Reporting Obligations in Healthcare

Mandatory Notifications

• The National Law requires mandatory notifications to protect the public.
• Separate guidelines exist for mandatory notifications about registered health practitioners and registered students.
• Guidelines about students are relevant for students, registered health practitioners, and education providers of registered students.
• Students should be familiar with these guidelines.
• According to the NMBA website, the National Law does not require a student to make a mandatory notification (complaint or concern); a complaint or concern can be raised about an impaired student.

Mandatory Notifications about Students

• The treating practitioner, non-treating practitioner, and education providers should make a mandatory notification.
• A mandatory notification is required if there are concerns that a student's impairment will place the public at substantial risk of harm.
• Students are not required to make a mandatory notification about a practitioner or another student.

Protection of Notifiers

• The National Law protects anyone making notifications in good faith.
• Good faith means being well-intentioned or without malice.
• Section 237 of the National Law protects from civil, criminal, and administrative liability, including defamation, for those making notifications in good faith.
• Making a notification is not a breach of professional etiquette or ethics and is an ethical responsibility.

Issues to be Reported

• Mandatory reporting is only about concerns about impairment.
• Impairment is defined as a physical or mental impairment, disability, condition, or disorder that detrimentally affects or is likely to affect the student's capacity to carry out clinical training.
• An illness or condition that does not have a detrimental impact on a student's capacity to undertake clinical training is not an impairment.

Professional Boundaries

• Professional boundaries in nursing protect the space between the professional's power and the client's vulnerability.
• They mark the edges between a professional, therapeutic relationship and a non-professional or personal relationship between a nurse and a person in their care.
• Professional boundaries ultimately serve to protect the community.
• When a boundary is crossed, the behavior is unprofessional and a misuse of power in the relationship.

A Continuum of Professional Behavior

• The continuum of professional behavior includes disinterested neglectful, therapeutic relationship, and boundary violations.
• Every nurse-client relationship can be plotted on this continuum.

Guiding Principles for Safe, Professional Practice

• Dual relationships and boundaries: avoid, but if unavoidable, establish, maintain, and communicate boundaries, and take steps to minimize risks of harm.
• Access to or disclosure of information: protect personal information of clients/patients, and consider carefully the need to disclose information.
• Therapeutic and care relationships: never withhold care as punishment, and be aware of potential person discomfort with physical contact and respond accordingly.
• Gifts, services, and financial relations: avoid anything beyond token gifts, and check with the organization if unsure.

Cultural Safety

• Cultural safety is a philosophy, epistemology, and a model for practice.
• It means flexible, responsive, and respectful health care, prioritizing clients' needs, and recognizing that health means different things to different people.
• Culturally safe nurses have undertaken a process of reflection on their own cultural identity and social position, recognize the impact of their own personal culture and social position, and are knowledgeable about Australian history and current social practices.

Principles of Cultural Safety

• Culture can be defined in many ways and is learned and dynamic.
• Ongoing critical reflection is needed, and power and privilege must be acknowledged.
• All human interactions have cultural dimensions, and all people are unique and experts on their own culture.
• Power sharing and negotiation is important to challenge racism, class privilege, and ethnocentrism.

Why We Need a Culturally Safe and Responsive Health System

• It improves access to health care and quality of care.
• It addresses racism and inequity, and delivers care based on individual needs, respecting cultural values, strengths, and differences.
• Culturally safe health care is defined with reference to people's experiences of receiving health care, how health care is delivered, and accessibility of services.

The Biomedical Model

• Focuses on treating individuals and ignores social origins of illness and prevention
• Based on the diagnosis and explanation of illness as a malfunction of the body's biological mechanisms
• Underpins most health professions and health services

Key Features of the Biomedical Model

• Doctrine of 'specific aetiology': every disease has a specific cause
• Body as a machine: body made up of interrelated parts, doctor as mechanic
• Mind-body distinction: disease located in physical body, mental state less important
• Neutral scientific process: medicine seen as neutral and objective

Limits of Biomedicine

• Reductionist: reduces disease to biological, cellular, molecular, and genetic levels, ignoring social and psychological aspects
• Narrow definition of health: health defined as absence of disease
• Individualistic: illnesses act upon people's bodies, causing illness
• Treatment vs. prevention: healthcare focused on curing, not preventing illness
• Treatment imperative: medicine seen as site for finding a cure

Implications of Biomedical Dominance for Cultural Safety

• Victim blaming: explaining social inequality through individual responsibility and assumed inferiority
• 'Lifestyle choices': individuals solely responsible for health choices, ignoring social context
• Medicalisation of life processes: normal human processes seen as medical problems requiring intervention
• Biological determinism: belief that individual and group behavior and social status are inevitable results of biology
• Objectification of patients: treatment focused on disease, dismissing patient experience

Structure-Agency Debate

• Social structure: recurring patterns of social interaction and institutions
• Agency: ability of individuals and groups to influence their own lives and society
• Debate: extent to which human behavior is determined by social structure

Discourses

• Bodies of knowledge shaping thoughts and influencing what is considered true
• Examples: gender roles, housing crisis, people who use drugs
• Influence of biomedical model on discourse around health

Implications for Power and Power Sharing

• Who defines a normal healthy body?
• Who decides where health budget is spent?
• Bio-power and biomedical dominance

Epistemology and Cultural Safety

• Knowledge is constructed by humans and is value and power laden.
• Critical perspectives aim for social change and theory of social constructionism.

Cultural Safety: A Model of Practice

• Flexible, responsive, and respectful healthcare that prioritizes clients' needs.
• Recognizes that health means different things to different people and is determined by the person and family, especially when caring for people from another culture.

Culturally Safe Nurses

• Have undertaken a process of reflection on their own cultural identity and social position.
• Recognize the impact of their own personal culture and social position on their professional practice and interactions.
• Are knowledgeable about Australian history and current social practices and have taken a stance on these.
• Consider, reflect, and are aware of professional and health organization cultures and their impact on client care, taking actions accordingly.

Principles of Cultural Safety

• Culture can be defined in many ways and is learned and dynamic.
• Multiple realities and no universally agreed definition of health.
• Ongoing critical reflection is needed for personal and organizational awareness.
• Acknowledge power and privilege.
• All human interactions have cultural dimensions.
• All people are unique and are experts on their own culture.
• Power sharing and negotiation are important to challenge racism, class privilege, and ethnocentrism.

Why We Need a Culturally Safe and Responsive Health System

• Improves access to healthcare and quality of care.
• Accessible healthcare is physically accessible, affordable, appropriate, and acceptable.
• Culturally safe healthcare respects cultural values, strengths, and differences.
• Addresses racism and inequity by requiring healthcare professionals and services to be culturally responsive and take action to overcome racism and power imbalances.

Cultural Safety in the Health Context

• Defined with reference to people's experiences of receiving healthcare, how healthcare is delivered, and accessibility of services.
• Delivers care based on individual needs, taking into account personal values, cultures, and beliefs.

Applying Cultural Safety into Practice

• Cultural safety is a philosophy that seeks social justice and fairness, confronting discrimination and racism.
• Applying cultural safety principles in practice improves access to healthcare and quality of care.
• It requires ongoing critical reflection, awareness, and action to overcome power imbalances and promote equitable healthcare.

Development of Nursing in Australia

• In the late 19th century, nursing services were provided mainly by charity organizations, focusing on sick-care and welfare, with an emphasis on hygiene and morals.
• There was no formal training in hospitals, and informal training was not always supported by hospital management, except for hygiene, order, and discipline.

Control and Power Struggles

• Many doctors did not see the need for nurses to be trained, except for menial work, patient hygiene, and other patient care.
• Power struggles existed between senior nurses, doctors, and hospital management to control nursing, with doctors often holding senior positions in nursing organizations.
• Doctors dominated the editorial content of nursing journals, limiting nurses' opportunities for improved pay and work conditions.

Nursing Registration Boards

• The Victorian Trained Nurses Association was established in 1902 as the first Australian nursing organization, requiring nurses to sit exams to become members.
• Nursing Registration Boards were established in Queensland in 1912 and other states in the 1920s, with hospitals responsible for nurse registration.

Gendered Social Processes

• Nursing was seen as "women's work" based on gendered social processes, with doctors working on professionalization strategies to exclude women from entering the medical profession and limiting the practices of other health workers, including midwives and nurses.

Medical Dominance and the Patel Case

• The Patel case exposed the systemic problem of medical dominance and the difficulty in challenging the clinical autonomy of doctors, with "whistle-blowers" having to turn to politicians and the media to have their concerns addressed.

Florence Nightingale and the Social Construction of Nursing Knowledge

• Florence Nightingale discussed ethical duties of confidentiality, communication, and the centrality of meeting patients' needs in her book "Notes on Nursing" (1860).

Cultural Safety in Healthcare

• In 2020, 22% of Indigenous Australian adults or their families reported being racially discriminated against by doctors, nurses, and/or medical staff in the last 12 months.
• Indigenous Australians waited longer for elective surgery and had a higher potentially avoidable mortality rate compared to non-Indigenous Australians.

Role of Health Professionals

• Health professionals, particularly nurses, play a significant role in improving outcomes by ensuring culturally safe and respectful care.

Life Expectancy Gap in First Nation Australians

• The life expectancy gap between First Nation Australians and the general population is 10 years lower.
• The question is whether we have the will to close this gap in a generation.

Health Inequity

• Poverty is the biggest enemy of health in the developing world, according to Kofi Annan, former Secretary-General of the United Nations.
• Income inequality in Australia is higher than the average of the rich countries that belong to the OECD.
• Since the mid-1970s, real earnings for the top tenth have risen by 59 per cent, while for the bottom tenth they have risen by just 15 per cent.

Impact of Increasing Inequality

• Big inequalities limit opportunities in the next generation, with rich parents having children who become rich and poor parents having children who become poor.
• Widespread public concern about growth of inequality questions the legitimacy of society.

Social Determinants of Health

• Social determinants of health, such as poverty, socioeconomic disadvantage, impact health outcomes.
• Understanding these social determinants helps provide culturally safe and person-centred care.
• Culture and background significantly impact health and health outcomes.

Covid-19 Pandemic and Health Inequality

• The Covid-19 pandemic has highlighted health inequities, with certain groups experiencing increased rates of morbidity and mortality.
• These groups include poorer people, marginalised ethnic minorities, low-paid essential workers, migrants, populations affected by emergencies, incarcerated populations, and homeless people.
• The social determinants of health that contribute to these inequities include poverty, deprivation, imposed mobility, lack of social protection, crowded housing, low occupational health standards, and unequal access to affordable treatment, prevention, and vaccination.

Learn about the mandatory notifications requirements in the National Law to protect the public, including guidelines for registered health practitioners and students.