PROFESSIONAL ADJUSTMENT: A REVIEW I. DEFINITION OF TERMS Nursing
Jurisprudence- embodies all the laws, rules, doctrines and principles, legal concerns, opinions and decision of competent authority regarding governance and regulation in relation with the practice of nursing Legislation- making of rules and principles Nursing Legislation- making of laws affecting the nature and science of nursing profession Rights- inborn claim which a person is permitted to have, to do and receive from others within the parameters permitted by the law Legal rights- claim which can be enforced by law against a person or community whose duty is to respect it Court- body where disputes are settled and where you enforced your rights Jurisdictionauthority to hear and decide legal controversies Venue- place where disputes are settled/suits can be held Legal remedy- means employ a right given by the law (1) Ordinary remedy- ordinary action or suit filed in court of law (2) Extra ordinary remedy- remedies which you can file during the hearing of the case; executed by writ Writ- mandatory rule of action 1. Writ of Certiorari- writ of review during the duration of the case filed on the next higher court a. abuse of discretion- biased b. abuse of jurisdiction- abuse of authority c. no way for an appeal or speedy remedy 2. Writ of Prohibition- stops a lower court from prosecuting the case 3. Writ of Mandamus- orders somebody a duty pertaining to his office 4. Writ of Quo Warranto- orders a recovery of an office or franchise
(3) Provisional remedy- given temporary during the hearing
for temporary protection of the party due to its present need 1. Injunction- refrain from doing an act 2. Preliminary injunction- pendency of the case during the hearing 3. Final injunction- granted after the case is settled Process- means to compel defendant/witness to appear in court 1. warrant- order directed to a person to do an act giving him protection from damages when he does an act 2. search warrant- searching for material/personal property to be presented in the court 3. subpoena ad testificandum- witness to testify 4. subpoena duces tecum- witness to appear in court with documents 5. summon- plaintiff compels to appeal in court Plaintiff- complaining party; used in civil cases Defendant- person charged of a crime Accuser- private party represented by the state; used in criminal cases Witness- has knowledge of the fact pertaining to the case; testify to the genuineness of the maker’s signature in an instrument Expert Witness- person who is qualified to testify based on special knowledge, skills, experience and training regarding to the case Damage- loss or injury sustained Damages- sum of money for compensation to injury/damage done
II. NURSING PROFESSION Nursing-
the diagnosis or treatment of human response to actual or potential problem (ANA) Profession- it is an organization of occupational group who has expertise, knowledge and extensive training in relation to their fields and usually governed with ethical code and process of certification and licensing
Nursing
Profession- performing of an act or activities, guided by a unique body of knowledge, training or by experience and ethical code, for a fee or compensation of nursing services to various clients—families, individuals and communities in all setting and stages of development for the promotion of health, prevention of illness, restoration of health and alleviation of suffering through Use of nursing process Building of link between the community and its resources and coordination of health care team Encouragement of family, individuals and community through health teaching Teaching, supervising and guiding the students in nursing education program Undertake nursing and health human resource development training and research Advanced Practice Nursingspecialization; this is a specialized education and experiences afar from basic nursing programs which requires knowledge, skills and supervision attained through graduate study in nursing Clinical Nurse Specialist (nurse specialist)- is an expert in the specialized field of nursing CHARACTERISTICS OF A PROFESSION Autonomy- independence and self-governace Authority- having an expertise/competent/highly advanced skills, knowledge or mastery not common to the general public Accountability- being responsible to one’s own actions; liable in the consequences of its action FOUR FOLD RESPONSIBILITY OF A NURSE a.Promotion of health b.Prevention of illness
c.Alleviation of suffering d.Restoration of health e.Spiritual Health—holistic care FIELDS OF NURSING (1) Hospital or Institutional Nursing- comprises all the staff nurses or nursing personnel giving the basic component of comprehensive patient care and family health in the hospital or related health facilities (2) Public Health Nursing (Community Health Nursing)- the focus of nursing care is more on the health promotion and health prevention rather than care of the sick; it gives emphasis on the care of the family and community rather than individual basis (3) School Nursing- responsible for all school activities— monitoring growth and development, screening health problems concerning the school the health needs, environmental safety, health education and health promotion of school children (4) Occupational Health Nursing or Industrial Nursing- the practice give emphasis on the promotion, protection and supervision of worker’s health condition and the safety of his working environment (5) Maternal and Child Health Nursing- focus on the care and safeguards the health and safety of mothers and children (6) Nursing Education- pertains to nurses under teaching or administrative staff of school or other educational institution (7) Pediatric Care Nursing- nursing care for the sick child (8) Private Duty Nursing- independently have a contract with patient which the nurse will provide a comprehensive nursing care in one-on-one ratio (9) Nursing Administration- participates in the formulation of policies and objectives in an administrative institution or similar establishments LEGAL RESPONSIBILITIES OF NURSES -SUPERVISION OF PATIENTS1. Application of principles based upon the biological, physical and social sciences as well as execution of nursing procedures 2. being responsible for the performance of every nursing procedure and technique for the recovery of the patient
3. being careful and conscientious in the discharge of duties to avoid liabilities for damages. -OPERATION OF PATIENTS1. The nurse attends to the matter of securing the patient’s signature on the form for giving consent to surgery 2. A form is called “operating permit” is usually provided by the hospital for the purpose. -UNAUTHORIZED DISCHARGE OF PATIENTSWhen a patient insists on leaving the hospital against the advice of the doctor, the nurse should require him to sign a statement whereby he assumes full responsibility for leaving the hospital and releases the hospital personnel from any responsibility. -CONCEPT OF ACCOUNTABILITY1. The accountability of the nurse to the patient, physician or to the public has a reference to the quality of nursing care she renders. 2. A contractual obligation which a nurse assumed exposes her to a certain degree of accountability; the term accountability carries the idea of sanction or penalty License- it is a legal document granted by
the government which permits a person, who has knowledge and skills in a particular field, to render services for the public, where such practice would be unlawful without a license. REMEMBER: The primary purpose of registration is to safeguard the health of the people by setting minimum standards that should be meet by the qualified practitioners POINTS TO PONDER: **OATH: Oath-Taking of profession before the Board or any authorized government officials is required to those candidates who successfully passed the examination **AUTOMATIC REGISTRATION: An automatic registration for nurses shall be given provided that his/her name appear in the roster of nurses
Registration by Reciprocity (RA 9173
Sec 20)a certificate of registration/professional license may be granted without examination to nurses registered under the law of foreign state or country provided that: 1. requirements in the said country are the same under this Act 2. laws of such country granted the same privileges to the registered nurse in the Philippines PRACTICE PROGRAM THROUGH SPECIAL/TEMPORARY PERMIT 1.internationally known specialists, or outstanding experts 2.on medical mission 3.exchange professors REVOCATION AND SUSPENSION OF CERTIFICATE OF REGISTRATION/PROFESSIONAL LICENSE OR SPECIAL/ TEMPORARY PERMIT 1. unprofessional and unethical conduct 2. causes like a. convicted by final judgment of any criminal offense b. guilty of immoral or dishonorable conduct c. declared by the court to be of unsound mind 3. gross incompetence of serious ignorance 4. malpractice or negligence 5. use of fraud, deceit, or false statements 6. practice during suspension 7. violation of this Act, rules and regulation, code of Ethics and technical standards for nursing practice, policies of the Board REMEMBER: Suspension of the certificate of registration or professional license shall be for a period not to exceed 4 years Suspension- temporarily not allowing the
nurse to practice his/her profession until the final adjustment of the case
Revocation- the license to practice is
cancel either temporarily or permanently REGISTRATION BY EXAMINATION -QUALIFICATIONS FOR ADMISSION TO LICENSURE EXAMINATIONa. citizen of the Philippines subject of a country which permits Filipino nurses to practice within its territorial limits on the same basis as the subject or citizen of such country, PROVIDED, the requirements for the registration or licensing of nurse in said country are substantially the same as those prescribed in this Act. b. of good moral character c. holder of a Bachelor’s Degree in Nursing -REQUIREMENTS FOR EXAMINATIONa. original transcript of records b. record of actual related learning experiences c. actual number of operating room scrubs and deliveries assisted d. certificate of live births e. marriage contract (if married, for female applicants) f. 4 passport size pictures with white background g. Community tax certificate -RATINGSa. must obtain a general weighted average of at least seventy five percent (75%) b. no rating below sixty percent (60%) in any subject REMEMBER: If an examinee obtains a general weighted average of 75% but has a rating below 60% in any or only -PROFESSIONAL IDENTIFICATION CARDsubject, the examinee must take the examination again but a. full name of the professional only on the subject where he/she rated below 60% b. license number c. date of registration d. date of issuance and expiration e. signature of the chairperson -REQUIREMENTS FOR INACTIVE NURSES RETURNING TO PRACTICE(Nurses who doesn’t actively practicing the profession for 5 consecutive years)
a. one moth of didactic training b. three months of practicum ORGANIZATION OF THE BOARD OF NURSING -CREATION AND COMPOSITION OF THE BOARDa. A chairperson and six members, appointed by the President of the Republic of the Philippines b. Two (2) nominees per vacancy of the PRC chosen and ranked from a list of three (3) nominees per vacancy of the accredited professional organization of nurses -QUALIFICATIONSa. natural born citizen and resident of the Philippines b. good standing of the accredited professional organization of nurses c. Registered Nurse, Master of Arts in Nursing, Master of Arts in Education or other allied profession from university duly recognized by the Government; provide that majority are Master of Arts in Nursing; Chairman is Master of Arts in Nursing holder d. At least ten (10) years of continuous practice, the last five (5) years in the Philippines e. Not convicted to any offense involving moral turpitude REMEMBER: Membership of the Board shall represent the 3 areas: (1) Nursing Education (2) Nursing Service (3) Community Health Nursing REMEMBER: Any person appointed as the Chairman or member of the Board shall immediately resign to any teaching position, review program in any local nursing board examination -TERM OF OFFICEor any office or employment in the government. a. 3 years ; can be reappointed for another 3 years b. any vacancy in the Board occurring shall be filled for the unexpired portion of the term only (HOLD OVER DOCTRINE) c. the Board shall be under the supervision of PRC -POWER AND DUTIES OF THE BOARDc. QUASI-LEGISLATIVE- making laws
1. promulgate a code of ethics in coordination and consultation with the accredited professional organization of nurse 2. recognize nursing specialty organization with the accredited professional organization 3. prescribe, adopt, issue and promulgate guidelines, regulations, measures and decisions that are necessary for the improvement of nursing practice d. QUASI-JUDICIAL- hearing 1. conducts hearings and investigations to resolve complaints against nurses for violations, unethical and unprofessional conduct 2. issues subpoena ad testificandum & subpoena duces tecum to secure appearance of respondents & production of documents and punish with contempt for non-compliance, impeding & or otherwise interfering with the conduct of the proceedings e. POLICE POWER- implementing laws 1. conduct the licensure examination 2. issue, suspend or revoke certificates of registration 3. monitor and enforce quality standards of nursing practice 4. ensure quality nursing education 5. recognize nursing specialty organizations in coordination with accredited professional organization 6. exercise powers necessary to ensure the maintenance of efficient, ethical, technical and moral professional standards in the practice of nursing taking into account the health needs of the nation. -REMOVAL OR SUSPENSION OF BOARD MEMBERSa. continued neglect of duty or incompetence b. commission or tolerance of irregularities in the licensure examination c. unprofessional, immoral or dishonorable conduct NURSING EDUCATION -QUALIFICATIONS OF THE FACULTYa. RN in the Philippines b. At least one (1) year of clinical field
c. Member of good standard in accredited professional organization of nurses d. Holder of Master’s degree in nursing, education or other allied medical and health sciences -QUALIFICATIONS OF THE DEANa. Master’s degree in nursing b. At least five (5) years experience in teaching -QUALIFICATIONS OF NURSING SERVICE ADMINISTRATORSa. Registered Nurse b. At least 2 years experience in general nursing service administration c. Bachelor of Science in Nursing degree holder with at least 9 units in management and administration courses at the graduate level d. Member of good standing of the accredited professional organization for nurses CHIEF NURSE/ DIRECTOR OF NURSING SERVICE: 5 yrs. experience in supervisory or managerial position & MAN holder MILITARY CHIEF NURSES: MAN plus completion of the General Staff Course (GSC) -QUALIFICATIONS OF THE CHIEF NURSE OR DIRECTOR OF NURSING SERVICEa. Master’s degree Major in Nursing b. At least five (5) years experience in supervisory or managerial position COMPREHENSIVE NURSING SPECIALTY PROGRAM AIM: Upgrade the level of skill and competence or specialty nurse clinicians not limited to the areas of critical care, oncology, renal and other areas -Board of Nursing with the coordination of: a. accredited professional organization b. Department of Health (DOH) c. Recognized specialty organizations REMEMBER: It is necessary to the beneficiaries of this program to render services in the hospital in the Philippines for a period of two (2) years of continuous service
NURSING SPECIALTY CERTIFICATION PROGRAM -with the basis of RA 7164, known as the Philippine Nursing Act of 1991, through Resolution No 14 of Board of Nursing, the Nursing Specialty Certification Program was created on February 18, 1999 to supervise the administration of new programs by the Specialty Certification Boards -JUSTIFICATIONSa. because of the increasing emphasis on the climate of specialization, the advances in science and technology direct an initiatives toward a high-quality performance in the field of choice b. due to the concept of globalization, it facilitate the removal of the barriers in trade, industry and services c. it impels the people to prepare in the services sector to meet the challenges as a response to the increasing demand of development d. adoption of system that recognize individual and collective efforts in terms of incentives and benefits e. enhancing the quality nursing care through deepening and refining of nursing practice due to the current trend of specialization in nursing practice as recognized by the ICN f. the need for a framework of the program and detailing the mechanics, guidelines and procedures for its implementation -3 PERSPECTIVES OF SPECIALTY CERTIFICATIONa. process b. mechanism c. art -LEVELS SUBJECT TO CERTIFICATIONa. Nurse Clinician—Level I b. Nurse Clinician—Level II c. Clinical Nurse Specialist—Level III SCOPE OF NURSING PRACTICE - 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. 1. It includes but not limited to: nursing care during conception, labor, delivery, infancy, childhood, toddler, pre-school, school age, adolescence, adulthood and old age. 2. As independent practitioners, nurses are primarily responsible for the promotion of health & prevention of illness. 3. 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. 4. Provide nursing 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 administration of written prescriptions for treatment therapies, oral, parenteral medications, internal examinations during labor in the absence of antenatal bleeding delivery in case of suturing of perineal laceration, special training shall be provided according to protocol established 5. Establish linkages with community resources and coordination with the health team 6. Provide health education to include families and communities -BON RESOLUTION NUMBER 20 SERIES OF 19941. Stages of development shall include conception, labor, delivery, newborn, neonatal, infancy, toddler, pre-school, school age, adolescence, adulthood, aged and death. 2. Nursing care of individual includes: Supervision and care of women during pregnancy and labor Performing internal examination and delivery of babies
Suturing lacerations in the absence of a physician Providing first aid and emergency care Recommending herbal and symptomatic medicines 3. Intravenous injections shall include: Intravenous administration of drugs, fluids and electrolytes, blood and blood products Insertion of needle butterfly in IV infusion REMEMBER: Teach, guide and supervise students in nursing education programs including administration of services in varied settings such as hospitals, and clinics and undertake consultation services; engage in such activities that require the utilization of knowledge and decision making skills as registered nurses REMEMBER: Undertake nursing and health human resources development training, which shall include but not limited to the development of advance nursing practice PROHIBITIONS IN THE PRACTICE OF NURSING Any person who practices nursing 1.without certificate of registration/ professional license; temporary permit 2.Who uses as his/her own certificate of registration/ license/permit of another 3.Who uses an invalid, suspended, revoked, expired, cancelled certificate, license or permit 4.Who gives any false evidence to the Board in order to obtain a cert. of registration/ license/ or permit 5.Who appends BSN/ RN or any similar appendages to his/her name without having been conferred said degree or registration 6.Who falsely advertises as registered/licensed nurse or uses any other means that tend to convey the impression that he/she is a registered/licensed nurse 7.Who as a registered/licensed nurse, abets or assists the illegal practice of a person who is not lawfully qualified to practice nursing
Penalty: Fine of P50,000.00 but not more than P100,000.00 or imprisonment of not less than 1 year but not more than 6 years or both 8. any person or the CEO of a juridical entity who undertakes inservice educational programs or who conducts review classes for both local & foreign examination without permit/clearance from the BON & PRC 9. any person or employer of nurses who violates the minimum base pay of nurses and the incentives & benefits that should be accorded as specified in RA 6758 “Compensation and classification Act of 1989” 10.Any person or the CEO of a juridical entity violating any provision of this Act and its rules and its rules and regulations
III. NURSES AND CONTRACTS Contracts- is a meeting of minds between two or more
people which establishes an agreement/obligation to perform or render some services -CHARACTERISTICS1. Obligatory- has force of law between parties 2. Autonomy- may establish agreement not contrary to law, morals good order, public order, public policy 3. Mutuality- binding on both parties 4. Relativity- takes effect between parties, their assigns & heirs -STAGES1. Negotiation- from indicate interest to time contract is concluded 2. Perfection- birth; meeting of the mind on object and cause 3. Consummationdeath; performance of respective commitments -KINDS1. Express Contract- when two parties discussed about the terms and conditions and agree orally or written in its contents 2. Implied Contract- there is no discussion between parties but the law implies that the contract implies that the contract exists 3. Formal Contract- the agreement is required by the law to be in writing 4. Informal Contract- does not required by the law to be in writing; concluded as a result of oral or written discussion
5. Illegal or Inexistent Contract- inexistent agreement therefore may not be enforced object or purpose is contrary to law simulated or fictitious object did not exist object beyond commerce of man performance of an impossible service object cannot be determined with certainty expressly prohibited or declared by law as void, invalid, ineffective direct result of n illegal contract 6. Void - can be annulled or voided One party is incapable of giving consent Consent is vitiated by mistake, violence, intimidation, undue influence, fraud -DOCTRINESa. duo ut des - I give that you give b. duo ut facias - I give, you do c. facio ut des - I do, you give d. Facio ut facias - I do, You do -ESSENTIAL REQUISITES OF CONTRACTS1. Consent Must be of legal age and mentally and physically competent Be of sound mind Not under the influence of intoxicating drugs Not suffering from mental disability Emancipated minor (minors that are already married) Not under civil interdiction 2. Object or subject matter of the contracts Not outside commerce of man All future things and impossible things or services Rights which are not intransmissible Future inheritance in cases expressly specified by law All services which are not contrary to law, morals, good customs, public order or public policy 3. Cause of Contract- consideration, material, cause, reason, motive, price or impelling influence
Prestation or promise of a thing or service Service or benefit which is to be compensated Mere liberality of the benefactor Breach of contract failure to perform an agreement, whether it is expressed or implied contract without a cause prevention of performance failure because of inconvenience or difficulty failure of cooperation in performance abandonment of duty substitution of performance failure to use due care -LEGAL EXCUSESa.Material misrepresentation is made and relied upon b.Performance is illegal c.Performance is made impossible by reason of illness/death of patient or nurse (force majeure-act of God) d.Insufficient contract
IV. NURSES AND ETHICS Nursing Ethics- embodies the principles
of right conduct applied in the nursing profession Ethics- purpose of governing conducts to ensure the protection of individual’s right -IMPORTANCE makes clear why one act is better than another keep an orderly social life by having agreements, understanding, principles or rules of procedure moral conduct and ethical system must be intelligently appraised and criticized Seeks to point out to men the true value of life and attempts to stimulate the moral sense, discover the true values of life and inspire men to gain in for quest of these values. Bioethics (Healthcare Ethics)- encompasses the questions of quality of life, life-sustaining and life-altering techniques and bioscience
1. Human Acts- voluntary; full knowledge, will to do it 2. Acts of Man- involuntary actions of man
-THEORIES1. Utilitarian or Teleological- the end justifies the means 2. Deontological- the act itself determine whether it is right or wrong; the end doesn’t justifies the means 3. Intuitionism- man inherently know what is right and wrong; reason -PRINCIPLES OF NURSING ETHICS1. Autonomy- independent to choose -the person has the right to make his/her decision in relations to his treatment/care • Consent- voluntarily giving of permission by the client • Informed consent- given by doctor to the patient regarding its illness (invasive procedures) • patient’s bill of rights • false imprisonment/ illegal detention • arbitrary detention- police; within 24 hours without case • restraints-good for 24 hours with doctor’s order REMEMBER: In death and dying: a. right of informed refusal- right to refuse medications b. DNR order- do not resuscitate; do not give life-sustaining devices c. death certificate d. care of the body- ask the significant others e. organ transplant f. organ donation g. autopsy h. assisted suicide REMEMBER: Nurse is the witness in signing of consent 2. Principle of Paternalism- nurse acts like a mother/father to the patient NURSING ALERT: TOO MUCH paternalism can cause DEPENDENCY
3. Non-maleficence – do no harm; remove harm; prevent harm REMEMBER: In telephone orders, it is for EMERGENCY and in case there is NO RESIDENT-ON-DUTY. Two nurses or more must verify the orders and must be sign by those nurses who verify the orders. It must also be sign by the doctor within 24 hours Imprudence - deficiency of action; lack of skill Negligence- lack of foresight; deficiency of perception Assault- any threat of harm addressed to client Battery- doing the assault 4. Beneficence- to do good; client advocate 5. Justice - allocation of good and services according to (1) equality (2) needs and (3) merit 6. Veracity- telling the truth a. Fraud – delivering deception intended to produce unlawful gain b. Defamation – character assassination -Libel - written -Slander- verbal/oral 7. Fidelity- loyalty/ faithfulness and keeping promises 8. Confidentiality- observing the seal of secrecy; privileged communication a. b. c. d.
REMEMBER: The seal of secrecy can be broken only if: (a) the patient himself breaks the seal (b) patient sign the waiver declaring the nurse can break the seal (c) subpoena in a criminal case REMEMBER: The nurse can be a witness when prohibition Morality-behavior in accordance with the
general ethical principles of health care -PRINCIPLES OF MORALITY1. The Golden Rule: Do not do unto others what you do not want others do unto you 2. Principle of Two Fold Effect: choosing the lesser evil which may result to a greater good
the action must be morally good the good action must not come from evil action 3. The Principle of Totality: The whole is greater than any of its part 4. Epikia: Exception to the general rule 5. One who acts under an agent is himself responsible 6. Principle of Self-Preservation: No one is obliged to betray himself 7. The end does not justify the means: Even though the outcome is good but the action is bad, it is considered legally and morally wrong 8. Defects of nature may be corrected 9. The greatest good for the greater number 10. No one is held to the impossible 11. The morality of cooperation: cooperates with good purpose 12. Principle relating to the origin and destruction of human life: God is the author of life therefore no one has the right to take it except Him 13. A little more or less does not change the substance of an act 14. If one is willing to cooperate in an act, no injustice is done to him The Good Samaritan Law- a legal doctrine designed to protect those who stop to render aid in an emergency -the rescuer is protected from liability when assisting in an emergency situation provided that it will not lead to recklessness/harm to the patient -“Love article”: If one does not act, you will be responsible for moral negligence. Courage is doing exactly what one believes in.” -We are not legally bound to help people in distress but morally bound. In emergency situation: save the life of the person at all cost without compensation REMEMBER: The elements of MALPRACTICE are IMPRUDENCE and NEGLIGENCE REMEMBER: The medical record is own by the hospital. A medical abstract is given to patient upon discharge REMEMBER: If the patient is in DNR (Do Not Resuscitate), you can give medications but NO to (a) intubation (b) IV drugs (c) chest compressions
Dean Emeritus Julita V. Sotejo- developed a code of
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ethics for Filipino Nurses Code of Ethics- amendment by Section 3 of Republic Act No 877 known as the Philippine Nursing Law and Section 6 of Presidential Decree No 223 NURSES AND PEOPLE - respect to the values, customs and spiritual beliefs of each individuals - the nurse must hold all personal information acquired in the process by giving nursing care with strict confidence in order to respect the patient’s privacy NURSES AND PRACTICE - being accountable for their own nursing practice - the nurse is responsible for their personal and professional growth and development - giving of quality care through maintaining or modifying standards of practice within any given situation - the nurse serves as an advocate to the patient NURSES and CO-WORKERS - maintaining a collaborative working relationship with the members of the health care team and co-workers - recognizing his/her capabilities and limitations in accepting responsibilities and delegating these responsibilities to coworkers NURSES AND SOCIETY - nurses are contributing members of society - recognizing the need for changes of the society and participate in supporting these activities to meet the needs and health of the people NURSES AND PROFESSION - nurses are expected to be a member of professional organizations - contributing to the development and growth of the nursing profession
- implementing the standards of nursing practice and nursing education REMEMBER: Giving of quality care related to the patient’s condition needs regardless of his/her race, creed, color, nationality or status is the primary responsibility of the nurse CODE OF ETHICS FOR NURSES (ANA, 1985) 1. Provides services with respect 2. Safeguards the client’s right to privacy 3. Safeguards the client and the public 4. Assumes responsibility and accountability 5. Maintains competence 6. Exercise informed judgment 7. Contribute to ongoing development 8. Improves standard of nursing 9. Protect the public from misinformation 10. Collaborates with members of the health professions PATIENT’S BILL OF RIGHTS 1. Right to considerate and respectful care 2. Right and is encouraged to obtain relevant, current and understandable information concerning diagnosis, treatment and prognosis 3. Right to make decisions and to refuse a recommended treatment or plan to care to the extent permitted by law 4. Right to have an advance directive 5. Right to every consideration of his privacy 6. Right to expect that all communications and records pertaining to his medical care should be treated as confidential 7. Right to review the records pertaining to his medical care 8. Right to expect that a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services 9. Right to ask and be informed of the existence of business relationships 10. Right to expect reasonable continuity of care
V. LAWS Law-
is the sum total of all rules and regulations pronounced by a supreme power in which the society is governed. It is a rule of conduct which dictates the right and prohibits the wrong; the effort of humanity to creates principles -2 DIVISIONS1. Divine Law- laws authored by God (Ten Commandments) 2. Human Law- laws made by man A. Public Law- applies to the people of the state a. Criminal Law- crimes and its penalty b. International Law- laws and relationships with other countries c. Political Law- politics, organization and administration of government B. Private Law- applies to private matters not concerning the public at large a. Civil Law- organizing family and regulating property b. Commercial Law- right to property and the relations of persons engaged in commerce c. Remedial Law- laws define how the organization’s rights and obligations are to be enforced and protected
VI. LEGAL ASPECTS AND THE NURSE Negligence- the doing of that thing
which a reasonably prudent person would not have done or the failure to do that thing which a reasonably prudent person should have done; commission or omission of an act -ESSENTIAL CONDITIONSa. The existence of a duty on the part of the person charged, to protect the complaining party from the injury received. b. Failure to meet standard care c. Foreseability of harm resulting from failure to meet standard d. An injury resulting from such failure -PROOF OF LIABILITY-
a. Duty- at the time of injury, a duty existed between nurse and
patient b. Breach of duty c. Proximate cause- breach was the legal cause of injury d. Damage or injury Doctrine of Res Ipsa Loquitor: “Let the thing speaks for itself” Doctrine of Respondeat Superior: “Let the master answers for the acts of the subordinate” Doctrine of Force Majeure: “Act of God” Captain of the Ship Doctrine: the leader of the team is the one liable in the actions of its members Doctrine of Corporate Liability: it id the liability of the hospital if in the case a defective equipments/failure lead to harm/injury of the patient Incompetence- lack of ability Torts- committed against a person or property which resulted to damages. The person who committed these acts are held liable in a civil action Assault- threatening harm or offensive bodily contact Battery- intentional, unconsented touching of another False Imprisonment or Illegal Detention- detention of a person without legal consent Invasion of Property and Breach of Confidentialityviolation to the right to privacy Defamation- character assassination whether written (libel) or verbal/oral (slander) CRIMINAL LIABILITY Crime/Felony-
an act or omission punishable by law (revised Penal Code) which can be done by dolo (with intent) or culpa (without intent) Omission- failure to do a duty
Intent- purpose to use a particular means to affect a result
(deliberate intent – freedom and intelligence) Motive- moving power which impels one to act for a definite result -PERSONS CRIMINALLY LIABLE1. Principal by direct participation- direct commits the crime by inducement- induce the performance of the crime by indispensable cooperation- with his presence, the crime take place 2. Accomplice- accessory before the fact; cooperate in the execution of the offense 3. Accessory- accessory after the fact ; having the knowledge of the commission of the crime profiting themselves or assisting others to profit concealing, destroying body of the crime, effects, instruments to prevent its discovery harboring concealing, assisting the escape of the principal -STAGES OF EXECUTION1. Consummatedelements of crime have been fulfilled/accomplished 2. Frustrated- without intention of not fulfilling the crime; some elements are done 3. Attempted- no elements have been fulfilled conspiracy – two or more person agreed and committed the felony; a means by which another person is held liable for the commission of a crime; each criminal is responsible for the acts of his associates provided such act is a result of a common plan. proposal a person who decided to commit a felony proposes its execution to another REMEMBER: In Arson and Rape—no frustrated; with consummated and attempted -DEGREE OF PUNISHMENT1. Grave Felonies- attaches to capital punishment (death) and imprisonment ranging from 6 years to life imprisonment
2. Less Grave Felonies- correctional (from one month to 6
years) -CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY1. Justifying- free from criminal and civil liability oself – defense unlawful aggression reasonable necessity of the means employed to prevent /repel it lack of sufficient provocation on the person defending himself o defense of relatives- up to 4th degree by consanguinity o defense of a stranger without intention or anger or revenge owho acts in fulfillment of a duty or in a lawful exercise of a right or office owho acts in obedience to an order by a superior for some lawful purpose 2. Exempting- no criminal liability but with civil liability o mistake of fact- ( ignorantia facti excusat) must be committed in good faith or under an honest belief an act or omission which is a result of a misapprehension of facts that is voluntary but not intentional; the actor performed an act which would be lawful had it been true as he believed it to be the accused believed to be an intruder showed mistake in identity due to good faith But if there is negligence, the said mistake of fact is not exempting, actor is liable by means of culpa (w/o intent) oAn insane or imbecile unless acted during lucid interval oUnder 9 years of age oOver 9 under 15, unless acted with discernment oWhile performing a lawful act w/ due care causes an injury by mere accident without fault or intention of doing it oWho acted under the compulsion of an irresistible force from a third person oImpulse of uncontrollable fear actor acts without a will; completely deprived of freedom it is an impulse coming from within the person of the actor
compulsion must be of such character as to leave no opportunity for the actor to escape one is compelled under the fear of death to join the rebels, he is not liable for rebellion oInsuperable or lawful cause applies to felonies committed by omission the law imposes a duty to perform the act, if he fails he violates the law; if it is due to lawful or insuperable cause, he is criminally exempt oInstigation when a peace officer induces a person to commit a crime, w/o inducement the crime will not be committed. If it is a private person he is principal by inducement Ex. A policeman induced a nurse to bring to him a prohibited drug w/c he made him believe he would buy and when the drug was delivered he made an arrest 3. Mitigating- lowers the penalty of the crime oUnder 18 or over 70 oNo intention to commit so grave a wrong oSufficient provocation or threat on the part of the offended party immediately preceded the act oVoluntary surrender oDeaf, dumb or blind or suffering from physical defect oSuch illness that would diminish the exercise of his will power 4. Aggravating- increasing the penalty oAdvantage of public position oIn contempt or insult to public authorities oAbuse of confidence or obvious ungratefulness oCommitted on occasion of epidemic, conflagration, shipwreck or other calamity or misfortune oIn consideration of a price or reward or promise oCommitted by means of fire, explosion, stranding of a vessel owith evident premeditation ocraft, fraud or disguise 5. Alternating- can be mitigating or aggravating depends on: orelationship o intoxication odegree of education
VII. NURSES AND CRIMES Parricide-
kills mother, father, descendants, spouse Murder- with intent to kill Homicide- without intent to kill Infanticide- kill infant below 3 years old Abortiontermination of pregnancy before reaching the age of viability (3 to 6 months) Child abuse- any form of cruelty to a child’s moral or metal well being or any form of sexual attack w/c may or may not amount to rape. Abused/neglected childsuffering from serious physical or emotional injuries inflicted on them including malnutrition Under Philippine Law, Child Abuse refers to the maltreatment, whether habitual or not, of the child, and such maltreatment includes any of the following: a.psychological and physical abuse, neglect, cruelty, sexual abuse and emotional maltreatment; b.any act, by deeds or words, which debases , degrades, or demeans the intrinsic worth and dignity of a child as a human being; c.unreasonable deprivation of the child’s basic needs for survival, such as food, shelter
d.failure to immediately give medical treatment to an injured child, resulting in serious impairment of his growth and development or in his permanent incapacity or death. Sexual harassment- words, gestures actions w/c tend to annoy and verbally abuse another person Simulation of birth- crime against status by substitution of one child with another; concealing or abandoning any legitimate child with intent to lose civil status Misdemeanor- use to express every offense inferior to felony and punishable by indictment or by particular prescribed proceedings; not punishable by Revised Penal Code, but by Special Law Example 1. a person who practices nursing without certificate of registration 2. any person assuming or using title r advertising as registered nurse without being conferred such title 3. any person advertising any title tending to convey the impression that she is a nurse (e.g. using nurse’s uniform and cap) Malpractice - the neglect of a physician or a nurse to apply that degree of skill and learning in the treatment of a patient, which is customarily applied in treating and caring for the sick or wounded similarly suffering in the same community. REMEMBER: For nurses, malpractice refers to the failure to follow a reasonable professional standard of care, thereby resulting in injury to a patient.
VIII. NURSES AND WILLS Succession – mode of acquisition of
rights, property & obligation transmitted thru will or by operation of law upon the death of the testator. Decedent (without last will and testament) - person whose property is
transmitted thru succession; testator (with last will and testament) Estate - interest in hand or property to be transmitted Testamentary capacity- capacity to comprehend the nature of transaction he is engaging that time, recollect the property to be disposed; the persons who would have claims to the property, comprehend the manner in which the instrument will distribute the property Wills – act whereby a person is permitted with the formalities prescribed by law to control to a certain degree the disposition of his property to take effect upon his death. -WHO MAY MAKE A WILLoAll persons who are not expressly prohibited by law (minors, mentally incapacitated; mental capacity to be determined at the time of its execution oMarried woman w/o the consent of the husband & w/o authority of the court ( separate property, share of the conjugal property or absolute community of property) -FORMS/KINDS1. Notarial- 3 or more credible witnesses, attestation clause, acknowledgement 2. Holographic – written, dated and signed by the testator himself 3. Joint or Mutual Will – not allowed as a matter of public policy -WITNESSES TO WILLSoLegal age oNot blind, deaf or blind oAble to read and write oDomiciled in the Philippines oIs not convicted of falsification of document or false testimony Living will oHealth care proxy form provided by hospitals oForms part of hospital records
oDesignates health care representative – physical/mental incapacity oIncludes to accept or refuse treatment, services, procedures, provide, withhold or withdraw life-sustaining devices; organ donation or acceptance oDoctors should be informed oSigned by patient and two other persons oIt has the force of law Advanced Directive / Durable power of attorney Document made by a competent individual to establish desired health care for the future or give someone else the right to make health care decision if the individual becomes incompetent. Made part of the medical record Physician must be notified of its presence so that orders will be consistent with client’ wishes
IX. NURSES AND NARCOTICS Dangerous Drug Board- was created
by RA 6425 (Dangerous Drug Act of 1972) Narcotic drugs- any drug which produces insensibility, stupor, melancholy or dullness of mind with delusions and which may be habit forming. Ex. opium, opium derivatives and synthetic opiates Dangerous drugs- refers to prohibited or regulated drugs Prohibited drugs- include opium, and its active components and derivatives (heroin, morphine, LSD) Regulated drugs- include self-inducing sedatives (Phenobarbital, amphetamines) RA 953 – Narcotics Drug Law
REMEMBER: The nurse must remember that the dispensing, administering, distribution or giving away of narcotics to a patient by a registered physician, veterinary surgeon or other practitioner registered under the narcotics drug law should be in THE COURSE OF HIS PROFESSIONAL PRACTICE only and for legitimate medical purposes. Nurse can handle narcotics in the course of their professional practice only as agents for practitioners of institutions under whose direction or supervision their duties are performed. MEDICAL ORDERS, DRUGS AND MEDICATIONS RA 6675 states that only registered Medical, Dental & Veterinary practitioners whether in private, public or corporation are only authorized to prescribe drugs. RA 5921 or Pharmacy Act – all prescription must contain the following: Name of prescriber PRC # Office or address Patient’s name, age sex, & data of prescription Drug must be written with its generic name REMEMBER: Dependent and coordinated function of the nurse and authorized personnel and only when the order is in writing and bears the doctor’s signature does the nurse have the legal right to follow them. INTRAVENOUS THERAPY AND LEGAL IMPLICATIONS Nurses now participate in complex intravenous therapy procedures that was once were performed by doctors. Legal rights to give IV injections are based on the Phil. Nursing Act of 1991, sec. 27 Art. V Board of Nursing resolution No. 8 series of 1994 -SCOPE OF DUTIES AND RESPONSIBILITIES OF IVTN-interpret orders perform venipuncture except cutdown prepare, monitor, additives, push administer blood, blood products as ordered
recognize incompatibilities maintain, replace in accordance with the procedure establish flow rate of fluids and blood proficient technical ability in the use, care and evaluation Documentation
X. THE PHILIPPINE NURSING LAW HISTORY February 5,1915 – RA 2493 Practice of nursing was under Medical and Surgical Law -CLASSIFICATIONS OF NURSESClass A: 1. Graduate of 2 ½ years in Nursing 2. Clinical experience must be done in a 30 bed capacity hospital in pediatrics, OB, Medicine, Surgery, EENT 3. Good moral character and good physical health 20 yrs. of age 4. Registration is with the Director of Health Class B: 2nd class nurses; nurse attendant; unregistered nurses 1. Graduate of intermediate grade 2. Good moral character and good physical health 3. Registration is with the district health officer 4. They were allowed to wear cap or uniform of class A nurses REMEMBER: On or after January 1, 1919 it is unlawful to practice nursing if not registered March 1, 1919 – RA 2808 – (First True Nursing Law) – The
Act Regulating the Practice of Nursing Profession in the Philippines -creation of the Board of Examiners (1 doctor as chair; 2 nurses as members) appointed by Secretary of Interior Chair: Dr. Juan Cabarus Members: Anastacia Giron-Tupas and Belen Del Rosario -FUNCTIONS OF BOEoissuance of certificate of registration
orevoke certificate of registration oadminister examination (practical & written oexamines the condition affecting practice of nursing March 8, 1922 - RA 3025 – Registration of Red Cross Aids & Welfare Workers oassist people during calamities war, disaster, epidemics and war oexamination dates – 2nd Monday of April and October instead of 2nd Monday of June and December ogrant privilege of practicing nursing without examination to nurses registered under the laws of any state or territory of the U. S. or any foreign country December 5, 1932 - RA 4007 – Reorganization Act of 1932 oBOE was put under the custody of Bureau of Civil Service 1950 – Congress passed two laws o RA 465- Standardization of Examination & Examination Fees o RA 546- BOE is under the direct supervision of Pres. of the Phil. 1953 – Birth of Filipino Nurses Association (Formal recognition) Legislative Committee Chair: Mrs. Obdulia Kabigting Members: Ms. Annie Sand Ms. Conchita Ruiz Ms. Jovita Sotejo – 1st FNA Pres. June 19, 1953 – Philippine Nursing Law sponsored by former Senator Geronima T. Pecson November 21, 1991 - RA 7164 – Philippine Nursing Law of 1991 - sponsored by Sen. Edgardo Angara & Sen. Heherson Alvarez October 21, 2002 - RA 9173 – Philippine Nursing Act of 2002 - sponsored Sen. Juan Flavier
Philippine Nursing Act of 2002: REPUBLIC ACT 9173 -An act providing for a more responsive nursing profession, repealing for the purpose RA 7164 known as the “Phil. Nursing Act of 1991 and for other purposes. This act shall be known as the “Phil. Nursing Act of 2002” Declaration of Policy: It is hereby declared the policy of the State to assumes responsibility for the protection and improvement of the nursing profession by instituting measures that will result in: • relevant nursing education, • humane working conditions, • better career prospect • a dignified existence of our nurses. The State hereby guarantees the delivery of quality basic health care services through an adequate nursing personnel system throughout the country. RA 7164 -upper 40% of graduating class -3x failure in board exam —repeat 4th year -BON must be citizen (born in the Philippines with Filipino parents; jus sanguinis and jus soli) - no removal
RA 9173 -take all you can -BON must be natural citizen - with removal
LAWS AND REGULATIONS AFFECTING NURSING/MIDWIFERY PRACTICE IN THE PHILIPPINES PRESIDENTIAL DECREES PD 48 - Four (4) children with paid maternity leave privilege PD 69 - Four (4) children for personal tax exemption
PD 110 - Creates civil service commission PD 223 - PRC was created PD 386 - Proposal of collective bargaining for nurses PD 422 - Amends PD 223 ; professional regulatory code PD 442 - New labor code PD 491 - Nutrition program; July is nutrion month PD 541 - Practice of former Filipino professionals in the Philippines PD 603 - Child and youth welfare code PD 626 - Employee compensation and state insurance fund PD 651 - Birth registration following delivery PD 719 - Revised population act PD 826 - Anti-improper garbage disposal PD 851 - 13th month pay PD 856 - Code of Sanitation PD 965 - Family planning and responsible parenthood instructions prior to issuance of marriage license PD 996 - Compulsory immunization for children below eight (8) years old against immunizable diseases PD 1083 - Muslim holidays PD 1588 - Settlement of disputes at the Barangay level PD 1636 - Compulsory SSS for self employed REPUBLIC ACTS Act 2808 - 1st True nursing law (1919); created 1st board of examiner; 1st board exam (1920) RA 1054 - Free emergency medical treatment and dental attendance to employees/laborers of any commercial, industrial or agricultural establishments RA 1080 - Civil service eligibility RA 1082 - Creation of rural health units all over the Philippines RA 1136- TB law, reorganizing division of TB control in the DOH RA 1612 - Privilege tax/professional tax/omnibus tax RA 1811 - Amends 1082 Rural health unit with 8 different categories and population groups to serve RA 2382 - Philippine medical act RA 2644 - Midwifery law RA 3573- Reporting of Communicable Diseases RA 3753- Civil Registry Law
RA 4073 - Treatment of leprosy in a government skin clinic, rural health unit or by duly licensed physician RA 4226- Hospital Licensure Act RA 4704 - 1st amendment of Philippine nursing law (1966) RA 5181 - Permanent residence and reciprocity qualifications for examinations/registration RA 5901 - Working hours (40 hours a week) , compensation and agencies with 100 bed capacity RA 6111 - Philippine medical care act (SSS and GSIS) RA 6136 - Injection and IV should be under the direction and with the presence of a doctor RA 6475 - Dangerous drug act19. RA 6675 - Generics act of 1988 RA 6675- Generics Act of 1988 RA 6713 - Code of conduct and ethical standards for public officials and employees RA 6725- Strengthening Prohibition on Discrimination against Women RA 6727 - Wage rationalization RA 6758 - Salary standardization of government employees RA 679 -Amends PD 148 ; women and child labor law no emplyment for 14 years old and below RA 6809 - Age of maturity is 18 years old RA 6972 - Day care center in every barangay RA 7160 - Local autonomy code RA 7170 - Legacy of donation of all or part of human body after death RA 7170 - Organ Donation RA 7192 - Women in development and national building RA 7277 - Magna carta for disabled persons RA 7305- Magna Carta of Public Health Workers RA 7392- Midwifery Law RA 7432 - Senior citizens benefits and privileges RA 7600 - Rooming –in and Breastfeeding Act of 1992 RA 7610 - Special protection of children against abuse, exploitation and discrimination RA 7624 - Drug education law RA 7641 - New retirement law for employees in the private sector RA 7658 - Law that prohibits the employment of children below 15 years of age
RA 7719 - National blood services act of 1994 RA 7875 - National health insurance act of 1995 RA 7876 - Senior citizen center for every barangay RA 7877 - Anti-sexual harassment act of 1995 RA 7883 - Barangay health workers benefits and incentives act of 1992 RA 8042 - Migrant workers and overseas Filipino act of 1995 RA 8172 - Asin Law of the Philippines RA 8177 - Death through lethal injection RA 8187 - Paternity leave act of 1995 RA 8282 - Social security law of 1997 (amended RA 1161) RA 8291 - Government service insurance system act of 1997 (amended PD 1146) RA 8344 - Hospitals/doctors to treat emergency cases referred for treatment RA 8353 - Anti-Rape Law RA 8423 - The traditional and alternative medicine act (TAMA) of 1997 RA 8424 - Personal tax exemptions RA 8493 - Herbal drafted RA 8749 - Clean air act of 1999 RA 8976 - National food fortification RA 8980 -Early Childhood Care & Development Act of the Philippines RA 8981 - PRC modernization act of 2000 RA 9003 - The ecological solid waste management act of 2000 RA 9165 - The comprehensive dangerous drugs act RA 9165- PRC Modernization Act of 2002 RA 9173 - The Philippine nursing act of 2002 RA 9211 - Tobacco regulation RA 9255 - Act allowing illegitimate children to use the surname of their father (amends RA 176 and EO 2069 - Family code of the Philippines) RA 9257 - Expanded senior citizen act RA 9262 - The anti-violence against women and children act of 2004 RA 9288 - Newborn Screening Act RA 9439 - Hospital Detention Act RA 977 - Phil nursing law (1953)
EXECUTIVE ORDERS EO 51 - Milk code EO 80- Collective Bargaining Rights of government workers EO 180 - Guidelines on the right to organize of government employees EO 203 - List of regular holidays and special days EO 2069 - Family code of the Philippines (amended by RA 6809) EO 226 - Command responsibility EO 296- Accredited professional organization of nurses must create a nomination committee composed of its past presidents who will screen nominees or applicants to the BON EO 857- Compulsory Dollar Remittance BOARD OF MIDWIFERY/NURSING RESOLUTIONS #557 Series 1988 - Code of ethics for midwives #100 Series 1983 - Implementing rules and regulations of RA 7392 # 187 s. 1991- Issuance and Renewal of Professional License # 217 s. 1992- Delisting of delinquent professionals #633 Series 1984 - ICN code of ethics #1955 Series 1989 - PNA code of ethics #08 Series 1994 - Special training on intravenous injections for the RN #20 Series 1994- Implementing rules and regulations of RA 7164 PRC Res. #6 (July 1981) regulate review centers PROCLAMATIONS, PRONOUNCEMENTS, LETTERS OF INSTRUCTIONS & HOUSE BILLS Proc. # 6- United Nations’ goal on Universal Child Immunization by 1990 Proc. # 539- Nurses’ Week (every 3rd week of October) LOI # 949- Legal basis of Primary Health Care HB 4110- REPRODUCTIVE Health Care Agenda Act of 2001 HB 3744- Empowerment of Women in Vulnerable Situation Act HB 3773- Responsible Parenthood and Population Movement Act of 2005 Proc. #118 - Professional Regulation week -June 16-22 Proc. #1275 - Midwifery week - every 3rd week of October
LOI #1000 - Members of accredited professional organizations given preference in hiring or attendance to seminars ILO Convention #149 - Improvement of life and work conditions of nursing personnel (ILO Recommendaions #157) SALIENT ASPECTS IN THE 1987 CONSTITUTION OF PHILIPPINES Article II – Declaration of principles & State Policies SECTION 11 – Human Dignity and Rights 12 – Sanctity of Family equal protection of the life of the mother and the life of the unborn form the conception 13 – Role of the youth in Nation Building 15 – Right to Health 16 – Right to a balanced and healthy ecology Article III – Bill of Rights SECTION 1 – Equal Protection of Laws and the due process of law 3 – Privacy of Communication and correspondence 8 – Formation of Unions, associations or societies 12 – To remain silent & have counsel when under investigation 14 – The accused person is presumed innocent until the contrary is approved Article IV – Citizenship SECTION 3 – Philippine Citizenship may be lost or reacquired in the Manner provided by law Article XIII – Social Justice & Human Rights SECTION 3 – Rights of all Workers of self-organization, collective bargaining and negotiations and peaceful concerted activities 11 – Priority for the needs of the under-privileged sick, elderly, disabled,woman and children 13 – Special Agency for disabled persons 14 – Protection of Working Women
Article XV – The Family SECTION 1 – Filipino Family as the foundation of the nation 2 – Marriage, as an inviolable social institution, is the foundation of the family 4 – The family has the duty to care for its elderly members
