LOC 2

Provide comprehensive nursing care in

accordance with the legal standards of
nursing practice
OBJECTIVS
• Define related concepts
• Outline the legal court system and their functions in
Namibia
• Describe the legal parameters applicable to nursing
practice
• Describe the aspects of human rights in the provision of
nursing care
• Discuss the fundamental rights of patients/clients,
families, communities as stipulated in the Constitution of
Namibia
Cont
• Discuss the patient charter of Namibia
• Differentiate between registration and
enrolment
• Distinguish between responsibility and
accountability
• Describe the areas in a health service which may
cause malpractice and litigation out of lack of
due care to enable the prevention of malpractice
in daily care.
Cont
• Discuss the rules relating to the acts of omission
by registered or enrolled persons which
constitute improper conduct or misconduct
Definition of concepts
• Legal: Something which is allowed or required by law.
• Legislation: A law or a set of laws passed by a
parliament.
• Policy: A plan of action agreed or chosen by a
political party.
• Human rights: Are the basic rights and freedoms that
all humans should be granted, such as right to life
and liberty, freedom of thought and expression, and
right to equality before the law.
Cont
• Negligence: Is when the nurse/midwife is
alleged to have failed to do what, in the opinion
of the complainant and his legal advisor, could
be expected from a reasonable nurse in similar
circumstances. (Searle & Pera, 1995: 277)
Cont
• Medico-legal hazards: Refers to medical and
legal problems that are a threat to the safety of
the patients.
• e.g. administering treatment wrongly/ in high
doses. Or failure to do something due to
negligence such as failure to monitor FHR of the
woman in labour.
cont
• Rule of law: It means that no person or
government is above the law. OR
• It means that no government or its officials can
enforce laws that are unfair or unjust
• Justice: Refers to fair treatment of patients and
the avoidance of discrimination and exploitation
• (Searle & Pera, 1995:142)
Cont
• Natural person: Is a legal subject who comes
into existence at birth
• A natural person and her legal subjectivity comes
to an end when death occurs
• The nurse is a natural person (Searle etal,
2013:189)
Cont
• Juristic person: Is a person created by the
process of law
• A nursing council is a ‘juristic person’ as it is
enabled by law to undertake all sorts of
responsibilities in performing its functions
• If a company is registered as a ‘juristic person’ it
can cease to exist by de-registration
Cont
• A juristic person ends when some action is taken
to withdraw its legal subjectivity
• (Searle etal , 2013:189)
Outline the legal court system and their functions in
Namibia
• There are three main legal court systems in
Namibia, namely:
• Constitutional law
• Civil law
• Common law
Constitutional law

• Professional organizations have constitutions

which authorize them and give them power
• Such organizations may be effected by an act of
parliament, or registered under either company
act or welfare act of the country
• These organizations are body corporates which
have certain powers conferred on them by body
members
Cont
• They have a definite standing under civil law, i.e.
they are juristic person (nursing council of
Namibia)
Civil law
• This regulates and enforces the legal rights of a
person
• It has 2 branches:
Cont
• Substantive law which deals in detail with the
legal rights and obligations of a person
• The law of procedure this sets out the nature of
the proceedings to be followed in a court to
secure redress when legal rights have been
infringed or legal duties neglected
Cont
• Health professional are often sued in court for
the commission or omission of an act which has
resulted in harm being done to the patient
Common law
• The term common law is used to denote all
those portions of national law not formed by
actual legislation, that is by act of parliament
Crimes
• A person who commits a crime, e.g. murder,
assault, theft or transgression of the law, is
punished by the state
Cont
Delict
• A delict is an act forbidden by law, but
committed without any wrongful intention,
which is injurious to a person or their property
• In a delict one who commits the offend may be
compelled to pay compensation to the offended
for the loss or injury suffered.
Cont
• Nurses facing prosecution in court will have to
face both the legislation governing nursing
(nursing board council) and common law aspect
• In addition to statutory and common law there is
a source of law called customs of community
• Customary law plays a minor role with the legal
system except in matters like tribal law
Describe the legal parameters applicable to nursing practice
Nursing Act 8 of 2004
• Purpose:
• To provide the establishment and constitution of a professional
Council for the nursing and midwifery or Accoucheur professions
• To determine the powers, duties and functions of such Council;
• To regulate the registration and enrolment of the members of such
professions
Cont
• To specify the education, training and
qualifications of persons practicing such
professions
• To prohibit the practicing of any such professions
without being registered
• To provide for matters incidental thereto.
(from Government Notice No. 153 of 2004)
Cont
• Government Gazette No. 2040, Notice 10 of
28/01/1999 :
• Nursing Professions Act, 1993:
• The Rules relating to the acts or omissions by the
Registered or enrolled persons constituting
improper conduct or misconduct.
Cont
• Government Gazette No. 2040, Notice 13 of
28/01/1999
• Nursing Professions Act, 1993:
• Regulations relating to the scope of practice of
persons who are registered or enrolled under
the Nursing Profession Act, 1993
Government Gazette no. 4140, Notice 250
of 17/10/2008:
• Regulations relating to the minimum requirements of
study for registration as a nurse or as a midwife
• Government Gazette No. 2010, Notice 11 of
28/01/1999
• Regulations relating to the registration and enrollment
of certain persons under the Nursing Act, 1993.
Describe the aspects of human rights in the provision of
nursing care

• Human rights of patients

• This refers to the rights of the population
regarding health matters
• These rights include the right to:
• Emergency medical treatment
• Information regarding one’s condition
Cont
• Give informed consent to treatment
• Participate in decision making regarding one’s
health
• Be informed when participating in research
• Privacy and confidentiality.
Cont
• Access to health records
• Submit complaints regarding health services
• Be treated with respect
• Self determination and independence
(autonomy)
Cont
• To decide what may be done to their bodies
• Receive information to enable them to make an
informed decision
• To know the effects of treatment
• Accept, refuse or stop treatment
Rights of nurses/service providers

• Practising according to what is legally permissible for their

specific practice
• Refusing to carry out a task that is regarded as being outside
the scope of their practice and for which they have
insufficient training or for which they have insufficient
knowledge and skills
• A safe working environment
Cont
• A working environment which is free of threats,
intimidation and/or interference
• A proper orientation
• Withholding participation in unethical and
incompetent practice
Cont
• Written policy guidelines and prescriptions
concerning the management or their working
environment
• A medical support or referral system to handle
emergency situations responsibly
Discuss the fundamental rights of patients/clients,
families, communities as stipulated in the
Constitution of Namibia

• All patients have the right to:

• Have access to services
• Integrity and dignity
• Have access to information
 THE RIGHT OF PATIENTS TO HAVE ACCESS
TO SERVICES
• The Patient Charter of Namibia,
• This means the right to:
• Receive care on the basis of need, regardless of:
• socio-economic status,
• race or ethnic origin,
• religion or beliefs,
• gender or sexual orientation,
• age, and political affiliation;
Cont
• Receive emergency care at all MOHSS facilities during
normal working hours and after hours where staff are
available;
• Be examined and treated as soon as reasonably
practically possible;
• Be referred to the next relevant level of care if
deemed necessary by the service provider
• Have access to the full range of preventative and
promotive services provided by the MOHSS at all
time
Cont

Receive the following services free of charge at

selected service points, such as:
• Immunization services
• Tuberculosis (TB) and Leprosy treatment
• Antenatal and postnatal services,
• Counseling services
Cont
• Family planning services
• Health education services
• Growth monitoring and child health
promotion.
• Give suggestions for improvement of services
THE RIGHT OF PATIENTS TO
INTEGRITY AND DIGNITY
• (The Patient Charter of Namibia,
• All patients/clients have the right to:
• Be treated with respect and courtesy at all times;
• Have their values, culture, religion and dignity respected at
all times
• To be listened to, to be heard.
Cont
• Privacy during consultation, physical
examination and treatment
• Confidentiality: all staff are legally obliged to
keep patient’s/ client’s information confidential
and use it only for the purpose of treatment,
unless legally obliged to do otherwise.
Cont
• Be given a clear explanation and advice on their
condition, illness and its proposed treatment
• Be informed upon request, on how to lodge any
complaint and have it investigated
• Be given detailed information on prescribed
treatment and possible intervention and to be
consulted when choices exist
THE RIGHT OF PATIENTS TO HAVE
ACCESS TO INFORMATION
(The Patient Charter of Namibia, July 1998: 8)
• All patients/clients have the right to:
• Be given detailed information on health and social welfare services
available and where to go for different services.
• Know the identity of the service provider attending to them.
Cont
• Access to the personal file in the presence of the
relevant staff though the file remains the
property of the ministry.
GENERAL RESPONSIBILITIES

Each patient/client has the responsibility to:

• Familiarize him/herself with the contents of this
charter and respect the rules and regulations of
the facility where she/he receives care.
• Keep his/her passport safe and have it at all
times even when travelling.
Cont
• Ask service provider for assistance and information.
• Accept that emergency cases will be given priority by service.
• Contribute towards the provision of service by paying service
fee.
• Be honest and give correct and true information to care
providers. (The Patient Charter of Namibia, July 1998: 9-10)
SPECIFIC RESPONSIBILITIES
• Each patient/client has the responsibility to:
• Bring along the necessary documents when
visiting any MOHSS facility , e.g. Health passport
(green/yellow/pink), identification (ID), or
Namibian Passport.
• Get to the health facility and back home.
• (The Patient Charter of Namibia, July 1998:11)
RESPONSIBILITIES RELATED TO THE
COMMUNITY
• Each community member has the responsibility
to:
• Attend and participate in education and
promotion activities organized by service
providers.
• Cooperate with service providers during
community treatment and care, e.g. By following
the prescribed instructions.
Cont
• Respect service providers and other users
• Maintain own personal hygiene.
• To sign “The refusal for Hospital Treatment (RHT) Form”
when refusing prescribed services and treatment and leaving
the facility.
• Keep the government facilities and their environment clean
and maintain hygienic conditions.
(The Patient Charter of Namibia, July 1998:12)
Discuss the patient charter of Namibia
• The patient Charter of Namibia was developed
to inform and create awareness amongst both
users and service providers, on issues that will
ensure a steady improvement of the service
rendered
• It reminds the providers to be sensitive to the
needs and interests of their patients.
Cont.
• The purpose of the patient charter is to recognise and protect the
integrity and dignity of patients
• It informs and reassures the nation that the services received are of
acceptable quality and affordable
• The charter recognises that with the community as partners, we can
achieve health for all Namibians
Cont
• Visit service facilities when required for necessary
follow-up
• Protect himself/herself against communicable
diseases esp. Sexually transmitted diseases such as
HIV.
• Report any threatening condition in the environment
to nearest service provider available
Cont
• Assist other community members as far as
possible during emergencies.
• Respect and safe guard government properties
 Describe the areas in a health service which may cause malpractice and
litigation out of lack of due care to enable the prevention of
malpractice in daily care.

Patients’ rights Examples of malpractices

Right to liberty and security of a person Patients are detained in hospital for inability
to pay

Right to privacy and confidentiality Patients’ medical information is open to all

staff
Patients are forced to disclose their medical
diagnosis to their employer in order to obtain
leave from work
Medical examination take place in public
conditions
Patient’s right
• Right to bodily integrity
• Right to security
• Right to freedom from torture and cruel,
inhuman and degrading treatment
• Right to the highest attainable standard
of health
Patient’s responsibility
• Doctors fail to obtain free an informed
consent from patients before
performing medical/surgical procedures
• Patients are not allowed to switch
doctors or health care providers
 Cont
Patient’s right Examples of malpractice
Right to life • Due to inadequate
reproductive health and
prenatal care complications
from pregnancy are a leading
cause of death for young
women
Right Examples of malpractice

Right to life • Ambulances fail to arrive at

certain communities or for
certain individuals in a timely
manner leading to patient
death
Patient’s right
Right to the highest attainable
standard of health
Example of malpractice
• Maternal and reproductive
health services are lacking
• Doctors and health facilities are
not located near
neighbourhoods of certain
communities
Patient;s right Example of malpractice

Right to freedom from torture and Prisoners are denied adequate

cruel inhuman and degrading medical services
treatment Women are sterilized without
their consent while giving birth
with caesarean section
Patient’s right Example of malpractice
Right to freedom from National laws restricting
torture and cruel inhuman opioids availability and
and degrading treatment access to cancer patients to
suffer unnecessarily
Patient’s right Example of
malpractice
Right to participate • Citizens lack an
in public policy opportunity to
comment on and
participate in the
setting of public
health priorities
Patient’s right
Right to the highest attainable
standard of health
Examples of malpractice
• Social policies
disproportionately exclude
patients from certain
communities from access to
health insurances
• Patients are given inferior
care
Patient’s right Examples of malpractice

Right to non-discrimination and • Teenagers are denied access to

equality family planning services
• Therapeutic abortion is illegal even
if the pregnancy is unplanned and
unwanted resulting in increased
cases of baby dumbing (except for
rape victims
Patient’s right Example of malpractice
Right to a remedy • The state takes
no/slow/limited action
to address any of the
violations described
above
Patient's right Example of malpractice
Right to decent working • Nurses are paid less than what
conditions their workload deserves,
compared to risks involved in
their work
• Medical staff are exposed to
dangerous high levels of
infections
Patient's right Example of a malpractice
• A nurse maybe infected with
HIV/hepatitis due to high
exposure and improperly
sterilized medical equipment
• Medical staff are threatened by
violent patients
Patient’s right Example of a
malpractice
Right to freedom of Authorities prevent
association a rally for improved
work conditions for
health workers
without justification
Patient's right Example of a malpractice
Right to due process A nurse facing
disciplinary proceedings
is unable to obtain access
to all evidence presented
against her in advance of
hearing
Patient’s right Example of a malpractice
Right to due process A doctor facing a medical
negligence law suit has still
not been given a hearing
date 5 years after
commencement of the
proceedings
Differentiate between registration and
enrolment
• The registered nurse/midwife must know not only
the scope of practice of her category of registration,
but the scope of enrolled nurses and enrolled
auxiliaries
• The registered nurse supervises the enrolled
categories
• The registered nurse starts at level 6/7 trainings and
above (diploma/degree)
Registration
• A nurse who went through the training and
his/her qualification was granted on the basis of
Nursing Act section 21 of Act 50 of 1978, should
exercise general nursing, psychiatric nursing,
community nursing as well as midwifery nursing
of all this should be registered.
The concept of enrolled nurse
• This applies to persons enrolled under a section of a Nursing
Act
• Enrolled nurse has certain options in her course, she may
train community nursing, psychiatric, but she is not enrolled
in these categories, she is only enrolled as a nurse
• The training of enrolled nurse is level 6 (2 years certificate
training)
Enrolment
• A nurse who went through nursing training and only able to
exercise some of the following options in her course,
psychiatric, geriatric, general or community nursing but did
not enrol with any of midwifery qualification/ course .
Cont
• Other than a midwifery qualification, there are no
other qualifications available to the enrolled nurse
unless she obtains a senior certificate and enters
training as a general nurse on a ‘bridging course’
• Otherwise they are allowed to enter a four year
comprehensive programme for them to be registered
nurse and midwife
The concept of enrolled nursing auxiliary
• There is one type of auxiliary nurse
• Their training is different from that of the professional nurse
• However the introduction of enrolled nurse training lead to
the cessation of the auxiliary nurse training
• Directly/indirectly accountable to a registered nurse
• (Searle & Pera, 1997: 93-94)
Distinguish between responsibility and accountability

• Derived from Latin words “ re” ( back) + “spondere” (to

pledge), which means to act, in return, to have an obligation
to account for something, that is, to be answerable to
someone or something.
• The term applies to one who has been delegated some duty
or responsibility by someone in authority and who is subject
to penalty in case of default.
Cont
• When a nurse or midwife accepts a post with a
health service authority, she accepts the
responsibilities that go with the post.
• She is responsible to her employer to carry out
her role, functions and tasks, and the policy of
her employer. (Searle & Pera, 1995: 229,
284)
ACCOUNTABILITY
• Accountability means that a person must
account for her actions,
• That, she or he must give satisfactory reasons for
her actions or explain her actions.
• An explanation of conduct can be demanded by
somebody who is empowered to seek such an
explanation.
Cont
• A sanction may be imposed.
• A registered person is accountable for her
actions, for the way in which she/he exercises
her responsibility.
• To be accountable, one must explain how one
did or did not exercise ones’ responsibilities.
RESPONSIBILITY
Refers to a duty to perform
some function in a
satisfactory manner
By accepting a post, one
accepts the responsibilities
that go with the post.
ACCOUNTABILITY
Entails giving an account of
one’s acts of omission and
commission.
Accountability relates to how
one exercises responsibility.
Responsibility is the basis for A registered person is
actions that requires accountable for her actions,
accountability. the way she exercised her
responsibility

Responsibility refers to being To be accountable one has to

delegated some duty by explain why he did/did not
someone in authority. exercise ones responsibilities
as a registered person.
Discuss the rules relating to the acts of omission by registered or
enrolled persons which constitute improper conduct or misconduct

• The following acts or omissions by a registered nurse shall constitute

improper conduct or misconduct in respect of which the Board may
conduct inquiries and take disciplinary:
• Omitting or neglecting to carry out such acts relating to monitoring,
diagnosing, treatment, prescription, collaboration, referral, co-
ordination and patient advocacy as the scope of the profession of a
registered nurse requires
Cont
• omitting or neglecting to maintain the health status of
a patient under his or her care or charge, or to protect
the name, person and possessions of that patient,
through:
• the correct identification of the patient
• the determination of the health status of the
patient and the physiological responses of the body
to disease conditions, trauma and stress
Cont
• the correct administration of treatment,
medication and care
• the prevention of accidents, injury or other
trauma;
• the prevention of infection and of the spread of
infection;
• the checking of all forms of diagnostic and
therapeutic interventions for the individual
Cont
• the specific care and treatment of the seriously ill patient, the
disturbed patient, the confused patient, the aged patient, infant
and children patients, the unconscious patient, the patient with
communication problems and the vulnerable and high-risk patient
• the monitoring of all vital signs of the patient concerned
Cont
• omitting or neglecting to keep clear and
accurate records of all actions which he or she
performs in connection with a patient
• contravenes section 27(1)(b), (2)(b) or (c) or (3)
of the Act of advertising:
• or permitting such advertisement, for
professional gain, other than by indicating his or
her name, address, telephone number, hours of
attendance and registered qualification
Cont
• of any other person, whether or not such person is registered or
enrolled under the Act or is a practitioner, or any product,
business, institution or organisation of any nature, for any purpose
and in any way, or permitting his or her name or photograph,
whether or not he or she is in uniform, to be used in such
advertisement,
Cont
• unilaterally breaking, without the approval of the other
party, a contract of service into which he or she has entered
• Refusing, omitting or neglecting to execute any lawful duties
for which he or she has been employed
Cont
• Supporting or assisting any person in any way in
illegal practice or action
• Employing of any person who is not registered or
enrolled in terms of the Act, to perform nursing
acts, except in an emergency
Cont
• Neglecting to refer the patient for medical care
where such care is beyond the scope of practice
of the nurse and delaying that referral
• Neglecting to do what he or she can do to save a
life, to arrest deterioration in the health status of
the patient, to prevent deformity or to reduce
pain and suffering
Cont
• Divulging information concerning a patient,
which information has become known to a
registered nurse in his or her professional
capacity, unless the information is made known:
Cont
• with the explicit consent, in writing, of a patient who is of
age, of the parent or guardian of a patient who is a minor,
or of the surviving spouse or child who is of age, or of a
patient who is deceased
• on the instruction of a court of law or where a registered
nurse is lawfully bound to make that information known
Cont
• in the exclusive interest of a patient who is not able
to, or is not capable of, granting permission
• in a professional consultation with anybody involved
in the treatment of the patient or, in the exclusive
interest of the patient, with any other person.
• Performing, except in a case of emergency, an act which
does not pertain to his or her registered profession or
for which he or she has inadequate training or
experience
Acts or omissions of an enrolled nurse constituting
improper conduct or misconduct

• These are in addition to the Acts of omission of the

registered nurse
• Omitting or neglecting to carry out such nursing care
as his or her enrolment requires under the direct or
indirect supervision or direction of a registered nurse,
or where applicable, under the direct or indirect
supervision of a medical practitioner or a dentist or on
his or her direction or written or verbal prescription
Cont
• committing any act or omission which brings or
is likely to bring the Board, any committee of the
Board or any of its members or officials, into
contempt or disrepute, or which hampers or is
likely to hamper the work of the Board
Acts or omissions of an enrolled midwife constituting
improper conduct or misconduct

• These are in addition to those of the registered midwives:

• Omitting or neglecting to identify health needs and to
promote the health of mother and child through such acts
and procedures as the scope of his or her practice permits
• Omitting or neglecting to protect the name, person and
possessions of a mother and child under his or her care or
charge through:
Cont
• the correct identification of the mother and
the child
• the prevention of accidents, injury or other
trauma
• the prevention of infection and of the spread
of infection
Cont
• the carrying out at reasonable intervals of all
observations and interventions while the
mother and child are in his or her care, and the
recording of those observations and
interventions
• Failing to comply with any regulation setting out
the conditions under which he or she may carry
on his or her profession
Outline the conditions under which nurses can be removed from the
roll or register

• The Council may remove from the register or roll concerned,

as the case may be, the name of any registered person or
enrolled person:
• 1 Who has failed to notify the registrar of any change of his
or her address, or who has failed to notify the registrar of his
or her correct physical address,
Cont
within a period of three months after the date of a request for
particulars of such physical address by the registrar by prepaid
registered letter addressed to that registered person or enrolled person
at his or her postal address as it appears in the register or roll
concerned.

2. Who has requested in writing that his or her name be removed from
the register or roll concerned, as the case may be
Cont
3.Who has failed to pay to the Council on or before 31 March
of the year concerned the annual fees determined by the
Council and payable by that registered person or enrolled
person.

4.Whose name has been removed from the register, record or

roll of any educational institution from which that person
received the qualification by virtue of which he or she was
registered or enrolled in terms of this Act.
Cont
5. Who has been registered or enrolled in error or as a result
of fraud or in circumstances not authorised by this Act

6. Who has been found guilty of unprofessional conduct and

upon whom the penalties have been imposed
Outline medico-legal hazards in the provision of nursing care

• Patients in healthcare settings place their trust in the

healthcare providers regarding their safety.
• Nurses share this responsibility with other healthcare
providers.
• Nurses who spend most of the time with patients regard the
patients’ safety as one of their primary responsibilities.
• The nurse plays a significant role in detecting certain safety
risks in healthcare.
Cont
• The primary function of the nurse is to promote health,
prevent diseases, provide care and detect illness early, treat
illness to prevent complications of the sick ,and must be
caring and facilitate a peaceful death for the very sick, and
should comfort the bereaved family.

• The environment, in which the above is expected to be

carried out, should be safe for the nurse, the patient and the
patient’s family.
Medico-legal hazards
• Refers to the threats to safety of all persons in the
healthcare settings, including patients, personnel and
visitors, that might result into legal implications.
• Examples of medico-legal hazards
• The contraction of a nosocomial infection, due to the
nurses' negligence, i.e. a patient to contract TB while
on admission was not having TB just because was
placed in the same ward with the suspected TB
patients. (in this case the patient can sue the
• The administration of a wrong medication to a patient that might
result into complications or deterioration of the patient’s condition
due to a nurse’s negligence of not identifying the patient properly
before treatment administration. (in this case the patient may sue the
particular nurse or the MOHSS as an organization).
• Needle prick by which a person contracts an infection such
as HIV/AIDS or hepatitis B viral infection, this can happen to
either the nurse or any staff in the healthcare setting such as
cleaners. (in this case the nurse or the cleaner can sue the
MOHSS)
• Injury of a patient sustained due to wet floor. in this case
the patient can sue the hospital, but the Registered nurse in
charge will be held responsible by the council.
Classify the types of negligence in nursing
care
• Gross negligence is failure to exercise even slight care to protect the rights of
others. For example, denying a client a right to health care services, such as
treatment or any supportive health services.
• Criminal negligence is a crime or an offense against the state and for which the
state punishes the individual. For example, any act of negligence resulting in a
death of a patient has serious consequences. In such case an inquest (formal
investigation) is held and the matter is handed to the Attorney-General to decide
whether or not to prosecute
• Contributory negligence is where the one who sues (the plaintiff)
may have contributed to his own injury, either deliberately or
accidentally, but where the injury occurred because of the
nurse/midwife (or other person) was negligent in some respect.

• If the nurse is negligent or incompetent, does willful damage to a

patient, or is dishonest, then action can be taken against her in form
of punishment:
Cont,
• Firstly by the court, in a criminal or civil action,
as the case may be;
• Secondly by the Nursing Council in disciplinary
action, as she is accountable for her actions; and
• Thirdly by her employer himself under staff
regulations.
Describe the types of trials in nursing care

• If the nurse/midwife practitioner is found guilty

of any offence, she or he faces three types of
penalties:
• Punishment by the courts
• Punishment by the registration authority
• Dismissal, a fine, demotion or permanent
withholding of promotion.
Punishment by the courts:
• Is in the form of a fine, a prison sentence, or as a
suspended sentence.
• Punishment by the registration authority:
• By the relevant Nursing Council, in terms of the
provisions of the Nursing Act.
Cont
• Dismissal, the imposition of a fine, demotion or permanent
withholding of promotion in the particular service (by the
employer):
• This must be done in accordance with the rules of a
particular authority, which must be made available to the
accused and to her counsel. Failing to do so, the accused can
seek redress in the courts.
• (Searle & Pera, 1995: 284)
Outline the various legislations related to
the nursing practice
• Government Gazette No. 2040, Notice 10 of
28/01/1999 :
• Nursing Professions Act, 1993:
• The Rules relating to the acts or omissions by the
Registered or enrolled persons constituting
improper conduct or misconduct.
Cont
• Government Gazette No. 2040, Notice 13 of
28/01/1999
• Nursing Professions Act, 1993:
• Regulations relating to the scope of practice of
persons who are registered or enrolled under
the Nursing Profession Act, 1993
Government Gazette no. 4140, Notice 250
of 17/10/2008:
• Regulations relating to the minimum requirements of
study for registration as a nurse or as a midwife
• Government Gazette No. 2010, Notice 11 of
28/01/1999
• Regulations relating to the registration and enrollment
of certain persons under the Nursing Act, 1993.
Explain the Scope of Practice of various nursing categories in
Namibia

• “Scope of practice” means the parameters within which a nurse,

midwife or Accoucheur must practice his or her profession
• Scope of practice of a registered nurse
• Assess and diagnose a health need and prescribe, provide and
execute a nursing regimen to meet the needs of a patient or a group
of patients or
Cont
• if necessary refer a patient to any other
registered persons e.g.
• registered medical doctor
• Registered dentist
• Registered psychologist
• Registered social worker/sociologist
• Registered pharmacist
• Give treatment or medication prescribed for a patient by any other registered
person or a person registered under the Allied Health Professions Act (doctor,
pharmacist, dentist etc)
• Treat and care for and administer medicine to a patient, including the monitoring
of the patient’s vital signs and his or her reaction to disease conditions,
medication and treatment and perform appropriate nursing interventions
• Prescribe and administer standard prescribed
medicines and treatment
• Prevent diseases and promote health, including
reproductive health and breastfeeding, by
means of the teaching and counselling of
patients
• Co-ordinate the health care regimens provided
for the patient by other registered persons or
persons registered under the Allied Health
Professions Act
• Prescribe, promote and maintain the hygiene,
physical comfort and re-assurance of a patient
Cont

• Promote exercise, rest and sleep with a view to the healing and
rehabilitation of a patient
• Facilitate body mechanisms to prevent bodily deformities in a patient
• Institute, maintain and supervise the fluid, electrolyte and acid base
balance of a patient
• Initiate, maintain and supervise the supply of oxygen to a patient
Discuss the Nursing Professions Act no 8 of 2004

• Nursing Act 8 of 2004

• Purpose:
• To provide the establishment and constitution of a
professional Council for the nursing and midwifery or
Accoucheur professions
• To determine the powers, duties and functions of such
Council;
Cont
• To regulate the registration and enrolment of the members
of such professions
• To specify the education, training and qualifications of
persons practicing such professions
• To prohibit the practicing of any such professions without
being registered
• To provide for matters incidental thereto.
(from Government Notice No. 153 of 2004)
• Facilitate the:
• healing of wounds and fractures, the protecting of
the skin and the maintaining of the sensory
function in a patient
• maintaining of bodily regulatory mechanisms and
functions in a patient;
• maintaining of the nutrition of a patient
• communication by and with a patient
• Assist in the attaining of optimum health for a patient
• Establish and maintain an environment in which the
physical and mental health of a patient is promoted
• Prepare a patient for operative, diagnostic and
therapeutic acts and the rendering pre-
operative, intra-operative and post-operative
nursing interventions
• Provide effective patient advocacy to enable the
patient to obtain the health care he or she needs
• Formulate and prescribe a comprehensive
nursing plan of care
• Render nursing interventions at different phases
of conditions or illnesses
Cont
• Administer local anaesthetics to a patient
• Accurately record and maintain a comprehensive
account of all nursing interventions
• Render life saving interventions in an emergency
situation
• Care for a terminally ill or dying patient
• Care for the body of a deceased patient.
Scope of practice of a registered midwife or Accoucheur

• In this regulation, a “patient” includes a mother or a child or a

mother and a child
• Assess and diagnose a health need in a patient, prescribe, provide and
execute a nursing or midwifery regimen to meet the needs of a
patient and if necessary refer that patient to any other registered
person or a person registered under the Allied Health Professions Act,
2004
• Give treatment or medication prescribed for a patient by a
registered person or doctor treat and care for and administer
medicine to a patient, including the monitoring of the
patient’s vital signs and the patient’s reaction to disease
conditions, medication and treatment and take appropriate
nursing and midwifery interventions
• Prescribe authorised interventions by any other registered
person or a registered person
• Administer a standard prescription by any other registered
person or a registered person
• Prevent diseases, including diseases related to pregnancy,
labour and puerperium and may promote health by teaching
and counselling of persons;
• Identify and manage high risk factors and emergency
conditions in a patient during labour, delivery and the
postnatal period
• Refer a patient to any other registered person
Monitor the:
• Progress of the pregnancy, labour and puerperium
including the vital signs of the patient
• Reaction of the mother and child to disease
conditions, trauma, stress, anxiety, medication and
treatment
• Prevent complications relating to pregnancy, labour
and puerperium
• Perform an episiotomy
• Suture first and second degree tears or episiotomy
• Administer local anaesthetics to a patient
• Prescribe and promote the maintaining of hygiene, physical
comfort and re-assurance of the patient
• Promote exercising, including antenatal and postnatal
exercising, rest and sleep with a view to the healing and
rehabilitation of a patient
• Facilitate body mechanisms and the preventing of bodily
deformities in a patient in the execution of the midwifery
regimen
Cont
• Initiate, maintain and supervise a supply of
oxygen to a patient
• Institute, maintain and supervise the fluid,
electrolyte and acid base balance of a patient
• Facilitate the healing of wounds and fractures,
the protection of the skin and the maintaining of
the sensory functions in a patient;
Cont
• Facilitate the maintaining of bodily regulatory mechanisms
and functions in a patient
• Facilitate, maintain and where necessary improve the
nutritional status of the patient
• Promote breastfeeding
• Facilitate communication by and with a patient in the
execution of the nursing and midwifery regimen
Cont
• Initiate, direct and actively participate in
providing reproductive health and family
planning services to female and male patients
• Establish and maintain an environment in which
the physical and mental health of a patient is
promoted
Cont
• Prepare a patient for operative, diagnostic and
therapeutic acts and may render pre-operative,
intra-operative and post operative midwifery
interventions for the patient
• Co-ordinate the health care regimens provided
for the patient by any other registered person
Cont
• Provide effective patient advocacy to enable the
patient to obtain the health care the patient
needs
• Formulate and prescribe a comprehensive
midwifery plan of care
• Render midwifery interventions at different
phases of conditions or illness
Cont
• Accurately record and maintain a comprehensive
account of all midwifery interventions
• Render life saving interventions in an emergency
situation
• Care for the terminally ill or dying patient
• Care for the body of the deceased patient.
Scope of practice of an enrolled nurse
• Rendering of nursing care to fulfil the needs of a
patient
• Executing of a nursing care plan for a patient
• Monitoring and evaluating of:
• The vital signs of a patient
• Reactions of a patient to trauma, stress,
anxiety, medication and treatment
Cont

• Preventing of diseases and the promoting of

health and reproductive health by teaching and
counselling of patients
• Promoting and maintaining of personal hygiene,
physical comfort and emotional well being of a
patient
Cont
• Promoting of exercise, rest and sleep with a view
to the healing and rehabilitation of a patient
• Facilitating body mechanisms and the preventing
of physical deformities in a patient in the
execution of the nursing regimen
• Initiating, supervising and maintaining of the supply of oxygen to a
patient
• Instituting, maintaining and supervising of the fluid, electrolyte and
acid base balance of a patient
• Facilitating the healing of wounds and fractures, the protecting of the
skin and the maintaining of the sensory function in a patient
• Promoting and maintaining of the body regulatory mechanisms and
functions in a patient
• Facilitating, maintaining and where necessary, the
improvement of the nutritional status of the patient
• Promoting of breastfeeding
• Promoting communication by and with a patient in the
execution of nursing care
• Promoting the attainment of optimal health in a person, the
family, group of persons and the community
Cont
• Establishing and maintaining of an environment
in which the physical and mental health of a
patient is promoted
• Preparing for and assisting with diagnostic and
therapeutic acts performed by any other
registered person or a person registered under
the Allied Health Professions
Cont
• Accurately recording and maintaining of a
comprehensive account of all nursing
interventions
• Rendering of life saving interventions in any
emergency situation
• Caring for the terminally ill or dying patient
• Caring for the body of the deceased patient.
Scope of practice of an enrolled midwife or
Accoucheur
• Identifying of a health need and promoting the
health of patient during pregnancy, labour and
puerperium
• Rendering of midwifery care to fulfil the needs of
a patient or a group of patients, including the
mother and child
• Executing of a midwifery care plan for a patient
• Monitoring of:
• the progress of pregnancy, labour and puerperium
• vital signs of mother and child
• reactions of the patient to disease conditions, trauma,
stress, anxiety, medication and treatment
• Preventing of complications related to pregnancy, labour and
puerperium
Cont
• Performing of an episiotomy
• Suturing of first and second degree tears or episiotomy
• Administering of local anaesthetics to a patient as directed by a
registered nurse or registered midwife or registered Accoucheur
• Preventing of diseases, including diseases related to pregnancy,
labour and puerperium
• Promoting of health and reproductive health by the teaching
and counselling of patients
• Promoting and maintaining personal hygiene, physical
comfort and the emotional wellbeing of a patient
• Promoting of exercises, including antenatal and postnatal
exercises, rest and sleep with a view to the healing and
rehabilitation of a patient
• Facilitating of body mechanisms and the prevention of
physical deformities in a patient in the execution of the
midwifery regimen
Cont
• Initiating, supervising and maintaining of the supply of
oxygen to a patient
• Instituting, maintaining and supervising of the fluid,
electrolyte and acid base balance of a patient
• Facilitating of the healing of wounds and fractures, the
protection of the skin and the maintaining of the sensory
function in a patient
Cont
• Promoting and maintaining of the body regulatory
mechanisms and functions in a patient
• Facilitating, maintaining and, where necessary, improving the
nutritional status of the patient
• Promoting of breastfeeding
• Promoting of communication by and with a patient in the
execution of midwifery care
Cont
• Promoting of the attaining of optimal health in a
person, the family, group of persons and the
community
• Establishing and maintaining an environment in
which the physical and mental health of a
patient is promoted
Cont
• Preparing for and assisting with diagnostic and
therapeutic acts performed by any other
registered person, or a person registered under
the Allied Health Professions Act, 2004
• Accurately recording and maintaining of a
comprehensive account of all nursing
interventions
Cont
• Rendering of life saving interventions in an
emergency situation
• Caring for the terminally ill or dying patient
• Caring for the body of the deceased patient
Scope of practice of a nursing auxiliary
• promoting and maintaining of the health of a patient, a
family and a community
• Providing of family health information to persons
• Caring for a patient and executing of a nursing care plan for a
patient
• Promoting and maintaining of the physical comfort, rest,
sleep, exercise and emotional wellbeing of a patient
Cont
• preventing of physical deformities and other complications in
a patient
• Monitoring and maintaining of the supply of oxygen to a
patient
• Monitoring and evaluation of the vital signs of a patient
• Promoting and maintaining of the body regulatory functions
of a patient
Cont
• Promoting the nutrition of a patient, person,
family and community
• Monitoring of the intake and output by a patient
• Promoting of communication by and with a
patient during his or her care
Cont

• Preparing of patients for and assisting with

diagnostic and therapeutic acts performed
by any other registered person or a person
registered under the Allied Health
Professions Act, 2004
• Preparing patients for and assisting during
surgical procedures under anaesthetic
Cont
• Accurately recording and maintaining of a
comprehensive account of all nursing
interventions
• Caring for the terminally ill or dying patient
• Caring for the body of the deceased patient
Explain the structure and functions of the Health
Professions Council of Namibia
• Structure of the nursing HPCNA
• The Council must consist of the following 10 members:
• Four (4) persons appointed by the Minister, of whom:
• One person must be the Head of Nursing Services in the
Ministry, and who must be registered as a nurse and a midwife,
or as a nurse and an Accoucheur
Cont
• One person must be registered as a nurse and a midwife, or
as a nurse and an Accoucheur, and who has expertise and
experience in primary health care matters
• Two persons must represent the public, and of whom one
must be a legal practitioner having not less than ten years
experience in the field of law
Cont
• One must be a person who, in the opinion of the Minister, is
suitably qualified having regard to the functions of the
Council, but who is not a registered person or an enrolled
person, the Head of the Nursing Department of the
University of Namibia
Cont
• Five persons elected in accordance with the Act must be:
• Registered as nurses and as midwives, or as nurses and as Accoucheur
elected by the registered nurses, the enrolled nurses, the registered
midwives, the enrolled midwives, the registered Accoucheur, the
enrolled Accoucheur and the nursing auxiliaries
Functions of HPCNA
• To control and exercise authority in respect of all matters affecting the
education and training of persons for the purpose of qualifying those
persons to be able to register or enrol, as the case may be, as
registered nurses or registered midwives or registered Accoucheur, or
as enrolled nurses or enrolled midwives or enrolled Accoucheur or as
nursing auxiliaries
• To establish, develop, and maintain universally
acceptable standards of control over persons
registered or enrolled in terms of this Act by
investigating in accordance with this Act, all
complaints, accusations or allegations relating to
the conduct of registered persons or enrolled
persons
• To encourage and promote efficiency in, and
responsibility to or in respect of, the practising of
such professions, and to guide the registered
persons and enrolled persons with regard to the
respective codes of conduct and ethical
standards for or relating to their professions
• To promote liaison in the field of the education and training
of persons in such professions, or being educated and
trained for the purpose of registration or enrolment to
practise any such profession, in Namibia or elsewhere
• To promote and control standards of training of persons for
the purpose of registration or enrolment to practise any such
profession
• To give advice or render assistance to any educational
institution or other examining body with regard to the
education, tuition and training of persons for the purpose of
registration or enrolment to practise any such profession
• To regulate the practising of such professions, and to ensure
that all persons practising such professions are registered or
enrolled, as the case may be
• To register or enrol persons to practise such
professions, or remove the name of a registered
person or an enrolled person from a register or
roll
• To promote the continuing professional
development of registered persons or enrolled
persons
• To promote research in the fields of the
professions to which this Act applies
• To assist in the promotion of health of the
population of Namibia
• To be transparent to the professions to which this
Act applies and to the general public in achieving
its objects and in performing its functions and
executing its powers
Cont,

• To maintain and enhance the dignity and the integrity

of registered persons and enrolled persons
• To deal firmly, fairly and promptly with registered
persons and enrolled persons against whom a charge,
complaint or allegation of unprofessional conduct has
been laid or whose fitness to practise his or her
profession is in doubt
• To advise the Minister on any matter falling
within the scope of this Act and relating to the
professions to which this Act applies
• To communicate to the Minister information on
matters of public interest acquired by it in the
course of the performance of its functions
• Differentiate the roles of a nurse
• Roles of a nurse can be:
• Independent
• Interdependent
• Dependent
The independent roles of a nurse:
• 1. Supervision of patient to ensure his safety and security
• Asepsis, cleanliness (safe environment)
• Security from physical and emotional hazards
• Patient must not injure himself and others
• Clear identification of a patient
2. Observation of patient.
• Signs and symptoms of infections
• Any change in the patient’s condition during the course of treatment
and illness
• Any reactions from treatments
• 3. Recording and reporting
• Observations made
• Instructions received and given
• Care and treatment carried out
Cont
• All records and reports must be accurate and
specific in such a manner that they are easily
understood by those who have read them and
carry on with the treatment
• 4. Assessment of patient’s responds to
treatment
• 5. Nursing diagnosis. This may be for:
• Nursing care
• For referral to a medical doctor
• For emergency action by the nurse before arrival
of the doctor on the scene.
• 6. Performing nursing procedures
Performing nursing procedures
• These are nursing procedures prescribed by the doctor
• They must carried out accurately, with competence
• Record keeping is necessary after the procedure
• 7. Supervision of personnel
• This is necessary so that duties are delegated to persons with
knowledge and ability to carry them out
Cont
• 8. Health education to patient/relatives
• This is to ensure that:
• Self-care is taken
• Treatment is continued at home even after discharge from
hospital
• Continued home based care
• Preventive aspects of health care must be emphasised
• The interdependent roles of a nurse
• This refers to the interrelationships between the nurse and
the patient; nurse and other members of the health team;
e.g. nursing and medicine
• Neither the nurse nor the doctor can provide all the care that
the patient needs.
• Coordination of activities and acknowledgement
of each other’s field of expertise is essential
• (x-ray, NIP, blood bank, pharmacy, kitchen,
mortuary, CSSD, laundry, physiotherapy,
orthopaedic)
Dependent roles of a nurse
• These are based on the law that authorises her
practice, the common law and relevant statutory
laws
• The Nursing Act is the law that empowers the
nurse to practice
• And the regulations set in terms of the Act
govern this practice
Cont
• It is the law, and only the law that authorises the
professional practice of the nurse
• It is the nurse’s duty to be aware of her
responsibilities under common law and laws
affecting health care
• Any nurse working under legal boundaries is
responsible for her own actions/acts
Cont
• Even when she works in the public sector or
private sector, she remains personally
responsible and accountable to the registration
authority, NNC and courts of law
• A nurse is accountable for the type of care she
gives in carrying out a prescription/doctor’s
order
Cont
• Her acceptance of a doctor’s prescription for
patient care constitutes an unwritten agreement
between professional colleagues
• She accepts the order and must see that it is
carried out
THANK YOU

THE END