Legal Aspect and the nurse

Professional Negligence refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the same, or similar circumstance would or would not do, and acting or the non acting of which is the proximate cause of injury to another person on his property.

Elements of Professional Negligence

1) Duty- duty is owed to a client > nurse fails to meet standard of care > scope of duty is within professional nursing boundaries. 2) Breach of duty deviation from standard of care is established. 3) Injury physical, emotional harm is established 4) Causation direct cause for failure to meet standard of care clearly established.

INFORM CLIENTS ABOUT????

Current
medical status and general course of illness

Alternatives to
proposed treatment

Proposed
treatment rationale

Risks and
benefits of proposed treatment

EXAMPLES: 1) Failure to report observations to attending physician. 2) Failure to exercise the degree of diligence which the circumstances of the particular case demands. 3) Mistaken identity. 4) Wrong medicine, wrong concentration, wrong route, wrong dose. 5) Defects in the equipment such as stretchers & wheelchairs may lead to falls thus injuring the patient.

6) Errors due to family assistance. 7) Administration of medicine without a doctors prescription.

DOCTRINE OF RES IPSA LOQUITOR

The thing speaks for itself

Conditions: 1) That the injury was of such nature that it would not normally occur unless there was a negligent act on the part of the someone; 2) That the injury was caused by an agency within the control of the defendant. 3) That the plaintiff himself did not engaged in any manner that would tend to bring about the injury.

DOCTRINE OF RESPONDEAT SUPERIOR

Let the master answer for the acts of the subordinate

DOCTRINE OF FORCE MAJEURE

Irrisistable Force

Legal Defense in Negligence

When the nurse know and attain that standard of care in giving service & that they have documented the care they give in a concise & accurate manner.

An injury
occurred within the Breadth of duty of the nurse where Cause of injury is the failure to perform the Duty!

M
A L P R A C T I C E

Denotes stepping beyond ones authority with serious consequences.

Refers to a negligent act committed in the course of professional performance.

COMPONENTS OF MALPRACTICE
1. Nurse has a duty 2. Nurse fails to follow the set standards 3. Actual harm occurs 4. Failure to act accdg to standards caused the injury.

STANDARD OF CARE is.

what a nurse with similar experience and education with sound judgment would have done given the similar situation.

CONFIDENTIALITY OF INFORMATION
Also termed as PRIVILEDGED COMMUNICATION given based on trust May only be revealed WHEN: 1.) The patient himself/herself permits such revelations as in the case of claim for hospitalization, insurance benefits, among others; 2.) The case is MEDICO-LEGAL such as attempted suicide, gunshot wounds which have to be reported to the local police or NBI or constabulary; 3.) The patient is ill of communicable disease and public safety maybe jeopardized, and;

4.) Given to members of the health team if information is relevant to his case. it may also be revealed as provided for by the law in ARTICLE IV, SEC. 4. of the new constitution, which states that: The privacy of communication & correspondence shall be inviolable except upon lawful order in the court or when public safety & order requires otherwise as prescribed by law.

RESPONSIBILITIES OF THE NURSE TO THE PATIENTS

Primary responsibilities to give him/her the kind of his/her condition needs. NEEDS PHYSICIANS ORDERS AILMENT
Regardless of his/her: 1. Race 2. Creed 3. Color 4. Nationality or status

Patients Responsibilities
Providing information. Complying with instructions. Informing the physician of refusal to treatment. Paying hospital charges. Following hospital rules & regulations. Showing respect & considerations.

RESPONSIBILITIES OF NURSE TO THE PHYSICIAN

Sec. 28 (a) of R.A. 9173 states that: It shall be the duty of the nurse to: 1.) Provide nursing care through the utilization of the nursing process. 2.) Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, comfort measures, health teachings, & administrative of written prescription for treatment, therapies, oral, topical, & parenteral medications.

3.) Internal examinations during labor in the absence of antenatal bleeding & delivery; 4.) In case of suturing of perineal laceration, special training shall be provided according to protocol established.

RESPONSIBILITIES OF NURSES TO THEIR COLLEAGUES

1.) To be able to get along smoothly with their colleagues. 2.) Shall adjust themselves to the organization and knows its policies and procedures. 3.) Shall establish good working relationship with coworkers 4.) Knows their place in the total organization so that they may cooperate, coordinate & maximize their work.

RESPONSIBILITIES OF NURSES TO THEMSELVES

1.) Maintaining competence by continuous learning. 2.) Conduct must bring credit to the profession. 3.) Live a life that will uphold their self respect DRESS-CODE. 4.) Act in a manners that is worth emulating.

LIABILITY OF NURSES FOR THE WORK OF NURSING AIDES Performs activity under the direct supervision of nurses. NURSES should not delegate their functions to nursing aides.

LIABILITY FOR THE WORK OF NURSING STUDENTS RA 9173

Nursing students do not perform professional nursing duties.

Supervised by their Clinical Instructors.

MEASURES TO MINIMIZE ERRORS

1) Nursing students should always be under supervision of their clinical instructors. 2) They should be given assignments that are at their level of training, experience and competency. 3) They should be advised to seek guidance especially if they are performing first time procedures. 4) They should be oriented to the policies of the nursing unit where they are assigned. 5) Their performance should be assessed frequently to determine their strength & weakness. 6) Frequent conference with the students.

Living Wills or Advance Directives

Fundamental Requirements: 1.) It is signed by the patient. 2.) Witnessed by two other persons who declare that the patient signed the weal. 3.) Sound of mind. 4.) Free of duress or undue influence. 5.) Witness must be 18 y/o. attached to patients chart it has a force of law

TELEPHONE ORDERS
1) Read back such orders to the physician. 2) Orders must be signed within 24 hrs. 3) Sign the name of the physician per her own & note the time the order was received. 4) At least 2 R.Ns as a witness.

 Voluntary without

INFORMED
C O N S E N T

coercion or force

Informed Competent, having the

capacity

Knowledgeable
information provided

Signed prior to pre-op

medications

Free and rational act that presupposes knowledge of the thing to which consent is being given by a person who is legally capable to give consent. ELEMENTS: 1) Diagnosis and explanation of the condition. 2) Fair explanation of the procedures to be done & its consequences.

3) Description of alternative treatments 4) Description of benefits 5) Prognosis PROOF OF CONSENT WHO MUST CONSENT CONSENT OF MINORS CONSENT OF MENTALLY ILL EMERGENCY SITUATION REFUSAL TO CONSENT CONSENT FOR STERILIZATION

Hospital

Legal Protection
Doctors rses

IF IT WAS OT CHARTED, IT WAS OT OBSERVED OR DO E

TORT
Is a legal wrong, committed against a person.
EXAMPLES: 1. Assault and Battery 2. False imprisonment or Illegal Detention 3. Invasion of Right to Privacy and Breach of Confidentiality 4. Defamation

CRIME
IN VIOLATION OF LAW

ACT

COMMITTED OR OMITTED

CRIME

CRIMINAL ACT -acts or offenses against a public welfare

CRIMINAL INTENT -state of mind of a person at the time the criminal act is committed, that is, he knows that an act is not lawful, and still decided to do it anyway

 general name for a criminal offense which does not in law amount to felony. - punishment- fine or less than one year imprisonment.

 public offense for which a convicted person is liable to be sentenced to death or to be imprisoned.

Deceit Deliberate intent

Fault Wrongful acts

CONSPIRACY TO COMMIT A CRIME

Exist when two or more persons agree to commit a felony and decide to do it.

CLASSIFICATION OF PERSONS WHO COMMIT FELONIES

PRINCIPAL

ACCESSORIES ACCOMPLICES

CLASSES OF FELONIES
CONSUMMATED

FRUSTRATED

ATTEMPTED

GRAVE FELONIES capital punishment (6years and 1 day to life imprisonment, fine of not > 6,000) LESS GRAVE 1 month and 1 day to 6 years; not exceeding 6,000 but not less than 200 LIGHT FELONY arresto menor; 1 day to 30 days; fine not exceeding 200

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY

Justifying Circumstance the acts of the actor are in accordance with the law , hence he incurs no criminal and civil liability ( no crime, no criminal). Self- defense Defense of Relative Defense of stranger State of necessity Fulfillment of duty Obedience to superior order

Exempting Circumstance those wherein there is an absence in the agent of the crime any of all the conditions that would make an act voluntary and hence, although there is no criminal liability, there is civil liability ( no criminal but there is crime ). Imbecility and Insanity Minority Accident

Mitigating Circumstances those that have the effect of reducing the penalty due to the lesser perversity of the offender. Voluntary Surrender Voluntary plea of guilty Deaf, and dumb, blind Incomplete self-defense Offender is below 18 or over 70 years old

Aggravating Circumstance those which increases the penalty. Taking advantage of official position Crime is committed in contempt of or with insult to public authorities

Alternative Circumstance either aggravating or mitigating depending on the facts of the situation. degree of relationship intoxication illiteracy or lack of education

POINTS TO OBSERVE IN ORDER TO AVOID CRIMINAL LIABILITY

1. Be very familiar with the Philippine Nursing Law 2. Beware of laws that affect nursing practice 3. At the start of employment, get a copy of your job description, the agencys rules, regulations and policies 4. Upgrade your skills and competence

5. Accept only such responsibility that is within the scope of your employment and your job description 6. Do not delegate your responsibility to others 7. Determine whether your subordinates are competent in the work you are assigning them 8. Develop good interpersonal relationship with your co workers, whether they be your supervisors, peers or subordinates

9. Consult your superiors for problems that may be too big for you to handle 10. Verify orders that are not clear to you or those that seem to be erroneous 11. The doctors should be informed about the patients condition 12. Keep in mind the value and necessity of keeping accurate and adequate records 13. Patients are entitled to an informed consent

WILLS
Is a legal declaration of a persons intentions upon death. It is called TESTAMENTARY DOCUMENT because it takes effect after the death of its maker.

 DECEDENT is a person whose property is transmitted through succession whether or not he left a will. TESTATRIX if the person making a will is a woman TESTATOR if the person left a will TESTATE a person who dies leaving a will INTESTATE one who dies without a will PROBATE validation of a will in a court.

GIFTS
FOUR LEGAL REQUIREMENTS the gift must consist of personal property there must be an intention to make the gifts there must be an indication of transfer of control over such property there must be acceptance by the recipient

 Act # 1931 Created for the ESTABLISHMENT OF NURSING SCHOOLS in the country under the Bureau of Education in 1909. Act # 1975 An act that transferred the school of NURSING UNDER THE BUREAU OF HEALTH. Act # 2468 An act that authorized the GRANTING OF THE TITLES of graduate in nursing and midwifery from the school of nursing of Philippine General Hospital in 1915.

 Act # 2808 This act provided for the earliest and TRUE NURSING LAW that served as the basis of the practice of nurses in the Philippines in 1919 and a year after its passage, the first local licensure or board examination for nurses was held in 1920. The First Board Examiners were created under act # 2808 composed of three members then appointed by the Secretary Interior. The chairman was a doctor of medicine and the other two are registered nurses who must possess an experience in the nursing profession for at least five years and with a reputable character.

 RA # 649 provided for the standardization of nurses salaries both in institutions and in public health. RA # 465 an act which STANDARDIZED THE FEES charged by the Examining Boards for Examination and Registration. RA # 546 An act that reorganized and placed all the BOARD OF EXAMINERS under the direct supervision of the President of the Philippines.

RA # 877 An Act also known as the Philippine Nursing Law of 1953 approved on June 19, 1953. This Law was sponsored by Senator Geromina T. Pecson which enacted to regulate the practice of nursing in the Philippines and to set up provisions for the registration of nurses, for the establishment and maintenance of standards of nursing education and nursing practice.

RA # 1080 This act approved on 1954 is also known as, An Act Declaring the Bar and Board Examinations as CIVIL SERVICE EXAMINATIONS which means that when a four year degree course graduate had passed the board examinations or the Bar examinations for lawyers they automatically become first grade civil service eligible.

 RA # 6136 In 1971, This Republic Act introduced other MINOR REVISIONS IN THE NURSING LAW of 1966 thus amending RA 4704 of 1966. RA 7164 PHILIPPINE NURSING ACT OF 1991 was sponsored by Senator Heherson Alvarez and was approved and signed by President Corazon Aquino on November 21, 1991.

 RA # 997 This Republic Act in 1954 ABOLISHED THE DIVISION OF NURSING and created a decentralized organization with a chief Public Health Nurse consultant in the office of the Secretary of Health, and five consultant positions in nursing; namely, in Maternal and Child Health, in Preventable Diseases, in Institutional Nursing, in Nursing Education, and in Hospital Standardization. RA # 4704 This act in 1966 AMENDED THE PHILIPPINE NURSING LAW OF 1953 otherwise known as RA 877 and introduced some minor revisions of the said act due to some developments of the practice of nursing in the country.

 ILO convention 149 and Recommendations 157 In 1977, the Philippine Nurses Association, formerly known as the Filipino Nurses Association established in 1922 lobbied our government for the adoption of ILO 149 and Recommendations 157 that were adopted in Geneva. It set the concerns of employment of nursing personnel and the CONDITIONS OF THE LIFE AND WORK OF NURSES and in 1978; the PNA passed The Declaration on the Economic and Social Welfare of Filipino Nurses.

 Proclamation No. 539 The President of the Philippines declared on October 17, 1958 that the last week of October (through this proclamation ) as the NURSES WEEK Presidential Decree No. 223 This decree formed the PROFESSIONAL REGULATION COMMISSION on June 23, 1973. Among its power is the regulation of different profession which used to be under the Civil Service Commission.

 RA 6511 This Act Amended RA 465 in 1972, which STANDARDIZED the examination and REGISTRATION fees charged by the various Board Examiners. Letter of Instruction No. 1000 this required that the members of Accredited Professional Organizations (eg. PNA) shall be given PRIORITY in the HIRING of employees in the government service and in the engagement of professional services.

 RA 1612 Refers to the payment of PRIVILEGE TAX before any business or occupation can be lawfully begun or pursued. RA 7392 This Act provided that only licensed midwives could practice and that nurses must pass first the MIDWIFERY EXAMINATION before they can practice midwifery

 RA 2382 PHILIPPINE MEDICAL ACT ; defines the practice of medicine in the Philippines. Section 10 of this Act provides: Act constituting the practice of medicine. A person shall be considered as engaged in the practice of medicine who shall for compensation, fee, salary, or reward in any form paid to him directly or through another or even without the same may physically examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental, physical condition or ailment nature, real or imaginary, regardless of the remedy or treatment administered, prescribed or recommended

Presidential Decree 541 a decree allowing former Filipino (BALIKBAYANS) professionals to practice their respective profession in the Philippines.

 RA 6425 DANGEROUS DRUG ACT enacted in 1972 declaring that sale, administration, delivery, distribution, and transportation of prohibited drugs are punishable by law. Act No. 3573 This Act in 1929 declared that all COMMUNICABLE DISEASES shall be REPORTED to the nearest health station, and that any person may be inoculated, administered or injected with prophylactic preparations. RA 1082 creation of RURAL HEALTH UNITS in the Philippines.

 RA 4073 liberalizes the LEPROSY TREATMENT. No person shall be confined in leprosarium unless such disease requires institutional treatment. Presidential Decree 996 COMPULSORY IMMUNIZATION for all children below eight years old. RA 8981 PRC MODERNIZATION ACT OF 2000 This Act gave the Professional Regulatory Commission its regulatory powers and is now an agency of its own.

 Presidential Decree 825 provided penalty for improper disposal of GARBAGE and other forms of uncleanliness. Presidential Decree 856 CODE OF SANITATION, provides for control of all factors in mans environment that affect health including the quality of water, food, milk, control of insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, unpleasant odors and control of nuisance.

 Presidential Decree 148 WOMAN AND CHILD LABOR LAW The employable age is 16 years and above and further provides for the privileges of working women. RA 6365 established a National Policy on Population and created the Commission on Population (POPCOM). PD 791 revised population Act. Empowered nurses and midwives to provide, dispense and administer acceptable METHODS OF CONTRACEPTION after having undergone training and having been granted authorization by POPCOM.

 PD 166 Strengthened FAMILY PLANNING programs through participation of private organizations and individuals in the formulation and implementation of the program planning policies. General Order No. 18 enjoins all citizens of the Philippines, universities, colleges, schools, government offices, mass media, voluntary and religious organizations of all creeds, business and industrial enterprises to promote the concept of family welfare, responsible parenthood and family planning.

 Letter of Instruction No. 47 directs all schools of medicine, nursing, midwifery and allied medical professions and social work to prepare, plan, and implement the INTEGRATION OF FAMILY PLANNING in their curricula and to require from their graduates sufficient appropriate licensing examination. Department of Labor Order No. 7 requires all industrial establishments to provide FAMILY PLANNING SERVICES.

 PD 48 limits paid MATERNITY LEAVE privileges to four children. PD 69 limits the number of children to FOUR for TAX EXEMPTIONS purposes. PD 965 requires that couples intending to get married must first undergo a family planning and responsible PARENTHOOD INSTRUCTION prior to the issuance of marriage license.

 RA 1054 requires the owner, lessee or operator of any commercial, industrial or agricultural establishment to furnish free EMERGENCY, medical, and dental ASSISTANCE to his employees and laborers. RA 4226 HOSPITAL LICENSURE ACT requires all hospital in the country to be licensed before it can offer to serve the community. The licensing agency is the Office For Hospital and Medical Services, Department of Health.

 RA 5901 nurses working in agencies with 100-bed capacity and/or above and are working in area of one million population are supposed to WORK 40 HOURS A WEEK. PD 442 LABOR CODE OF THE PHILIPPINES provides the right of the workers to self-organization and collective bargaining agreement. PD 603 CHILD AND YOUTH WELFARE CODE protects and promotes the rights and welfare of children and youth.

 PD 651 decrees the REGISTRATION OF BIRTH of a child within 30 days with the Civil Registrar. PD 1519 MEDICARE BENEFITS TO ALL GOVERNMENT EMPLOYEES regardless of status of appointment. PD 626 EMPLOYEE COMPENSATION AND STATE INSURANCE FUND RA 6675 GENERICS ACT OF 1998

 RA 6758 - standardized the salaries of government employees which include the nursing personnel. RA 7160 LOCAL GOVERNMENT CODE OF 1991devolution of powers from national to local government. RA 7305 MAGNA CARTA FOR PUBLIC HEALTH WORKERS

RA 7600 ROOMING-IN AND BREASTFEEDING ACT OF 1992 provides that babies born in private and government hospitals should be roomed-in with their mothers to promote breastfeeding and ensure safe and adequate nutrition to children. EO 51 MILK CODE RA 7432 SENIOR CITIZENS ACT does honor and justice to our peoples long tradition of giving high regard to elderly. 20% discount in all public establishments such as restaurants, pharmacies, public utility vehicles and hospitals. PRC Resolution No. 2004-17 Series of 2004 REIMPLEMENTED CONTINUING PROFESSIONAL EDUCATION requiring sixty (60) credit units for three years for professionals with bachelors degree

The Patients Bill of Rights (Filipino)

The patient has the right to considerate and respectful care, irrespective of socioeconomic status The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected and understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person in his behalf. He has the right to know by name and in person, the physician and nurse responsible in coordinating his care

 The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include but not necessarily limited to the specific procedure and/or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient has also the right to know the name of the person responsible for the procedures and/or treatment.

 The patient has the right to refuse treatment/life giving measures, to the extent permitted by law, and to be informed of the medical consequences of his action. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. The patient has the right to expect that all communication and records pertaining to his care should be treated confidential.

 The patient has the right to expect that within its capacity, a hospital must make reasonable response to the request of patient for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of care. When medically permissible a patient may be transferred to another facility only after he has received complete information concerning the needs and the alternatives to such transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer.

 The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. The patient has the right to obtain information as to the existence of any professional relationship among individuals, by name, who are treating him. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research project

 The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby his physicians or a delegate of the physician of the patients continuing health care requirements following discharge informs him. The patient has the right to examine and receive an explanation of his bill regardless of source of payment. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.

NURSES BILL OF RIGHTS

Nurses have the right to practice in a manner that fulfills their obligation to society and to those who receive nursing care. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the code of Ethics for nurses and its interpretive statements.

 Nurses have the right to freely and openly advocate for themselves and their patients, without fear or retribution Nurses have the right to a fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities. Nurses have the right to a work environment that is safe for themselves and their patients. - Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings

AMENDED CODE OF ETHICS

Their conduct should be such that would bring credit to the profession. Just like any other professional, nurses are looked upon with respect in the community. They should therefore endeavor to live a life that would uphold their self-respect. Especially when nurses are on duty, they should try to look neat and attractive. Female nurses are advised to use moderate make-up and have a neat hairstyle. They should wear uniforms that are not too short or tight fitting that would tend to restrict movements, nor expose unnecessarily

any part of the body while giving care to the patients. Clean uniforms and clean bodies tend to enhance the image of nurses. Use of anti-perspirant is advised most specially during hot summer months. Male nurses are likewise advised to be clean, shaven, hair clipped close to the nape of the neck instead of flowing to the shoulders.

The use of the uniform should be specified in the policy of the hospital/agency. It should be worn only when on duty. Dining in the public, shopping or going to the market while in uniform is discouraged. Nurses caps are worn only while on duty. These are either carried in bags or are left in their places of assignment.

Jewelry, such as earrings, necklaces or bracelets are not allowed while on duty. However, wedding rings, school rings or school pins may be worn.

 Nurses are looked upon by nursing students as their role models. Therefore, especially while they are on duty, they should act in a manner that is worth emulating. Sincere and compassionate attitudes toward patients are caught by those around them. Soon their working environment becomes permeated with good working relationships that are so vital in dealing with patients.

GENERAL REMINDERS!!!