The Paramedicine Board of Australia (the Board) has adopted professional capabilities for registered paramedics on an interim basis and will apply them, as appropriate, to its regulatory functions.
These capabilities identify the knowledge, skills and professional attributes needed for safe and competent practice of paramedicine in Australia and draw on the Professional Competency Standards – Paramedics Version 2.2 2013 published by the Council of Ambulance Authorities and the Australasian Competency Standards for Paramedics 2011 published by Paramedicine Australasia.
These professional capabilities will eventually be replaced when the National Board adopts professional capabilities that will be developed as part of a project commissioned by the National Board. That project will include wide consultation with stakeholders and is expected to begin in early 2019.
The Professional capabilities for registered paramedics apply to all registered paramedics and to individuals seeking to qualify for registration, including:
The National Board has powers under the National Law1 to develop standards, codes and guidelines about the eligibility of individuals for registration in the paramedicine profession.
Some of the National Board's standards, codes and guidelines refer to competent and ethical practice.
1 Section 38 of the Health Practitioner Regulation National Law, as in force in each state and territory.
This code seeks to assist and support registered health practitioners to deliver effective regulated health services within an ethical framework. Practitioners have a duty to make the care of patients or clients their first concern and to practise safely and effectively. Maintaining a high level of professional competence and conduct is essential for good care.
The code contains important standards for practitioner behaviour in relation to:
Making decisions about healthcare is the shared responsibility of the practitioner and the patients or clients (or their representative).
Relationships based on openness, trust and good communication will enable practitioners to work in partnership with their patients or clients. An important part of the practitioner–patient/client relationship is effective communication, in all forms, including in person, written and electronic.
Practitioners have ethical and legal obligations to protect the privacy of people requiring and receiving care. Patients or clients have a right to expect that practitioners and their staff will hold information about them in confidence, unless information is required to be released by law or public interest considerations.
Practitioners need to obtain informed consent for the care that they provide to their patients or clients. Caring for children and young people brings additional responsibilities for practitioners.
Good practice involves genuine efforts to understand the cultural needs and contexts of different patients or clients to obtain good health outcomes. Practitioners need to be aware that some patients or clients have additional needs and modify their approach appropriately.
When adverse events occur, practitioners have a responsibility to be open and honest in communication with patients or clients to review what has occurred.
In some circumstances, the relationship between a practitioner and a patient or client may become ineffective or compromised and may need to end.
Good relationships with colleagues and other practitioners strengthen the practitioner–patient/client relationship and enhance care.
Practitioners have a responsibility to contribute to the effectiveness and efficacy of the healthcare system.
Minimising risk to patients or clients is a fundamental component of practice. Good practice involves understanding and applying the key principles of risk minimisation and management to practice.
Maintaining and developing a practitioner's knowledge, skills and professional behaviour are core aspects of good practice.
Teaching, supervising and mentoring practitioners and students is important for the development of practitioners and for the care of patients or clients. It is part of good practice to contribute to these activities, and provide support, assessment, feedback and supervision for colleagues, practitioners in training and students.
Underpinning this code is the assumption that practitioners will exercise their professional judgement to deliver the best possible outcome for their patients.
This code seeks to assist and support practitioners to deliver appropriate, effective services within an ethical framework. Practitioners have a professional responsibility to be familiar with this code and to apply the guidance it contains.
This code will be used:
Practitioners must always act in accordance with the law. The code is not a substitute for the provisions of the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law), other relevant legislation and case law. If there is any conflict between the code and the law, the law takes precedence. Practitioners need to be aware of and comply with, the standards, guidelines and policies of their National Board.
The code does not address in detail the range of general legal obligations that apply to practitioners, such as those under privacy, child protection and antidiscrimination legislation; responsibilities to employees and other individuals present at a practice under workplace health and safety legislation; and vicarious liability for employees under the general law. Practitioners should ensure that they are aware of their legal obligations and act in accordance with them.
This code is not an exhaustive study of professional ethics or an ethics guide. It does not address the standards of practice within individual health professions or disciplines. These standards of practice are generally found in documents issued by the relevant National Boards and/or professional bodies.
While good healthcare respects the rights of patients or clients, this code is not a charter of rights (an example of a charter is the Australian charter of healthcare rights issued by the Australian Commission on Safety and Quality in Health Care.
The focus of this code is on good practice and professional behaviour. It is not intended as a mechanism to address disputes between professional colleagues, e.g. in relation to termination of business relationships and disputes over patients or clients.
While individual practitioners have their own personal beliefs and values, there are certain professional values on which all practitioners are expected to base their practice. These professional values apply to the practitioner’s conduct regardless of the setting, including in person and electronically, e.g. social media, e-health etc.
Practitioners have a duty to make the care of patients or clients their first concern and to practise safely and effectively. They must be ethical and trustworthy. Patients or clients trust practitioners because they believe that, in addition to being competent, practitioners will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion. Patients or clients also rely on practitioners to protect their confidentiality.
Practitioners have a responsibility to protect and promote the health of individuals and the community.
Good practice is centred on patients or clients. It involves practitioners understanding that each patient or client is unique and working in partnership with patients or clients, adapting what they do to address the needs and reasonable expectations of each person. This includes cultural awareness: being aware of their own culture and beliefs and respectful of the beliefs and cultures of others, and recognising that these cultural differences may impact on the practitioner–patient/client relationship and on the delivery of services. Good practice also includes being aware that differences such as gender, sexuality, age, belief systems and other anti-discrimination grounds in relevant legislation may influence care needs, and avoiding discrimination on the basis of these differences.
Effective communication in all forms underpins every aspect of good practice.
Professionalism embodies all the qualities described here and includes self-awareness and self-reflection. Practitioners are expected to reflect regularly on whether they are practising effectively, on what is happening in their relationships with patients or clients and colleagues, and on their own health and wellbeing. They have a duty to keep their skills and knowledge up to date, refine and develop their clinical judgement as they gain experience, and contribute to their profession.
Practitioners have a responsibility to recognise and work within the limits of their competence and scope of practice. Scopes of practice vary according to different roles; for example, practitioners, researchers and managers will all have quite different competence and scopes of practice. To illustrate, in relation to working within their scope of practice, practitioners may need to consider whether they have the appropriate qualifications and experience to provide advice on over the counter and scheduled medicines, herbal remedies, vitamin supplements, etc.
Practitioners should be committed to safety and quality in healthcare (see the Australian Commission on Safety and Quality in Health Care and references section at the end of this code).
Australia is culturally and linguistically diverse. We inhabit a land that, for many ages, was held and cared for by Aboriginal and/or Torres Strait Islander Australians, whose history and culture have uniquely shaped our nation. Our society is further enriched by the contribution of people from many nations who have made Australia their home.
Practitioners in Australia reflect the cultural diversity of our society and this diversity strengthens the health professions.
There are many ways to practise a health profession in Australia. Practitioners have critical roles in caring for people who are unwell, assisting people to recover and seeking to keep people well. This code focuses on these roles. For practitioners with roles that involve little or no contact with patients or clients, not all of this code may be relevant, but the underpinning principles will still apply.
There are several conditions or situations in which patients or clients may have limited competence or capacity to make independent decisions about their healthcare; for example, people with dementia or acute conditions that temporarily affect competence and children or young people, depending on their age and capacity (see Section 3.5 Informed consent).
In this code, reference to the terms ‘patients or clients’ also includes substitute decision-makers for patients or clients who do not have the capacity to make their own decisions. These can be parents or a legally appointed decision-maker. If in doubt, seek advice from the relevant guardianship authority.
Care of the patient or client is the primary concern for health professionals in clinical practice. Providing good care includes:
Maintaining a high level of professional competence and conduct is essential for good care. Good practice involves:
Making decisions about healthcare is the shared responsibility of the treating practitioner and the patient or client who may wish to involve their family, carer/s and/or others. Practitioners have the responsibility to create and foster conditions for this to occur. (Also see Section 1.4 Substitute decision-makers.)
Practitioner decisions about access to care need to be free from bias and discrimination. Good practice involves:
Treating patients or clients in emergencies requires practitioners to consider a range of issues, in addition to the provision of best care. Good practice involves offering assistance in an emergency that takes account of the practitioner’s own safety, skills, the availability of other options and the impact on any other patients or clients under the practitioner’s care, and continuing to provide that assistance until services are no longer required.
Relationships based on respect, trust and good communication will enable practitioners to work in partnership with patients or clients.
A good partnership between a practitioner and the person they are caring for requires high standards of personal conduct. This involves:
An important part of the practitioner–patient/client relationship is effective communication. This involves:
Practitioners have ethical and legal obligations to protect the privacy of people requiring and receiving care. Patients or clients have right to expect that practitioners and their staff will hold information about them in confidence, unless release of information is required by law or public interest considerations. Good practice involves:
Informed consent is a person’s voluntary decision about healthcare that is made with knowledge and understanding of the benefits and risks involved. A useful guide to the information that practitioners need to give to patients is available in the National Health and Medical Research Council (NHMRC) publication General guidelines for medical practitioners in providing information to patients. The NHMRC guidelines cover the information that practitioners should provide about their proposed management or approach, including the need to provide more information where the risk of harm is greater and likely to be more serious and advice about how to present information.
Good practice involves:
Caring for children and young people brings additional responsibilities for practitioners. Mandatory reporting of child abuse and neglect is legislated in all states and territories in Australia. Practitioners have a responsibility to be aware of the mandatory reporting requirements in their state or territory.
Good practice involves an awareness of the cultural needs and contexts of all patients and clients, to obtain good health outcomes. This includes:
Some patients or clients (including those with impaired decision-making capacity) have additional needs. Good practice in managing the care of these patients or clients includes:
When adverse events occur, practitioners have a responsibility to be open and honest in communication with a patient or client to review what has occurred and to report appropriately (also see ‘open disclosure’ at Section 6.2(a)). When something goes wrong, good practice involves:
Patients or clients have a right to complain about their care. When a complaint is made or a formal notification is received by a Board, good practice involves:
Practitioners have a vital role in assisting the community to deal with the reality of death and its consequences. In caring for patients or clients towards the end of their life, good practice involves:
In some circumstances, the relationship between a practitioner and a patient or client may become ineffective or compromised and may need to end. Good practice involves ensuring that the patient or client is informed adequately of the decision and facilitating arrangements for the continuing care of the patient or client, including passing on relevant clinical information.
Good practice includes recognising the potential conflicts, risks and complexities of providing care to those in a close relationship, for example close friends, work colleagues and family members and that this can be inappropriate because of the lack of objectivity, possible discontinuity of care and risks to the practitioner or patient. When a practitioner chooses to provide care to those in a close relationship, good practice requires that:
Where practitioners are considering treating multiple patients or clients simultaneously in class or group work, or more than one individual patient or client at the same time, practitioners should consider whether this mode of treatment is appropriate to the patients or clients involved, including whether it could compromise the quality of care (see also Section 3.4 Confidentiality and privacy and Section 3.5 Informed consent).
When closing or relocating a practice, or when an employed practitioner moves between practices, good practice involves:
Good relationships with colleagues and other practitioners strengthen the practitioner–patient/client relationship and enhance patient care.
Good care is enhanced when there is mutual respect and clear communication between all health professionals involved in the care of the patient or client. Good practice involves:
Delegation involves one practitioner asking another person or member of staff to provide care on behalf of the delegating practitioner while that practitioner retains overall responsibility for the care of the patient or client.
Referral involves one practitioner sending a patient or client to obtain an opinion or treatment from another practitioner. Referral usually involves the transfer (in part) of responsibility for the care of the patient or client, usually for a defined time and a particular purpose, such as care that is outside the referring practitioner’s expertise or scope of practice.
Handover is the process of transferring all responsibility to another practitioner.
Many practitioners work closely with a wide range of other practitioners, with benefits for patient care.
Effective collaboration is a fundamental aspect of good practice when working in a team. The care of patients or clients is improved when there is mutual respect and clear communication as well as an understanding of the responsibilities, capacities, constraints and ethical codes of each other’s health professions. Working in a team does not alter a practitioner’s personal accountability for professional conduct and the care provided. When working in a team, good practice involves:
Good patient care requires coordination between all treating practitioners. Good practice involves:
Practitioners have a responsibility to contribute to the effectiveness and efficiency of the healthcare system.
It is important to use healthcare resources wisely. Good practice involves:
There are significant disparities in the health status of different groups in the Australian community. These disparities result from social, cultural, geographic, health-related and other factors. In particular, Indigenous Australians bear the burden of gross social, cultural and health inequity. Other groups may experience health disparities including people with intellectual or physical disabilities, those from culturally and linguistically diverse backgrounds and refugees. Good practice involves using expertise and influence to protect and advance the health and wellbeing of individual patients or clients, communities and populations.
Practitioners have a responsibility to promote the health of the community through disease prevention and control, education and, where relevant, screening. Good practice involves:
Risk is inherent in healthcare. Minimising risk to patients or clients is an important component of practice. Good practice involves understanding and applying the key principles of risk minimisation and management in practice.
Good practice in relation to risk management involves:
The welfare of patients or clients may be put at risk if a practitioner is performing poorly. If there is a risk, good practice involves: