Anti-vaccine nurses and midwives 40

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Kate Cadd is a registered nurse and registered midwife in Western Australia:

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On May 5 2016, Cadd cited her midwifery registration on her Facebook profile:

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Cadd is a member of the public, anti-vaccination, Vaxxed Australia/New Zealand Facebook group:

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Cadd is a member of the rabid anti-vaccination Facebook group, Vaccine Choice Australia:

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On November 11 2016, in the Vaxxed Australia/New Zealand Facebook group, Cadd cited her midwifery registration in arguing that the whooping cough vaccine booster causes birth complications, and argued that the parents of deceased baby, Riley Hughes, will be responsible for more harmful birth complications due to their advocacy for  the pregnancy booster:

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On August 31 2015, in the anti-vaccination Vaccine Choice Australia Facebook group, Cadd cited her midwifery registration in promoting homeopathic immunisation:

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On July 12 2015, in Vaccine Choice Australia, Cadd cited her midwifery registration in arguing against workplace and adult immunisations:

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On June 30 2015, in Vaccine Choice Australia, Cadd used her midwifery registration to argue against the provision of Vitamin K for a newborn baby:

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Vaxxed Australia/New Zealand public group posts

On November 10 2016, Cadd advised another group member to seek homeopathic detoxification for vaccination recovery:

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On October 19 2016, Cadd joined in with other group members who argued that immunisation is a cause of SIDS:

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On June 21 2016, Cadd joined in with other group members who claimed that vaccines are destroying a generation of children:

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Vaccine Choice Australia (formerly Vaccine Free Australia) posts

On November 11 2016, Cadd cited her midwifery registration in providing advice to another group member:

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On November 9 2016, Cadd argued that premature births are caused by vaccines:

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On October 21 2016, Cadd admitted that her own doctor has been unable to convince her to immunise her children:

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On October 18 2016, Cadd joined in with other group members who argued that the recent murder of two autistic children is ultimately the fault of vaccines:

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On October 4 and 5 2016, Cadd cited her midwifery registration in providing medical advice to another group member:

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On September 13 2016, Cadd cited her midwifery registration in downplaying the serious risks posed by whooping cough infection, and implied that her children are somehow more robust for being unvaccinated against the disease:

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On August 28 2016, Cadd applauded the anti-vaccinationism of a US celebrity doctor who featured in the anti-vaccination movie, Vaxxed:

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On August 21 2016, Cadd joined in with other group members who mocked yet another finding that vaccines do not cause autism:

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On August 4 2016, Cadd provided medical advice to another group member:

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On July 6 2016, Cadd joined in with other group members who attacked television presenters over an immunisation story, calling the story “sheep journalism”:

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On July 6 2016, Cadd cited her midwifery registration and joined in with other group members in attacking the Light for Riley Facebook page, and argued that immunisation causes stillbirths. Cadd also demonstrates that she does not understand the medical literature on this subject:

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On June 18 2016, Cadd joined in with other group members, such as Rixta Francis, in arguing that vaccines cause autism, and that this conspiracy is being covered up:

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On June 8 2016, Cadd cited her midwifery registration in advocating against the provision of the Hepatitis B vaccine, and Vitamin K, for a newborn baby:

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On June 8 2016, Cadd joined in with other members, including group admin, Courtney Hebberman, in championing an anti-vaccination-friendly doctor:

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On April 25 2016, Cadd cited her midwifery registration in a thread which downplays the seriousness of the unprofessionalism of baby-cracking chiropractor, Ian Rossborough:

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On April  19 2016, Cadd cited her midwifery registration in advising another member to ‘definitely’ use chiropractic and acupuncture for an upcoming breach birth:

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On April 15 2016, Cadd joined in with other group members in denigrating immunisation, in response to an unsubstantiated story of mass vaccine injury:

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On March 27 2016, Cadd cited her midwifery registration in providing advice to another member who was looking to decline a pregnancy glucose test:

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On March 22 2016, Cadd joined in with other group members who were attacking the Light for Riley Facebook page; and Cadd provided misinformation about the safety of the third trimester whooping cough vaccine boosters:

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On February 18 2016, Cadd joined in with other group members in championing Tasha David – the president of the disreputable anti-vaccination pressure group, the Australian Vaccination-skeptics Network – after one of David’s television appearances. Cadd also referred to a doctor who promotes immunisation as an, “ill informed sheep conferring Quack dr”:

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On February 17 2016, Cadd advised another member to seek acupressure and cloves for a friend who was due to have a medical appointment the following day, for a breech pregnancy:

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On February 16 2016, Cadd cited her midwifery registration and discussed patients who use the services of her workplace’s birthing unit, using unfavourable terms:

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On November 18 2015, Cadd joined in with other group members who were distressed over the stories of anti-vaccination activist, Jenny McCarthy, who claims that her son’s autism was caused by vaccines:

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On November 18 2015, Cadd joined in with other group members in vilifying the mother of deceased baby boy, Riley Hughes – Catherine Hughes – and provided misinformation about the third trimester whooping cough booster. One of those who joined in with the trolling and vilification of Catherine Hughes was Helena Denley, a person who was responsible for the death of her own toddler, Isabella, due to the withholding of necessary medical care:

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On September 16 and 17 2015, Cadd lamented the anti-vaccination movement’s attacks on the family of Riley Hughes. Group members on her post then left comments attacking the family of Riley Hughes, and journalist Cathy O’Leary, with one member posting an image which misuses Riley’s image, against the wishes of Riley’s parents:

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On September 14 2015, Cadd joined in with other group members, including the public officer of the Australian Vaccination-skeptics Network, Meryl Dorey, in providing non-evidence-based, crank cancer cure medical advice to a group member:

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On August 24 2015, Cadd joined in with other group members in attacking the maternal whooping cough immunisation booster as dangerous for babies:

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On August 5 2015, Cadd cited her midwifery registration in providing paediatric advice to another group member:

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On August 3 2015, Cadd sought non-evidence-based medical advice from the other anti-vaccination group members:

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On August 1 2015, Cadd joined in with other group members in vilifying evidence-based immunisation advocates, via an anti-vaccination meme:

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On July 29 2015, Cadd cited her midwifery registration in downplaying the seriousness of unprofessional chiropractors who sneak into hospitals to adjust neonates:

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On July 28 2015, Cadd argued that there is a conspiracy to sweep adverse reactions to  vaccines, “under the carpet”:

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On July 19 2015, Cadd cited her midwifery registration in arguing against workplace immunisation requirements:

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On July 18 2015, Cadd cited her midwifery registration in providing advice to another group member:

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On July 13 2016, Cadd joined other group members in attacking the World Health Organisation, arguing that the organisation is corrupt, based on an article by anti-vaccination conspiracy theorist, Sherri Tenpenny:

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On July 12 2015, Cadd joined in with other group members, including group admin, Courtney Hebberman, and dog breeder, Anita Bugges, in arguing that stillbirths are caused by the whooping cough and influenza vaccines:

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On April 20 2015, Cadd argued that pregnant women should not be provided with influenza immunisation, adding:

No no no…I just can’t understand the logic of Drs to inject a women and her DEVELOPING BABY with a flu needle which is riddled with neurotoxins…

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On April 6 2015, Cadd cited her midwifery registration:

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On April 6 2015, Cadd claimed that anti-vaccination activists are “educated and informed” and stated that “homeoprophylaxis needs to be made a choice” as an alternative method of retaining immunisation-related child care benefit payments:

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The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the activities of Kate Cadd.

Thanks for reading.

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Addendum 1

National competency standards for the midwife (PDF)

Legal and professional practice

Competency 1

Functions in accordance with legislation and common law affecting midwifery practice

Element 1.1

Demonstrates and acts upon knowledge of legislation and common law pertinent to midwifery practice.

Element 1.2

Complies with policies and guidelines that have legal and professional implications for practice.

Element 1.3

Formulates documentation according to legal and professional guidelines.

Element 1.4

Fulfils the duty of care in the course of midwifery practice.

Competency 2

Accepts accountability and responsibility for own actions within midwifery practice.

Element 2.1

Recognises and acts within own knowledge base and scope of practice.

Element 2.2

Identifies unsafe practice and takes appropriate action.

Element 2.3

Consults with, and refers to, another midwife or appropriate health care provider when the needs of the woman and her baby fall outside own scope of practice or competence.

Element 2.4

Delegates, when necessary, activities matching abilities and scope of practice and provides appropriate supervision.

Element 2.5

Assumes responsibility for professional midwifery leadership functions.

Midwifery knowledge and practice

Competency 3

Communicates information to facilitate decision making by the woman.

Element 3.1

Communicates effectively with the woman, her family and friends.

Element 3.2

Provides learning opportunities appropriate to the woman’s needs.

Element 3.3

Plans and evaluates care in partnership with the woman.

Competency 4

Promotes safe and effective midwifery care.

Element 4.1

Applies knowledge, skills and attitudes to enable woman centred care.

Element 4.2

Provides or supports midwifery continuity of care.

Element 4.3

Manages the midwifery care of women and their babies.

Competency 5

Assesses, plans, provides and evaluates safe and effective midwifery care.

Element 5.1

Uses midwifery knowledge and skills to facilitate an optimal experience for the woman.

Element 5.2

Assesses the health and well being of the woman and her baby.

Element 5.3

Plans, provides, and is responsible for, safe and effective midwifery care.

Element 5.4

Protects, promotes and supports breastfeeding.

Element 5.5

Demonstrates the ability to initiate, supply and administer relevant pharmacological substances in a safe and effective manner within relevant state or territory legislation.

Element 5.6

Evaluates the midwifery care provided to the woman and her baby.

Competency 6

Assesses, plans, provides and evaluates safe and effective midwifery care for the woman and/or baby with complex needs.

Element 6.1

Uses a range of midwifery knowledge and skills to provide midwifery care for the woman and/or her baby with complex needs as part of a collaborative team.

Element 6.2

Recognises and responds effectively in emergencies or urgent situations.

Midwifery as primary health care

Competency 7

Advocates to protect the rights of women, families and communities in relation to maternity care.

Element 7.1

Respects and supports women and their families to be self determining in promoting their own health and well–being.

Element 7.2

Acts to ensure that the rights of women receiving maternity care are respected.

Competency 8

Develops effective strategies to implement and support collaborative midwifery practice.

Element 8.1

Demonstrates effective communication with midwives, health care providers and other professionals.

Element 8.2

Establishes, maintains and evaluates professional relationships with other health care providers.

Competency 9

Actively supports midwifery as a public health strategy.

Element 9.1

Advocates for, and promotes midwifery practice, within the context of public health policy.

Element 9.2

Collaborates with, and refers women to, appropriate community agencies and support networks.

Competency 10

Ensures midwifery practice is culturally safe.

Element 10.1

Plans, implements and evaluates strategies for providing culturally safe practice for women, their families and colleagues.

Competency 11

Bases midwifery practice on ethical decision making.

Element 11.1

Practises in accordance with the endorsed Code of Ethics and relevant state/ territories and commonwealth privacy obligations under law.

Competency 12

Identifies personal beliefs and develops these in ways that enhance midwifery practice.

Element 12.1

Addresses the impact of personal beliefs and experiences on the provision of midwifery care.

Element 12.2

Appraises and addresses the impact of power relations on midwifery practice.

Competency 13

Acts to enhance the professional development of self and others.

Element 13.1

Assesses and acts upon own professional development needs.

Element 13.2

Contributes to, and evaluates, the learning experiences and professional development of others.

Competency 14

Uses research to inform midwifery practice.

Element 14.1

Ensures research evidence is incorporated into practice.

Element 14.2

Interprets evidence as a basis to inform practice and decision making.

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Addendum 2

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

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Addendum 3

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

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Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

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Addendum 4

Code of professional conduct for midwives

Midwives practise competently in accordance with legislation, standards and professional practice

1 Midwives practise in a safe and competent manner.

Conduct statement 1

Midwives practise in a safe and competent manner

Explanation

1 Midwives are personally accountable to the woman and her infant(s); their employer and their profession for the provision of safe and competent midwifery care. It is the responsibility of each midwife to maintain the competence necessary for current practice. Maintenance of competence includes participation in ongoing professional development to maintain and improve knowledge, skills and attitudes relevant to practice in a clinical, management, education or research setting.

2 Midwives practise in a manner that recognises the woman’s right to receive accurate information; be protected against foreseeable risk of harm to themselves and their infant(s); and have freedom to make choices in relation to their care.

3 Midwives practise within the scope of midwifery, according to the International Confederation of Midwives Definition of the Midwife (2005).

6 Midwives make known to an appropriate person or authority any circumstance that may compromise professional standards, or any observation of questionable, unethical or unlawful practice, and intervene to safeguard the individual if the concern is unresolved.

2 Midwives practise in accordance with the standards of the profession and broader health system.

Conduct statement 2

Midwives practise in accordance with the standards of the profession and broader health system

Explanation

1 Midwives practise in partnership with the woman, and in accordance with the standards of the profession (e.g. the Board-approved National competency standards for the midwife), to provide safe and effective midwifery care.

2 Midwives practise in accordance with wider standards relating to safety and quality in midwifery care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery.

Conduct statement 3

Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery

Explanation

1 Midwives are familiar with relevant laws and ensure they do not engage in practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Midwives practise in accordance with laws relevant to the midwife’s area of practice.

3 Midwives witnessing the unlawful conduct of colleagues and other co-workers, whether in midwifery practice, management, education or research, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other action as necessary to safeguard people and the public interest.

6 Midwives who are employees support the responsible use of the resources of their employing organisations.

4 Midwives respect the dignity, culture, values and beliefs of each woman and her infant(s) in their care and the woman’s partner and family, and of colleagues.

5 Midwives treat personal information obtained in a professional capacity as private and confidential.

Conduct statement 5

Midwives treat personal information obtained in a professional capacity as private and confidential

Explanation

The treatment of personal information should be considered in conjunction with the Guidelines to the National Privacy Principles 2001, which support the Privacy Act 1988 (Cwth). Many jurisdictions also have legislation and policies relating to privacy and confidentiality of personal health information including midwifery care records.

1 Midwives have ethical and legal obligations to treat personal information obtained in a professional capacity as confidential. Midwives protect the privacy of each woman, her infant(s) and family by treating the information gained in the relationship as confidential, restricting its use to professional purposes only.

6 Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products.

Conduct statement 6

Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products

Explanation

1 When midwives provide advice about any care or product, they fully explain the advantages and disadvantages of alternative products or care so individuals can make informed choices. Midwives refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and midwifery care.

2 Midwives accurately represent the nature of the midwifery care they intend to provide.

3 Where specific care or a specific product is advised, midwives ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Midwives refrain from the deceptive endorsement of services or products.

Midwives practise within a woman-centred framework

7 Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman.

Conduct statement 7

Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman

Explanation

1 Midwives ensure the mother and her infant(s) are the primary focus of midwifery care.

2 Midwives support the health and wellbeing of each woman and her infant(s), promoting and preserving practices that contribute to the woman’s self-confidence and the wellbeing of the woman and her infant(s).

4 Midwives support informed decision making by advising the woman and, where the woman wishes, her partner, family, friends or health interpreter, of the nature and purpose of the midwifery care, and assist the woman to make informed decisions about that care.

6 Midwives advocate for the protection of the rights of each woman, her infant(s), partner, family and community in relation to midwifery care.

8 Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each woman and her infant(s).

Conduct statement 8

Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each women and her infant(s)

Explanation

1 Midwives promote and preserve the trust inherent in the woman-midwife partnership.

2 An inherent power imbalance exists within the relationship between each woman and midwives that may make the woman and her infant(s) in their care vulnerable and open to exploitation. Midwives actively preserve the dignity of people through practised kindness and by recognising the potential vulnerability and powerlessness of each woman being cared for by midwives. The power relativities between a woman and a midwife can be significant, particularly where the woman has limited knowledge, experiences fear or pain, needs assistance with personal care, or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between midwives and each woman in their care that must be recognised and managed.

9 Midwives maintain and build on the community’s trust and confidence in the midwifery profession.

Conduct statement 9

Midwives maintain and build on the community’s trust and confidence in the midwifery profession

Explanation

1 The conduct of midwives maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of midwives in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual midwives or the profession were to diminish, this might jeopardise the inherent trust between the midwifery profession and women, as well as the community more generally, necessary for effective relationships and the effective delivery of midwifery care.

3 Midwives consider the ethical interests of the midwifery profession when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

Midwives practise midwifery reflectively and ethically

10 Midwives practise midwifery reflectively and ethically.

Conduct statement 10                  

Midwives practise midwifery reflectively and ethically

Explanation

1 Midwives practise midwifery reflectively and ethically, practising in accordance with the Code of ethics for midwives in Australia, in order to learn from experience and contribute to personal

2 Midwives develop and maintain appropriate and current midwifery advice, support and care for each woman in their care and her infant(s) and family.

3 Midwives evaluate their conduct and competency according to the standards of the midwifery profession.

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Code of ethics for midwives

1 Midwives value quality midwifery care for each woman and her infant(s).

Value statement 1

Midwives value quality midwifery care for each woman and her infant(s)

Explanation

At the heart of valuing quality midwifery care is valuing each woman, the process of childbirth, the woman- midwife partnership, and the mother-baby relationship. This involves midwives assisting each woman during pregnancy, birth and the early postnatal period, providing support, advice and care according to individual needs. The woman-midwife partnership focuses on the health and midwifery needs of the woman, her infant(s) and her partner and family. Midwives have a responsibility not to interfere with the normal process of pregnancy and childbirth unless it is necessary for the safety of the women and infant(s). Quality midwifery care also necessitates midwives being accountable for the standard of care they provide; helping to raise the standard; and taking action when they consider, on reasonable grounds, the standard to be unacceptable. This includes a responsibility to question and report unethical behaviour or treatment.

2 Midwives value respect and kindness for self and others.

3 Midwives value the diversity of people.

4 Midwives value access to quality midwifery care for each woman and her infant(s).

5 Midwives value informed decision making.

Value statement 5

Midwives value informed decision making

Explanation

Midwives value people’s interests in making free and informed decisions. This includes each woman having the opportunity to verify the meaning and implication of information being given to her when making decisions about her maternity care and childbirth experience. Midwives also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised

6 Midwives value a culture of safety in midwifery care.

Value statement 6

Midwives value a culture of safety in midwifery care

Explanation

Valuing a culture of safety involves midwives actively engaging in the development of shared knowledge and understanding of the importance of safety – physical, emotional, social and spiritual – as a crucial component of contemporary midwifery care. Midwives who value a culture of safety support reasonable measures, processes and reporting systems designed to reduce the incidence and impact of preventable adverse events in the provision of midwifery care. They also support the open disclosure to women of any adverse events affecting them or their infants during the course of their care

7 Midwives value ethical management of information.

Value statement 7

Midwives value ethical management of information

Explanation

The generation and management of information (including midwifery care records and other documents) are performed with professionalism and integrity. This requires the information being recorded to be accurate, non-judgemental and relevant to the midwifery care of the woman and her infant(s). All midwifery documentation is a record that cannot be changed or altered other than by the addition of further information. A notation in a record or a document used for midwifery care communication can have a powerful positive or negative impact on the quality of care received by a woman and her infant(s). These effects can be long-lasting, either through ensuring the provision of quality care, or through enshrining stigma, stereotyping and judgement in maternity care decision making and maternity care provision experienced by a woman and her infant(s).

The ethical management of information involves respecting people’s privacy and confidentiality without compromising health or safety. This applies to all types of data, including clinical and research data, irrespective of the medium in which the information occurs or is stored. Personal information may only be shared with the consent of the individual or with lawful authorisation.

8 Midwives value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

Value statement 8

Midwives value a socially, economically and ecologically sustainable environment, promoting health and wellbeing

Explanation

Midwives value strategies aimed at preventing, minimising and overcoming the harmful effects of economic, social or ecological factors on the health of each woman, her infant(s), family and community. Commitment to a healthy environment involves the conservation and efficient use of resources such as energy, water and fuel, as well as clinical and other materials.

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Addendum 5

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

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Anti-vaccine nurses and midwives 39

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Samara Douglas is a registered nurse and registered midwife, from Victoria, who also practises as a homeopath:

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Douglas frequently uses her nursing and midwifery registrations in her various professional biographies.

Douglas cites her AHPRA registrations on her website, for her business, Sorelle Homeopathy:

douglas-1-sorelle-homeopathy-about-page-website-rn-rm

Douglas cites her AHPRA registrations on her LinkedIn page:

douglas-1-linkedin-rn-rm-rego-sorelle-etc

On November 11 and 12 2016, on the Vaxxed Australia/New Zealand anti-vaccination Facebook page, Douglas cited her nursing and midwifery registrations, in response to anti-vaccination conspiracy theorist, Graeme Peter Little (AKA Peter Pope), claiming that she treats “vaccine damage”; also stating that she is aware of the professional codes and advertising guidelines to which she is bound; and stating that she has done a lot of study with discredited homeopath, Isaac Golden:

douglas-3-vaxxed-anz-nov-11-12-2016-op-1

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Douglas also publishes a Facebook page for her business, Sorelle Homeopathy:

On September 17 2015, Douglas promoted the anti-vaccination movie, Bought:

douglas-4-sorelle-sept-17-2015-bought

On June 8 2015, Douglas promoted homeopath, Isaac Golden, and his discredited, fictional immunisation program, homeoprophylaxis:

douglas-5-sorelle-june-8-2015-homeoprophylaxis-golden

On June 9 2015, Douglas again promoted Isaac Golden and his fictional homeopathic immunisation:

douglas-6-sorelle-june-9-2015-homeoprophylaxis-golden

The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the activities of Samara Douglas.

Thanks for reading.

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Addendum 1

National competency standards for the midwife (PDF)

Legal and professional practice

Competency 1

Functions in accordance with legislation and common law affecting midwifery practice

Element 1.1

Demonstrates and acts upon knowledge of legislation and common law pertinent to midwifery practice.

Element 1.2

Complies with policies and guidelines that have legal and professional implications for practice.

Element 1.3

Formulates documentation according to legal and professional guidelines.

Element 1.4

Fulfils the duty of care in the course of midwifery practice.

Competency 2

Accepts accountability and responsibility for own actions within midwifery practice.

Element 2.1

Recognises and acts within own knowledge base and scope of practice.

Element 2.2

Identifies unsafe practice and takes appropriate action.

Element 2.3

Consults with, and refers to, another midwife or appropriate health care provider when the needs of the woman and her baby fall outside own scope of practice or competence.

Element 2.4

Delegates, when necessary, activities matching abilities and scope of practice and provides appropriate supervision.

Element 2.5

Assumes responsibility for professional midwifery leadership functions.

Midwifery knowledge and practice

Competency 3

Communicates information to facilitate decision making by the woman.

Element 3.1

Communicates effectively with the woman, her family and friends.

Element 3.2

Provides learning opportunities appropriate to the woman’s needs.

Element 3.3

Plans and evaluates care in partnership with the woman.

Competency 4

Promotes safe and effective midwifery care.

Element 4.1

Applies knowledge, skills and attitudes to enable woman centred care.

Element 4.2

Provides or supports midwifery continuity of care.

Element 4.3

Manages the midwifery care of women and their babies.

Competency 5

Assesses, plans, provides and evaluates safe and effective midwifery care.

Element 5.1

Uses midwifery knowledge and skills to facilitate an optimal experience for the woman.

Element 5.2

Assesses the health and well being of the woman and her baby.

Element 5.3

Plans, provides, and is responsible for, safe and effective midwifery care.

Element 5.4

Protects, promotes and supports breastfeeding.

Element 5.5

Demonstrates the ability to initiate, supply and administer relevant pharmacological substances in a safe and effective manner within relevant state or territory legislation.

Element 5.6

Evaluates the midwifery care provided to the woman and her baby.

Competency 6

Assesses, plans, provides and evaluates safe and effective midwifery care for the woman and/or baby with complex needs.

Element 6.1

Uses a range of midwifery knowledge and skills to provide midwifery care for the woman and/or her baby with complex needs as part of a collaborative team.

Element 6.2

Recognises and responds effectively in emergencies or urgent situations.

Midwifery as primary health care

Competency 7

Advocates to protect the rights of women, families and communities in relation to maternity care.

Element 7.1

Respects and supports women and their families to be self determining in promoting their own health and well–being.

Element 7.2

Acts to ensure that the rights of women receiving maternity care are respected.

Competency 8

Develops effective strategies to implement and support collaborative midwifery practice.

Element 8.1

Demonstrates effective communication with midwives, health care providers and other professionals.

Element 8.2

Establishes, maintains and evaluates professional relationships with other health care providers.

Competency 9

Actively supports midwifery as a public health strategy.

Element 9.1

Advocates for, and promotes midwifery practice, within the context of public health policy.

Element 9.2

Collaborates with, and refers women to, appropriate community agencies and support networks.

Competency 10

Ensures midwifery practice is culturally safe.

Element 10.1

Plans, implements and evaluates strategies for providing culturally safe practice for women, their families and colleagues.

Competency 11

Bases midwifery practice on ethical decision making.

Element 11.1

Practises in accordance with the endorsed Code of Ethics and relevant state/ territories and commonwealth privacy obligations under law.

Competency 12

Identifies personal beliefs and develops these in ways that enhance midwifery practice.

Element 12.1

Addresses the impact of personal beliefs and experiences on the provision of midwifery care.

Element 12.2

Appraises and addresses the impact of power relations on midwifery practice.

Competency 13

Acts to enhance the professional development of self and others.

Element 13.1

Assesses and acts upon own professional development needs.

Element 13.2

Contributes to, and evaluates, the learning experiences and professional development of others.

Competency 14

Uses research to inform midwifery practice.

Element 14.1

Ensures research evidence is incorporated into practice.

Element 14.2

Interprets evidence as a basis to inform practice and decision making.

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Addendum 2

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

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Addendum 3

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

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Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

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Addendum 4

Code of professional conduct for midwives

Midwives practise competently in accordance with legislation, standards and professional practice

1 Midwives practise in a safe and competent manner.

Conduct statement 1

Midwives practise in a safe and competent manner

Explanation

1 Midwives are personally accountable to the woman and her infant(s); their employer and their profession for the provision of safe and competent midwifery care. It is the responsibility of each midwife to maintain the competence necessary for current practice. Maintenance of competence includes participation in ongoing professional development to maintain and improve knowledge, skills and attitudes relevant to practice in a clinical, management, education or research setting.

2 Midwives practise in a manner that recognises the woman’s right to receive accurate information; be protected against foreseeable risk of harm to themselves and their infant(s); and have freedom to make choices in relation to their care.

3 Midwives practise within the scope of midwifery, according to the International Confederation of Midwives Definition of the Midwife (2005).

6 Midwives make known to an appropriate person or authority any circumstance that may compromise professional standards, or any observation of questionable, unethical or unlawful practice, and intervene to safeguard the individual if the concern is unresolved.

2 Midwives practise in accordance with the standards of the profession and broader health system.

Conduct statement 2

Midwives practise in accordance with the standards of the profession and broader health system

Explanation

1 Midwives practise in partnership with the woman, and in accordance with the standards of the profession (e.g. the Board-approved National competency standards for the midwife), to provide safe and effective midwifery care.

2 Midwives practise in accordance with wider standards relating to safety and quality in midwifery care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery.

Conduct statement 3

Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery

Explanation

1 Midwives are familiar with relevant laws and ensure they do not engage in practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Midwives practise in accordance with laws relevant to the midwife’s area of practice.

3 Midwives witnessing the unlawful conduct of colleagues and other co-workers, whether in midwifery practice, management, education or research, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other action as necessary to safeguard people and the public interest.

6 Midwives who are employees support the responsible use of the resources of their employing organisations.

4 Midwives respect the dignity, culture, values and beliefs of each woman and her infant(s) in their care and the woman’s partner and family, and of colleagues.

5 Midwives treat personal information obtained in a professional capacity as private and confidential.

Conduct statement 5

Midwives treat personal information obtained in a professional capacity as private and confidential

Explanation

The treatment of personal information should be considered in conjunction with the Guidelines to the National Privacy Principles 2001, which support the Privacy Act 1988 (Cwth). Many jurisdictions also have legislation and policies relating to privacy and confidentiality of personal health information including midwifery care records.

1 Midwives have ethical and legal obligations to treat personal information obtained in a professional capacity as confidential. Midwives protect the privacy of each woman, her infant(s) and family by treating the information gained in the relationship as confidential, restricting its use to professional purposes only.

6 Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products.

Conduct statement 6

Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products

Explanation

1 When midwives provide advice about any care or product, they fully explain the advantages and disadvantages of alternative products or care so individuals can make informed choices. Midwives refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and midwifery care.

2 Midwives accurately represent the nature of the midwifery care they intend to provide.

3 Where specific care or a specific product is advised, midwives ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Midwives refrain from the deceptive endorsement of services or products.

Midwives practise within a woman-centred framework

7 Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman.

Conduct statement 7

Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman

Explanation

1 Midwives ensure the mother and her infant(s) are the primary focus of midwifery care.

2 Midwives support the health and wellbeing of each woman and her infant(s), promoting and preserving practices that contribute to the woman’s self-confidence and the wellbeing of the woman and her infant(s).

4 Midwives support informed decision making by advising the woman and, where the woman wishes, her partner, family, friends or health interpreter, of the nature and purpose of the midwifery care, and assist the woman to make informed decisions about that care.

6 Midwives advocate for the protection of the rights of each woman, her infant(s), partner, family and community in relation to midwifery care.

8 Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each woman and her infant(s).

Conduct statement 8

Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each women and her infant(s)

Explanation

1 Midwives promote and preserve the trust inherent in the woman-midwife partnership.

2 An inherent power imbalance exists within the relationship between each woman and midwives that may make the woman and her infant(s) in their care vulnerable and open to exploitation. Midwives actively preserve the dignity of people through practised kindness and by recognising the potential vulnerability and powerlessness of each woman being cared for by midwives. The power relativities between a woman and a midwife can be significant, particularly where the woman has limited knowledge, experiences fear or pain, needs assistance with personal care, or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between midwives and each woman in their care that must be recognised and managed.

9 Midwives maintain and build on the community’s trust and confidence in the midwifery profession.

Conduct statement 9

Midwives maintain and build on the community’s trust and confidence in the midwifery profession

Explanation

1 The conduct of midwives maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of midwives in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual midwives or the profession were to diminish, this might jeopardise the inherent trust between the midwifery profession and women, as well as the community more generally, necessary for effective relationships and the effective delivery of midwifery care.

3 Midwives consider the ethical interests of the midwifery profession when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

Midwives practise midwifery reflectively and ethically

10 Midwives practise midwifery reflectively and ethically.

Conduct statement 10                  

Midwives practise midwifery reflectively and ethically

Explanation

1 Midwives practise midwifery reflectively and ethically, practising in accordance with the Code of ethics for midwives in Australia, in order to learn from experience and contribute to personal

2 Midwives develop and maintain appropriate and current midwifery advice, support and care for each woman in their care and her infant(s) and family.

3 Midwives evaluate their conduct and competency according to the standards of the midwifery profession.

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Code of ethics for midwives

1 Midwives value quality midwifery care for each woman and her infant(s).

Value statement 1

Midwives value quality midwifery care for each woman and her infant(s)

Explanation

At the heart of valuing quality midwifery care is valuing each woman, the process of childbirth, the woman- midwife partnership, and the mother-baby relationship. This involves midwives assisting each woman during pregnancy, birth and the early postnatal period, providing support, advice and care according to individual needs. The woman-midwife partnership focuses on the health and midwifery needs of the woman, her infant(s) and her partner and family. Midwives have a responsibility not to interfere with the normal process of pregnancy and childbirth unless it is necessary for the safety of the women and infant(s). Quality midwifery care also necessitates midwives being accountable for the standard of care they provide; helping to raise the standard; and taking action when they consider, on reasonable grounds, the standard to be unacceptable. This includes a responsibility to question and report unethical behaviour or treatment.

2 Midwives value respect and kindness for self and others.

3 Midwives value the diversity of people.

4 Midwives value access to quality midwifery care for each woman and her infant(s).

5 Midwives value informed decision making.

Value statement 5

Midwives value informed decision making

Explanation

Midwives value people’s interests in making free and informed decisions. This includes each woman having the opportunity to verify the meaning and implication of information being given to her when making decisions about her maternity care and childbirth experience. Midwives also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised

6 Midwives value a culture of safety in midwifery care.

Value statement 6

Midwives value a culture of safety in midwifery care

Explanation

Valuing a culture of safety involves midwives actively engaging in the development of shared knowledge and understanding of the importance of safety – physical, emotional, social and spiritual – as a crucial component of contemporary midwifery care. Midwives who value a culture of safety support reasonable measures, processes and reporting systems designed to reduce the incidence and impact of preventable adverse events in the provision of midwifery care. They also support the open disclosure to women of any adverse events affecting them or their infants during the course of their care

7 Midwives value ethical management of information.

Value statement 7

Midwives value ethical management of information

Explanation

The generation and management of information (including midwifery care records and other documents) are performed with professionalism and integrity. This requires the information being recorded to be accurate, non-judgemental and relevant to the midwifery care of the woman and her infant(s). All midwifery documentation is a record that cannot be changed or altered other than by the addition of further information. A notation in a record or a document used for midwifery care communication can have a powerful positive or negative impact on the quality of care received by a woman and her infant(s). These effects can be long-lasting, either through ensuring the provision of quality care, or through enshrining stigma, stereotyping and judgement in maternity care decision making and maternity care provision experienced by a woman and her infant(s).

The ethical management of information involves respecting people’s privacy and confidentiality without compromising health or safety. This applies to all types of data, including clinical and research data, irrespective of the medium in which the information occurs or is stored. Personal information may only be shared with the consent of the individual or with lawful authorisation.

8 Midwives value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

Value statement 8

Midwives value a socially, economically and ecologically sustainable environment, promoting health and wellbeing

Explanation

Midwives value strategies aimed at preventing, minimising and overcoming the harmful effects of economic, social or ecological factors on the health of each woman, her infant(s), family and community. Commitment to a healthy environment involves the conservation and efficient use of resources such as energy, water and fuel, as well as clinical and other materials.

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Addendum 5

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

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Anti-vaccine nurses and midwives 38

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Tracy Starling is a registered nurse and registered midwife in Western Australia:

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Starling is a member of the rabid anti-vaccination Facebook group, Vaccine Choice Australia:

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Vaccine Choice Australia posts: 

On May 28 2016, Starling cited her midwifery registration on a post which vilifies the Light for Riley campaign. This post includes anti-vaccination activist, Tanya Hammond, declaring that “dTap is poison”:

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On June 4 2016, in Vaccine Choice Australia, Starling offered information on how to access the dangerous, discredited crank cancer treatment known as Gerson Therapy, provided by anti-vaccination entrepreneur, Tyler Tolman, in Bali:

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On April 10 2016, Starling advised another member to seek homeopathy for  the treatment of unsubstantiated “vaccine damage”:

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On February 27 2016, Starling advised a vulnerable new mother to seek the services of a homeopath to pre-treat any imagined vaccine damage to which this new mother’s baby might succumb; adding that Australia is now living under a “dictatorship run by drug companies”:

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On February 25 2016, Starling agreed with anti-vaccination activist, Greg French, that immunisation is “child abuse”:

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On November 3 2015, Starling cited her midwifery registration in providing advice to VCA group members:

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Starling’s Facebook profile:

On May 13 2016, Starling promoted the discredited cancer charlatan, Stanislaw Burzynski:

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On May 9 2016, Starling promoted lies about mammography, from conspiracy theory website, Natural News:

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On May 8 2016, Starling promoted the dangerously ineffective breast thermography. In Australia, a doctor has been struck off for referring a patient for this therapy:

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On May 5 2016, Starling publicly cited her midwifery registration in celebration of International Midwives Day:

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On December 8 2015, Starling promoted the anti-vaccination, conspiracy theory petition which was created to stop the new whole-of-life immunisation register:

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The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the activities of Tracy Starling.

Thanks for reading.

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Addendum 1

National competency standards for the midwife (PDF)

Legal and professional practice

Competency 1

Functions in accordance with legislation and common law affecting midwifery practice

Element 1.1

Demonstrates and acts upon knowledge of legislation and common law pertinent to midwifery practice.

Element 1.2

Complies with policies and guidelines that have legal and professional implications for practice.

Element 1.3

Formulates documentation according to legal and professional guidelines.

Element 1.4

Fulfils the duty of care in the course of midwifery practice.

Competency 2

Accepts accountability and responsibility for own actions within midwifery practice.

Element 2.1

Recognises and acts within own knowledge base and scope of practice.

Element 2.2

Identifies unsafe practice and takes appropriate action.

Element 2.3

Consults with, and refers to, another midwife or appropriate health care provider when the needs of the woman and her baby fall outside own scope of practice or competence.

Element 2.4

Delegates, when necessary, activities matching abilities and scope of practice and provides appropriate supervision.

Element 2.5

Assumes responsibility for professional midwifery leadership functions.

Midwifery knowledge and practice

Competency 3

Communicates information to facilitate decision making by the woman.

Element 3.1

Communicates effectively with the woman, her family and friends.

Element 3.2

Provides learning opportunities appropriate to the woman’s needs.

Element 3.3

Plans and evaluates care in partnership with the woman.

Competency 4

Promotes safe and effective midwifery care.

Element 4.1

Applies knowledge, skills and attitudes to enable woman centred care.

Element 4.2

Provides or supports midwifery continuity of care.

Element 4.3

Manages the midwifery care of women and their babies.

Competency 5

Assesses, plans, provides and evaluates safe and effective midwifery care.

Element 5.1

Uses midwifery knowledge and skills to facilitate an optimal experience for the woman.

Element 5.2

Assesses the health and well being of the woman and her baby.

Element 5.3

Plans, provides, and is responsible for, safe and effective midwifery care.

Element 5.4

Protects, promotes and supports breastfeeding.

Element 5.5

Demonstrates the ability to initiate, supply and administer relevant pharmacological substances in a safe and effective manner within relevant state or territory legislation.

Element 5.6

Evaluates the midwifery care provided to the woman and her baby.

Competency 6

Assesses, plans, provides and evaluates safe and effective midwifery care for the woman and/or baby with complex needs.

Element 6.1

Uses a range of midwifery knowledge and skills to provide midwifery care for the woman and/or her baby with complex needs as part of a collaborative team.

Element 6.2

Recognises and responds effectively in emergencies or urgent situations.

Midwifery as primary health care

Competency 7

Advocates to protect the rights of women, families and communities in relation to maternity care.

Element 7.1

Respects and supports women and their families to be self determining in promoting their own health and well–being.

Element 7.2

Acts to ensure that the rights of women receiving maternity care are respected.

Competency 8

Develops effective strategies to implement and support collaborative midwifery practice.

Element 8.1

Demonstrates effective communication with midwives, health care providers and other professionals.

Element 8.2

Establishes, maintains and evaluates professional relationships with other health care providers.

Competency 9

Actively supports midwifery as a public health strategy.

Element 9.1

Advocates for, and promotes midwifery practice, within the context of public health policy.

Element 9.2

Collaborates with, and refers women to, appropriate community agencies and support networks.

Competency 10

Ensures midwifery practice is culturally safe.

Element 10.1

Plans, implements and evaluates strategies for providing culturally safe practice for women, their families and colleagues.

Competency 11

Bases midwifery practice on ethical decision making.

Element 11.1

Practises in accordance with the endorsed Code of Ethics and relevant state/ territories and commonwealth privacy obligations under law.

Competency 12

Identifies personal beliefs and develops these in ways that enhance midwifery practice.

Element 12.1

Addresses the impact of personal beliefs and experiences on the provision of midwifery care.

Element 12.2

Appraises and addresses the impact of power relations on midwifery practice.

Competency 13

Acts to enhance the professional development of self and others.

Element 13.1

Assesses and acts upon own professional development needs.

Element 13.2

Contributes to, and evaluates, the learning experiences and professional development of others.

Competency 14

Uses research to inform midwifery practice.

Element 14.1

Ensures research evidence is incorporated into practice.

Element 14.2

Interprets evidence as a basis to inform practice and decision making.

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Addendum 2

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

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Addendum 3

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

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Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

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Addendum 4

Code of professional conduct for midwives

Midwives practise competently in accordance with legislation, standards and professional practice

1 Midwives practise in a safe and competent manner.

Conduct statement 1

Midwives practise in a safe and competent manner

Explanation

1 Midwives are personally accountable to the woman and her infant(s); their employer and their profession for the provision of safe and competent midwifery care. It is the responsibility of each midwife to maintain the competence necessary for current practice. Maintenance of competence includes participation in ongoing professional development to maintain and improve knowledge, skills and attitudes relevant to practice in a clinical, management, education or research setting.

2 Midwives practise in a manner that recognises the woman’s right to receive accurate information; be protected against foreseeable risk of harm to themselves and their infant(s); and have freedom to make choices in relation to their care.

3 Midwives practise within the scope of midwifery, according to the International Confederation of Midwives Definition of the Midwife (2005).

6 Midwives make known to an appropriate person or authority any circumstance that may compromise professional standards, or any observation of questionable, unethical or unlawful practice, and intervene to safeguard the individual if the concern is unresolved.

2 Midwives practise in accordance with the standards of the profession and broader health system.

Conduct statement 2

Midwives practise in accordance with the standards of the profession and broader health system

Explanation

1 Midwives practise in partnership with the woman, and in accordance with the standards of the profession (e.g. the Board-approved National competency standards for the midwife), to provide safe and effective midwifery care.

2 Midwives practise in accordance with wider standards relating to safety and quality in midwifery care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery.

Conduct statement 3

Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery

Explanation

1 Midwives are familiar with relevant laws and ensure they do not engage in practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Midwives practise in accordance with laws relevant to the midwife’s area of practice.

3 Midwives witnessing the unlawful conduct of colleagues and other co-workers, whether in midwifery practice, management, education or research, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other action as necessary to safeguard people and the public interest.

6 Midwives who are employees support the responsible use of the resources of their employing organisations.

4 Midwives respect the dignity, culture, values and beliefs of each woman and her infant(s) in their care and the woman’s partner and family, and of colleagues.

5 Midwives treat personal information obtained in a professional capacity as private and confidential.

Conduct statement 5

Midwives treat personal information obtained in a professional capacity as private and confidential

Explanation

The treatment of personal information should be considered in conjunction with the Guidelines to the National Privacy Principles 2001, which support the Privacy Act 1988 (Cwth). Many jurisdictions also have legislation and policies relating to privacy and confidentiality of personal health information including midwifery care records.

1 Midwives have ethical and legal obligations to treat personal information obtained in a professional capacity as confidential. Midwives protect the privacy of each woman, her infant(s) and family by treating the information gained in the relationship as confidential, restricting its use to professional purposes only.

6 Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products.

Conduct statement 6

Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products

Explanation

1 When midwives provide advice about any care or product, they fully explain the advantages and disadvantages of alternative products or care so individuals can make informed choices. Midwives refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and midwifery care.

2 Midwives accurately represent the nature of the midwifery care they intend to provide.

3 Where specific care or a specific product is advised, midwives ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Midwives refrain from the deceptive endorsement of services or products.

Midwives practise within a woman-centred framework

7 Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman.

Conduct statement 7

Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman

Explanation

1 Midwives ensure the mother and her infant(s) are the primary focus of midwifery care.

2 Midwives support the health and wellbeing of each woman and her infant(s), promoting and preserving practices that contribute to the woman’s self-confidence and the wellbeing of the woman and her infant(s).

4 Midwives support informed decision making by advising the woman and, where the woman wishes, her partner, family, friends or health interpreter, of the nature and purpose of the midwifery care, and assist the woman to make informed decisions about that care.

6 Midwives advocate for the protection of the rights of each woman, her infant(s), partner, family and community in relation to midwifery care.

8 Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each woman and her infant(s).

Conduct statement 8

Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each women and her infant(s)

Explanation

1 Midwives promote and preserve the trust inherent in the woman-midwife partnership.

2 An inherent power imbalance exists within the relationship between each woman and midwives that may make the woman and her infant(s) in their care vulnerable and open to exploitation. Midwives actively preserve the dignity of people through practised kindness and by recognising the potential vulnerability and powerlessness of each woman being cared for by midwives. The power relativities between a woman and a midwife can be significant, particularly where the woman has limited knowledge, experiences fear or pain, needs assistance with personal care, or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between midwives and each woman in their care that must be recognised and managed.

9 Midwives maintain and build on the community’s trust and confidence in the midwifery profession.

Conduct statement 9

Midwives maintain and build on the community’s trust and confidence in the midwifery profession

Explanation

1 The conduct of midwives maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of midwives in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual midwives or the profession were to diminish, this might jeopardise the inherent trust between the midwifery profession and women, as well as the community more generally, necessary for effective relationships and the effective delivery of midwifery care.

3 Midwives consider the ethical interests of the midwifery profession when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

Midwives practise midwifery reflectively and ethically

10 Midwives practise midwifery reflectively and ethically.

Conduct statement 10                  

Midwives practise midwifery reflectively and ethically

Explanation

1 Midwives practise midwifery reflectively and ethically, practising in accordance with the Code of ethics for midwives in Australia, in order to learn from experience and contribute to personal

2 Midwives develop and maintain appropriate and current midwifery advice, support and care for each woman in their care and her infant(s) and family.

3 Midwives evaluate their conduct and competency according to the standards of the midwifery profession.

____________________________________

Code of ethics for midwives

1 Midwives value quality midwifery care for each woman and her infant(s).

Value statement 1

Midwives value quality midwifery care for each woman and her infant(s)

Explanation

At the heart of valuing quality midwifery care is valuing each woman, the process of childbirth, the woman- midwife partnership, and the mother-baby relationship. This involves midwives assisting each woman during pregnancy, birth and the early postnatal period, providing support, advice and care according to individual needs. The woman-midwife partnership focuses on the health and midwifery needs of the woman, her infant(s) and her partner and family. Midwives have a responsibility not to interfere with the normal process of pregnancy and childbirth unless it is necessary for the safety of the women and infant(s). Quality midwifery care also necessitates midwives being accountable for the standard of care they provide; helping to raise the standard; and taking action when they consider, on reasonable grounds, the standard to be unacceptable. This includes a responsibility to question and report unethical behaviour or treatment.

2 Midwives value respect and kindness for self and others.

3 Midwives value the diversity of people.

4 Midwives value access to quality midwifery care for each woman and her infant(s).

5 Midwives value informed decision making.

Value statement 5

Midwives value informed decision making

Explanation

Midwives value people’s interests in making free and informed decisions. This includes each woman having the opportunity to verify the meaning and implication of information being given to her when making decisions about her maternity care and childbirth experience. Midwives also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised

6 Midwives value a culture of safety in midwifery care.

Value statement 6

Midwives value a culture of safety in midwifery care

Explanation

Valuing a culture of safety involves midwives actively engaging in the development of shared knowledge and understanding of the importance of safety – physical, emotional, social and spiritual – as a crucial component of contemporary midwifery care. Midwives who value a culture of safety support reasonable measures, processes and reporting systems designed to reduce the incidence and impact of preventable adverse events in the provision of midwifery care. They also support the open disclosure to women of any adverse events affecting them or their infants during the course of their care

7 Midwives value ethical management of information.

Value statement 7

Midwives value ethical management of information

Explanation

The generation and management of information (including midwifery care records and other documents) are performed with professionalism and integrity. This requires the information being recorded to be accurate, non-judgemental and relevant to the midwifery care of the woman and her infant(s). All midwifery documentation is a record that cannot be changed or altered other than by the addition of further information. A notation in a record or a document used for midwifery care communication can have a powerful positive or negative impact on the quality of care received by a woman and her infant(s). These effects can be long-lasting, either through ensuring the provision of quality care, or through enshrining stigma, stereotyping and judgement in maternity care decision making and maternity care provision experienced by a woman and her infant(s).

The ethical management of information involves respecting people’s privacy and confidentiality without compromising health or safety. This applies to all types of data, including clinical and research data, irrespective of the medium in which the information occurs or is stored. Personal information may only be shared with the consent of the individual or with lawful authorisation.

8 Midwives value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

Value statement 8

Midwives value a socially, economically and ecologically sustainable environment, promoting health and wellbeing

Explanation

Midwives value strategies aimed at preventing, minimising and overcoming the harmful effects of economic, social or ecological factors on the health of each woman, her infant(s), family and community. Commitment to a healthy environment involves the conservation and efficient use of resources such as energy, water and fuel, as well as clinical and other materials.

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Addendum 5

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

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Anti-vaccine nurses and midwives 37

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Matty Wightman is a registered nurse in South Australia:

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Wightman is a member of the rabid anti-vaccination Facebook group, Anti-Vaccination Australia:

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On May 15 2016, Wightman cited her nursing registration and former employment in discussing the immunisation of former paediatric patients with autism:

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On May 5 2016, in her very first post in Anti-Vaccination Australia, Wightman’s nursing registration and former employer were clearly visible:

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On May 5 2016, Wightman posted this anti-vaccination article:

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On May 12 2016, Wightman cited a conspiracy theory – and joined in with conspiracy theorist, John Scudamore of whale[dot]to – in her argument that vaccines are not safe or effective:

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On May 13 2016, Wightman posted a flawed anti-vaccination paper from anti-vaccination activist, Neil Z Miller, a computer scientist:

wightman-9-may-13-2016-ava-miller-study

On May 13 2016, Wightman joined with Laura Shakespeare – the wife and business partner of anti-vaccination chiropractor, Tim Shakespeare, who both own and run Life Rebel Chiropractic – in offering anti-vaccination support to a new group member:

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On June 4 2016, Wightman cited her nursing registration in joining in with anti-vaccination nurse, Serene Johnson, and AVA group admin, Belgin Colak, in denigrating the evidence-based practises of medical practitioners:

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On June 6 2016, Wightman posted an anti-vaccination screed against the Prevenar 13 vaccine, because she didn’t understand her citation:

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On June 19 2016, Wightman posted this anti-vaccination meme:

wightman-17-ava-june-19-2016-antivax-meme-burn-house-down

On August 29 2016, Wightman actively attempted to dissuade a vulnerable mother from immunising her toddler, even thought the toddler had had no adverse reactions to previous vaccines:

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On November 8 2016, Wightman posted this anti-vaccination meme:

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The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the anti-vaccination activism of Matty Wightman.

Thanks for reading.

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Addendum 1

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

________________________________

Addendum 2

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

_____________________________________

Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

1 Self: Nurses make informed decisions in relation to their practice within the constraints of their professional role and in accordance with ethical and legal requirements. Nurses are entitled to do this without undue pressure or coercion of any kind. Nurses are responsible for ensuring their decision-making is based on contemporary, relevant and well-founded knowledge and information.

2 Person (health consumer): Nurses value the legal and moral right of people, including children, to participate whenever possible in decision-making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. This may involve ensuring people who do not speak English have access to a qualified health interpreter. Nurses recognise and respect the rights of people to engage in shared decision-making when consenting to care and treatment. Nurses also value the contribution made by persons whose decision-making may be restricted because of incapacity, disability or other factors, including legal constraints. Nurses are knowledgeable about such circumstances and in facilitating the role of family members, partners, friends and others in contributing to decision-making processes.

3 Colleagues: Nurses respect the rights of colleagues and members of other disciplines to participate in informed decision-making. Making these collaborative and informed decisions includes involving the person requiring or receiving nursing care (or their representative) in decisions relating to their nursing or health care, without being subject to coercion of any kind.

4 Community: Nurses value the contribution made by the community to nursing and health care decision-making through a range of activities, including consumer groups, advocacy and membership of health-related committees. Nurses also assist in keeping the community accurately informed on nursing and health-related issues.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

1 Self: Nurses value safe practice and a safe working environment; practise within the limitations of their knowledge and skills; and recognise and avoid situations where their ability to deliver quality care may be impaired. Nurses have a moral and legal right to practise in a safe environment, without fear for their own safety or that of others, and they seek remedies through accepted channels, including legal action, when this is not the case. Nurses value the maintenance of competence in contributing to a safe care and practice environment.

2 Person (health consumer): Nurses recognise that people are vulnerable to injuries and illnesses as a result of preventable human error and adverse events while in health care settings. Nurses play a key role in the detection and prevention of errors and adverse events in health care settings, and support and participate in systems to identify circumstances where people are at risk of harm. Nurses act to prevent or control such risks through prevention, monitoring, early identification and early management of adverse events. Nurses contribute to the confidential reporting of adverse events and errors, and to organisational processes for the open disclosure of these events to persons affected during the course of their care.

3 Colleagues: Nurses work with their colleagues to create a culture of safety. Nurses support the development of safer health care systems through non-punitive human error, adverse event management and related education. Nurses value the critical relationship between consumer safety and interprofessional competencies, including trustful communication, teamwork and situation awareness. Nurses view the detection of their own errors and risks or those of their colleagues as opportunities for achieving a safer health care system.

4 Community: Nurses, acting through their professional and industrial organisations and other appropriate authorities, participate in developing and improving the safety and quality of health care services for all people. This includes actively promoting the provision of equitable, just and culturally and socially responsive health care services for all people living, or seeking residence or asylum, in Australia. It also involves raising public awareness about the nature and importance of consumer safety programs in health care services.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

________________________________________

Addendum 3

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

___________________________________________

 

Posted in anti-vaccination, anti-vaccination dishonesty, Anti-vaccine thugs, hospitals, Immunisation, nurse, public health, skeptic, stop the australian vaccination network, vaccination | Tagged , , , , , , , , , , , , , | 2 Comments

Anti-vaccine nurses and midwives 36

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Arnna Pickering is a registered nurse in Victoria who also practises as a kinesiologist:

pickering-2-profile-kinesiologist

pickering-2-ahpra-rego

Pickering is a member of the rabid anti-vaccination Facebook group, Anti-Vaccination Australia:

pickering-4-ava-member

Pickering is a member of the rabid anti-vaccination Facebook group, Vaccine Choice Australia:

pickering-4-vca-member

On October 4 2016, in Anti-Vaccination Australia, Pickering cited her nursing registration in advising another member against a tetanus immunisation which was being recommended by hospital staff for the member’s husband, for a deep wound:

pickering-7-ava-october-3-2016-nurse-no-to-tetanus-vax-1

pickering-7-ava-october-4-2016-nurse-no-to-tetanus-vax-2

On May 26 2016, in Vaccine Choice Australia, Pickering cited her nursing registration and employment as a school nurse and wellbeing coordinator, in denigrating her school’s and council’s public immunisation activities:

pickering-8-vca-may-26-2016-rn-school-1

pickering-8-vca-may-26-2016-rn-school-2

pickering-8-vca-may-26-2016-rn-school-3-nelson

On March 27 2016, Pickering’s nursing registration was cited by her friend in adding Pickering to Vaccine Choice Australia:

pickering-2-vca-member-approve

On June 12 2016, Pickering denigrated a local doctor who posted articles warning the community about the anti-vaccination activities of the Health Australia Party:

pickering-5-vca-june-12-2016-hap-local-doctor

pickering-6-vca-june-12-2016-hap-cont

The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the anti-vaccination activism of Arnna Pickering.

Thanks for reading.

_________________________________

Addendum 1

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

________________________________

Addendum 2

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

_____________________________________

Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

1 Self: Nurses make informed decisions in relation to their practice within the constraints of their professional role and in accordance with ethical and legal requirements. Nurses are entitled to do this without undue pressure or coercion of any kind. Nurses are responsible for ensuring their decision-making is based on contemporary, relevant and well-founded knowledge and information.

2 Person (health consumer): Nurses value the legal and moral right of people, including children, to participate whenever possible in decision-making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. This may involve ensuring people who do not speak English have access to a qualified health interpreter. Nurses recognise and respect the rights of people to engage in shared decision-making when consenting to care and treatment. Nurses also value the contribution made by persons whose decision-making may be restricted because of incapacity, disability or other factors, including legal constraints. Nurses are knowledgeable about such circumstances and in facilitating the role of family members, partners, friends and others in contributing to decision-making processes.

3 Colleagues: Nurses respect the rights of colleagues and members of other disciplines to participate in informed decision-making. Making these collaborative and informed decisions includes involving the person requiring or receiving nursing care (or their representative) in decisions relating to their nursing or health care, without being subject to coercion of any kind.

4 Community: Nurses value the contribution made by the community to nursing and health care decision-making through a range of activities, including consumer groups, advocacy and membership of health-related committees. Nurses also assist in keeping the community accurately informed on nursing and health-related issues.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

1 Self: Nurses value safe practice and a safe working environment; practise within the limitations of their knowledge and skills; and recognise and avoid situations where their ability to deliver quality care may be impaired. Nurses have a moral and legal right to practise in a safe environment, without fear for their own safety or that of others, and they seek remedies through accepted channels, including legal action, when this is not the case. Nurses value the maintenance of competence in contributing to a safe care and practice environment.

2 Person (health consumer): Nurses recognise that people are vulnerable to injuries and illnesses as a result of preventable human error and adverse events while in health care settings. Nurses play a key role in the detection and prevention of errors and adverse events in health care settings, and support and participate in systems to identify circumstances where people are at risk of harm. Nurses act to prevent or control such risks through prevention, monitoring, early identification and early management of adverse events. Nurses contribute to the confidential reporting of adverse events and errors, and to organisational processes for the open disclosure of these events to persons affected during the course of their care.

3 Colleagues: Nurses work with their colleagues to create a culture of safety. Nurses support the development of safer health care systems through non-punitive human error, adverse event management and related education. Nurses value the critical relationship between consumer safety and interprofessional competencies, including trustful communication, teamwork and situation awareness. Nurses view the detection of their own errors and risks or those of their colleagues as opportunities for achieving a safer health care system.

4 Community: Nurses, acting through their professional and industrial organisations and other appropriate authorities, participate in developing and improving the safety and quality of health care services for all people. This includes actively promoting the provision of equitable, just and culturally and socially responsive health care services for all people living, or seeking residence or asylum, in Australia. It also involves raising public awareness about the nature and importance of consumer safety programs in health care services.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

________________________________________

Addendum 3

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

___________________________________________

Posted in anti-vaccination, anti-vaccination dishonesty, Health Australia Party, Immunisation, nurse, public health, skeptic, stop the australian vaccination network, vaccination | Tagged , , , , , , , , , , , | Leave a comment

Anti-vaccine nurses and midwives 35

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Anita O’Keeffe is a registered nurse, formerly of  Western Australia, who currently practises in Ireland. O’Keeffe’s Facebook profile has been deleted:

okeeffe-1-fb-photo-public

2016 AHPRA registration shows Western Australia:

okeeffe-2-ahpra-rego-2016-wa

2017 AHPRA registration shows Ireland:

okeeffe-2-ahpra-rego-2017-ie

On May 2 2016, in anti-vaccination Facebook group, Vaccine Choice Australia, O’Keeffe commented in support of antivax enrolled nurse, Megan Cox, who posted a workplace influenza immunisation promotion photograph in order to denigrate  influenza immunisation as “poisom”. O’Keeffe commented that she would like to “tear it down”, and that her own hospital staff were “dropping like flies”:

cox-7-may-2-2016-hospital-vax-poison

cox-8-may-2-2016-hospital-vax-poison-anita-okeeffe-and-katie-rose-lewis

The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the anti-vaccination activism of Anita O’Keeffe.

Thanks for reading.

_________________________________

Addendum 1

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

________________________________

Addendum 2

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

_____________________________________

Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

1 Self: Nurses make informed decisions in relation to their practice within the constraints of their professional role and in accordance with ethical and legal requirements. Nurses are entitled to do this without undue pressure or coercion of any kind. Nurses are responsible for ensuring their decision-making is based on contemporary, relevant and well-founded knowledge and information.

2 Person (health consumer): Nurses value the legal and moral right of people, including children, to participate whenever possible in decision-making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. This may involve ensuring people who do not speak English have access to a qualified health interpreter. Nurses recognise and respect the rights of people to engage in shared decision-making when consenting to care and treatment. Nurses also value the contribution made by persons whose decision-making may be restricted because of incapacity, disability or other factors, including legal constraints. Nurses are knowledgeable about such circumstances and in facilitating the role of family members, partners, friends and others in contributing to decision-making processes.

3 Colleagues: Nurses respect the rights of colleagues and members of other disciplines to participate in informed decision-making. Making these collaborative and informed decisions includes involving the person requiring or receiving nursing care (or their representative) in decisions relating to their nursing or health care, without being subject to coercion of any kind.

4 Community: Nurses value the contribution made by the community to nursing and health care decision-making through a range of activities, including consumer groups, advocacy and membership of health-related committees. Nurses also assist in keeping the community accurately informed on nursing and health-related issues.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

1 Self: Nurses value safe practice and a safe working environment; practise within the limitations of their knowledge and skills; and recognise and avoid situations where their ability to deliver quality care may be impaired. Nurses have a moral and legal right to practise in a safe environment, without fear for their own safety or that of others, and they seek remedies through accepted channels, including legal action, when this is not the case. Nurses value the maintenance of competence in contributing to a safe care and practice environment.

2 Person (health consumer): Nurses recognise that people are vulnerable to injuries and illnesses as a result of preventable human error and adverse events while in health care settings. Nurses play a key role in the detection and prevention of errors and adverse events in health care settings, and support and participate in systems to identify circumstances where people are at risk of harm. Nurses act to prevent or control such risks through prevention, monitoring, early identification and early management of adverse events. Nurses contribute to the confidential reporting of adverse events and errors, and to organisational processes for the open disclosure of these events to persons affected during the course of their care.

3 Colleagues: Nurses work with their colleagues to create a culture of safety. Nurses support the development of safer health care systems through non-punitive human error, adverse event management and related education. Nurses value the critical relationship between consumer safety and interprofessional competencies, including trustful communication, teamwork and situation awareness. Nurses view the detection of their own errors and risks or those of their colleagues as opportunities for achieving a safer health care system.

4 Community: Nurses, acting through their professional and industrial organisations and other appropriate authorities, participate in developing and improving the safety and quality of health care services for all people. This includes actively promoting the provision of equitable, just and culturally and socially responsive health care services for all people living, or seeking residence or asylum, in Australia. It also involves raising public awareness about the nature and importance of consumer safety programs in health care services.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

________________________________________

Addendum 3

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

___________________________________________

 

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Anti-vaccine nurses and midwives 34

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Samantha Hall is a registered nurse in Queensland:

hall-s-1-profile-birkdale

hall-s-2-ahpra-rego

On September 22 2016, Hall cited her nursing registration on The Bendigo Advertiser’s Facebook page to bolster her anti-vaccination claims in support of the anti-vaccination movie, Vaxxed, which was planned to be shown at the CLIFF film  festival, in Castlemaine, Victoria:

hall-s-5-september-22-2016-vaxxed-cliff-bendigo-advertiser-op

hall-s-5-september-22-2016-registered-nurse

hall-s-5-september-22-2016-registered-nurse-cont

On April 23 and 24 2015, on her Facebook profile, Hall shared an anti-vaccination petition directed at the then-prime minister and added anti-vaccination commentary which included conspiracies surrounding the World Health Organisation, doctors, researchers, and politicians. Hall also cited a video by discredited anti-vaccination doctor, Russell Blaylock:

hall-s-3-profile-april-23-2015-antivax

hall-s-3-profile-cont

hall-s-3-profile-cont-2

On June 10 2013, on her Facebook profile, Hall shared anti-fluoride misinformation:

hall-s-4-profile-june-10-2013-antiflouride

Hall is a member of the rabid anti-vaccination Facebook group, Vaccine Choice Australia (formerly Vaccine Free Australia):

hall-s-3-member-vca

On July 25 2016, Hall cited her nursing registration to denigrate evidence-based medical professionals:

hall-s-6-vca-july-25-2016-denigrate-drs-op

hall-s-6-vca-july-25-2016-denigrate-drs-rn-med-centre

On May 7 and 2016, Hall cited her nursing registration to denigrate medical professionals, and denigrated anaesthetists, with VCA admin Courtney Hebberman:

hall-s-7-vca-may-7-2016-op

hall-s-7-vca-may-7-2016-rn-cited

hall-s-7-vca-may-8-2016-anaesthetist-hebberman

On April 26 and 27 2016, Hall cited her nursing registration and employment to denigrate annual influenza immunisation, workplace immunisation, childhood immunisation, and parents of immunised children:

hall-s-8-vca-april-26-2016-op

hall-s-8-vca-april-26-2016-triage-rn-vax-aes

hall-s-8-vca-april-26-2016-mask-instead-of-flu-vax

hall-s-8-vca-april-27-2016-triage-rn-aes

On December 15 2015, Hall argued that a “healthy child” is a child who is not immunised:

hall-s-9-vca-december-15-2015-ccr-ftba-op

hall-s-9-vca-december-15-2015-ccr-etc-unvaxed-equals-healthy-child

On August 17 2015, Hall cited her nursing registration to denigrate the benefits of public immunisation, and referred to vaccines as “poison”:

hall-s-10-vca-august-16-2015-no-vax-for-childcare-op

hall-s-10-vca-august-17-2015-nurse-cited-antivax-childcare

The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the anti-vaccination activism of Samantha Hall.

Thanks for reading.

_________________________________

Addendum 1

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

________________________________

Addendum 2

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

_____________________________________

Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

1 Self: Nurses make informed decisions in relation to their practice within the constraints of their professional role and in accordance with ethical and legal requirements. Nurses are entitled to do this without undue pressure or coercion of any kind. Nurses are responsible for ensuring their decision-making is based on contemporary, relevant and well-founded knowledge and information.

2 Person (health consumer): Nurses value the legal and moral right of people, including children, to participate whenever possible in decision-making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. This may involve ensuring people who do not speak English have access to a qualified health interpreter. Nurses recognise and respect the rights of people to engage in shared decision-making when consenting to care and treatment. Nurses also value the contribution made by persons whose decision-making may be restricted because of incapacity, disability or other factors, including legal constraints. Nurses are knowledgeable about such circumstances and in facilitating the role of family members, partners, friends and others in contributing to decision-making processes.

3 Colleagues: Nurses respect the rights of colleagues and members of other disciplines to participate in informed decision-making. Making these collaborative and informed decisions includes involving the person requiring or receiving nursing care (or their representative) in decisions relating to their nursing or health care, without being subject to coercion of any kind.

4 Community: Nurses value the contribution made by the community to nursing and health care decision-making through a range of activities, including consumer groups, advocacy and membership of health-related committees. Nurses also assist in keeping the community accurately informed on nursing and health-related issues.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

1 Self: Nurses value safe practice and a safe working environment; practise within the limitations of their knowledge and skills; and recognise and avoid situations where their ability to deliver quality care may be impaired. Nurses have a moral and legal right to practise in a safe environment, without fear for their own safety or that of others, and they seek remedies through accepted channels, including legal action, when this is not the case. Nurses value the maintenance of competence in contributing to a safe care and practice environment.

2 Person (health consumer): Nurses recognise that people are vulnerable to injuries and illnesses as a result of preventable human error and adverse events while in health care settings. Nurses play a key role in the detection and prevention of errors and adverse events in health care settings, and support and participate in systems to identify circumstances where people are at risk of harm. Nurses act to prevent or control such risks through prevention, monitoring, early identification and early management of adverse events. Nurses contribute to the confidential reporting of adverse events and errors, and to organisational processes for the open disclosure of these events to persons affected during the course of their care.

3 Colleagues: Nurses work with their colleagues to create a culture of safety. Nurses support the development of safer health care systems through non-punitive human error, adverse event management and related education. Nurses value the critical relationship between consumer safety and interprofessional competencies, including trustful communication, teamwork and situation awareness. Nurses view the detection of their own errors and risks or those of their colleagues as opportunities for achieving a safer health care system.

4 Community: Nurses, acting through their professional and industrial organisations and other appropriate authorities, participate in developing and improving the safety and quality of health care services for all people. This includes actively promoting the provision of equitable, just and culturally and socially responsive health care services for all people living, or seeking residence or asylum, in Australia. It also involves raising public awareness about the nature and importance of consumer safety programs in health care services.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

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Addendum 3

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

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Anti-vaccine nurses and midwives 33

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Rachael Sieber is a registered nurse and registered midwife in Victoria:

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Sieber is a member of the Australian Vaccination-skeptics Network, and anti-vaccination protest Facebook pages:

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On January 11 2016, Sieber posted on the page of the discredited Australian Vaccination-skeptics Network, citing her midwifery registration to bolster planned anti-vaccination protests:

sieber-2-avn-midwife-comment-antivax

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The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the activities of Rachael Sieber.

Thanks for reading.

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Addendum 1

National competency standards for the midwife (PDF)

Legal and professional practice

Competency 1

Functions in accordance with legislation and common law affecting midwifery practice

Element 1.1

Demonstrates and acts upon knowledge of legislation and common law pertinent to midwifery practice.

Element 1.2

Complies with policies and guidelines that have legal and professional implications for practice.

Element 1.3

Formulates documentation according to legal and professional guidelines.

Element 1.4

Fulfils the duty of care in the course of midwifery practice.

Competency 2

Accepts accountability and responsibility for own actions within midwifery practice.

Element 2.1

Recognises and acts within own knowledge base and scope of practice.

Element 2.2

Identifies unsafe practice and takes appropriate action.

Element 2.3

Consults with, and refers to, another midwife or appropriate health care provider when the needs of the woman and her baby fall outside own scope of practice or competence.

Element 2.4

Delegates, when necessary, activities matching abilities and scope of practice and provides appropriate supervision.

Element 2.5

Assumes responsibility for professional midwifery leadership functions.

Midwifery knowledge and practice

Competency 3

Communicates information to facilitate decision making by the woman.

Element 3.1

Communicates effectively with the woman, her family and friends.

Element 3.2

Provides learning opportunities appropriate to the woman’s needs.

Element 3.3

Plans and evaluates care in partnership with the woman.

Competency 4

Promotes safe and effective midwifery care.

Element 4.1

Applies knowledge, skills and attitudes to enable woman centred care.

Element 4.2

Provides or supports midwifery continuity of care.

Element 4.3

Manages the midwifery care of women and their babies.

Competency 5

Assesses, plans, provides and evaluates safe and effective midwifery care.

Element 5.1

Uses midwifery knowledge and skills to facilitate an optimal experience for the woman.

Element 5.2

Assesses the health and well being of the woman and her baby.

Element 5.3

Plans, provides, and is responsible for, safe and effective midwifery care.

Element 5.4

Protects, promotes and supports breastfeeding.

Element 5.5

Demonstrates the ability to initiate, supply and administer relevant pharmacological substances in a safe and effective manner within relevant state or territory legislation.

Element 5.6

Evaluates the midwifery care provided to the woman and her baby.

Competency 6

Assesses, plans, provides and evaluates safe and effective midwifery care for the woman and/or baby with complex needs.

Element 6.1

Uses a range of midwifery knowledge and skills to provide midwifery care for the woman and/or her baby with complex needs as part of a collaborative team.

Element 6.2

Recognises and responds effectively in emergencies or urgent situations.

Midwifery as primary health care

Competency 7

Advocates to protect the rights of women, families and communities in relation to maternity care.

Element 7.1

Respects and supports women and their families to be self determining in promoting their own health and well–being.

Element 7.2

Acts to ensure that the rights of women receiving maternity care are respected.

Competency 8

Develops effective strategies to implement and support collaborative midwifery practice.

Element 8.1

Demonstrates effective communication with midwives, health care providers and other professionals.

Element 8.2

Establishes, maintains and evaluates professional relationships with other health care providers.

Competency 9

Actively supports midwifery as a public health strategy.

Element 9.1

Advocates for, and promotes midwifery practice, within the context of public health policy.

Element 9.2

Collaborates with, and refers women to, appropriate community agencies and support networks.

Competency 10

Ensures midwifery practice is culturally safe.

Element 10.1

Plans, implements and evaluates strategies for providing culturally safe practice for women, their families and colleagues.

Competency 11

Bases midwifery practice on ethical decision making.

Element 11.1

Practises in accordance with the endorsed Code of Ethics and relevant state/ territories and commonwealth privacy obligations under law.

Competency 12

Identifies personal beliefs and develops these in ways that enhance midwifery practice.

Element 12.1

Addresses the impact of personal beliefs and experiences on the provision of midwifery care.

Element 12.2

Appraises and addresses the impact of power relations on midwifery practice.

Competency 13

Acts to enhance the professional development of self and others.

Element 13.1

Assesses and acts upon own professional development needs.

Element 13.2

Contributes to, and evaluates, the learning experiences and professional development of others.

Competency 14

Uses research to inform midwifery practice.

Element 14.1

Ensures research evidence is incorporated into practice.

Element 14.2

Interprets evidence as a basis to inform practice and decision making.

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Addendum 2

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

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Addendum 3

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

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Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

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Addendum 4

Code of professional conduct for midwives

Midwives practise competently in accordance with legislation, standards and professional practice

1 Midwives practise in a safe and competent manner.

Conduct statement 1

Midwives practise in a safe and competent manner

Explanation

1 Midwives are personally accountable to the woman and her infant(s); their employer and their profession for the provision of safe and competent midwifery care. It is the responsibility of each midwife to maintain the competence necessary for current practice. Maintenance of competence includes participation in ongoing professional development to maintain and improve knowledge, skills and attitudes relevant to practice in a clinical, management, education or research setting.

2 Midwives practise in a manner that recognises the woman’s right to receive accurate information; be protected against foreseeable risk of harm to themselves and their infant(s); and have freedom to make choices in relation to their care.

3 Midwives practise within the scope of midwifery, according to the International Confederation of Midwives Definition of the Midwife (2005).

6 Midwives make known to an appropriate person or authority any circumstance that may compromise professional standards, or any observation of questionable, unethical or unlawful practice, and intervene to safeguard the individual if the concern is unresolved.

2 Midwives practise in accordance with the standards of the profession and broader health system.

Conduct statement 2

Midwives practise in accordance with the standards of the profession and broader health system

Explanation

1 Midwives practise in partnership with the woman, and in accordance with the standards of the profession (e.g. the Board-approved National competency standards for the midwife), to provide safe and effective midwifery care.

2 Midwives practise in accordance with wider standards relating to safety and quality in midwifery care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery.

Conduct statement 3

Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery

Explanation

1 Midwives are familiar with relevant laws and ensure they do not engage in practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Midwives practise in accordance with laws relevant to the midwife’s area of practice.

3 Midwives witnessing the unlawful conduct of colleagues and other co-workers, whether in midwifery practice, management, education or research, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other action as necessary to safeguard people and the public interest.

6 Midwives who are employees support the responsible use of the resources of their employing organisations.

4 Midwives respect the dignity, culture, values and beliefs of each woman and her infant(s) in their care and the woman’s partner and family, and of colleagues.

5 Midwives treat personal information obtained in a professional capacity as private and confidential.

Conduct statement 5

Midwives treat personal information obtained in a professional capacity as private and confidential

Explanation

The treatment of personal information should be considered in conjunction with the Guidelines to the National Privacy Principles 2001, which support the Privacy Act 1988 (Cwth). Many jurisdictions also have legislation and policies relating to privacy and confidentiality of personal health information including midwifery care records.

1 Midwives have ethical and legal obligations to treat personal information obtained in a professional capacity as confidential. Midwives protect the privacy of each woman, her infant(s) and family by treating the information gained in the relationship as confidential, restricting its use to professional purposes only.

6 Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products.

Conduct statement 6

Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products

Explanation

1 When midwives provide advice about any care or product, they fully explain the advantages and disadvantages of alternative products or care so individuals can make informed choices. Midwives refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and midwifery care.

2 Midwives accurately represent the nature of the midwifery care they intend to provide.

3 Where specific care or a specific product is advised, midwives ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Midwives refrain from the deceptive endorsement of services or products.

Midwives practise within a woman-centred framework

7 Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman.

Conduct statement 7

Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman

Explanation

1 Midwives ensure the mother and her infant(s) are the primary focus of midwifery care.

2 Midwives support the health and wellbeing of each woman and her infant(s), promoting and preserving practices that contribute to the woman’s self-confidence and the wellbeing of the woman and her infant(s).

4 Midwives support informed decision making by advising the woman and, where the woman wishes, her partner, family, friends or health interpreter, of the nature and purpose of the midwifery care, and assist the woman to make informed decisions about that care.

6 Midwives advocate for the protection of the rights of each woman, her infant(s), partner, family and community in relation to midwifery care.

8 Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each woman and her infant(s).

Conduct statement 8

Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each women and her infant(s)

Explanation

1 Midwives promote and preserve the trust inherent in the woman-midwife partnership.

2 An inherent power imbalance exists within the relationship between each woman and midwives that may make the woman and her infant(s) in their care vulnerable and open to exploitation. Midwives actively preserve the dignity of people through practised kindness and by recognising the potential vulnerability and powerlessness of each woman being cared for by midwives. The power relativities between a woman and a midwife can be significant, particularly where the woman has limited knowledge, experiences fear or pain, needs assistance with personal care, or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between midwives and each woman in their care that must be recognised and managed.

9 Midwives maintain and build on the community’s trust and confidence in the midwifery profession.

Conduct statement 9

Midwives maintain and build on the community’s trust and confidence in the midwifery profession

Explanation

1 The conduct of midwives maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of midwives in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual midwives or the profession were to diminish, this might jeopardise the inherent trust between the midwifery profession and women, as well as the community more generally, necessary for effective relationships and the effective delivery of midwifery care.

3 Midwives consider the ethical interests of the midwifery profession when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

Midwives practise midwifery reflectively and ethically

10 Midwives practise midwifery reflectively and ethically.

Conduct statement 10                  

Midwives practise midwifery reflectively and ethically

Explanation

1 Midwives practise midwifery reflectively and ethically, practising in accordance with the Code of ethics for midwives in Australia, in order to learn from experience and contribute to personal

2 Midwives develop and maintain appropriate and current midwifery advice, support and care for each woman in their care and her infant(s) and family.

3 Midwives evaluate their conduct and competency according to the standards of the midwifery profession.

____________________________________

Code of ethics for midwives

1 Midwives value quality midwifery care for each woman and her infant(s).

Value statement 1

Midwives value quality midwifery care for each woman and her infant(s)

Explanation

At the heart of valuing quality midwifery care is valuing each woman, the process of childbirth, the woman- midwife partnership, and the mother-baby relationship. This involves midwives assisting each woman during pregnancy, birth and the early postnatal period, providing support, advice and care according to individual needs. The woman-midwife partnership focuses on the health and midwifery needs of the woman, her infant(s) and her partner and family. Midwives have a responsibility not to interfere with the normal process of pregnancy and childbirth unless it is necessary for the safety of the women and infant(s). Quality midwifery care also necessitates midwives being accountable for the standard of care they provide; helping to raise the standard; and taking action when they consider, on reasonable grounds, the standard to be unacceptable. This includes a responsibility to question and report unethical behaviour or treatment.

2 Midwives value respect and kindness for self and others.

3 Midwives value the diversity of people.

4 Midwives value access to quality midwifery care for each woman and her infant(s).

5 Midwives value informed decision making.

Value statement 5

Midwives value informed decision making

Explanation

Midwives value people’s interests in making free and informed decisions. This includes each woman having the opportunity to verify the meaning and implication of information being given to her when making decisions about her maternity care and childbirth experience. Midwives also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised

6 Midwives value a culture of safety in midwifery care.

Value statement 6

Midwives value a culture of safety in midwifery care

Explanation

Valuing a culture of safety involves midwives actively engaging in the development of shared knowledge and understanding of the importance of safety – physical, emotional, social and spiritual – as a crucial component of contemporary midwifery care. Midwives who value a culture of safety support reasonable measures, processes and reporting systems designed to reduce the incidence and impact of preventable adverse events in the provision of midwifery care. They also support the open disclosure to women of any adverse events affecting them or their infants during the course of their care

7 Midwives value ethical management of information.

Value statement 7

Midwives value ethical management of information

Explanation

The generation and management of information (including midwifery care records and other documents) are performed with professionalism and integrity. This requires the information being recorded to be accurate, non-judgemental and relevant to the midwifery care of the woman and her infant(s). All midwifery documentation is a record that cannot be changed or altered other than by the addition of further information. A notation in a record or a document used for midwifery care communication can have a powerful positive or negative impact on the quality of care received by a woman and her infant(s). These effects can be long-lasting, either through ensuring the provision of quality care, or through enshrining stigma, stereotyping and judgement in maternity care decision making and maternity care provision experienced by a woman and her infant(s).

The ethical management of information involves respecting people’s privacy and confidentiality without compromising health or safety. This applies to all types of data, including clinical and research data, irrespective of the medium in which the information occurs or is stored. Personal information may only be shared with the consent of the individual or with lawful authorisation.

8 Midwives value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

Value statement 8

Midwives value a socially, economically and ecologically sustainable environment, promoting health and wellbeing

Explanation

Midwives value strategies aimed at preventing, minimising and overcoming the harmful effects of economic, social or ecological factors on the health of each woman, her infant(s), family and community. Commitment to a healthy environment involves the conservation and efficient use of resources such as energy, water and fuel, as well as clinical and other materials.

_________________________________________

Addendum 5

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

______________________________________

 

Posted in anti-vaccination, anti-vaccination dishonesty, australian vaccination network, AVN, meryl dorey, midwife, nurse, public health, skeptic, stop the australian vaccination network, Tasha David, vaccination | Tagged , , , , , , , , , , , , , , , , , | Leave a comment

Anti-vaccine nurses and midwives 32

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Jill Whalley is a registered nurse who operates as a masseuse, in Queensland:

whalley-1-profile-public

whalley-2-ahpra-rego

On March 1 2016, Whalley cited her nursing registration to bolster her comment on an anti-vaccination petition directed to Victorian Health Minister, Jill Hennessy:

whalley-4-change-dot-org-petition-nurse

On May 27 2013, on her Facebook profile,Whalley promoted an article from the discredited anti-vaccination pressure group, the Australian Vaccination-skeptics Network:

whalley-3-2013-avn-email

The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the anti-vaccination activism of Jill Whalley.

Thanks for reading.

_________________________________

Addendum 1

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

________________________________

Addendum 2

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

_____________________________________

Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

1 Self: Nurses make informed decisions in relation to their practice within the constraints of their professional role and in accordance with ethical and legal requirements. Nurses are entitled to do this without undue pressure or coercion of any kind. Nurses are responsible for ensuring their decision-making is based on contemporary, relevant and well-founded knowledge and information.

2 Person (health consumer): Nurses value the legal and moral right of people, including children, to participate whenever possible in decision-making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. This may involve ensuring people who do not speak English have access to a qualified health interpreter. Nurses recognise and respect the rights of people to engage in shared decision-making when consenting to care and treatment. Nurses also value the contribution made by persons whose decision-making may be restricted because of incapacity, disability or other factors, including legal constraints. Nurses are knowledgeable about such circumstances and in facilitating the role of family members, partners, friends and others in contributing to decision-making processes.

3 Colleagues: Nurses respect the rights of colleagues and members of other disciplines to participate in informed decision-making. Making these collaborative and informed decisions includes involving the person requiring or receiving nursing care (or their representative) in decisions relating to their nursing or health care, without being subject to coercion of any kind.

4 Community: Nurses value the contribution made by the community to nursing and health care decision-making through a range of activities, including consumer groups, advocacy and membership of health-related committees. Nurses also assist in keeping the community accurately informed on nursing and health-related issues.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

1 Self: Nurses value safe practice and a safe working environment; practise within the limitations of their knowledge and skills; and recognise and avoid situations where their ability to deliver quality care may be impaired. Nurses have a moral and legal right to practise in a safe environment, without fear for their own safety or that of others, and they seek remedies through accepted channels, including legal action, when this is not the case. Nurses value the maintenance of competence in contributing to a safe care and practice environment.

2 Person (health consumer): Nurses recognise that people are vulnerable to injuries and illnesses as a result of preventable human error and adverse events while in health care settings. Nurses play a key role in the detection and prevention of errors and adverse events in health care settings, and support and participate in systems to identify circumstances where people are at risk of harm. Nurses act to prevent or control such risks through prevention, monitoring, early identification and early management of adverse events. Nurses contribute to the confidential reporting of adverse events and errors, and to organisational processes for the open disclosure of these events to persons affected during the course of their care.

3 Colleagues: Nurses work with their colleagues to create a culture of safety. Nurses support the development of safer health care systems through non-punitive human error, adverse event management and related education. Nurses value the critical relationship between consumer safety and interprofessional competencies, including trustful communication, teamwork and situation awareness. Nurses view the detection of their own errors and risks or those of their colleagues as opportunities for achieving a safer health care system.

4 Community: Nurses, acting through their professional and industrial organisations and other appropriate authorities, participate in developing and improving the safety and quality of health care services for all people. This includes actively promoting the provision of equitable, just and culturally and socially responsive health care services for all people living, or seeking residence or asylum, in Australia. It also involves raising public awareness about the nature and importance of consumer safety programs in health care services.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

________________________________________

Addendum 3

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

___________________________________________

Posted in anti-vaccination, anti-vaccination dishonesty, australian vaccination network, AVN, meryl dorey, nurse, public health, skeptic, stop the australian vaccination network, Tasha David, vaccination | Tagged , , , , , , , , , , , , , , | Leave a comment

Anti-vaccine nurses and midwives 31

On October 11 2016, the Nursing and Midwifery Board of Australia responded to a number of complaints regarding anti-vaccination material and advice being disseminated by registered nurses, enrolled nurses, and registered midwives, by publishing a new position statement on anti-vaccination misinformation:

NMBA position on nurses, midwives and vaccination

The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.

The NMBA recognises the Australian National Immunisation Handbook 10th edition as providing evidence-based advice to health professionals about the safe and effective use of vaccines and the public health benefits associated with vaccination. The NMBA supports the use of the handbook by registered nurses, enrolled nurses and midwives who are giving vaccines. The handbook is available from the Immunise Australia Program website.

The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.

All registered nurses, enrolled nurses and midwives are required to practise in accordance with professional standards set by the NMBA, including the codes of conduct, codes of ethics and the standards for practice, in particular the social media policy and the guidelines for advertising regulated health services.

What should I do if I notice a nurse or midwife is promoting anti-vaccination material?

If you have concerns about a nurse or midwife you can make a complaint to AHPRA. The NMBA will consider whether the nurse or midwife has breached their professional obligations and will treat these matters seriously. Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.

Sarah Jones-Rochford is a registered nurse who works in the Intensive Care Unit emergency department of a Melbourne private hospital:

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Jones-Rochford has been a member of the rabid anti-vaccination group, Vaccine Choice Australia (formerly Vaccine Free Australia), for up to two years:

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On October 21 2015, Jones-Rochford breached the confidentiality of an ICU ED patient so as to make  anti-vaccination arguments against the influenza immunisation:

jr-2-vca-october-21-2015-surgical-flu-shot-op

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On January 14 2016,  Jones-Rochford breached the confidentiality of another ED/ICU patient who was critically ill at the time:

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On January 15 2016,  Jones-Rochford identified herself as an anti-vaccination nurse, citing her registration:

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On January 7 2015,  Jones-Rochford posted on the page of anti-vaccination activist Sherri Tenpenny, promoting Tenpenny’s ill-fated non-tour of Australia:

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On January 19 2015, Jones-Rochford sought medical advice from anti-vaccination Facebook page, The Thinking Moms’ Revolution:

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On July 3 2015, on her Facebook profile, Jones-Rochford promoted anti-vaccination misinformation regarding mercury in vaccines and autism:

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On May 9 2016, on her Facebook profile, Jones-Rochford shared a call-out from anti-vaccination chiropractors – including her own anti-vaccination chiropractor, Simon Floreani – urging people to bombard a journalist and attack the Australian Medical Association:

jr-5-may-9-2016-profile-floreani

Vaccine Choice Australia posts

On October 21 2016, Jones-Rochford joined in with VCA members in attacking Victorian Health Minister, Jill Hennessy:

jr-7-vca-oct-21-2016-jill-hennessy-1

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On September 14 2016, Jones-Rochford was in contact with VCA admin, Trent Wiseman:

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On September 3 2016, Jones-Rochford joined in with other anti-vaccination activists in talking up the virtues of having unvaccinated children:

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On August 30 2016, Jones-Rochford joined other antivax members in blaming vaccines for the unrelated death of a baby boy:

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On August 18 2016, Jones-Rochford advised another member to seek out chiropractic for the treatment of eczema:

jr-11-vca-august-18-2016-chiro-for-eczema-1

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On July 27 2016, Jones-Rochford advised another member to seek out chiropractic for the care of two sick children:

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On July 25 2016, Jones-Rochford sought advice from the antivax group on non-evidence-based therapeutic devices:

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On July 19 2016, Jones-Rochford noted that the conspiracy sea-cruise of discredited antivax activist, Andrew Wakefield, was “interesting!!”

jr-14-vca-july-19-wakefield-conspira-sea

On July 20 2016, Jones-Rochford shared conspiracy theories about dairy foods:

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On June 14 2016, Jones-Rochford noted that she was aware and disgusted that registered health practitioners were being investigated by AHPRA for the dissemination of anti-vaccination misinformation:

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On June 13 2016, Jones-Rochford argued that Big Pharma advertising is the cause of children being “bombarded with shit”, for health conditions:

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On June 9 2016, Jones-Rochford congratulated another antivax member for an anti-vaccination screed:

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On June 4 2016, Jones-Rochford advised another member to use homeoprophylaxis, from discredited homeopath, Isaac Golden, as an alternative to travel immunisations for  a  baby:

jr-19-vca-june-5-2016-homeoproph-travel-vax-1

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On May 30 2016, Jones-Rochford commented in support of abusive anti-vaccination activists Shawn Dhu and Tasha David – the president of the disreputable Australian Vaccination-skeptics Network – in lambasting the evidence-based Telethon Kids Institute:

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On May 25 2016, Jones-Rochford commented on the virtues of having unvaccinated children:

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On May 22 2016, Jones-Rochford promoted the use of chiropractic in the medical treatment of eczema:

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On April 29  2016, Jones-Rochford provided non-evidence-based medical advice in the treatment of eczema, without seeing a patient:

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On April 25 and 26 2016, Jones-Rochford attacked Mamamia and health regulators over investigations of anti-vaccination, baby-cracking chiropractor, Ian Rossborough:

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On April 25 2016, Jones-Rochford advised another member to seek out a paediatric chiropractor for fussy eating in a baby:

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On April 25 2016, Jones-Rochford joined in with other anti-vaccinationists in attacking concerning news reports of low uptake of childhood immunisation:

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On April 24 2016, Jones-Rochford joined in with other members in lauding the efforts of anti-vaccination filmmakers:

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On April 22 2016, Jones-Rochford was in contact with VCA admins when adding new members to the anti-vaccination group:

jr-28-vca-april-23-2016-add-friend-admin-zoe-trump

On April 10 2016, Jones-Rochford denigrated the evidence-based immunisation stance of Dr Karl Kruszelnicki:

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On April 3 2016, Jones-Rochford attacked a work colleague as a “bully”, because he posted evidence-based immunisation information on a work social media forum:

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On March 27 2016, Jones-Rochford vilified evidence-based authors Emily Willingham and Tara Haelle, in support of anti-vaccination activism from Robert De Niro:

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On March 24 2016, Jones-Rochford joined with VCA admins Pheebz Hill (Shinrin Yoku) and Trent Wiseman, and veteran anti-vaccination activist, Wendy Lydall, in advising an unnamed member to use homeoprophylaxis as an alternative to evidence-based travel immunisation:

jr-32-vca-march-24-2016-travel-vax-homeoproph-1

jr-32-vca-march-24-2016-travel-vax-homeoproph-2-lydall

On March 2 2016, Jones-Rochford provided medical advice to an individual regarding dog bites and tetanus:

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On February 27 2016, Jones-Rochford implied that unimmunised children are stronger than immunised children:

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On February 27 2016, Jones-Rochford stated that the immunisation of children is “sacrificing your child for no reason”:

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On February 15 2016, Jones-Rochford  provided non-evidence-based health advice to a  mother with a sick 8-week-old baby:

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On February 14 2016, Jones-Rochford referred to childcare benefit immunisation requirements as “blackmail”:

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On February 12 2016, Jones-Rochford claimed that the immunisation of at-risk  babies in neonatal  intensive care units is “sad”:

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On January 31 2016, Jones-Rochford equated childhood immunisation to poor eating habits:

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On January 28 2016, Jones-Rochford became enraged at an article which correctly pointed out the non-evidence-based claims of the anti-vaccination movement as a form of denialism:

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On January 21 2016, Jones-Rochford claimed that her chiropractor, Simon Floreani, was ambushed on the television program, The Project. Floreani was simply asked to  substantiate claims which are commonly made by non-evidence-based chiropractors:

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On January 13 2016, Jones-Rochford commented in support of anti-vaccination activist and conspiracy theorist, Judy Wilyman:

jr-42-vca-january-13-2016-wilyman-defense

On January 12 2016, Jones-Rochford advised another member to read the anti-vaccination book, Well Adjusted Babies, by antivax chiropractor, Jennifer Barham-Floreani, as a legitimate source of information on the provision of Vitamin K to babies:

jr-43-vca-january-12-2015-promote-well-adjusted-babies-for-vit-k-info

On January 11 2016, Jones-Rochford provided non-evidence-based impetigo treatment advice:

jr-44-vca-january-11-2016-schoolsores-med-advice-vit-c

On July 14 2015, Jones-Rochford advised anti-vaccination enrolled nurse, Megan Cox, to  lie to her employer about her immunisation history:

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On July 19 2015, Jones-Rochford joined other anti-vaccination activists in attacking Mia Freedman, who was seeking treatment advice for her ill child:

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On July 19 2015, Jones-Rochford sought medical advice from the rabid anti-vaccination group, for the treatment of hand, foot and mouth disease in a baby:

jr-47-vca-july-19-2015-hfm-info

The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s competency standards, codes, guidelines, and social media policy from which readers may wish to choose when lodging any complaint regarding the anti-vaccination activism of Sarah Jones-Rochford.

Thanks for reading.

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Addendum 1

National competency standards for the registered nurse (PDF)

Professional practice

Relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.

1 Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law

1.2 Fulfils the duty of care

1.3 Recognises and responds appropriately to unsafe or unprofessional practice

2 Practises within a professional and ethical nursing framework

2.1 Practises in accordance with the nursing profession’s codes of ethics and conduct

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups

2.4 Advocates for individuals/groups and their rights for nursing and health care within organisational and management structures

2.5 Understands and practises within own scope of practice

2.6 Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care

2.7 Recognises the differences in accountability and responsibility between registered nurses, enrolled nurses and unlicensed care workers

Critical thinking and analysis

Relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/ groups is an important professional bench- mark.

3 Practises within an evidence-based framework

3.1 Identifies the relevance of research to improving individual/group health outcomes

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care

3.3 Demonstrates analytical skills in accessing and evaluating health information and research evidence

3.4 Supports and contributes to nursing and health care research

3.5 Participates in quality improvement activities

4 Participates in ongoing professional development of self and others

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance:

4.2 Participates in professional development to enhance nursing practice

4.3 Contributes to the professional development of others

4.4 Uses appropriate strategies to manage own responses to the professional work environment

Provision and coordination of care

Relates to the coordination, organisation and provision of nursing care that includes the assessment of individuals/ groups, planning, implementation and evaluation of care.

5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group

5.2 Uses a range of assessment techniques to collect relevant and accurate data

5.3 Analyses and interprets assessment data accurately

6 Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team

6.1 Determines agreed priorities for resolving health needs of individuals/groups:

6.2 Identifies expected and agreed individual/group health outcomes including a time frame for achievement

6.3 Documents a plan of care to achieve expected outcomes

6.4 Plans for continuity of care to achieve expected outcomes

7 Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes

7.1 Effectively manages the nursing care of individuals/groups

7.2 Provides nursing care according to the documented care or treatment plan

7.3 Prioritises workload based on the individual/group’s needs, acuity and optimal time for intervention

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately

7.7 Educates individuals/groups to promote independence and control over their health

8 Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team

8.1 Determines progress of individuals/groups toward planned outcomes

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation data

Collaborative and therapeutic practice

Relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to nurses understanding their contribution to the interdisciplinary health care team.

9 Establishes, maintains and appropriately concludes therapeutic relationships

9.1 Establishes therapeutic relationships that are goal directed and recognises professional boundaries

9.2 Communicates effectively with individuals/groups to facilitate provision of care

9.3 Uses appropriate strategies to promote an individual’s/group’s self-esteem, dignity, integrity and

9.4 Assists and supports individuals/groups to make informed health care decisions

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security

10 Collaborates with the interdisciplinary health care team to provide comprehensive nursing care

10.1 Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’s/group’s needs and health care setting

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers

10.3 Facilitates coordination of care to achieve agreed health outcomes

10.4 Collaborates with the health care team to inform policy and guideline development

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Addendum 2

Nursing and Midwifery Board of Australia Codes and Guidelines.

Code of Professional Conduct for Nurses in Australia

1 Nurses practise in a safe and competent manner.

2 Nurses practise in accordance with the standards of the profession and broader health system.

Conduct Statement 2

Nurses practise in accordance with the standards of the profession and broader health system

Explanation

1 Nurses are responsible for ensuring the standard of their practice conforms to professional standards developed and agreed by the profession, with the object of enhancing the safety of people in their care as well as their partners, family members and other members of the person’s nominated network. This responsibility also applies to the nurses’ colleagues.

2 Nurses practise in accordance with wider standards relating to safety and quality in health care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Conduct Statement 3

Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing

Explanation

1 Nurses are familiar with relevant laws and ensure they do not engage in clinical or other practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Nurses witnessing the unlawful conduct of colleagues and other co-workers, whether in clinical, management, education or research areas of practice, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other appropriate action as necessary to safeguard people and the public interest.

4 Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

5 Nurses treat personal information obtained in a professional capacity as private and confidential.

6 Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Conduct Statement 6

Nurses provide impartial, honest and accurate information in relation to nursing care and health care products

Explanation

1 When nurses provide advice about any care or product, they fully explain the advantages and disadvantages of alternative care or products so individuals can make informed choices. Nurses refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and nursing care.

2 Nurses accurately represent the nature of their services or the care they intend to provide.

3 Where a specific care or a specific product is advised, nurses ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Deceptive endorsement of products or services or receipt of remuneration for products or services primarily for personal gain, other than remuneration in the course of a proper commercial relationship, is improper.

7 Nurses support the health, wellbeing and informed decision-making of people requiring or receiving care.

8 Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

Conduct Statement 8

Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care

Explanation

1 An inherent power imbalance exists within the relationship between people receiving care and nurses that may make the persons in their care vulnerable and open to exploitation. Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care. Significant vulnerability and powerlessness can arise from the experience of illness and the need to engage with the health care system. The power relativities between a person and a nurse can be significant, particularly where the person has limited knowledge; experiences pain and illness; needs assistance with personal care; belongs to a marginalised group; or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between nurses and persons in their care that must be recognised and managed.

4 Nurses fulfil roles outside the professional role, including those as family members, friends and community members. Nurses are aware that dual relationships may compromise care outcomes and always conduct professional relationships with the primary intent of benefit for the person receiving care. Nurses take care when giving professional advice to people with whom they have a dual relationship (e.g. a family member or friend) and advise them to seek independent advice due to the existence of actual or potential conflicts of interest.

9 Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Conduct Statement 9

Nurses maintain and build on the community’s trust and confidence in the nursing profession

Explanation

1 The conduct of nurses maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of nurses in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual nurses or the profession were to diminish, this might jeopardise the inherent trust between the nursing profession and the public necessary for effective therapeutic relationships and the effective delivery of nursing care.

3 Nurses consider the ethical interests of the nursing profession and the community when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

10 Nurses practise nursing reflectively and ethically.

Conduct Statement 10

Nurses practise nursing reflectively and ethically

Explanation

1 Nurses practise nursing reflectively and ethically, in accordance with the Code of Ethics for Nurses in Australia, in order to learn from experience and contribute to personal and professional practice.

2 Nurses develop and maintain appropriate and current quality nursing advice, support and care for each person requiring and receiving care and their partners, families and other members of their nominated social network. This responsibility also applies to colleagues of nurses.

3 Nurses evaluate their conduct and competency according to the standards of the nursing profession.

4 Nurses contribute to the professional development of students and colleagues.

5 Nurses participating in research do so in accordance with recognised research guidelines and do not violate their duty of care to persons receiving nursing care.

6 Nurses advise employers and any persons in their care of any reduction in their capacity to practise due to health, social or other factors, while they seek ways of redressing the problem.

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Code of Ethics for Nurses in Australia

1 Nurses value quality nursing care for all people.

2 Nurses value respect and kindness for self and others.

3 Nurses value the diversity of people.

4 Nurses value access to quality nursing and health care for all people.

5 Nurses value informed decision-making.

Value Statement 5

Nurses value informed decision-making

Explanation

Nurses value people’s interests in making free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. Nurses also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised.

1 Self: Nurses make informed decisions in relation to their practice within the constraints of their professional role and in accordance with ethical and legal requirements. Nurses are entitled to do this without undue pressure or coercion of any kind. Nurses are responsible for ensuring their decision-making is based on contemporary, relevant and well-founded knowledge and information.

2 Person (health consumer): Nurses value the legal and moral right of people, including children, to participate whenever possible in decision-making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. This may involve ensuring people who do not speak English have access to a qualified health interpreter. Nurses recognise and respect the rights of people to engage in shared decision-making when consenting to care and treatment. Nurses also value the contribution made by persons whose decision-making may be restricted because of incapacity, disability or other factors, including legal constraints. Nurses are knowledgeable about such circumstances and in facilitating the role of family members, partners, friends and others in contributing to decision-making processes.

3 Colleagues: Nurses respect the rights of colleagues and members of other disciplines to participate in informed decision-making. Making these collaborative and informed decisions includes involving the person requiring or receiving nursing care (or their representative) in decisions relating to their nursing or health care, without being subject to coercion of any kind.

4 Community: Nurses value the contribution made by the community to nursing and health care decision-making through a range of activities, including consumer groups, advocacy and membership of health-related committees. Nurses also assist in keeping the community accurately informed on nursing and health-related issues.

6 Nurses value a culture of safety in nursing and health care.

Value Statement 6

Nurses value a culture of safety in nursing and health care

Explanation

Valuing a culture of safety involves nurses actively engaging in the development of shared knowledge and understanding of the crucial importance of safety in contemporary health care. Nurses who value a culture of safety appreciate that safety is everyone’s responsibility. Nurses support the development of risk management processes and a practice environment designed to reduce the incidence and impact of preventable adverse events in health care. Nurses also support the open disclosure of any adverse events to any person affected during the course of their care.

1 Self: Nurses value safe practice and a safe working environment; practise within the limitations of their knowledge and skills; and recognise and avoid situations where their ability to deliver quality care may be impaired. Nurses have a moral and legal right to practise in a safe environment, without fear for their own safety or that of others, and they seek remedies through accepted channels, including legal action, when this is not the case. Nurses value the maintenance of competence in contributing to a safe care and practice environment.

2 Person (health consumer): Nurses recognise that people are vulnerable to injuries and illnesses as a result of preventable human error and adverse events while in health care settings. Nurses play a key role in the detection and prevention of errors and adverse events in health care settings, and support and participate in systems to identify circumstances where people are at risk of harm. Nurses act to prevent or control such risks through prevention, monitoring, early identification and early management of adverse events. Nurses contribute to the confidential reporting of adverse events and errors, and to organisational processes for the open disclosure of these events to persons affected during the course of their care.

3 Colleagues: Nurses work with their colleagues to create a culture of safety. Nurses support the development of safer health care systems through non-punitive human error, adverse event management and related education. Nurses value the critical relationship between consumer safety and interprofessional competencies, including trustful communication, teamwork and situation awareness. Nurses view the detection of their own errors and risks or those of their colleagues as opportunities for achieving a safer health care system.

4 Community: Nurses, acting through their professional and industrial organisations and other appropriate authorities, participate in developing and improving the safety and quality of health care services for all people. This includes actively promoting the provision of equitable, just and culturally and socially responsive health care services for all people living, or seeking residence or asylum, in Australia. It also involves raising public awareness about the nature and importance of consumer safety programs in health care services.

7 Nurses value ethical management of information.

8 Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

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Addendum 3

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

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