Assignment 1: Clinical case write up

Task: Research project and presentation

Criteria: Case write up 10% and presentation 10%

Length: Up to 1,500 words and 30 minutes presentations

Weight: 20%

Assignment 2: Clinical case presentation(bedside)skills

Task: Perform all clinical requirements

Criteria: The extent to which students can demonstrate knowledge, skills and understanding

of clinical surgery

Length: 7 weeks

Weight: 30%

Assignment 3: Attitude & behaviour

Task: Clinical practical attachment in hospital

Criteria: The extent to which students must Demonstrated ability to carry out responsibility,

take inititive, and committments during clinical attachment.

Length: 7 weeks

Weight: 10%

Assignment 3: End of semester examTask: Written exam

Criteria: The extent to which students can demonstrate knowledge and understanding of

clinical surgery

Length: 2 hours

Weight: 40%

REFERENCESAdams JC, Hamblen DL. 1999. Outline of Fractures. London: Churchill Livingstone.

Adams JC, Hamblen DL. 2001. Outline of Orthopedics. London: Churchill Livingstone.

Australian First Aid, 1989, 2nd EDN, St. John Ambulance Australia, Canberra

Kuzma J. 2006. Surgery for primary health care workers in PNG, DWU Press. Madang

Simon B. 1998. Anaesthesia for HEO. 3rd Edn, DWU, Madang

Watters DAK, Wilson IH, Leaver RJ. 2004. A Care for critically ill patient in the tropics.

SUPERVISOR WEEKLY PROGRAM



17

Attendance record

NB: HE 213 . Pharmacology lecture for HE 2 Class at the main campus.

...............................................................................................................................................

DAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

TIME

8am – 10am Ward round Operating

Theatre

Ward round

Operating

Theatre

Ward round

10.30am – 12MD

Ward Tutorial

(HE 313)

Ward Tutorial

(HE 313)

Ward Tutorial

(HE 313)

TEA BREAK

10.30am –12MDWard Tutorial

(HE 313)

Operating

Theatre

Ward Tutorial

(HE 313)

Operating

Theatre

Ward Tutorial

(HE 313)

LUNCH BREAK

14.30pm – 15.30pm Lecture

HE213 MM2

Lecture

HE213 MM2

Lecture

HE213 MM2

Operating

Theatre

R415 – 14.30

Tutorial

HE311

R415

1.30-2.30pm

DATES COMMENTS

NAME



18

History Taking and Clinical Examination

DiagnosisIn general, diagnosis (plural diagnoses) has two distinct dictionary definitions. The first

definition is "the recognition of a disease or condition by its outward signs and

symptoms", while the second definition is "the analysis of the underlying

physiological/biochemical cause(s) of a disease or condition".

In medicine, diagnosis or diagnostics is the process of identifying a medical condition or

disease by its signs, symptoms, and from the results of various diagnostic procedures.

The conclusion reached through this process is called a diagnosis. The term "diagnostic

criteria" designates the combination of symptoms which allows the doctor to ascertain the

diagnosis of the respective disease.

Typically, someone with abnormal symptoms will consult a physician, who will then

obtain a history of the patient's illness and examine him for signs of disease. The

physician will formulate a hypothesis of likely diagnoses and in many cases will obtainfurther testing to confirm or clarify the diagnosis before providing treatment.

Medical tests commonly performed are measuring blood pressure, checking the pulse

rate, listening to the heart with a stethoscope, urine tests, fecal tests, saliva tests, blood

tests, medical imaging, electrocardiogram, hydrogen breath test and occasionally biopsy.

Relationship of diagnosis to medical practiceA physician's job is to know the human body and its functions in terms of normality

(homeostasis). The four cornerstones of diagnostic medicine, each essential for

understanding homeostasis, are: anatomy (the structure of the human body), physiology(how the body works), pathology (what can go wrong with the anatomy and physiology)

and psychology (thought and behavior). Once the doctor knows what is normal and can

measure the patient's current condition against those norms, she or he can then determine

the patient's particular departure from homeostasis and the degree of departure. This is

called the diagnosis. Once a diagnosis has been reached, the doctor is able to propose a

management plan, which will include treatment as well as plans for follow-up. From this

point on, in addition to treating the patient's condition, the doctor educates the patient

about the causes, progression, outcomes, and possible treatments of his ailments, as well

as providing advice for maintaining health.

Diagnostic procedureDiagnosis is a fluid process in which the physician responds to information garnered

from the patient and others, from a physical examination of the patient, and from medical

tests performed upon the patient.

The doctor then conducts a physical examination of the patient, studies the patient's

medical record, and asks further questions as he goes, in an effort to rule out as many of

the potential conditions as possible. When the list is narrowed down to a single condition,

this is called the differential diagnosis, and provides the basis for a hypothesis of what is

ailing the patient.



19

Once the physician has completed the diagnosis, he explains the prognosis to the patient

and proposes a treatment plan which includes therapy and follow-up (further

consultations and tests to monitor the condition and the progress of the treatment, if

needed), usually according to the guideline provided by the medical field on the treatment

of the particular illness.

Treatment itself may indicate a need for review of the diagnosis if there is a failure to

respond to treatments that would normally work.

Medical historyThe medical history or anamnesis of a patient is information gained by a physician or

other healthcare professional by asking specific questions, either of the patient or of other

people who know the person and can give suitable information (in this case, it is

sometimes called heteroanamnesis), with the aim of obtaining information useful in

formulating a diagnosis and providing medical care to the patient. This kind of

information is called the symptoms, in contrast with clinical signs, which are ascertained

by direct examination.

The information obtained in this way, together with clinical examination, enables the

physician to form a diagnosis and treatment plan. If a diagnosis cannot be made then a

provisional diagnosis may be formulated, and other possibilities (the differential

diagnosis) may be added, by convention listed in order of likelihood. The treatment plan

may then include further investigations to try and clarify the diagnosis.

A physician typically asks questions to obtain the following information about the

patient:

Identification and demographics: The name, age, height, weight.

The "chief complaint (CC)" — the major health problem or concern, and its time

course.

History of present illless (HOPI) - details about the complaints enumerated in the

CC.

History of past illness (HPI)(including major illnesses, any previous

surgery/operations, any current ongoing illness, eg diabetes)

Review of systems(ROS) Systematic questioning about different organ systems

Family diseases

Childhood diseases

Social history - including living arrangements, occupation, drug use (including

tobacco, alcohol, other recreational drug use), recent foreign travel and exposure

to environmental pathogens through recreational activities or pets.

Regular medications (including those prescribed by doctors, and others obtained

over the counter or alternative medicine)

Allergies Sex life, obstetric/gynecological history and so on as appropriate.

History-taking may be comprehensive history taking (a fixed and extensive set of

questions are asked, as practised only by medical students) or iterative hypothesis testing

(questions are limited and adapted to rule in or out likely diagnoses based on information

already obtained, as practised by busy clinicians).



20

SymptomStrictly, a symptom is a sensation or change in health function experienced by a

patient. Thus, symptoms may be loosely classified as strong, mild or weak. In

this, medically correct, sense of the word, it is a subjective report, as opposed to a

sign, which is objective evidence of the presence of a disease or disorder.

Medical signSimply, a sign is an indication of some fact or quality; and, in everyday English, a

medical sign is an "objective" indication of some medical fact or quality that is detected

by a physician during a physical examination of a patient—such as elevated blood

pressure.

Signs versus symptomsSigns are commonly distinguished from symptoms as follows: a symptom is something

abnormal, that is relevant to disease, experienced by a patient, whilst a sign is something

abnormal, that is relevant to disease, discovered by the physician during his examinationof the patient:

…a sign is an objective symptom of a disease; a symptom is a subjective sign of

disease.

Types of signsMedical signs may be classified by the type of inference that may be made from their

presence, for example:

Prognostic signs (from progignokein, προγιγνωσκειν, "to know beforehand"):

signs that indicate the outcome of the current bodily state of the patient (i.e.,

rather than indicating the name of the disease). Prognostic signs always point tothe future.

Anamnestic signs "able to recall to mind"):

signs that (taking into account the current state of a patient's body), indicate the

past existence of a certain disease or condition. Anamnestic signs always point to

the past .

Diagnostic signs "able to distinguish"): signs

that lead to the recognition and identification of a disease (i.e., they indicate the

name of the disease).

Pathognomonic signs "skilled in diagnosis", "judge"): the particular signs whose presence means,

beyond any doubt, that a particular disease is present. They represent a marked intensification of adiagnostic sign. Singular pathognonomic signs are relatively uncommon.

[Thus] a symptom is a phenomenon, caused by an illness and observable directly

in experience. We may speak of it as a manifestation of illness. When the

observer reflects on that phenomenon and uses it as a base for further inferences,

then that symptom is transformed into a sign. As a sign it points beyond itself —

perhaps to the present illness, or to the past or to the future. That to which a sign

points is part of its meaning, which may be rich and complex, or scanty, or any

gradation in between.

In medicine, then, a sign is thus a phenomenon from which we may get a message,



21

a message that tells us something about the patient or the disease. A phenomenon

or observation that does not convey a message is not a sign. The distinction

between signs and symptom rests

Signs as tests

In some senses, the process of diagnosis is always a matter of assessing the likelihood that a given condition is present in the patient. In a patient who presents with haemoptysis

(coughing up blood), the haemoptysis is very much more likely to be caused by

respiratory disease than by the patient having broken their toe. Each question in the

history taking allows the medical practitioner to narrow down their view of the cause of

the symptom, testing and building up their hypotheses as they go along.

Examination, which is essentially looking for clinical signs, allows the medical

practitioner to see if there is evidence in the patient's body to support their hypotheses

about the disease that might be present.

A patient who has given a good story to support a diagnosis of tuberculosis might be

found, on examination, to show signs that lead the practitioner away from that diagnosis

and more towards sarcoidosis, for example. Examination for signs tests the practitioner's

hypotheses, and each time a sign is found that supports a given diagnosis, that diagnosis

becomes more likely.

Special tests (blood tests, radiology, scans, a biopsy, etc.) also allow a hypothesis to be

tested. These special tests are also said to show signs in a clinical sense. Again, a test can

be considered pathognonomic for a given disease, but in that case the test is generally

said to be "diagnostic" of that disease rather than pathognonomic. An example would be

a history of a fall from a height, followed by a lot of pain in the leg. The signs (a swollen,

tender, distorted lower leg) are only very strongly suggestive of a fracture; it might not

actually be broken, and even if it is, the particular kind of fracture and its degree of

dislocation need to be known, so the practitioner orders an x-ray. The x-ray film shows a

fractured tibia, so the film is said to be diagnostic of the fracture.

Examples of signs Ascites (fluid in the abdomen)

Cachexia (loss of weight, muscle

atrophy)

Caput medusae (dilated umbilical

veins)

Clubbing (deformed nails)

Cough

Death rattle ( last moments of life ina person/animal)

Gynecomastia (excessive breast

tissue in males)

Hemoptysis (blood-stained sputum)

Hepatosplenomegaly (enlarged liver

and spleen)

Icterus ("jaundice")

Lymphadenopathy (swollen lymph

nodes)



22

Palmar erythema (reddening of

Physical examinationPhysical examination or clinical examination is the process by which a health care

provider investigates the body of a patient for signs of disease. It generally follows the

taking of the medical history — an account of the symptoms as experienced by thepatient. Together with the medical history, the physical examination aids in determining

the correct diagnosis and devising the treatment plan

Vital SignsTemperature

Temperature recording gives an indication of core body temperature which is normally

tightly controlled (thermoregulation) as it affects the rate of chemical reactions.

The main reason for checking body temperature is to solicit any signs of systemic

infection or inflammation in the presence of a fever

Blood pressureThe blood pressure is recorded as two readings, a high systolic pressure which is the

maximal contraction of the heart and the lower diastolic or resting pressure. Usually the

blood pressure is taken in the right arm unless there is some damage to the arm.

PulseThe pulse is the physical expansion of the artery. Its rate is usually measured either at the

wrist or the ankle and is recorded as beats per minute. The pulse commonly is taken is the

radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist and is taken at

the elbow (brachial artery), at the neck against the carotid artery (carotid pulse), behind

the knee (popliteal artery), or in the foot dorsalis pedis or posterior tibial arteries. The

pulse rate can also be measured by listening directly to the heartbeat using a stethoscope.

The pulse varies with age. A newborn or infant can have a heart rate of about 130-150

beats per minute. A toddler's heart will beat about 100-120 times per minute, an older

child's heartbeat is around 90-110 beats per minute, adolescents around 80-100 beats per

minute, and adults pulse rate is anywhere between 50 and 80 beats per minute.

Respiratory rate

Varies with age, but the normal reference range is 16-20 breaths/minute.

General appearanceObvious apparent features as the patient enters the consulting room and in the course of

taking the history (e.g. mobility problem or deafness)

JACCOL, a mnemonic for Jaundice, suggestion of Anaemia (pale colour of skin

or conjunctiva), Cyanosis (blue coloration of lips or extremities), Clubbing



23

Inspection (medicine)

In medicine, inspection (Latin word "Inspectio" or the act of beholding) is the thorough

and unhurried visualization of the client. This requires the use of the naked eye.

During inspection, the examiner observes:

External signs:

Body features and symmetry appearance

Nutritional state or weight

Skin color

Frequency and volume of breaths during respiration

Movement of the abdomen and each side of the chest during respiration

Hair distribution

divercation of recti muscle

umbilicus (site-shape-color- infiltration)

Gait and manner of speaking

Gross Deviation:

Abnormal contour

Scars and striae

Visible masses

Discoloration

Swelling

Tremor

In medical practice, inspection is however not limited to visual information alone.

Inspection also involves:

Listening to any sounds emanating from the client

Odors that may be present

Palpation

Palpation is a method of examination in which the examiner feels an object to determine

its size, shape, firmness, or location. Medical doctors, for example, may palpate body

parts to check for swelling or disease.

Percussion (medicine)

Percussion is a method used by a clinican to find out about the changes in the thorax or

abdomen. It is done by tapping on a surface to determine the underlying structure. It is

one of the four methods of clinical examination: inspection, palpation, percussion and

auscultation. It is done with the middle finger of right hand tapping on the middle finger

of the left hand, which is positioned with the whole palm on the body.

Auscultation

Auscultation is the technical term for listening to the internal sounds of the body, usually

using a stethoscope. Auscultation is normally performed for the purposes of examiningthe circulatory system and respiratory system (heart sounds and breath sounds), as well as

the gastrointestinal system (bowel sounds). Auscultation is a skill that requires substantial clinical

experience, and good listening skills.

……………………………………………………………………………………………………………………………..



24

Assessment Task(Case presentation)

Presentation format.

Comprehensive format headed with;

Definition (Topic) ( 5 marks)

Epidemiology

The epidemiology describes the incidence and prevalence of disease. (5 marks)

Pathology

The pathology relates to the Aetiology and pathogenesis of disease. (5 marks)

Scope of disease (complications)

Disease can present as primary condition or as a result of a secondary complication.

(5 marks)

Clinical features (5 marks)

This relates mainly to symptoms and examination features of disease and any other associated

complications.

investigations,Lab Test (5 marks)

Further investigations refer to investigations not usually performed for all patients with clinical

features suggestive of the underlying disease, as well as more invasive or specific investigations for

patients with specific indications or associated complications.

Initial management (5 marks)Initial management provides information and instruction on simple first line measures on

the management of disease or the important first step of emergency management.

Medical management (5 marks)

Medical management refers to all non surgical management and usually describes risk-factor

modification and drug treatment, although it may include any other intervention performed by

physician.

Surgical management (5 marks)

Surgical management describes the surgical management, procedure, result and complications,

usually in sufficient detail to obtain informed consent.

Indication for referral (5 marks)

What are the indications for referral from Health centre/District hospital

Prognosis (5 marks)

The prognosis is used to describe the natural history of untreated disease as well as the result of

treatment.

References. (5 marks)



\25

.................................................................................................................

REFERENCING PROCEDURES

Introductory comments

In academic writing, an author almost always gets information from the writings of others. It is

essential that these sources be acknowledged. These acknowledgements provide evidence of

professional reading and give support to the points being made. University students are expected to

demonstrate this practice.

There is no one simple internationally used set of referencing procedures. This can be seen as you

look at referencing styles in different academic publications. The style being described in these

notes uses the author-date format from the Style Manual (Australian Government Publishing Service

1994). This is used by public servants and also by many publishers, authors, editors, businesses,

private individuals and educational and other institutions in Australia.

Consistency in how you apply a referencing style is important. You may use a recognised style otherthan the one in the AGPS Style Manual but the important thing is to use it consistently.

A. Reference list at end of text

List in alphabetical order by the surname of the author. If typing, use italics for titles of books and

journals. Do not underline as this covers the down strokes of letters and slows down reading

comprehension. Only in hand-written work is underlining used to indicate book and journal titles.

1.1 One author

Marsh, C.J. 1992, Key Concepts for Understanding Curriculum, The Falmer Press, London.

1.2 Two or more authorsHuling, L., Hall, G., Hord, S. & Rutherford, W. 1983, A Multi-Dimensional Approach for Assessing

Implementation Success, Southwest Educational Development Laboratory, Austin, Texas.

1.3 Edition of a book

Barry, K. & King, L. 1998, Beginning Teaching and Beyond, 3rd

edn, Social Science Press, Australia.

1.4 One editor

Guthrie, G. (ed.) 1987, Basic Research Techniques, Report No. 55 Educational Research Unit,

University of Papua New Guinea.

1.5 Two editors

Pigdon, K. & Woolley, M. (eds) 1992, The Big Picture: Integrating Children’s Learning, Eleanor

Curtain, Armadale.

1.6 Chapter or article in a collection

Smith, Geoffrey 1972, ‘Education, history and development’, in Encyclopaedia of Papua New Guinea,

Peter Ryan (ed.), Melbourne University Press, Australia, pp. 315-330.



\26

1.7 Article from a journal

N’Drawii, J. 2003, ‘Social problems faced by female student teachers at Madang Teachers College’,

MTC Search, vol. 6, no. 4, pp. 6-10.

1.8 Article from a newspaper with known author

Kapigeno, J. 2004, ‘Schools warned against sending children home’, Weekend National, 13-15 February, p. 6.

1.9 Article from a newspaper, author not indicated

Weekend National, 13-15 February 2004, ‘Lae tax officer charged with K26,000 fraud’, p. 7.

1.10 Paper presented at a meeting, seminar or conference

Tivinarlik, A. & Nongkas, C. 2002, Catholic leadership in Papua New Guinea secondary schools,

paper presented at the Australian Catholic University conference on leadership.

1.11 Unpublished thesis

Tivinarlik, A. 2000, Leadership styles of New Ireland high school administrators: a Papua New Guineastudy , PhD thesis, University of Iowa, USA.

1.12 Dictionary, thesaurus, atlas. Bible etc

The Macquarie Dictionary 1991, 2nd

edn, Macquarie University, Australia.

1.13 Two or more publication by same author in same year

Department of Education 2000a, National Education Plan 1995-2004 Update 1, Waigani, Papua New

Guinea.

Department of Education 2000b, Primary Education Handbook , 2nd

edn, Waigani, Papua New

Guinea.

1.14 Films and video recordings – title, format, date

First Contact (video recording) 1981.

Haus and Home (television production) 2 March 2004, EMTV.

1.15 author, date, title, www address

Curriculum Reform Implementation Project 2004, ‘Upper primary student resources for PNG

Department of Education, www.pngcurriculumreform.ac.pg, accessed 12 June 2007.

B. In-text references

2.1 author-date, and sometimes page

Matane (1986) was the first to suggest a philosophical change.

Matane (1986, p. 4) stressed the importance of integral human development.Research into leadership styles (Tivinarlik & Nongkas 2002) found …

Several studies (Dorrow & O’Neal 1979, Mullaney 1978, Talpers 1981) found …

2.2 et al (and others) for three or more authors

The concerns-based adoption model (Huling, et al. 1983) was trialled widely.



\27

2.3 Quotation – less than three lines – single quotation marks

The Ministerial Committee argued that ‘education should not be considered as a passport to a paid

job’ (Matane 1986, p. 1) and described how attitudes of educators, parents and young people must

change.

2.4 Citation in text – more than three lines– indent, block, no quotation marks

Josephs (2000, p. 29) argued that:

The greatest single factor affecting quality is the teacher. Pre-service and in-service

opportunities for teachers are important indicators, but for some children the

presence of a teacher in the classroom would be a welcome bonus. It is common

knowledge that some teachers absent themselves from classrooms regularly and

without authority.

C. Some other points concerning academic writing

3.1 Abbreviations contain the initial letter and other letters of a word or words but not the final

letter.

vol. no. p. pp. i.e. e.g. ed.

Abbreviations using capital letters are written without full stops.PhD PNG UPNG PO UNESCO

3.2 A contraction has at least the first and last letter of a word. It is written without a full stop

eds (editors), edn (edition), Dept (Department), Mr (Mister), Dr (Doctor)

3.3 Non-discriminatory and inclusive language is to be used. Avoid using ‘man’ in a generic sense

and use alternatives such as headteacher, police officer, chairperson etc. Avoid the awkward use of

he/she, him/her by rewriting the sentence in the plural.

3.4 Use full stops at the end of sentences but not headings and sub-headings. Use single quotation

marks to enclose exact words of a writer or speaker. Do not hyphenate words at the ends of lines,put the whole word on the next line.

3.5 Lists. A colon is used to introduce a list. Punctuation is not needed at the ends of items in a list.

The last listed item is followed by a full stop. Avoid unnecessary numbering in lists unless it is

needed to show order, e.g. to make something.

3.6 Use headings and sub-headings to organize your text. Avoid creating sub-subheadings.

3.7 The first time an acronym is used, give the words in full followed by the letters in parentheses,

e.g. Divine Word University (DWU). After that, the acronym can be used by itself.

Approved by DWU Academ

…………………………………………………………………………………………………………………………



\28

ASSESSMENT COVER-SHEET

DIVINE WORD UNVIVERSITY

Degree Rural Health

ASSESSMENT COVER-SHEET

STUDENT NAME: DUE DATE

UNIT TITLE: UNIT CODE:

ASSESSMENT TITLE:

LECTURER:

Your assessment should meet the following requirements. Please confirm by ticking boxes before

submitting your assessment. Assessment presentation is your responsibility.



\29

Your name and the essay title as footer on

each page

Assessment is presented on A4 paper

Printed single sided, page numbers on

bottom right corner

Pages firmly stapled together

Top & bottom margins 2cms minimum

Left margin 4cm & right margin 3cm

Double or 1½ line spacing

Text left justified

Typed, spell checked and paginated

Referencing is consistent and

thorough

Declaration below is completed

Copy retained by student

Declaration:

This essay / assessment is all my own work, except where duly acknowledged. Ideas taken from

other sources are indicated with footnotes; words or passages taken from other sources are

marked with quotation marks, citations and appropriate references.

Signed: Date:

.............................................................................………………….........………………...........

OPERATION NOTES

Name: ……………………………Age/Sex………………Admission No……..……...

Date: ……………………….

Operative Diagnosis: …………………………

Indications: …………………………………...

Operation: ……………………………………

SURGEON: …………………………….. ANAESTHETIST: …………………

Incision/Approach:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Finding:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________



\30

Procedure:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Post operative instruction:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

...............................................................................................................................

REFERRAL FORM

Bundi Health Centre

P.O.Box 10

BUNDI

Madang Province

20th February 2011

To: ________________________

________________________

________________________

________________________

Dear Sir,

We are referring you ………………………………age of 20 years for your help and attention.

Clinical Details:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________



\31

We should be grateful if you would kindly take over the management of this patient, and

let us know in due course of the patient’s progress.

Yours sincerely,

______________________

Health Extension Officer (OIC)

..............................................................................

CODE OF ETHICS

The following code of ethics has been approved by the Health Extension Officers

Association. It is an attempt to help members of the association with common ethicalproblems which may be expected to arise in the course of our members’ professional

practice.

Members who may be confronted with ethical problems requiring individual consideration,

or if he/she is in doubt about the course of action to take in any professional difficulty,

he/she should seek proper assistance through the Secretary, Papua New Guinea H.E.O.

Association.

Disciplinary matters over registration of H.E.O.’s is the responsibility of the P.N.G. Medical

Board.

The H.E.O. Association has the responsibility of informing its members about their duties

and the ethical demands placed upon them by the H.E.O. profession. “Professionalmisconduct” should be interpreted as follows:

“An H.E.O. who, in the course of professional practice, has done something which will bereasonably regarded as disgraceful by other members of the H.E.O. profession with a high

standard of behavior shall be regarded as having committed professional misconduct.”

GENERAL PRINCIPLE

Members of the H.E.O. profession accept the following principles for which they strive:

To observe truth and non-violence at all times and to be dedicated to the well being

of his/her country and fellow citizens.

To actively support moves to change policies that will improve the health status of

people of Papua New Guinea, especially those living in the rural areas.

To render service in activities other than health, that may be carried out withincommunities from time to time to establish a society where justice and equality shall

prevail.

To realize and work towards the ideal that maximum well being and happiness of

humanity can only be achieved when within communities people are non-violently



\32

organized as self-reliant rural and urban communities where scientific and other

values are harmoniously combined for the welfare of all.

1. DUTIES OF H.E.O.’s IN GENERAL

1.1. An H.E.O. must maintain the highest stand and of professional conduct

towards individuals and society

1.2. An H.E.O. must regard his/her profession as a service to individuals and

society and not simply a profit making organization. To this end, an H.E.O

must not allow himself/herself to be influenced by how much he/she can get,

but rather, how much and what he/she can give.

1.3. It is unethical for an H.E.O. to receive or demand to be given in connection

with services he/she give to a patient or community other than paid to

him/her by the employing agency.

1.4. Under no circumstances is an H.E.O. to do anything that would weaken the

mental or physical resistance of a human being except from strictlytherapeutic or prophylactic indications imposed in the interest of the patient.

1.5. When an H.E.O. is called upon to give evidence or a certificate, he/she should

only state the facts that can be proved.

1.6. It is the responsibility of the H.E.O. to assure himself/herself of the

competence of nurses, C.H.W’s and other auxiliary staff.

1.7. An H.E.O. must not exercise favoritism to any one individual on the staff

when dealing with disciplinary matters.

2. DUTIES OF H.E.O.’s TO THE SICK

2.1 An H.E.O. must always remember the importance of preserving life from the

foetus until death.

2.2 No matter who the patient is, or how sick he is, an H.E.O. must give his/her

best care and attention to his/her patient. An H.E.O. must never discriminate

on the basis of race, religion, tribe, social position, political party or ability topay, suffer from pain of body and mind when he is under the care of an H.E.O.

2.3 An H.E.O. must keep in mind that patients may change their attitudes

because of diseases he may acquire, becoming too demanding, mentally

unstable and un-cooperative. In all these circumstances, and H.E.O. must always keep calm and be polite and friendly to the patient.

2.4 An H.E.O. must accept consequences of his/her professional judgment or

practice and report to the appropriate authority at once when mistakes are

being made.

2.5 An H.E.O. owes to his/her patient complete loyalty and all the resources of

his /her knowledge. It only appropriate therefore when an examination or

treatment is beyond his/her capacity, that he/she should consult another

H.E.O. who may have the necessary ability, seek the opinion of a doctor or

transfer the patient to the hospital where a doctor could take over theresponsibility of caring of the patient.



\33

2.6 An H.E.O. because he/she owes his/her knowledge to the patient, must keep

all information which has been disclosed to him/her by the patient

absolutely confidential. An H.E.O. must never betray the confidence

entrusted to him/her by the patient.

2.7 Occasionally, an H.E.O. will be permitted to break the bond of secrecy

without the specific consent of the patient.

a: In the interest of the patient, his spouse and H.E.O.

An H.E.O. may discuss with a wife or a husband the condition of a marriage

partner. This is a day to day occurrence. The H.E.O.’s common sense tells

him/her what information can be disclosed.

b: Statutory requirements

There are certain cases where an H.E.O. is required by law to disclose

confidential information about a patient. These cases are few and clearly

defined. For instance, H.E.O.’s are required by law to notify the Department

of Health in cases of certain diseases, mainly the communicable diseases.

c: The medical witness

An H.E.O. may be required by law to disclose confidential information

concerning his/her patients on the direction of a court of law. However, the

H.E.O. may express reluctance to divulge certain information. He would be

guided by the decision of the judge.

d: Danger to society

The H.E.O. may feel duty bound to disclose confidential information about a

patient who is in danger to a society. Such occasions are rare and are

necessitated only by the public safety. For example, the uncontrolled

epileptic who refuses to surrender his/her driving license cannot be

expected to be entitled to the confidence enjoyed by other patients. The

H.E.O. may then pass the necessary information on to the appropriate

authorities.

e: Cruelty to a child

When cruelty to a child is discovered during course of professional practice,the H.E.O. should not hesitate to bring the information to the attention of the

appropriate authorities.

f: Criminal cases

No H.E.O. must withhold knowledge of marked crime. Secrecy is certainly not

desirable where a patient appears to die of a criminal act (e.g. poisoning,maltreatment). A death certificate should not be signed in these cases until

permission to do so has been given by the coroner. On the other hand, an

H.E.O. should not b agent of the police, or a private detective. An H.E.O.

should be guided by his/her conscience as to when it is essential that he/she

reveal information obtained in confidence from a patient.

2.8 Consent of examination and treatment

a: No one is obliged to submit himself/herself to examination or treatment except in a few obvious cases where the law requires it. an H.E.O. should



\34

remember that it is the patient’s consent which makes it lawful for the H.E.O.

to examine or treat him/her.

b: On most occasions, consent for treatment and examination is implied. This is

when the patient does not express his/her consent, but it is implied by

his/her action in submitting to examination or treatment.

c: Expressed consent

Occasionally, it is desirable that the patient gives consent in more positive

terms. This is required when procedures requiring loss of the patient’s

consciousness are indicated. On all these occasions, patients consent can be

expressed verbally or in writing. An H.E.O. is advised to seek writtenauthority from the patient as this carries more authority and permanence.

A verbal consent, if appropriate, must be given in the presence of a reliable

witness who can be called upon to confirm it. a consent should always be

obtained before pre-medication is given. Before an H.E.O. examines a female

patient, he must always have a second female person present.

d: The injured, unconscious patient

whatever his age, the unconscious patient should be treated immediately in

whatever way is necessary, without wasting time in seeking the consent of

relatives, which in any event would probably have no legal validity.

e: The mentally incapable

A mental patient legally detained has been deprived of his/her rights to

decide for himself/herself and the H.E.O. in whose care he/she has been

placed, may authorize procedures he/she thinks necessary for the patient’s

welfare.

f: The young

Only in the very young, thus incapable of providing their own consent, has

the consent of the parents or guardians real validity and this should obtained

if possible. At the age of 16 years, a person of normal intelligence should

make his/her own decisions in regard to treatment or examination should becarried out on the basis of the young person’s consent alone.

g: Blood transfusion

if an adult adamantly refuses his consent to blood transfusion (e.g. on the

grounds of religious conviction), even if his/her life would be imperiled if transfusion were withheld, such an adult should have his/her beliefs

respected. The H.E.O. should refer the matter to a doctor who will decide

appropriate courses of action. In the case of a child under 16 years whose

legal guardian objects to blood transfusion of the child and transfusion is

definitely indicated for the child (e.g. following an accident to the child), then

transfusion should not be withheld.

h: Contraception

The introduction of an IUCD into a married woman without her husband’s

consent, unless done for the health and safety of the wife, is unwise. The



\35

husband may thus be deprived of the opportunity of procreation by an action

of which he neither knows nor approves, and there is the possibility of action

for damages being taken against the H.E.O. in such a case.

With regard to pills, the final act in contraception is taken by the wife in

swallowing them, and the H.E.O. is thus a more remote agent. However,

unless it is undesirable for medical reasons that she become pregnant, to

provide the pill to the wife of a disapproving husband is unwise.

In regard to the provision of contraception to an unmarried female of 16

years or more, known by the H.E.O. to be having sexual intercourse, the

H.E.O. will by guided by the principles that he/she will do what is best for the

welfare of his/her patient. He/she is certainly breaking no law in providingcontraception to such a patient.

2.9 Informing the patient

A patient has the right to know the facts and opinion about his case. In

serious illness, especially where likelihood of recovery is slight or absent, the

H.E.O. should use great care in deciding what he/she tells the patient andhow he/she tells him, bearing in mind that he/she must act on the patient’s

best interests. It should perfectly ethical to inform near and responsible

relatives of the true state of affairs in such a case and to discuss how far

he/she the H.E.O, should go in giving his /her opinion when the patient

demands it.

2.10 An H.E.O must give the necessary treatment in emergency.

2.11 An H.E.O. may cease attending a case if he/she feels that the professional

relationship is unsatisfactory due to the conduct of the patient or the

patient’s guardians or where confidence has been lost, or when the case is

beyond his/her ability, provided:

a: the fullest allowance has been made for the patient’s unsatisfactory conduct.

b: arrangements for the transfer of the patient have been adequately made.

c: withdrawal of attendance does not interfere with the patient’s welfare or

treatment.

2.12 Sexual intercourse with a patient or relatives of a patient is forbidden. Every

family and every community has the right to expect their special relationship

with the H.E.O. to be guaranteed against abuse.

2.13 An H.E.O. while on duty, if incapable of looking after his/her patient’sproperly because of drunkenness or drug abuse, is guilty of serious

professional misconduct.

3. DUTIES OF H.E.O’s TO THE COMMUNITY

3.1 An H.E.O. must provide his/her services equally to all individuals in a

community regardless of race, tribe, political beliefs, or where an individual

comes from. An H.E.O. must never exercise the “wantok” system when

providing his/her service to the community.

3.2 An H.E.O. must respect the integrity of the community.



\36

3.3 An H.E.O. must also get involved in community heath related activities.

3.4 An H.E.O. must show courtesy, respect for or the village elders, and

community when dealing with the village community feelings when

conducting public health programs and other community health orientated

activities.

3.5 An H.E.O. must not undermine the traditional cultures of the village

communities.

3.6 An H.E.O. must not abuse a member of the opposite sex when carrying out

public health programs within a village.

3.7 For instance, it would be improper for an H.E.O. to have a sexual intercourse

with a village girl or a woman when he/she carrying out a patrol.

3.8 An H.E.O. must have sympathetic attitudes towards the need of the

community. He/she must not use bulldozing tactics in getting a village

community to participation in the delivery of health services, (e.g. if there is atraditional ceremony being held by the village community coinciding with

the H.E.O. program the H.E.O. should not interfere with these ceremonies).

3.9 An H.E.O. must not use his/her status to influence the community (e.g. when

campaigning for election to Parliament).

3.10 An H.E.O. must be helpful to the community by example rather than by

telling (e.g. an H.E.O. should take part in projects like digging of toilets, water

supply, instead of telling people to do the work.

3.11 An H.E.O. must not behave in a drunken manner towards an individual

member of the community.

An H.E.O. must not be involved in drunken brawls within the community.

4. DUTIES OF H.E.O’s TO THE NATION

4.1 An H.E.O. must be loyal to the government of the day.

4.2 An H.E.O must never ask what the nation should do for him/her, but rather

he/she must ask him/herself what he/she can do for the nation.

5. DUTIES OF H.E.O’s TO THE EMPLOYER

5.1 An H.E.O. must abide by the rules and regulations set down by his/her employer inthe interest of the nation.

5.2 An H.E.O. must be loyal to his/her employer, (e.g. he/she must never criticism made

by the H.E.O. against his/her employer must be constructive and must be made in

confidence).

5.3 An H.E.O. must obey instructions given to him/her by his/her employer within

reason, (e.g. if an H.E.O. is posted to serve in an area where his/her employers

consider to have a greater need, the H.E.O. must be willing to go).

5.4 An H.E.O. must be cautious in the utilization of available resources, in the persuit of his/her employer’s aim (e.g. an H.E.O. must not misuse funds allocated to him/her,

the H.E.O. must not misuse his employer’s properties under his/her care.



\37

5.5 An H.E.O. must use drugs wisely; he/she must discourage wastage of drugs.

5.6 An H.E.O. must never allow wastage through inefficiency or lack of concern for

maintenance of health center supplies and equipment, (e.g. he/she must never allow

a refrigerator to run out of kerosene which could ultimately lead to the wastage

vaccines).

6. DUTIES OF H.E.O’s TO THE PROFESSION

6.1 An H.E.O. must be loyal to his/her profession. For instance, an H.E.O, must carry out

all his/her duties to the best of his/her ability.

6.2 An H.E.O. must strive to maintain a high standard of professional conduct. An H.E.O.

must set a good example in the maintenance of good health, and maintaining a high

standard of health as required by his/her profession, (e.g. maintain a clean

environment of health centre, maintain a high standard of cleanliness in his/her

personal appearance.

7. DUTIES OF H.E.O’s TO OTHERS

An H.E.O. must behave towards others as he/she would have them behave towards

him/her.

a: Doctors

An H.E.O. must give due respect to a doctor, regardless of personal differences.

An H.E.O. must never allow professional jealousy between him/her and a doctor to

over ride the H.E.O’s concern for his/her patients or the community he/she serves.

b: Supervisors

An H.E.O. must carry out instructions given to him/her by his/her supervisors. If an

H.E.O. has good reasons to disagree with his/her supervisor’s instructions, he/she

should communicate his/her disagreement in a polite and respectful manner.

c: Nurses

An H.E.O. must establish and maintain effective co-operation between him/her and

the nurses. He/she must never allow him/herself to think of nurses as having and

inferior status to this own.

d: Environment Health Officer (E.H.O’s)

An H.E.O. must never regard him/herself as superior to Environmental Health

Officers. An H.E.O. must ensure a high standard of working relationship between

him/herself and the Environment Health Officer in the interest of their communities

and the nation as a whole.

e: Dental Therapist

An H.E.O. must observe similar relationships applicable to the H.E.O. and the E.H.O’s

and nurses.

f: Malaria Eradication Officers



\38

An H.E.O. must maintain relationships with the malaria eradication officers similar

to the type of relationship he/she maintains with E.H.O’s, nurses and dental

therapist.

8. DUTIES OF H.E.O’s TO EACH OTHER

8.1 An H.E.O has a moral obligation to his/her patients. If he/she lacks the necessary

ability to examine or to treat a patient, he/she must consult with another H.E.O. to

seek advice and assistance in the treatment of the patient. An H.E.O. must never

think that asking his/her fellow H.E.O. is below his/her dignity.

8.2 It is unethical for an H.E.O. to gossip about a fellow H.E.O. to others. In the interest of

the H.E.O. profession, H.E.O’s are expected to discuss problems affection each otherdirectly instead of resorting to malicious gossip.

8.3 As colleagues, H.E.O’s must support each other morally and professionally. It is

unethical for a H.E.O. to criticize the inability and inefficiency of another H.E.O. in

front of a patient or individual of a community. Criticism of a colleague must be done

courteously with professional interest being the aim. H.E.O’s should never be

offended when criticisms against them are made by a colleague on the basis of professional practice.

9. DUTIES OF H.E.O’s TO HIMSELF/HERSELF

9.1 An H.E.O. must continually seek to better him/herself professionally. This implies

that H.E.O’s learning does not end once he/she graduates from the college. An H.E.O.

must continue to keep up with the latest development in the field of H.E.O. education

and must accept personal responsibility to keep him/herself informed of educational

development in the H.E.O. profession.

9.2 An H.E.O. must actively seek to better him/herself by developing responsible

attitudes towards him/herself, (e.g. an H.E.O. must avoid excessive consumption of

alcohol. This could lead to personal disaster). He/she must have the welfare of

him/herself and his/her family safe-guided against undesirable consequences.

9.3 An H.E.O. must protect him/herself from diseases that may lead to possible bad

effect on his/her professional efficiency.



\39

HUMANITY

This criterion requires all who are concerned with the delivery of health care

to treat those whom they service as fellow human being, entitled to respect,

understanding and sympathy. Entitled also to be treated in a manner free

from arrogance or disc

s ward rotation manual may 2011

Documents