Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice
Professional Foundations of Nursing and Midwifery Practice
The practitioner the Council expects
Professional Foundations is the "thinking" paper: it tests the identity, standards and decision-making framework of the registered practitioner rather than isolated facts. You must be able to define nursing and midwifery using scope-of-practice language, state the requirements for initial registration and annual renewal (PIN, practising licence, continuing professional development), and distinguish the scope of a registered nurse, a registered midwife, a community health nurse and a health assistant.
Core concepts to master
The nursing process - Assessment, nursing Diagnosis, Planning, Implementation, Evaluation - underpins most scenario items. Know therapeutic communication (open questions, reflection, silence, empathy) as distinct from social conversation, and the professional boundaries that separate them. Understand delegation: the delegator retains accountability, and the five rights of delegation are the right task, circumstance, person, direction/communication and supervision. Know the chain of command and when to escalate. Be able to explain evidence-based practice, reflective practice, incident reporting and the legal weight of documentation - if it is not recorded, it was not done.
Traps
Questions asking for the "first" action usually want assessment or safety, not a procedure or paperwork. Options that replace advocacy with paternalism ("tell the patient what to do") are almost always wrong. Do not assume a student or health assistant may perform a task simply because they have watched it done.
Worked example
A patient becomes breathless during a blood transfusion. The best first action is not to document or to telephone the doctor first - it is to stop the transfusion, keep the line patent with normal saline, call for help and monitor. Safety and assessment before procedure and paperwork.
Ethics and Regulation of Nursing and Midwifery Practice
Law and ethics as one framework
Regulation items test the Health Professions Regulatory Bodies Act, 2013 (Act 857), which established the Nursing and Midwifery Council of Ghana, together with the Council's code of conduct and disciplinary procedures. Know what the Council can do: register and license practitioners, set standards, accredit training institutions, investigate complaints and impose sanctions up to removal from the register. Know the practitioner's duties: practise within scope, maintain competence, keep confidentiality, obtain valid consent and report unsafe practice.
Principles and their clashes
Autonomy (the patient's right to decide), beneficence (do good), non-maleficence (do no harm), justice (fairness in distribution), veracity (truthfulness) and fidelity (keeping promises). Ethics is the reasoning behind a rule; law is the enforceable minimum. Most ethical dilemmas in exams are clashes between autonomy and beneficence.
Negligence and malpractice
Four elements must all be proved: a duty of care existed, the standard of care was breached, the breach caused the harm, and actual damage resulted. Remove any one element and the claim fails.
Traps
Confusing assault (a threat or attempt) with battery (unauthorised touching); forgetting that a competent adult may refuse even life-saving treatment; overlooking the recognised exceptions to confidentiality (patient consent, statutory reporting, serious risk to a named third party, court order); and assuming a relative may consent for an adult.
Worked example
A Jehovah's Witness adult with severe anaemia refuses blood. Covert transfusion would be battery and a breach of autonomy, even though it appears beneficent. Correct action: respect the refusal, document it, explore alternatives and escalate - do not overrule a competent adult.