Anti-vaccine nurses and midwives 9

Laurie Cairns-Cowan is a registered midwife in Western Australia. Her registration was approved under the Trans-Tasman Mutual Recognition Act 1997:

Cairns 1 AHPRA rego

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

Cairns 23 AVA member pixelated

On February 15 2016, Cairns-Cowan identified herself as a registered midwife:

Cairns 2 AVA Vit K midwife February 15 2016

On her profile, Cairns-Cowan notes hospitals at which she has worked previously, including in supervisory roles. This would raise questions with these hospitals as to the appropriateness of a midwife – who does not appear to be a registered nurse – operating in positions which would appear to be inappropriate given her qualifications:

Cairns 7 profile midwife work at kids ward

Cairns 8 profile hospital post

Cairns 9 profile Fiona STanley hospital

Today, April 14 2016, Cairns-Cowan posted this anti-vaccination meme which claims that the influenza vaccine contains toxic chemicals, in Anti-Vaccination Australia:

Cairns 29 AVA April 14 antivax billboard

On April 11 2016 – only three days ago – in Anti-Vaccination Australia, Cairns-Cowan advised a vulnerable mother not to vaccinate her toddler:

Cairns 22 AVA April 11 2016 advises new mother not to vaccinate

On April 11 2016, Cairns-Cowan told a pregnant mother to go with her gut in refusing to immunise her child:

Cairns 21 AVA April 11 2016 vax prob wrong listen to gut

On April 11 2016, Cairns-Cowan claimed vaccines cause death, gluten intolerance, autism, and type 1 diabetes:

Cairns 14 AVA vax autism cont April 11 2016

On April 11 2016, Cairns-Cowan listed her reasons for not immunising her children, including citing her employment in the medical field:

Cairns 12 AVA April 11 2016 works in medical field

On April 5 2016, Cairns-Cowan posted a photograph taken at her workplace in which she argued against the influenza  immunisation, as well as denigrating the immunisation of newborn babies in her hospital:

Cairns 10 AVA flu vax midwife works hospital April 5 2016

Cairns 11 AVA April 5 2016 workplace vaccines kids vaxed

On April 4 2016, Cairns-Cowan posted this anti-vaccine meme which argues against immunisation for meningitis:

Cairns 20 AVA April 4 2016 anti meningitis vax RFK meme

On March 31 2016, Cairns-Cowan promoted and donated to a fundraising campaign run by Anti-Vaccination Australia admin Belgin Colak, so as to print and disseminate anti-vaccination paraphernalia into the community:

Cairns 19 AVA March 31 2016 contribute to antivax fyers campaign Colak

On March 9 2016, Cairns-Cowan requested information about detoxing from immunisation, something which is not required:

Cairns 18 AVA March 9 2016 vax detox

On February 21 2016, Cairns-Cowan promoted anti-vaccination guru Don Tolman:

Cairns 17 AVA Feb 21 2016 Tolman

On February 19 2016, Cairns-Cowan argued against the MMR vaccine, based on her own flawed understanding of vaccine adverse events, whilst citing her employment once again:

Cairns 16 AVA Feb 19 2016 Midwife MMR AE PI

On February 15 2016, Cairns-Cowan shared misinformation about dental amalgams:

Cairns 15 Feb 15 2016 AVA amalgams

Cairns- Cowan also shares anti-vaccination misinformation on her Facebook profile, often tagging other friends.

This was shared twice, in May 2015:

Cairns 13 profile May CE vax not nec first post

Cairns 13 profile May CE vax not nec second post

Cairns-Cowan also shared misinformation against the incredibly safe and effective HPV vaccine.

From May 13 2015:

Cairns 4 Gardasil

From May 13 2015:

Cairns 5 Gardasil profile

From April 16 2015:

Cairns 6 Gardasil profile

Complaints about this registered health practitioner can be made to the Nursing and Midwifery Board of Australia, here.

The following addenda contain excepts from the NMBA competency standards, codes and guidelines from which a complainant might wish to choose.

Thanks for reading.

_________________________________

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.

_________________________________

Addendum 2

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 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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