Nursing Leadership and Management: Ethicomoral/ Legal Aspects of Health Care and Nursing Practice

NURSING LEADERSHIP AND
MANAGEMENT
ETHICOMORAL/ LEGAL ASPECTS OF

HEALTH CARE AND NURSING PRACTICE
PROFESSION
• Is a calling that requires special
knowledge, skill and preparation.
• An occupation that requires
advanced knowledge and skills and
that it grows out of society’s needs
for special services.
CHARACTERISTICS OF A PROFESSION
• A basic profession requires an extended
education of its members, as well as a basic
liberal foundation.
• A profession has a theoretical body of
knowledge leading to defined skills, abilities
and norms.
• A profession provides a specific service.
• Members of a profession have autonomy in
decision- making and practice.
• The profession has a code of ethics for practice.
NURSING
• A discipline involved in the delivery
of health care to the society.
• A helping profession
• Service-oriented to maintain health
and well- being of people.
• An art and a science.
• Has completed a basic nursing education
program
a. Two-year associate in Health Science
Education (ASHE)
S.Y. 1998-1999
a. Four-year BSN Prototype
Curriculum S.Y. 2008-2009
• Licensed to practice nursing
in the country
MEANING OF PROFESSIONAL NURSING
- The Philippine Nursing Act of 1991
(R.A. 7164) has been repealed by the
Philippine Nursing Act of 2002(R.A.
9173).Note the changes in the scope of
nursing practice.
RA 9173 Philippine Nursing Act of 2002
Article VI. Practice
S28. Scope of Nursing
It shall be the duty of the nurse to:
Provide nursing care through the utilization of the
nursing process. Nursing care includes:….
In case of suturing of perineal laceration, special

training shall be provided according to protocol
established;
(b) establish linkages with community resources and
coordination with the health team;
(c) Provide health education to individuals, families
and communities;
(d) Teach, guide and supervise students in nursing
education programs including the administration of
nursing services in varied settings such as hospitals
and clinics; undertake consultation services; engage in
such activities that require the utilization of knowledge
and decision-making skills of a registered nurse; and
(e)Undertake nursing and health human resource
development training and research, which shall include, but
not limited to, the development of advance nursing practice;
Provided, That this section shall not apply to nursing students who
perform nursing functions under the direct supervision of a qualified
faculty:
Provided, further, That in the practice of nursing in all settings, the
nurse is duty-bound to observe the Code of Ethics for nurses and
uphold the standards of safe nursing practice. The nurse is required to
maintain competence by continual learning through continuing
professional education to be provided by the accredited professional
organization or any recognized professional nursing organization:
QUALIFICATIONS AND
ABILITIES OF A PROFESSIONAL
NURSE A. Professional
Preparation
The professional nurse must:
1. Have a license to practice
nursing in the country;
2. Have a Bachelor of Science
degree in Nursing; and
3. Be physically and mentally fit.
B. Personal Qualities and Professional
Proficiencies
The personal qualities and professional proficiencies
of a nurse include
1. Interest and willingness to works and
learn with individuals/groups in a variety of
settings; 2. A warm personality and concern
for people;
3. Resourcefulness and creativity as well as
well-balanced emotional condition;
4. Capacity and ability to work cooperatively
with others;
5. Initiative to improve self and service;
6. Competence in performing work through
the use of nursing process;
7. Skill in decision-making, communicating,
and relating with others and being research
oriented; and 8. Active participation in issues
confronting nurses and nursing.
BASIC EDUCATIONAL PROGRAM IN NURSING
Until 1983, there was only one basic educational
program in nursing - the four-year collegiate degree
programleadingto the Bachelor of Science in Nursing.
The basic three-year hospital-based program leading to
the title GraduateinNursingwas phased out. It is to be
noted, however, that revision of this program continues
as seen fit by the Council of Deans,thePhilippine
Colleges of Nursing, the Commission on Higher
Education, and nursing practitioners. Colleges
mayalsoaddcourses that will enrich their curriculum.
However, effective School Year 1998-1999, the
curriculum for the common two-year Associate in
HealthScienceEducation (ASHE) was enforced.
THE BSN CURRICULUM
The four-year Bachelor of Science in Nursing
Program offers a competency-based community
orientedcurriculumtoeducate future nurse practitioners
to assume their roles and responsibilities in the
Philippine Health Care System. It aimstoprepare
nurses for entry level positions in any healthcare
setting in the country, I.e., hospitals, clinics,
healthcarecenters,homes, and communities.
Specifically, the end-of-program competencies,
also referred to as terminal competencies, expect a
graduateto1. Utilize the nursing process in the care
of individuals, families, and community by 1.1.
Assessing the client’s healthcare status,
1.2. Planning with client and/or significant others
the nursing action based on identified needs
andproblems, 1.3. Implementing appropriate
nursing interventions (wholly compensatory, partially
compensatory, supportive,educative),
 1.4. Modifying interventions, and
1.5. Evaluating the results of nursing
interventions accordingly based on criteria
established;
2. Communicate effectively at all levels of
healthcare in various settings by
 2.1. Applying “therapeutic use of self’,
2.2. Documenting and reporting observations,
responses to nursing actions, and
2.3. Relating with clients, families, communities,
and groups and members of health team; 3. Utilize
the elements of management in any healthcare
setting by
 3.1. Utilizing management process in the delivery
of healthcare,
 3.2. Participating in the formulation and
implementation of policies, and
3.3. Working independently and/or in collaboration
with others on matters promoting a better qualityof life;
4. Utilize research findings in the care of
clients; and
5. Assume responsibility for personal
and professional growth and
development by 5.1. Promoting
professional and personal growth,
5.2. Accepting accountability for
professional action, and
5.3. Participating in the solution of
health/social problems.
Overall, the BSN program intends to
produce a professional nurse who
demonstrate the following behaviors: 1.
Caring behavior (compassionate, competent
and committed);
2. Ability to practice legal, ethico-moral,
social responsibilities/accountabilities;
3. Critical and creative thinking; and
4. Skill in practicing S-K-A and values for
the promotion of health, prevention of illness,
restoration of health, alleviationof suffering;
assisting clients to face death with dignity
and peace.
DEFINITION OF LICENSE
A license is a legal document given by the
government that permits a person to offer to the public
his or her skills and knowledge in a particular
jurisdiction, where such practice would otherwise be
unlawful without a license. The license to practice
nursing is granted by the appropriate authority to
applicants or candidates who have fulfilled certain
established requirements. Such a license permits the
nurse to practice within the country or state and gives
him/her the privilege of representing herself/himself as
a licensed nurse.
The appropriate authority to administer,
implement, and enforce the regulatory policies of
government with respect to the regulation and
licensing of the various professions and occupations
under its jurisdictions is the Professional Regulation
Commission (PRC).
Need for Licensure
The primary purpose of registration is to
protect the health of the people by
establishing minimum standards which
qualified practitioners must meet. Licensure
discourages certain persons who may be
tempted to misinterpret themselves as
nurses. It is the most important tool for legal
control and enforcement of nursing practice.
It is also used to gather statistical data about
nurses and nursing in the country.
DEFINITION OF REGISTRATION
Registration is the recording of names of persons who have
qualified under the law to practice their respective professions.
Nurses’ names are recorder in a registry or registration book
which contains the following information: 1. Full name of
registrant;
2. Number and date of registration;
3. Age, sex and place of birth;
4. Place of business;
5. Post office address;
6. Name of school, college or university from which he or she
graduated or in which he or she has studied;
7. Date of such graduation or term of study, together with the time
spent in the study of the profession elsewhere, if any; and
8. All other degrees granted to him or her from other institutions of
learning.
A certificate of registration is issued by the PRC to show such
qualification.
Qualifications for admission to PNLE
a. He/she is a citizen of the Philippines, or a
citizen or subject of a country which permits
Filipino nurses to practice within its
territorial limits;
b. He/she is of good moral character; and
c. He/she is a holder of a Bachelor's Degree in
Nursing from a college or university that
complies with the standards of nursing
education duly recognized by the proper
government agency.
Philippine Nursing Act of 2002 ARTICLE IV Examination and
Registration
Rati
• ngs
An examinee must obtain a general average of at
least 75 with a rating of not below 60 in any
subject.
• An examinee who obtains an average rating of 75
or higher but gets a rating below 60 in any
subject must take the examination again but only
in the subject or subjects where he/she is rated
below 60.
Philippine Nursing Act of 2002 ARTICLE IV Examination and
Registration
Oath Taking of Nurses
• All successful candidates in the
examination shall be required to
take an oath of profession before
the Board or any government
official authorized to administer
oaths prior to entering upon the
nursing practice.
Philippine Nursing Act of 2002 ARTICLE IV
Examination and Registration
• All successful candidates in the
examination shall be required to
take an oath of profession before
the Board or any government
official authorized to administer
oaths prior to entering upon the
nursing practice.
Oathtaking can be hosted by the:
• respective schools of the board passers
• PRC Regional Offices in coordination with
the Accredited Professional Organization
(APO) provided that they get clearance
from the Board of Nursing and the
Professional Regulation Commission main
office.
• individual oath-taking before the Board
of Nursing (BON) or PRC officials
Registration of Nurses
• All nurses whose names appear at
the roster of nurses shall be
automatically or ipso facto registered
as nurses under this Act upon its
effectivity.
Registration by Reciprocity
• A certificate of registration/professional license
may be issued without examination to nurses
registered under the laws of a foreign state or
country.
• The requirements for registration or licensing of
nurses in said country are substantially the same
as those prescribed under this Act.
• The laws of such state or country grant the
same privileges to registered nurses of the
Philippines on the same basis as the subjects
or citizens of such foreign state or country.
Non-registration and Non-issuance of Certificates of
Registration/Professional License
• No person convicted by final judgment of any
criminal offense involving moral turpitude or any
person guilty of immoral or dishonorable
conduct or any person declared by the court to
be of unsound mind shall be registered and be
issued a certificate of registration/ professional
license or a special/temporary permit.
• The Board shall furnish the applicant a
written statement setting forth the reasons
for its actions, which shall be incorporated in
the records of the Board.
Revocation and suspension of Certificate of
Registration/ Professional License
a. Unprofessional and unethical conduct;
b. Gross incompetence or serious ignorance;
c. Malpractice or negligence in the practice of
nursing;
d. Use of fraud, deceit, or false statements in
obtaining a certificate of
registration/professional license;
e. Violation of this Act, Code of Ethics for nurses and
technical standards for nursing practice, policies
of the Board and the Commission; or
Revocation and suspension of Certificate of
Registration/ Professional License
f. For practicing his/her profession
during his/her suspension from
such practice;
The suspension of the certificate of
registration/ professional license
shall be for a period not to exceed
four (4) years.
Re-issuance of Revoked Certificates
and Replacement of Lost Certificates
• The Board may, after the expiration of a
maximum of 4 years from the date of
revocation of a certificate, for reasons of
equity and justice and when the cause for
revocation has disappeared or has been
cured and corrected, upon proper
application therefor and the payment of
the required fees, issue another copy of
the certificate of registration/ professional
license.
Philippine Nursing Act of 2002 ARTICLE IV Examination
and Registration
JOFRED M. MARTINEZ, RN,
M
NGARN
eview andTraining Center,
Inc.
Iloilo City, Philippines
• Responsibility is the obligation to perform duties, tasks
or roles using sound professional judgement and
being answerable for the decisions made in doing
this.
• Accountability is being able to give an account of
one’s nursing judgements, actions and omissions.
Accountability is about maintaining competency and
safeguarding quality patient care outcomes and
standards of the profession, while being answerable
to those who are affected by one’s nursing practice.
ACCOUNTABILITY TOTHE
•CLIENT
The foremost accountability of the nurse is to the client.
You hold yourself out to the client as someone havingthe
special knowledge, training and skills associated with
nursing.
ACCOUNTABILITY TOTHE EMPLOYER
• As anemployee you have the responsibility to work within
the scope of employment as defined by the employer.
• You are responsible to know your terms of employment, and
to work within those terms.
ACCOUNTABILITY TOTHE
•PROFESSI ONyou are accountable to meet the standards
As a nurse
of your profession. These standards may be
contained in the nursing Act itself or in Regulations
accompanying that Act.
NURSING
JURISPRUDENCE
NURSING
LEGISLATION
LA
W
TYPES OF LAW ACCORDING
TO SOURCE OF AUTHORITY
 Divine Law – laws
authored by God
 Human Law – laws
authored by men
TYPES OF HUMAN
LAW
PRIVATE OR CIVIL LAW
PUBLIC
LAW
PUBLIC LAW– department of law which is
concerned with the state in its political or
sovereign capacity. It is a law that applies
generally to people of the state adopting or
enacting it.
 Criminal Law – treats the nature, extent
and degree of every crime and adjusts to
it the adequate and necessary penalty.
 International Law – the law which regulates
the intercourse of nations
• Public International Law – control the
conduct of independent state in their
relation to each other.
• Private International Law – conflict law
 Political Law –Regulates the relation
between the state and individuals that
compose it.
• Constitutional Law - law that relates the
constitution, as a permanent system of
political and juridical government, as
distinguished from statutory and common
law, which relate to matters subordinate
to such constitution.
• Administrative Law – the body of rules and
regulations and orders and decisions
created by administrative agencies of
government.
• Law of Public Administration
• Law of Public Corporation
 Private Law – law that relates the private
matters which do not concern the public
at large
• Civil Law – organizing the family
and regulating property.
• Commercial Law – relates to the rights
of property and the relations of
persons engaged in commerce.
• Remedial Law – methods of enforcing
rights or obtaining redress (correcting the
wrong)
THE GOODSAMARITAN LAW
 Anurse, therefore, who renders first aid or
treatment at the scene of an emergency and
who doesso within the standard of care,
acting in good faith, is relieved of the
consequences of the act.
LAWSUI
T
PARTIES TOA
CASE
 Complainant VS Defendant: CIVIL CASE
 PlaintiffVS Accused: CRIMINAL
CASE WITNESS
 an individual held upon to give necessary details
either for the accused or against the accused
STATUTE OF
LI
MRefers
ITATIOto
NSthe lengthof time
following the event during
which the plaintiffmay file a
suit.
DUE PROCESS
 Afair and orderly process
which aims toprotect and
enforce a person’s right.
FUNDAMENTAL REQUIREMENTS OF DUE
PROCESS
1. Right to be informed
2. Right to remain silent
3. Right to competent counsel
4. No use of violence, threat, torture
5. Right to know the witnessface to
face
PHASES OF DUE
PROCESS
 PRE-TRIAL - eliminate
matters not in dispute,
agree on issues or settle
procedural matters.
 TRIAL - facts are presented
and determined; law
applied at the end.
WRITTEN ORDERS OF
COURTlegal notes from court
WRIT-
SUBPOENA - an order in
court
 Duces tecum (papers) bring
documents, objects,
materials, chart to court
 Ad testificandum (person)
testify as witness at a
specified time and place
WRITTEN ORDERS OF
C
OS
UURM
TMON - a writ commanding an authorized
person to notify a partyto appear in court to
answer a complaint made against him.
 WARRANT - a writing from a competent authority
in pursuance of law, directing the doing of an act
addressed to a person competent to do it
TYPES OF
W
AWarrant
RRANT ofarrest - a court order
to arrest or detain a person
 Search warrant - a court order
to search for properties
LEGAL CONCEPTS AND ISSUES IN NURSING
 LIABILITY: is an obligation or debt that can be
enforced by law. A person who is liable for
malpractice is usually required to pay for damages.
 DAMAGES: refers to compensation in
money recoverable for a loss of damage.
NEGLIGENCE – failure to do
something which a reasonable
and prudent person should have
done.
Types of negligence
• Commission – wrong doing
• Omission – total neglectof care
–
didn’t do anything
ELEMENTS OF NEGLIGENCE
 Existence of aduty on the partof the person
charged to use due care under circumstances
 Failure to meet the standard of due care
 The foreseeability of harm resulting from failure
to meet the standard
 The fact that the breach of this standard resulted in
an injury to the plaintiff
• One shall act with justice,
give every man his due,
observe honesty and good
faith.
- Civil Code, Article 19
• Those who, in the performance
of their obligations through
negligence cause any injury to
another, are liable for damages.
- Civil Code, Article 19
TYPES OF NEGLIGENCE
As a crime (culpa criminal)
 Felony committed by culpa or
fault due to imprudence, lack of
foresight, lack of skills,
negligence
As torts (culpa contractual)
 Negligence – malfeasance,
misfeasance, non-
 Malfeasance – performance of an act which ought
not to be done
 Misfeasance – improper performance of some
act which might lawfully be done
 Nonfeasance – omission of some act which ought
to be performed
TYPES OF NEGLIGENCE
As quasi-delict (culpa aquiliana)
 No pre-existing contractual
relations
 Negligence, lack of due care
EXAMPLES OF NEGLIGENCE
 Burns
 Objects left inside the patient’s body
 Falls of elderly
 Falls of children
 Failure to observe and take appropriate action
as needed
SPECIFIC EXAMPLES OF NEGLIGENCE
 Failure to report observationsto attending
physicians
 Failure to exercise the degree of diligence which
the circumstances of the particular case
demands
 Mistaken identity
 Wrong medicine, wrong concentration, wrong
route, wrong dose
“the thing speaks for itself”
• Doctrine that infers negligence from the very
nature of an accident or injury in the absence of
direct evidence on how any defendant behaved.
Elements
 The injury is of the kind that does not ordinarily
occur without negligence.
 The injury is caused by an agency or instrumentality
within the exclusivecontrol of the defendant.
 The injury-causing accident is not by any voluntary
action or contribution on the part of the plaintiff.
 The defendant's non-negligent explanation does not
completely explain plaintiff’s injury.
“let the master
• Doctrine thatanswer"
a party is responsible for (has
vicarious liability for) acts of their agents.
There arethree considerations generally:
• Was the act committed within the time and
space limits of the agency?
• Was the offense incidental to, or of the same
general nature as, the responsibilities the agent is
authorized to perform?
• Was the agentmotivated to any degree to benefit the
principal by committing the act?
“good father of a family"
• The employer is liable upon finding that he has
been negligent in the selection of his employees
(culpa in eligiendo) or in the supervisionof his
employees (culpa in vigilando).
Frolic and Detour
• Detour occurs when anemployee or agent makes
a minor departure from his employer's charge.
• Frolic is amajor departure when the employee is
acting on his own and for his own benefit, rather
thana minor sidetrack in the course of obeying an
order from the employer.
"He who acts through another does the act himself."
• The master is obliged to perform the duties by
employing servants, he is responsible for their act
in the same way that he is responsible for his
own acts.
"superior
force"
• Essentially frees both parties from liability or obligation
when an extraordinary event or circumstance beyond the
control of the parties, such as a war, strike, riot, crime, or
an event described by the legal term act of God (hurricane,
flood, earthquake, volcanic eruption, etc.), prevents one or
both parties from fulfilling their obligations under the
contract.
EXAMPLES OF MALPRACTICE
• Anesthesia related
complications
• Failure to follow
advance directive
• Failure of hospital or pharmacy
to dispense the right
medicine, dosage
Legal defense in negligence
• Nurses should know and attain that standard of care
in giving service and that they have documented the
care they give in a concise and accurate manner
• If the patient’s careless conduct contributes to his own
injury, the patient cannot bring suit against the nurse.
MALPRACTICE
• Acts or conducts that are not
authorizedor licensed or
competent or skilled to
perform, resulting to injuries
or non- injurious
consequences
• Negligent act committed in the
course of professional
performance
ELEMENTS OF MALPRACTICE
• Duty of the nurse
• Dereliction or breach of
duty
• Direct result (injury or
harm)
• Damages
• Exceeds the limits of
the standards of care
• Foreseeability of harm
• Misdiagnosis of an illness,
failure to diagnose or relay
diagnosis
• Birth Injuries
• Surgical Complications
• Prescription errors
• Failure toprovide treatment
• Anesthesia related
complications
• Failure to follow
advance directive
• Failure of hospital or pharmacy
to dispense the right
medicine, dosage
INCOMPETENCE
 Is the lack of ability, legal qualifications or fitness
to discharge the required duty
 Although a nurse is registered, if in the performance
of her dutyshe manifests incompetency, there is
ground for revocationor suspension of her certificate
of registration
Liability of nurses for the work of unlicensed assistive
personnel
• Unlicensed assistive personnel (UAP) are unlicensed
health care providers trained to function in a
supportive role by providing patient/client care
activities as delegated by the RN.
• The term includes, but is not limited to nurse
aides, orderlies, assistants, attendants, or
technicians.
Liability of nurses for the work of unlicensed assistive
personnel
• Nursing aides perform selected nursing activities
under the direct supervisionof nurses.
• Their responsibilities usually pertains to the
routine care of chronically ill patients. They are
therefore responsible for their own actions.
Five Rights of Delegation:
• Right Task: The task is appropriate for delegation;
• Right Circumstances: The appropriateness of the
patient setting, available resources, and other
relevant factors are considered;
• Right Person: The right person is delegating the
right task to the right person to be performed on
the right person;
Five Rights of Delegation:
• Right Direction/Communication: Aclear, concise
description of the task, including its objective,
limits and expectations is given; and
• Right Supervision: Appropriate monitoring,
evaluation, intervention, and feedbackare provided
(NCSBN, 1995).
Responsibilities and duties of a
U
•APs ng, documentingand reporting clinical and treatment
Observi
information, including patients' behavioral changes
• Assisting with motion exercises and other
rehabilitative measures
• Takingand recording blood pressure, temperature, pulse,
respiration, and body weight
• Assisting with ambulation and mobilization of patients
Responsibilities and duties of a
U
•APs
Collecting specimens for requiredmedical tests
• Providing emotional and support services to patients,
their families and other caregivers
• Assisting with personal hygiene
• Assisting with meal preparation, grocery shopping,
dietary planning, and food and fluid intake.
LIABILITY OF NURSES FORTHE WORK OF NURSING
STUENTS
• Under R.A. 9173, nursing students do not
perform professional nursing duties.
• Nursingstudents should be under supervisionof their
clinical instructors in order that the errors committed
by nursing students will be avoided or minimized.
• They should be given assignments that are their level
of training experience and competency.
LIABILITY FORTHE WORK OF NURSING STUDENTS
• They should be advised to seek guidance if they
areperforming a procedure for the first time.
• They should be oriented to the policies where they
are assigned.
• Their performance should be assessed frequently
to determine their strength and weaknesses.
• R.A. 6675 states thatonly validly registered
medical, dental, and veterinary practitioners are
authorizedto prescribe drugs.
• All government health agencies shall use generic
terminology or generic names in all transactions
related to purchasing, prescribing, dispensing and
administeringof drugs and medicines.
Generics Act of 1988
• Drug outlets, including drugstores, hospital and non-
hospital pharmacies and non-traditional outlets such
as supermarkets and stores, shall inform any buyer
about any and all other drug products havingthe
same generic name, together with their corresponding
prices so that the buyer may adequately exercise, his
option. Generics Act of
1988
In accordance with R.A. 5921, all prescriptions must
contain the following information:
• name of the prescriber
• office address
• professional registration number
• professional tax receipt number
• patient’s/client’s name, age, and sex, and date of
prescription. Pharmacy Law
Role of the nurse in drug administration
• The nurse is also responsible for ensuring that they
have the knowledge to ensure the correct
administrationof drugs. This includes pharmacology,
anatomy and physiology, and legal issues.
• Medication charts are legal documents and must
be completed accurately and unambiguously in
order to ensure that patients receive safe and
optimal drug therapy.
Role of the nurse in drug administration
• The nurse is also responsible for ensuring that they
have the knowledge to ensure the correct
administrationof drugs. This includes pharmacology,
anatomy and physiology, and legal issues.
• Medication charts are legal documents and must
be completed accurately and unambiguously in
order to ensure that patients receive safe and
optimal drug therapy.
 Philippine Nursing Act of 1991 Section 28 states that in
the administration of intravenous injection, special
training shall be required according to protocol
established
 Board of Nursing Resolution No. 8 states that without
such training and who administers intravenous
injections to patients shall be held liable either
criminally under Sec 30 Art. VII of said law or
administratively under sec 21 Art III or both (whether
causing or not an injury or death to the patient)
SCOPE OF DUTIES ANDRESPONSIBLITIES IN IV THERAPY
 Interpretation of the doctor’s orders for IV therapy
 Performance ofvenipuncture, insertion of
needles, cannulas except TPN and cut down
 Preparation, administration, monitoring and
termination of intravenous solutions such as additives,
intravenous medications, and intravenous push
 Administration of blood/blood products as ordered by
the physicians
 Recognition of solutions and medicine incompatibilities
 Maintenance and replacement of sites, tubing,
dressings, in accordance with established procedures
 Establishment of flow rates of solutions, medicines,
blood and blood components
 Utilization of thorough knowledge and proficient
technical ability in the use/care, maintenance, and
evaluation of intravenous equipment
 Nursing management of total parenteral nutrition,
out- patient intravenous care
 Maintenance of established infection control and
aseptic nursing interventions
 Maintenance of appropriate documentation,
associated with the preparation, administration and
termination of all forms of intravenous therapy.
 Doctors should limit telephone orders to extreme
emergency where there is no alternative. Nurse should
read back such order to the physician to make certain
the order has been correctly written.
 Such order should be signed by the physician within
24 hours
 The nurse should sign the physician’s name per her
own
and note the time and order was received
 Created as a means of
communication among health care
practitioners.
 Serve two important functions:
to provide legal documentation,
and obtain third party payments
(e.g. health insurance)
 If information is not charted, it
was not done or observed
• Supplies rich material for medical and nursing
research
• Serves as a legal protection for the hospital, doctor,
and nurse by reflecting the disease or condition of
the patient and his management.
• “if it was not charted, it was not observed or done”
• Nurses are expected to record fully, accurately,
legibly and promptly their observations from
admission to the time of the patient’s discharge.
• Nurses are legally and ethically bound to protect the
patient’s chart from unauthorized person.
CHARTING DONE BY STUDENT NURSES
• When a nurse or clinical instructor counter signs the
charting of the nursing student,he/she has personal
knowledge of information and that such is accurate
and authentic.
• Anyone who countersignswithout verification
commits herself to possible legal risks.
• It is an administrative report that
is required of nurses if there are
violations of standards and
policies whether or not injury
occurs.
• Through incident reports,hospital
administration can monitor
quality of patient care and
institute some measures to
prevent similar incidents in the
future.
• Keep statements factual,
objective, do not draw
conclusions
• Do not mention incident report
in charting
• May or may not be allowed
into court
Remember that patients who feel that doctors and
nurses have done their best are not as likely to sue as
a patient who feels ignored or neglected.
A little kindness goes along way!
• CONSENT - a “ free and rational actthat presupposes
knowledge of the thing to which consent is being given by
a person who is legally capable to give consent”
• NATURE OF CONSENT - an authorization by the patient or
a person authorized by the law to give the consent on
the patient’s behalf.
• INFORMED CONSENT – a written consent should be signed
to show that the procedure is the one consented to and
that the person understands the nature of the procedure
Essential elements of informed
consent
• The diagnosis and explanation of the condition
• Afair explanation of the procedures to be done and
used and the consequences
• Adescription of alternative treatments or procedures
• Adescription of the benefits to be expected
• Material rights
• The prognosis, the recommended care, procedure is
refused
The nurse’s responsibility in witnessing the giving of
informed
consent involves:
• witnessing the exchange between the client and
the physician
• witnessing the client affix his signature
• establishing that the client really understood.
Who must
consent
? age
• Legal
• Patient must consent in his own behalf
• If he is incompetent, or physically unable, and is not in
emergency case, consent must betaken from another
who is authorizedto give it in his own behalf.
Consent of
•minParents
ors or someone standing in their behalf, gives
the consent to medical or surgical treatment of a
minor.
• Parental consent is not needed if the patient is married
or emancipated
Consent of mentaly
ill
• Amentally incompetentperson cannot legally consent
to medical or surgical treatment.
• The consent must betaken from parents or legal
guardian.
Mental competency
• All patients are presumed to be competent
unless declared incompetent by a court of law.
• Supporting documentation of the patient’s behaviors,
speech, decision making and physical and mental
status are very useful in establishing his/her mental
competency
Emergency situation
• No consent is necessary because inaction at such
time may cause greater injury.
• If time is available and an informed consent is
possible, it is best that this be taken toprotect all the
parties concerned.
Refusal to consent
• Apatient who is mentally and legally competent has
the right torefuse thetouching of his body or to
submit to a medical or surgical procedure no matter
how necessary, nor how imminent the danger to his
life or health if he fails to submit to treatment.
Consent for
•steriSterilization
lization is the termination of the ability to
produce offspring.
• The husband and the wife must consent to the
procedure if the operation is primarily to accomplish
sterilization.
• If emergency cases like ectopic pregnancy and
abruptio placentae, consent from patient is
sufficient.
 The nurse shouldexercise
reasonable care in selecting
equipment to beused in
patients.
 Generally, a nurse is not liable for
a non-observable and non-
discoverable defect in the
equipment.
Contract
• Is ameeting of minds between two
persons where they bind themselves
to give something or to render some
services.
• Anything could be subjected to a
contract as long as these are not
contrary to law, morals, good customs,
public order and public policy.
Kinds of contract
• Formal Contracts - refers to an agreement b/w
parties and is required to be in writing e.g.marriage
contracts
• Informal Contracts - one in which concluded as the
result of a written document where the law does
not require the same to be in writing.
• Express Contracts - The one in which the
conditions and terms of contract are given orally or
in writing by the parties concerned.
Kinds of contract
• Implied Contracts - one that is concluded as a result
of acts of conduct of the parties to which the law
ascribes an objective intentions to enter into a
contract.
• Voidcontracts - one that is inexistent from the very
beginning and therefore may notbe enforced.
• Illegal contracts - one that is expressly prohibited
by law
Illegal contracts
• Those that are made in protection of the law
• Consent obtained by fraud
• Those obtained under duress
• Those obtained under undue influence
• Those obtained through material
misrepresentation
Wills
• It is a legal declaration of a person’s intentions
upon
death.
• DECEDENT - a person whose property is transmitted
through succession whether or not he left a will. If he
left a will he is called a TESTATOR. If a woman
TESTATRIX
• HOLOGRAPHIC WILL - a will that is written and
signed by the testator
Wills
• HEIR is a person called tosuccession either by
the provision of a will or by operation of law
• There should bea witness who knows the
handwriting and signature of the testator explicitly
declares that the will and the signature are in the
handwriting of the testator
Nurse’s obligation in the execution of a will
• The nurse should note the soundness of the patient’s
mind and that there was free from fraud or undue
influence and that the patient was above 18 years or
of age .
• The patient should write that the will was signed by
the testator, that the witnesses were all present at
the same time and signed the will I the presence of
the testator
Living will
• Is an individual’s signed request to be allowed to
die when life can be supported onlymechanically
or by heroic measures.
• It alsoincludes the decision to acceptor refuse any
treatment, service or procedure used to diagnose
or treat his/her physical or mental condition and
decisions to provide
Advance directive & health care proxy
• The patient designates a health care representative,
usually a member of the family, a friend or a family
physician to make decisions for him/her when
he/she is unable, due to physical or mental
incapacity, acceptor refuse treatment, service or
procedure used to diagnose or treat his/her
physical or mental condition and decisions to
provide, withhold or withdraw life sustaining
measures
Important points
• Anurse especially those taking care of well-to-do
patients should remember that the main requisite
for making a will is testamentary capacity or sanity.
• The person who makes a will should at least be
18 years old and is not prohibited by law.
• The will is written and should be witnessed by
three credible witnesses, unless it is holographic
will.
Important points
• Aholographic will is one that is entirely written,
dated and signed by hand.
• There is no legal reason for the nurse torefuse
to witness the preparation of a will.
• Alegal wrong, committed against a
person or property independent
of a contract which rendersthe
person who commits it liable for
damages in a civil action.
• Aperson who has been wronged
seeks compensation for the injury
or wrong he has suffered from the
wrong doer.
Examples of tort
ASSAULT AND
BATTERY
• Assault is a unjustifiable attempt to touch
another person or even the threat of doing so.
• Battery is the actual carrying out of the
threatened physical contact
DEFAMATION OF CHARACTER occurs where a
person discusses another individual in terms that
diminish reputation.
Defamation of character
 Slander – oral defamation of a person by speaking
unprivileged or false words by which his reputation
is damaged.
 Libel – defamation by written words, cartoons or
such representations that cause a person to be
avoided, ridiculed or held in contempt or tend to
injure him in his work.
• It is making someone
wrongfully feel that he or
she cannot leave the place.
• The unjustifiable detention of
a person without a legal
warrant within boundaries
fixed by the defendant by an
act or violation of duty
intended to result in such
confinement.
• Restraints should be used with caution and
discretion.
• All patients should have the right to independence
and freedom of movement.
• Restraintsrequire a physician’s order.
• If a patient or his legal guardian refusesto be
restrained, this should be documented in the patient’s
medical record.
• The right to privacy is the right to be left alone,
the right to be free from unwarranted publicity
and
exposure to public view as well as the right to live one’s
life without havinganyone’s name, picture or private
affairs made public against one’s will.
• Nurses may become liable for invasion of right to
privacy if they divulge information from a
patient’s chart to improper sources or
unauthorized persons
CRIME - act committed or omitted in violation of the
law.
Criminal offenses are composed of two elements:
1. Criminal Act
2. Evil/criminal intent
Aconspiracy to commit a crime exists when two or
more persons agree to commit a felony and decide to
do it.
Conspiracy to commit a crime
• Principals - are those who take a direct part in
the execution of the act, who directly force or
induce others to commit it; or who cooperate
in the commission of the offense by another act
without which it would not havebeen
accomplished.
• Accomplices - are those who, not being principals,
cooperate in the execution of the offense by
previous and simultaneous act.
Conspiracy to commit a crime
• Accessories - are those who, havingthe knowledge of
the commission of the crime. Assisting the offender
to profit from thecrime either by disposing the body,
concealing or assisting in escape of the principal of
the crime.
Criminal actions
• Misdemeanor - a general name for criminal
offense which does not in law amount to felony.
• Felony - a public offense for which a convicted
person is liable to be sentenced to death or be
imprisoned in a penitentiary or prison. It is
committed with deceit and fault.
Criminal negligence
 Reckless Imprudence - when a person does an act
or fails to do involuntary without malice, from
which damage results immediately.
 Simple Imprudence - means that the person or
nurse did not use precaution and the damage was
not immediate or the impending danger was not
evident or manifest.
Criminal intent
 Is the stateof mind of a person at the time the
criminal act is committed, that is, he/she knows that
an act is lawful and still decided to do it anyway.
 Deliberate intent includes two other elements
without which there can be no crime. These are
freedom and intelligence.
Criminal intent
 When a person accused of thecrime offers evidence
showing insanity, necessity, compulsion, accident, or
infancy the court will decide if he did not commit a
criminal offense and will declare the personnot
guilty.
Classes of
felonies
• Consummated - when all the elements necessary for
its execution and accomplishment are present.
• Frustrated - when the offender performs all the acts or
execution which will produce the felony as a
consequence butwhich nevertheless, do not produce it
by reason of causes independent of the will of the
perpetrator.
• Attempted - when the offender commences the commission
of the same directly by overt acts, and does not perform the
acts which shall produce the felony.
Felonies according to degree of punishment
• Grave Felonies - are those to which the law attaches the
capital punishment or penalties which in any of their
periods are afflictive. (imprisonment ranging from 6 yrs
and 1 day with fine not exceeding P6,000)
• Less Grave Felonies - are those which the law punishes
with penalties which in their maximum period are
correctional (imprisonment ranging from 1 month and 1
day to 6 yrs or fine not exceeding 6,000 but not below
200)
Felonies according to degree of punishment
• Light Felonies - are those infractions of law for the
commission of which the penalty of “arresto
menor” (imprisonment for 1 day to 30 days or a
fine notexceeding 200 or both of which are
imposed)
JUSTIFYING CIRCUMSTANCES
• These are thedefenses in which the accused is
deemed to have acted in accordance with the law
and therefore the act is lawful.
Circumstances which exempts a person from criminal
liability:
• There is no mens rea or criminal intent
• The circumstances pertain to the act and not to the
actor. Hence all who participated in the act will
be benefited. Thus if the principal is acquitted
there will be no accomplices and accessories.
liability:
• These apply only to intentional felonies, not to acts
by omissions or to culpable felonies or to violations
of special laws
• When he acts in defense of his rights
• When he acts in defense of his relatives rights
liability:
• When he acts in defense of a strangers rights and that
the person defending is not induced by revenge or
evil motives.
• When any person who, in order to avoid an injury
does an act which causes damage to another
provided that an evil sought to be avoided actually
exists.
liability:
• When he acts in the fulfillment of aduty or in
lawful exercise of a right or office.
EXEMPTING CIRCUMSTANCES
• These are defenses where the accused committed
a crime but is not criminally liable.
• There is a crime, and there is civil liability but
no criminal.
liability:
• The basis is the lack of any of the elements
which makes the act/omission voluntary, i.e.
freedom, intelligence, intent or due care.
• They apply to both intentional and culpable felonies
and they may be available in violations of special
laws.
liability:
• These defenses pertain to the actor and not the
act.
• They are personal to the accused in whom they are
present and the effects do not extend to theother
participants. Thus if a principal is acquitted, the
other principals, accessories and accomplices are
still liable.
liability:
• An imbecile or an insane person, unless the latter
has acted during a lucid interval
• Apersonunder nine years of age
• Aperson over nine years of age and under
fifteen unless he acted with discernment.
MITIGATING CIRCUMSTANCES
• Are those which do not constitute justification or
excuse of the offense in question, but which, in
fairness and mercy, may be considered as
extenuating or reducing the degree of moral
culpability.
There are certain circumstances under which the law
exempts a person from criminal liability:
• Circumstances which are otherwise justifying or
exempting were it not for the fact that all
requisites necessary to justify the act or to exempt
the offender from criminal liability in the
respective cases are not attendant
liability:
• When the offender has no intention to commit
so gravea wrong as the one committed
• When the offender is under eighteen years of age
or over 70 years old
• When sufficient provocation or threat on the part of
the offended party immediately precedes the act
• When the act is committed in the immediate vindication of a
grave offense to the one committing the felony, his/her
spouse, ascendants, descendants, legitimate, natural or
adopted brothers, or relative by affinity within the same
degree
liability:
• When a person acts upon an impulse so powerful
as naturally to have produced an obfuscation
• When the offender voluntarily surrenders himself to a
person in authority or confesses before the court
prior to the presentation of the evidence for the
prosecution
• When the defender is deaf and dumb, blind
Lack of education is not mitigating
in:
 Rape
 Forcible abduction
 Arson
 Treason
Lack of education is not mitigating in:
 In crimes against chastity like seduction and acts
of lasciviousness
 Those acts committed in a merciless or
heinous manner
AGGRAVATING CIRCUMSTANCES
• Are those attending the commission of a crime and
which increase the criminal liability of the offender or
make his guilt more severe.
• When the offender takes advantage of his public
position
• When the crime is committed in contempt of or with
insult to public authorities
liability:
• When the act is committed with insult or disregard
of the respect of theoffended party on account of
his rank, age, sex
• When the act is committed with abuse or
confidence or obvious ungratefulness
• When a crime is committed in a place of worship
Circumstances which exempts a person from criminal liability:
• When the crime is committed on the occasion of a
conflagration, shipwreck, earthquake, epidemicor
other calamity or misfortune
• When the crime is committed in consideration of a
price, reward or promise
• When the crime is committed by means of inundation,
fire, poison, explosion, standings of a vessel or
intentional damage
liability:
• When the act is committed with evident
premeditation or after unlawful entry
• When craft, fraud, or disguise is employed when
the wrong done in the commission of thecrime is
deliberately augmented by causing other wrongs
not necessary for its commission
ALTERNATIVE CIRCUMSTANCES
• Those which may either be appreciated as
mitigating or aggravating according to the nature
and effects of thecrime and other conditions
attending its commission.
• Is an act of baseness,
vileness or depravity in
social or private duties
which a man owes to his
fellow man or to society in
general, an act contrary to
the accepted and customary
rule of right and duty
between men
MURDER
• Is the unlawful killing of a
human being with intent to
kill. It is a very serious
crime.
• Nurses should keep in
mind that death resulting
from a criminal abortion is
murder.
• Euthanasia is also
HOMICIDE
• Is the killing of a human being in another.
• It may be committed without criminal intent, by
any person whom kills another, other than his
father, mother, or child or any of his ascendants
or descendants, or his spouse, without any of the
circumstances attendant the crime of murder
enumeratedabove being present.
ABORTION
• Is illegal according to the
revised penalcode. The
patient should assume
responsibility for her
abortion.
• She should be made to sign
a statement relieving the
hospital and its personnel
from liability
• INFANTICIDE - Is the killing of a child less than three days
of age. The mother of the child who commits this crime
shall suffer penalty of imprisonment ranging from two
years and four months and 1 day to 6 years
• PARRICIDE - is a crime committed by one who kills her/his
father, mother or child whether legitimate or illegitimate,
or any of his/her ascendants or descendants or his/her
spouse.
• ROBBERY - is a crime against a person or property
• R.A. 6425 known as the Dangerous Drug Act of 1972
covers the administration and regulation of the
manufacture, distribution, dispensingof controlled
drugs.
• Persons authorizedto prescribe or dispense these drugs
are required to register and have a special license for this
purpose
• Affidavit - is a written statement made under oath
before a notary public or other person duly
authorized
• Contempt of Court - is the willful disobedience to,
or open disrespect for, the rules of court
• Defendant - the person being accused of a
wrongdoing;the therefore needs to defend
themselves
• Day in court - the right of a person to appear in
court and beheard concerning his
• Due process - is fair and orderly process which aims to
protect
and enforce a person’s rights
• False Testimony - is punishable both criminal and civil law
• Hearsay Evidence - is evidence that is derived from
something the witness heard from others
• Inquest - is the legal inquiryinto the cause or manner of a
death
• Perjury - is the willful telling of a lie under oath
• Plaintiff- the person who files the lawsuit and is seeking
for a perceived wrongdoing
• Prima facie Evidence - evidence, which if unexplained
or uncontradicted would establish the fact alleged
• Privileged Communication - statements uttered in
good faith. These are not permittedto be divulged in
court justice.
• Statute of Limitations - define the lengthof time
following the event during which the plaintiffmay file
the lawsuit
• Subpoena - is an order that requires a person to attend
at a specific time and place to testify as witness
• Subpoena Duces Tecum - is a subpoena that requires a
witness to bring required papers/ documents and the
like which may be in his possession
• Summons - is a writ commanding an authorized person
to notify a partyto appear in court to answer a
complaint made against them
• Warrant - is writing from a competent authority in
pursuance of law, directing the doing of an act,
and addressed to a person competent to do it
• Subpoena Duces Tecum - is a subpoena that requires a
witness to bring required papers/ documents and the
like which may be in his possession
• Summons - is a writ commanding an authorized person
to notify a partyto appear in court to answer a
complaint made against them
• Warrant - is writing from a competent authority in
pursuance of law, directing the doing of an act,
and addressed to a person competent to do it
 Be very familiar with the Philippine Nursing Law
 Beware of laws that affect nursing practice
 At the start of employment, get a copy of your
job description, the agency’s rules, regulations
and policies
 Upgrade your skills and competence
 Accept only such responsibility that is within the
scope of your employment and your job
description
 Do not delegate your responsibility to others
 Determinewhether your subordinates are
competent in the work are assigning them
 Develop good interpersonal relationships with your
co- workers, whether theybe your supervisors, peers,
orsubordinates
 Consult your superiors for problems that may be
too big for you to handle
 Verify orders that are not clear to you or those
that seem to be erroneous
 The doctors should be informed about the
patient’s
condition
 Keep in mind the value and necessityof
keepingaccurate and adequate records
 Patients are entitled to an informed consent
Republic Act No. 2493dated February 5, 1915 – The first
law affecting the practice of nursing in the Philippines.
a. Sec. 7 – states that everyperson desiring to practice nursing in
the Philippines shall apply to the Director of Health for a
Certificate of registration as a nurse.
b. Sec. 8 – states that it shall be unlawful for any person to
practice as a nurse in any of its branches in the Phil. until the
proper certificate of registration has been obtained.
c. This is also an actthat provides for the examination
and registration of nurses in the Philippines.
Republic Act No. 2808 dated March 1, 1919 – an act
regulating the practice of nursing profession in the
Philippines otherwise known as theNursing Law.
Significance of this Law
 The first board of examinees for nurses was created
composed of three members appointed by the Secretary
of Interior (one doctor of medicine as chairman and two
memberswho are registered nurses, had experience in
the nursingprofession for at least five years of reputable
character)
The Board has the following powers:
1. Issue andrevoke certificates of registration forpractitioners
of the nursing profession.
2. Study the conditions affecting the practice of the
nursing profession in all parts of the Philippines.
3. Exercise the power conferred by the law to maintain
efficient, ethical and technical standards in nursing
profession.
4. Promulgate regulations governing the nurse examination
and standards to be attained.
 Republic Act No. 4007dated December 5, 1931
(Reorganization Law) – took effect the conduct of board
examination and placed the direct supervisionof the
Bureau of Civil Service.
 RA 465 – standardizedthe fees charge by the
examining board.
 RA 546 – reorganized and placed all the board
examinees under the direct supervisionof the Pres. of
the Phil.
 RA 877dated June 19, 1953 – was enactedas an entirely
new law created by the Filipino Nurses Associated (now
PNA) namely: Ms. Obdulia Kabigting as chairman; Dean JV
Sutejo and Conchita Ruiz. The act was sponsored by Sen.
Geronima Pecson.
 The purpose is to “regulate the practice of nursing in the
Philippines and to set up provisions for the registration of
the nurses for the establishment and maintenance of
standards of nursing education and practice.”
 RA 1080dated June 15, 1954 – An act declaring the BAR
and
BOARDOF EXAMINATION as “Civil Service Examination”
 RA 9173 October 21, 2002 – an actproviding for a more
responsive nursingprofession repealing for the purpose RA
# 7164, otherwise known as the Philippine Nursing Act of
1991.
THE PHILIPPINE NURSING ACT OF
2002
1. Title of the law and its provision (Article I)
2. Declaration of Policy (Article II)
3. Organization of the Board of Nursing (Article III)
4. Examination and Registration (Article IV)
5. Nursing Education (Article V)
6. Nursing Practice (Article VI)
7. Health Human Resources Production, Utilization
and Development (Article VII)
8. Penal and Miscellaneous Provisions (Article VIII)
• The2002
Board is now composed of a Chairmanand six members
instead of a Chairmanand four members
• Submission of names of qualified nominees by the Accredited
Professional Organization (APO) to the Commission, three
(3) nominees per vacancy, not later than three months
beforethe vacancy
• The Commission submits to the office of the President two
(2) nominees per vacancy not later than two months before
the vacancy occurs. The appointment must be issued not
later than thirty (30) days beforescheduled licensure
examination.
2002 BOARD OF
NURSING
CARMELITA C. GLORIA B.
DIVINAGRACIA ARCOS
OIC – Board of Nursing Member
2002 BOARD OF
NURSING
CORA A. CARFREDDA P.
AÑONUEVO DUMLAO
Member Member
2002 BOARD OF
NURSING
GLENDA S. FLORENCE C.
ARQUIZA CAWAON
Member Member
• 2002cations of Board Members
Qualifi
 Educational requirement for members of the Board
is not
limited to registered nurses with Master’s degree in
nursing but also to registered nurses withmaster’s
degrees in education, or other allied medicalprofession
provided that the Chairperson and majority of the
members are holders of a Master’s degree in nursing
 Of the ten years of continuous practice of the profession
prior to appointment, the lastfive (5) years must be in
the Philippines.
2002
• Added the powers and duties of the Board
 Adopt and regulate a Code of Ethics and Code of
Technical Standards for the practice of nursing within
one year from the effectivity of this act.
 Recognize specialty organization in coordination
with accredited professional organization.
• Licensure Examination and Registration
 Specific dates of examination has been deleted
2002
Specific dates of examination – not earlier than one
(1) month and not later than2 months after the
closing of each semestral term.
 Specific age of applicants has been deleted
• Ratings
 Specific number of times an examinee may take
the licensure examination has been deleted
 Removal examination shall be taken within two (2)
years after the last failed examination
2002
• Revocati
on and Suspension of Certificate of Registration
 Implementing Rules and Regulations, Code of Ethics,
Code of Technical Standards, for Nursing Practice and
policies of the Board and of the Commission
 Sec. 28g for practicing the professionduring the period
of suspension
 Period of Suspension of the certificate of
registration/professional license not to exceed four
(4) years
• 2002
Nursi
ng Education
 Requirement for inactive nurses returning to practice –
Nurse who have not actively practiced the profession
shall undergo one (1) month of didactic training and
three (3) months of practicum
 Qualifications ofFaculty – Requirement of clinical
experience in a field of specialization has been
reduced from three (3) years to one (1) year in a
field of specialization
• 2002
Nursi
ng Education
 The Dean of the College of Nursing must have at least
five
(5) years of experience in teaching and supervising
a nursing education program.
• Nursing Practice
 Scope of Nursing – Duties and responsibilities
of the Nurse
 Special training for intravenous injections but Nursing
Service Administrators still require formal training for the
safety of the patient and the protection of the nurse and
of the institution.
• 2002
Nursi
ng Practice
 Special training for suturing the Lacerated perineum
Note:This is being undertaken by the Association of Nursing Service Administrators of
the
Philippines (ANSAP)with the Maternal and Child Association of the Philippines
(MCNAP)
 Observe the Code of Ethics and the Code of
Technical Standards to maintain competence
through continual professional education
 Health human resource production and Utilization
The minimum base pay of nurses working in the public health institutions shall notbe
lower than salary grade 15.
• 2002 ve Nursing Specialty Program
Comprehensi
 The Board is mandated to formulate and develop a
comprehensive nursing specialty program that would
upgrade the level of skills and competency of
specialty nurse clinicians in the country
 International Labor Organization Convention
149
 ILO Recommendation 1977
 International Councilof Nurses
 Philippine Nurses Association
 Code of Ethics for Nurses
 Magna Carta for Health Workers (RA 7305)
 Philippine Nursing Law
 Philippine Constitution
 Somera Case
 Maki v. Murray Hospital
 Ybarra v. Spanggard
 Ales v. Ryan et al
 Nicholson v. Sisters of Charity of
Providence
 Ratliffe v. Wesley Hospital
 Aderhold v. Bishop
 Borwege v. City of Owatonna
Several days prior to May 26, 1929, Pedro Clemente
took his daughter, Anastacia Clemente, to Dr. Gregorio
Favis at Manila. The latter decided to perform a
tonsilectomy and instructed the father and daughter to
go to St. Paul’s Hospital where he would perform the
operation at 7am on May 26, 1929.
Assisting Lorenza Somera, a Head Nurse, were student
nurses Valentina Andaya and Consolacion Montinola.
The assistant surgeon was Dr. Bartolome.
During the operation, Dr. Favis asked Dr. Bartholome for
Novocain solution. Ms. Montinola handed Dr. Bartolome
a syringe of solution which was handed in turnto Dr.
Favis who injected the same to the patient .After a few
minutes, Dr. Bartolome noticed that the patient was
becoming pale and acting as if dying. He called the
attention of Dr. Favis to this but the latter said it was
not unusual. Athird syringe of solution was injected
and a few minutes later, the patient died in a few
minutes.
Dr. Favis asked if the Novocain was fresh. Ms. Somera
replied that the solution was not Novocain but 10
cocaine. In court, Ms. Montinola testified sheheard Dr.
Favis order
cocaine with adrenalin for injection and heard Ms. Somera
to have verified the order. The autopsy report and
testimony of the Medico-legal Officer showed that the
patient was suffering from status lymphaticus and that
such patients were known to die even with so slight an
injury as a needle- prick.
Facts not brought in the trial were 1) that Ms. Somera.
Had finished her training only on May 20, 1929; 2) that
she had not received her registration certificate and
was not an experienced graduate as states in the
prosecution;
3) that Dr. Favis had performed tonsilectomy but
once previously in St. Paul’s and that no order from
Dr. Favis was given before his arrival.
The two accused doctors were absolved of the crime
but Lorenza Somera was condemned to suffer one year
and one day imprisonment and toindemnify the heirs
of Anastacia Clemente the sum of P1, 000.00 with
subsidiary imprisonment in case of insolvency and to
pay one-third of costs.
In view of the recommendation of two of the justices of
the supreme Court who reviewed the case upon the
appeal of the counsel fo the defense, the unanimous
recommendation of the Board of Pardons, and the
petition of the Philippine Nurses Association for
executive clemency.
Additional Info:
1. In 1929, in Manila, Lorenza Somera (a nurse), was
found guilty of manslaughter, sentenced to a year in
prison, and fined one thousand pesos forfollowing
a physician's orders.. She was found guilty because
when the doctor said cocaine insteadof procaine,
she did not question his orders.
2. Nursescannot just depend on what thedoctors say;
they have to know if what the doctor orders is
correct.
Additional Info:
3. Nurses have adopted the ethic of advocacy
for patients
4. Unfortunately hospitals don’t like having problems
called to the public's attention, and give the nurses
a very bad time about it.
• Pursuant to Section 3 of Republic Act No. 877, known as
the Philippine Nursing Law, and Section 6 of PD No.
233, the amended Code of Ethicsfor Nurses
recommended and endorsed by the Philippine Nurses
Association was adopted to govern the practice of nursing
in the Philippines.
• The Code was adoptedunder Republic Act 9173 and
promulgated by the Board of Nursing under Resolution
No. 220 Series of 2004 last July14, 2004.
Nurses have four fundamental responsibilities: to
promote health, to prevent illness, to restore health
and to alleviate suffering. The need for nursing is
universal.
Inherent in nursing is respect for human rights,
including cultural rights, the right to life and choice, to
dignity and to be treated with respect. Nursing care is
respectful of and unrestricted by considerations of age,
colour, creed, culture, disability or illness, gender,
sexual orientation, nationality, politics, race or social
status.
Nurses render health services to the individual, the
family and the community and co-ordinate their
services with those of related groups.
• The nurse’s primary professional responsibility is to
people requiring nursing care.
• The nurse promotes an environment in which the
human rights, values, customs and spiritual beliefs
of the individual, family and community are
respected.
• The nurse ensures that the individual receives
sufficient information on which to base consent for
care and related treatment.
• The nurse holds in confidence personal
information and uses judgment in sharing this
information.
• The nurse shares withsociety the responsibility for
initiating and supporting action to meet the health
and social needs of the public, in particular those of
vulnerable populations.
• The nurse also shares responsibility to sustain
and protect the natural environment from
depletion, pollution, degradation and
• The nurse carries personal responsibility and
accountability for nursing practice, and for
maintaining competence by continual learning.
• The nurse maintains a standard of personal health
such that the ability toprovide care is not
compromised.
• The nurse uses judgment regarding
individual competence when accepting and
delegating responsibility.
• The nurse at all times maintains standards of
personal conduct which reflect well on the
profession andenhance public confidence.
• The nurse, in providing care, ensures that use of
technology and scientific advances are compatible
with the safety, dignity and rights of people.
• The nurse assumes the major role in determining
and implementing acceptable standards of clinical
nursing practice, management, research and
education.
• The nurse is active in developing a core of
research- based professional knowledge.
• The nurse, acting through the professional
organization, participates in creating and maintaining
safe, equitable social and economic working
conditions in nursing.
• determining and implementing acceptable standards
of clinical nursing practice, management, research
and education.
• developing a core of research-based
professional knowledge.
• acting through the professional organization,
participates in creating and maintaining safe,
equitable social and economic working conditions in
nursing.
• The nurse sustains a co-operative relationship with
co- workers in nursing and other fields.
• The nurse takes appropriate action to safeguard
individuals, families and communities when their
health is endangered by a coworker or any other
person.
HOSPITAL OR INSTITUTIONAL
Nursi
•NURSINGng in hospital and related
health facilities such as
extended care facilities, nursing
homes and neighborhood
clinics, compromises the entire
basic component of
comprehensive patient care and
family health.
HOSPITAL OR INSTITUTIONAL NURSING
Qualifications of Nursing Service
Admi
Secti n9isoftrati
on 2 RAo9n
173 specifies that a person occupying supervisory or
managerial
positions requiring knowledge of nursing must:
• Be a registered nurse in the Philippines
• Have at least two (2) years of experience in general
nursing service administration
• Possess adegree of Bachelor ofScience in Nursing, with
at least nine (9) units in management and
administration courses at the graduate level; and
Qualifications of Nursing Service
Admi
Secti nisoftrati
on 29 RAo917
n 3 specifies that a person occupying supervisory or
managerial
positions requiring knowledge of nursing must:
• Be a member of good standing of the
accredited professional organization of nurses
Chief Nurse or Director of Nursing Service Shall
in addition to the foregoing qualification,
possess;
• At least five(5) years of experience in a supervisory
ormanagerial position in nursing
• Amaster’s a degree major in nursing
PUBLIC HEALTH NURSING OR
COMMUNITY HEALTH
NURSI
• TheNGfocus of nursing care is
only on family and community
health rather than on
individual basis.
• Here, the nurse will be able to
see the total picture of family
and community health.
PRIVATE DUTY NURSING
• Aprivate nurse is a registered
nurse who undertakes to give
comprehensive nursing care to
a client on a one on one ratio,
an independent contractor.
• The patient may be provided
care in the hospital or in the
home.
PRIVATE DUTY
NURSI
Pri NGnurse practitioner are grouped into two categories
vateduty
• General Private Duty Nurse - has the capability
for providing basic nursing care at any type of
patient
• Private Duty nurse specialist - foregoing abilities
expected of the general nurse practitioner and as
a result of his or her specialized preparation a
private nurse specialist
OCCUPATIONAL HEALTH
NURSING OR INDUSTRIAL
NURSING
• The practice focuses on
promotion, protection, and
supervisionof workers health
within the context of a safe
and healthy worker
environment.
NURSING EDUCATION
• Anurseeducator is a nurse who
teaches and prepares nurses
(RN) for entry into practice
positions.
• They can also teach in various
patient care settings toprovide
continuing educationto
licensed nursing staff.
NURSING
EDU
The CATIO
faculty N have academic preparation appropriate to his/her
shall
teaching assignment. In addition to being a Filipino citizen and having
good moral character, the following qualifications must be observed:
• Registered Nurse in the Philippines with
current/valid PRC ID
• Holder of Master’s degree in Nursing, Education or
other allied medical and health sciences conferred by
a college or university duly recognized by the CHED;
NURSING
EDU
The CATIOshall
College N be administered by a full-time dean with the following
qualifications:
• Filipino citizen;
• Registered Nurse in the Philippines with current
and valid PRC ID;
• Holder of Master’s degree in Nursing (MAN, MN,
MSN) conferred by a college or university duly
recognized by the CHED;
NURSING
EDU
The CATIOshall
qualifications:
• Has at least 1 year experience of clinical practice
and a total ofat least 5 years experience in teaching,
administration and supervisionof nursing
education;
• Physically and mentally fit;
• Of good moral character;
NURSING
EDU
The CATIOshall
qualifications:
• Has no other teaching assignments or administrative
functions in other public/private institutions or
higher education institutions;
• Member ofaccredited professional nursing
organization of good standing;
NURSING
EDU
The CATIOshall
qualifications:
• Upon appointment, he/she must be an active member
of good standing of the Association of Deans of
Philippine College of Nursing (ADPCN); and,
• Upon appointment, he/she should have a duly notarized
employment contract ofat least 1 academic year
renewable annually. The contract should specify the
academic rank.
NURSING
EDU
The CATIO
faculty N have academic preparation appropriate to his/her
shall
teaching assignment. In addition to being a Filipino citizen and having
good moral character, the following qualifications must be observed:
• At least one (1) year of clinical practice
• Amember of accredited professional
nursing organization of good standing.
MILITARY NURSING
• Military nurses are
healthcare professionals
who provide medical care to
patients in military clinics
and hospitals.
• Military nurses may serve in
the Army, the Navy or the
Air Force.
Military nursing qualifications
• Must have rank of 2nd lieutenant
• Have adequate knowledge of general nursing
theory and practice, including about biological,
social, and medical science and their application
• Knowledge on latest development in nursing field
• Performcomprehensive nursing care
Benefits and privilege of a military nurse
Highly salary rate and allowances according to rank:
• 2nd Lieutenant- initially receives the same base
pay as officers of equivalent ranks.
• Flight pay for flight nurses- 50of base pay
• Hazard pay- 20of base pay
• Cold weather clothing allowance
• Overseas pay
SCHOOL HEALTH NURSING
• Responsible for the school’s
activities in the areas of
health service, health
education and
environmental health and
safety.
Responsibilities of school health nurse
• Organizing and implementing the school
health programs
• Coordinatingschool health programs
• Undertaking functions directly related to
pupil’s health
• Evaluating school health programs
• Carrying out functions related to the healthof
school personnel.
CLINIC
•NURSI NGin this field must have
Nurse
excellent teaching and
communication skills, exhibit
organizational and leadership
ability, possess good
assessment skills, andhave
good insight in order to
anticipate and interpret the
needs of their patients.
ADVANCE PRACTICE
•NURSI
AnNG la term for nurses
umbrel
who have specialized education
and experience beyond the
basic nursing program. This field
covers the roles of the clinical
nurse specialist.
INDEPENDENT NURSING
PRACTICE
• Nurse is self-employed and
provides professional
nursing services to clients
and their families.
Predicted outcomes of the new role of nurses
as Independent Nurse Practitioner
• It will encourage professional nurses to extend their
capabilities and assume greater responsibilities for
designated areas of generalized nursing practice.
• The amount of health care will be more increased and
accessible to people.
• The nurse’s involvement in the client’s family or community
will
increase the nurse’s sensitivity and response to their client’s
PARISH NURSE
• The role that gathers in
churches, cathedrals,
temples, mosques, and
acknowledge common faith
traditions.
• Respond to health an wellness
needs within the context of
populations of faith
community.
PARISH NURSE
Functions:
• Provider of spiritual care
• Health Counselor
• Health Advocate
• Health Educator
• Facilitator of Support Groups
• Trainer or Volunteers
• Liaison to community resources and referral
agent.
HOSPICE NURSE
• Provides a family centered
care and allows clients to live
and remain at homes with
comfort, independence and
dignity, while alleviating the
strains caused by terminal
phase i.e. at the time of
death.
HOSPICE
NURSE
Function:
• Pain & symptom control.
• Spiritual Care
• Home Care and impatient Care
• Family Conferences
• Co-ordination of Care
• Bereavement Care
REHABILITATION NURSE
• Anurse who specializes in
assisting persons with
disabilities and chronic illness
to attain optimal function,
health and adapt to an altered
life style.
NURSE EPIDEMIOLOGIST
• Monitors standards and
procedures for the control and
prevention of infectious
diseases and other conditions
of public health significance
including nosocomial
infections.
Nursing professional development builds on the basic
education and experience of nurses throughout their
professional careers for the ultimate goalof ensuring
the quality of health care to the public.
GRADUATE EDUCATION OR MASTER’S DEGREE
• Prepares leaders in nursing who will influence
the practice and study of the nursing
profession.
DOCTORAL DEGREE
Prepares nurses forpositions such as:
• Administrators of nursing colleges
• Nursing research specialists
• Consultants of nursing services
• Nursing education programs or hospital
services
BON Resolution 2013-774 s. 2013
Continuing Professional Development
Guidelines
Objectives:
• Continuously improve the quality of registered professionals
by updating them with latest
scientific/technological/ethical trends in the practice of
profession.
• Support to lifelong learning in the enhancement of
competencies of professionals.
BON Resolution 2013-774 s. 2013
Continuing Professional Development
Guidelines
Objectives:
• Deliver quality CPD activities aligned with the Philippine
Qualifications Framework for national relevance and
global competitiveness.
• The Philippine Nurses
Association is a professional
organization in the Philippines
established to promote the
holistic welfareof nurses and to
prepare them to be globally-
competitive.
• It used to be known as
Filipino Nurses Association
MS. RUTH THELMA P.
TINGDA
National President
• Ang Nars
• Association of Deans of Philippine Colleges of
Nursing (ADPCN)
• Association of Diabetes Nurse Educators of
the Philippines (ADNEP)
• Association of Nursing Service Administrators of
the Philippines (ANSAP)
• Association of Private Duty Nurse
Practitioners Philippines (APDNPP)
• Critical Care Nurses Association of the
Philippines (CCNAPI)
• Gerontology Nurses Association of the
Philippines (GNAP)
• Military Nurses Association of the Philippines
(MNAP)
• Mother and Child Nurses Association of
the Philippines (MCNAP)
• National League of Philippine Government
Nurses (NLPGN)
• Occupational Health Nurses Association of
the Philippines (OHNAP)
• Operating Room Nurses Association of the
Philippines (ORNAP)
• Philippine Hospital Infection Control
Nurses Association (PHICNA)
• Philippine Nursing Informatics Association
(PNIA)
• Philippine Nursing Research Society
(PNRS)
• Philippine Oncology Nurses Association
(PONA)
• Philippine Society of Emergency Care
• Renal Nurses Association of the Philippines
(RENAP)
• Society of Cardiovascular Nurse Practitioners of
the Philippines (SCVNPPI)
• Philippine Association of Public Health Nursing
Faculty
• Psychiatric Nursing Specialists Foundation of
the Philippines
• Integrated Registered Nurses of the
BOARDOF NURSING Board Resolution No. 220 Series of
2004
• Article I Preamble
• Article II Registered Nurses And People
• Article III Registered Nurses And Practice
• Article IV Registered Nurses And Co-workers
• Article V Registered Nurses, Society And
Environment
• Article VI Registered Nurses And The Profession
Nursing is to nurture and
care... patient's life is in our
hands,
so love our profession...
ITS A CALLING!
1. Lydia M. Venzon, RN, MAN, PhD, FPCHA and Ronald
M. Venzon Professional Nursing in the Philippines
11th Edition, C&EPublishing Corp.,
2010 10th Edition, C&EPublishing
Corp., 2005
2. Commission on Higher Education CHED
Memorandum Order (CMO)no. 14, S. 2009
3. Commission on Higher Education CHED
Memorandum Order (CMO)no. 30, S. 2001

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NURSING LEADERSHIP AND

ETHICOMORAL/ LEGAL ASPECTS OF

In case of suturing of perineal laceration, special

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