Glossary of Nursing and Midwifery Terms

We use various terms in the standards, requirements and guidelines published on this website and in documents we produce. This glossary briefly explains some of these terms.

Use this A-Z list to go to a word or term:
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z 

A

Accountability

Refers to the responsibility that practitioners have for their actions, inactions, decisions and the care they provide to individuals. It involves being answerable for one’s professional conduct, adhering to ethical standards, and complying with legal and regulatory requirements. Practitioners are accountable for ensuring safety of individuals, delivering evidence-based care, maintaining confidentiality and acting within the scope of their practice. This accountability extends to professional development, as practitioners must continuously update their knowledge and skills. They are  expected to collaborate with other healthcare team members, ensuring the best outcomes for patients and service users while advocating for their rights and wellbeing.

Practitioners are accountable to the individual, the public, the NMBI, their employer and any relevant supervisory authority. There are three main considerations: organisational, team and personal accountability.

Action plan

An action plan is a plan drawn up by the Preceptor, the undergraduate / postgraduate student and the Verifier to facilitate and monitor the achievement of competence. It is initiated if necessary at the intermediate meeting if problem areas are identified.

Advance healthcare directive

A capable individual has the right to refuse treatment.

An advance healthcare directive should be respected on condition that:

• the individual made an informed choice at the time of making the
• advanced healthcare directive
• the decision in the directive covers the situation that has now arisen,and
• there is no indication that the individual has changed their mind since the advance healthcare directive or plan was made.

The Advance Healthcare Directive must comply with the provisions of the Assisted Decision Making (Capacity)(Amendment) Act, 2022. This is a legal framework that supports individuals who lack or may be deemed to lack capacity. It uses a functional approach to decision-making and places the obligation on all those working in healthcare to support an individual whose capacity may be in question to ensure they are part of the decision-making process. This includes advance healthcare directives. A cognitive impairment is relevant in this context only if it affects capacity.

Advanced practice

Advanced practice relates to registered nurses and registered midwives who engage in continuing professional development and clinical supervision; and who practice at an advanced level as independent, autonomous, and expert practitioners. These registered nurses and midwives work within an agreed scope of practice and must meet the Board’s established criteria to register as an Advanced Nurse Practitioner (RANP) or Advanced Midwife Practitioner (RAMP). 

Adverse event

An incident which results in or could result in harm.

Advocacy

In nursing and midwifery is a crucial aspect of both professions, emphasising the role of practitioners as advocates. This involves promoting and protecting the rights, needs and preferences of individuals while
ensuring they receive appropriate care. 

Practitioners advocate for individuals by listening to their concerns, respecting their values and ensuring their voices are included in decisionmaking. They provide education about health conditions, treatment options and possible outcomes, empowering patients and service users to make informed choices. Advocacy also involves collaborating with other healthcare professionals to deliver comprehensive care that meets individual needs.

Appropriate

Matching the circumstances, meeting the needs of the individual, groups or situation.

Artificial Intellegence (AI)

AI is emerging in healthcare and has the potential for significant transformation of care. Some examples of the use of AI include, monitoring vital signs via wearable devices, alerting practitioners to urgent changes and analysing medical histories to identify individuals at risk for complications. AI systems may also provide evidence-based recommendations for treatment and streamline administrative tasks like scheduling. Practitioners should be cautious about the interpretation of AI recommendations, as they must retain assessment and judgment, and ultimate accountability for their actions and omissions.

Assessment

Patient assessment guides safe practice, and encompasses physical, mental, cultural, environmental and spiritual assessment. Physical examination skills are essential to inform critical thinking, clinical decision-making, planning of therapeutic interventions, and identifying achievable person-centred outcomes. Assessment and patient responses to planned interventions requires constant reassessment and monitoring for evidence of deterioration or failure to meet the planned outcome.

Assessment (student)

Determining the extent to which an individual reaches the desired level of competence in skill, knowledge, understanding or attitudes in relation to a specified goal. Assessment measures the integration and application of theory to patient care learned throughout the programme, and requires the undergraduate / postgraduate nurse or midwife to demonstrate proficiency within practice through the achievement of learning outcomes.

Authority

Refers to the recognised responsibility granted to practitioners through their education, training, experience and professional standards. It enables them to make decisions, provide care, and lead within their scope of practice,  supported by legal, ethical and organisational frameworks to ensure accountability and prioritise person-centred care.

Autonomy

Refers to the ability of practitioners to make independent decisions and take actions based on their professional judgment. While professionals have decision-making power, they remain accountable to ethical guidelines, legislation, PPPGs and the public. This autonomy fosters trust in their expertise and allows for high standards of practice. This can empower them to advocate for individuals, assess and manage care, and respond swiftly to changes in the individuals’ conditions. Autonomy fosters accountability and encourages collaboration with other healthcare professionals. Ultimately, it plays a crucial role in providing high-quality, person-centred care.

B

C 
 

Capacity and informed consent

I is essential to presume that individuals have the capacity to make their own decisions unless there is a good reason to doubt it. Every adult with capacity has the right to refuse care or treatment, and their decision  must be respected, even if there is disagreement. Documentation of the refusal and the explanation provided should be clear in the individual’s records. 

Before any treatment or intervention, informed consent must be obtained to respect the individual’s autonomy and right to control their own life. Effective communication is crucial; individuals should receive information in an understandable manner, potentially using translation services if needed.

Caseload       

The number of people, service users, clients or patients managed by a health professional at a particular time.

Clinical audit

A quality improvement process that seeks to improve services, care delivery and ultimately patients' outcomes through systematic review of care measured against explicit published criteria.

Clinical governance

The system of authority to which healthcare teams are accountable for the quality, safety and satisfaction of patients in the care they deliver.

Clinical indemnity insurance

Practitioners are legally accountable for ensuring they have appropriate professional indemnity insurance.
Individuals expect practitioners to hold insurance in case there is a substantiated claim of professional negligence against them. If you are employed in the public health service or in certain voluntary organisations, you are indemnified by the Clinical Indemnity Scheme (CIS). If you are working in the private sector, you may be covered by your employer’s insurance.

In the interest of an individual’s safety and protecting the public, you must ensure that you have professional indemnity insurance if you are working in private or independent practice.

Clinical placement co-ordinator (CPC)    

A Clinical Placement Co-ordinator (CPC) is an experienced registered nurse or registered midwife who supports the facilitation of learning, and assessment of competence, among nursing / midwifery undergraduate students in the practice setting.

Clinical supervision

Is the facilitation of learning through the formal reviewing of clinical experiences with a professional colleague(s) who shares useful and insightful feedback. Clinical supervision involves reflection and is an opportunity for the professionals involved to explore alternative perspectives with a commitment to enhancing clinical outcomes.  Clinical supervision is central to the development and maintenance of high standards of professional performance and competence. 

Closed loop communication

Where individuals repeat the information back to the individual to ensure they understand. Sometimes, an individual’s health may prevent them from participating in the consent process. In such cases, assess their capacity based on relevant laws and regulations, while taking steps to support their decision-making. To determine capacity, consider whether the individual can understand, retain and communicate information about the decision at hand.

Capacity is specific to each decision; lacking capacity for one decision does not mean they lack it for other decisions. If someone cannot decide, consult with a legally authorised representative.

The information provided should be tailored to the individual’s needs, including their beliefs and culture. Always allow enough time for questions and decision-making, while keeping them informed about any changes to their condition or treatment options.

In emergencies, treatment can proceed without consent if it is necessary to save a life or prevent significant health deterioration. When using digital health technologies, explicit consent must be obtained for processing health data. Any withdrawal of consent should lead to the deletion of personal data.

Collaborative practice

Collaborative practice occurs when health workers from different professional backgrounds work together with persons of all ages, families, groups and communities in the achievement of shared effective health care outcomes.

Colleagues

Co-workers, other health and social care professionals, other healthcare workers, and nursing and midwifery students.

Competence

Refers to the ability of practitioners to consistently demonstrate the necessary skills, knowledge, judgement and attitudes required to provide safe, effective and ethical care. This includes not only technical proficiency in clinical tasks but also the capacity to assess and respond to the physical, emotional and psychological needs of  individuals. Competence involves ongoing professional development, adherence to established PPPGs, and the ability to make informed decisions in complex and dynamic healthcare settings. Ultimately, competence ensures that practitioners can deliver high-quality care that meets the needs of individuals and communities while promoting safety and wellbeing.

Competences

The knowledge, understanding, practical skill and ability levels specified in the learning outcomes that are directly related to academic award level.

Competency

The ability of a nurse or midwife to practise safely and effectively fulfilling their professional responsibility within their scope of practice.

Competency framework

A discrete collection of competencies and their indicators specifying the expected standards of effective performance.

Concerns about colleagues or systems

 If you have concerns about a colleague’s conduct or competence, you should talk to the individual initially to highlight your concerns. If the conduct or competence concern continues, you should inform your manager. In a situation where you have concern about potentially unsafe systems, you must act to prevent any immediate risk to an individual’s safety by taking appropriate steps to notify the relevant person or authority about your concerns as soon as possible. If you are unsure who you should report your concern to, ask a senior colleague for advice.

If you are concerned about a colleague’s health or professional competence due to alcohol or drug misuse, a  physical or psychological disorder or other factors, you have an overriding duty to make sure that individuals are protected. The best way to support a colleague in these circumstances, is to advise them to seek professional help in line with the principles of the Code. However, if there is a serious risk to an individual’s safety, you should inform senior management of your concerns immediately, in accordance with local policy and inform NMBI, if  required. 

Conduct

A person’s moral practices, actions, beliefs and standards of behaviour.

Confidentiality and privacy

Confidentiality is central to the practitioner and individual’s relationship. Each individual needs to be confident that their personal information and their basic dignity will be protected by you. Relationships are built on trust. Any improper breach of this trust, even if accidental, damages the relationship and the general trust worthiness of the professions of nursing and midwifery. 

Conscientious objection

Refers to a practitioner’s strong moral or religious objection to providing, or participating in certain healthcare services or interventions. This may arise in various contexts, such as refusing to be involved in procedures like abortions or certain treatments that conflict with the practitioner’s deeply held beliefs. While practitioners have the right to refuse participation based on their convictions, it is essential that they do so responsibly. This includes informing their employers and ensuring that individuals are directed to alternative providers who can meet their needs without delay. Conscientious objection must be balanced with the duty to provide care, and practitioners are encouraged to communicate openly with individuals about their limitations. Conscientious objection requires careful consideration of both the rights of practitioners and the rights of individuals to receive comprehensive care.

Critical elements

These are defined as the set of single, discrete, observable behaviours that are mandatory for the designated skill at the targeted level of practice. They represent principles that are essential to ascribe competent performance. They enable the learning outcomes both from a clinical and curriculum perspective to be achieved.

Cultural competence

The attainment and demonstration of integrity and respect among health professionals who work with people from diverse ethnic origins in the achievement of effective care outcomes.

Culturally safe and respectful practice

Culturally safe and respectful practice requires having knowledge of, and insight into how culture, values, attitudes, assumptions and beliefs influence interactions with an individual, families and colleagues. To ensure culturally safe and respectful practice, it is important to acknowledge that only the individual and/or their family can determine whether care is culturally safe and respectful. 

It is important to establish a relationship of trust with each individual by being honest, acting consistently, and delivering safe and competent care.

Adopt practices that respect diversity, avoid bias, discrimination and racism, and challenge belief based upon assumption (for example, based on gender, disability, race, ethnicity, religion, socioeconomics, sexuality, age or political beliefs). By developing and promoting actions such as raising awareness, challenging discrimination, and encouraging attitude and behaviour changes towards a more inclusive culture, a positive and culturally safe work environment can be created through role modelling and supporting the rights, dignity, and safety of others,  including both individuals and colleagues.

D

Data Protection Officer (DPO)

Is a designated individual within an organisation responsible for overseeing data protection strategies and ensuring compliance with relevant data protection laws and regulations, such as the General Data Protection Regulation (GDPR). They play a crucial role in safeguarding personal data, which is particularly important in sectors like healthcare, where sensitive information about individuals is routinely handled. 

Delegation

Refers to the process by which practitioners assign specific tasks or responsibilities to other healthcare team  members, such as students, regulated and unregulated staff, while maintaining overall accountability for the individual’s care. Delegation involves clear communication, ensuring that the designated individual has the appropriate skills, knowledge and authority to perform the task safely and effectively. It also requires the delegating practitioner to monitor and evaluate the outcome of the delegated tasks to ensure safety and quality of care are maintained. The practitioner who is delegating is accountable for the decision to delegate. The practitioner, student or regulated/unregulated healthcare worker is responsible for carrying out the delegated role or activity in an appropriate manner and is accountable for the appropriate performance of that role or activity. Employers and managers must support practitioners in delegation and supervision of students or regulated/unregulated staff by providing appropriate organisational policy and resources.

Disclosure of information outside the healthcare team without consent

In limited situations, information can be disclosed without consent when required by law or if it is in the public interest. Individuals involved should be informed of such disclosure unless doing so would compromise the  purpose of the disclosure.

You must disclose information when required by law, including:

• when a judge issues a court order
• when requested by a tribunal or a body formed by legislative act 
• under relevant legislation (Patient Safety [Notifiable Incidents and Open Disclosure] Act 2023)
• according to infectious diseases regulations, or
• if a crime, such as sexual assault or violence, is suspected against a child or a vulnerable individual (Criminal Justice [Withholding of Information on Offences against Children and Vulnerable Persons] Act 2012)

Disclosure may be in the public interest when the benefit to others or society outweighs the duty of  confidentiality, for example to prevent harm from serious diseases or crime. This requires balancing individual rights with public interest, and legal guidance may be required. Only necessary information should be shared with relevant authorities.

Diversity, equality and inclusion (DEI)

Embracing diversity means recognising and valuing the unique backgrounds, experiences, and perspectives of individuals and healthcare providers. This includes considerations of race, ethnicity, gender, sexual orientation, age, disability and socioeconomic status.

Equality emphasises the importance of providing fair treatment and access to healthcare services for all individuals, regardless of their background. Practitioners should strive to eliminate disparities in healthcare outcomes, and ensure that all patients and service users receive the same quality of care. This commitment to equality helps build trust within communities and improves overall public health. NMBI supports the avoidance of language which implies that there are only two genders.

Domain

An organised cluster of competencies in broad categories that represent the functions of the registered nurse / registered midwife in contemporary practice.

Duty of care

An obligation to perform to a certain standard of conduct for the protection of another against an unreasonable risk of harm.

E

Ethics

The principles, values and virtues that enable people to live a morally good life. Applied to nursing and midwifery, the moral principles presented in the Code of Professional Conduct and Ethics for registered nurses and registered midwives underpin professional practice.

Evidence-based practice (EBP)

Involves integrating the best available research evidence with the practitioner’s expertise, and the individual patient’s values and preferences to guide healthcare decisions. This approach ensures that care is informed by the latest scientific findings, which can lead to improved outcomes and enhanced quality of care.
Practitioners use EBP to evaluate and apply research findings to realworld situations, considering their own skills and experiences while also respecting the unique needs and choices of individuals. Actively involving individuals in the decision-making process and honouring their preferences, EBP promotes a collaborative and personalised approach to care.

This method not only enhances the effectiveness of interventions but also empowers individuals, fostering a sense of ownership over their health and wellbeing. Ultimately, evidence-based practice is essential for delivering
high-quality, effective and person-centred care.

Expanded practice

An authorised / agreed change in the role of an individual registered nurse or registered midwife to include areas of practice that have not previously been within their scope of practice, but are within the overall scope of practice of the nursing and midwifery professions.

F

Family-centred care

A philosophy of care based on a collaborative relationship between the child, family and healthcare provider in decision-making about healthcare interventions.

G

Guideline

Defined as a principle or criterion that guides or directs action. Guideline development emphasises using clear evidence from the existing literature, rather than expert opinion alone, as the basis for advisor materials.

H

Handwritten prescription

A written prescription is handwritten on a single pre-printed form usually taken from a prescription pad. All handwritten prescriptions must be written in ink.

Harm

Any deliberate or accidental physical, emotional, psychological, social or reputational injury or damage to the health of a person or to any other party or parties to whom a duty of care is owed.

Health and wellbeing

A state of complete physical, social and mental wellbeing, and not merely the absence of disease or infirmity. Within the context of health promotion, health has been considered less as an abstract state and more as a means to an end. It is a positive concept emphasising personal resources as well as physical capabilities.

Health assessment and structured physical examination

See assessement.

Healthcare record

All information collected, processed and held in either manual and / or electronic formats pertaining to a person under the care of a registered midwife or nurse or health care team, including personal care plans, clinical data, images, unique identification, investigation, samples, correspondence and communications relating to the person and their care.

Health continuum

Integrated care – or the health continuum – aims to join up health and social care services to improve quality and put patient outcomes and experiences at the centre of the health service. It means changing how care is provided so people with complex needs can live healthier and more independent lives.

Health literacy

Is the ability to read, understand and use healthcare information. Practitioners play an important part in  improving health literacy, as incorporating it into practice is essential for delivering highquality care. Using  terminology that is easy to understand, and offering time and explanations may help those individuals become better informed about their health and as a result may lead to improved health outcomes.

I

Inaction

Failure to act in a situation where an action is required.

Incident

An event or circumstance which could or does lead to unintended and unnecessary harm to a person, or to a complaint being made, or to loss or damage.

Indicators

Statements describing the type of behaviours that would be observed when effective performance of a competence is demonstrated.

Integrity

Upholding the values of the nursing and midwifery profession and the accepted standards of practice. Acting with integrity is acting honestly and behaving as expected under the Code of Professional Conduct and Ethics.

ISBAR 

ISBAR is a mnemonic to enhance the quality of information health care professionals share. In a medical setting, it improves patient safety by allowing health care staff to communicate in a structured and standardised format. ISBAR – I = Identify yourself, S= Situation, B= Background, A= Assessment, R= Recommendation

J

K

Knowledge

The cognitive representation of ideas, events or happenings. May be derived from practical or professional experience as well as from formal instruction or study, articulated in terms of description, memory, understanding, thinking, analysis, synthesis, debate and research.

L

Learning

Learning is the lifelong process of transforming information, ideas and experience through imitation, practice and reflection into relatively permanent new knowledge, skills, know-how, behaviour, and attitudes.

Learning contract

A learning contract is a means of reconciling the learning needs of the Return to Practice Nurse with the requirements for successful completion of the period of clinical practice and assessment. This is achieved through negotiation of learning needs and objectives. The focus is on the development of competence through achievement of the learning outcomes.

Learning log 

The learning log represents documented evidence of learning recorded by the undergraduate / postgraduate student in the form of a diary or journal. It facilitates assessment in the specified Domains of Competence as outlined by NMBI.

Learning outcomes

Learning outcomes for programmes of study specify the acquisition of knowledge, understanding, ability and skills that a learner should have attained through the process of learning which is demonstrated in terms of level of competency by a defined end point.

Lifelong learning

All learning activities undertaken throughout life, with the aim of improving knowledge, skills and competences within a personal, civic, social and / or employment-related perspective.

M

Maternity care

Care for women from when they access care or services during pregnancy, labour and birth through to the care of women and their baby in the postnatal period.

Maximum

Greatest possible quantity or value attainable.

Must

Commands the action a nurse or midwife is obliged to take from which no deviation whatsoever is allowed.

N

National clinical guidelines            

Systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about appropriate health care for specific clinical circumstances across the entire clinical system.

O

Omission

Failure to do something, especially something that a person has a moral or legal obligation to do.

Open disclosure and raising concerns

Open disclosure is an honest, open, compassionate and timely approach to communicating with an individual, and if appropriate, their family/carers, following a patient safety incident. This includes acknowledging, apologising and explaining when things go wrong. Practitioners have legal responsibilities and need to comply with any mandatory reporting requirements. They have a professional duty to acknowledge when something has gone wrong and to provide an honest explanation of what happened. They must prioritise the interests of individuals in their care and act to protect them if they think there is a risk.

Practitioners must follow any relevant mandatory reporting laws to protect groups that are particularly at risk, including reporting obligations relating to care of older persons, child abuse and neglect. They must remain alert to other groups who may be vulnerable and at risk of physical harm and sexual exploitation, and act on welfare concerns where appropriate. Regardless of the role or location, it is important for practitioners to know how to raise concerns appropriately

P

Patient

A person who uses health and social care services. In some instances, the terms ‘client’, ‘individual’, ‘person’, ‘people’, ‘resident’, ‘service user’, ‘mother’, ‘woman’ or ‘baby’ are used in place of the term patient depending on the health or social care setting.

Patient assessment

See assessment

Performance Criteria

These are statements of selected actions or behaviours that identify how achievement of competence is demonstrated.

Period of Adaptation

A period of adaptation is a period of supervised practice possibly being accompanied by further education and training. The supervised practice is under the responsibility of a registered midwife. This period of supervised practice shall be the subject of assessment. 

Person

A person means an individual who uses health and social care services. In some instances, the terms 'client', 'individual', 'patient', 'people', 'resident', 'service user', 'mother', or 'baby', ’child’, ‘young person’ are used in place of the term person depending on the health or social care setting.

Person-centred nursing and midwifery

Respecting a person’s values and beliefs by involving her / him centrally in decision-making, providing for the person’s needs within an empathetic approach to affect mutually agreed effective outcomes. 

Practice         

Any role, whether remunerated or not, in which the individual uses his / her skills and knowledge as a nurse or midwife, incorporating, direct and indirect patient care.

Practice placement

A clinical site, approved by NMBI, to provide appropriate learning experiences for undergraduate or postgraduate nursing or midwifery students.

Practice standards for midwives

Authoritative statements developed, monitored and enforced by the Nursing and Midwifery Board of Ireland to describe the responsibilities and conduct expected of registered midwives. The standards are based on the principles and values that underpin professional midwifery practice.

Preceptor

A preceptor is a registered nurse or registered midwife who has undertaken preparation for the role and who supports undergraduate nursing or midwifery students in their learning in the practice setting and assumes the role of supervisor and assessor of the students’ achievement of clinical learning outcomes and competence.

Policy

A written statement that indicates clearly the position and values of the organisation on a given subject.

Primary care

Primary care is an approach to care that includes a range of services designed to keep people well, from promotion of health and screening for disease to assessment, diagnosis, treatment and rehabilitation as well as personal social services. The services provide first-level contact that is fully accessible by self-referral and have a strong emphasis on working with communities and individuals to improve their health and social well-being.

Primary carer

Nominated family member(s), or another, as agreed with the patient, with whom the health professional collaborates in the development of evidence based plans of care.

Professional autonomy

Refers to the ability of practitioners to use their knowledge and expertise critically to deliver safe and high-quality
healthcare to individuals. This autonomy allows practitioners to make informed decisions based on clinical judgement, evidence-based practices and an understanding of the needs of individuals. The degree of autonomy can vary significantly among practitioners, influenced by legislative frameworks, organisational policies and individual circumstances. Legislation, regulations and PPPGs may define the scope of practice for practitioners, outlining what they are authorised to do within their professional roles. The culture and policies of the healthcare
organisation can either empower or restrict practitioners’ ability to exercise their autonomy. Individual factors, such as experience, confidence and education, also play a crucial role in determining how effectively a practitioner can act autonomously.

Ultimately, fostering professional autonomy is essential for enhancing the quality of care, as it enables practitioners to respond more effectively to the complexities of care and adapt their approaches based on the unique context of each situation.

Protected disclosure

A practitioner, in good faith, can report specific concerns, encouraging healthcare professionals to speak up about serious issues that could jeopardise safety or the integrity of the healthcare system. Practitioners can report safety concerns that pose risks to individuals or the public, such as unsafe practices, inadequate staffing or potential hazards in clinical environments, thereby ensuring that necessary actions are taken to protect health and safety. They also have a duty to report violations of legal obligations, including breaches of health regulations, laws or ethical standards, which helps maintain the integrity of the healthcare system and safeguard individuals’ rights. Additionally, concerns about the misuse or waste of public funds, such as resources allocated for patient care, can be disclosed, promoting financial accountability, and ensuring that resources benefit individuals and the community effectively.

When disclosures are made in good faith, practitioners are protected from adverse consequences like dismissal, disciplinary action or harassment, fostering a culture of transparency and accountability in healthcare settings. To qualify for protection, disclosures typically must follow specific legal frameworks, often requiring reporting to designated individuals or regulatory bodies. Practitioners are encouraged to adhere to established protocols to ensure their concerns are handled appropriately while maintaining confidentiality when needed. Overall, protected disclosure empowers healthcare professionals to consider the will and preferences of individuals and the public, contributing to a safer and more ethical healthcare environment.

Public health

Public health deals with the structures, processes and competencies required to monitor, protect and promote the health of defined populations. Whereas public health used to rely heavily on legislation and concentrate on programmes for disease control, the new health for all based public health is more strategic. It draws on the contribution of many sectors, disciplines and actors; it operates in policy-making spheres as well as at technical levels; it encourages community participation; and it places strong emphasis on the social, economic and environmental determinants of health (EUR/RC48/13 1998).
 
The following key elements of public health have been identified:

• Assessing the health needs of a population.
• Planning and implementing programmes that promote and protect health, i.e. immunisation and screening programmes, health promotion. campaigns and planning and delivering integrated services across agencies.
• Working with other agencies to address the wider threat to health e.g. housing, transport, social exclusion.
• Identifying health inequalities and taking action to address these.

Q

Quality care

Care that is person-centred, safe, effective and results in better health and wellbeing.

Quality of practice

Evidence-based professional standards balanced against patient needs, patient satisfaction and organisational efficiency.

R

Referral

An act of referring someone for consultation, review, or further action if the required intervention is outside the scope of practice of the nurse or midwife’s competence to provide safe, quality care.

Reflection

Reflection is both a theoretical and practical concept that involves reviewing one’s practice, pondering alternatives, thinking critically and creatively, and analysing other evidence with a view to learning from experiences. Reflective practice involves a conscious review of an event, situation, information or emotion encountered with the aim of analysing and evaluating the experience to apply insights to future practice. Reflection enables individuals and teams to engage in a structured intellectual activity that critically evaluates experiences and practices, promotes change and results in self-awareness, deeper understandings, learning that is meaningful and memorable, and enhanced clinical outcomes.   

Registered midwife

A midwife whose name is entered in the Midwives Division of the Register of Nurses and Midwives maintained by NMBI.

Registered nurse

A nurse whose name is entered in the Nursing Division of the Register of the Nurses and Midwives maintained by NMBI.

Regulation

A rule or law designed to control or govern conduct.

Requirement

Something that is compulsory and a necessary condition for achievement or approval.

Respect for the dignity of the person

The Universal Declaration of Human Rights (United Nations, 1948) states that freedom, justice and peace are built on dignity and equality of the person.

The values and standards established for respecting the dignity of the person are also referenced in:

• The Constitution of Ireland (Government of Ireland, 1937)
• The European Convention for the Protection of Human Rights and Fundamental Freedoms (Council of Europe, 1950)
• The Equal Status Acts (Government of Ireland, 2000–2018)
• The United Nations Convention on the Rights of Persons with Disabilities, 2007 (ratified by the Government of Ireland, 2018)
• The United Nations Convention on the Rights of the Child (Government of Ireland 1992, 2002)
• Charter of Fundamental Rights of the European Union 2012/C 326/02 (Article 1 deals with Human Dignity).

Responsibility

Refers to a practitioner’s obligation to perform competently at an acceptable level, which is determined by their education, training and professional standards. This means that registered nurses and registered midwives are expected to carry out their roles effectively and ethically, ensuring that their practice aligns with established guidelines and best practices.

S

Scope of practice     

The range of roles, functions, responsibilities and activities which a registered nurse or registered midwife is educated, competent and has authority to perform. For more details, visit the Scope of Practice section.

Self-determination

A person taking control of their own life and making one’s own decisions.

Service needs analysis

This definition as it applies to advance practice means established service need based on audit findings using quantitative and data. These data illustrate the benefit of preparing the site for employment of Advanced Practice in terms of positive outcomes.  Service needs analysis may be used to justify employment costs in the organisation’s service plan / business case. It is the health care provider’s responsibility to determine the need for the development of advanced practice posts to meet their service needs. Principles underpinning support for the development of advanced practice posts include safety, equity, security, respect, partnership, reciprocity, and multi-disciplinary team work.

Should

Indicates a strong recommendation to perform a particular action from which deviation in particular circumstances must be justified.

Site preparation

As relates to advanced practice, this means  the development of a health service site by an organisation to support the employment of Advanced Nurse/Midwife Practitioner Candidates (ANPcs/AMPcs) and Registered Advanced Nurse/Midwife Practitioners (RANP/RAMP) in terms of preparing a comprehensive job description that clearly outlines the scope of practice of the post. Before a post is created the principles of necessity, effectiveness, role delineation, relevance and transparency must be considered.  Site preparation involves the development of evidence based policies, procedures, protocols and guidelines to support Advanced Nurse / Midwife Practitioner Candidates and Registered Advanced Nurse / Midwife Practitioners in their roles.  Site
preparation may also involve service level agreements and memoranda of understanding to enable the RANP/RAMP fulfil his/her role. 

Standards

Authoritative tatements developed, monitored and enforced by the Nursing and Midwifery Board of Ireland to describe the responsibilities and conduct expected of registered nurses and midwives. The standards are based on the principles and values that underpin professional practice.

Sufficient knowledge

Having knowledge equal to the proposed end as specified in a learning outcome or practice-based indicator as judged by the person evaluating the performance of the learner or peer.

Supernumerary status

Students undertaking the registration education programme are surplus to the staffing requirements for the health care setting during the supernumerary period of the programme. This excludes a final placement of 36 weeks internship, which consolidates the completed theoretical component of the programme. Students continue to need support and supervision during the internship period to enable them achieve clinical competence during the practice placement and in the interest of patient safety. 

Supervision

Practitioners may be required to supervise, delegate to, and educate students and regulated/unregulated colleagues in providing safe person-centred care. Supervision enables students to learn and safely achieve competence and autonomy in their professional role. All NMBI practitioners can supervise students, serving as role models for safe and effective practice. Students may be supervised by other registered healthcare professionals.

The main types of supervision include:

• Direct supervision: involves the practitioner being physically present while students provide care. The supervisor observes the student’s actions in real-time, offering immediate feedback and guidance.
• Indirect supervision: the practitioner is not physically present but is available for consultation and support. Students may work independently and can seek advice or clarification as needed. This type of supervision encourages autonomy while still providing safe learning.
• Remote supervision: With advancements in technology, remote supervision allows supervisors to oversee student activities from a distance, often using video conferencing tools. This can be particularly useful in scenarios where in-person supervision is not feasible, such as when students are placed in geographically dispersed locations.
• Peer supervision: In some educational settings, students may supervise one another under the guidance of a qualified instructor. This collaborative approach encourages teamwork and critical thinking, allowing students to learn from each other’s experiences and insights.
• Reflective supervision: This type of supervision focuses on the reflective practice of students. Supervisors encourage students to think critically about their experiences, decisions, and the care they provide, facilitating deeper learning and self-awareness.
• Simulation-based supervision: In a controlled environment, students participate in simulated clinical scenarios where they can practice their skills and decision-making without risk to real individuals. Supervisors provide feedback during or after the simulation, enhancing the learning experience.

Each type of supervision plays a crucial role in developing nursing and midwifery students’ knowledge, skills and competencies, ensuring they are well-prepared for their future roles in healthcare. Balancing approaches to
supervision helps to cultivate both practical skills, and independent critical thinking and decision making. 

Sustainability

Sustainability in healthcare focuses on promoting environmental, social and economic health. For practitioners, this means incorporating sustainable practices into daily routines. Key considerations include efficient resource management (optimising the use of water, energy and supplies to reduce waste) alongside waste reduction strategies like recycling and minimising single-use plastics. Practitioners play a vital role in the care of individuals by encouraging sustainable lifestyle choices through health education, advocating for organisational policies that promote sustainability and enhancing knowledge about sustainable practices.

T

Therapeutic relationship

Therapeutic relationships are vital for providing effective and compassionate care, built on trust, respect, and a focus on the individual’s wellbeing. Establishing a safe environment encourages individuals to share sensitive information, while open and empathetic communication (through active listening and clear explanations), helps individuals feel understood. Focusing on individual needs, preferences and values, empowers individuals to actively participate in their care. Maintaining professional boundaries protects both the individual and the practitioner, ensuring the focus remains on health needs. Practitioners also advocate for individuals’ rights and preferences within the healthcare system, and understanding and respecting cultural backgrounds enhance trust and address specific health beliefs. Practitioners should engage in reflection and self-awareness to recognise their biases and emotions, allowing them to provide nonjudgmental care. Therapeutic relationships can contribute to better health outcomes by creating a supportive and trusting environment.

U

Unregulated healthcare worker 

A person who is not statutorily regulated and is employed within a healthcare, residential or community setting and whose role includes a component of direct patient care and the performance of delegated care activities, supported in organisational policy.

V

Validation of a programme

Validation is the process by which an awarding body shall satisfy itself that a learner may attain knowledge, skill or competence for the purpose of an award made by the awarding body.

Verifier

The verifier is an independent person who ensures that the assessment is conducted fairly. If difficulties arise during the period of adaptation the verifier is responsible for verifying the assessment process. The verifier attends the intermediate and final meeting if requested to do so by a Return to Practice Nurse, undergraduate or postgraduate nursing or midwifery student, the Preceptor or both. A link academic, Clinical Placement Coordinator or Clinical Nurse Manager may serve as a verifier.

W

Woman

A female person of any age.

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