Challenges and needed reforms in midwifery and nursing regulatory systems in India: Implications for education and practice.

BACKGROUND: In India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms. METHODS: We undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective. RESULTS: There is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges. CONCLUSIONS: India is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.

Reconocimiento de la prescripción enfermera en España, una batalla a punto de culminar / The recognition of prescribing by nurses, a battle that is about to be won

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United States Model Midwifery Legislation and Regulation: Development of a Consensus Document.

INTRODUCTION: Midwifery is defined and regulated across all 50 United States. However, states' regulations vary markedly, creating confusion for policy makers and consumers, and can limit services to women. In 2011, the International Confederation of Midwives released Global Standards for Midwifery Education, Regulation, and Association, providing guidance for international midwifery for the first time. US organizations representing midwifery education, regulation, and professional associations (US MERA) agreed to work together on common goals. METHODS: The purpose of this modified Delphi study, conducted by US MERA, was to develop a consensus document on principles of model US midwifery legislation and regulation. Expert panelists (N = 51) across maternal and child health care professions and consumer groups participated over several iterative rounds. RESULTS: The final document establishes guiding principles for US midwifery regulation, including regulatory authority, education, qualifications, regulation, registration and licensure, standards of practice and conduct, complaints, and third-party payment for services. DISCUSSION: As more US states recognize and license midwives of all credentials and in every practice setting, we can envision a time when equity, informed choice, safety, and seamless access to quality midwifery care will be the right of every birthing family.

Prescripción enfermera: más barreras para cuidar a las mujeres / No disponible

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Perceptions of Indonesian general practitioners in maintaining standards of medical practice at a time of health reform.

BACKGROUND: There is little research on how GPs experience the demands of maintaining standards of medical practice in developing countries and what strategies might improve their capability to provide high-quality primary health care (PHC). OBJECTIVE: This study aims to explore the underlying factors, which shape GPs' experience within the Indonesian PHC system and impact on their experience of professional practice. METHODS: A grounded theory approach was applied using semi-structured interviews of 25 purposively selected GPs in West Sumatra, Indonesia. The interviews were analysed inductively through an iterative process of the interplay between empirical data, emerging analysis and theory development. RESULTS: Three major health care systems attribute shaped GPs' experiences of professional practice, including (i) a restricted concept of the PHC system, (ii) lack of regulation of private primary care practice conducted by GPs, midwives, nurses and specialists and (iii) low coverage and inappropriate policy of the health insurance system. CONCLUSION: The findings indicate that a major revision of current health care system is required with a focus on promoting the concept of PHC services to the population, redefining the role of the GP to deliver recognised best practice within available resources, changing the way GPs are remunerated by the public health system and the health insurance industry, policing of the regulations related to the scope of practice of other health care professionals, particularly midwives and nurses, and regulation of prescribing. GPs can be the champions of the PHC service that Indonesia needs, but it requires sustained systematic change.

Comparative analysis of nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks: a discussion paper.

AIMS: To review, discuss and compare nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks. BACKGROUND: Scope of practice in professional nursing and midwifery is an evolving process which needs to be responsive to clinical, service, societal, demographic and fiscal changes. Codes and frameworks offer a system of rules and principles by which the nursing and midwifery professions are expected to regulate members and demonstrate responsibility to society. DESIGN: Discussion paper. DATA SOURCES: Twelve scope of practice and associated decision-making frameworks (January 2000-March 2014). IMPLICATIONS FOR NURSING: Two main approaches to the regulation of the scope of practice and associated decision-making frameworks exist internationally. The first approach is policy and regulation driven and behaviour oriented. The second approach is based on notions of autonomous decision-making, professionalism and accountability. The two approaches are not mutually exclusive, but have similar elements with a different emphasis. Both approaches lack explicit recognition of the aesthetic aspects of care and patient choice, which is a fundamental principle of evidence-based practice. CONCLUSION: Nursing organizations, regulatory authorities and nurses should recognize that scope of practice and the associated responsibility for decision-making provides a very public statement about the status of nursing in a given jurisdiction.

A framework to support the revalidation process.

In January 2016, all registered nurses and midwives will be required to revalidate their practice every three years. This will have implications for individual registrants and line managers. In May 2014 the chief nursing officer for Wales launched a new governance framework for post-registration nurse education in Wales. This article describes the framework, how it underpins a continuous cycle of improvement in care delivery, and how it could be used to support nurses and nurse managers to meet the requirements of the revalidation process.

Exploring historical conflicts between midwives and nurses: a perspective from Chile.

This article explores issues of historical disputes between nurses and midwives based in Chile. The interaction of these two professions in that country has become an arena of competition which leads to conflicts periodically, such as those related to the ownership of the care of new-borns, and that of projects aimed at relieving nurse shortages by enhancing midwives' nursing skills. Specifically, this article aims to build on historical and contemporary resources analysed from a sociological perspective, and present comparatively a rationale concerning nursing/midwifery jurisdictional conflicts through a social history account. Our analysis suggests that nurses/midwives interaction has been shaped by social-historical transformations and the continuous evolution of the healthcare system as a whole, resulting in a race towards technologisation. These interprofessional conflicts can be explained partly by mechanisms of boundary expansion within an organisational/interpretive domain, as well as varying degrees of medicalisation; and partly by a competition possibly originating from a middle-class consciousness. An eventual merger of the two professions might lead to the enhancement of the political power of the caring professions and integrated care.

[Et d'allhora in poi, mai si sentì più bene: a historical survey to find nursing origins in post-tridentine whitchcraft lawsuits in County of Bormio (1596-1630)]. / Et d'allhora in poi, mai si sentì più bene: un'indagine storica alla ricerca delle origini dell'assistenza infermieristica nei processi per stregoneria del Contado di Bormio nel periodo post-tridentino (1596-1630).

INTRODUCTION: The phenomenon of witch-hunting in the post-tridentine period is a crucial moment for the history of nursing care. Modern historiography tells that women accused of witchcraft were custodian of female knowledge, both in domestic and small communities. PURPOSE: To investigate the witchcraft phenomenon in specific context of Bormio country- side, in order to identify proper nursing acts in gestures of women accused of witchcraft or sorcery. METHODS: Process for witchcraft - sorcery against 7 women in Bormio, between 1590 and 1631, were reviewed through a historical research methodology: sources retrieval, description and documentary analysis characterization, interpretation. RESULTS: In nearly all legal proceedings analyzed an indictment due to a healthcare expertise was found in terms of touch, feed, nearness, word. By multiple daily acts of women, intention to help and to express solidarity was clear, in a scenario of disease and suffering, solidarity is shown by acts of care. CONCLUSIONS: As a result of this study, we can resume that the period of the witches, so hard for women , was an age of repression for history of nursing itself. Mankind lifestyle, assistance, aid are ontological and anthropological foundations of nursing. Therefore, a past research of the traces of those foundations could mean rebuilding the own sense of nursing act: we tried to get an approach to that sense also "listening to" the gestures of women in Bormio.

Development of a framework to measure health profession regulation strengthening.

This paper describes the development of a framework to evaluate the progress and impact of a multi-year US government initiative to strengthen nursing and midwifery professional regulation in sub-Saharan Africa. The framework was designed as a capability maturity model, which is a stepwise series of performance levels that describe the sophistication of processes necessary to achieve an organization's objectives. A model from the field of software design was adapted to comprise the key functions of a nursing and midwifery regulatory body and describe five stages of advancing each function. The framework was used to measure the progress of five countries that received direct assistance to strengthen regulations and to benchmark the status of regulations in the 17 countries participating in the initiative. The framework captured meaningful advancements in regulatory strengthening in the five supported countries and the level of regulatory capacity in participating countries. The project uses the framework to assess yearly progress of supported countries, track the overall impact of the project on national and regional nursing regulation, and to identify national and regional priorities for regulatory strengthening. It is the first of its kind to document and measure progress toward sustainably strengthening nursing and midwifery regulation in Africa.