Chapter 2
Legal and Ethical Issues in Maternal-Child Nursing
Resource Library
Image library
Figure 2-1Healthy People 2010 identifies objectives for each indicator (USDHHS, 2000).
Figure 2-2A sample power of attorney for health care plus organ donor form.
Figure 2-3An incident report form.
Figure 2-4Obtaining informed consent is the responsibility of the person performing the procedure. The nurse may be asked to witness the consent signature.
Companion website: Healthy People 2010 - State Policies for Minors
Learning Outcome 1
Describe federal initiatives to protect children.
Concepts for Lecture
1. The US government established programs to improve children’s care, such as Medicaid’s Early and Periodic Screening, Diagnosis and Treatment; Women, Infants, and Children’s program; National School Lunch Program.
2. The U.S. Department of Health and Human Services released Healthy People 2000 and Healthy People 2010 to develop goals and objectives for health care.
3. The nurse should understand general guiding principles of legal and ethical issues affecting children and obtain legal advice for complex issues.
PowerPoint Lecture Slides
(NOTE:The number on each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1 Federal Government Programs to Improve Children’s Care
•Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
•Women, Infants, and Children (WIC) program
•National School Lunch Program
2 U.S. Department of Health and Human Services
•Healthy People 2000
•Healthy People 2010
3 Legal and Ethical Issues Affecting Children
•Vary from state to state
•Need to understand general principles
• Obtain legal advice for complex issues
Suggestions for Classroom Activities
•Have students review the goals and objectives for Healthy People 2010 at Discuss goals involving care of children.
•Have students research legal and ethical issues affecting the health care of children in the state in which they live. Discuss their research findings in class.
•Have students view state’s regulations on sex education and sexually transmitted diseases.
Suggestions for Clinical Activities
•None
Learning Outcome 2
Describe parents’ rights as they relate to the care of children.
Concepts for Lecture
1. With few exceptions, parents have the authority to make decisions for their minor children regarding health care.
The LPN/LVN must provide nursing care in an unbi-ased manner and report all concerns to the supervis-ing RN.
PowerPoint Lecture Slides
(NOTE:The number on each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1 Parents’ Rights
•Authority to make decisions for minor children
•Right to give informed consent for procedures
•Right to have nursing care provided in an unbiased manner
1a Exceptions to Parents’ Rights
•Parents are incapacitated and unable to make decision
•Actual or suspected child abuse or neglect
•Parents’ choice does not permit life-saving procedures for child
Suggestions for Classroom Activities
•Review the steps and rationales for witnessing informed consent in Procedure 2-1.
•Discuss the legalities regarding who can sign an informed consent.
Suggestions for Clinical Activities
•Have students review informed consents in assigned client’s medical records when in the clinical setting.
Learning Outcome 3
Describe client rights as they relate to children.
Concepts for Lecture
1. Some states have a mature minor act that allows children to make decisions about their treatment.
Emancipated minors are responsible for their own health care decisions and expenses.
The Client’s Bill of Rights needs to be explained in age-appropriate language.
2. Children need to be given as much control as possible by including them in decisions about their health care.
It is the responsibility of the nurse to help the client and family understand how to participate in the client’s care.
3. Children have the same rights to privacy and confidentiality as adults do.
PowerPoint Lecture Slides
(NOTE:The number on each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1 Child’s Rights
•Mature Minor Act
•Emancipated minors
•Client’s Bill of Rights
2 Expectations of Parents and Children in Health Care
•Provide accurate and complete information about health issues
•Increase knowledge about diagnosis and treatment
•Be responsible for their own actions
•Report changes in client condition
•Keep appointments
•Meet financial obligations for health care
3 Privacy and Confidentiality
•Privacy: screening from view
•Confidentiality: keep secret any privileged information
•Parents may have right to access their dependent child’s medical record
Suggestions for Classroom Activities
•Discuss how to address the Client’s Bill of Rights (Box 2-1) in age-appropriate language for children to understand.
•Have students review HIPAA guidelines.
Suggestions for Clinical Activities
•Have students obtain a copy of the Client’s Bill of Rights. Discuss how the Clients Bill of Rights pertains to children.
Learning Outcome 4
Name situations that the nurse must legally report to public agencies.
Concepts for Lecture
1. If a client’s health problem puts the community at risk, or if child abuse or neglect is suspected, the nurse must notify the appropriate public health or law enforcement agency.
The nurse who fails to report suspicions may be held liable by the courts.
The nurse must record detailed information in the client’s chart and complete report forms provided by investigating agencies.
2. The federal Patient Self-Determination Act requires health care institutions to inform clients of their rights to treatment, including advance directives or “living wills.
The nurse needs to use effective therapeutic communication to help resolve conflict in regard to the rights to treatment or to withhold treatment.
PowerPoint Lecture Slides
(NOTE:The number on each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1 Legally Reportable Situations
•Communicable diseases
•Child abuse or neglect
•Threats to injure oneself
•Suspicion of abuse
2 Patient Self-Determination Act
Suggestions for Classroom Activities
•Have students discuss situations that are reportable to appropriate agencies.
•Have students review the Client Self-Determination Act.
•Arrange for a nurse or counselor from the Health Department or from an Abuse Prevention Center to speak with students about reportable situations.
Suggestions for Clinical Activities
•Role-play the use of therapeutic communication techniques for situations in need of resolving conflicts of treatment.
Learning Outcome 5
Describe the difference between legal and ethical issues.
Concepts for Lecture
1. Ethical issues are situations that require intervention based on a system of values and ideas that are shaped from a sense of right or wrong.
Legal issues are situations that require intervention based on state or federal laws.
PowerPoint Lecture Slides
(NOTE:The number on each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1 Legal and Ethical Issues
•Ethical Issues
° Intervention based on values and ideas
•Legal issues
° Intervention based on state or federal laws
Suggestions for Classroom Activities
•Identify situations and discuss whether they are legal or ethical issues.
Suggestions for Clinical Activities
•None
Learning Outcome 6
Describe common legal and ethical issues that can affect the mother, child, and family.
Concepts for Lecture
1. The nurse must keep an open mind about legal and ethical situations and provide nonjudgmental nursing care to the mother, child, and family.
The nurse must be familiar with the state and federal laws governing situations such as assisted reproduction, nontraditional parents, pregnancy after rape, and barrier-breaking technologies.
PowerPoint Lecture Slides
(NOTE:The number on each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1 Legal and Ethical Issues
•Assisted reproduction
•Nontraditional parents
•Pregnancy after rape
•Barrier-breaking technologies
Suggestions for Classroom Activities
•Review steps in making ethical decisions (Box 2-2).
•Divide students into groups and have them discuss case studies of legal and ethical issues. Have them share their answers with the class.
Suggestions for Clinical Activities
•None
Learning Outcome 7
Describe the practical and vocational nurse’s role in legal/ethical issues.
Concepts for Lecture
1. The LVN/LPN’s nursing practice is guided by the nurse’s Code of Ethics and the Scope and Standards of Practice.
2. When providing nursing care to a client who has legal or ethical issues, the priorities are therapeutic listening, critical thinking, and awareness of the law.
3. Nursing interventions for clients with legal and ethical issues are based on the situation in which they occur.
PowerPoint Lecture Slides
(NOTE:The number on each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1 LPN/LVN’s Role in Legal and Ethical Issues
•Follow Scope and Standards of Practice
•Provide testimony
•Do no harm
•Participate in ethics committees
•Refer to support groups
2 Priorities in Nursing Care
•Therapeutic listening
° Reflecting, open-ended questions, silence
•Critical thinking
•Awareness of the law
3 Nursing Interventions in Legal or Ethical Situations
•Practice within limits of state nurse practice act
•Know laws of state practicing in
•Never advise client based on your values
•Uphold client confidentiality
3a Nursing Interventions in Legal or Ethical Situations
•Collaborate with other health care members
•Practice culturally sensitive nursing care
•Provide quality nursing care
•Report incidents promptly and accurately
Suggestions for Classroom Activities
•Review the nurse’s Code of Ethics (Box 2-3).
•Assign students to research other cultures and discuss how to provide culturally sensitive nursing care (Box 2-5).
Suggestions for Clinical Activities
•Assign students to provide nursing care to clients from differing cultures. In postconference, have students discuss any problems encountered in caring for these clients and families.