Nursing – diagnosis/treatment of human responses to an actual or potential health

problem.
3 areas:
- Nursing service

- Nursing education

- Health nursing

Professional Nurse – a person whose name and registration or professional license

number is entered in the PRC registry book and computerized data base as legally
authorized to practice the nursing profession.
Practicing Professional Nurse – you perform or acts activity that is related to nursing,
application of nursing profession
Professional Adjustment – growth of whole person in the development of the
capabilities to make him fit to assure his position.
Calcium – high risk of heart problem or attack
Professional competency – ability to use knowledge and skills and activities and make
judgement to enable a professional nurse to manage/deal with problems that arise in the
practice.

Different Fields in Nursing:

Hospital/Institutional Nursing Public Health Nursing
Community Health Nursing Private duty/special d
uty nursing Military nursing
Industrial/occupational nursing School nursing
Nursing education Clinical nursing
Independent practice
nursing

1988 – nurses deciding to renew their PRC license were required to present 20 contact
hrs/year x 3 years = 60 contact hours
1999 – no longer required
2004 – implements the requirement
Credits excess – doctoral and masters degree
CPE = Continuing Professional Education

Nurse and Ethics

A. Morality – behavior in accordance with the general ethical principles of health care;
personally held beliefs; opinions that guide our actions.

B. Principles of Morality
1. The golden rule
2. Two-fold effect – choose the lesser evil
3. Principle of totality
4. Epikia – exception to the general rule
 5. One who acts under an agent is himself responsible.
6. No one is obliged to betray himself.
7. The end does not justify the means.
8. Defects of nature may be corrected.
9. If one is willing to cooperate in an act, no injustice is done.
10. A little more or less does not change the substance of an act.
11. The greater good for the greater number.
12. No one is held to the impossible
13. The morality of cooperation.
14. Principle relating to the origin and destruction of human life.
15. The Good Samaritan law (“Love Article”) – if one does not act, you will be
responsible for moral negligence.

Restraint – every 24 hours of consent

- tied on the bed frame ; every 2 hours – checking of circulation

C. Ethics – rules, principles that guide nursing decisions/conduct in terms of rightness,

wrongness of that decision/actions
- serves the purpose of governing conduct to ensure protection of individual’s
right

D. Importance – make clear any one act is better than other

- keep an orderly social life by having argument, understanding
principle/rules of procedure.
- moral conduct and ethical sys. must be intelligently appraised and
criticized

Bioethics - principles that govern rights and proper conduct of a person regarding life,
biology and with health professionals
Ethical dilemma – problem in decision making because there is no correct/wrong choice
Human Acts – voluntary, full knowledge, will to do it
Acts of Man – involuntary actions of man

Theories:
Utilitarian/Teleological – the end justifies the means
Deontological – the end does not justify the means; the acts are the criterion for the
determination of good and not the consequence.
Intuitionism – people inherently knows what is right and what is wrong

Principles of Nsg. Ethics:

1. Autonomy – “self determination”
- informed consent (med condition; treatment adv/disadvantage; procedure
adv/disa
dv.; alternative tx adv/disadv.)
* witness – genuine and authentic
- consent – the patient gives permission to the person to do/give something to her
 * admission
* blood transfusion
* surgical consent (circulating nurse)
* research consent
* special consent like restraints, photographing the client, disposal of body
parts during surgery, organ donation/autopsy
- patient’s bill of rights
- illegal detention/false imprisonment (RA 9439) “hosp. detention act” – no
patient dead/alive shall be detained in any medical/hosp. facility if they weren’t
able to pay medical bills.
- restraints
- Living Will/Advanced Directive/Durable power of attorney – making a choice
(making a choice); healthcare proxy, treatment, procedure, DNR – life
sustaining devices, organ donation, transplant, autopsy
Refusal – waiver – surrendering your right
- death and dying – right to informed; care of the body; organ donation (RA
7170); autopsy; assisted suicide; unauthorized patient’s discharge

*Last Will – transfer of property that will take happen on death.

Consent: People who can give:

 18 above
 Mentally capacitated
 Not under the influence of intoxicating drug/liquor
 Not under civil interdiction
 Emancipated minors (not under the guard of their parents; minors who are living
alone & away from their parents; minors serving the military)
Living will – upon admission
Advanced directive – wala pang naka-confine, may pauna ng pasabi
Durable power of atty. – bago pa ma-confine ang patient may inappoint ng health care
proxy

DNR (no code order) – an order by the patient’s physician instructing the withholding of
CPR if the patient goes into cardiac/respiratory arrest.
- informed refusal (waiver) from the family/patient
- DNR must have a doctor’s order

Duties of the nurse:

1. assure that everyone in the process understands the meaning of DNR
2. in case of conflict, nurse will often act as mediator and help participants reach
some shared understanding
3. ensure that the ff. information are documented:
• patient’s condition
• prognosis
• summary of decision making
• parties involved in the decision making
 • future date to review the DNR order

SECOND LECTURE

2. Paternalism – giving care like a good father/mother of a family.

3. Non-maleficence – do not harm; remove harm; prevent harm
- medication rights (pt., drug, route, time, dose, documentation, education, refuse,
assessment, evaluation) *when the pt. refuse, encircle the time and put initials.
- doctor’s order
- telephone order
- imprudence – deficiency of action; lack of skill; you did something without any
skill.
3 medical professionals who can prescribe: medical doctors, vet. doctors, dentists

BON Res. No. 20 Series 1994 – nurses can suture perineal location in the absence of any
physician

- Negligence – lack of foresight; deficiency of perception

- Professional negligence
Elements:
 (+) duty
 Deriliation of duty (breach)
 Direct cause
 Damage
- Res Ipsa Loquitor – let the thing speak for itself
- Respondent Superior – Master-Servant Rule “Let the master answer for the
acts of his slaves” – appointed by the hospital
- Force Majeure – Act of God
- Captain of the Ship Doctrine – (team leader) specific task for a specific
period of time
- Doctrine of Corporate Liability – liability of the hosp., defective
equipment/facilities

- Assault – Threaten your patient to harm

- Battery – a threat that is put into action
- Malpractice – failure to follow a responsible professional standard of care, thereby
resulting to injury to a patient

4. Beneficence – to do good; client advocate, fighting for the right of your client
5. Justice – allocation of goods and services and how to whom they are distributed.
* equality – everyone receives the same
* need – greater services go to those with greater needs
* merit – services go to more deserving (used as a criterion for transplant
recipients)
6. Veracity – telling the truth
a. Fraud – deliberate deception intended to produce; unlawful gain
 b. Defamation – character assassination (verbal/written); misrepresentation
(nagpapanggap)
c. Libel – written
d. Slander – verbal oral
e. Medical record – patient owns the info (medical abstract/history)
- hosp owns the record
- pt and the members of the health care team can view/access the
chart
7. Fidelity – loyalty/faithfulness and keep promises
8. Confidentiality – observing the seal of secrecy
> Privileged communication – (client-doctor; client-nurse)
> Invasion of privacy
> Hearsay evidence – chismis
> Dying declaration/ ante-mortem statement
> Nurses as witness
- when prohibition applies
- duration of the seal of secrecy
3 instances that the seal of secrecy can be broken:
1. when the info came from the patient himself
2. when the patient executes a waiver for the release of the info
3. when you are called to testify in a criminal case

Nurses Code of Ethics: Four-fold responsibility of a nurse

BON Res # 633 s. 1984 ICN Code of Ethics
- Promotion of Health
- Prevention of Illness amend – inaayos lang
- Alleviation of suffering
- Restoration of health
- Spiritual health (holistic care)
- self-transcendence – going beyond self to help others reach self –
actualization (5th declaration)
BON Res # 1995 s. 1989 PNA Code of Ethics was promulgated

Nurses and Contracts

Contracts – meeting of the minds between 2 persons whereby one binds himself with
respect to the other, to give something/ to render some services (Article 1305, CC)

Characteristics of Contracts:
1. Obligatory – force of law between parties
2. Autonomy – may establish agreement not contrary to law, good morals order,
public order, public policy
3. Mutuality – binding on both parties
4. Relativity – takes effect between parties, their assigns and ers.

Stages of Contract:
 1. Negotiation Phase – for the time you show interest until the time of contract
2. Perfection – birth; meeting of the mind on object and cause
3. Consummation – death; performance of respective commitments

Kinds of Contract:
1. express – formal agreement whether written/verbal
2. implied – presumed/informed from acts
• duo ut des – I give that you give
• duo ut facias – I give, you do
• Facio ut des – I do, you give
• Facio ut facias – I do, you do
3. formal – required to be in writing by some special laws
4. Informal – is not required to be in writing; intention is based on written
document, correspondence/ oral/written agreement
5. void / inexistent
 object / purpose is contrary to law
 simulated/fictitious
 object did not exist
 object beyond commerce of man
 performance of an impossible service
 object cannot be determined with certainty
 expressly prohibited/declared by laws as void, invalid,
ineffective
 direct result of an illegal contract
6. voidable – can be annulled/voided
- one party is incapable of giving consent
- consent is vitiated by mistake, violence, intimidation, undue influence, fraud

ELEMENTS OF VALIDITY – CONSENT – OBJECT – CAUSE

Breach of contract – failure to perform an agreement whether express/implied

1) prevention of performance
2) failure because of inconvenience/difficulty
3) failure of cooperation
4) abandonment of duty
5) substitution of performance
6) failure to use due care (negligence & imprudence)

Law – rule of civil conduct prescribed by the supreme power of the state commanding to
do what is right and prohibiting what is wrong
- contribute to the progress and general welfare of the society
- to minimize violation of laws
Legislation – act/process of making laws
Nursing Jurisprudence – comprises all the legal rules and principles affecting the
nursing profession
Rights – innate capacity to control actions of others with the approval and sanction of the
state (eg. Bill of rights)
Legal Rights – claim which can be enforced by law against a person/community whose
duty is to respect it
Plaintiff – complaining party (accuser)
Defendant – person charged of a crime (accused)
Accuser – private offended, party represented by the state (People of the Phil.)
Witness – has knowledge of the fact pertaining to the case, testify to the genuineness of
the makers’ signature in an instrument
Expert Witness – one who is qualified to testify based on special knowledge, skills
experiences and training
Damage - loss/injury
Damages – sum of money for compensation to injury/damage done
Process – compel the defendant to appear in court
- mandatory invitation
Warrant – direct a person to do an act, addressed to an office, affording him protection
from damages when he does the act (court police)
Search Warrant – to search for material/personal property and bring them to court
Subpoena Ad Testificandum – witness to testify
Subpoena Duces Tecum – witness and documents
Summon – defendant to testify

Nurses and Criminal Liability:

Crimes – act/omission; intentional/unintentional; punishable by the RPC (Revised Penal
Code)
- aka felony
- criminally and civil liable
Torts – legal wrong; assault, battery, slander, libel, invasion of privacy, breach of
confidentiality, illegal detention; civil; pay damages
Misdemeanor – acts/omissions punishable by special law/ ordinances
- Sec. 35 RA 9173 – penal probision nsg. Law
- Criminal/civil liability or both
- Imprisonment of not less than 1 year and not more than 6 years
- Not less than 100, 000 but not more than.

Malpractice – PRC-BON
-suspend/cancelled/revoked license

B. Stages of execution
1) Consummated – all the elements are done to perform the crime (eg. Naabort na
talaga)
2) Frustrated – napigilan
3) Attempted – (eg. Ni-raid, may preparation)

C. Persons criminally liable

 1. Principal – during the act of the felony (direct participation, inducement,
indispensable cooperation)
2. Accomplice – accessory before the fact
3. Accessory – after the fact (profiled from the crime; destroy/conceal the
body of the crime; conceal/harbor a criminal; assist in the escape of the criminal)

Conspiracy – “The act of one is the act of all”

D. Circumstances affecting criminal liability

1. justifying – free from criminal and civil liability
- self- defense
- unlawful aggression
- reasonable necessity of the means employed prevent/repel it
- lack of sufficient provocation on the person defending himself
- defense of relatives – up to 4th degree by consanguinity> up to 1st cousin; that in
the case of provocation was given by the attacked that the one making defense
had no part therein
- defense of stranger – (2nd cousin up) defending not induced by resentment,
revenge or other evil motive
- who acts in fulfillment of a duty or in a lawful exercise of a right
or office
- who acts in obedience to an order by a superior for some lawful
purpose

2. Exempting – no criminal liability only civil liability (damages)

* mistake of fact – (ignorantia facti excusat) must be committed in good
faith/under an honest belief
* an insane/imbecile unless acted during lucid interval
* under 9 years old (schoolers)
* over 9 under 15, unless acted with discernment
* mistake in identity – napagkamalan mo siyang siya yung nagnakaw aggravating
circumstance
* while performing a lawful act with due care causes an injury by mere accident
without fault/intention of doing it (negligence)
* who acted under the compulsion of an irresistible force from a 3rd person
* impulse of uncontrollable fear of an equal/greater injury
* insuperable/lawful cause

3. Mitigating Circumstances – decreases penalty

* under 18 or over 70
* no intention to commit so grave a wrong
* sufficient provocation/threat on the part of the offended party immediately
preceded the act
* voluntary surrender
* dumb or blind, suffering from physical defect
* such illness that would diminish the exercise of his will power
 * committed in the immediate vindication of a grave offense to the one
committing the felony, his/her spouse, ascendants, descendants, legitimate,
natural/adopted brothers/sisters, relative by affinity within the same degree
* acted upon an impulse so powerful as naturally to have produced an obfuscation
(crime of passion)

4. Aggravating – increases penalty

* advantage of public position
* in contempt/insult to public authorities
* abuse of confidence or obvious ungratefulness
* committed on occasion of epidemic conflagration, shipwreck/ other
calamity/misfortune
* in consideration of a price/reward/promise
* committed by means of fire, expulsion, stranded of a vessel
* with evident premeditation (mistake in identity)
* fraud/disguise
Simple theft – nang-umit sa stranger
Qualified theft – nagnakaw sa family/somebody who trusted you

5. Alternating (either mitigating/aggravating)

* relationship, intoxication, degree of education
* education is not mitigating in rape, forcible abduction, arson, treason, seduction,
acts of lasciviousness, heinous crimes

NURSES AND CRIMES:

A. Parricide – ascendants, descendants (legitimate/illegitimate),
spouse (aggravating)
B. Murder – with intent to kill
C. Homicide – without the intent to kill
D. Infanticide – less than 3 years of age
E. Abortion – termination of pregnancy before fetus is viable (3-6
mos)

Under Phil. Law, Child Abuse refers to the maltreatment, whether habitual/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/words which debases, degrades/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

Sexual harassment – words, gestures, actions which tend to annoy and verbally abuse
another person.
Simulation of birth – crime against status by substitution of one child with another;
concealing/abandoning any legitimate child with intent to lose civil status
- 30 days from the time of birth (Birth Registration Act)
- Birth attendant passes it to the civil registrar