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Independent practitioner, independent midwifery practitioner issues and challenges
The document discusses issues related to independent nursing practice, specifically for nurse practitioners and midwives. It defines nursing and the roles of nurse practitioners who can manage medical conditions, order tests, treatments, and medications. It also defines independent nurse practitioners and midwives. Key issues for independent practice include scope of services, conflict of interest, endorsement, advertising, fees, informed consent, documentation, confidentiality, and liability protection. Areas of independent nursing practice are also outlined, along with standards and challenges for independent midwifery practice in India.
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Independent practitioner, independent midwifery practitioner issues and challenges
- 1. INDEPENDENT PRACTICE ISSUES INNURSING Ms ARIFA T N FIRST YEAR M.Sc NURSING, MIMS CON
- 2. INTRODUCTION DEFINITION OFNURSING According to Virginia Anderson Assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as soon as possible
- 3. INTRODUCTION Nurse practitioner(NP’s) manageacute and chronic medical conditions, both physical and mental, through history and physical examination and ordering of diagnostic tests and medical treatments. NP’s are qualified to diagnose medical problems, order treatments, perform advanced procedures, prescribes medicines and make referrals for wide range of acute and chronic medical conditions within their scope of practice.
- 4. INDEPENDENT NURSE PRACTITIONERS Self employed nurses Still bound by all nursing legislations and standards Face some unique challenges
- 5. DEFINITION Nurse practitioners(NPs) Nurse practitioners (NPs) are registered nurses who have graduate level nursing preparation as a nurse practitioner at the master’s or doctoral level and perform comprehensive assessments and promote health and the prevention of illness and injury.
- 6. An INPis defined as, “A registered nurse who provides professionals nursing services as a proprietor of a business, through direct patient care, education, research, administration or consultation.”
- 7. DEFINITION Nurse practitioners(NPs) A nurse practitioner (NP) is defined as , “ an advanced practice registered nurse (APRN) who has completed graduate level education ( either a master of nursing or doctor of nursing practice degree).
- 8. KEY PRACTICES COMPONENTSTO CONSIDER THE SCOPE OF SERVICES A nurse needs to clearly identify that he/she is providing nursing services, the extent of those nursing services and under what conditions he/she will refer clients to other health care professionals Must maintain the high standards of nursing and uphold the public trust that has been bestowed on the nursing profession
- 9. KEY ISSUES TOCONSIDER- PROFESSIONAL ISSUES Conflict of interest Endorsement Advertising Fees Informed consent Documentation Confidentiality Other issues Liability protection Networking Business or legal council
- 10. Conflict of interest Primary obligation is providing professional care to his/her clients In a position of trust and cannot use their position to influence their clients for financial gain of non financial benefit
- 11. Conflict of interest Avoid selling products or services to clients they are treating Avoid conflict of interest situations in their practice, particularly when it comes to the endorsement and advertising of products
- 12. Endorsement Endorsing orpromoting a product or services is closely linked to conflict of interest Endorsement occures when a nurse uses her credentials to lend credibility to a commercial product line or service
- 13. Endorsement The endorsementof a product or service without providing information about other options could mislead the public and compromise trust For example, a nurse in independent practice who provides foot care services should not sell any foot care products for her clients.
- 14. Advertising There arelimitations on how a nurse can advertise his or her services Advertising may take various forms, such as business cards listing in telephone directories, announcements in newspapers and periodicals, and promotional materials It can include information such as a description of services and nursing credentials, practice experience, fee, address and phone number
- 15. Practice guideline independentpractice fees The college does not determine or approve specific service fees. According to Nursing Act 1991 and the accompanying regulations, the following activities related to fees are considered professional misconduct. a. Submitting an account or change for services that the member knows is false or misleading b. Failing to fulfill the terms of an agreement for professional services
- 16. Practice guideline independentpractice fees c. Changing a fee that is excessive in relation to the service for which is charged d. Offering or giving a reduction for prompt payment of an account. Before setting fees , a nurse should research the fees of other nurses who have similar qualification and experience and who provide comparable services
- 17. Informed consent Nursein independent practice are expected to obtain informed consent before performing any treatment For consent to be valid, it must relate directly to the treatment
- 18. Informed consent Treatmentis defined as anything that is performed for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health related purposes, and includes a course or plan of treatment
- 19. Documentation An integralpart of service that a nurse provides is creating and maintaining accurate and complete health records and documentation Health records are the means by which information about the client is communicated the health care team and how to continuity of care is maintained They also demonstrate the nurses accountability and answer questions about the type of care provided
- 20. Confidentiality Nurse inindependent practice are requires to maintain the confidentiality of the client information and cannot communicate the information to another person unless the client or client’s representative gives consent or it is required by law
- 21. Other issues Regulatedprofessionals may incorporate their independent practice under legislation Business or legal council Liability of protection Networking:
- 22. Other issues Regulatedprofessionals may incorporate their independent practice under legislation Business or legal council: nurses may want to seek legal advise before starting an independent nursing practice Liability of protection: the college recommends that nurses in independent practice purchase liability protection to enable public redress if any problems occures Networking: entrepreneurial support groups for self employed nurses offer assistance with peer feedback, idea and issue sharing, planning for vacation and sickness etc.
- 23. AREAS OF INDEPENDENTNURSING PRACTICE CONSULTANCY GERIATRIC NURSING MEDICAL SURGICAL NURSING PRACTICE PAEDIATRIC NURSING PSYCHIATRIC NURSING
- 24. AREAS OF INDEPENDENTNURSING PRACTICE SCHOOL HEALTH NURSING ADULT NURSE PRACTITIONER FAMILY NURSE PRACTITIONER ACUTE CARE NURSE PRACTITIONER MIDWIFERY AND WOMEN’S HEALTH NURSING
- 25. RESPONSIBILITY OF AINDEPENDENT NURSE PRACTIONER Universal precautions Unacceptable practices Verifying recipient eligibility Private duty nursing requirements Emergency and back-up procedures Written statement of recipient rights Contracts with recipient and/or family Required information for medical record Terminating service to a recipient
- 26.
- 27. INTRODUCTION Activities ofhealth care providers who are experts in women health care including prenatal care to the expectant mothers, attending at birth and providing post partum care to mother and infant Practitioners of midwifery are known as midwives.
- 28. Independent midwiferypractice enables registered nurse midwives to utilize their knowledge skills, judgment and authority in the provision of midwifery practice package and primary women’s health services while maintaining accountability for the management of patient care in accordance with midwifery standards laid down by the midwifery or nursing council of their country
- 29. Independent shouldnot interpreted to mean alone, as there are clinical situations when any prudent practitioner would seek the assistance of other qualified.
- 30. MIDWIFERY PRACTICE PACKAGEFOR INDEPENDENT PRACTICE • Access to a midwife 24 hours a day , 7 days a week • Two midwives available alternatively and provide women centered antenatal, intrapartum and postnatal midwifery care. • Antenatal care in privacy • Continuity of care through out labour • Post natal care up to 6 weeks • Knowledgeable breast feeding support
- 31. STANDARDS FOR MIDWIFERYPRACTICE Midwifery practice as conducted by midwife is the independent management of women's health care focusing particularly on pregnancy, child birth, the postpartum period care of newborn, family planning and gynecological needs of women
- 32. Midwives provideconsultation management, collaborative management or referral as indicated according to standards of midwifery practice In India as such standards of midwifery practice act are not developed to do independent midwifery practices which are one of the essential requirements. American college of nursing midwives has defined eight standards of practice
- 33. STANDARD 1 Midwiferycare is provided by qualified practitioners Midwifery should be registered Shows evidence of continuing competency as required by certification agency by council It is in compliance with the legal requirements of the jurisdiction where the midwifery practice occurs
- 34. STANDARD II Midwiferycare occurs in a safe environment within the context of the family, community and a system of health care Demonstrate a safe mechanism for obtaining medical consultation , collaboration and referral Uses community services as needed
- 35. STANDARD II Demonstrateknowledge of the medical, psychological , economical , cultural, and family factors that affect care Demonstrates appropriate techniques for emergency management including arrangements for emergency transportation Promotes involvement of support persons in the practice settings
- 36. STANDARD III Themidwives practices in accordance with the philosophy and code of ethics of the professional body provides clients with a description of the scope of midwifery services and information regarding the client’s rights and responsibilities Provides clients with information regarding services when care required is not within the midwives' scope of practice
- 37. STANDARD III Providesclient with information regarding health care decisions and the state of science regarding these choices to allow for informed decision making Midwifery care supports individual rights and self- determination within boundaries of safety
- 38. STANDARD IV Midwiferycare is comprised of knowledge, skills, and judgments that foster the delivery of safe, satisfying, and culturally competent care. The midwife collects and assesses client care data, develops and implement individualized plan of management and evaluates outcome of care
- 39. STANDARD IV Demonstratesthe clinical skills and judgments described in the basic midwifery practice. Practices in accordance with standards Practices in accordance with service or practice guidelines that meet the requirements of the particular institution or practice settings
- 40. STANDARD V Midwiferycare is based upon knowledge, skills, and judgments which are reflected in written practice guidelines and are used to guide the scope of midwifery care and services provided to clients.
- 41. STANDARD V Midwifesdescribes the parameters of services for independent and collaborative midwifery management and transfer of care when needed Establish practice guidelines for each specialty area which may include, but is not care of the child bearing family and newborn care
- 42. STANDARD VI Midwiferycare is documented in a format that is accessible and competent The midwives uses records that facilitate communications and institutions
- 43. STANDARD VI Providesprompt and complete documentation of evaluation, course of management and outcome of care. Promotes documentation system that provides for confidentiality and transmissibility of health records Maintain confidentiality in verbal and written communications
- 44. STANDARD VII Providesfor systemic collection of practice data as a part of a programme of quality, management Seeks consultation to review problems, including peer review of care Acts to resolve problems identified
- 45. STANDARD VIII Midwiferypractice may be expanded beyond the set competencies to incorporate new procedures that improve care for women and their families The midwife identifies the need for new procedure taking into consideration consumer demand, standards for safe practice and availability of other qualified personnel
- 46. STANDARD VIII Ensuresthat there are no institutional state or council statures, regulations or laws that would constrain the midwife from incorporation of procedure into practice Reports the incorporation of this procedure to the authority. In respect to provide standardized practice independently, the nurse midwife has to meet required education, experience, advanced skills and competency
- 47. CHALLENGES FOR INDIANMIDWIVES PRACTICE CHALLENGES CHALLENGES FOR LAW REGULATION EDUCATIONAL CHALLENGE CHALLENGES FOR RESEARCH ACTIVITIES CHALLENGES FOR POLICY MAKERS
- 48. PRACTICE CHALLENGES Midwivesshould be recognized as independent practitioners with the rights and responsibilities regarding scope of practice. Authority and accountability that all Independent by share. Health organization should use to allow quality and standard based midwifery care. Midwife should ensure case consultation, collaboration and referral provided to a woman without interruption and for overall benefits
- 49. CHALLENGES FOR LAWREGULATION State regulators should enact laws which are based on entry to practice standards on successful completion of midwifery educational programme. Health care system should develop privileging and credentializing mechanisms for midwives that are consistent with professional standards, recognize established process that permits midwives to build upon competencies within their statutory scope of practice.
- 50. EDUCATIONAL CHALLENGE Directentry midwife programme to create a new category of professional midwife. The midwifery profession should identify, develop and implement mechanism to recruit midwives who reflect Indian population with their competencies. It is needed to develop categories of midwives as per their expertise in their midwifery
- 51. CHALLENGES FOR RESEARCH ACTIVITIES It is required to continually grow and evolve in order to provide evidence based midwifery practice which will help to practice independently. Analysis of midwifery practice in view of consumers or women who receive care.
- 52. CHALLENGES FOR POLICYMAKERS Some of the most pressing issue regarding midwifery go beyond the current scope of regulatory bodies, professional associations, educators and practitioners. Policy makers are to be convinced for the importance of independent practice. Research efforts have found the midwifery makes a positive contribution to the health of the women and babies.
- 53.