issues in nursing
• Definition of
• Key issues
• Areas of independent
• Responsibility of
• Definition of midwife
• Independent midwifery
• Standards for midwifery
• Challenges for Indian
• NURSE PRACTIONERS
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.
KEY ISSUES TO CONSIDER -
1. Conflict of interest
5. Informed consent
3. Other issues
Business or legal council
AREAS OF INDEPENDENT NURSING
• GERIATRIC NURSING
• MEDICAL SURGICAL NURSING PRACTICE
• PAEDIATRIC NURSING
• PSYCHIATRIC NURSING
• Women Health Nursing
• School Health Nursing
RESPONSIBILITY OF A INDEPENDENT
• UNIVERSAL PRECAUTION
• UNACCEPTABLE PRACTICES
Independent midwifery practice
• Access to a midwife 24 hours a day, 7 days a
• Provide women centered care antenatal,
intrapartum and postnatal midwifery care.
• Antenatal care in privacy.
• Continuity of care through the labour.
• Postnatal care up to 6 weeks.
• Knowledgeable breastfeeding support.
Standards for midwifery practice
• Midwifery care is provided by qualified
• Midwifery care occurs in a safe environment
within the context of the family, community,
and a system of health care.
• Midwifery care supports individual rights and
self-determination within boundaries of
• Midwifery care is comprised of knowledge,
skills, and judgments that foster the delivery
of safe, satisfying, and culturally competent
• Midwifery care 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.
• Midwifery care is documented in a format
that is accessible and complete.
• Midwifery care is evaluated according to an
established program for quality management
that includes a plan to identify and resolve
• Midwifery practice may be expanded beyond
the ACNM core competencies to incorporate
new procedures that improve care for
women and their families.
• Midwives should 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.
Challenges for law regulation
• State regulators should enact laws which are
based on entry to practice standards on
successful completion of midwifery educational
• 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.
• Direct entry 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
• It is needed to develop categories of midwives
as per their expertise in their midwifery.
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
• Analysis of midwifery practice in view of
consumers or women who receive care.
Challenges for policy makers
• 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.
• Basher P. Shabeer, Khan Yasheen S. “A concise text book of advanced nursing
practice”, EMMESS Medical Publishers, first edition 2012, page no. 694-698.
• Kozier B, Erb G, Barman A, Synder AJ. Fundaments of Nursing, concepts, process
and practice, edition 7 2001.
• Potter Perry;S, fundaments of nursing by Jackie crisp, patricia ann potter, 2nd
edition, Annegriffin perry page no. 143-155.
• World Health Organization (2001) Health and human rights publication series,
WHO press, geneva available: www.who.int accessed 19 march 2008.
• A.A.C. Title 9, Chapter 10, Article 8: Hospices; Inpatient Hospice Services. (2003).
• AAFP. (2008). Guidelines on the Supervision of Certified Nurse Midwives, Nurse
Practitioners and Physician Assistants. Retrieved March 5, 2009, from American
Academy of Family
s/n/nonphysicianproviders.html American Association of Colleges of Nursing.
(2004). AACN Position Statement on the Practice
• www.Wikipedia .com