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.

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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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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:

sieber-1-profile-jonas

sieber-1-ahpra-rego-rn-rm

Sieber is a member of the Australian Vaccination-skeptics Network, and anti-vaccination protest Facebook pages:

sieber-4-profile-likes-avn-njnp-protest

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

sieber-3-avn-midwife-protest-zoo-meeting-january-11-2016

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.

_____________________________________

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.

________________________________________

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:

jr-1-profile-public-pixelate

Jones-Rochford has been a member of the rabid anti-vaccination group, Vaccine Choice Australia (formerly Vaccine Free Australia), for up to two years:

jr-1-vca-member-2-yrs

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:

jr-2-tenpenny-tour-january-2015

On January 19 2015, Jones-Rochford sought medical advice from anti-vaccination Facebook page, The Thinking Moms’ Revolution:

jr-2-tmr-jan-2015

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

jr-7-vca-oct-21-2016-jill-hennessy-2

On September 14 2016, Jones-Rochford was in contact with VCA admin, Trent Wiseman:

jr-8-vca-september-14-2016-pm-trent-wiseman-admin

On September 3 2016, Jones-Rochford joined in with other anti-vaccination activists in talking up the virtues of having unvaccinated children:

jr-9-vca-sept-3-2016-unvaxed-1

jr-9-vca-sept-3-2016-unvaxed-2

On August 30 2016, Jones-Rochford joined other antivax members in blaming vaccines for the unrelated death of a baby boy:

jr-10-vca-aug-30-2016-blame-vax-1

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On August 18 2016, Jones-Rochford advised another member to seek out chiropractic for the treatment of eczema:

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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!!”

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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:

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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:

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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:

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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:

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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:

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On January 11 2016, Jones-Rochford provided non-evidence-based impetigo treatment advice:

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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:

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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 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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Anti-vaccine nurses and midwives 30

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.

Gabriella Page is a registered nurse in Queensland:

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Page is a member of the rabid anti-vaccination Facebook group, Vaccine Choice Australia (formerly Vaccine Free Australia):

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On November 19 2015, Page joined in with the ugly vilification of the parents of deceased baby, Riley Hughes, who have been the subject of over eighteen months of abuse from anti-vaccination activists. In the comment with which Page agreed, the Hughes family are accused of being responsible for the deaths of unborn babies:

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On August 14 2015, Page cited her nursing registration in response to a question about workplace immunisation:

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On September 18 2015, in response  to  a question from VCA admin Courtney Hebberman, Page cited her nursing registration in arguing against childhood immunisation, including the provision of Vitamin K. Page acknowledged that she gets questions about her anti-vaccination stance at her hospital. Page stated that nothing will change her views:

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page-41-vca-september-18-2015-antivax-story-registered-nurse-vax-autism-etc

On November 20 2015, Page cited her nursing registration in arguing against the evidence-based “status quo” of workplace immunisation policies for hospital workers:

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On November 19 2015, Page cited her nursing registration in denigrating “pushy doctors” who advise in favour of routine childhood immunisation. Page advocated being dishonest with these doctors:

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On July 23 2016, Page spoke highly of anti-vaccination conspiracy theorist, David Icke, and his recent Australian tour:

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On May 10 2016, Page cited her nursing registration, discussing workplace influenza immunisation with anti-vaccine nurse, Megan Cox:

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On April 18 2016, Page commented in favour of enlarging anti-vaccination group networks:

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On April 14 2016, Page commented in favour of  the anti-vaccination movie, Vaxxed, and Robert De Niro’s stance against immunisation:

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On March 12 2016, Page stated that news items regarding an increase in whooping cough notifications are “rubbish propaganda”:

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On February 25 2016, Page discussed her neighbour’s autistic child in a comment thread pertaining to vaccines and autism:

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On December 10 2015, Page posted a video of anti-vaccination conspiracy theorist Sharyl Attkisson, who claims that pharmaceutical propaganda is being disseminated by a cabal of paid trolls:

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On December 6 2015, Page assisted an anti-vaccination colleague in making flawed anti-vaccination arguments using vaccine product inserts:

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On November 27 2015, Page advised an anti-vaccination colleague to tell a vulnerable friend to watch anti-vaccination films Bought and The Greater Good:

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On November 25 2015, Page called an anti-vaccination colleague’s conspiracy-laden antivax rant a “beautiful truth”:

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page-16-vca-november-25-2015-antivax-tract-beautiful-truth

On November 23 and 24 2015, Page advised another group member on how to avoid or treat whooping cough in a baby, including information from disreputable US anti-vaccination doctor, Suzanne Humphries, who advises Vitamin C as a whooping cough treatment:

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page-18-vca-november-23-2015-wholistic-gp-wc-etc

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On November 14 2015, Page sought information from the rabid anti-vaccination group regarding Q Fever immunisation for her husband:

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On October 21 2015, responding to a concerning post in which Melbourne ED registered nurse, Sarah Jones-Rochford, breaches the confidentiality of her patient to make a case that influenza immunisations are responsible for unrelated health conditions, Page states that it “happens all the time”:

page-26-vca-october-21-surgical-flu-shot-op-jones-rochford

On October 19 2015, Page advises an anti-vaccination colleague to have her father watch the antivax movies, The Greater Good and Bought:

page-27-vca-october-19-2015-bought-greater-good-promote

On October 8 2015, Page advised a group member on misusing vaccine product inserts to make an anti-vaccination argument against the MMR vaccine:

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On October 1 2015, Page misrepresented the risks of acquiring a vaccine preventable disease, if one was vaccinated versus unvaccinated:

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page-31-vca-october-1-2015-meme-get-disease-anyway-lol

On September 24 2015, Page advised a nursing student to seek a  medical exemption so as to avoid workplace immunisations:

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On September 24 2015, Page made arguments against the provision of Vitamin K, to an expectant mother who was writing her birth plan:

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On September 24 2015, Page referred to the immunisation of babies as, injecting “that crap”:

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On September 20 2015, Page attended the anti-vaccination protest in Brisbane, alongside other activists such as Meryl Dorey, the spokesperson of the disreputable anti-vaccination organisation, the Australian Vaccination-skeptics Network:

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On September 20 2015, Page congratulated the creator of a document which states that vaccines are neither safe nor effective, as “awesome”:

page-39-vca-september-20-2015-list-vax-niether-safe-or-effective-awesome

On September 14 2015, Page joined in with Meryl Dorey in advocating the misuse of cannabis oil as a cancer cure, for a female with stage 3 cancer with metastases:

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page-43-vca-september-14-2015-crank-cancer-cure-meryl-dorey

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On September 5 2015, Page offered dubious medical treatment advice to the mother of an unseen child:

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On August 11 2015, Page contacted the VCA admins regarding adding members to the anti-vaccination group:

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On August 7 2015, Page joined a comment thread which included advice from anti-vaccination businessperson Stephanie Messenger, Anna Rodgers (who vilified the family of Riley Hughes and claimed that Riley never existed), and Tristan Wells (who likened Riley Hughes’  family to evil fascists and who advocates for the execution of doctors).  Page sought Wells’ advice on how to argue with evidence-based health advocates:

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page-51-vca-august-7-2015-tristan-wells-how-to-antivax

On July 29 and 30 2015, Page stated that she desired to join with another anti-vaccination activists in the harassment of a local member of parliament:

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On July 27 2015, Page congratulated an anti-vaccination blog post from Conscious Life Mama as “awesome”:

page-53-vca-july-27-2015-conscious-life-mama-antivax-blog-post-is-awesome

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 Gabriella Page.

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 29

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.

Megan Cox is an enrolled nurse in Victoria:

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Cox has been a member of the rabid anti-vaccination Facebook group, Vaccine Choice Australia (formerly Vaccine Free Australia), for some time:

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On July 12 2016, Cox stated that she works in Epping, which is also the location of The Northern Hospital:

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On May 2 and 3 2016, Cox posted a photo, taken at her place of employment, and proceeded to denigrate the hospital’s influenza immunisation campaign as “poisom”:

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On May 9 2016, Cox posted comments denigrating her workplace’s immunisation policies:

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On July 13 and 14 2015, Cox admitted that she was going to lie to her employer about her immunisation history. Cox was advised to lie by another Victorian nurse, Sarah Jones-Rochford [edit: Cox changed her Facebook screen-name to “Louise Megan” after the publication of this blog post]:

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On August 25 2015, Cox denigrated her workplace whooping cough immunisation policy for working with infected patients, and denigrated her work colleagues who did receive the whooping cough immunisation:

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On September 25 2015, Cox cited her nursing employment in relation to workplace immunisations. Cox appears to have ticked off that she had received immunisations:

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On October 2 2016, Cox sought out information from the anti-vaccination group in an effort to dissuade her family members, who were expecting a new baby, from receiving whooping cough vaccines:

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On August 8 2016, Cox sought anti-vaccination articles to spread misinformation about whooping cough vaccine shedding, to her mother-in-law (it is impossible for the whooping cough vaccine to shed):

cox-27-vca-august-8-2016-wc-vax-pregnancy-mil

On June 14 2016, Cox sought information from the anti-vaccination group in an attempt  to dissuade her father from receiving an influenza immunisation:

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On May 3 and 4 2016, Cox  sought misinformation from the anti-vaccination group regarding the MMRV vaccine’s ability to shed:

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On January 3 2016, Cox shared an anti-vaccination article citing the discredited researcher, Tetyana Obukhanych:

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On December 15 2015, Cox and her anti-vaccination colleagues denigrated the childhood immunisation catch-up  program, whilst clearly having little knowledge of the program:

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On November 30 3015, Cox agreed with her anti-vaccination colleague that vaccine product inserts should carry horrific warning pictures:

cox-13-vca-november-30-2015-childcare-op

cox-14-vca-november-30-2015-childcare

cox-15-vca-november-30-2015-childcare

On November 17 2015, Cox added her family members to the anti-vaccination group, to  further proselytise anti-vaccinationism among her family members:

cox-16-vca-november-17-2015-add-members

On September 23 2015, Cox cited her workplace proximity to doctors as a possible  “bonus” in her desire to obtain conscientious objection forms:

cox-19-vca-september-23-2015-co-work-with-drs-bonus-op

cox-20-vca-september-23-2015-co-bonus-work-with-drs

On September 10 2015, Cox noted her pride in her son’s anti-evidence-based medicine comments:

cox-21-vca-september-10-2015-brainwashed-kid-drs-poison-with-chemicals

On August 26 2015, Cox congratulated one of her anti-vaccination colleague’s obvious knowledge deficit regarding thiomersal in vaccines:

cox-22-vca-august-25-2015-congrat-colleague-mercury-flu-shot-lie

On December 13 2015, Cox acknowledged that she was very aware that the anti-vaccination group was not secret, nor private:

cox-33-vca-december-13-2015-trolls-in-group-1

cox-33-vca-december-13-2015-trolls-in-group-2

Again, this is Cox’s photo taken of her workplace and published in the anti-vaccination group, on May 2 2016:

cox-25-may-2-2016-hospital-photo

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 Megan Cox.

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 28

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.

Cassandra Frith is a registered nurse and registered midwife in Queensland:

frith-1-profile-john-flynn-auckland-hospitals

frith-2-ahpra-rn-rm-regos

On September 15 2016, the Light For Riley memorial and health advocacy Facebook page posted an announcement that the new Immunisation Foundation of Australia had been launched.

Baby Riley Hughes passed away from whooping cough, in March 2015. His parents are public health heroes, and Catherine Hughes is the 2016 WA Young Australian of the Year.

Riley’s Mum and Dad shared a photo of Riley’s little sister, Lucy, wearing her “superheroes vaccinate” onesie. Lucy was about to have her immunisations:

lucy

On September 15 2016, Cassandra Frith left a comment on that Light for Riley post, stating that childhood immunisations are “like playing Russian roulette”. Frith – citing her role as a “health professional” – continued on to claim that serious vaccine adverse events are not “often discussed or widely documented”:

frith-3-lfr-september-15-2016-vaccines-are-russian-roulette

Frith claims to have immunised her children, so she cannot strictly be labelled, “anti-vaccine”; however, she asserts well-worn anti-vaccination tropes in overstating the frequency of serious vaccine adverse events. And Frith cites her employment as a health professional to makes these claims.

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 Cassandra Frith.

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

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 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 27

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.

Pamela O’Connor is a registered nurse in New South Wales. O’Connor was recently featured and interviewed in Rose Brennan’s Daily Telegraph article on anti-vaccination nurses and midwives, regarding the Nursing and Midwifery Board of Australia’s recent position statement:

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On October 11 2015, O’Connor cited her nursing registration on her public Facebook profile:

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There are so many non-evidence-based posts that sub-headings are supplied for each category.

Anti-vaccination

On July 26 2016, O’Connor shared misinformation alleging a conspiracy to murder anti-vaccination healthcare workers:

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On July 26 2016, O’Connor shared misinformation from Peter Dingle, regarding the HPV vaccine:

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On July 5 2016, O’Connor shared misinformation claiming that vaccines cause autism:

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On July 3 2016, O’Connor shared misinformation about vaccination, citing Vladimir Putin:

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On June 27 2016, O’Connor shared misinformation about the HPV vaccine, citing Sherri Tenpenny’s conspiracy site, Truthkings:

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On June 14 2016, O’Connor shared misinformation alleging that vaccines cause autism, citing the anti-vaccination movie, Vaxxed:

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On May 16 2016, O’Connor shared misinformation alleging that vaccines cause autism:

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On May 11 2016, O’Connor shared misinformation about the mumps immunisation, from Mercola:

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On May 8 2016, O’Connor shared misinformation about the Gardasil immunisation:

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On April 5 2016, O’Connor shared misinformation regarding the immunisation schedule, citing the term, “Weapons of Mass Vaccination”:

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On April 4 2016, O’Connor shared misinformation from Peter Dingle alleging that vaccines cause autism:

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On March 15 2016, O’Connor shared misinformation surrounding vaccine exemption forms:

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On March 12 2016, O’Connor shared misinformation claiming that vaccines are not safe, nor effective, from the discredited anti-vaccination researcher, Tetyana Obukhanych:

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On March 12 2016, O’Connor shared misinformation from anti-vaccination, anti-Semitic website, The Crazz Files:

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On March 12 2016, O’Connor shared misinformation attacking Victorian Health Minister, Jill Hennessy, from conspiracy website, Natural News:

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On March 12 2016, O’Connor shared misinformation falsely asserting that a vaccine product insert states that vaccines cause autism:

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On March 3 2016, O’Connor shared misinformation from Natural News asserting that the swine flu vaccine causes brain damage:

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On February 9 2016, O’Connor shared misinformation from Peter Dingle, surrounding the whooping cough immunisation; Dingle being incapable of spelling the name of the disease:

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On January 29 2016, O’Connor shared misinformation from Peter Dingle against the HPV immunisation:

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On January 27 2016, O’Connor shared misinformation from Peter Dingle surrounding the HPV vaccine:

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On January 20 2016, O’Connor shared misinformation alleging that the influenza immunisation is more dangerous than influenza:

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On January 17 2016, O’Connor shared misinformation from Vaccine Liberation Army, another conspiracy website:

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On January 11 2016, O’Connor shared misinformation against the Gardasil immunisation:

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On January 4 2016, O’Connor shared misinformation surrounding US vaccine adverse events payments:

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On December 22 2015, O’Connor shared misinformation from conspiracy website, Infowars:

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On December 17 2015, O’Connor shared misinformation about the Gardasil vaccine:

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On December 17 2015, O’Connor shared misinformation from Peter Dingle asserting that vaccines cause autism:

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On December 9 2015, O’Connor shared misinformation asserting that vaccines cause cancer:

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On October 28 2015, O’Connor shared misinformation about the influenza vaccine:

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On October 13 2015, O’Connor shared misinformation from US anti-vaccination activist Ginger Taylor which falsely claims that a list of studies show that vaccines cause autism. None of the studies supports the link:

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On October 5 2015, O’Connor shared misinformation claiming that vaccines cause autism:

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On September 29 2015, O’Connor shared misinformation from discredited anti-vaccination researchers in Canada, which falsely claims that vaccines contain toxic levels of aluminium:

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On September 23 2015, O’Connor shared misinformation claiming that vaccines cause autism:

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On September 22 2015, O’Connor shared misinformation in the form of a petition claiming a nefarious intent behind the adult immunisation register:

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On August 23 2015, O’Connor shared misinformation against the French immunisation schedule, which is demonstrably untrue:

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On July 12 2015, O’Connor shared misinformation in the form of the anti-vaccination conspiracy theory petition, as above:

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On May 7 2015, O’Connor shared misinformation from Infowars, regarding the daughters of then-Prime Minister, Tony Abbott:

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On April 20 2015, O’Connor shared misinformation in the form  of a petition surrounding immunisation and child care rebates:

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On April 15 2015, O’Connor shared misinformation regarding vaccine exemption forms:

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On March 16 2015, O’Connor shared misinformation against the routine immunisation of children:

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Anti-vaccination, zika conspiracies

On February 6 2016, O’Connor shared misinformation from Peter Dingle asserting that vaccines are the cause of  microcephaly in Brazil, and not zika:

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On February 2 2016, O’Connor shared misinformation asserting that vaccines are the cause of microcephaly, which includes a stolen photo of two sisters whose stories are exploited by anti-vaccination activists, against their  mother’s wishes:

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On January 31 2016, O’Connor shared misinformation from Peter Dingle, citing conspiracy theorist, John Rappoport, asserting that vaccines are the cause of microcephaly in Brazil:

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Zika conspiracies

On July 26 2016, O’Connor shared misinformation asserting that Monsanto is the cause of microcephaly in Brazil:

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On February 15 2016, O’Connor shared misinformation blaming Monsanto for microcephaly in Brazil:

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On February 9 2016, O’Connor shared misinformation from Peter Dingle claiming that drug companies are behind the zika “lie” in Brazil:

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On February 9 2016, O’Connor shared misinformation which asserts that the zika outbreak is a “hoax”:

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Non-evidence-based cancer cures

On June 19 2016, O’Connor shared misinformation claiming that cannabis oil can cure cancer:

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On June 19 2016, O’Connor shared misinformation from Sayer Ji, arguing against evidence-based cancer treatments:

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On June 18 2016, O’Connor shared misinformation claiming that cannabis oil is a treatment for cancer:

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On June 13 2016, O’Connor shared misinformation against evidence-based cancer treatments:

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On June 4 2016, O’Connor shared misinformation which asserts that cannabis oil is a treatment for cancer:

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On May 27 2016, O’Connor shared misinformation from entrepreneurial charlatan, David Wolfe, which argues against evidence-based cancer treatments:

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On March 13 2016, O’Connor shared misinformation which claims that cannabis oil is a cancer cure:

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On January 29 2016, O’Connor shared misinformation from con-artist, David Wolfe, which claims that ginger is an effective cancer treatment, and argues against evidence-based treatments:

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On January 26 2016, O’Connor shared misinformation which claims that cannabis oil is a cure for childhood leukemia:

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On January 20 2016, O’Connor shared misinformation claiming that cannabis oil is a cancer cure:

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On January 20 2016, O’Connor shared misinformation which promoted the discredited cancer cures claims of disreputable doctor, Stanislaw Burzynski:

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On January 12 2016, O’Connor shared misinformation which claims that an alkaline diet is an effective cancer treatment:

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On December 31 2015, O’Connor shared misinformation which claims that a home-remedy is a cure for four types of cancer:

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On November 19 2015, O’Connor shared misinformation which asserts that coconut oil is a cancer cure:

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On October 26 2015, O’Connor shared misinformation which claims that ginger is a more effective cancer cure than evidence-based cancer treatments:

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On October 21 2015, O’Connor shared misinformation promoting the anti-vaccination, crank-cancer-cure documentary series, The Truth About Cancer:

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On October 5 2015, O’Connor shared misinformation promoting The Truth About Cancer:

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On September 25 2015, O’Connor shared misinformation which asserts that THC is an effective cancer treatment:

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On September 18 2015, O’Connor shared misinformation promoting the disreputable doctor, Stanislaw Burzynski:

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On August 25 2015, O’Connor shared misinformation claiming that cannabis cures cancer:

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On May 25 2015, O’Connor shared misinformation claiming that cannabis is an effective treatment for cancer:

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Big Pharma and Rothschild conspiracies

On March 13 2016, O’Connor shared anti-Semitic misinformation asserting a conspiracy of the ruling global elite:

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On October 23 2015, O’Connor shared misinformation against evidence-based healthcare, regarding iatrogenic deaths:

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On September 29 2015, O’Connor shared misinformation from Peter Dingle, claiming a vast conspiracy of harm caused by evidence-based healthcare, and making an incorrect claim about leading causes of death:

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Anti-fluoridation

On May 27 2016, O’Connor shared misinformation against water fluoridation:

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On February 18 2016, O’Connor shared misinformation claiming that water fluoridation is somehow neurotoxic:

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On November 20 2015, O’Connor shared misinformation from Natural News claiming that the fluoridation of water is “poison on tap”:

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On November 11 2015, O’Connor shared misinformation asserting that water fluoridation is neurotoxic:

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On September 28 2015, O’Connor shared misinformation which asserts several lies about water fluoridation:

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On May 18 2015, O’Connor shared misinformation from charlatan, David Wolfe, asserting a number of falsehoods about fluoride and other common ingredients:

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On March 10 2015, O’Connor shared misinformation claiming that fluoride in water is a toxin:

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Anti-statins

On July 16 2016, O’Connor shared misinformation against statins, and warning members of the public to cease taking their prescribed statin medication:

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On June 30 3016, O’Connor shared misinformation against statins:

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On June 3 2016, O’Connor shared misinformation against statins:

pam-18-statins

On May 30 2016, O’Connor shared misinformation against statins, asserting that pomegranate is a better treatment:

pam-19-statins

On May 2 2016, O’Connor shared misinformation against statins, which she called “scary”:

pam-26-statins

On February 10 2016, O’Connor shared misinformation from Peter Dingle, against statins, which asserts that they are a “medical lie”:

pam-43-statins

On May 10 2016, O’Connor shared separate misinformation from Peter Dingle, against statins, which asserts that they are a “medical lie”:

pam-45-statins

On October 14 2015, O’Connor shared misinformation from Peter Dingle, against statins:

pam-79-statins

On June 10 2015, O’Connor shared misinformation from Mercola, against statins:

pam-94-statins

GMO and autism-cure claims

On February 2 2016, O’Connor shared misinformation from discredited computer scientist, Stephanie Seneff, which asserts that glyphosate causes autism:

pam-51-seneff-gmo

On February 2 2016, O’Connor shared misinformation claiming that cannabis oil is a treatment for non-verbal autism:

pam-53-autism

Anti-mammography

On April 19 2016, O’Connor shared misinformation against life-saving mammograms:

pam-27-mammograms

On February 10 2016, O’Connor shared misinformation against mammograms:

pam-44-mammograms

On February 6 2016, O’Connor shared misinformation against mammograms:

pam-49-mammograms

On October 12 2015, O’Connor shared misinformation against mammograms:

pam-81-mammograms

Wi-Fi claims

On March 12 2016, O’Connor shared misinformation about Wi-Fi:

pam-33-wifi

On March 10 2016, O’Connor shared misinformation about Wi-Fi:

pam-38-wifi

On February 29 2016, O’Connor shared misinformation about Wi-Fi:

pam-40-wifi

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 Pamela O’Connor, as well as her other non-evidence-based claims.

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 26

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.

Loretta Baxter (Loretta Blaikie, Loretta Salakas) is an registered enrolled nurse in New South Wales. Baxter cited her employer – Holdsworth House Medical Practice – as well as her employment as a practice nurse, and her nursing qualifications on her Facebook profile. Holdsworth House Medical Practice confirmed that Baxter is employed as a practice nurse in their Sydney practice; they did not respond to requests to provide Baxter’s AHPRA registration number:

salakas-1-baxter-profile-holdsworth-house-nurse-university-uts

salakas-45-loretta-blaikie-en-ahpra-registration

Anti-Vaccination Australia Facebook group

On October 18 2016, Baxter responded to a post regarding the Nursing and Midwifery Board of Australia’s new position statement on antivax nurses. Baxter claimed that her employers condone her anti-vaccination activism, and she affirmed that she would continue her outspoken anti-vaccination activism regardless of the NMBA’s position statement:

I’m a nurse and will continue to say what I believe about vaccines. They can shove their guidelines up there ass

Suzy Singleton my boss and colleagues all know my views on this issue and are fine with it. I have worked here for a long time and my views and beliefs are no secret to anyone in my workplace so I think I’m safe

salakas-42-ava-october-18-2016-nmba-op-breana-stanley

salakas-1-rn-ava-october-18-2016-baxter-rn-nmba-shove-guidelines-up-arse

On March 30 2016, Baxter volunteered – along with another antivax midwife, Laurie Cairns-Cowan – to disseminate anti-vaccination propaganda in the community via letterbox drops:

salakas-43-ava-march-30-2016-letterbox-1-belgin-colak

salakas-43-ava-march-30-2016-letterbox-2

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AV vs PV 2 Facebook group

On August 24 2015, Baxter wrongly asserted that there are no safety or efficacy studies for the maternal whooping cough immunisation:

salakas-41-avpv-august-24-2015-no-wc-pregnancy-booster-safety-studies

On September 10 2015, Baxter cited her employment as a nurse in a “sexual health clinic”, to provide dangerous misinformation against the Gardasil immunisation:

salakas-32-avpa-sept-10-2015-sexual-health-vaccine-op

salakas-33-avpv-sept-10-2015-works-in-sexual-health-clinic

More screenshots from the above thread, containing more of Baxter’s anti-vaccination claims, are provided at the end of this post.

Vaccine Choice Australia Facebook group

On November 18 2014, Baxter admitted to lying about her immunisation history, whilst citing her nursing registration to bolster her lies:

salakas-30-vca-november-18-2014-lied-about-ae-to-vax-for-work-co-op

salakas-31-november-18-2014-lied-about-immunisation-status-adverse-recations-for-work

On November 20 2014, Baxter assisted another parent in procuring an immunisation exemption for a child:

salakas-29-vca-november-20-2014-co-forms-dr-in-gordon

On January 9 2015, Baxter cited her nursing registration in an argument against workplace influenza immunisation:

salakas-1-vca-january-10-2015-rn-work-vax-loretta-salakas-baxter

On January 13 2015, Baxter posted a photograph of her “healthy unvaccinated girls”:

salakas-28-vca-jan-13-2015-photo-unvaxed-girls-pixelated

On February 7 2015, Baxter admitted to lying to emergency medical staff, stating that her children are vaccinated:

salakas-26-vca-feb-7-2015-lying-about-kid-vax-status-op

salakas-27-vca-feb-7-2015-lying-about-vax-status

On February 23 2015, Baxter provided anti-vaccination graphs to a commenter which cited death rates, in answer to a question about disease incidence: