NURSING RESEARCH RESEARCH
Nursing Research Kerlinger Kerlinger - the systematic, empirical, controlled and critical investigation of a hypothetical proposition in relation to a natural phenomena/ problem Conducted to affirm or deny a hypothesis •
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Phenomenon. everyday phenomenon that affects the nurse (eg. bacteria, drugs, physician) •
Phenomenon + hypothesis = research research problem problem ∟>(educated guess/scientific/ tentative answer) Without hypothesis there is no research research problem, only a problem
Major Characteristics of a Good or Major Research Systematic o conduct research in a step by step process or procedure procedure Empirical o objective data should be observable/measurable or readily collected using your senses Controlled/ manipulated Methods/tool of controlling is research research design o Critical investigation/fact finding investigation In order to answer the data is by using facts. o Looking for human beings who can give us facts o •
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Purpose of Research in Nursing Profession [DEED] Descriptive o observe, describe and record o gain richer familiarity regarding the phenomena 100% known to RN o Exploratory Explore to those areas that are unknown o Observe more o o 50%-50% (50%known to nurses and 50% unknown to the nurses Experimental o Active intervention, active manipulation o Want to find out cause & effect Done something before observing results o Developmental o To improve the system of care for the your patient. •
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Develop and improve existing system Conducting research is for the benefit the pt or patient care/pt focus o
Florence Nightingale Birthplace – Italy Training Ground – Germany Greatest Contribution – environmental Theory, training RNs in Crimean War War • • •
Ethics of a Researcher •
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S – Scientific Objective – conductive research for a good purpose or object for your pt C – Cooperation and Consent. Do not conduct data/experiment data/experiment w/o a consent (legally the patient owns the chart. However the hospital owns the chart) I – Integrity – worked hard on the research E – Equitable – acknowledging works or contribution of others N – Nobility – protect the rights of your subjects o Right not to be harmed (physical, mental, moral harm) usually done during experimental research Physical Harm/ Negligence - undeliberate physical harm Commission – done outside the standard practice of nursing (eg. urinary catheter placed on the nose of the pt) Omission – from the very start, you did not do something about it. Moral Harm Assault – mental fear/threat without physical harm Battery – physically you harm the pt Restraint is never an a n independent nursing order Restraint physical restraint – eg. Jacket chemical restraint restraint – eg. use of psychotropic drug Moral harm Slander – oral defamation Libel – published or placed in the newspaper o Right to self-determination self-determination o Right to privacy Anonymity – identity of subject may not be disclosed. Privacy of the Informant (pt) eg. conduct a •
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study on HIV pt. but the pt wants his name to be written in the newspaper as Mr. X, Mr. Y or Mr. W Confidentiality – information acquired must be disclosed. Privacy of the information eg. conduct a study on HIV pt. but the pt wants the nurse should only know T – Truthfulness – put only the data you have collected I – Importance – importance to the nursing profession F – Factual – facts or data I – Ideal (follow the 11 steps of research) research) C – Courage
Steps in Nursing Research Process Identification/formulation Identification/formulation of research o problem - anything that requires requires solution thru scientific investigation. Sources of problem : o C – concepts (Ca, PTB, MI) L – literature, essays, books, journals I – Issues E – experience N – Nursing problems T – theories •
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Characteristics of a research research problem G – general applicability and use Re – Researchable F – Feasible and measurable F – actors of a feasible research research : time, money, experience of the researcher, instruments, population I – importance to nursing profession N – novelty/originality Plagiarism/illegal replication – unauthorized use of another’s literary work without any consent or permission S – significance to nursing 2 types of research according to use basic/pure research only the research benefits the research It is only for your personal necessity Answers your own question Applied research •
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problem solving Solving the problems of the patient. Variable – subject to change Kinds of variable Independent variable use this to stimulate a target population o Dependent variable/Effectual variable results of the effects of the study o Intervening Variable Comes between dependent and o independent o Example: orghanism variable, internal factor, sex, gender, color • •
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Extraneous Variable o External infuences that can be changed Example: citizenship, educational status o Dichotomous Variable 2 choices/ 2 results o Example: Male/ Female o Polychotomous Variable Multiple choices o o Example: Preferred Preferred foods – Chinese, Japanese, American. . . . .
Examples “A comparative Study in the Income of Filipino Nurses Employed in P.G.H. P.G.H. and N.Y.G.H.” N.Y.G.H.” Independent variable : PGH and NYGH (place of work) Target population : Filipino nurses Dependent variable : income
Research: 1. Identi Identify fy the Probl Problem em 2. Purpose Purpose – objective objective using SMART SMART (Systematic, (Systematic, Measurabl Measurable, e, Attainable, Realistic, Realistic, Time Bounded) 3. Define Define Terms erms a. Conceptual Conceptual Defini Definition tion – dicti dictionary onary defini definition tion b. Operationa Operationall Definition Definition – defined defined in accordan accordance ce on how the researcher used the word 4. Revision evision of of Terms erms •
Review of related literature o Purposes :
to have an update regarding your topic to have a basis of theoretical and conceptual framework Main sources of literatures literatures Conceptual Formulated Authors Can be sold Books – general use Research Researcher Research works only Future research purpose only
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Formulation Formulation of conceptual and theoretical framework o Thery – relationship between concepts o Conceptual framework diagrammatic and structural presentation of the problem hypothesis o Paradigm actual structural presentation of your conceptual framework Formulating hypothesis o 5 types of hypothesis Null/statistical Null/statistical hypothesis shows no relationship or difference between an independent variable and dependent variable. ID = DV Eg. “There is no difference regarding regarding professional opportunities of Filipino Nurses working in the Philippines from those working in USA.” Simple/Operational Simple/Operational hypothesis/Alternative hypothesis/Alternative hypothesis this shows shows relationship between a single independent variable from single dependent variable. Eg. “Filipinos “Filipinos Nurses working in USA has more professional opportunities than those working in the Philippines. Complex hypothesis •
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this shows a relationship between two or more independent variable from two or more dependent variable. Eg. “Filipino nurses who worked for 5yrs and passed the CGFNS, TORFL, TSE, NCLEX has greater opportunities in NY as compared to those in Manila Directional hypothesis specifies the direction of the relationship between variables Eg. “Filipino “Filipino Nurses working in the USA has more professional opportunities than those working in the Phils.” Non-directional only predicts the relationship, but has no specific direction between variables. Eg. “There is a big difference between a Filipino Nurses working in USA than those working in the Phils.” •
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Selecting research design o Systematic controlled plan for finding the answer to a problem o Roadmap, blueprint of the study Should have a proper resign design o If improper research design, there will be improper o collection of data o Purpose : key or tool for proper p roper collection of data o Types According to Application Basic/ Pure o For personal knowledge, curiosity Applied o Based on problem solving approach According to Methods Experimental o performing active manipulation, observe and record the result. Types of Experimental Reseach o control divide grp into 2. •
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Group a – control/comparison control/comparison grp – will use the same soap everyday Group b – experimental grp – those who will use the sample soap randomization using sample by chance. Choose randomly to avoid redundancy of result Manipulation Performing intervention Validation comparison of the effects Quasi-experimental false experiment. experiment. No control sample. Non-experimental o No manipulation is done. Only observation, describe and record record down the result. Types of non-experimental research o design base on time element Retrospective (Ex Post Facto) Getting actual experience experience Studies a group of people after its occurrence, experience experience or facts. Experience of people in the past Descriptive Observe, describe & record. Study of current current events. Prospective Study of research research about future ccurrence or future events. Historical Past that is written, documented, published and recorded Primary Data o Observe •
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1st hand information o person himself Secondary Data o 2nd Hand Information About the past using records, records, journals, books. Study of the dead people thru his written materials, facts according to data quantitative data base on numerical interpretation, interpretation, datas that are measurable, using your senses, data that are observable. qualitative subjective data, feelings, perception, beliefs, culture, attitude Survey Research Design Group Small Face to face Large – not good result Methods Mailed survey Face to face Telephone Telephone survey o
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According to Time Orientation Cross Sectional Applicable to 2 or more identical group Short term For comparison Longitudinal 1 group only with initial and follow up survey long term study for developmental study •
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Selecting your population and samples sample o part of population, data is collected. experimental treatment in The recipient of the experimental experimental experimental design or the individuals to be observed in a non-experimental non-experimental design o Types of sampling Probability - equal presentation/ chances in the population. Simple random technique o Used a single/identical group. Fish bowl technique o Stratified random sampling o You will first going to create a sub population from the whole population before doing randomization. o One population, you divide it. Cluster random sampling o You will first create a sub area in a population before doing the randomization. In one population, you make it smaller Systematic random sampling choosing a sample every nth name in the o population. o Multiple of 100 names o Sampling frame – list of names appearing as your population Non-probability sampling – you are not choosing Non-probability by chance. Accidental/ convenience sampling Base on the accessibility/availability of o your sample. o Kung sino pinakamalapit syo, yun ang kukunin mo. Purposive/judgmental Purposive/judgmental sampling o base on the common knowledge or popular knowledge. Snow-ball sampling get sampling base on last referral o Quota Sampling Setting criteria and getting samples o fitting the criteria •
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Conducting pilot studies Collecting data types : o questionnaires – use of pen and paper method dichotomous – divided into two. Eg. true orfalse. Yes or no rating scale – poor 1, good 2, better 3, best 4 multiple choice Interview – use of oral method of collection of data. Use of active listening Structured – with checklist, formal talk, list of question Unstructured – informal talk, no pattern, anything goes records – pre existing data observation – use of ocular method using your senses participant observation non-participant observation Problems : o Hawthorne’s effects The data you get from your sample is not accurate. The sample has a problem Solution : double blind research research – they should not be conscious that they are being studied o Halo effect The researcher has a problem. He is manipulating the data collection. It is affected by special feelings/treatment feelings/treatment between the researcher researcher and the sample. Analysis of Data part of research when the researcher is forming a body of o knowledge out of data collected for the purpose of affirming or denying your hypothesis o Methods Nominal method get data by means of categories. eg. male, female, income •
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Ordinal method – base on rank eg. mild, moderate, severe Interval base on the distance between 2 numerical values eg. BP – 150/100 – 120/80, wt, circumference, ht ratio – 3:10 children are malnourish Interpretation of Data o 2 Methods quantitative method – base on numerical or graphical standards qualitative method – use of narrative words Communicating your conclusion o Explaining the results of your work to the public o Conclusion – final answer to your research Recommendation Recommendation – suggestion to others o Dissemination of Information o Methods : thesis/book – written form symposia/symposium – oral presentation presentation publish – a lot will be able to read your research
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LEADERSHIP
Nursing Leadership style or process whereby a person is called by a nurse leader were influence of group of people called his followers for the purpose of attaining only one goal/objective. •
Principle for Effective Leadership Unity of Command – one group given by one leader Unity of Direction – one group should always have one objective Subordination of your personal to your general interest – patient first policy o R – rescue your patient o A – alert the fire alarm o C – confine the fire in one area • •
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E – extinguisher application o Esprit d’ corp/team spirit - Fault of one is the fault of all Respondeat Superior/Command responsibility responsibility o let the master or the superior answer for f or the negligence of his subordinates in in half of his his patient who suffer from injury or death. you can delegate responsibility but not the accountability o o
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Theories of Nursing Leadership Great-Man theory – born as a leader Trait theory t heory – develop characteristics or born with the characteristics o 3 traits of a leader P – personality (adaptability, independence, creative/assertive, creative/assertive, advocate) ability to adjust to the need of the pt I – intelligence (proper judgment, proper decision making, proper communication) A – ability – (influence others, respect others, participate and cooperate) Proper way to influence is thru health teaching Charismatic theory – becomes a leader because of the charm Situational theory/case to case basis o a person can be a leader in one situation but only a follower in another situation. (eg. becomes a leader in where he specializes) • •
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Leadership styles Authocratic/Authoritarian/dictatorial/”hard” Authocratic/Authoritari an/dictatorial/”hard” leader o unilateral style of leadership. Only the leader here performs the decision making without getting the inputs from his members. o One sided style of leadership Behavior : A – apathy – insensitive to others B – Boisterous speech C – consistency D – Dominating E – Exploitative behavior F – ferocious behavior, to coerce or compel the group to follow him •
not a good style of leadership but only best style during emergency or intensive crisis Permissive, ultra-liberal, ultra-liberal, laissez faire, free-rein o
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Loose style of nursing leadership. o Giving excess freedom or liberality towards your subordinates if to lenient in your subordinates, there will be ↓ control and power = ↑ negligence Democratic/participative o best style of leadership. Mutual style of nursing leadership o
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5 Power of a Good Leader Legitimate/ Formal/ exclusive Power Exercise Exercise because you are appointed to a higher position o Expert Power o You acquire extra – ordinary skills, talent or ability Referent Power Charisma and charm o Reward Power + power for the part of the leader o gives rewards, bonus, promotion, compensation o Coercive Power – power on the part of the leader o o reprimand, suspend, terminate •
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ABC’s skills, qualities and abilities A – Authority basis of the leader to delegate tasks, responsibilities, jobs o to be performed by his subordinates sub ordinates 2 types of authority o Centralized – top to bottom for proper management Decentralized – Bottom, to manage directly B – Behavioral S – specialized body of knowledge and skills to do safe o care o P – patient centered o A – accountability – liable for the results of your actions C – confidentiality – nurse-patient relationship o Exceptions to confidentiality of the contract : P – patient consent, if there is I – inform/report to healthcare team for purpose of precautionary precautionary measures C – Communicable disease RA 3573 Law on Notifiable Disease o 24 – Polio/ Measle o o 1 Week – SAD/ HIV/Tetanus Neonaturom C – Crimes •
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Child Abuse E – ethics o
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48 hours, Baranggay, NGO
IV THERAPIST: Old RN, Training, 50 Insertion, ANSAP New RN, Training •
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C – Communication skill o transfer of information with understanding o Communication barriers/communication barriers/communication backlog – eg. Dialect differences, differences, noise, deaf, deaf, high level level of anxiety, hallucinating D – Decision making skills o Steps identify the problem identify person affected o ptions/alternative ve gather options/alternati brainstorming delphitechnique – gathering solutions outside the group (eg. specialized nurse) choose and implement Evaluation E – Ethics o Principles Principle of Autonomy o independent judgment or decision making in all situation the pt himself is the one who should decide for his own care Consent respect the decision of the pt explain the risk to the patient/SO waiver - a legal doc when the pt refuse for treatment. Principle of Veracity o telling the truth to the patient #1 the patient has the right to know from the PHYSICIAN (not the nurse) o Principle of Double Effects if the pt is made to choose between 2 equal danger and he only needs to choose one, choose the one that will produce one good effect and less evil effect. Principle of Beneficence o doing good to the patient (eg. providing therapeutic communication, providing privacy) • •
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Principle of Non-Maleficence Non-Maleficence do no harm 3 types of Harm Physical – negligence by commission Mental – assault and battery Moral – slander and libel Principle of Justice o Prioritize the needs of the patient. To be able to provide nursing care to the patient, provide the nursing process. Nursing Process characteristics : A – acceptable universally B - based patients assessment needs C – client focused D – dynamics – base on the ever changing needs of the pt E – equitable care F – familiarity/rapport to the patient G – goal directed towards solving the assess needs of the patient (SMART) o Principle of Respect/Inviolability of life Suicide and abortion is violation of this principle F – Face/solve Conflicts o any clash of ideas resulting to crisis o Methods of resolving conflict avoidance – by paying attention smoothing – appealing to ones conscience and kindness unilateral action – use of forced fear or threat negotiation – best method in resolving resolving conflict. The head nurse should offer negotiation between conflicting parties. o
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NURSING MANAGEMENT NURSING MANAGEMENT choosing the right person and giving them the appropriate task for the purpose of achieving their goal/objective in achieving total care
Frederick Taylor’s Scientific Management Theory Elements o choosing the appropriate person (TAO) (TAO) o choosing the appropriate team o choosing the appropriate training choosing the appropriate tools o Human Relations theory the be a good manager, there should be a good interpersonal relationship between the leader and follower Douglas Mc Gregor’s Motivational theory Theory X Negative workers o o negligence, inefficient, ineffective workers workers Theory Y o Positive workers o diligent, effective, efficient worker theory X should be given focus because they are prone to negligence and malpractice. Max Weber’s Bureaucratic/ authoritarian Theory whoever is on the top would perform the management function centralized Elton Mayto’s Behavioral Theory overtime pay, rest day, day off provide physical needs of the workers Hawthorne’s Effect o If workers knows they are observed they become more efficient Henry Fayol’s Principle of Management Unity of Command – one leader, one command Unity of Direction – one group should always have one goal Remuneration of Personnel – patient first policy Esprit de corps – team spirit Command responsibility/Respondeat responsibility/Respondeat Superior – let the superior answer the fault of his subordinates even harm or death Balance between centralization and decentralization Security tenure Delegation of responsibility Proper Compensation of workers
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RA 7305 (Magna Carta Law) – salary grade 50 P13,000/month Overtime pay – additional of 25%/hr Night Differential – additional of 10%/hr Legal holiday – x 2 Philhealth - Benefit of worker both related and nonrelated work (aesthetic, dental and cosmetics are not included) Maternity leave – 60days leave is NSD, 78days if CS only to first 4 pregnancy only to legitimate spouse Paternity leave – 7day/1week leave Senior Citizen’s Act – 20% discount
5 steps in Management Process Planning stage o looking ahead of time. Formulating Formulating future futu re goals/objective o Types of plan o Standard/Operational Standard/Operational Plan (NCP) plans for everyday or ordinary activities Strategic/Contingency Plan Strategic/Contingency plan used during sudden or acute crisis Long-range/future Plan plans which you can’t evaluated immediately. Usually last months or yrs. Used for chronic pt which requires requires longer period of care. o Stages of Planning Process Mission – present reason when established your organization Vision - statement of your future purpose of your future organization Philosophy – set of values and beliefs of your organization Goal – general statement of your purpose Objectives – more specific statement of your purpose Policies – set of rules and regulations in your organization Procedures Budgeting – proper allocation of your resources 3 types o •
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Personnel Compensation for salaries of workers Operational everyday use of equipment and facilities (gloves, water, electricity) Capital long term use equipment (MRI, CT Scan, hospital beds, hospital buildings) •
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Organizing o 4 stages Organize your team RN Subordinates Duties of the RN Only assessment can perform the nurse Only the nurse can perform HT Only the nurse should explain the procedure procedure to the patient Preparation, Preparation, administration, treatment of drugs to the patient The nurse can only perform evaluation The nurse can only do judgment • • •
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Delegate Task They can only delegate to subordinates the Routinary task (standard, unchanging procedure) procedure) eg. monitoring of I&O, bathing, ambulating, toileting, shampooing, transporting, feeding, clothing, wiping Stable patient - predictable outcome (eg. postmortem care with direct supervision of the nurse only) Supervision – need guidance Staff Schedule/ Staffing Schedules (How many hours) o Traditional – 8hrs a day/40hrs/wk o Ten hour shift/4 days a week Baylor plan – it consist of two shifting o nurses traditional – mon-fri 8hrs •
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2nd shift – 12hr shift during weekends o Part-time Part-time work – fewer working hours per day and may choose the day or work. Less than 8hrs job On – call – during shortage of nurses/staff o but increase in the number of patients. Methods of Nursing care Delivery Different Methods Primary – 24hrs a day o Primary nurse is the only nurse who is responsible to make a care plan of the patient from the moment of admission till the moment of discharge. (eg. private duty nurse or special nurse) Functional Method o DOH format/government hospitals Assign nurse : Duty/task One nurse, one task Highly recommended during a period of shortage of nurses and budget poorest method of delivery because communication is hindered o Case Method/Case Nursing provide total care within your shift. Used in ICU department C – Case Method T – total care to the patient O – one is to one ratio Directing/Delegation irecting/Delegation stage a job or a task is done or performed by another perform for o you o What you cannot delegate: you cannot delegate total control of the procedure you can’t delegate discipline of subordinates or staff members. Confidential task Technical Technical task Medical task performing surgical procedure is done by the doc not the nurse
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Coordination/Collaboration the nurse needs to collaborate to other members of the o health care team. o Multi-interdisciplinary Multi-interdisciplinary approach – to be able to provide holistic approach to the patient. Types of Collaboration o Interpersonal/Intradepartmental One patient, one unit. Collaboration between one nurse to another healthcare team in one unit/department Eg. MI patient - nurse, dietary, specialized in cardio Interdepartmental 4 units in one hospital. Coordination of the patients care between 2more units/departments units/departments but still under one same hospital or institution Eg. patient due for fo r appendectomy is transferred to the OR Inter Agency/Institutional Agency/Institutional Coordination of patient’s care between 2 or more hospitals/health care institution for the benefit of the patient Eg. lying – in due for C/S and was transferred to a hospital Evaluation/Controlling o stage wherein you determine whether or not your plans for your patient is met or achieved o Methods of evaluating staff performance Checklist it is being evaluated higher than you. (eg. nurse manager/supervisor or head nurse) • •
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Nursing rounds it is being evaluated higher than you. (eg. Nurse manager/supervisor or head nurse) Psychiatric ward is not done by nursing rounds Peer review same rank or level is being evaluated you poor method Performance appraisal •
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the patient evaluates you best method in evaluation
PROFESSIONAL ADJUSTMENT AND NURSING JURISPRUDENCE Professional A calling in which its members profess to have acquired special values, knowledge, training or by experience so that they may guide others others in that special field. field. Nursing is a profession Calling – service oriented Others – patients • •
Characteristics by profession A – accountability/liability for the result C – caring profession Central Focus C – competent E – ethics S – service oriented S – specialized scientific body of knowledge and skills • • • • • •
PROFESSIONAL DUTIES OF A NURSE UNDER RA 9173 All are independent nursing actions Promotive, preventive, curative and rehab care in all health care service health education utilizes nursing process link of patients in different health care services services collaboration of patient’s care for continuity of patient care train nursing students supervision of subordinates accurate recording and reporting execution execution of valid doctor’s order (the only one that is dependent nursing action) Perennial Perennial Suturing after training Perform Perform IE if antenatal bleeding is absent and before full delivery •
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A doctor’s order is valid when giving medication is when it is put into writing and signed by the physician. Whatever is not put into writing is considered not ordered by the physician.
Good Samaritan Act During emergency, national calamity, national epidemic there is no doctor around the life or the patient is in possible danger, then you can give give drugs alone provided you know the drugs for the patient. •
RA 8344 – No deposit policy during emergency cases only Areas of Nursing Practice 1. Institutional Nursing Hospital Based Venue D – Duties are routinary and supervised A – Acquired Acquired different learning and technical skills C- Coordination with HCT S – Specialized areas o Nurse Generalist – community nurse o Nurse specialist – staff nurse • • • • •
2. Public Health Nursing Once a Public nurse in the community, you are focus on the preventive preventive and promotive of health health because this is is the mandate of Primary Health Care Law. 1st PHC Date : 1978 o o Place : Alma Ata o Country : Russia o Local version of F. Marcos after 1yr of Alma Ata Conference: Letter Letter of Instruction 949 that mandates that o all public workers to have a duty of promotive and preventive preventive care for the patient. Promotion of Public Health o PD 8976 – Micronutrient Micronutrient Supplement Act Vit. A, iron supplements, iodine o PD 825 (Environmental sanitation law of the Phils.) It is cleanliness of the environment. Outside the institution (eg. proper disposal of excreta, excreta, proper drainage system) o PD 856 (sanitation code of the Phils.) Involves proper sanitation of an institution that engage in food and water supply. supply. Inside the •
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institution. (eg. canteen, mineral water store, public market, Sex shop : ADONIS, PEGASUS, CHICOS) not applicable to private sex practitioners. Prevention of Disease o PD 996 (EPI law) Compulsory Immunization of children below 9 y/o Psychological Psychological and social adjustments because you will be taking care of numerous clients o RA 7160 (local government code) decentralization or devolution of care. The DOH together with DILG and local government units (brgy, provincial) together with community participation p articipation they made a local health board which is the MAYOR. Purpose of local health board : it makes quality health care available, accessible and proximal proximal for all Participation is maintained with all members of the community, health care team and family •
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3. Occupation Health Nursing industrial or company health nurse Duties : Curative/rehabilitative o C – care for sick/injured laborers R – Referral V – Visit and ff. ups (home visits) o Promotive/Preventive N – nutritional S – safety and sanitation C – Counseling • •
4. Clinical Instructor Qualifications Qualifications : o A – accredited nursing Org M – MAN in nursing or other health courses O – One yr clinical experience R – R.N.
PHILIPPINE NURSES ASSOCIATION When was PNA founded : Oct. 22, 1922 (10-22- 22) o Who is the founder PNA : Anastacia G. Guiron Tupas o o Purposes :
P – professional well-being U - unity P – promotes reciprocity even outside the Phils. A – advancement of the knowledge and skills of the nurse E – ethics promulgation
Proclamation Order 539 Declared by Pres. Pres. Garcia law declaring the last week Oct as the official nurses week. •
School of Nursing in the Philippines UPCN – 1st Schools originated in the Phil. Iloilo Mission hospital o PGH o o St. Luke’s o Mary Johnston Hospital o St. Paul Hospital o San Juan de Dios • •
Contracts and Consents Characteristics of a Valid Consent V – voluntariness O – Opportunities to ask questionbe explained to pt T – treatment explained to the patient U – understood by pt M – matured both physically and mentally • • • • •
Criteria of a good consent : 18 y/o – above Mentally capacitated (absence of insanity and imbecility) If below 18 y/o and mentally incapacitated a proxy consent : in chronological order Parents o Guardian o o physician (if parents and guardian are dead) Guardian Ad Litem – social worker or Surgeon • • •
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Nurses and Illegal Detention
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it happens if someone will limit the freedom of the patient to move or travel from one place to another. HIV Patient – should be kept in one room Felacio Felacio – oral sex – most fastest mode of transfer o o Cannalingus – tongue on clitoris o Analingus – tongue on anus – least mode of transfer
Last Will and Testament Act whereby a person is permitted by the law to have control cont rol in the manner of disposing/ giving his estate but will take effect at the time of his death Testate Testate Succession – son or daughter will inherit the last will of the parents Intestate Succession – without last will and testament 2 types of Last Will and Testament Property o Notarial/ Ordinary Will Check LOC Check proper location of the signature – end part of all the pages at the side Nurses can be a witness Holographic Will During emergency cases No witness involved call a persdon who knows and familiar with the handwritten of the testator Entire last will and testament is hand written dated and signed by the testator o Life Body Advance Directives Respectful death Direction/ instruction of the patient in advance DNR, donate organ, o rgan, cremation •
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Medications and prescription only registered registered medical, dental and veterinary practitioners are authorized to prescribe drugs 3 information o name of the AMD, address of his clinic/hosp and PTRC license # name of the pt, age, sex o drug name, frequency, duration of the drug o RA 6675 Generic Act •
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all prescribe drug must be written in generic and brand name or generic name but never the brand name alone) o Purpose : for the pt to choose what brand name they want Remember the 10 R’s of medication Right patient name by checking the pt wrist tag Verbal or telephone – only done during emergency emergency doubts or error – in case there is doubt in medication, refer to the physician IV drugs – in proper training o
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Documentation, recording and charting Patient Chart – absolutely legal Purpose of a patient Chart Communication and conitinuity of care o o Assurance of quality of care o Research o Legal document Statistics of disease o Subpoena – order coming from the court Subpoena Duces Tecum Tecum – any documents, objects, papers, o materials Subpoena Ad Testificandum – person who will testify o (witness) Do’s in Charting o F – full, factual and objectively accurate o L – legible o I – immediate P – Personal o Adendum – late entry/late documentation Don’ts in charting L – language, jargons or words which are unacceptable o I – improper corrections o o S – Spaces and skips o Abbreviation • •
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LEGAL DOCTRINES IN NURSING Professional Negligence Negligence failure to do something which are reasonable and prudent nurse should have done something under a particular situation. (eg. failure to raise side rales when the pt is unconscious) 3 elements of negligence •
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duty on part of the nurse failure to do said duty injury, harm, death – most important negligence
Malpractice injury, harm or death is not important in malpractice The nurse is allowed to perform episiorrhapy with proper training but not episiotomy The nurse is allowed to perform IE but with 2 conditions : o fetal aberration/ abnormal delivery o prior to complete delivery • • • •
Crimes affecting nurses Types Types of crime : Manner of Commission DOLO – crimes committed with deceit. Crime with real o criminal intention CULPA – crimes committed under negligence. Crimes that o are intentional stages of execution o consummated when the crime intended is totally committed or perfected frustrated o the offended performs everything to consummate the crime but it did not happen attempted o crime has not happened (overt acts – acts merely showing the intention to commit the crime) degree of participation participation o principal degree of participation is very important/indispensable because he is the primary author of the crime.. If no principle, there is no crime. accomplice o participation is merely dispensable. Usually performs before (eg. referral by the nurse of a abortionist to a pregnant women) or during the crime eg. OB nurse is is to perform perform abortion. The nurse is look out for police. The nurse is the accomplice. o accessory usually performs after the crime (eg. stole a nebulizer in the hospital. Sold the nebulizer to an • •
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asthmatic pt) This is an accessory because he benefited from the crime
RA 7877 – Anti sexual harassment law committed by any person who exercises authority. (eg. teacher to student, head nurse to staff nurse). That person who is in authority is asking for a sexual favor in an exchange of another favor. •
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Types of o f Rape Ordinary rape a forcible penetration of an organ for copulation to another o organ for copulation. (eg. women are only the victim) sexual assault o anything that is forcible inserted to a body orifice with sexual malice. o Also form of rape (eg. hand or an object is being inserted in the anal. Committed in both female or male) Intervention : o S – safety (emotional or physical safety) R – report (↓ 18 – report to brgy.) R – referral (if father is the rapist, refer to DSWD) •
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Abortion is the expulsion or termination of a product of conception before the stage of viability. (3-6month/12-24weeks) Infanticide kill the person in less than 3days or 72hrs of life. Parricide killing another person to whom you have a relationship (mother, father, husband) Homicide unintentionally killing another person without any relationship (eg. negligence in giving meds) Murder intentionally killing another person without any relationship Simulation of birth committed by any person who shall substitute one child to another child or alter his identities for the purpose of losing his civil status. (eg. the midwife failed to report the birth of the baby, giving wrong information of the gender of the baby) PD 651 (Birth registration act) law any person who assist in giving birth to report within 30 days to the Local Civil Registration Registration Office •
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Law Affecting Nurses Act 2808 (yr. 1919) – first true nursing law o It removed from the doctor the control of nurses with 3 man team (1 chairman and 2 members all nurses) 1920 – 1st official board exam 1st nursing school (6months) o Iloilo Mission Hospital (1906) o PGH School of Nursing (1907) o St. Luke’s school of nursing (1907) Mary Johnson’s school of Nursing (1907) o St. Paul Iloilo 1907) o o San Juan de Dios (1907) 1st college of nursing (4years) – UP RA 7164 (1991) RA 9173 (Oct 21, 2002) Board of Nursing o Old o M – MAN o A – Accredited Accredited Nursing Org (PNA) o F – five MAN team (1 chairman, 4 members) S – 65 y/o – 1 year interim period o N – Not convicted of any crime o o P – Pecuniary interest (Absence) o T – 10 years nursing practice o C- Citizen Cit izen of R.P. R.P. New M – MAN o A – Accredited Accredited Nursing Org (PNA) o S – 7 MAN team (1 chairman, 6members) o o I – immediately resigned upon appt. o N – Not convicted of any crime P – Pecuniary interest (Absence) o o T – 10 years nursing practice but 5 yrs must be in the Phils. o C- Citizen & resident of R.P. Who formulates the question of the Board Exam? – Board of Nursing In having a license it is a Privilege not a Right Board of Nursing issues the license PRC issues the certificate of registration CHED are the ones who has the power to open and close a nursing school •
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BON just inspects 5 consecutive years of below 80% passing rate, the school will be closed Powers and Functions of BON o L – Licensure exam o I – Issue COR o M – Monitor standards of nursing practice E – Education o C – Code of ethics o o H – Hear and decides cases of negligence and malpractice o A – Accredits Accredits different organizations G – Guides Nursing Practice in the phils o
Dean R.N.,MAN 5 years nursing experience experience Clinical Instructor A – allied in nursing or any allied health courses M – member of PNA O – 1 yr experience R – R.N. Nursing Administrator Administrator
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Supervisor/Manager Community H • •
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Military Hosp
B – BSN RN A – Accredited Org N – 9 units T – 2 yrs
Chief/Director RN + MAN + 5 yrs supervisor experience (N.B. if primary hosp)
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Add only master’s in PHN or CHN
MAN + GSC (Gen. Staffing Course)
Examinees CGM (Good Moral Character) Proofs of Valid Holder of Filipino Citizenship Proofs of valid holder of a BSN Degree only from schools whose curriculum is approved by the CHED
3 docs sub to PRC RLE certificate TOR with Scanned picture List of cases Examination fee is P900 Last day Is :
Other related laws PD 223 – PRC Act RA 1080 – Civil Service exam Cum Laude, Board passer – eligible in taking CSE RA 6425 – Dangerous drugs Act o punishable with 2 chemical substances Prohibited drugs chemical substance totally, abosultely can’t be consumed by human being (eg. Shabu, Mariana, Cocaine, Opium) Regulated drugs you can use this drug provided the pt has the prescription and the AMD has appropriate license coming from the BFAD or Dangerous Drugs RA 7600 – Baby Friendly Hospital. Early bonding for mother is Early Rooming in and early o baby breast technique for early bonding Early bonding for father is thru cuddling E.O. 51 – Milk Code (Breast Milk) o Avoid manufactured or formula milk How to be an R.N. under 9173 o Have all qualifications o take the exam o acquire the required ratings o In order to pass the examination, an examinee must obtain a general average of at least 75 % with a rating of not below sixty percent (60%) in any subject o An examinee who obtains an average rating of 75% or higher but gets gets a rating below 60% in any subject must take the examination again but only in the subject or subjects where he/she us treated below 60 % (60%). In order to pass the succeeding examination, an examinee must obtain a rating of at least 75% in the subject or subjects repeated.” RA 8981 –Modernization Act. • •
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For every 5,000, results will be released after 5days PRC rating NAME Text to 263 (smart) 233 (globe)
What are the grounds for nurse not to be registered? D – Dishonorable conduct o U – Unsound mind o M – moral turpitude o o I – Indecent immortal conduct
