Reglamento Municipal de Beneficencia y Sanidad, Elche 1928 / Regulamento Municipal de Caridade e Saúde, Elche 1928 / Municipal Regulation of Charity and Health, Elche 1928

The health policy of Primo de Rivera elaborated a regulatory legal body to protect the needyclasses that attended to their needs; the increase in health activity led to the creation of a large number ofcare institutions as well as professional health professionals involved in its development. Objectives: theresearch aims to analyze the practical application of the municipal Health and Welfare Regulations of thecity of 1928 and, on the other hand, its impact on the social life of the underprivileged class. Method: ahistorical research based on the literature review was carried out. Documentary sources: documentarycatalogs of libraries and documentary archives, electronic databases, catalogs of magazines specializingin history and other online sources. Descriptors used: midwife, practitioner, doctor, pharmacist, census ofthe poor. Results: documents from studies based on primary sources were included in the analysis and theresults are presented in 4 sections: The Municipal Regulation of 1928, Pharmacists and medicines forpoor patients, Doctors and practitioners and Midwives, midwives and childbirth teachers. Conclusion: theRegulation is applied long before its publication and health care is constantly exercised by all theprofessionals that comprise it; the number of practitioners is equal to that of doctors in this period; theCity Council is responsible for paying pharmaceuticals for poor patients to pharmacists and is distributedby quarters; With regard to doctors, and since 1924, sufficient places have been created for the demand ofthe poor, which will increase, as well as possible substitutes; the creation of the dental clinic for the poorin the Santo Hospital in 1930 is included; in 1928 and 1929 there are 4 matrons for the four districts ofthe city, following the legislation; In 1930 the municipal midwives received an annual salary increasefrom 720 to 900 pesetas from the town council. (AU)

La política sanitaria de Primo de Rivera elaboró un cuerpo legal reglamentario para proteger a lasclases menesterosas que atendía sus necesidades; el aumento de la actividad sanitaria supuso la creaciónde un gran número de instituciones asistenciales así como de sanitarios profesionales implicados en sudesarrollo. Objetivos: la investigación tiene por objetivos analizar la aplicación práctica del Reglamentomunicipal de Sanidad y Beneficencia de la ciudad de 1928 y, por otra parte, su repercusión en la vidasocial de la clase menesterosa. Método: se llevó a cabo una investigación histórica basada en la revisiónbibliográfica. Fuentes documentales: catálogos documentales de bibliotecas y archivos documentales,bases de datos electrónicas, catálogos de revistas especializadas en historia y otras fuentes de red.Descriptores utilizados: matrona, practicante, médico, farmacéutico, padrón de pobres. Resultados: en elanálisis se incluyeron documentos procedentes de estudios basados en fuentes primarias y los resultadosse presentan en 4 apartados: El Reglamento municipal de 1928, Farmacéuticos y medicamentos paraenfermos pobres, Médicos y practicantes y Matronas, comadronas y profesoras de partos. Conclusión: elReglamento se aplica mucho antes de su publicación y la asistencia sanitaria es ejercida de maneraconstante por todos los profesionales que la integran; el número de practicantes se equipara al de médicosen este período; el Ayuntamiento se hace cargo del pago de medicamentos para enfermos pobres a losfarmacéuticos y se reparte por trimestres; respecto a los médicos, y desde 1924, se van creando plazassuficientes para la demanda del padrón de pobres, que irá en aumento, así como posibles suplentes; seincluye la creación del gabinete odontológico para pobres en el Santo Hospital en 1930; en 1928 y 1929hay 4 matronas para los cuatro distritos de la ciudad, siguiendo la legislación; en 1930 las matronasmunicipales reciben un aumento. (AU)

A política de saúde de Primo de Rivera elaborou um órgão legal regulador para proteger asclasses carentes que atendiam às suas necessidades; O aumento da atividade de saúde levou à criação deum grande número de instituições assistenciais, bem como de profissionais de saúde envolvidos no seudesenvolvimento. Objetivos: a pesquisa visa analisar a aplicação prática do Regulamento Municipal deSaúde e Previdência da cidade de 1928 e, por outro lado, seu impacto na vida social da classe menosfavorecida. Método: foi realizada uma pesquisa histórica com base na revisão de literatura. Fontesdocumentais: catálogos documentais de bibliotecas e arquivos documentais, bases de dados eletrônicas,catálogos de revistas especializadas em história e outras fontes online. Descritores utilizados: parteira,praticante, médico, farmacêutico, censo dos pobres. Resultados: foram incluídos na análise documentosde estudos baseados em fontes primárias e os resultados são apresentados em 4 seções: O RegulamentoMunicipal de 1928, Farmacêuticos e medicamentos para doentes pobres, Médicos e praticantes eParteiras, parteiras e professoras de parto.Conclusão: o Regulamento é aplicado muito antes de suapublicação e a assistência à saúde é exercida constantemente por todos os profissionais que o compõem; onúmero de praticantes é igual ao de médicos nesse período; a Câmara Municipal é responsável pelopagamento dos medicamentos dos doentes pobres aos farmacêuticos e é distribuído por trimestres; Noque diz respeito aos médicos, e desde 1924, foram criadas vagas suficientes para a procura dos pobres,que irá aumentar, bem como eventuais substitutos; inclui-se a criação da clínica odontológica para pobresno Hospital Santo em 1930; em 1928 e 1929 há 4 matronas para os quatro bairros da cidade, seguindo alegislação; Em 1930, as parteiras municipais receberam um aumento salarial anual de 720 para 900pesetas da câmara municipal. (AU)

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.

Australian midwives and clinical investigation: Exploration of the personal and professional impact.

BACKGROUND: The purpose of regulation of health professionals is public protection. Concerns regarding professional conduct or midwifery care can lead to clinical investigation. Midwifery literature reveals midwives feel ill-equipped and unprepared for clinical investigation and experience stress and abreaction. AIM: To explore the lived experience of clinical investigation and identify the personal and professional impact on Australian midwives. METHOD: Semi-structured interviews of a purposive sample of Australian midwives. Data analysis was informed by a phenomenological conceptual framework derived from Husserl, Heidegger and Merleau-Ponty. FINDINGS: Twelve midwives were interviewed, with seven under current investigation. Discussion involved personal and professional experiences of three or more investigations each, over a period of three to five years. Most investigations were instigated by hospitals with two complaints from women. Seven participants were alleged negligent following adverse neonatal outcomes and five had misconduct allegations. Midwives were employed or in private practice and half provided homebirth services. Themes included being safe, being connected, time and being, perception and well-being. DISCUSSION: The investigative process involves different health services, state and national bodies using varying powers and processes over protracted time periods. Participants discussed aspects such as disrespect, inequity, powerlessness, silence and ostracization. Midwives who successfully navigated clinical investigation developed resilience through reflection on clinical practice in a culture of safety. CONCLUSION: The process of regulating midwives, designed to protect the Australian public, may be harming investigated midwives. Understanding the personal and professional impact of clinical investigation needs to underpin midwifery education, clinical practice, inform policy and regulatory reform.

Barriers and enablers for midwives to use the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives.

BACKGROUND: In 2010, the Nursing and Midwifery Board of Australia introduced a new registration standard: Endorsement for scheduled medicines for midwives. The endorsement enables midwives to provide women with Medicare-rebatable care, prescribe relevant medications, and order relevant Medicare-rebatable diagnostics. Translating endorsement education into clinical midwifery practice has been slow, indicating the presence of barriers affecting midwives' ability to use this standard, despite it increasing their scope for service provision. AIM: To discover the mechanisms affecting midwives' ability to work to full scope of practice after completing a programme of study leading to endorsement. METHODS: An observational (non-experimental) design was used. Midwives who had completed an education programme leading to endorsement were invited to complete a survey. Descriptive statistics were used to analyse the quantitative questions and content analysis was conducted on the qualitative data. FINDINGS: Results indicated that barriers - such as the limitations of Medicare provisions for endorsed midwives and a general lack of support for the role - restrict endorsed midwives' ability to provide quality maternity services. Having some form of support for the role may act as an enabler, in addition to midwives having personal determination and confidence in their ability to use the endorsement. Recommendations to strengthen the endorsed midwife's role include facilitating endorsement use in the public sector, relaxing Medicare Benefit Schedule and Pharmaceutical Benefit Scheme restrictions, raising awareness of the role and scope, and improving midwives' pre-endorsement preparation. CONCLUSION: This study highlights the need for an all-of-system approach to support and develop the endorsed midwife's role.

Telemedicine services in the work of a doctor, dentist, nurse and midwife - analysis of legal regulations in Poland and the possibility of their implementation on the example of selected European countries.

INTRODUCTION AND OBJECTIVE: The aim of the study is to discuss the legal framework for telemedicine services in Poland, and to present telemedicine solutions used in selected European countries. MATERIAL AND METHODS: The analysis of legal cts was chosen as a research method in order to determine legal possibilities for medical professionals to use telemedicine services. A literature review was undertaken to demonstrate the possibilities of telemedicine as used in the United Kingdom, Germany, Norway, The Netherlands and Sweden. RESULTS: The Act on the professions of a doctor and a dentist states that the doctor and the dentist can perform their profession via ICT systems or communication systems. The doctor is obliged to practice in accordance with current medical knowledge and available methods. 'Available methods' include considering information and communication measures that may allow prevention, recognition or treatment. The Act on the profession of a nurse and a midwife states that the nurse and midwife perform the professions using current medical knowledge and the mediation of ICT systems or communication systems. Thus, the legislator has clearly authorized persons performing these professions to provide services in the field of telemedicine. However, despite the existence of a legal basis for using telemedicine, its development in Poland is not as high as in the United Kingdom, Germany, Norway, The Netherlands or Sweden. CONCLUSIONS: The legislator gradually introduces legal solutions necessary for the development of telemedicine services, although the pace of these changes, as well as building the technical infrastructure that is the basis for the proper provision of telemedicine services, are too slow.

["Humanized childbirth and the right to choose:" analysis of a public hearing in Rio de Janeiro]. / "Parto humanizado e o direito da escolha": análise de uma audiência pública no Rio de Janeiro.

This work uses a field survey to analyze a plenary session of the Rio de Janeiro Legislative Assembly entitled "Humanized childbirth and the right to choose." Understanding this as a political space for conflicts of knowledge pertaining to the areas of medicine, nursing, and legislature, we consider the content of this session and discourses of power/knowledge surrounding the female body and reproduction. The article explores tensions around the political struggle for "humanized childbirth" via demands made by the Regional Council of Nursing. We also address the history of the medicalization of childbirth and the role of nurses, professionals specialized in low-risk births (obstetrizes), and midwives in this process.

O trabalho analisa, por meio de pesquisa de campo, uma plenária da Assembleia Legislativa do Rio de Janeiro, "Parto humanizado e o direito da escolha". Entendendo esse como um espaço político de conflitos dos saberes da área médica, da enfermagem e do Legislativo, é ponderado o conteúdo da plenária com os discursos de saber/poder acerca do corpo feminino e de sua reprodução. O artigo explora as tensões em torno da luta política pelo "parto humanizado" a partir de demandas feitas pelo Conselho Regional de Enfermagem. É abordada também a história da medicalização do parto e o papel das enfermeiras, obstetrizes e parteiras nesse processo.

"Parto humanizado e o direito da escolha": análise de uma audiência pública no Rio de Janeiro / "Humanized childbirth and the right to choose: " analysis of a public hearing in Rio de Janeiro

Resumo O trabalho analisa, por meio de pesquisa de campo, uma plenária da Assembleia Legislativa do Rio de Janeiro, "Parto humanizado e o direito da escolha". Entendendo esse como um espaço político de conflitos dos saberes da área médica, da enfermagem e do Legislativo, é ponderado o conteúdo da plenária com os discursos de saber/poder acerca do corpo feminino e de sua reprodução. O artigo explora as tensões em torno da luta política pelo "parto humanizado" a partir de demandas feitas pelo Conselho Regional de Enfermagem. É abordada também a história da medicalização do parto e o papel das enfermeiras, obstetrizes e parteiras nesse processo.

Abstract This work uses a field survey to analyze a plenary session of the Rio de Janeiro Legislative Assembly entitled "Humanized childbirth and the right to choose." Understanding this as a political space for conflicts of knowledge pertaining to the areas of medicine, nursing, and legislature, we consider the content of this session and discourses of power/knowledge surrounding the female body and reproduction. The article explores tensions around the political struggle for "humanized childbirth" via demands made by the Regional Council of Nursing. We also address the history of the medicalization of childbirth and the role of nurses, professionals specialized in low-risk births (obstetrizes), and midwives in this process.

Midwifery education, regulation and association in the Democratic Republic of Congo (DRC) - current state and challenges.

Background: In the Democratic Republic of Congo (DRC), maternal and neonatal health outcomes are poor and delivering healthcare services of sufficient quality is a challenge as there are only 0.6 midwives, physicians, or nurses for every 1,000 inhabitants.Objective: To explore the current state of the midwifery profession in the DRC and to suggest suitable strategies for increasing the quality and quantity of a highly competent midwifery health workforce in the DRC.Methods: Data were collected at a workshop with 17 key persons using three questionnaires developed by the International Confederation of Midwives, and three focus group discussions. The analysis was focusing on quantitative and qualitative content.Results: In DRC the midwife profession is not legislated. A midwifery association is well established, but due to a lack of resources does not function optimally. Two midwifery education programmes exist: a three-year direct-entry programme resulting in a diploma in midwifery, and a 12-month postgraduate programme for nurses resulting in a certificate in midwifery. Neither of the programmes leads to a bachelor's or master's degree. At the institutions offering the midwifery programmes (n = 16), the educators' academic qualifications are lower than required and there is a lack of teaching and training equipment for meeting the education needs.Conclusions: The Sustainable Development Goal on health, and specifically the health of mother and newborn, will be difficult to meet in the DRC. We therefore suggest that (i) the midwifery education programmes be improved to meet international standards; (ii) these programmes be designed in a way that allows for an academic degree at either the bachelor's or master's level; (iii) the competence level of the midwifery educators be increased; and, most crucially, (iv) a regulatory structure be formed that legislates and regulates the midwifery profession and its autonomous practice.

The Scope of Midwifery Practice Regulations and the Availability of the Certified Nurse-Midwifery and Certified Midwifery Workforce, 2012-2016.

INTRODUCTION: Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level. METHODS: Midwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse-Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs. RESULTS: Twenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife-attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001). DISCUSSION: Midwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States.

Barriers and enablers for midwives using endorsement for scheduled medicines: A literature review.

PROBLEM: There are currently 429 midwives in Australia who hold the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives. Little is known about how midwives are using the endorsement and what factors impact on its use. OBJECTIVE: To critically examine the literature to discover what the barriers and enablers are for midwives to use the endorsement. METHOD: A search was undertaken examining literature published since 2004. Due to a lack of articles specific to midwifery, the search was widened to include literature related to similar non-medical health professions. The search was divided into two streams: accessing the Medicare Benefits Schedule and accessing the Pharmaceutical Benefits Scheme and prescribing. Twenty-six primary articles from 2009 onward met the review criteria. FINDINGS: Although singular barriers and enablers to both streams were identified, many of the themes act as both enabler and barrier. Themes common to both the Medicare Benefits Schedule focus and the Pharmaceutical Benefits Scheme and prescribing focus are that of medical support, scope of practice, ongoing support from health care consumers and management, and endorsement processes. Barriers occur approximately three times more frequently than enablers. CONCLUSION: Barriers and enablers occur for various reasons including legislative, regulatory, organisational, and the individual's support for and attitude towards these roles. To overcome barriers and facilitate the success of emerging non-medical extended practice roles, significant buy-in and investment is needed across all levels of the health system. The review highlights a significant gap in knowledge about the endorsement's use in midwifery.

Knowledge of US Midwifery Credentials Among Members of the American College of Nurse-Midwives.

INTRODUCTION: Three midwifery credentials are granted in the United States: certified nurse-midwife (CNM), certified midwife (CM), and certified professional midwife (CPM). Confusion about US midwifery credentials may restrict growth of the midwifery profession. This survey assessed American College of Nurse-Midwives (ACNM) members' knowledge of US midwifery credentials. METHODS: ACNM members (N = 7551) were surveyed via email in 2017. The survey asked respondents to report demographic information and to identify correct statements about the education, certification, and scope of practice of CNMs, CMs, and CPMs. Responses to 17 items about all midwives certified in the United States, a 5-item subset specific to CNMs/CMs, and one item related to location of midwifery practice by credential were analyzed. RESULTS: Nearly a quarter of the membership (22.1%) responded to the survey. Higher scores on the survey indicated greater identification of correct statements about the education, certification, scope, and location of practice of CNMs, CMs, and CPMs. Significant differences in scores were found among ACNM members based on their level of education, degree of professional involvement in midwifery, and prior practice as a nurse. ACNM members with higher scores on the survey held a doctorate, worked in Region I, and had greater professional leadership involvement in midwifery organizations. Participants with less nursing experience prior to their midwifery education also scored significantly higher on the survey. DISCUSSION: Although two-thirds of respondents correctly answered items on the preparation, credentialing, and scope of practice of CNMs, CMs, and CPMs, a significant minority had gaps in knowledge. Results of this survey suggest the need for outreach about US midwifery credentials. Future research to replicate and expand upon this survey may benefit the profession of midwifery in the United States.

Ethical dilemmas and legal aspects in contraceptive counselling for women with intellectual disability-Focus group interviews among midwives in Sweden.

BACKGROUND: Few studies have explored ethical and legal issues in contraceptive counselling among women with intellectual disability (ID). This study aimed to gain a deeper understanding of these issues during midwifery contraceptive counselling. METHOD: The present authors interviewed 19 midwives in five focus groups in Sweden 2016 - 2017 and analysed data with content analysis. RESULTS: The participants expressed that women with intellectual disability have equal right to relationships and sexual expressions, but feared exposure to sexual exploitation/abuse. They experienced ethical dilemmas related to principles of fairness and autonomy, but strived to provide assistance in spite of the women's cognitive impairment, presence of supporting persons and uncertainty of optimal counselling. Organizational support was insufficient. CONCLUSIONS: The midwives experienced ambivalence, uncertainty and ethical dilemmas in their counselling. They were, however, aware of legal aspects and strived for the women's best interest, right to self-determination and autonomous choices. The participants wanted better professional teamwork and support.

Potential conflicts in midwifery practice regarding conscientious objection to abortions in Scotland.

BACKGROUND:: This study was developed as a result of a court case involving conflicts between midwives' professional practice and their faith when caring for women undergoing abortions in Scotland. RESEARCH QUESTIONS:: What are practising Roman Catholics' perspectives of potential conflicts between midwives' professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the 'conscience clause' to midwifery practice today? and What are participants' understandings of Canon 1398 in relation to midwifery practice? RESEARCH DESIGN:: The theoretical underpinning of this study was Gadamer's hermeneutic out of which the method developed by Fleming et al. involving a five-stage approach was utilised. PARTICIPANTS AND RESEARCH CONTEXT:: The research was conducted in the south of Scotland. A purposive sampling method was used. Eight participants who were practising Roman Catholics familiar with the subject of conscientious objection who were either midwives, lawyers (civil, canon or both) or priests contributed. ETHICAL CONSIDERATIONS:: The major ethical issues related to respect for autonomy, maintaining confidentiality and obtaining voluntary informed consent. Parish priests agreed to act as gatekeepers to prospective participants. All legal requirements were addressed regarding data collection and storage. Approval was given by the ethics committee of the university with which one of the researchers were associated. FINDINGS:: Three key themes provide an understanding of the situation in which midwives find themselves when considering the care for a woman admitted for an abortion: competing legal systems, competing views of conscience and limits of participation. CONCLUSION:: Clear guidelines for practice should be developed by a multi-professional and consumer group based on an update of the abortion law to reflect the change from a surgical to medical procedure. Clarification of Canon 1398 in relation to what is and is not participation in the procurement of abortion would be of benefit to midwives with a conscientious objection.

Legal complaints about midwives and the impact on the profession.

INTRODUCTION:: Midwives play an important role in maintaining and increasing women's health and well-being. Training professional midwives is one of the main policies of any healthcare system. Since the number of complaints against midwives has increased recently, this study was conducted to explore the perspectives of midwives regarding patients' complaint to authorities and their impacts on the profession of midwifery. METHODS:: Being conducted in 2013, this qualitative study was the first of its type in Iran. Data were collected through in-depth semi-structured interviews with 14 midwives working in different cities across the country. The participants were selected using a purposive sampling method. Interviews were transcribed verbatim and analyzed following a qualitative content analysis approach. Written text was then coded, and themes were extracted from the data. Ethical considerations: The study was conducted with midwives' free informed consent and was approved by Ethics Committee of Tehran University of Medical Sciences. FINDINGS:: By analyzing the data, four main themes regarding the impact of complaint on midwifery profession were developed. These included the following: "dissatisfied of midwifery, professional deviation, obsession with work, and weakening of the professional status." CONCLUSION:: The experience of patients' complaint to legal authorities against midwives was described, by participants, as a painful experience. Lack of midwives' knowledge about professional rules and litigation process created many problems for them and could negatively affect their practice and the society's attitude toward midwifery. Thus, we suggest that in order to prevent such problems, midwives and midwifery students should be educated regarding factors that have the potential to create such problems and also prevention strategies.

How Australian dual registrants identified as midwives to meet national registration-renewal requirements.

AIM: A theoretical discussion using categorisation theory to discuss the final analysis of findings from research which investigated midwives' responses to the changed registration-renewal requirements in Australia after the introduction of national registration. BACKGROUND: In 2010 the Health Practitioner Regulation National Law Act introduced national registration to standardise the regulation of health professionals in Australia. Annual registration-renewal standards required all health professionals to meet the same standards of clear police check, insurance for scope of practice, Continuing Professional Development (CPD) and Recency of Practice (ROP). QUESTION: How did dual registered midwives respond to the changed registration-renewal requirements when national registration was introduced? METHODS: A longitudinal single case study was conducted in two phases between 2011-2013 with a purposive sample of 24 midwives from five states of Australia to perform individual or group interviews. FINDINGS: Participants used inclusion and exclusion criteria to create boundaries around practice to illustrate how they met the registration-renewal standards. Accentuation (exaggeration) of practice helped them define their separate professional registrations. Boundaries included the type of person being cared for, practice activities. and place of practice. CONCLUSION: The theory of categorisation helped explain the dual registrants' behaviour and rationalise their midwifery responses.

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