Values for Nurses and Midwives

National Awareness Programme

Cork University Hospital

9th Annual Child and Family Nursing Conference

Bille Na nAltrai agus gCnaimseach, 2011 Nurses and Midwives ACT 2011

The Act commences in a number of stages:

• Stage 1 (in effect from midnight on 31st December 2011):

Full Act Available at www.nmbi.ie

1. Protection of the Public:

(Self regulation is no longer considered to be in the best interest of the public), e.g.

- Neary Case (Ireland)

- Shipman Case (UK). Dame Janet Smiths Report outlined that "The BMC focused too much on the interests of the Doctor, and not sufficiently on protection of the Public".

Reasons for Change

Regulation of the Professions of Nursing & Midwifery

• “The purpose of the act is to enhance the protection of the public and its dealings with Nurses and Midwives”

• “To ensure the integrity of the practice of Nursing and Midwifery

• To satisfy the public and professions that “all Nurses and Midwives are appropriately qualified and

competent to practice in a safe manner on an on-going basis “

(Nurses & Midwives Act 2011)

Other Regulated Professions

• Pharmacists • Doctors • Lawyers • Dentists • CORU (regulators of Health & Social Care

Professionals) as follows: Social Workers /Radiographers/ Dietitians, Occupational Therapists /Physiotherapists/ Radiation Therapists / Speech & Language Therapists / Optometrists, Dispensing Opticians.

Functions of Nursing & Midwifery Board of Ireland

Protection of the Public

Education Training Practice

Professional Conduct

• The Board’s functions include the registration of Nurses, Midwives, Candidates and Advanced Midwife Practitioner/Advanced Nurse Practitioner posts.

• The Board’s functions also include the setting of

standards of practice and ethical guidance for nurses and midwives and the maintenance of their professional competence. (New Function)

Structure of An Bord Altranais and Cnaimhseachais na hEireann

(Section 22) Outlines the membership of the

Board. The Board shall consist of 23 members (was 29), appointed as follows:

(1) Appointed Members (15)

(2) Elected Members (8)

Maintenance of Professional Competence (Part 11 of the Act)

• A Registered Nurse and a Registered Midwife, shall maintain professional competence on an on-going basis (new – development)

• A Registered Nurse or Midwife shall whenever required by the Board, demonstrate competence to the satisfaction of the Board

• The Board may require a RN/RM who fails to demonstrate competence, to attend a course or courses of further education or training

Maintenance of Professional Competence

• Duty of employers in relation to maintenance of professional competence of RN’s and RM’s.

Section 90 (1)

“An employer of a Registered Nurse or Registered Midwife shall facilitate the maintenance by that Nurse or Midwife, of his or her professional competence, pursuant to a professional competence scheme”

Nursing and Midwifery Board of Ireland (NMBI)

Role and functions The Board Nurses and Midwives Act 2011 Current projects www.nmbi.ie Ezine updates

Re-affirming the Values with Nurses & Midwives

Compassion, Care and Commitment

Position Paper available at

https://www.nmbi.ie/NMBI/media/NMBI/Position-Paper-Values-for-Nurses-and-Midwives-June-2016.pdf

Compassion

• Empathy and respect for the person

• Dignity of the person is upheld at all times

• The nurse and midwife upholds the trust of the person by providing care that is based on integrity, genuineness, kindness, comfort, and presence

(Department of Health 2016)

Care

• Required knowledge, skill and competence to connect with a person by genuinely listening to and communicating with the person, demonstrating safe evidence-based and collaborative practice

(Department of Health 2016)

Commitment

• Person-centered approach to professional practice

• Professional courage and a commitment to lifelong learning that is demonstrated by intellectual engagement.

• Commitment is further demonstrated by a work ethic that is underpinned by a passion and drive for professionalism to develop self and support teams with diligence and resilience

(Department of Health 2016)

Office of Nursing & Midwifery Services Director

Nursing & Midwifery Planning &

Development Units

Centres of Nurse & Midwifery Education

National Leadership

&

Innovation Centre

Role of the ONMSD

• Advanced and Specialist Nursing

and Midwifery Practice.

• Practice Development.

• Continuing Professional

Development.

• Governance.

• Safe Quality Care.

• Leadership.

http://www.hse.ie/eng/about/Who/ONMSD/

Theoretical Frameworks

Careful Nursing Philosophy and Professional Practice Model available at http://www.carefulnursing.ie/ (Meehan T. 2016)

McCarthy G. & Landers M. (2010) A Conceptual Model of Nursing – A Model of Personhood for Irish Nursing. Nursing Science Quarterly 23(4), 243-247.

Challenges

Beware of ‘Normalisation of Deviance’

Is the gradual erosion of best practice as a result of the acceptance and tolerance of small incremental deviations from the standard (Prielipp et al. 2010)

Group think - there’s a natural human tendency to rationalise shortcuts under pressure, especially when nothing bad happens. The lack of bad outcomes can reinforce the “rightness” of trusting past success instead of objectively assessing risk (NASA 2014)

Reflection

• Conveys meanings that range from questioning assumptions, beliefs or ‘taken for granted’ practices, through to more explicit engagement in the process of critical and creative thinking in order to make connections between experience and learning in practice (Higgins 2011).

• Internally examining and exploring an issue of concern triggered by an experience which creates and clarifies meaning in terms of self, and which results in a changed conceptual perspective (Boyd & Fales 1983).

• Reflection is a deliberate, orderly and structured intellectual activity (Bolton 2001).

Reflection

• Characterised by engagement, pondering alternatives, drawing inferences, taking diverse perspectives, calling for situational awareness and understanding (Higgins 2011)

• Reflection involves exploring situations of perplexity, hesitation, doubt, inner discomforts resulting in learning which is meaningful and memorable (Levitt Jones 2007)

• Reflection involves stepping back to gain new insights,

knowledge and hopefully some clarity. Reflection involves reviewing practice to ponder the meaning of what happened, the impact of it, and the direction one is taking.

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1

4

3

2

Creating alternative methods of action

Trial

Awakening

(Action)

Looking back on the action

Awareness

of

essential

aspects

ALACT Model (Korthagen et al 2001)

Onion Model Your environment Your competencies Your skills Your beliefs Your core …. Why did you come into the profession in the first place? (Korthagen 2009) Compassion, Care and Commitment

Documenting the Values

The Care Plan

The care plan is an essential tool in the delivery of care as it provides easily accessible reference, which outlines each person’s unique needs and the evidence based interventions that committed professionals have planned with compassion to meet unique needs of the person

The Care Plan

• Communicates Compassionate Care

• Committed nurses & midwives must think critically and reflect on each individual’s response to planned interventions

• Provides an auditable account of the whole patient journey

ASPIRE to the Values

• Assess • Select • Plan • Implement

• Review • Evaluate

Assessment

Provides the professional with sufficient information to formulate a person-centered problem/need

Objective and subjective assessments

Subjective assessments involve getting to know the person.

Professional spends time with the person to inform the care plan Download and reflect on Poem for Everyone

Select

A need / problem(s) for which the professional is legally permitted to intervene independently and can be held accountable for the outcomes.

Plan

• Person-centered Goals

• Realistic

• Measurable

• Time frame (SMART)

Implement

Actions/interventions that you, the nurse or midwife will take

Nurse /Midwife who writes the interventions must ensure that this care is evidence based

Interventions change based on the person’s response

Interventions start with an Action Verb

Pre- printed care plans allowing for individual differences

Review

Unique responses Effectiveness Variances Clinical judgement Document time Change plan

Evaluate

Interventions

The need / problem

Document (timing)

Audit trail

Re-assess

Revise plan

Interventions by other members of the team

Status of the problem

Compassion, Care and Commitment

REFLECTIVE PRACTICE A L A C T

ONION A S P I R E

Further information

Mary Doolan mdoolan@nmbi.ie Catherine Killilea catherine.killilea@hse.ie May 16th 2017 Conference Conference details are available using the following link: http://www.hse.ie/eng/about/Who/ONMSD/Nursing%20and%20Midwifery%20Values/ValuesConference2017.html Continue to re-affirm the values in practice