NCM 107 (Care of mother, child and

STUDENT’S ACTIVITY SHEET adolescent (well clients)- Lecture)

BS NURSING /SECOND YEAR
Session # 3

LESSON TITLE: SCOPE AND STANDARD , LEGAL Materials:

CONSIDERATION , ETHICAL CONSIDERATION OF
Student: Notebook, pens & paper, SAS
MATERNAL AND CHILD NURSING References:
 Pillitteri, Adele. (2010) Maternal & child health
LEARNING OUTCOMES: nursing :care of the childbearing & childrearing
Upon completion of this lesson, the nursing student can: family. 6th Edition. Philadelphia, PA : Lippincott
Williams & Wilkins
 Adhere to the ethico-legal considerations when providing  American Nurses Association. (2015). Code of
safe and quality maternal and child nursing care based on ethics with interpretative statements. Silver
the law and regulatory and institutional requirements. Spring, MD: Author. Retrieved from
http://www.nursingworld.org/MainMenuCategori
 Apply the code of ethics for nurses in the different health
es/EthicsStandards/CodeofEthicsforNurses/Co
related scenarios in upholding the professional standards de-ofEthics-For-Nurses.html
of a registered nurse.  Ladewig, P., London, M., & Davidson, M.
 Recognize and conform to the patient’s bill of rights in (2006). A look at the contemporary maternal-
providing patient centered care to clients. newborn nursing care. 6th Edition. Pearson
Education, Inc.
 NCLEX: Legal Aspects of Nursing. (2017,
January 19). Brillant Nurse.
https://brilliantnurse.com/legal-aspects-of-
nursing/
 Laws, Rules, and Issuances for Cases
Involving Family, Domestic Relations, Women
and Children. (2015). Philippine Judicial
Academy.
https://sb.judiciary.gov.ph/libdocs/gad/Laws,%2
0Rules%20and%20Issuances%20for%20Case
s%20Involving%20Family,%20Domest.pdf

LESSON REVIEW (15 minutes)

Good day students! You are about to start module 3. To give you a brief preview for today’s lesson, you will
answer this activity below:

Define the following terms briefly in the space provided. Two points each.

a. Health Promotion - _________________________________________________________________________

b. Health Maintenance - _______________________________________________________________________
c. Health Restoration - ________________________________________________________________________
d. Heath Rehabilitation - ______________________________________________________________________
e. Educator - _______________________________________________________________________________

Now, you are ready for the main lesson.

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PHINMA Education (Department of Nursing) 1 of 10
MAIN LESSON (50 minutes)
You should read SCOPE AND STANDARD , LEGAL CONSIDERATION , ETHICAL CONSIDERATION OF
MATERNAL AND CHILD NURSING topic. You can highlight the module and read other books about this lesson
for further references.
-Use the book Maternal and Child Nursing Chapter 1 page 22-23.
- Fill-in the missing ideas/concept/definitions in the space provided.

NURSING: SCOPE AND STANDARDS OF PRACTICE

Standards are authoritative statement by which the nursing profession describes the responsibility for which its
practitioners are accountable. It reflects the values and priorities of the profession.
SEC. 28.Scope of Nursing. — A person shall be deemed to be practicing nursing within the meaning of this Act
when he/she singly or in collaboration with another, initiates and performs nursing services to individuals,
families and communities in any health care setting. It includes, but not limited to, nursing care during
conception, labor, delivery, infancy, childhood, toddler, pre-school, school age, adolescence, adulthood
and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and
prevention of illness. As members of the health team, nurses shall collaborate with other health care providers
for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and
when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to:

(a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited
to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and
procedures, essential primary health care, comfort measures, health teachings, and administration of written
prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labor in
the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be
provided according to protocol established;

(b) Establish linkages with community resources and coordination with the health team;

(c) Provide health education to individuals, families and communities;

(d) Teach, guide and supervise students in nursing education programs including the administration of nursing
services in varied settings such as hospitals and clinics; undertake consultation services; engage in such
activities that require the utilization of knowledge and decision-making skills of a registered nurse; and

(e) Undertake nursing and health human resource development training and research, which shall include, but not
limited to, the development of advance nursing practice;

Provided, That this section shall not apply to nursing students who perform nursing functions under the
direct supervision of a qualified faculty: Provided, further, That in the practice of nursing in all settings, the
nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice.
The nurse is required to maintain competence by continual learning through continuing professional education to
be provided by the accredited professional organization or any recognized professional nursing organization:
Provided, finally, That the program and activity for the continuing professional education shall be submitted to and
approved by the Board.

SEC. 29.Qualifications of Nursing Service Administrators. — A person occupying supervisory or managerial

positions requiring knowledge of nursing must:
(a) Be a registered nurse in the Philippines;
(b) Have at least two (2) years experience in general nursing service administration;
(c) Possess a degree of Bachelor of Science in Nursing, with at least nine (9) units in management and
administration courses at the graduate level; and
(d) Be a member of good standing of the accredited professional organization of nurses;

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Provided, that a person occupying the position of chief nurse or director of nursing service shall, in addition to the
foregoing qualifications, possess:
(1) At least five (5) years of experience in a supervisory or managerial position in nursing; and
(2) A master’s degree major in nursing;

Provided, further, That for primary hospitals, the maximum academic qualifications and experiences for a chief
nurse shall be as specified in subsections (a), (b), and (c) of this section: Provided, furthermore, That for chief
nurses in the public health agencies, those who have a master’s degree in public health/community health
nursing shall be given priority. Provided, even further, That for chief nurses in military hospitals, priority shall be
given to those who have finished a master’s degree in nursing and the completion of the General Staff Course
(GSC): Provided, finally, That those occupying such positions before the effectivity of this Act shall be given a
period of five (5) years within which to qualify.

B. LEGAL CONSIDERATIONS OF MATERNAL-CHILD PRACTICE

It is important for nurses to recognize that nursing practice is guided by legal restrictions and professional
obligation. Legal responsibilities are regulated by state. Nurses need to be aware of these standards, as well as
legal and ethical concepts and principles because nurses are accountable for their actions in these areas in their
professional life.

Legal Concepts that apply to Maternal and Child Nursing Practice

A. Standards: identify the minimal knowledge and conduct expected from a professional practitioner
delivering care to the mother and child. Standards are applied as they relate to practitioner’s experience
and educational preparation:nursing care during conception, labor, delivery, infancy, childhood,
toddler, pre-school, school age, adolescence.

Maternal and child health nursing carries some legal concerns that extend above and beyond other areas
of nursing, because care is often given to an “unseen client”—the fetus—or to clients who are not of legal
age for giving consent for medical procedures.

Nurses are legally responsible for protecting the rights of their clients, including confidentiality, and are
accountable for the quality of their individual nursing care and that of other health care team members.
B. ___________________: “Omission to do something that a reasonable person, guided by those ordinary
considerations which ordinarily regulate human affairs would do; or doing something which a reasonable
and prudent person would not do”. Types of negligent acts related to:
a. Sponge counts: incorrect counts or failure to count.
b. Burns: heating pads, solutions, steam vaporizers.
c. Falls: side rails left down, infant left unattended.
d. Failure to observe and take appropriate action—forgetting to take vital signs and check dressing
in a client who is newly postoperative.
e. Wrong medicine, wrong dose and concentration, wrong route, wrong client.
f. Mistaken identity—wrong client for surgery.
g. Failure to communicate—ignore, forget, fail to monitor, report, or document client’s status or to
report complaints of client or family.
h. Loss of or damage to client’s property— dentures, jewelry, money.
i. Inappropriate use of equipment (e.g., excessive IV fluids via pump).
C. _____________________ – professional negligence, misconduct, or unreasonable lack of skill resulting
in injury or loss to the recipient of the professional services.
D. Competence – ability or qualification to make informed decisions
E. Informed Consent : agreement to the performance of a procedure /treatment based on the knowledge of
facts, risks, and alternatives
a. Simple: having capacity to give consent for the treatment or procedure
b. Valid : having capacity to give consent and also demonstrating an understanding of the nature of
the treatment , expected effects, passible side effects and alternatives to treatment
F. ___________________– unjustifiable threat or attempt to touch or injure another.
G. Battery- unlawful touching or injury to another

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 H. Crime- acts that is violation of duty or breach of law, punishable by the state by fine or imprisonment
I. Tort: a legal wrong committed against a person, his or her rights or properly; intentional, willfully
committed without just cause.

Legal responsibilities of the Nurse

A nurse is expected to:

1. Be responsible for his or her own actions
2. Protect the rights and safety of patients.
3. Witness , but not obtain , informed consent for medical procedures
4. Document and communicate information regarding client care and responses
5. Refuse to carryout orders that the nurse knows /believs are harmful to the client.
6. Perform acts allowed by that scope of nursing practice.
7. Reveal client’s confidential information only to appropriate persons
8. Perform acts for which nurse is qualified by either education or experience
9. Witness a will (this is not legal obligation, but the nurse may choose to do so)
10. Restrain client only in emergencies to prevent injury to self/others. Client has the right to be free from
unlawful restraints.

Laws and Republic Acts involving Family, Domestic Relations, Women and Children

Presidential Decree No. 603 The Child is one of the most important assets of the nation. Every effort should
- The Child and Youth be exerted to promote his welfare and enhance his opportunities for a useful and
Welfare Code happy life.

Executive Order No. 209 Marriage is a special contract of permanent union between a man and a woman
The Family Code in the entered into in accordance with law for the establishment of conjugal and family
Philippines life.

Republic Act No. 7610 - It is hereby declared to be the policy of the State to provide special protection to
“Special Protection of children from all forms of abuse, neglect, cruelty, exploitation and discrimination,
Children Against Abuse, and other conditions prejudicial to their development; provide sanctions for their
Exploitation and commission and carry out a program for prevention and deterrence of and crisis
Discrimination Act.” intervention in situations of child abuse, exploitation and discrimination.

It is the policy of the State to promote the family as the foundation of the nation,
________________________ strengthen its solidarity and ensure its total development.

Republic Act No.9262 - It is hereby declared that the State values the dignity of women and children and
“Anti-Violence Against guarantees full respect for human rights.
Women and Their Children
Act of 2004.”
Republic Act No. 9710 - Recognizing that the economic, political, and sociocultural realities affect
“The Magna Carta of women’s current condition, the State affirms the role of women in nation building
Women.” and ensures the substantive equality of women and men.

Republic Act No. 1015 - In accordance with Article II, Section 15 of the Constitution, it is hereby declared
“Mandatory Infants and to be the policy of the State to take a proactive role in the preventive health care
Children Health of infants and children.
Immunization Act of 2011.”
Republic Act No. 10354 - The State recognizes and guarantees the human rights of all persons including
“The Responsible their right to equality and nondiscrimination of these rights, the right to
Parenthood and sustainable human development, the right to health which includes reproductive
Reproductive Health Act of health, the right to education and information, and the right to choose and make

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2012.” decisions for themselves in accordance with their religious convictions, ethics,
cultural beliefs, and the demands of responsible parenthood.

C. PATIENT’S BILL OF RIGHTS

1. Right to Appropriate Every person has a right to health and medical care corresponding to his state of
Medical Care and Humane health, without any discrimination and within the limits of the resources, manpower
Treatment and competence available for health and medical care at the relevant time.
2. Right to Informed The patient has a right to a clear, truthful and substantial explanation, in a
Consent. manner and language understandable to the patient, of all proposed procedures,
whether diagnostic, preventive, curative, rehabilitative or therapeutic.
The privacy of the patients must be assured at all stages of his treatment.
3_____________________
In the course of his/her treatment and hospital care, the patient or his/her legal
4. Right to Information guardian has a right to be informed of the result of the evaluation of the nature and
extent of his/her disease, any other additional or further contemplated medical
treatment on surgical procedure or procedures, including any other additional
medicines to be administered and their generic counterpart including the possible
complications and other pertinent facts, statistics or studies, regarding his/her
illness, any change in the plan of care before the change is made, and the
person's participation in the plan of care and necessary changes before its
implementation.
5. The Right to The patient is free to choose the health care provider to serve him as well as the
Choose Health Care facility except when he is under the care of a service facility or when public health
Provider and Facility and safety so demands or when the patient expressly waives this right in writing.
6. Right to Self- The patient has the right to avail himself/herself of any recommended diagnostic
Determination and treatment procedures.
7. Right to Religious Belief The patient has the right to refuse medical treatment or procedures which may be
contrary to his religious beliefs, subject to the limitations described in the preceding
subsection
The patient is entitled to a summary of his medical history and condition.
8.
_____________________
9. Right to Leave The patient has the right to leave hospital or any other health care institution
regardless of his physical condition.
10. Right to Refuse The patient has the right to be advised if the health care provider plans to involve
Participation In Medical him in medical research, including but not limited to human experimentation which
Research may be performed only with the written informed consent of the patient.
11. Right to The patient has the right to communicate with relatives and other persons and to
Correspondence and to receive visitors subject to reasonable limits prescribed by the rules and regulations
Receive Visitors of the health care institution.
12. Right to Express The patient has the right to express complaints and grievances about the care and
Grievances services received without fear of discrimination or reprisal and to know about the
disposition of such complaints.
13. Right to be Informed of Every person has the right to be informed of his rights and obligations as a patient.
His Rights and Obligations
as a Patient

D. ETHIC-MORAL CONSIDERATIONS OF MATERNAL CHILD PRACTICE

NURSING ETHICS
- Division of ethics which deals with moral behavior or nurses in the practice of their profession.

Ethical Concepts That Apply to Nursing Practice

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 A. Ethics – rules and principles that guide nursing decisions or conduct in terms of the life
rightness/wrongness of that decision or action
B. Morals: personally held beliefs, opinions and attitudes that guide our actions
C. Values: appraisal of what is “good”.
a. Dilemmas may occur when different values conflict
b. Example: client’s right to refuse treatment to benefit client and carry out treatment.
D. Ethical dilemma: a problem in making a decision because there is no clearly correct or right choice. This
may result in having to choose an action that violates one principle or value in order to promote another.
E. ________________: an individual has the right to make his or her own decision regarding treatment and
care.
F. Paternalism: another person makes decisions about what is right or best for the individual.
G. Beneficence: promoting good or doing no harm to others.
H. Right to know: right to knowledge necessary or helpful in making an informed decision.
I. Principle of double effect: promoting good may involve some expected harm, such as adverse side
effects of medication.
J. Distributive justice: allocation of goods and services and how or to whom they are distributed.
a. Equality : everyone receives the same
b. Need: greater services got o those with greater need
c. Merit: services go to more deserving ( used as c criterion for transplant recepients)
K. Fidelity- a promise that the individual will fulfill all commitments made to himself or herself and to others.
L. Confidentiality- states that anything said to nurses and other health-care providers by their patients must
be held in the strictest confidence.
M. ________________- requires nurses to be truthful. Truth is fundamental to building a trusting
relationship.
N. Accountability- linked to fidelity and means accepting responsibility for one’s actions. Nurses are
accountable to their patients and to their colleagues.

Code of Ethics for Registered Nurse

The Code of ethics for Nurse serves the following purposes:
1. It is concise statement of the ethical obligation and duties of every individual who enters the nursing
profession
2. It is the profession’ non-negotiable ethical standards
3. It is an expression of nursing’s own understanding of its commitment to society

ETHICAL PRINCIPLES
REGISTERED NURSES AND PEOPLE
 Values, customs, and spiritual beliefs held by individuals shall be respected.
 Individual freedom to make rational and unconstrained decisions shall be respected.
 Personal information acquired in the process of giving nursing care shall be held in strict confidence.

REGISTERED NURSES AND PRACTICE

 Human life is inviolable
 Quality and excellence in the care of the patient are the goals of nursing practice
 Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing
accountability
 Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard
their rights and privileges.
 Registered nurses are aware that their actions have professional, ethical, moral and legal
dimensions. They strive to perform their work in the best interest of all concerned.

REGISTERED NURSES AND CO-WORKERS

 The registered nurse is in solidarity with other members of the healthcare team in working for patient’s
best interest

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  The registered nurse maintain collegial and collaborative working relationship with colleagues and
other health care providers

REGISTERED NURSES, SOCIETY AND ENVIRONMENT

 The preservation of life, respect for human rights, and promotion of healthy environment shall be a
commitment of a registered nurse.
 The establishment of linkages with public in promoting local, national and international efforts to meet and
social needs of the people as a contributing member of society is a noble concern of a Registered Nurse.

REGISTERED NURSES AND THE PROFESSION

 Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal.
 Compliance with the by-laws of the accredited professional organization (PNA) and other professional
organization of which the registered nurse is a member is a lofty duty
 Commitment to continual learning and active participation in the developing and growth of the profession
are commendable obligation
 Contribution of the improvement of the socio-economic condition and welfare of nurses through
appropriate legislation is a practice and a mission

CHECK FOR UNDERSTANDING (25 minutes)

You will answer and rationalize this by yourself. One (1) point will be given to correct answer and another one (1)
point for the correct ratio. You are given 25 minutes for this activity:

Multiple Choice(1-10 items)

1. A female client tells the nurse that she has tested positive for HIV, but she does not want the nurse to tell
anyone. What is the best action for the nurse to take?
a. Document this information on the client’s chart
b. Tell the client’s physician
c. Inform the health care team who will come to in contact with the client
d. Encourage the client to disclose this information to her physician.
Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. A young woman who has tested positive for HIV tells the nurse that she has had many sexual partners. She
tells her nurse that she believs that she will die soon. What would be the best response for the nurse to
make?
a. “Where there’s life there is hope”.
b. “Would you like to talk to the nurse who works with HIV-positive clients?”
c. “You are a long way from dying”.
d. “Not everyone who is HIV positive will develop AIDS and die”.
Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. A pregnant woman is offered the opportunit to participate in research on a new theraphy. The researcher asks
the nurse to obtain the client’s consent. What would the most appropriate action for the nurse to take?
a. Be sure the clients understand the project before signing the consent form
b. Read the consent form to the client and give her an opportunity to aks questions
c. Refuse to be one to obtain the client’s consent
d. Give the form to the client and tell her to read it carefully before signing

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Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. The pregnant woman has signed the consent form for a research study but changed her mind. The nurse tells
the client that she has the right to change her mind based upn which of the following principles?
a. Paternalism
b. Autonomy and informed consent
c. Beneficence and double effect
d. Competence and right to know
Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. A postpartum woman has just returned to the OB from delivery room. The nurse transferred her to her bed but
did not put the side rails. The client fell and was injured. What kind of liability does the nurse have?
a. None
b. Negligence
c. Intentional tort
d. Assault and battery
Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

6. The nurse is in the hospital’s public cafeteria and hears two nursing students talking about the client at room
406. They are using the client’s name and discussing intimate details about the client’s illness. Which of the
following actions is best for the nurse to take?
a. Go over and tell the nursing students that their actions are inappropriate, especially in a public place.
b. Wait and tell the nursing students later that they were overheard
c. Tell the nursing students’ clinical instructor. It is the clinical instructor’s responsibility to address the
issue
d. Say nothing.it is not nurse’s job or responsibility for the student’s actions.
Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
7. A client on your OB-GYNe ward has cousin who is a physician and wants to see the chart. Which of the
following response of the nurse to take?
a. Hand the cousin the client chart to review
b. Ask the client to sign authorization and have someone review the chart with the cousin.
c. Call the attending physician and have the doctor speak with the cousin
d. Tell the cousin that the request cannot be granted.

Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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8. The charge nurse observes a new staff nurse who is changing a dressing on a surgical wound. After carefully
washing her hands the nurse dons sterile gloves to remove the old dressing .after removing the dirt dressing ,
the nurse reomoves the gloves and dons a new pair of sterile gloves in a prearation for cleaning and
redressing the wound. What would be the most appropriate actions of the charge nurse?
a. Interrupt the procdure to inform the staff nurse that the sterile gloves are not needed to remove the
old dressing.
b. Congratulate the nurse on the use of good techniques
c. Discuss dressing change technique eith the nurse at a later date.
d. Interrupt the procedure to inform the nurse of the nedd to wash her hands after removal of the dirty
dressing and gloves.

Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

9. Honey, a registered nurse is caring for a 40 year old male patient in the emergency department. The patient
has been drinking alcohol and is asking for medication. When you instruct the patient that they have to wait to be
seen by the doctor, the patient becomes verbally abusive. You then obtain a set of restraints and instruct the
patient if they do not calm down you will restrain them. What can you be charged with?
a. Invasion of privacy
b. Battery
c. Negligence
d. Assault
Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

10. Cole, a pediatric nurse is working with a child and suspect physical abuse. What is his primary legal
responsibility?
a. Document an assessment thoroughly and accurately
b. Report the abuse to local authorities
c. Refer the family to support groups
d. Assist the family in identifying resources and support systems
Answer: _________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

LESSON WRAP-UP(10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to
help you track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

Closing activity: 3-2-1

Answer the following questions in the space provided.

Three things you learned:

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1. _____________________________________________________________
2. _____________________________________________________________
3. _____________________________________________________________
Two things that you’d like to learn more about:
1. _____________________________________________________________
2. _____________________________________________________________
One question you still have:
1. _____________________________________________________________

For next session, review ETHICAL AND SOCIAL ISSUES IN PERI-NATAL NURSING.

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