Leg exam- legislation Flashcards
Crimes Act
1961
MW has a ‘duty’ to have reasonable knowledge, skill, care when provdiing treatment that may endanger woman or baby’s life
allows Police to investigate health practitioner, whether or not regulatory authorities (Midwifery Council or HDC) are investigating
NZ Bill of Rights
1990
human has right to refuse medical treatment
human has right to not be subjected to medical experimentation without their consent
Human Rights Act
1993 (amended 2001)
Established Human Rights Review Tribunal
people can bring submissions to seek damages - when a practitioner is found guilty of breaching Human Rights Act, Privacy Act, Health and Disability services Commissioner Act
Health and disability services commissioner Act
1994
Established to have independent regulatory body to hear complaints about health professionals
recognises ‘consumers have rights, providers have duties’
Established ‘Code’ - regulation that is enforceable by law
Memorise the HDC Code of Rights
Give an example for each related to MW
**1996- 10 Rights
Provider of health and disability services must tell people about their rights and enable them to be used
-
**1) C- Right to Complain
** providers have to follow process / schedule to resolve complaint fairly + quikcly - should be told about HDC complaint process
*** - 2) C- RIght to efffective communication
delivered in a way that you understand / in an environment that you can communicate - 3) D- right to dignity and independence
- 4) D- right to fair treatment ( freedom from discrimination, harassment, coercion, exploitation (financial, sexual))
**age, gender, ethnicity, beliefs, social status should not affect your treatment. should not be delivered with force/ threat / harassment
*** - 5) I - right to be fully informed - all information provided, answers to your questions, written info if requested
- 6) I- right to make informed choice, give informed consent
*only receive service when you consent, you should be considered competent to give consent unless reasonable grounds to think otherwise. can give consent to participate in research / teaching, or for your body to be used / stored
- 6) I- right to make informed choice, give informed consent
- 7) R- right to be treated with respect
**take into account cultural, religious, social, ethnic needs, values, beliefs
**
9) 8) R - right in respect to research / teaching - 9) S- Right to support
- support person can accompany you, as long as it’s safe / doesn’t affect other people’s rights
- 10) S- Right to receives services at appropriate standard*
- receive skill with reasonable skill and care, meeting legal, ethical and professional standards, professionals working together,
Injury prevention, rehab and compensation Act
2001 (amended 2005)
-allows consumers to brign civil claim for monetary damage, for ‘treatment injury’ (or omission of treatment)
since 2005- doesn’t require ACC to prove ‘medical error’ from health professional
MW must give documentation to support ACC’s investigation
ACC claim may result in HDC code complaint / MCNZ notified (competency review panel may investigate)
What are functions of law
1) provide protection to citizens
2) administer / regulate entitlements
3) sanction those that offend norms and values of society
what is statutory law
law passed by parliament, written form in ‘statutes’
what are ACTS
Can override /replace previous statutes
make provisions for Regulations
What are Regulations
provide detail to issues in Acts
What/ when is the Nurses Act
1977 initially- established regulation of MW’s with nurses
1990 Amendment- established autonomy of MW’s
2003- superseded by HPCAA
What is HPCAA
- 2003 - Health Practitioner Competency Assurance Act
- intention- to protect safety and health of members of public.
- established one regulatory framework for all recognised health professions
- established ‘Responsible authorities’ who have legal responsibility to assure competence of professsionals (inl. MCNZ)
- established Health Practitioner Disciplinary Tribunal- to keep regulatory + disciplinary function separate
- implication for MW- first time that MW is recognised as separate to nursing
What process would you recommend to a woman that wants to make a complaint?
Comfortable talking to MW herself? She is req to follow specific process/ schedule to ensure complaint is responded to effectively / timely
otherwise
1) NZCOM Resolution Committee- can mediation help?
2) then can go to MCNZ who will refer concern to HDC, or go directly to HDC
- start with HDC Patient Advocacy Service -
if this isn’t succesful, they can lodge complaint with HDC Commissioner (they may seek opinion from Profession -i.e. MCNZ).
HDC may then decide to do full investigation, or refer consumer to NZCOM Resolutions Committee, or to MCNZ (Professional Conduct Committee, Competency Review Panel).
Consumer may prefer not to go through HDC, as their complaint can get lost in the process- may prefer mediation process via NZCOM Resolutions committee
Also talk about Prviacy code- woman has right to access info about herself
You are a student midwife on placement in the local hospital birthing unit. The Midwife in charge asks you to go into a room to assist the midwife who is caring for a woman in labour and has requested assistance. What needs to happen next and what parts of the ‘The Code’ does this relate to?
Code requires that woman is aware she is participating in teaching and must have option to decline /gives consent.
important that woman is able to make decision in environment that she feels comfortable to ask questions- recommend the LMC/ ACM asks the woman
if woman gives consent, it’s important i only provide care for which i have skills/ knowledge. important to treat woman with respect / dignity / ensure she is fully informed
You are working in the postnatal ward and Anna’s baby is due for the Newborn Metabolic Screening Test. What will you need to do before you are able to carry out the procedure?
Follow Code of Consumer Rights
-explain right to informed choice / consent-
explain the procedure is optional anna can decline or consent.
- right to be fully informed
provide information about why test is recommended what test involves, other options. - invite questions to ensure she feels fully informed - explain rights for information under privacy code - explain that info will be stored securely- disclosed only to Anna.
rights upheld when participating in research or teaching
- explain that Anna can decide what happens to the blood products collected- explain that what collected blood may be used for (incl. may be used for research)
right to effective communication
-communicate in a way that she understands, that is respectful.
- offer written info, ask her if she wants time to review
right to receive services at appropriate standard
- ensure i have the req level of skills/ knowledge to carry out procedure
right to receive services free of discrimination / harassment/ coercion
right to respect- respect of cultural preferences
You are the Lead Maternity Carer Midwife for Anna who is in her first pregnancy. At the booking appointment you are required to inform Anna of her rights relating to receiving health services. What information do you need to share with Anna in relation to the Code of Health and Disability Services Consumer Rights and what will assist you?
- Start by being clear that Anna has rights as a consumer of health services, and all health providers (e.g. LMC’s + hospitals) have legal responsibilities- that if she feels that her rights are not being met, there is process to complain. i would share a link to the HDC website and encourage her to read the Code.
At a high level, i would explain Anna has the right to receive services free of discrimination at a certain standard, right to information, right to consent, right to complain, right to change providers
What are obligations to give informed consent?
legal
* HDS Code of consumer rights
* Bill of Rights
* Human Rights Act
Professional
*Standards of practice (guide practice and appropriate usage of MW’s knowledge- ( “uphold each woman’s right to consent)
* Code of Ethics-
Regulatory
*Competencies (minimim standard): outline expected behaviour for MW to support informed decision making -i.e. provide information and supports woman in informed decision kaing , respects need to be self determining, formulates care plan in partnership with woman
What are components of informed consent
ensure she is aware she has right to informed choice + consent
provide information about all options
promote partnership
communicate effectively/ ensure she has environment
respect woman’s right to self determination
what is difference between consent, informed consent, informed choice
- consent- give permission to something that can’t be done without consent
- informed consent- receiving / understanding information to make reasoned decision
- informed choice- exchange of information to make iformed, unpressured, reasoned decision - by someone who is competent
what are components of Valid consent
voluntary - free of coercison, harassment
information- enough info to make reasoned decision
comprehension
decision- conscious process (not acuiescence)
but be aware that women’s choices are still restricted by availability of options, midwives preferences (protective steering)
what are types of coercion
overt- force / legal threat
covert- subtle, guilt / fear, not evidence based
how can MW support evidence based decision making
promote continuity of care/ trust over time
ask woman what is important to them
use clinical info from assessments
find evidence
discuss with woman/ make it clear woman can self determine
reflect on emotions, outcomes, consequences
communicate with respect to woman’s values, free of coercion
woman should have reflected on her own prefernces (cultural safe)
What are ethical frameworks
Deontological - rules of behaviour that are not contextual. e.g. Hippocratic Oath.
e.g. Do no harm, protect confidentiality, promote health
Medical ethics-
- autonomy (respect clients right to make decisions for themself)
- beneficence- promote wellbeing
- non maleficence- minimise harm
- justice- treat everyone fairly / no discrimination
Utilitarian- ends justify the means. choose option based on outcome.
Midwifery- make decisions in partnership
What are different types of advocacy role?
- legal- advocate speaks for woman, determines what info she provides
- health care- advocate helps woman find info, follow up on complaints (e.g. HDS independent advocacy service)
*MW- advocate helps women identify what is important to her, then assists her to find ways to achieve it. MW Advocate walks alongside woman
What is the Privacy Act
1993 (Amended 2020)
governs how organisations can collect, store, use and share your information.
- and rights for people to access /edit info about themselves
-Privacy commissioner to ensure compliance
What are consumer expectations for health info?
kept confidential
used for purposes it was gathered
treated as sensitive
ongoing use
What is health info Privacy Code
2020 (part of 2020 amendment to Privacy Act)
13 principles for health professionals
gathering info
- lawful purpose- only collect relevant info
- fully informed (use/ who it will be shared with, why is it gathered, how will it be stored, whether supply of info is mandatory or voluntary)
- direct from source
- via lawful means (don’t mislead person when gathering info)
- check accurate, before sharing
disclosing
-don’t disclose, unless legal reason (e.g. request compliance under Family Violence Act)
storing,
store for 10years (Health regulations )
destroy securely
take reasonable actions to protect it- notify Privacy Commissioner / person, if there is a breach
give person access to info, allow them to edit it if they want
take steps when disclosing health info to overseas agent - notify person that privacy laws don’t apply
limits on use- don’t use info for antoher purpose
usually confidential- but NHI number means it is essentially not annoymous)
health regulations
requirement that health professionals keep original health information (incl. diaries and phone logs) for at least 10years
info can be transferred to another health provider (with individual’s permission)
info may be rquested by certain agencies- MW should keep original and make copies. And document a record of the written request, and what info has been shared.
What is Pae Ora?
2022 “Healthy Futures Act”
aims to promote health of all new zealanders, achieve equity in health outcomes (esp for Maori)
replaced Public Health and Disability Act (2000)- disestablished 20 DHB’s and Health promotion Agency to form 3 new entitiees
- Te Whatu Ora- health NZ- leads and coordinates delivery of health services
- Maori health authority (independent statutory authority, to drive improvement in hauora maori)
Primary Maternity Services Notice
Sec 96 (Pae Ora)
Service contract- sets out terms and conditions with which LMC’s can claim public funding for primary maternity services (secondary maternity services covered elsewhere) - who can receive services, what services are covered, what’s expected
LMC’s deemed to consent to T&C’s when they become authorised practitioners , and make claims
also sets out how LMC’s work with other providers (Guidelines for consultation) + Access agreement
MW’s under random audity- MW must provide evidence of services provided, share notes with women so women accurately report to auditors
What are 5 obligations of LMC under ‘Primary Maternity Services Notice’
**LMC responsible for holistically assessing needs of mum and baby
**- holistic (obstetric, family, medical, physical), then ongoing progression
newborn exams, in line with well child schedule
- DV screening
**LMC responsible for developing plan of care with mum, for mum and baby
**discuss place of birth, screening, vaccinations
*** LMC responsible for ensuring woman has access to care/ continuity of care
**- 24/7 access - phone / in person consult for urgent requirements
organise back up if not available
be responsible for AN/Intrapartum, PP
* LMC responsible for providing care, and ensuring care provided via referrals
- eg. offer referral for Wellchild, within 4 weeks after birth
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**LMC responsible to share information with National Immunisation Register
**- record of birth and any vaccines administered
