Ethics and Law
Domain overview
Ethics and Law tests whether you can apply ethical principles and Nepali law to bedside decisions: consent, confidentiality, negligence, reproductive rights and professional boundaries. The Constitution of Nepal, 2072 recognises the right to health and privacy; professional conduct is also governed by the NNC.
Core principles and rules
- Autonomy: a competent adult may accept or refuse treatment, even if others disagree.
- Beneficence and non-maleficence: act in the patient’s interest and avoid avoidable harm.
- Justice: fair allocation of care without discrimination.
- Confidentiality: share information only with consent or when law requires it, using the minimum necessary.
- Consent: must be informed, voluntary, specific and given by a person with capacity. A signature alone is not proof of valid consent. Emergency treatment may proceed when life is at risk and consent cannot be obtained.
- Negligence: requires duty of care, breach of the standard, causation and damage.
Reproductive and mental health law
Under the Safe Motherhood and Reproductive Health Rights Act, 2077, abortion is available on request up to 12 weeks, and in specified circumstances between 12 and 28 weeks, at approved sites. A competent adult woman does not need her husband’s consent. Sex-selective abortion is prohibited. The Mental Health Act, 2075 provides safeguards for admission and treatment; restraint must have legal and clinical justification.
Worked example. A married woman at 10 weeks requests an abortion; her husband opposes it. Reasoning: she is an adult with capacity, and spousal consent is not required within the 12-week limit. The nurse should respect confidentiality, provide non-judgemental information, refer to an approved site, and document her decision without disclosing it to the husband.
Traps that cost marks
- Seeking family consent for a competent adult’s decision.
- Breaching confidentiality on social media or in corridors.
- Calling every bad outcome negligence.
- Performing abortion beyond legal limits or at an unapproved site.
- Restraining a patient without lawful authority or monitoring.
Professional Standards and Health Care Delivery in Nepal
Domain overview
Professional Standards and Health Care Delivery in Nepal tests how nursing fits the federal health system and how professional standards shape safe, respectful care. Expect questions on referral, levels of care, national programmes and the nurse’s role in quality and patient safety.
Health system structure
Under the Constitution of Nepal, 2072, health responsibilities are shared across federal, provincial and local levels. The Ministry of Health and Population sets national policy and standards; provincial ministries manage provincial hospitals and services; local governments own and operate health posts, basic health services and community programmes. The Basic Health Care Package and National Health Insurance are key financing and service mechanisms.
Levels and referral
The delivery network commonly runs from community health workers and female community health volunteers, to health posts, primary health centres, district hospitals, provincial hospitals and federal tertiary hospitals. Referral should match the patient’s needs and facility capacity. Stabilise, communicate, document and accompany when necessary; do not delay referral for procedures beyond your scope.
Professional standards
- Follow the NNC code and scope of practice, and maintain CPD.
- Provide respectful, non-discriminatory care, including respectful maternity care.
- Practise hand hygiene, safe waste disposal and patient identification.
- Work in teams, report incidents honestly and participate in quality improvement.
Worked example. An ANM at a health post diagnoses obstructed labour in a woman with a prolonged second stage. Reasoning: this exceeds health-post capacity. The ANM should stabilise the woman, start IV access and monitor vital signs, arrange urgent referral to a facility with comprehensive emergency obstetric care, communicate the findings to the receiving hospital, and send a skilled escort with records. Attempting delivery at the health post risks uterine rupture and fetal death.
Traps that cost marks
- Bypassing referral levels without clinical need or system reason.
- Assuming every facility can provide the same services.
- Practising beyond scope because no senior staff are present.
- Blaming patients for late presentation instead of improving referral pathways.
- Treating health programmes as vertical silos rather than integrated care.