The South African Nursing Council

Regulations Relating to the Scope of Practice of Persons Who are Registered or Enrolled under the Nursing Act, 1978

The Minister of Health and Welfare has, on the recommendation of the South African Nursing Council, in terms of Section 45(1)(q) of the Nursing Act, 1978 (Act 50 of 1978), made the regulations as set out in the Schedule hereto.

SCHEDULE

CHAPTER 1. - DEFINITIONS

1.    In these regulations "the Act" shall mean the Nursing Act, 1978 (Act 50 of 1978), and any expression to which a meaning has been assigned in the Act, shall bear such meaning and, unless the context otherwise indicates-

"child" shall include the unborn child;

"co-ordination" shall mean the bringing together of the acts of members of the health team to meet the spectrum of identified health needs of an individual or a group;

"diagnosing" shall mean the identification of, and discriminating between physical, psychological and social signs and symptoms in man;

"health needs" shall mean those signs, symptoms and processes which denote the individual's interaction with any actual or potential health problem and which require nursing intervention;

"midwifery regimen" shall mean the regulation and implementation of those matters which through midwifery intervention, have an influence on the course and management of pregnancy, all stages of labour and the puerperium and includes the provision of care plans, their implementation and evaluation and the recording of the course of pregnancy, labour and puerperium and of any health problem and the care received by the mother and child whilst in the charge of the midwife;

"nursing regimen" shall mean the regulation of those matters which, through nursing intervention have an influence on the preventive, promotive, curative or rehabilitative aspects of health care and includes the provision of nursing care plans, their implementation and evaluation thereof and recording of the course of the health problem, the health care received by a patient and its outcome whilst a patient is in the charge of the nurse;

"prescribing" shall mean giving the written directions regarding those treating, nursing care, co-ordinating, collaborating and patient advocacy functions essential to the effective execution and management of the nursing regimen;

"registered person" shall mean a person who is registered as a nurse or as a midwife in terms of the Act or as a medical practitioner or dentist in terms of the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act 56 of 1974);

"treatment" shall mean selection and performance of those therapeutic measures essential to the effective execution and management of the nursing regimen.

CHAPTER 2. - THE SCOPE OF PRACTICE OF REGISTERED NURSES

2.    The scope of practice of a registered nurse shall entail the following acts or procedures, which may be performed by scientifically based physical, chemical, psychological, social, educational and technological means applicable to health care practice:

(a)    The diagnosing of a health need and the prescribing, provision and execution of a nursing regimen to meet the need of a patient or group of patients or, where necessary, by referral to a registered person;

(b)    the execution of a program of treatment or medication prescribed by a registered person for a patient;

(c)    the treatment and care of and the administration of medicine to a patient, including the monitoring of the patient's vital signs and of his reaction to disease conditions, trauma, stress, anxiety, medication and treatment;

(d)    the prevention of disease and promotion of health and family planning by teaching to and counselling with individuals and groups of persons;

(e)    the prescribing, promotion or maintenance of hygiene, physical comfort and re-assurance of the patient;

(f)    the promotion of exercise, rest and sleep with a view to healing and rehabilitation of a patient;

(g)    the facilitation of body mechanics and the prevention of bodily deformities in a patient in the execution of the nursing regimen;

(h)    the supervision over and maintenance of a supply of oxygen to a patient;

(i)    the supervision over and maintenance of fluid, electrolyte and acid base balance of a patient;

(j)    the facilitation of the healing of wounds and fractures, the protection of the skin and the maintenance of sensory functions in a patient;

(k)    the facilitation of the maintenance of bodily regulatory mechanisms and functions in a patient;

(l)    the facilitation of the maintenance of nutrition of a patient;

(m)    the supervision over and maintenance of elimination by a patient;

(n)    the facilitation of communication by and with a patient in the execution of the nursing regimen;

(o)    the facilitation of the attainment of optimum health for the individual, the family, groups and the community in the execution of the nursing regimen;

(p)    the establishment and maintenance, in the execution of the nursing regimen, of an environment in which the physical and mental health of a patient is promoted;

(q)    preparation for and assistance with operative, diagnostic and therapeutic acts for the patient;

(r)    the co-ordination of the health care regimens provided for the patient by other categories of health personnel;

(s)    the provision of effective patient advocacy to enable the patient to obtain the health care he needs;

(t)    care of the dying patient and the care of a recently deceased patient within the execution of the nursing regimen.

CHAPTER 3 - THE SCOPE OF PRACTICE OF A REGISTERED MIDWIFE

3.    The scope of practice of a registered midwife shall entail the following scientifically based acts or procedures which apply to the practice of midwifery and which relate to the mother and child in the course of pregnancy, labour and the puerperium:

(a)    the diagnosing of a health need and the facilitation of the attainment of optimum physical and mental health for the mother and child by the prescribing, provision and execution of a midwifery regimen or, where necessary, referral to a registered person or by obtaining the assistance of a registered person, as the case may be;

(b)    the execution of a programme of treatment or medication prescribed by a registered person;

(c)    the prevention of disease relating to pregnancy, labour and the puerperium and the promotion of health and family planning by teaching and counselling individuals, families and groups of persons, by implementation of family planning skills and by monitoring the health status of the mother and child;

(d)    the monitoring of-

(i)    the progress of pregnancy, labour and the puerperium;

(ii)    the vital signs of the mother and child;

(iii)    the reaction of the mother and child to disease conditions, trauma, stress, anxiety, medication and treatment;

(e)    the prevention of complications relating to pregnancy, labour and the puerperium including:

(i)    the performance of an episiotomy;

(ii)    the suturing of first and second degree tears or an episiotomy;

(iii)    the administration of a local anaesthetic;

(f)    the administration of medicine to the mother or child;

(g)    the prescribing, promotion or maintenance of hygiene, physical comfort and reassurance of the mother and child;

(h)    the promotion of exercise, including ante-natal and post-natal exercises, rest and sleep;

(i)    the facilitation of body mechanics and the prevention of bodily deformities in the execution of the midwifery regimen;

(j)    the supervision over and maintenance of a supply of oxygen to the mother and child;

(k)    the supervision over and maintenance of fluid, electrolyte and acid base balance of the mother and child;

(l)    the facilitation of the healing of wounds, the protection of the skin and the maintenance of sensory functions in the mother and child;

(m)    the facilitation of the maintenance of bodily regulatory mechanisms and functions in the mother and child;

(n)    the facilitation, maintenance and, where necessary, the improvement of the nutritional status of the mother and child;

(o)    the promotion of breastfeeding;

(p)    the supervision over and maintenance of elimination by the mother and child;

(q)    the facilitation of communication by and with the mother and father or family in the execution of the midwifery regimen;

(r)    the establishment and maintenance, in the execution of the midwifery regimen, of an environment in which the physical and mental health of mother and child is promoted;

(s)    preparation for and assistance with operative, diagnostic and therapeutic acts for the mother and child;

(t)    the co-ordination of the health care regimens provided for the mother and child by other categories of health personnel;

(u)    the provision of effective advocacy to enable the mother and child to obtain the health care they need;

(v)    care of the dying patient and a recently deceased patient within the execution of the midwifery regimen.

CHAPTER 4. - THE SCOPE OF PRACTICE OF ENROLLED MIDWIVES

4.    The scope of practice of an enrolled midwife shall entail the following acts or procedures which apply to the practice of midwifery:

(a)    The identification of a health need and the promotion of the health of the mother and child by means of examination and advice during, and supervision over and handling of, normal pregnancy, uncomplicated labour and normal puerperium;

(b)    the promotion or maintenance of hygiene and physical comfort and the reassurance of the mother and child;

(c)    the promotion of exercise, rest and sleep;

(d)    the control, promotion and maintenance of the following in the mother and child:

(i)    Respiratory functions;

(ii)    intake and output functions;

(iii)    blood pressure, temperature, pulse rate and foetal heart;

(e)    the promotion, maintenance and improvement of the nutritional status of the mother and child;

(f)    the promotion of breastfeeding;

(g)    the provision of information on health and family planning;

(h)    the care of a dying patient, a recently deceased patient and a stillborn infant.

CHAPTER 5: THE SCOPE OF PRACTICE OF ENROLLED NURSES

5.    The scope of practice of an enrolled nurse shall entail the following acts and procedures as part of the nursing regimen planned and initiated by a registered nurse or registered midwife and carried out under his direct or indirect supervision:

(a)    The carrying out of nursing care to fulfil the health needs of a patient or a group of patients;

(b)    caring for a patient, and executing a nursing care plan for a patient, including the monitoring of vital signs and the observation of reactions to medication and treatment;

(c)    the prevention of disease and the promotion of health and family planning by means of information to individuals and groups;

(d)    the promotion and maintenance of the hygiene, physical comfort and reassurance of a patient;

(e)    the promotion and maintenance of exercise, rest and sleep with a view to the healing and rehabilitation of a patient;

(f)    the prevention of physical deformity and other complications in a patient;

(g)    the supervision over and maintenance of a supply of oxygen to a patient;

(h)    the supervision over and maintenance of the fluid balance of a patient;

(i)    the promotion of the healing of wounds and fractures, the protection of the skin and the maintenance of sensory functions in a patient;

(j)    the promotion and maintenance of the body regulatory mechanisms and functions in a patient;

(k)    the feeding of a patient;

(l)    the promotion and maintenance of elimination in a patient;

(m)    the promotion of communication by and with a patient in the execution of nursing care;

(n)    the promotion of the attainment of optimal health in the individual, the family, groups and the community;

(o)    the promotion and maintenance of an environment in which the physical and mental health of a patient are promoted;

(p)    preparation for and assistance with diagnostic and therapeutic acts by a registered person;

(q)    preparation for and assistance with surgical procedures and anaesthetic;

(r)    care of a dying patient and a recently deceased patient.

CHAPTER 6: THE SCOPE OF PRACTICE OF ENROLLED NURSING ASSISTANTS

6.    The scope of practice of an enrolled nursing assistant shall entail the following acts and procedures as part of the nursing regimen planned and initiated by a registered nurse or registered midwife and carried out under his direct or indirect supervision:

(a)    The promotion and maintenance of the health of a patient, a family and a community;

(b)    the provision of health and family planning information to individuals and groups;

(c)    the care of a patient and the execution of a nursing care plan for a patient;

(d)    the promotion and maintenance of the hygiene of a patient, a family and a community;

(e)    the promotion and maintenance of the physical comfort, rest, sleep, exercise and reassurance of a patient;

(f)    the prevention of physical deformity and other complications in a patient;

(g)    the supervision over and maintenance of a supply of oxygen to a patient;

(h)    the taking of the blood pressure, temperature, pulse and respiration of a patient;

(i)    the promotion and maintenance of the body regulatory functions of a patient;

(j)    the promotion of the nutrition of a patient, a family and a community;

(k)    the maintenance of intake and elimination in a patient;

(l)    the promotion of communication with a patient during his care;

(m)    the preparation of individuals and groups for the execution of diagnostic procedures and therapeutic acts by a registered person;

(n)    the preparation for and assistance during surgical procedures under anaesthetic;

(o)    the care of a dying patient and a recently deceased patient.

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