Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

ANMC National Guidelines on Boundaries of Professional Practice for Nurses and Midwives

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

ANMC National Guidelines on Boundaries of Professional Practice for Nurses and Midwives

Article excerpt

The Australian Nursing and Midwifery Council (ANMC) is the peak national organisation established in the early nineties to bring a national approach to the regulatory framework for the profession of nursing and the profession of midwifery. The ANMC leads, and is responsible for supporting and establishing credible research initiatives and projects to provide the evidence required to inform this agenda. In accordance with the strategic direction of ANMC to establish a national approach to the regulation of the nursing profession and the midwifery profession, it is both essential and timely to consider the regulatory requirements and the professional benefits of undertaking a project to develop National Guidelines on Boundaries of Professional Practice for Nurses and Midwives.

Since 1998, most of Australia's Nursing and Midwifery Regulatory Authorities have published documents on boundaries of professional practice with respect to nurses and midwives. The NSW Boundaries of Professional Practice document stands out as the most comprehensive and credible document of its type developed in Australia. These guidelines, which have been adopted in Queensland, have been rigorously researched and validity tested by a team of experts. They are the product of a comprehensive literature review as well as a wide consultation process, together with an awareness of the National Health and Medical Research Council (NHMRC) principles of the development of clinical practice guidelines. The guidelines include a decision-making framework for identifying unsafe or dubious practice and a bank of case studies that apply the principles of safe practice to specific clinical scenarios. They also include a framework for illustrating the boundaries in nurse-client relationships and a decision-making flowchart. The guidelines are the product of an authenticated development process that safeguards against error. However, as they were developed in 1999 the ANMC concluded that it would be necessary to review and update them before releasing them as the national guidelines.

The ANMC earlier this year engaged Professor Margaret McMillan, Deputy Head, Faculty of Health, at the University of Newcastle as the consultant on the project team. Professor McMillan was the chief investigator on the 1999 project that developed the original guidelines. Her involvement in the original project makes her particularly eligible to oversee the development of the national guidelines using the NSW guidelines as the base document.

This editorial invites the reader to consider the dierapeutic relationships between the nurse/ midwife-patient/client and to examine the dynamic and ever-changing context in which the nurse or midwife provides care. The author also asks the reader to further consider what factors influence the nurse or midwife to 'boundary cross' and how they can identify and prevent diis event from occurring within their practice.

The nursing and midwifery professions require that members provide a caring service to those patients or clients with whom they work. The nature of the interaction that occurs between a nurse/midwife and a patient /client is a helping and caring one with die professional onus on the nurse or midwife to maintain a relationship that is therapeutic. This means that it is the responsibility of the nurse or midwife, to maintain his/her professional and personal boundaries as well as to assist colleagues and patients/clients in maintaining their boundaries. The nurse or midwife-patient/client relationship is based on trust, respect, intimacy and power. Betrayal of any of these components can be seen as abuse or exploitation of the patient/ client.

It may seem like common sense that a nurse or midwife will recognise the boundaries between a professional and personal relationship, however, the very intimate nature of nursing and midwifery provides a potential for a breakdown in the therapeutic relationship and for boundary crossings and violations to occur. …

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