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
-
**LMC responsible to share information with National Immunisation Register
**- record of birth and any vaccines administered
what services are required to claim PN
at least 7 visits, at least 5 at home. 1 within 1 day of being discharged.
Examine baby in accordance with WC schedule
examine mum when clinically appropriate, before referring to primary health care provider
WC referral
support BF, newborn c are, immunisations, assess for PND, education, contraception
what is difference between consult / transfer
consult: in communication with woman, seek opinion, assessment guidance from specailist / 2nd /3rd care provider.
transfer: clinical responsibility transfers from LMC to specialist / 2nd / 3rd care provider
what is the health act
1956
sets out roles and responsibilities of individuals to safeguard public health
(eg. MoH)
What is Births, Deaths and Marriages Registration Act
Requires all Births (live birth and stillbirth) to be Notified + Registered
What is a Notification of birth
requirement that BDM Office are notified of all births (live + stillbirth) within 5 working days of birth
completed by LMC (in homebirth) and hospital (endorsed by LMC )
requires mothers name + address, gender of baby, live birth /stillbirth
what is birth registration
completed by parents- for all babies that are stillbirth + live birth
what is a live birth
any product of conception, showing signs of life (any age)
what is a stillbirth
dead fetus that dies >20 weeks, or weighs >400grams
what is a miscarriage
dead fetus that dies <20 weeks, or weighs <400grams
what is a neonatal death
death of a live birth, within 28 days
what is a maternal death
any death caused by/ worsened by pregnancy or its treatment- up to 42 days post partum. doesn’t include accidental or incidental deaths
What is the Coroner’s Act
2006
Required to investigate neonatal + maternal deaths to understand cause of death - these must be reported to Coroner
Stillbirths may be reported to Coroner if cause of death unknown- Coroner can choose to investigate
Contraception, sterilisation and abortion act
1977 (ammended 1990)
specifies circumstances that contraception + related info can be provided
Implication for MW- MW’s can talk about contraception throughout pregnancy, but cannot prescribe until postnatally. from 1990, it’s legal to provide information / prescribe for women<16yrs
Abortion legislation act
2020
overrided Crimes Act and Contraception, sterilisation and abortion Act
decriminalised Abortion and increased access of services- allows more health providers to provide abortion
for abortion <20 weeks, no statutory reason requred
for abortion >20 weeks, complete process to assess whether it is clinically appropriate (consult another health professional, assess wellbeing + gestation, regard legal/ethical/ professional standards)
abortion falls within MW’s scope, are able to conscientiously object, but must provide woman contact details of nearest service and provide info objectively
if MW provides abortion service, they must notify Director General of Health within month of termination (keeping woman annonymous)
Adoption Act
1955 (Amended 1987)
Outlines process for adoption to take place, OT are ‘statutory agents’ to manage OT process.
requires MW’s to ensure women are aware of mandatory statutory pathway, make referrals to appropriate agency, support women in their decisions
process involves birth parents choosing adopted parents, birth parent cannot finalise decision until 12days post birth
currently under review to update statutes for surrogacy (currently, birth mother is ‘parent’ regardless of where sperm/egg came from. genetic parent may have to go through adoption process.
Oranga Tamariki Act
2017
provides protection + safety to children; and procedures to manage youth offending
promotes sharing of info between health providers
sets out MW expectation (but not legal mandate) to report concerns to OT
OT overrides Privacy Act, enabling MW to disclose info without consent ,free of civil/criminal / disciplinary prosecution
MW legally required to respond to requests from OT/ police
Family Group conference
- series of meetings between family + professionals to address concerns / develop plans - aim to avoid court hearing
- MW may be involved and give her opinion on mum’s ability to care for baby
scenario; if a MW has concerns about whanau’s ability to care for baby, who should they contact, who info can they legally share?
depending on concern- ideally start with discussion with woman, try to refer her to social service support rather than go immediately to OT/Police (try not to break up family)
if concerns about child safety, you have legal expectation under OT Act + professional+regulatory requirement to report to OT.
Try to get consent before sharing information, but not necessary if you have concerns about child/ woman/ your safety.
disclose relevant, accurate info. if you don’t have consent, document why. document evidence, and what is just your opinion.
scenario: you have been contacted by OT because they have concerns about mother and you suspect they are seeking to uplift baby. what info do you need to share?
1) ask for request in writing, discuss request with NZCOM. consider request aligns with ‘legal purpose’ / appropriate requesters identified in Family Violence Act
2) ideally ask for consent before sharing info - may not be possible
3) disclose only accurate, relevant info- document whether you have consent to share. be factual, document when it is your opinion only
scenario: if you believe OT claims are unjustifiable
- ask OT for more information
- try and participate in Family Group conference
- support woman to access legal/social support
scenario: you think a woman is suffering from abuse, when you ask her - she denies it
first talk to her- validate importance of abuse. ask her if she’s worried about baby’s safety.
if you have immediate concerns- report to OT
try to engage NZCOM/ colleagues for support
Care of Children Act
2004
sets out arrangements for guardianship / care of children
puts child’s welfare at centre - guards their rights in Family court
implication for MW- MW must always put child’s interests first
Vulnerable children’s Act / Children’s Act
2014
to improve responsibility of professionals to develop safe and competent workforce, who can better identify, support and protect vulnerable children
Implication for MW- MW required to have Child Protection Policy + pass safety checks
What is MW’s responsibility if she suspects NB is at risk of abuse
-Under Vulnerable Children’s Act- MW expected to have a Child Protection Policy
- Under Care of Children’s Act- MW has to put child’s interests first
- Under OT Act- MW expected to report concerns to OT
- Family Violence Act- defines abuse (can be one off, or multiple acts), and clarifies responsibility of health professioanls to share info
Professional
-Code of Ethics- ‘MW’s should ensure that no action / omission on their part, places woman or her baby at risk’
Family Violence Act
2018
Purpose: stop and prevent family violence
- defines / recognising violence in all its forms,
- supports sharing of info between agencies - clarifies responsibilty of health practitioners in relation to sharing info with other agencies
MW implications
MW has duty ( but not mandatory req) to share info if it is shared iwth lawful purpose (Aligning to family violence act), in good faith,disclosed to Family violence gency/ social service practitioner
only share relevant / accurate info
document decision to share
ideally get consent- but MW protectd from civil, criminal, disciplinary proceedings if ifno shared in good faith and followed family violence process
definition of family
includes partner/ family member/ someone you share a house with/ close personal relationship
definition of violence
includes physical, emotional, psychological (harassment, stalking, damage or threat to property or pets)
can be one act of abuse, or many that form pattern of behaviour (for which each viewed in isolation, appears trivial)
Parental leave and employment protection act
2017
Parents entitled to share 26 weeks paid leave
Under ‘THe Notice’ LMC is expected to explain this to whanau
Describe NZCOM’s professional identity- where is this communicated?
equal
woman centred
information sharing / informed decision making
shared responsibilities and accountabilities
inclusive
reflected in
-MW Philosophy
-Code of Ethics
-Standards of Practice (and adoption of Turanga Kaupapa)
- Consensus statements
what are elements of professionalism’
personal (self confidence, motivaton, organised)
professional (knowledge, skills, belonging to professional bdoy)
intra professional morality- ethical, trustworthy, protecting confidentiality, justice, anti discrimination
define professionalisation
occupation becomes a profession
professionalism
internalisation of professional values and practices, by members
Code of Ethics
NZCOM
3 Areas of accountability
Women
partnership, self determination, informed choice and consent, holistic needs, confidentiality, don’t interfere with normal process of birth, refer to others when required, personal beliefs shouldn’t deprive women of care, ensure no action / omission puts womn+baby at risk
community
Tiriti Principles, social justice, acknowledge role of community groups, effective role model for health promotion
colleagues + profession
support and sustain each other, seek career growth, share knowledge with others, uphold professional standards, acknowledge expertise of other health professsionals, tak actions when colleagues infringe accepted standards, support education, advance MW knowledge whilst protecting women’s rights
scenario: how can Code of Ethics support you..
1) in advocating for normal birth, when woman wants to birth in a secondary / tertiary hospital
Responsibility to woman:
informed choice and consent
work in partnership
respect her holistic needs
accept her right to make decisions / control her pregnancy experience
also have a responsibility not to interfere with normal process of birth- could offer to share evidence with woman about birth outcomes / birth settings
scenario: how can Code of Ethics support you..
in maintaining confidentiality when debriefing with other MW’s
Ethical responsibility to women:
protect privacy / maintain confidentiality- don’t disclose without consent
ethical responsibility to colleagues / profession-
share MW knowledge with others
MW could ask woman for consent to discuss woman’s experience with others- explain she’ll keep it confidential, debrief in a private setting
scenario: how can Code of Ethics support you..
when working with a MW whom you have concerns about her practice
Ethical responsibility to colleagues and profession
-support / sustain each other professionally
- take action if an act by colleagues infringes accepted standards of care
1) talk to the MW about concerns
2) report concerns to Council
scenario- how can code of ethics support you
when a reporter asks your opinion about a MW matter in the media
Code of ethics-
MW has ethical responsibility to support / sustain each other
uphold professional standards/ avoid compromise just for reasons of personal expedience
code of conduct
they act in a way that doesnt bring MW profession into disrepute
conduct themselves personally/professionally in a way that maintains public trust and confdience in MW profession
avoid making public comment which may bring profession into disrepute
scenario- how can code of ethics support you
when the woman makes a choice which you believe may be detrimental to her health / baby
code of ethics
ethical responsibility to women to:
- to respect woman’s right to make decisions, informed consent and choice
- ensure no act / omission causes harm to woman/baby- responsibility to ensure everything is documented and that the woman understands
- if MW is unsure about implications of decision, then should request consent to woman make referral
- responsibility to be true to her own value system, but also ensure woman is not deprived of essential care
What are the Standards Of Practice
NZCOM
provide guidance for MW practice, appropriate use of MW’s body of knwledge
integrate Turanga Kaupapa principles
10 standards
1) Work in partnership
2) uphold woman’s right to choice / consent
3) collates + documents assessments of mum and baby’s health
4) maintains records/ makes these available
5) MW care planned with the woman
6) MW actions prioritised + implented appropriately- no act/ omission placing woman at risk
7) MW is accountable to the woman, herself, MW profession, and wider community
8) MW Evaluates her practice(feedback, portfolio, MSR)
9) MW negotiates completion of MW partnership with woman
10) develops and shares MW knowledge, initiates and promotes research
What is the MSR
Midwifery Standards review
purpose: quality assurance process + professional development
- reflect on data, feedback / practice, using Standards for Practice + Turanga Kaupapa
- supported by 1 MW peer + 1 consumer rep
- develop Professional Development Plan
run by NZCOM, every 3 years ( 1st grad year, then 2 years later, then 3 years ongoing)
MW philosphy
partnership
continuity
holistic needs
normal process of childbirth
promote woman’s wellbeing
MW is dynamic in appraoch - integrates experience + research, collaborates with other specialists
Summarise objective/ functions of MCNZ
HPCAA (2003) ‘Responsible Authority’
Role: regulate MW’s, ensure they meet standard of education, conduct and performance to provdie high qulaity culturally safe healthcare
Functions
Set qualifications to become midwife, accredit preregistration programs
set standards for clinical, cultural competence
set Code of Conduct
register midwives
recertify midwives each year
review + ensure competence + fitness of midwives
What is the Recertification program
within 3 year period:
annually
apply for APC -
complete emergency skills refresher
8 hrs Professional activities
8 hrs continuing education (FY23- incl. one off Abortion training)
MSR- every 3 years
what are two MCNZ disciplinary bodies
Professional Conduct Committee:
- legal responsibility to investigate concerns about conduct- refer to Health Practitioner Disciplinary Tribunal / or to Competency Review Panel
- 2 MWs+ 1 layperson
Competency Review Panel
1-2 MW
meet with MW and observe her practice- (not disciplinary in nature). may recommend limitation to her scope/ suspend practice
What is the Code of Conduct
MCNZ
Explicit statements about professional conduct
provides a measure, by which MW’s are measured
support’s PCC in assessing breach of conduct
1) professional relationships
-obtain, use in a way that protects woman’s confidentiality + privacy
- maintain professional relationships - be careful providing care to women that you have existing relationship with / - don’t get involved romantically
- don’t let personal beliefs affect care to women
- be respectful/ non-discriminatory
- -end relationship appropriately
- provide impartial, honest, care (incl. written info in woman’s notes should be understandable, clear, professional)
2) interprofessional relationships
- follow due process making referrals / transfers
- interact with colleagues fairly/ respectfully i.e. don’t bully/ harass, don’t make unfounded criticism that undermines women’s confidence, ( follow process if they are concerned about colleague’s practice)
-always provide appropriate care to women in emergencies
3) professional behaviour
act in a way that doesn’t bring profession into disrepute
be fit to practice
use social netowrking sites iwth caution (be aware that text is unreliable)
don’t accept/give gifts that could be perfceived as gaining favour
don’t use drugs that impair clnical judgemetn
act without delay if they think health professional is putting womanbaby at risk
manage safe workloads
claim remuneration only as appropriate
what are risks of texting / what can you to do manage risk
risk
- info can be misunderstood
- delay receiving message
- you don’t know who is reading message
- easy to send inacurate info/ to the wrong person
manage
-get consent to text
establish boundaries- what to text/ what to ring for
-check who is reading texts
- manage security of texts
- cerate system to confirm receipt of text
statement of cultural competence
turanga kaupapa
