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Professional Adjustment, Legal Management, Ethics & Research in Nursing

NURSING RESEARCH
Nursing Research
• Kerlinger - the systematic, empirical, controlled and critical investigation of a hypothetical proposition in
relation to a natural phenomena/ problem
• Conducted to affirm or deny a hypothesis

Phenomenon.
• everyday phenomenon that affects the nurse (eg. bacteria, drugs, physician)

Phenomenon + hypothesis = research problem


∟>(educated guess/scientific/ tentative answer)
Without hypothesis there is no research problem, only a problem

Major Characteristics of a Good or Major Research


• Systematic
• conduct research in a step by step process or procedure
• Empirical
• objective data should be observable/measurable or readily collected using your senses
• Controlled/ manipulated
• Methods/tool of controlling is research design
• Critical investigation/fact finding investigation
• In order to answer the data is by using facts.
• Looking for human beings who can give us facts

Purpose of Research in Nursing Profession [DEED]


• Descriptive
• observe, describe and record
• gain richer familiarity regarding the phenomena
• 100% known to RN
• Exploratory
• Explore to those areas that are unknown
• Observe more
• 50%-50% (50%known to nurses and 50% unknown to the nurses
• Experimental
• Active intervention, active manipulation
• Want to find out cause & effect
• Done something before observing results
• Developmental
• To improve the system of care for the your patient.
• Develop and improve existing system
Conducting research is for the benefit the pt or patient care/pt focus

Ethics of a Researcher
• S – Scientific Objective – conductive research for a good purpose or object for your pt
• C – Cooperation and Consent. Do not conduct data/experiment w/o a consent (legally the patient
owns the chart. However the hospital owns the chart)
• I – Integrity – worked hard on the research
• E – Equitable – acknowledging works or contribution of others
• N – Nobility – protect the rights of your subjects
• Right not to be harmed
• (physical, mental, moral harm) usually done during experimental research
• Physical Harm/ Negligence - undeliberate physical harm
• Commission – done outside the standard practice of nursing (eg. urinary
catheter placed on the nose of the pt)
• Omission – from the very start, you did not do something about it.
• Moral Harm
• Assault – mental fear/threat without physical harm
• Battery – physically you harm the pt
• Restraint is never an independent nursing order
• physical restraint – eg. Jacket
• chemical restraint – eg. use of psychotropic drug
• Moral harm
• Slander – oral defamation
• Libel – published or placed in the newspaper
• Right to self-determination
• Right to privacy
• Anonymity – identity of subject may not be disclosed. Privacy of the Informant (pt) eg.
conduct a study on HIV pt. but the pt wants his name to be written in the newspaper as
Mr. X, Mr. Y or Mr. W
• Confidentiality – information acquired must be disclosed. Privacy of the information eg.
conduct a study on HIV pt. but the pt wants the nurse should only know
• T – Truthfulness – put only the data you have collected
• I – Importance – importance to the nursing profession
• F – Factual – facts or data
• I – Ideal (follow the 11 steps of research)
• C – Courage

Steps in Nursing Research Process


• Identification/formulation of research
• problem - anything that requires solution thru scientific investigation.
• Sources of problem :
• C – concepts (Ca, PTB, MI)
• L – literature, essays, books, journals
• I – Issues
• E – experience
• N – Nursing problems
• T – theories

• Characteristics of a research problem


• G – general applicability and use
• Re – Researchable
• F – Feasible and measurable
• F – actors of a feasible research :
• time, money, experience of the researcher, instruments, population
• I – importance to nursing profession
• N – novelty/originality
• Plagiarism/illegal replication – unauthorized use of another’s literary work without
any consent or permission
• S – significance to nursing
• 2 types of research according to use
• basic/pure research
• only the research benefits the research
• It is only for your personal necessity
• Answers your own question
• Applied research
• problem solving
• Solving the problems of the patient.
• Variable – subject to change
KINDS OF VARIABLE
• Independent variable • Extraneous Variable
• use this to stimulate a target population • External infuences that can be changed
• Dependent variable/Effectual variable • Example: citizenship, educational status
• results of the effects of the study • Dichotomous Variable
• Intervening Variable • 2 choices/ 2 results
• Comes between dependent and • Example: Male/ Female
independent • Polychotomous Variable
• Example: orghanism variable, internal • Multiple choices
factor, sex, gender, color • Example: Preferred foods – Chinese,
Japanese, American. . . . .
Examples
“A comparative Study in the Income of Filipino Nurses
Employed in P.G.H. and N.Y.G.H.”

Independent variable : PGH and NYGH (place of work)


Target population : Filipino nurses
Dependent variable : income

Research:
• Identify the Problem
• Purpose – objective using SMART (Systematic, Measurable, Attainable, Realistic, Time Bounded)
• Define Terms
• Conceptual Definition – dictionary definition
• Operational Definition – defined in accordance on how the researcher used the word
• Revision of Terms

Review of related literature

• Purposes :
• to have an update regarding your topic
• to have a basis of theoretical and conceptual framework
• Main sources of literatures
• Conceptual • Research
• Formulated • Researcher
• Authors • Research works only
• Can be sold • Future research purpose only
• Books – general use
Formulation of conceptual and theoretical framework
• Theory – relationship between concepts
• Conceptual framework
• diagrammatic and structural presentation of the problem hypothesis
• Paradigm
• actual structural presentation of your conceptual framework

• Formulating hypothesis
• 5 types of hypothesis
• Null/statistical hypothesis
• shows no relationship or difference between an independent variable and
dependent variable. ID = DV
• Eg. “There is no difference regarding professional opportunities of Filipino Nurses
working in the Philippines from those working in USA.”

• Simple/Operational hypothesis/Alternative hypothesis


• this shows relationship between a single independent variable from single
dependent variable.
• Eg. “Filipinos Nurses working in USA has more professional opportunities than
those working in the Philippines.
• Complex hypothesis
• this shows a relationship between two or more independent variable from two or
more dependent variable.
• Eg. “Filipino nurses who worked for 5yrs and passed the CGFNS, TORFL, TSE,
NCLEX has greater opportunities in NY as compared to those in Manila
• Directional hypothesis
• specifies the direction of the relationship between variables
• Eg. “Filipino Nurses working in the USA has more professional opportunities than
those working in the Phils.”
• Non-directional
• only predicts the relationship, but has no specific direction between variables.
• Eg. “There is a big difference between a Filipino Nurses working in USA than
those working in the Phils.”

• Selecting research design


• Systematic controlled plan for finding the answer to a problem
• Roadmap, blueprint of the study
• Should have a proper resign design
• If improper research design, there will be improper collection of data
• Purpose : key or tool for proper collection of data

• Types
• According to Application
• Basic/ Pure
• For personal knowledge, curiosity
• Applied
• Based on problem solving approach
• According to Methods
• Experimental
• performing active manipulation, observe and record the result.
• Types of Experimental Reseach
• control
• divide grp into 2.
• Group a – control grp – will use the same soap everyday
• Group b – experimental grp – those who will use sample soap
• randomization
• using sample by chance.
• Choose randomly to avoid redundancy of result
• Manipulation
• Performing intervention
• Validation
• comparison of the effects
• Quasi-experimental
• false experiment; No control sample.
• Non-experimental
• No manipulation is done. Only observation, describe and record down the result.
• Types of non-experimental research design base on time element
• Retrospective (Ex Post Facto)
• Getting actual experience
• Studies a group of people after its occurrence, experience or facts.
• Experience of people in the past
• Descriptive
• Observe, describe & record.
• Study of current events.
• Prospective
• Study of research about future occurrence or future events.
• Historical
• Past that is written, documented, published and recorded
• Primary Data
• Observe
• 1st hand information
• person himself
• Secondary Data
• 2nd Hand Information
• About the past using records, journals, books.
• Study of the dead people thru his written materials, facts
• according to data
• quantitative
• data base on numerical interpretation, datas that are measurable, using your senses,
data that are observable.
• qualitative
• subjective data, feelings, perception, beliefs, culture, attitude
Survey Research Design
• Group • Methods
• Small • Mailed survey
• Face to face • Face to face
• Large – not good result • Telephone survey

• According to Time Orientation


• Cross Sectional • Longitudinal
• Applicable to 2 or more • 1 group only
identical group • with initial and follow up survey
• Short term • long term study
• For comparison • for developmental study

• Selecting your population and samples


• sample
• part of population, data is collected.
• The recipient of the experimental treatment in experimental design or the individuals to
be observed in a non-experimental design
• Types of sampling
• Probability - equal presentation/ chances in the population.
• Simple random technique
• Used a single/identical group.
• Fish bowl technique
• Stratified random sampling
• You will first going to create a sub population from the whole population
before doing randomization.
• One population, you divide it.
• Cluster random sampling
• You will first create a sub area in a population before doing the
randomization. In one population, you make it smaller
• Systematic random sampling
• choosing a sample every nth name in the population.
• Multiple of 100 names
• Sampling frame – list of names appearing as your population

• Non-probability sampling – you are not choosing by chance.


• Accidental/ convenience sampling
• Base on the accessibility/availability of your sample.
• Kung sino pinakamalapit syo, yun ang kukunin mo.
• Purposive/judgmental sampling
• base on the common knowledge or popular knowledge.
• Snow-ball sampling
• get sampling base on last referral
• Quota Sampling
• Setting criteria and getting samples fitting the criteria
• Conducting pilot studies
• Collecting data
• types :
• questionnaires – use of pen and paper method
• dichotomous – divided into two. Eg. true orfalse. Yes or no
• rating scale – poor 1, good 2, better 3, best 4
• multiple choice
• Interview – use of oral method of collection of data. Use of active listening
• Structured – with checklist, formal talk, list of question
• Unstructured – informal talk, no pattern, anything goes
• records – pre existing data
• observation – use of ocular method using your senses
• participant observation
• non-participant observation
• Problems :
• Hawthorne’s effects
• The data you get from your sample is not accurate.
• The sample has a problem
• Solution : double blind research – they should not be conscious
that they are being studied
• Halo effect
• The researcher has a problem.
• He is manipulating the data collection.
• It is affected by special feelings/treatment between the researcher
and the sample.
• Analysis of Data
• part of research when the researcher is forming a body of knowledge out of data collected for
the purpose of affirming or denying your hypothesis
• Methods
• Nominal method
• get data by means of categories.
• eg. male, female, income
• Ordinal method – base on rank eg. mild, moderate, severe
• Interval
• base on the distance between 2 numerical values
• eg. BP – 150/100 – 120/80, wt, circumference, ht
• ratio – 3:10 children are malnourish
• Interpretation of Data
• 2 Methods
• quantitative method – base on numerical or graphical standards
• qualitative method – use of narrative words
• Communicating your conclusion
• Explaining the results of your work to the public
• Conclusion – final answer to your research
• Recommendation – suggestion to others
• Dissemination of Information
• Methods :
• thesis/book – written form
• symposia/symposium – oral presentation
• publish – a lot will be able to read your research

LEADERSHIP

Nursing Leadership
• style or process whereby a person is called by a nurse leader were influence of group of people called
his followers for the purpose of attaining only one goal/objective.

Principle for Effective Leadership


• Unity of Command – one group given by one leader
• Unity of Direction – one group should always have one objective
• Subordination of your personal to your general interest – patient first policy
• R – rescue your patient
• A – alert the fire alarm
• C – confine the fire in one area
• E – extinguisher application
• Esprit d’ corp/team spirit - Fault of one is the fault of all
• Respondeat Superior/Command responsibility
• let the master or the superior answer for the negligence of his subordinates in half of his patient
who suffer from injury or death.
• you can delegate responsibility but not the accountability

Theories of Nursing Leadership


• Great-Man theory – born as a leader
• Trait theory – develop characteristics or born with the characteristics
• 3 traits of a leader
• P – personality (adaptability, independence, creative/assertive, advocate) ability to
adjust to the need of the pt
• I – intelligence (proper judgment, proper decision making, proper communication)
• A – ability – (influence others, respect others, participate and cooperate) Proper way to
influence is thru health teaching
• Charismatic theory – becomes a leader because of the charm
• Situational theory/case to case basis
• a person can be a leader in one situation but only a follower in another situation. (eg. becomes
a leader in where he specializes)

Leadership styles
• Authocratic/Authoritarian/dictatorial/”hard” leader
• unilateral style of leadership. Only the leader here performs the decision making without getting
the inputs from his members.
• One sided style of leadership Behavior :
A – apathy – insensitive to others
B – Boisterous speech
C – consistency
D – Dominating
E – Exploitative behavior
F – ferocious behavior, to coerce or compel the group to follow him
• not a good style of leadership but only best style during emergency or intensive crisis

• Permissive, ultra-liberal, laissez faire, free-rein


• Loose style of nursing leadership.
• Giving excess freedom or liberality towards your subordinates if to lenient in your subordinates,
there will be ↓ control and power = ↑ negligence
• Democratic/participative
• best style of leadership. Mutual style of nursing leadership

5 Power of a Good Leader


• Legitimate/ Formal/ exclusive Power • Reward Power
• Exercise because you are appointed • + power for the part of the leader
to a higher position • gives rewards, bonus, promotion,
• Expert Power compensation
• You acquire extra – ordinary skills, • Coercive Power
talent or ability • – power on the part of the leader
• Referent Power • reprimand, suspend, terminate
• Charisma and charm

ABC’s skills, qualities and abilities


• A – Authority
• basis of the leader to delegate tasks, responsibilities, jobs to be performed by his subordinates
• 2 types of authority
• Centralized – top to bottom for proper management
• Decentralized – Bottom, to manage directly
• B – Behavioral
• S – specialized body of knowledge and skills to do safe care
• P – patient centered
• A – accountability – liable for the results of your actions
• C – confidentiality – nurse-patient relationship
• Exceptions to confidentiality of the contract :
• P – patient consent, if there is
• I – inform/report to healthcare team for purpose of precautionary measures
• C – Communicable disease
• RA 3573 Law on Notifiable Disease
• 24 – Polio/ Measle
• 1 Week – SAD/ HIV/Tetanus Neonaturom
• C – Crimes
• Child Abuse 48 hours, Baranggay, NGO
• E – ethics

IV THERAPIST: Old RN, Training, 50 Insertion, ANSAP


New RN, Training

• C – Communication skill
• transfer of information with understanding
• Communication barriers/communication backlog – eg. Dialect differences, noise, deaf, high
level of anxiety, hallucinating
• D – Decision making skills
• Steps
• identify the problem
• identify person affected
• gather options/alternative
• brainstorming
• delphitechnique – gathering solutions outside the group (eg. specialized nurse)
• choose and implement
• Evaluation

• E – Ethics
• Principles
• Principle of Autonomy
• independent judgment or decision making
• in all situation the pt himself is the one who should decide for his own care
• Consent
• respect the decision of the pt
• explain the risk to the patient/SO
• waiver - a legal doc when the pt refuse for treatment.
• Principle of Veracity
• telling the truth to the patient
• #1 the patient has the right to know from the PHYSICIAN (not the nurse)
• Principle of Double Effects
• if the pt is made to choose between 2 equal danger and he only needs to choose one,
choose the one that will produce one good effect and less evil effect.
• Principle of Beneficence
• doing good to the patient (eg. providing therapeutic communication, providing privacy)
• Principle of Non-Maleficence
• do no harm
• 3 types of Harm
• Physical – negligence by commission
• Mental – assault and battery
• Moral – slander and libel
• Principle of Justice
• Prioritize the needs of the patient.
• To be able to provide nursing care to the patient, provide the nursing process.
• Nursing Process characteristics :
• A – acceptable universally
• B - based patients assessment needs
• C – client focused
• D – dynamics – base on the ever changing needs of the pt
• E – equitable care
• F – familiarity/rapport to the patient
• G – goal directed towards solving the assess needs of the patient (SMART)
• Principle of Respect/Inviolability of life
• Suicide and abortion is violation of this principle
• F – Face/solve Conflicts
• any clash of ideas resulting to crisis
• Methods of resolving conflict
• avoidance – by paying attention
• smoothing – appealing to ones conscience and kindness
• unilateral action – use of forced fear or threat
• negotiation – best method in resolving conflict. The head nurse should offer negotiation
between conflicting parties.

NURSING MANAGEMENT
NURSING MANAGEMENT
• choosing the right person and giving them the appropriate task for the purpose of achieving their
goal/objective in achieving total care

Frederick Taylor’s Scientific Management Theory


• Elements
• choosing the appropriate person (TAO)
• choosing the appropriate team
• choosing the appropriate training
• choosing the appropriate tools

Human Relations theory


• the be a good manager, there should be a good interpersonal relationship between the leader and
follower

Douglas Mc Gregor’s Motivational theory


• Theory X
• Negative workers
• negligence, inefficient, ineffective workers
• Theory Y
• Positive workers
• diligent, effective, efficient worker
• theory X should be given focus because they are prone to negligence and malpractice.

Max Weber’s Bureaucratic/ authoritarian Theory


• whoever is on the top would perform the management function
• centralized

Elton Mayto’s Behavioral Theory


• overtime pay, rest day, day off
• provide physical needs of the workers
• Hawthorne’s Effect
• If workers knows they are observed they become more efficient

Henry Fayol’s Principle of Management


• Unity of Command – one leader, one command
• Unity of Direction – one group should always have one goal
• Remuneration of Personnel – patient first policy
• Esprit de corps – team spirit
• Command responsibility/Respondeat Superior – let the superior answer the fault of his subordinates
even harm or death
• Balance between centralization and decentralization
• Security tenure
• Delegation of responsibility
• Proper Compensation of workers
• RA 7305 (Magna Carta Law) – salary grade 50 P13,000/month
• Overtime pay – additional of 25%/hr
• Night Differential – additional of 10%/hr
• Legal holiday – x 2
• Philhealth - Benefit of worker both related and non-related work (aesthetic, dental and
cosmetics are not included)
• Maternity leave – 60days leave is NSD, 78days if CS only to first 4 pregnancy only to legitimate
spouse
• Paternity leave – 7day/1week leave
• Senior Citizen’s Act – 20% discount
5 steps in Management Process
• Planning stage
• looking ahead of time.
• Formulating future goals/objective
• Types of plan
• Standard/Operational Plan (NCP)
• plans for everyday or ordinary activities
• Strategic/Contingency Plan
• plan used during sudden or acute crisis
• Long-range/future Plan
• plans which you can’t evaluated immediately.
• Usually last months or yrs.
• Used for chronic pt which requires longer period of care.
• Stages of Planning Process
• Mission – present reason when established your organization
• Vision - statement of your future purpose of your future organization
• Philosophy – set of values and beliefs of your organization
• Goal – general statement of your purpose
• Objectives – more specific statement of your purpose
• Policies – set of rules and regulations in your organization
• Procedures
• Budgeting – proper allocation of your resources
• 3 types
• Personnel
• Compensation for salaries of workers
• Operational
• everyday use of equipment and facilities (gloves, water, electricity)
• Capital
• long term equipment (MRI, CT Scan, hospital beds, hospital buildings)
• Organizing
• 4 stages
• Organize your team RN Subordinates
• Duties of the RN
• Only assessment can perform the nurse
• Only the nurse can perform HT
• Only the nurse should explain the procedure to the patient
• Preparation, administration, treatment of drugs to the patient
• The nurse can only perform evaluation & judgment
• Delegate Task
• They can only delegate to subordinates the Routinary task (standard,
unchanging procedure) eg. monitoring of I&O, bathing, ambulating, toileting,
shampooing, transporting, feeding, clothing, wiping
• Stable patient - predictable outcome (eg. postmortem care with direct supervision
of the nurse only)
• Supervision – need guidance
• Staff Schedule/ Staffing
• Schedules (How many hours)
• Traditional – 8hrs a day/40hrs/wk
• Ten hour shift/4 days a week
• Baylor plan – it consist of two shifting nurses
• traditional – mon-fri 8hrs
• 2nd shift – 12hr shift during weekends
• Part-time work – fewer working hours per day and may choose the day or
work. Less than 8hrs job
• On – call – during shortage of nurses/staff but increase in the number of
patients.
• Methods of Nursing care Delivery
• Different Methods
• Primary – 24hrs a day
• Primary nurse is the only nurse who is responsible to make a care
plan of the patient from the moment of admission till the moment
of discharge. (eg. private duty nurse or special nurse)
• Functional Method
• DOH format/government hospitals
• Assign nurse :
• Duty/task
• One nurse, one task
• Highly recommended during a period of shortage of nurses
and budget
• poorest method of delivery because communication is hindered
• Case Method/Case Nursing
• provide total care within your shift. Used in ICU department
• C – Case Method
• T – total care to the patient
• O – one is to one ratio
• Directing/Delegation stage
• a job or a task is done or performed by another perform for you
• What you cannot delegate:
• you cannot delegate total control of the procedure
• you can’t delegate discipline of subordinates or staff members.
• Confidential task
• Technical task
• Medical task performing surgical procedure is done by the doc not the nurse
• Coordination/Collaboration
• the nurse needs to collaborate to other members of the health care team.
• Multi-interdisciplinary approach – to be able to provide holistic approach to the patient.
• Types of Collaboration
• Interpersonal/Intradepartmental
• One patient, one unit.
• Collaboration between one nurse to another healthcare team in one
unit/department
• Eg. MI patient - nurse, dietary, specialized in cardio
• Interdepartmental
• 4 units in one hospital.
• Coordination of the patients care between 2-more units/departments but still
under one same hospital or institution
• Eg. patient due for appendectomy is transferred to the OR
• Inter Agency/Institutional
• Coordination of patient’s care between 2 or more hospitals/health care institution
for the benefit of the patient
• Eg. lying – in due for C/S and was transferred to a hospital
• Evaluation/Controlling
• stage wherein you determine whether or not your plans for your patient is met or achieved
• Methods of evaluating staff performance
• Checklist
• it is being evaluated higher than you. (eg. nurse manager/supervisor or head
nurse)
• Nursing rounds
• it is being evaluated higher than you. (eg. Nurse manager/supervisor or head
nurse)
• Psychiatric ward is not done by nursing rounds

• Peer review
• same rank or level is being evaluated you
• poor method
• Performance appraisal
• the patient evaluates you
• best method in evaluation

PROFESSIONAL ADJUSTMENT AND NURSING JURISPRUDENCE

Professional
• A calling in which its members profess to have acquired special values, knowledge, training or by
experience so that they may guide others in that special field.

Nursing is a profession
• Calling – service oriented
• Others – patients

Characteristics by profession
• A – accountability/liability for the result
• C – caring profession Central Focus
• C – competent
• E – ethics
• S – service oriented
• S – specialized scientific body of knowledge and skills

PROFESSIONAL DUTIES OF A NURSE UNDER RA 9173

All are independent nursing actions


• Promotive, preventive, curative and rehab care • supervision of subordinates
in all health care service • accurate recording and reporting
• health education • execution of valid doctor’s order (the only one
• utilizes nursing process that is dependent nursing action)
• link of patients in different health care services • Perennial Suturing after training
• collaboration of patient’s care for continuity of • Perform IE if antenatal bleeding is absent and
patient care before full delivery
• train nursing students
A doctor’s order is valid when giving medication is when it is put into writing and signed by the physician.
Whatever is not put into writing is considered not ordered by the physician.

Good Samaritan Act


• During emergency, national calamity, national epidemic there is no doctor around the life or the patient
is in possible danger, then you can give drugs alone provided you know the drugs for the patient.

RA 8344 – No deposit policy during emergency cases only

Areas of Nursing Practice


1. Institutional Nursing
• Hospital Based Venue
• D – Duties are routinary and supervised
• A – Acquired different learning and technical skills
• C- Coordination with HCT
• S – Specialized areas
• Nurse Generalist – community nurse
• Nurse specialist – staff nurse

2. Public Health Nursing


• Once a Public nurse in the community, you are focus on the preventive and promotive of health
because this is the mandate of Primary Health Care Law.
• 1st PHC
• Date : 1978
• Place : Alma Ata
• Country : Russia
• Local version of F. Marcos after 1yr of Alma Ata
• Conference: Letter of Instruction 949 that mandates that all public workers to have a duty of
promotive and preventive care for the patient.
• Promotion of Public Health
• PD 8976 – Micronutrient Supplement Act
• Vit. A, iron supplements, iodine
• PD 825 (Environmental sanitation law of the Phils.)
• It is cleanliness of the environment. Outside the institution (eg. proper disposal of
excreta, proper drainage system)
• PD 856 (sanitation code of the Phils.)
• Involves proper sanitation of an institution that engage in food and water supply. Inside
the institution. (eg. canteen, mineral water store, public market, Sex shop : ADONIS,
PEGASUS, CHICOS) not applicable to private sex practitioners.
• Prevention of Disease
• PD 996 (EPI law)
• Compulsory Immunization of children below 9 y/o
• Psychological and social adjustments because you will be taking care of numerous clients
• RA 7160 (local government code)
• decentralization or devolution of care. The DOH together with DILG and local
government units (brgy, provincial) together with community participation they made a
local health board which is the MAYOR.
• Purpose of local health board : it makes quality health care available, accessible and
proximal for all
• Participation is maintained with all members of the community, health care team and family

3. Occupation Health Nursing


• industrial or company health nurse
• Duties :
• Curative/rehabilitative • C – care for sick/injured laborers
• R – Referral • N – nutritional
• V – Visit and ff. ups (home visits) • S – safety and sanitation
• Promotive/Preventive • C – Counseling

4. Clinical Instructor
• Qualifications :
• A – accredited nursing Org
• M – MAN in nursing or other health courses
• O – One yr clinical experience
• R – R.N.

PHILIPPINE NURSES ASSOCIATION


• When was PNA founded : Oct. 22, 1922 (10-22- 22)
• Who is the founder PNA : Anastacia G. Guiron Tupas
• Purposes :
• P – professional well-being
• U - unity
• P – promotes reciprocity even outside the Phils.
• A – advancement of the knowledge and skills of the nurse
• E – ethics promulgation
Proclamation Order 539
• Declared by Pres. Garcia law declaring the last week Oct as the official nurses week.

School of Nursing in the Philippines


• UPCN – 1st
• Schools originated in the Phil.
• Iloilo Mission hospital
• PGH
• St. Luke’s
• Mary Johnston Hospital
• St. Paul Hospital
• San Juan de Dios

Contracts and Consents

Characteristics of a Valid Consent Criteria of a good consent :


• V – voluntariness • 18 y/o – above
• O – Opportunities to ask question be • Mentally capacitated (absence of insanity
explained to pt and imbecility)
• T – treatment explained to the patient • If below 18 y/o and mentally incapacitated a
• U – understood by pt proxy consent : in chronological order
• M – matured both physically and mentally • Parents
• Guardian
• physician (if parents and guardian
are dead)
• Guardian Ad Litem – social worker or
Surgeon

Nurses and Illegal Detention


• it happens if someone will limit the freedom of the patient to move or travel from one place to another.
• HIV Patient – should be kept in one room
• Felacio – oral sex – most fastest mode of transfer
• Cannalingus – tongue on clitoris
• Analingus – tongue on anus – least mode of transfer

Last Will and Testament


• Act whereby a person is permitted by the law to have control in the manner of disposing/ giving his
estate but will take effect at the time of his death
• Testate Succession – son or daughter will inherit the last will of the parents
• Intestate Succession – without last will and testament
• 2 types of Last Will and Testament
• Property
• Notarial/ Ordinary Will
• Check LOC
• Check proper location of the signature – end part of all the pages at the side
• Nurses can be a witness
• Holographic Will
• During emergency cases
• No witness involved call a persdon who knows and familiar with the handwritten
of the testator
• Entire last will and testament is hand written dated and signed by the testator
• Life Body
• Advance Directives
• Respectful death
• Direction/ instruction of the patient in advance
• DNR, donate organ, cremation
Medications and prescription
• only registered medical, dental and veterinary practitioners are authorized to prescribe drugs
• 3 information
• name of the AMD, address of his clinic/hosp and PTRC license #
• name of the pt, age, sex
• drug name, frequency, duration of the drug
• RA 6675 Generic Act
• all prescribe drug must be written in generic and brand name or generic name but never the
brand name alone)
• Purpose : for the pt to choose what brand name they want
• Remember the 10 R’s of medication
• Right patient name by checking the pt wrist tag
• Verbal or telephone – only done during emergency
• doubts or error – in case there is doubt in medication, refer to the physician
• IV drugs – in proper training

Documentation, recording and charting


• Patient Chart – absolutely legal
• Purpose of a patient Chart
• Communication and conitinuity of care
• Assurance of quality of care
• Research
• Legal document
• Statistics of disease
• Subpoena – order coming from the court
• Subpoena Duces Tecum – any documents, objects, papers, materials
• Subpoena Ad Testificandum – person who will testify (witness)
• Do’s in Charting
• F – full, factual and objectively accurate
• L – legible
• I – immediate
• P – Personal
• Adendum – late entry/late documentation
• Don’ts in charting
• L – language, jargons or words which are unacceptable
• I – improper corrections
• S – Spaces and skips
• Abbreviation

LEGAL DOCTRINES IN NURSING

Professional Negligence
Negligence
• failure to do something which are reasonable and prudent nurse should have done something under a
particular situation. (eg. failure to raise side rales when the pt is unconscious)
• 3 elements of negligence
• duty on part of the nurse
• failure to do said duty
• injury, harm, death – most important negligence
Malpractice
• injury, harm or death is not important in malpractice
• The nurse is allowed to perform episiorrhapy
• with proper training but not episiotomy
• The nurse is allowed to perform IE but with 2 conditions :
• fetal aberration/ abnormal delivery
• prior to complete delivery
Crimes affecting nurses
• Types of crime :
• Manner of Commission
• DOLO – crimes committed with deceit. Crime with real criminal intention
• CULPA – crimes committed under negligence. Crimes that are intentional
• stages of execution
• consummated
• when the crime intended is totally committed or perfected
• frustrated
• the offended performs everything to consummate the crime but it did not happen
• attempted
• crime has not happened (overt acts – acts merely showing the intention to commit the
crime)
• degree of participation
• principal
• degree of participation is very important/indispensable because he is the primary author
of the crime.. If no principle, there is no crime.
• accomplice
• participation is merely dispensable.
• Usually performs before (eg. referral by the nurse of a abortionist to a pregnant women)
or during the crime eg. OB nurse is to perform abortion. The nurse is look out for police.
The nurse is the accomplice.
• accessory
• usually performs after the crime (eg. stole a nebulizer in the hospital. Sold the nebulizer
to an asthmatic pt) This is an accessory because he benefited from the crime

RA 7877 – Anti sexual harassment law


• committed by any person who exercises authority. (eg. teacher to student, head nurse to staff nurse).
• That person who is in authority is asking for a sexual favor in an exchange of another favor.

Types of Rape
• Ordinary rape
• a forcible penetration of an organ for copulation to another organ for copulation. (eg. women are
only the victim)
• sexual assault
• anything that is forcible inserted to a body orifice with sexual malice.
• Also form of rape (eg. hand or an object is being inserted in the anal. Committed in both female
or male)
• Intervention :
• S – safety (emotional or physical safety)
• R – report (↓ 18 – report to brgy.)
• R – referral (if father is the rapist, refer to DSWD)

Abortion
• is the expulsion or termination of a product of conception before the stage of viability. (3-6month/12-
24weeks)
Infanticide
• kill the person in less than 3days or 72hrs of life.

Parricide
• killing another person to whom you have a relationship (mother, father, husband)
Homicide
• unintentionally killing another person without any relationship (eg. negligence in giving meds)
Murder
• intentionally killing another person without any relationship

Simulation of birth
• committed by any person who shall substitute one child to another child or alter his identities for the
purpose of losing his civil status. (eg. the midwife failed to report the birth of the baby, giving wrong
information of the gender of the baby)
PD 651 (Birth registration act)
• law any person who assist in giving birth to report within 30 days to the Local Civil Registration Office
Law Affecting Nurses
• Act 2808 (yr. 1919) – first true nursing law
• It removed from the doctor the control of nurses with 3 man team (1 chairman and 2 members
all nurses)
• 1920 – 1st official board exam
• 1st nursing school (6months)
• Iloilo Mission Hospital (1906)
• PGH School of Nursing (1907)
• St. Luke’s school of nursing (1907)
• Mary Johnson’s school of Nursing (1907)
• St. Paul Iloilo 1907)
• San Juan de Dios (1907)
• 1st college of nursing (4years) – UP
• RA 7164 (1991)
• RA 9173 (Oct 21, 2002)
Board of Nursing REQUIREMENTS
• Old • New
• M – MAN • M – MAN
• A – Accredited Nursing Org (PNA) • A – Accredited Nursing Org (PNA)
• F – five MAN team (1 chairman, 4 • S – 7 MAN team (1 chairman, 6members)
members) • I – immediately resigned upon appt.
• S – 65 y/o – 1 year interim period • N – Not convicted of any crime
• N – Not convicted of any crime • P – Pecuniary interest (Absence)
• P – Pecuniary interest (Absence) • T – 10 years nursing practice but 5 yrs
• T – 10 years nursing practice must be in the Phils.
• C- Citizen of R.P. • C- Citizen & resident of R.P.

• Who formulates the question of the Board Exam? – Board of Nursing


• In having a license it is a Privilege not a Right
• Board of Nursing issues the license
• PRC issues the certificate of registration
• CHED are the ones who has the power to open and close a nursing school
• BON just inspects 5 consecutive years of below 80% passing rate, the school will be closed

• Powers and Functions of BON • Dean


• L – Licensure exam • R.N., MAN
• I – Issue COR • 5 years nursing experience
• M – Monitor standards of nursing • Clinical Instructor
practice • A – allied in nursing or any
• E – Education allied health courses
• C – Code of ethics • M – member of PNA
• H – Hear and decides cases of • O – 1 yr experience
negligence and malpractice • R – R.N.
• A – Accredits different organizations • Nursing Administrator
• G – Guides Nursing Practice in the
phils

Supervisor/Manager H Community Military Hosp

• B – BSN RN
• A – Accredited Org
• N – 9 units
• T – 2 yrs

Chief/Director
RN + MAN +5 yrs supervisor Add only master’s in PHN or CHN MAN + GSC (Gen.Staffing Course)
experience (N.B. if primary hosp)

• Examinees
• CGM (Good Moral Character) • 3 docs sub to PRC
• Proofs of Valid Holder of Filipino • RLE certificate
Citizenship • TOR with Scanned picture
Proofs of valid holder of a BSN Degree only from • List of cases
schools whose curriculum is approved by the CHED • Examination fee is P900
• Last day Is :

Other related laws


PD 223 – PRC Act


RA 1080 – Civil Service exam Cum Laude, Board passer – eligible in taking CSE

RA 6425 – Dangerous drugs Act
• punishable with 2 chemical substances
• Prohibited drugs
• chemical substance totally, abosultely can’t be consumed by human being (eg.
Shabu, Mariana, Cocaine, Opium)
• Regulated drugs
• you can use this drug provided the pt has the prescription and the AMD has
appropriate license coming from the BFAD or Dangerous Drugs
RA 7600 – Baby Friendly Hospital.


Early bonding for mother is Early Rooming in and early baby breast technique for early bonding
Early bonding for father is thru cuddling
E.O. 51 – Milk Code (Breast Milk)
• Avoid manufactured or formula milk
How to be an R.N. under 9173

• Have all qualifications


• take the exam
• acquire the required ratings
• In order to pass the examination, an examinee must obtain a general average of at least 75 %
with a rating of not below sixty percent (60%) in any subject
• 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 us
treated below 60 % (60%). In order to pass the succeeding examination, an examinee must
obtain a rating of at least 75% in the subject or subjects repeated.”
RA 8981 –Modernization Act.

• For every 5,000, results will be released after 5days


PRC rating NAME

• Text to 263 (smart) 233 (globe)

What are the grounds for nurse not to be registered?

• D – Dishonorable conduct
• U – Unsound mind
• M – moral turpitude
• I – Indecent immortal conduct