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Clinical Management of Category III Fetal Heart Rate Tracings
The National Institute of Child Health and Human Development (NICHD) workgroup standard for fetal heart rate monitoring assessment and categorization, first proposed in 1997 and subsequently updated in 2008 was meant to promote commonality of FHR tracing nomenclature and interpretation. Based on these recommendations, a three-tiered categorization pattern based on the visual assessment of the fetal heart rate pattern was adopted. This module aims to review and apply essential FHR content in several clinical scenarios to highlight an important Clinical Pearl: The Category III tracing is a rare intrapartum FHR pattern that is highly associated with fetal acidemia and adverse neonatal outcomes.
Consistently apply 1997 and 2008 NICHD definitions and terminology when describing intrapartum fetal heart rate patterns.
Identify intrapartum fetal heart rate tracings using the 2008 NICHD 3-tiered system.
Recognize the fetal heart rate characteristics that define a Category III pattern.
Review the diagnostic imprecision and clinical significance of minimal fetal heart rate variability.
An Overview of Trial of Labor After Cesarean Section
This course provides an overview about the safety of patients undergoing a trial of labor after cesarean (TOLAC) to attempt a vaginal birth after cesarean delivery (VBAC). Research evidence has influenced where VBACs are performed, which women are eligible and how the practice is conducted, including the safe use of induction/augmentation medications. The safety of VBAC for mother and newborn always remains the primary underlying principle that guides care.
Identify three risk factors and benefits associated with TOLAC and recommendations for safe TOLAC.
Recall essential components of nursing education, informed consent, safe medication administration, and fetal assessment related to TOLAC.
Clinical Management of Uterine Atony
A case of obstetrical hemorrhage due to uterine atony, requiring medical and surgical interventions and blood component replacement therapy is presented. Emphasis: A review of obstetrical hemorrhage, etiologies, and treatments is provided. The importance of early recognition and response to excessive blood loss is stressed. Medical and surgical interventions for uterine atony are reviewed. Current recommendations for blood component replacement therapy for massive hemorrhage are discussed.
List common risk factors for OH.
Review medical treatments for uterine atony.
Identify pre-surgical and surgical treatments for uterine atony.
Describe blood component therapy for massive hemorrhage.
Fetal Heart Tracing Pattern Evolution
Intrapartum fetal heart rate monitoring is an integral part of modern day obstetrics and when properly interpreted, may provide valuable insight into the fetal metabolic state. During labor, the physiologic stress posed by regular uterine contractions and maternal expulsive efforts may adversely impact the fetal acid-base status, leading to changes in the fetal heart rate pattern.
This module aims to review and apply essential FHR content in several clinical scenarios to highlight an important Clinical Pearl: Management of the laboring patient requires that the FHR pattern trends are interpreted in context with the clinical scenario and progress of labor.
Consistently apply 1997 and 2008 NICHD definitions when describing intrapartum fetal heart rate patterns.
Identify the importance of FHR variability evolution when assessing the FHR pattern.
Review the importance of FHR tracing trend assessment when managing the abnormal intrapartum FHR tracing.
Recognize the importance of clinical scenario, FHR pattern evolution, and stage of labor when managing the Category II tracing in labor.
Obstetric Hemorrhage: Mitigating Risk to Improve Outcomes
Two cases are presented. Risk factors, including recurring and nonrecurring, for obstetrical hemorrhage, are reviewed. Delivery preparations and preventative strategies are discussed. Methodologies that better quantify blood loss, allowing for earlier recognition of excessive blood loss, are presented. Management of the patient experiencing obstetric hemorrhage, including a review of current guidelines for blood component replacement therapy, are reviewed.
List recurring and nonrecurring risk factors for obstetrical hemorrhage. List the four Ts of OH.
Identify low, medium and high risk patients for OH.
Review blood component therapy for large volume blood loss.
Shoulder Dystocia: Teamwork and Training
This content is intended for all members of the obstetric team and is based on the educational theory that team performance is enhanced when all members of the team have the same understanding of the task and procedure to be performed.
Enhance situational awareness for patients at increased risks for shoulder dystocia (SD). Design a team-based SD simulation drill. Improve obstetrical team performance through enhanced cooperation in deliveries complicated by SD. Review methods to enhance communications with teams.
Social Determinants of Maternal-Fetal Health
The goal of this course is to educate nurses and physicians about key social determinants of health (SDOH) and health disparities affecting maternal and fetal outcomes.
Identify at least four social determinants/disparities of health impacting maternal-fetal health outcomes.
Describe at least two clinical and/or social support interventions to be used in clinical practice to decrease bias regarding social determinants and improve maternal-fetal health outcomes.
Emergent Delivery of Infant
The management of the female who presents to the emergency department (ED) in active labor is stressful and overwhelming. Ideally, the ED has a plan in place, based on hospital resources, for the imminent delivery of a newborn. Decisions regarding delivery in the ED or transferring the patient to labor and delivery are based on a variety of factors. Knowledge of the possible complications of delivery will provide anticipatory guidance to improve maternal and fetal outcomes.
Know the clinical presentation and physical exam findings associated with pregnancy.
Recognize the common complications associated with pregnancy. Plan the steps to prepare the process of delivery of a newborn.
Recognize common complications of delivery of a newborn.
Clinical Management of Category II Fetal Heart Tracing
Three different obstetrical scenarios, complicated by a Category II Fetal Heart Rate pattern, are presented to illustrate the importance of clinical context when formulating management plans. Emphasis, characteristics, and potential etiologies of Category II fetal heart rate tracings are reviewed. Management of the patient with a Category II fetal heart rate pattern is discussed, with special emphasis on the importance of the clinical context and fetal heart rate pattern evolution.
Describe characteristics of Category II FHR tracings.
Identify common etiologies for Category II FHR tracings during labor.
Examine clinical interventions for Category II FHR tracings.
Review the etiology-based management of Category II FHR tracings.
An Overview of Substance Use Disorders
Substance use is a growing problem across populations. As a helping professional, you need a basic understanding of how substance use affects your clients. This information will help you to provide support and resources to help clients seek treatment and recovery. In this course, you will explore substance use disorders, how they develop, and their impact on individuals. The course also explains your role as a paraprofessional when working with individuals with substance use disorders. You will be provided an overview of evidence-based interventions and the types of substance use treatment programs available, when additional treatment may be necessary. Detailed examples will help you to apply this information in your own work. The goal of this course is to provide paraprofessionals and peer support specialists in health and human service settings with information on substance use disorders and evidence-based interventions.
Explain what a substance use disorder is, how it develops, and how it impacts individuals.
Identify strategies that paraprofessionals can use when working with individuals diagnosed with substance use disorders to encourage behavior change.
Describe the types of treatment that exist for people diagnosed with substance use disorders.
Applying HIPAA Regulations in Behavioral Health
HIPAA rules underlie every service related to behavioral health, and they change to meet evolving trends. There are potentially catastrophic organizational and individual consequences if the current HIPAA rules are not followed. This course will help you to identify potential legal and ethical issues related to HIPAA, improve your compliance approach, and develop more effective risk management strategies.
The goal of this course is to assist alcohol and drug counselors, marriage and family therapists, professional counselors, psychologists, social workers, and nurses in health and human services settings in understanding and applying current HIPAA regulations.
Indicate the purpose of HIPAA and how it applies to behavioral healthcare providers.
Recall at least three ways that the Privacy Rule impacts the day-to-day responsibilities of behavioral health providers.
Identify at least three steps that behavioral health providers need to take to ensure compliance with the Security Rule.
Motivational Interviewing: An Introduction
In this course, you will learn about Motivational Interviewing, an intervention to help people discover their own desire and ability to make difficult changes. Motivational Interviewing (MI) is a way of communicating that draws out people’s own thoughts and beliefs in order to help them address their ambivalence about making a change.
The course uses a blend of instructive information and interactive exercises to help you understand and apply its core concepts. The goal of this course is to provide addictions, behavioral health counseling, marriage and family therapy, nursing, psychology, and social work professionals in health and human service settings with the skills to define and demonstrate the core concepts of Motivational Interviewing.
Describe the overall purpose of Motivational Interviewing and how it impacts the change process.
Recall the key elements of the MI spirit and how these can support clients in the change process.
Define ambivalence, change talk, and sustain talk, and how these concepts relate to MI.
Recovery Principles and Practices in Behavioral Health Treatment
This is an exciting time to work in the field of behavioral health treatment. The field has changed dramatically in the direction of operating on the principles of recovery. Recovery treatment involves changing our attitudes and beliefs about serious mental illness and the long-term effects of these illnesses over the lifespan to reflect the belief that recovery is the expected outcome. The field continues to expand into areas of advancing the integration of mental health to physical health, connecting to multiple dimensions of wellness and alternative medicine, as well as incorporation of peer recovery specialists. Each of these areas supports the recovery of persons with behavioral health issues.
Recall the defining principles of the wellness and recovery movement in the treatment of persons with serious mental illness (SMI).
Indicate at least three ways you can align your practices with the guiding principles of recovery when working with individuals with SMI.
Identify three things you can do to help individuals overcome the stigma of diagnosis of SMI.
Cultural Perspectives in Childbearing
As the population of the U.S. soars in diversity, healthcare professionals must be prepared to care for childbearing families from many different cultures. All cultures and families should be given the same respect, be assured of the highest quality of care, have their religious, ethnic, and cultural values respected and integrated into their care, and have their physical and educational needs met in a way that honors their spiritual beliefs and individuality. Knowledge of the cultures one is serving and the influence they have on women’s perceptions of childbirth are important for achieving positive outcomes. Equally and perhaps more important is applying the principles of cultural humility to nursing care.
The goal of this continuing education course is to improve the ability of nurses and health educators in acute care settings to assess and meet the sociocultural needs of childbearing families of diverse cultural and social groups.
Recall the relationship of culture, subculture, acculturation, assimilation, ethnocentrism, cultural relativism, and cultural humility to healthcare practice.
Recognize elements of cultural assessment and respectful maternity care that can improve quality of care and meet the unique needs of culturally diverse families.
Intimate Partner Violence in Pregnant Women
Healthcare professionals often feel unprepared to ask about abuse or to counsel a pregnant woman who is being abused, although they are in a unique position to assess for IPV and to support women who experience it. As such, it is necessary for clinicians to skillfully screen for IPV and offer effective interventions when appropriate.
Recognize three barriers to and three recommendations for assessing IPV.
Recall four questions that are used to assess for IPV.
Identify three intervention strategies for women experiencing IPV.
Nursing Assessment of the Pediatric Patient
In this course, you will learn about pediatric anatomical and physiological differences, which will help you recognize normal variations throughout your assessment. Additionally, you will learn communication methods to help children feel more at ease during your assessment. Finally, you will understand essential warning signs that require immediate referral to additional medical professionals using the available resources and tools.
Choose at least three strategies to help ensure success during an exam of the infant, child, and adolescent. Identify the proper way to perform a pediatric head-to-toe assessment using appropriate resource tools. Recognize signs in the infant, child, and adolescent that are concerning.
Opioid Use During Pregnancy
Americans are using opioids at an alarming rate, whether through prescriptions or illegal means. Parallel to this problem is the use of opioids during pregnancy.
The goal for this course is to present RNs, PAs, physicians, and entry-level drug and alcohol counselors in inpatient or outpatient settings with best practices for identifying and managing pregnant women who are using opioids.
Recognize the risks and complications related to opioid use disorder during pregnancy.
Identify evidence-based treatment recommendations for opioid use disorder during pregnancy.
Perioperative Pediatric Conditions
Perioperative professionals must have a fundamental understanding of the anatomical, physiological, psychological, and emotional differences of children compared to adults and how these differences impact the care needs of pediatric patients in the perioperative period.
Identify anatomical, physiological, psychological, and emotional differences in pediatric patients and how those differences impact care needs in the perioperative setting.
Recognize strategies for preventing and responding to medication errors and adverse drug events involving children in the perioperative setting.
Recall surgical considerations for pediatric patients.
The Biopsychosocial Model of Substance-Related and Addictive Disorders
Addictive disorders were once seen mainly as medical issues. However, this view overlooked other important factors. The biopsychosocial model offers a more complete perspective by considering biological, social, and psychological aspects. This course will explain the main ideas of this model, how it differs from other views, and how it can help treat addictive disorders.
Explain how addictive disorders develop according to the three primary areas of the biopsychosocial model.
State how the biopsychosocial model differs from other perspectives on addictive disorders.
Describe how the biopsychosocial model impacts treatment approaches for addictive disorders.
Adult Obesity in the U.S.
Obesity rates in the U.S. have risen to the level of an epidemic, as 1 in 3 adults are affected by this disease. Obesity is a disease that significantly affects a person’s health and is not simply due to poor diet and lack of exercise. This course introduces healthcare professionals to the causes, management, and treatment options for adult obesity.
The goal of this course is to familiarize healthcare professionals with the growing epidemic of obesity among adults in the U.S.
Identify the current problem and contributing factors of obesity in the U.S.
Describe the management and treatment options for obesity.
CEN: Gynecological and Obstetrical Emergencies
The Certified Emergency Nurse (CEN®) is required to demonstrate competency in the domain of emergency nursing which includes knowledge of gynecological and obstetrical conditions and diseases, their signs and symptoms, management, and applicable nursing interventions.
Identify signs and symptoms of gynecological and obstetrical emergencies and injuries.
Describe a comprehensive plan for the care of gynecological and obstetrical conditions including diagnostic and treatment interventions, and patient education.
Boundaries in the Treatment Relationship
This course explains the concept of a professional therapeutic boundary and how it differs from a personal relationship. You will learn about the ethical role of the clinical practitioner in establishing appropriate roles and boundaries, the difference between boundary crossings and boundary violations, how to appropriately use social media and other technology, and how to recognize situations with high potential for harmful boundary violations. As you master these skills, you will become more effective in maintaining an appropriate relationship between you and your clients.
Recall the meaning of a therapeutic boundary and the difference between boundary crossings and boundary violations.
Indicate how to avoid the red flags of boundary violations.
Discuss current standards for use of social media and other technology pertaining to maintaining therapeutic boundaries.
Pediatric Patients and Concussion Management
Concussion is a form of mild traumatic brain injury that is common in children and adolescents. Despite increased awareness about the injury, concussion remains under-reported and under-diagnosed. Nurses and Radiology Technicians must be aware of the identification, diagnosis, and management of concussions in pediatric patients.
Identify signs and symptoms of concussions in pediatric patients.
Recognize the evaluation, diagnosis, and management of concussions in pediatric patients.
Recall the complications of concussions in pediatric patients.
Integration of Primary and Behavioral Healthcare
You will learn about the costs, benefits, and goals of integrated care systems. As there are numerous challenges to integrating care, you will become aware of some of these key challenges, and familiar with particular characteristics of well-functioning integrated care systems. Finally, you will learn a variety of ways that behavioral healthcare professionals, including you, can function effectively in an integrated care environment.
Recall the different levels of integrated care and types of integrated care settings.
Indicate at least three tools or interventions you can use to facilitate an integrated approach to care delivery.
EMTALA Requirements
The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted to prevent patient dumping by hospitals seeking to avoid unrecoverable costs of care for patients without insurance or the ability to pay for medical services. Language within the statute has led to inconsistencies in how it has been interpreted. Patient dumping and inappropriate medical screening examinations (MSEs) are the most common reasons for EMTALA violations (Ladd & Gupta, 2021). This course will describe how key terms are currently interpreted and how they apply to hospitals with a dedicated emergency department (ED). In addition, learners will have an opportunity to review cases where EMTALA violations were alleged and judgments applied by the courts.
Define key terms and requirements associated with EMTALA.
Describe how EMTALA applies to certain situations.