The risk matrix shows a pregnant individual presenting with symptoms that could indicate a deviation from normal antenatal physiology, specifically concerning potential preeclampsia. This scenario is professionally challenging because it requires the midwife to accurately assess the severity of the symptoms, differentiate between normal physiological changes of pregnancy and potential complications, and initiate timely, appropriate management within the scope of practice and regulatory guidelines. The potential for rapid deterioration necessitates careful judgment and adherence to established protocols. The best approach involves a comprehensive assessment of the individual’s vital signs, including blood pressure and urinalysis for protein, alongside a thorough review of their reported symptoms and medical history. This systematic evaluation allows for the identification of potential red flags indicative of hypertensive disorders of pregnancy. Following this, the midwife should consult the established clinical guidelines and protocols for managing suspected preeclampsia, which typically involves escalating care to a physician or specialist obstetric team for further diagnosis and management, while continuing to monitor the patient closely. This aligns with the regulatory framework that mandates midwives to recognize and manage deviations from normal pregnancy, and to seek consultation or transfer care when a condition exceeds their scope of practice or requires specialized medical intervention. Ethical considerations also dictate prioritizing patient safety through prompt and appropriate referral. An incorrect approach would be to dismiss the symptoms as normal pregnancy discomfort without a thorough physiological assessment and documentation. This fails to adhere to the regulatory requirement of vigilant monitoring and assessment for potential complications, potentially delaying crucial diagnosis and intervention. Another incorrect approach is to initiate treatment for preeclampsia without a confirmed diagnosis or consultation with a physician, as this could lead to inappropriate interventions and potential harm, exceeding the midwife’s scope of practice and contravening established protocols for managing complex conditions. Finally, delaying consultation with a physician or obstetric team until the patient’s condition has significantly worsened is a critical failure, as it violates the principle of timely referral for conditions requiring a higher level of care and jeopardizes patient safety. Professionals should employ a decision-making framework that begins with a thorough, evidence-based assessment of the patient’s physiological status. This should be followed by a clear understanding of the established clinical pathways and regulatory requirements for managing antenatal complications. When symptoms or signs suggest a deviation from normal, the framework dictates a systematic approach to differential diagnosis, followed by prompt consultation or referral according to established protocols, ensuring patient safety and adherence to professional standards.

Scenario Analysis: This scenario is professionally challenging because it requires a midwife to navigate the complex requirements for advanced licensure while simultaneously ensuring their educational pathway aligns with the specific standards set forth by the North American Midwifery Education and Simulation Licensure Board. Misinterpreting eligibility criteria can lead to significant delays, wasted resources, and potential ethical breaches if a midwife practices beyond their authorized scope. Careful judgment is required to accurately assess one’s qualifications against the defined purpose of the advanced licensure. Correct Approach Analysis: The best professional practice involves a thorough review of the official documentation outlining the purpose and eligibility for the Advanced North American Midwifery Education and Simulation Licensure Examination. This includes understanding the specific educational prerequisites, the types of simulation experiences required, and the intended scope of practice that the advanced licensure aims to certify. Adhering to these documented requirements ensures that the midwife’s application is valid and that they are pursuing licensure for the correct reasons, aligning with the board’s objectives for advancing midwifery practice and simulation competency. This approach directly addresses the regulatory framework by ensuring compliance with the established standards for advanced licensure. Incorrect Approaches Analysis: Pursuing advanced licensure based solely on anecdotal advice from colleagues, without verifying against official board guidelines, is professionally unacceptable. This approach risks misinterpreting requirements, leading to an incomplete or invalid application, and potentially practicing outside the scope of their current licensure. Relying on a general understanding of advanced practice without confirming the specific educational and simulation components mandated by the North American Midwifery Education and Simulation Licensure Board is also a failure. This overlooks the precise purpose of the advanced licensure, which is to validate specific competencies in both education and simulation, not just general advanced clinical skills. Finally, assuming that prior general continuing education credits automatically fulfill the advanced simulation requirements is a critical error. The board’s purpose for advanced licensure is to ensure specialized proficiency in simulation-based education and assessment, which requires dedicated, specific training and experience that general CE may not cover. Professional Reasoning: Professionals should adopt a systematic approach to licensure and credentialing. This involves proactively seeking out and meticulously reviewing official documentation from the relevant licensing body. When in doubt, direct communication with the board or its representatives is crucial. Professionals should always prioritize understanding the specific purpose and defined eligibility criteria for any advanced credential to ensure their pursuit is aligned with regulatory intent and their own professional development goals.

Scenario Analysis: This scenario is professionally challenging because it requires the midwife to balance the immediate needs of a patient with the strict requirements of licensure and regulatory oversight. The midwife must act decisively to provide care while simultaneously ensuring that all actions are compliant with the governing body’s standards and that any deviations are properly documented and justified. Failure to adhere to these regulations can have serious consequences for both the patient and the midwife’s professional standing. Correct Approach Analysis: The best professional practice involves immediately assessing the patient’s clinical status and providing necessary emergent care, while concurrently initiating the process for obtaining provisional licensure or a temporary practice permit. This approach prioritizes patient safety and well-being by ensuring immediate access to care, while also demonstrating a commitment to regulatory compliance by proactively seeking the appropriate authorization to practice. This aligns with the ethical imperative to do no harm and the regulatory requirement to be licensed before practicing. The midwife’s actions are guided by the principle of beneficence, ensuring the patient receives timely and appropriate care, and by the principle of fidelity, upholding professional standards and legal obligations. Incorrect Approaches Analysis: One incorrect approach involves proceeding with patient care without any attempt to secure provisional licensure, relying solely on the assumption that the full license is imminent. This is a direct violation of licensure laws, which typically require a valid license or permit to practice midwifery. The ethical failure here is the disregard for legal and professional boundaries, potentially jeopardizing patient safety by practicing outside of authorized parameters. Another incorrect approach is to delay necessary patient care until the full license is officially granted, even if the patient’s condition is deteriorating. This approach prioritizes strict adherence to the letter of the law over the immediate medical needs of the patient, violating the ethical principle of beneficence and the midwife’s duty to act in the patient’s best interest. While regulatory compliance is crucial, it should not supersede life-saving or critical care interventions when a reasonable pathway to licensure is being pursued. A further incorrect approach is to perform patient care and then attempt to retroactively obtain licensure or a waiver after the fact. This demonstrates a lack of foresight and a disregard for the established regulatory process. It places the midwife in a precarious legal and ethical position, as practicing without authorization, even if the care provided was competent, is generally not permissible. This approach undermines the integrity of the licensing system designed to protect the public. Professional Reasoning: Professionals facing similar situations should employ a framework that prioritizes patient safety and ethical obligations while actively engaging with regulatory requirements. This involves a rapid assessment of the clinical situation, immediate provision of necessary care if the patient’s condition warrants it, and simultaneous proactive communication with the relevant licensing board to understand and initiate the process for provisional or temporary practice authorization. Documentation of all communications and actions is paramount. The decision-making process should be guided by a hierarchy of needs, where immediate patient well-being is addressed first, followed by diligent pursuit of all necessary legal and regulatory authorizations.

Scenario Analysis: This scenario is professionally challenging because it requires the midwife to navigate a complex intersection of patient autonomy, evolving legal frameworks regarding reproductive rights, and the ethical obligation to provide comprehensive, unbiased information. The midwife must balance the patient’s immediate request with the broader legal and ethical landscape, ensuring that the patient’s decision-making is fully informed and respects their rights, while also adhering to professional standards and regulatory requirements. The rapid pace of legal and societal changes in reproductive healthcare necessitates continuous professional development and a commitment to evidence-based, patient-centered care. Correct Approach Analysis: The best professional practice involves providing the patient with accurate, comprehensive, and unbiased information about all available options for family planning and reproductive health, including contraception, sterilization, and abortion services, as permitted by current North American midwifery practice guidelines and relevant state/provincial laws. This approach respects patient autonomy by empowering them to make informed decisions based on their personal values and circumstances. It aligns with the ethical principles of beneficence (acting in the patient’s best interest by providing complete information) and non-maleficence (avoiding harm by not withholding options or imposing personal beliefs). Furthermore, it adheres to regulatory frameworks that mandate informed consent and patient-centered care, ensuring that the midwife acts as a facilitator of the patient’s choices rather than a gatekeeper. Incorrect Approaches Analysis: Providing only information about methods of contraception that the midwife personally favors or believes are most appropriate for the patient, without disclosing other legal and available options, constitutes a failure to uphold patient autonomy and the principle of informed consent. This approach may also violate professional ethical codes that prohibit the imposition of personal beliefs on patient care and could contravene regulations requiring comprehensive counseling on all medically appropriate reproductive health services. Refusing to discuss or provide information on abortion services, even if legally permissible and requested by the patient, represents a failure to provide comprehensive reproductive healthcare. This can be a violation of professional standards and potentially legal requirements, depending on the specific jurisdiction’s laws regarding the scope of midwifery practice and access to reproductive services. It undermines the patient’s right to access all legal healthcare options and can lead to significant harm by forcing the patient to seek care elsewhere without adequate support or information. Directing the patient to a specific clinic or provider for certain services without first ensuring the patient understands all their options and has had their questions fully addressed, or without confirming the patient’s informed consent for referral, can be problematic. While referrals are a necessary part of care, the primary responsibility remains with the midwife to ensure the patient is fully informed and has made their own decision about seeking that referral. This approach risks bypassing the crucial informed consent process and may not fully respect the patient’s agency in choosing their healthcare pathway. Professional Reasoning: Professionals should approach such situations by first actively listening to the patient’s stated needs and concerns. They should then access and review current, evidence-based information on all relevant family planning, sexual health, and reproductive rights options, ensuring this information is aligned with the specific legal and regulatory framework of their North American jurisdiction. The next step is to present this information clearly, accurately, and without bias, using language that is understandable to the patient. Crucially, the professional must create a safe space for the patient to ask questions, express concerns, and explore their options without judgment. The decision-making process should always prioritize the patient’s right to self-determination and informed consent, ensuring that any subsequent actions are taken with the patient’s explicit agreement and understanding.

This scenario presents a professional challenge due to the inherent tension between providing culturally sensitive care and adhering to established licensure and scope of practice regulations within the North American context. Midwives must navigate diverse cultural beliefs and practices surrounding birth while ensuring their actions remain within the legal and ethical boundaries of their professional licensure. Careful judgment is required to balance respect for cultural autonomy with the responsibility to provide safe, evidence-based care and to uphold regulatory standards. The approach that represents best professional practice involves actively seeking and integrating knowledge of the client’s cultural background and preferences into the midwifery care plan, while simultaneously ensuring that all proposed interventions and care models align with the midwife’s scope of practice as defined by North American midwifery licensure regulations and relevant professional guidelines. This includes open communication with the client and their family to understand their specific needs and beliefs, and collaboratively developing a care plan that respects these while remaining within the established legal and ethical framework. This approach is correct because it prioritizes patient-centered care and cultural safety, which are foundational ethical principles in midwifery, while also demonstrating strict adherence to regulatory requirements for licensure and practice. It ensures that the midwife is acting within their authorized scope and upholding professional standards of care. An incorrect approach involves assuming that all cultural practices are inherently safe and permissible within the scope of midwifery practice without critical evaluation or consultation with regulatory bodies or professional guidelines. This failure to critically assess cultural practices against established safety standards and regulatory frameworks can lead to providing care that is outside the midwife’s licensure or that compromises client safety, thereby violating regulatory requirements and ethical obligations. Another incorrect approach is to dismiss or override a client’s cultural preferences solely based on a perceived conflict with standard midwifery protocols, without first attempting to understand the cultural context or explore potential accommodations. This can result in culturally unsafe care, alienating the client and potentially leading to a breakdown in the therapeutic relationship, and may also contraindicate the collaborative and respectful approach mandated by professional ethical codes. A further incorrect approach is to delegate care that falls outside the midwife’s scope of practice to individuals who may not be licensed or adequately trained, under the guise of accommodating cultural practices. This is a direct violation of licensure regulations, which strictly define the responsibilities and limitations of a midwife, and can lead to significant patient harm and legal repercussions. Professionals should employ a decision-making framework that begins with a thorough understanding of the client’s cultural background and expressed needs. This should be followed by a comprehensive review of their own scope of practice as defined by their North American licensure and relevant professional standards. Where potential conflicts arise, the professional should engage in open dialogue with the client to explore shared understanding and potential compromises. Consultation with professional organizations, regulatory bodies, or experienced colleagues is crucial when navigating complex ethical or regulatory ambiguities. The ultimate decision must prioritize client safety, cultural respect, and strict adherence to all applicable laws and regulations governing midwifery practice.

Scenario Analysis: This scenario is professionally challenging because it requires a midwife to balance the immediate demands of patient care with the long-term professional development necessary for maintaining licensure. The pressure to prioritize current clinical needs can sometimes overshadow the proactive steps required for ongoing education and compliance, leading to potential licensure issues. Careful judgment is required to integrate continuous learning into a demanding practice. Correct Approach Analysis: The best approach involves proactively identifying and scheduling required continuing education units (CEUs) well in advance of the licensure renewal deadline. This includes researching approved providers, understanding the specific CEU requirements for North American midwifery licensure (which vary by state/province but generally mandate a certain number of hours in specific areas like ethics, patient safety, and clinical skills), and allocating dedicated time for completion. This proactive strategy ensures that the midwife meets all regulatory obligations without compromising patient care or facing last-minute stress and potential non-compliance. Regulatory bodies, such as state boards of nursing or midwifery, mandate specific CEU requirements to ensure practitioners remain current with best practices, evolving medical knowledge, and ethical standards. Adhering to these requirements is a fundamental aspect of maintaining an active and valid license. Incorrect Approaches Analysis: One incorrect approach is to wait until the licensure renewal period is imminent to begin researching and completing CEUs. This often leads to a rushed selection of courses, potentially resulting in the completion of irrelevant or low-quality education, and a higher risk of missing the deadline. This failure to plan demonstrates a disregard for the regulatory framework that mandates timely professional development and can be interpreted as a lack of commitment to maintaining professional competency. Another incorrect approach is to assume that all clinical experience automatically counts towards CEU requirements. While practical experience is invaluable, regulatory bodies typically have specific guidelines for what constitutes acceptable CEUs, often requiring formal coursework, workshops, or approved online modules. Relying solely on anecdotal learning from practice without formal validation does not meet the established educational standards for licensure renewal. A further incorrect approach is to only complete CEUs that are immediately relevant to current clinical practice, neglecting areas mandated by the licensing board that may not be part of daily routine but are crucial for comprehensive midwifery practice and ethical conduct. This selective approach can lead to gaps in knowledge and skills, potentially impacting patient care in situations outside the midwife’s immediate comfort zone and failing to meet the broad educational objectives set by regulatory authorities. Professional Reasoning: Professionals should adopt a systematic approach to licensure maintenance. This involves regularly reviewing the specific requirements of their licensing board, creating an annual professional development plan that includes identifying and scheduling CEUs, and tracking progress towards completion. A proactive mindset, coupled with diligent record-keeping, ensures that all regulatory obligations are met efficiently and effectively, thereby safeguarding both the professional’s license and the quality of patient care.

This scenario presents a professional challenge because it requires balancing the midwife’s clinical expertise with the birthing person’s autonomy and values, particularly when those values might diverge from standard medical recommendations. The core of the challenge lies in ensuring that the birthing person is fully informed and empowered to make decisions that align with their personal beliefs and circumstances, while the midwife upholds their professional duty of care and adherence to established standards. Careful judgment is required to navigate potential conflicts, ensure effective communication, and maintain a trusting relationship. The best approach involves a comprehensive, holistic assessment that prioritizes open dialogue and shared decision-making. This means actively listening to the birthing person’s concerns, understanding their cultural background, personal preferences, and previous experiences. It requires presenting all available evidence-based options, including potential risks and benefits, in a clear, understandable manner, and then collaboratively developing a birth plan that respects the birthing person’s choices, even if they differ from the midwife’s initial recommendations, provided these choices do not pose an immediate, severe threat to maternal or fetal well-being that cannot be mitigated. This aligns with the ethical principles of autonomy, beneficence, and non-maleficence, and is supported by professional guidelines that emphasize patient-centered care and informed consent. An incorrect approach would be to present a single recommended course of action without thoroughly exploring the birthing person’s perspective or offering alternatives. This fails to uphold the principle of autonomy, as it bypasses the birthing person’s right to make informed choices about their own body and healthcare. It also risks alienating the birthing person and eroding trust, potentially leading to non-adherence to the birth plan. Another professionally unacceptable approach is to dismiss the birthing person’s concerns or preferences as uninformed or irrational, and then proceed with a plan that does not reflect their wishes. This demonstrates a lack of respect for the birthing person’s lived experience and values, and can be seen as paternalistic. It violates the ethical imperative to treat individuals with dignity and respect, and can lead to significant psychological distress for the birthing person. A further incorrect approach involves providing incomplete or biased information about the available options, thereby subtly steering the birthing person towards a particular decision without their full understanding of the implications. This undermines the principle of informed consent, which requires that all relevant information be presented truthfully and without coercion. It also breaches the midwife’s professional responsibility to act in the best interests of the birthing person by ensuring they have the necessary knowledge to make a truly autonomous decision. Professionals should employ a decision-making framework that begins with establishing rapport and trust. This is followed by a thorough, non-judgmental assessment of the birthing person’s physical, emotional, cultural, and spiritual needs. Next, all evidence-based options are presented, with risks and benefits clearly articulated. The midwife then facilitates a discussion, actively listening to the birthing person’s responses and addressing any questions or concerns. The final step involves collaboratively developing a birth plan that reflects the birthing person’s informed choices, with ongoing reassessment and adaptation as needed throughout the pregnancy and birth.

Scenario Analysis: This scenario presents a professional challenge related to the interpretation and application of licensure examination policies, specifically concerning blueprint weighting, scoring, and retake procedures. The challenge lies in navigating the potential for ambiguity in policy language and ensuring that decisions made are fair, consistent, and compliant with the established regulatory framework for advanced North American midwifery education and simulation licensure. Misinterpreting these policies could lead to inequitable treatment of candidates, undermine the integrity of the examination process, and potentially violate the governing body’s mandate. Careful judgment is required to uphold the principles of fairness, transparency, and adherence to established guidelines. Correct Approach Analysis: The best professional approach involves a thorough review of the official examination blueprint and the published retake policy document. This approach is correct because it directly addresses the source of truth for examination structure and candidate progression. The official blueprint details the weighting of content areas, which directly informs how scores are calculated and interpreted. Similarly, the retake policy outlines the specific conditions, limitations, and procedures for candidates who do not achieve a passing score. By consulting these primary documents, the individual ensures that their understanding and application of the policies are based on the most accurate and authoritative information available, thereby upholding regulatory compliance and ensuring fair treatment of all candidates. This aligns with the ethical obligation to administer examinations with integrity and adherence to established standards. Incorrect Approaches Analysis: Relying solely on anecdotal information from colleagues or past candidates about how the blueprint weighting or retake policies have been applied in the past represents a significant regulatory and ethical failure. This approach is problematic because it substitutes potentially outdated, misinterpreted, or even incorrect personal experiences for the official, codified policies. Such reliance can lead to inconsistent application of rules, unfair advantages or disadvantages for candidates, and a breakdown in the standardized examination process. It fails to acknowledge that policies can be updated or clarified, and that individual interpretations may not reflect the official intent or requirements. Assuming that the scoring algorithm is straightforward and does not require specific clarification from the examination board, even if the candidate’s score appears unusually low or high, is also an incorrect approach. This assumption bypasses the critical step of verifying the scoring methodology against the official documentation or seeking clarification when anomalies arise. Examination scoring can be complex, especially when factoring in weighted content areas. Failing to confirm the scoring mechanism can lead to incorrect score interpretations and potentially unfounded appeals or challenges by candidates, undermining the credibility of the examination. Making a decision about a candidate’s eligibility for a retake based on a general understanding of “fairness” without consulting the explicit retake policy is a direct violation of regulatory compliance. While fairness is a guiding principle, it must be operationalized through adherence to established rules. The retake policy will contain specific criteria, such as the number of attempts allowed, waiting periods, and any required remediation. Deviating from these explicit guidelines based on a subjective interpretation of fairness, even with good intentions, can lead to discriminatory practices and a failure to uphold the established regulatory framework. Professional Reasoning: Professionals facing situations involving examination policies should adopt a systematic decision-making process. First, identify the specific policy or procedural question at hand. Second, consult the most authoritative and current official documentation related to the examination blueprint, scoring, and retake policies. If any aspect of the documentation is unclear or if an anomaly arises, the next step is to seek formal clarification from the examination board or the relevant regulatory body. Document all communications and decisions made. Finally, ensure that all actions taken are consistent with the official policies and are applied equitably to all candidates, thereby maintaining the integrity and fairness of the licensure examination process.

This scenario is professionally challenging because it requires the preceptor to balance the educational needs of the student with the immediate safety and well-being of the client. The preceptor must ensure that the student is developing essential skills and knowledge in a supervised environment while upholding the highest standards of midwifery care and adhering to regulatory requirements for licensure and practice. Careful judgment is required to assess the student’s readiness for increasing autonomy and to intervene appropriately when necessary. The best approach involves the preceptor maintaining direct supervision and actively guiding the student through the entire process, providing real-time feedback and ensuring all actions taken are within the scope of practice for a student midwife under supervision, as mandated by the North American Registry of Midwives (NARM) standards and relevant state/provincial midwifery practice acts. This ensures that the client receives safe, competent care and that the student is learning under optimal conditions, reinforcing the core knowledge domains of clinical skills, ethical practice, and professional responsibility. The preceptor’s role is to facilitate learning while safeguarding the client, which this approach achieves by keeping the student’s actions directly observable and manageable. An incorrect approach would be to allow the student to independently manage the labor and delivery without direct, continuous oversight, even if the preceptor is present in the facility. This violates the principle of direct supervision essential for student practitioners and could lead to deviations from best practices or emergent situations being mishandled, contravening regulatory expectations for supervised learning and client safety. Another incorrect approach would be to perform all critical aspects of the care yourself while having the student observe passively. While this ensures client safety, it fails to provide the student with the necessary hands-on experience and opportunities for skill development within the core knowledge domains of clinical practice. This passive observation does not adequately prepare the student for independent practice and falls short of the educational objectives for a midwifery student. A further incorrect approach would be to delegate tasks to the student that are beyond their current demonstrated competency or the scope of practice for a student midwife, even if the preceptor believes the student might be capable. This poses an unacceptable risk to the client and is a failure of the preceptor’s duty to ensure appropriate supervision and progressive skill development, potentially leading to regulatory violations. Professionals should employ a decision-making framework that prioritizes client safety above all else, followed by adherence to regulatory requirements and then educational objectives. This involves a continuous assessment of the student’s skills, knowledge, and judgment, coupled with an understanding of the specific clinical situation and the potential risks involved. The preceptor must be prepared to intervene, adjust the level of supervision, and provide constructive feedback to foster the student’s growth while upholding professional standards.

This scenario is professionally challenging because it requires the midwife to rapidly assess a complex obstetric emergency, prioritize interventions based on potential fetal compromise, and coordinate care within a simulated environment that mirrors real-world pressures. The midwife must balance immediate clinical action with adherence to established protocols and ethical considerations regarding patient safety and informed decision-making, even in a simulated context. The best approach involves immediate activation of the emergency response protocol for suspected fetal distress, which includes continuous electronic fetal monitoring, notifying the obstetric team, and preparing for potential urgent intervention. This aligns with North American midwifery standards of practice and regulatory guidelines that mandate prompt and appropriate management of fetal distress to optimize perinatal outcomes. The ethical imperative to act swiftly and decisively to protect fetal well-being is paramount. This approach prioritizes the most critical steps for fetal assessment and intervention, ensuring that the simulated scenario reflects best practices in obstetric emergency management. An incorrect approach would be to delay activating the emergency response protocol while attempting to re-evaluate the fetal heart rate pattern independently for an extended period. This failure to promptly involve the obstetric team and initiate standard emergency procedures constitutes a breach of professional responsibility and regulatory expectations for managing obstetric emergencies, potentially leading to adverse outcomes. Another incorrect approach would be to focus solely on non-pharmacological interventions without escalating care or preparing for more invasive measures. While comfort measures are important, they are insufficient as the sole response to significant fetal distress, and failing to recognize the need for advanced interventions or consultation violates established protocols for fetal surveillance and obstetric emergencies. A further incorrect approach would be to proceed with a simulated vaginal birth without confirming adequate fetal well-being or consulting with the obstetric team, especially if the fetal monitoring indicates distress. This demonstrates a critical lapse in judgment and adherence to safety protocols, potentially endangering the simulated fetus and contravening professional standards for managing high-risk obstetric situations. Professionals should employ a systematic decision-making framework that begins with rapid assessment of the situation, identification of potential risks, and immediate activation of relevant protocols. This framework emphasizes continuous reassessment, clear communication, and timely escalation of care in accordance with established guidelines and ethical principles.