Professional & Personality Development in Nursing PDF

PROFESSIONAL & PERSONALITY DEVELOPMENT IN THE NURSING PROFESSION DR. CHARLIEMANE A. BULLALAYAO Dean, College of Allied Health Sciences Professor ETHICS ▪came from the Greek word ethos which means moral duty ▪refers to a standard to examine and understand moral life M...

PROFESSIONAL & PERSONALITY DEVELOPMENT IN THE NURSING PROFESSION DR. CHARLIEMANE A. BULLALAYAO Dean, College of Allied Health Sciences Professor ETHICS ▪came from the Greek word ethos which means moral duty ▪refers to a standard to examine and understand moral life MORALS ▪derived from the Greek word moralis which refers to the social consensus about moral conduct for human beings and society ▪right or wrong, good or evil, proper or improper, cruel or benevolent acts are explained in terms of morality PROFESSIONAL ETHICS – a branch of moral science concerned with the obligations that a member of the professional owes to the public HEALTH CARE ETHICS – a division of ethics that relates to human health; decides on the realms of human values, morals, customs, personal belief, and faith BIO-ETHICS – specific domain of ethics that focuses on moral issues in the field of health care; evolved into a discipline all on its own as a result of life and death dilemmas faced by health care practitioners Ethico-Moral Aspects of Nursing Divine Command Ethics ▪ Based on the theory that there is a Supreme or Divine being that sets down the rules to guide moral decisions ▪ For Christians, these rules are found in the Ten Commandments ▪ Differences in religion pose problems such as what to do when the decision would conflict with one religious belief – Jehovah’s Witnesses will not receive blood transfusion even if their lives will be put in danger ▪ This is also applicable to cases of euthanasia, referral of a patient to an abortionist Divine Command Theory includes the claim that morality is ultimately based on the commands or character of God, and that the morally right action is the one that God commands or requires.  VOWS CHASTITY OBEDIENCE POVERTY 3 IMPORTANT PLACES TO VISIT Autonomy ▪ it involves self-determination and freedom to choose and implement one’s decision, free from deceit, duress, constraint, or coercion ▪ this is called informed consent ▪ the person making the decision must be deemed competent: a. intellectual capacity to make a rational decision b. must be of legal age c. that the decision is of his own free will and not coerced or put under duress to do so DECEIT ▪ dishonest behavior that is intended to make someone believe something that is not true ▪ “panlilinlang” DURESS ▪ threats, violence, constraints, or other action brought to bear on someone to do something against their will or better judgment ▪ “pilit” CONSTRAINT ▪ Limitation or restriction ▪ “paghihigpit” COERCION ▪ the practice of persuading someone to do something by using force or threats ▪ “pamimilit” Therapeutic Privilege ▪A legal exception of the rule of informed consent, which allows the caregiver to proceed with the care in case of emergency, incompetence, waiver, or implied consent Veracity – the patient has the responsibility to provide, to the best of his knowledge, accurate and complete information about his complaints, past illness, previous hospitalizations, medications being taken, allergies, religious restrictions, and other matters relevant to his health Beneficence – promotes doing acts of kindness and mercy that directly benefit the patient – these acts promote the health of the patient, prevent illness or complications, alleviate suffering and assist towards a peaceful death if the inevitable comes Examples of Beneficence in Nursing Practice Providing high-quality patient care Respecting the autonomy of their patients and respecting their wishes regarding their care Providing patients with emotional support Ensuring patients’ medical needs are met Educating patients about healthy lifestyle choices Coordinating patient care with other healthcare providers Nonmaleficence ▪ It is stated as an admonition in the negative form to remind health practitioners to do no harm ▪ It is the obligation of a physician not to harm the patient. This simply stated principle supports several moral rules − do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life. Justice ▪ the right to demand to be treated justly, fairly, and equally Responsibilities of the Nurse to Patients ▪ the primary responsibility of nurses is to give them the kind of care their condition needs regardless of their race, creed, color, nationality, or status ▪ the patient’s care shall be based on needs, the physician’s orders and shall include the families so they can participate in their care Confidentiality of Information ▪ AKA Privileged Communication – because it is given based on trust ▪ Patients and or their relatives are expected to give the necessary information so that proper diagnosis and treatment could be made ▪ Patients and families are entitled to know information or facts within the limits determined by the physician PATIENT’S RESPONSIBILITIES Providing information – has the responsibility to provide – to the best of their knowledge – accurate and complete information about their complaints, past illnesses, hospitalization, medication, and other matters relating to their health. If the patient cannot provide said information, the family is responsible for doing so on their behalf Complying with instructions – patient is responsible for complying with the treatment plan recommended by the attending physician. They are expected to keep appointments abiding by the hospital rules. Informing the physician of refusal – a patient who refuses treatment or to be compliant with the treatment regimen must inform the physician of his decision Paying hospital charges - he/she is responsible for ensuring that financial obligations of his/her health care are fulfilled as promptly as possible Following Hospital rules and regulations – he/she is responsible for following the hospital rules and regulations and shall advise his/her family to do so Showing respect and consideration – he/she must be considerate of the rights of other patients and hospital personnel and shall assist in the control of noise. The client must respect the property of others and that of the hospital Nurses’ Bills of Rights – advocated by the ANA and adopted by its Board of Directors on June 26, 2001 1. Nurses have the right to practice in a manner that fulfills their obligations to society and those who receive nursing care 2. Nurses have the right to practice in environments that allow them to act following professional standards and legally authorized scopes of practice 3. Nurses have the right to a work environment that supports and facilitates ethical practice 4. Nurses have the right to freely and openly advocate for themselves and their parents, without fear of retribution 5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities 6. Nurses have the right to a work environment that is safe for themselves and their patients 7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings Basic Human Rights of Research Subjects 1.Right to informed consent – the subject must understand the risk involved, the benefits anticipated, time and energy requirements and any anticipated loss of dignity or autonomy; any anticipated pain or discomfort, psychological stress or embarrassment; and the way data will be handled and reported 2. The right to refuse and/or withdraw from participation – the person has the right to refuse to participate. Nurses shall explore the reason for refusing. Refusal to participate can be minimized if at the onset the subject has given a careful and honest opinion on what is to be done. 3. Right to privacy – the right includes the privacy of one’s thoughts, opinions, and physical presence, and privacy of one’s records. He/she has the freedom to decide the time, the extent, and circumstances he/she willingly share his/her presence, thoughts, beliefs, attitudes, and behaviors with others 4. Right to confidentiality or anonymity of data – data about the research subjects shall be handled confidentially. Data shall be available only to the research staff and be reported anonymously. Data shall not be used other than for the specific purpose for which the subject gave consent and shall not be made public or available to others 5. Right to be protected from harm – there shall be an appropriate balance between potential benefits of the research and the risks assumed by the subjects. This is called the risk-benefit ratio in which the benefits outweigh the harm – these include physical, legal, emotional, financial, and social harm Responsibilities of The Nurse To The Physician 1. It is therefore expected that nurses will not carry out doctor’s orders but help plan and implement patient care as well 2. The patient’s condition should be reported including results of therapies so that management of care can be properly monitored and modified as necessary 3. If any of the medical orders were not carried out for some reason, such shall not only be brought to the attention of the physician but also noted properly in the patient’s chart – explore the patient’s reason for refusal. Clarify misconceptions as needed 4. Nurses shall familiarize themselves with the various routines, methods, or idiosyncrasies of physicians, so those smooth relationships can be maintained Responsibilities of The Nurse to Their Colleagues 1. Nurses must know their place in the total organization so that they may cooperate, coordinate and maximize their work. Loyalty and consideration of others while at work will foster a healthy relationship. 2. Constructive criticism is always welcome but not fault- finding. Fault finders, gossipers, and those who are fond of intrigues will surely resent it too if they become the target of their practices Responsibilities of Nurses To Themselves 1.Nurses shall live a life that will uphold their self-respect 2.They shall try to look neat and attractive – females are advised to use moderate make-up and have a neat hairstyle. They shall wear uniforms that are neither too short nor tight-fitting that will tend to restrict movements, nor expose unnecessarily any part of the body while giving care to patients – clean uniforms and clean bodies tend to enhance the image of nurses 3.Use of anti-perspiring is advised most especially during hot summer months. Male nurses are likewise advised to be clean-shaven, with hair clipped close to the nape instead of flowing to the shoulders 4. Uniforms shall be worn only on duty. Dinning in public, shopping, or going to the market while in uniform is discouraged 5. Nurses’ caps are worn only while on duty 6. Jewelry such as earrings, necklaces, or bracelets is not worn while on duty. However, wedding rings, school rings, or pins may be worn 7. Nurses should act in a manner that is worth emulating. Sincere and compassionate attitudes towards patients are caught by those around them Moral Principles 1. The Golden Rule. God said, “Do unto others what you would like others to do unto you”. Since nurses like others to treat them kindly and with respect, they should be willing to do the same to others too. 2. The two-fold effect. When a nurse is faced with a situation which may have both good and bad effects, how should she choose which one to follow? The basis of action may be the following: a.That the action must be morally good b.That the good effect must be willed and the back effect merely allowed c. That the good effect must not come from an evil action but from the initial action itself directly d.That the good effect must be greater than the bad 3. The Principle of Totality. The whole is greater than any of its parts 4. Epikia. “Exception to the general rule”. It is a reasonable presumption that the authority making the law will not wish to bind a person in some particular case, even though the case is covered by the letter of the law 5. One who acts through an agent in himself responsible 6. No one is obliged to betray himself/herself – in testifying before a court, no one can force any person to answer a question if such will incriminate (will cause to look guilty) him or her. 7. The end does not justify the means 8. Defects of nature may be corrected - children born with congenital defects can be corrected by plastic surgery 9. If one is willing to cooperate in the act, no injustice is done to him/her a.Willing to participate in the act b.Right age c.Sane (sound mind) d.No violation of human rights 10. A little more or less does not change the substance of an act – getting others property without permission is guilty of theft 11. The greatest good for the greatest number – although there may be some who has a slight reaction (medications), the greater population may be considered rather than the isolated few 12. No one is held to the impossible - to promise that a patient will live may be impossibility. Medical practitioners cannot be held to the impossible if they have done their best to take care of the patient and then later die. 13. The morality of cooperation - formal cooperation to an evil act should not be participated by a nurse even a doctor commands for it 14. Principle relating to the origin and destruction of life – thou shall not kill Spiritual Commitment of Nurses 1. Christian nurses often refer to the bible for inspirational passages that will enhance and strengthen their love and concern for their fellowmen. Muslims, on the other hand, find appropriate passages in the Quran 2. St. Paul’s message to the Colossians is very apt for nurses. He said, “You are the chosen people of God. He loves you and chose you for His own. So then, clothe yourselves with compassion, kindness, humility, gentleness, and patience.” 3. The nurse’s ministry is reflected in God’s two great commandments: “Love the Lord God with all your heart, and with all your soul and with all your mind” and “Love your neighbors as yourself.” 4. The role of nurses in providing non-prejudicial, non-discriminatory care can be based on the story of the Good Samaritan. God has asked us to love one another as He loves us. 5. Jesus has exhorted us, “not to become tired of doing good, for if we do not give up, the time will come when we will reap the harvest.” 6. Doing one’s duties with a cheerful heart does good like medicine but a broken spirit makes one sick 7. God gave assurance that man will inherit the kingdom of God. “For whenever we feed the hungry, give water to the thirsty, take in a stranger, and visit those in prison, we have done these to God.” 8. Stillbirths of Catholic parents are given emergency baptism 9. If there is a danger of death, Roman Catholic patients are obliged to receive the sacraments. Confessions and communion are recommended The Good Samaritan Law 1. It has been passed in the USA to encourage on-the-spot volunteer first aid emergencies by persons with the proper knowledge and skills 2. The Good Samaritan Act is based on the biblical story of a man who aided an injured person who was waylaid by thieves and was left half-dead. The Samaritan took care of him with compassion, bounded up to his wounds, brought him to an inn, and took care of him. Nurses And Suffering 1. A Christian nurse’s duty is not only to give physical care but to pray for or with them so that they may also have spiritual healing and to make them feel that God is with them always 2. Psalms 23 - portrays God as a good shepherd, feeding (verse 1) and leading (verse 3) his flock.... It is known that the shepherd is to know each sheep by name, thus when God is given the analogy of a shepherd, he is not only a protector but also the caretaker. Life In God’s Service 1. Nurses can use their different gifts following the grace that God has given them 2. If their gifts are to speak God’s message, they should do it according to the faith they have; if it is to serve, they should serve; if it is to teach, they should teach; if it is to encourage others, they should do so Legal Aspects of Nursing 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 Purpose of License 1. To protect the health of the people by establishing minimum standards which qualified practitioners must meet 2. It is used to gather statistical data about nurses and nursing in the country Professional Regulation Commission – the appropriate authority to administer, implement and enforce the regulatory policies of government concerning the regulation and licensing of the various professions and occupations under its jurisdiction Registration – is the recording of names of persons who have qualified under the law to practice their respective professions Nurses’ names are recorded 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 from which he or she graduated or in which he or she has studied 7. Date of graduation or term of study, together with the time spent in the study or the profession elsewhere 8. All other degrees granted to him or her from other institutions of learning RECIPROCITY − mutuality in the grant and enjoyment of privileges between persons or nation − it is a relation established by law, treaty, or agreement between two countries or states, whereby each country or state grants to citizens of each other, the privilege of being admitted to the practice of the profession within their respective territorial jurisdiction − it is based on the principle of “DO UT DES” which means that for a country to expect a favor from another, it should be willing to give a corresponding favor Section 20. 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: Provided, that the requirements for registration or licensing of nurses in the said country are substantially the same as those prescribed under this Act: Provided, further, That 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. Examination and Registration Section 12. Licensure Examination All applicants for a license to practice nursing shall be required to pass a written examination, which shall be given by the Board in such places and dates as may be designated by the Commission: Provided that it shall be in accordance with Republic Act No. 8981, otherwise known as the "PRC Modernization Act of 2000." "PRC Modernization Act of 2000” SECTION 2. Statement of Policy. The State recognizes the important role of professionals in nation building and, towards this end, promotes the sustained development of a reservoir of professionals whose competence has been determined by honest and credible licensure examinations and whose standards of professional service and practice are internationally recognized and of professional service and practice are internationally recognized and considered world-class brought about the regulatory measures, programs and activities that foster professional growth an advancement. Section 13. Qualifications for Admission to the Licensure Examination. - In order to be admitted to the examination for nurses, an applicant must, at the time of filing his/her application, establish to the satisfaction of the Board that: 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 on the same basis as the subject or citizen of such country: Provided, That the requirements for the registration or licensing of nurses in the said country are substantially the same as those prescribed in this Act; 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. a. Requirement for Examination Basic requirements under the PRC 1. PSA birth certificate 2. Marriage contract for married female applicants 3. TOR with scanned picture and remarks “ for board examination purposes” for first timers and repeaters 4. Payment 5. Summary of RLE Major cases – 3 Circulating Nurse – 3 Assisted Deliveries – 3 Cord Dressing – 3 6. Certificate of Undertaking duly signed by a qualified Dean – if under CMO 30 7. Notarized certificate of undertaking – CMO 14 s 2009 Section 14. Scope of Examination The scope of the examination for the practice of nursing in the Philippines shall be determined by the Board. The Board shall take into consideration the objectives of the nursing curriculum, the broad areas of nursing, and other related disciplines and competencies in determining the subjects of examinations. Whereas, the following are the current classification of the subjects for the PNLE with each having one hundred items and percentage weight of 20% Nursing Practice I – Foundation of Nursing and Professional Nursing Practice Nursing Practice II – Community Health Nursing and Care of the Mother and Child Nursing Practice III – Care of Clients with Physiologic and Psychological Alterations (A) Nursing Practice IV – Care of Clients with Physiologic and Psychological Alterations (B) Nursing Practice V – Care of Clients with Physiologic and Psychological Alterations (C)  However, under Professional Regulatory Board of Nursing Resolution No. 11, Series of 2017, the subjects were further reclassified as follows: Whereas, the Board initiated consultations with its stakeholders, including the members of the Association of Deans of the Philippine Colleges of Nursing, to review the current classifications of the subjects of the PNLE, and to recommend the possible changes and revisions thereto for the consideration of the Commission. Wherefore, the Board resolves, as it is hereby resolved, to reclassify the subjects in the PLE as follows: ✓ The Nursing Practice I on Foundation of Nursing and Professional Nursing Practice shall no longer be treated as a separate and independent component of the PNLE, but instead be subsumed or integrated in all the PNLE examination subjects. ✓ The Nursing Practice I shall be reclassified and renamed as Community Health Nursing, and which shall be assigned a relative weight of twenty percent (20%). ✓ The Nursing Practice II shall be reclassified and renamed as Care of Healthy/At Risk Mother and Child, and which shall be assigned a relative weight of twenty percent (20%). Resolved further, that the classifications and descriptions of Nursing Practice III, IV, and V shall be retained. The Resolution shall be applied starting November 2017 PNLE and all succeeding schedules. Section 15. Ratings - To pass the examination, an examinee must obtain a general average of at least seventy-five percent (75%) with a rating of not below sixty percent (60%) in any subject. An examinee who obtains an average rating of seventy-five percent (75%) or higher but gets a rating below sixty percent (60%) in any subject must take the examination again but only in the subject or subjects where he/she is rated below sixty percent (60%). To pass the succeeding examination, an examinee must obtain a rating of at least seventy-five percent (75%) in the subject or subjects repeated.  Section 16. Oath - All successful candidates in the examination shall be required to take an oath of a profession before the Board or any government official authorized to administer oaths before entering upon the nursing practice. The schedule of oath-taking is within fifteen days upon the release of the results of the licensure examination Passing the licensure examination does not mean that a person is already a registered nurse. Registration comes after his/her oath, and a registrant possesses all qualifications, having none of any disqualifications to be a registered nurse. Being a registered nurse, one will be included among the list of qualified nurse practitioners in the Philippines as officially registered before the Professional Regulation Commission. Having a license and certificate of registration legally proves one's qualification to practice. Notably, having a license and a certificate of registration is never a demandable right, but a mere privilege subject to the regulations imposed by the State. Hence, under Section 17, Article IV, R.A. 9173, it is stated that:  A certificate of registration/professional license as a nurse shall be issued to an applicant who passes the examination upon payment of the prescribed fees. Every certificate of registration/ professional license shall show the full name of the registrant, the serial number, the signature of the Chairperson of the Commission and of the Members of the Board, and the official seal of the Commission. A professional identification card, duly signed by the Chairperson of the Commission, bearing the date of registration, license number, and the date of issuance and expiration thereof shall likewise be issued to every registrant upon payment of the required fees.  However, there are two instances under the law that allows the practice of nursing profession without taking the PRC Nursing Licensure Examination. Sections 20 and 21, Article IV, R.A. 9173 provides criteria to acquire a certificate of registration by reciprocity, and a special or temporary permit to practice nursing. The law states that: SEC. 20. 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: Provided, That the requirements for registration or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided, further, That 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. Renewal of Nurse’s License. Every practicing professional of the occupations regulated by the PRC shall pay a fee for three years which shall be paid on the professional’s birth month Compliance with Continuing Professional Development (CPD) Act of 2016 Section 23. Revocation and suspension of Certificate of Registration/Professional License and Cancellation of Special/Temporary Permit. The Board shall have the power to revoke or suspend the certificate of registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds: a. For any of the causes mentioned in the preceding section; b. For unprofessional and unethical conduct; c. For gross incompetence or serious ignorance; d. For malpractice or negligence in the practice of nursing; e. For the use of fraud, deceit, or false statements in obtaining a certificate of registration/professional license or a temporary/special permit; f. For violation of this Act, the rules and regulations, Code of Ethics for nurses and technical standards for nursing practice, policies of the Board and the Commission, or the conditions and limitations for the issuance of the temporarily/special permit; or g. For practicing his/her profession during his/her suspension from such practice.  Provided, however, that the suspension of the certificate of registration/professional license shall be for a period not to exceed four (4) years. SEC. 24. Re-issuance of Revoked Certificates and Replacement of Lost Certificates. - The Board may, after the expiration of a maximum of four (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.  A new certificate of registration/professional license to replace the certificate that has been lost, destroyed or mutilated may be issued, subject to the rules of the Board. If for any reason, a registered nurse has been inactive in practice for five (5) consecutive years, he/she will not be allowed to return to service unless there will be a certification that the nurse undergo one (1) month of didactic training and three (3) months of practicum. It shall be the duty of the Board of Nursing to accredit hospitals, which shall conduct the said training program (Section 26, Article V, R.A. 9173).  A new certificate of registration/professional license to replace the certificate that has been lost, destroyed or mutilated may be issued, subject to the rules of the Board. If for any reason, a registered nurse has been inactive in practice for five (5) consecutive years, he/she will not be allowed to return to service unless there will be a certification that the nurse undergo one (1) month of didactic training and three (3) months of practicum. It shall be the duty of the Board of Nursing to accredit hospitals, which shall conduct the said training program (Section 26, Article V, R.A. 9173). Due process of law ARTICLE III Section 1 of the 1987 Philippine Constitution states that no person shall be deprived of life, liberty, or property without due process of law, nor shall any person be denied the equal protection of the laws. It is also defined as a “law which hears before it condemns, which proceeds upon inquiry and renders judgment only after trial The Licensing Board a.Organization and Composition Section 3. Creation and Composition of the Board - There shall be created a Professional Regulatory Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They shall be appointed by the president of the Republic of the Philippines from among two (2) recommendees, per vacancy, of the Professional Regulation Commission, hereinafter referred to as the Commission, chosen and ranked from a list of three (3) nominees, per vacancy, of the accredited professional organization of nurses in the Philippines who possess the qualifications prescribed in Section 4 of this Act. Members of the BOARD OF NURSING ELSIE A. TEE, Chairperson CARMELITA C. DIVINAGRACIA, Member ZENAIDA C. GAGNO, Member ELIZABETH C. LAGRITO, Member MARYLOU B. ONG, Member LEAH PRIMITIVA S. PAQUIZ, Member MERLE L. SALVANI, Member Chairman of the BON: Elsie A. Tee ELSIE ANTIPORA-TEE, RN,RPHS,MAN,PHD B.S. in Nursing at San Pedro College, Davao City B.S. in Pharmacy at University of Immaculate Concepcion, Davao City Master of Arts in Nursing at Ateneo de Davao Doctor of Philosophy, Major in Educational Administration Filipino theorist Elsie Antiporta is most recognized for her research on the idea of "family crises." Antiporta examines the concept that families have crises as they go through various life phases in her art. DR. CARMELITA DIVINAGRACIA, PHD, RN Filipino Nurse Theorist - Association of the Deans Philippine Colleges of Nursing (ADPCN) Former President- Dean of University of the East Ramon Magsaysay Memorial Medical Center, Inc.(UERMMMC) College of Nursing Member of CHED ‘s Technical committee on Nursing Education Has been lauded for developing the art and competency of teaching nursing Has been a clinic nurse, staff nurse, head nurse, instructor, assistant dean and dean Expert in Research and Education Has lectured and written about her work as a nurse and has use her hands- on experience to develop better ways to teach nursing Her love for nursing and her dedication to carve out learning tools for nursing students has been a commendable and rare field of discipline ZENAIDA GAGNO, MA, RN (Former President PNA Jeddah Chapter) (Chairperson, PNA International Relations) DR. ELIZABETH C. LAGRITO, PH. D, RN VP for Programs & Development Governor, PNA Region X MARY LOU ONG, DSCN, RN Governor PNA Region VII Former Chairman, PNA BOG Former Dean, Cebu Normal University, College of Nursing DR. LEAH PRIMITIVA S PAQUIZ, RN, MPH, MAN, DEd former PNA National President in 2007 and was re-elected in 2008 MARLE L. SALVANI, PhD, RN Former PNA National President Former PNA Governor Region VI Former Faculty, University of St. Lasalle, College of Nursing Section 4. Qualifications of the Chairperson and Members of the Board – The Chairperson and Members of the Board shall, at the time of their appointment, possess the following qualifications: a. Be a natural-born citizen and resident of the Philippines; b. Be a member of good standing of the accredited professional organization of nurses; c. Be a registered nurse and holder of a master's degree in nursing, education, or other allied medical profession conferred by a college or university duly recognized by the Government: Provided, That the majority of the members of the Board shall be holders of a master's degree in nursing: Provided, further, That the Chairperson shall be a holder of a master's degree in nursing; d.Have at least ten (10) years of continuous practice of the profession before appointment: Provided, however, That the last five (5) years of which shall be in the Philippines; and e.Not have been convicted of any offense involving moral turpitude; provided, that the membership to the Board shall represent the three (3) areas of nursing, namely: nursing education, nursing service, and community health nursing. Term of Office Section 6. Term of Office - The Chairperson and Members of the Board shall hold office for a term of three (3) years and until their successors shall have been appointed and qualified: Provided that the Chairperson and members of the Board may be re-appointed for another term. Any vacancy in the Board occurring within the term of a Member shall be filled for the unexpired portion of the term only. Each Member of the Board shall take the proper oath of office before the performance of his/her duties. The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under Republic Act No. 7164 until their replacements have been appointed by the President and shall have been duly qualified. Compensation Section 7. Compensation of the Board Members - The Chairperson and Members of the Board shall receive compensation and allowances comparable to the compensation and allowances received by the Chairperson and members of other professional regulatory boards. Removal or Suspension of Board Members Section 11. Removal or Suspension of Board Members - The president may remove or suspend any member of the Board after having been allowed to defend himself/herself in a proper administrative investigation, on the following grounds; a.Continued neglect of duty or incompetence; b.Commission or toleration of irregularities in the licensure examination; and c.Unprofessional immoral or dishonorable conduct. Powers, Functions, and Responsibilities of the Board of Nursing Section 9. Powers and Duties of the Board - The Board shall supervise and regulate the practice of the nursing profession and shall have the following powers, duties, and functions: a.Conduct the licensure examination for nurses; b.The issue, suspend or revoke certificates of registration for the practice of nursing; c. Monitor and enforce quality standards of nursing practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation; d. Ensure quality nursing education by examining the prescribed facilities of universities or colleges of nursing or departments of nursing education and those seeking permission to open nursing courses to ensure that standards of nursing education are properly complied with and maintained at all times. The authority to open and close colleges of nursing and/or nursing education programs shall be vested on the Commission on Higher Education upon the written recommendation of the Board; e.Conduct hearings and investigations to resolve complaints against nurse practitioners for unethical and unprofessional conduct and violations of this Act, or its rules and regulations and in connection therewith, issue subpoena ad testificandum and subpoena duces tecum to secure the appearance of respondents and witnesses and the production of documents and punish with contempt persons obstructing, impeding and/or otherwise interfering with the conduct of such proceedings, upon application with the court; f. Promulgate a Code of Ethics in coordination and consultation with the accredited professional organization of nurses within one (1) year from the effectivity of this Act; e.Recognize nursing specialty organizations in coordination with the accredited professional organization; and f. Prescribe, adopt issue and promulgate guidelines, regulations, g. Measures and decisions may be necessary for the improvements of the nursing practice, advancement of the profession, and for the proper and full enforcement of this Act subject to the review and approval by the Commission. Legal Aspects and the Nurse Responsibility and Accountability for the Practice of Professional Nursing – when nurses undertake to practice their profession, they are held responsible and accountable for the quality of performance of their duties Professional Negligence – refers to the commission or omission of an act, according to a duty that a reasonably prudent person in the same or similar circumstances would or would not do and acting on which is the proximate cause of injury to another person or his property The elements of professional negligence a. Existence of duty on the part of the person charged to use due care under circumstances b. Failure to meet the standard of due care c. The foreseeability of harm resulting from failure to meet the standard d. The act that the breach of this standard resulted in an injury to the plaintiff Specific examples of negligence a. Failure to report to attending physician b. Failure to exercise the degree of diligence which the circumstances of the particular case demands c. Mistaken identity d. Wrong medicine, wrong concentration, wrong route, wrong dose e. Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients f. Errors due to family assistance g. Administration of medicine without a doctor’s prescription The doctrine of Res Ipsa Loquitor - “the thing speaks for itself Three conditions are required to establish a defendant’s negligence without proving specific conduct. These are: a. That the injury was such of such nature that it would not normally occur unless there was a negligent act on the part of someone b. That the injury was caused by an agency within the control of the defendant c. That the plaintiff himself did not engage in any matter that would tend to bring about the injury Examples a.A patient came in walking to the out-patient clinic for injection. Upon administering the injection to his buttocks, the patient experienced extreme pain. His leg felt weak and he was subsequently paralyzed. b.The presence of sponges in the patient’s abdomen after an operation c.Fracture of a newly delivered baby born by breech presentation Malpractice – the idea of improper or unskillful care of a patient by a nurse; stepping beyond one’s authority with serious consequences MALPRACTICE NEGLIGENCE The doctrine of Force Majeure - An irreversible force, one that is unforeseen or inevitable - Under the Civil Code of the Philippines, no person shall be responsible for those events which cannot be foreseen or which, though foreseen, are inevitable, except in cases expressly specified by law - Floods, fire, earthquakes, and accidents fall under this doctrine, and nurses who fail to render service during these circumstances are not held negligent - Habitual tardiness due to heavy traffic is not considered an excuse The doctrine of Respondeat Superior - Let the master answer for the acts of the subordinate - This doctrine applies only to those actions performed by the employee within the scope of his employment - Examples a. The hospital will be held liable, if, to cut down on expenses it decides to hire underboard nurses or midwives in place of professional nurses and these persons prove to be incompetent b. The surgeon will be held responsible in case a laparotomy pack is left in a patient’s abdomen Incompetence - Lack of ability, legal qualifications, or fitness to discharge the required duty - Although a nurse is registered, if in the performance of her duty she manifests incompetency, there is ground for revocation or suspension of his/her certificate of registration Liability for the work of nursing students 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: Provided, finally, That the program and activity for the continuing professional education shall be submitted to and approved by the Board. So that errors committed by nursing students will be avoided and or minimized, the following measures are taken ✓ Nursing students should always be under the supervision of their clinical instructor ✓ They should be given assignments that are at their level of training, experience, and competency ✓ They should be advised to seek guidance especially if they are performing a procedure for the first time ✓ They should be oriented to the policies of the nursing unit where they are assigned ✓ Frequent conferences with the students will reveal their problems which they may want to bring to the attention of their instructors or vice-versa. Discussion of these problems will iron out doubts and possible solutions may be provided Medical Orders, Drugs, and Medications - RA 6675 states that only validly registered medical, dental and veterinary practitioners are authorized to prescribe drugs - Prescriptions made by unauthorized persons constitute illegal practice of medicine, dentistry, and veterinary medicine - The Pharmacy Act (RA 5921) amended all prescriptions must contain the following information: Name of the prescriber, office address, professional registration number, patient’s name, and sex, date of prescription - RA 6675 (Philippine Generics Act) requires that all drugs be written in their generic names - The general rule requiring a nurse to execute all lawful orders of a physician is tempered by common sense. The nurse must not execute an order if she is reasonably certain it will result to harm to the patient Telephone Orders -Only in an extreme emergency and when no other resident or intern is available should a nurse receive telephone orders -The 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 on his/her next visit within 24 hours -The nurse should sign the name of the physician on her own and note the time the order was received Consent to medical and surgical procedures Consent – 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 Informed consent – established principle of law that every human being of adult years and sound mind has the right to determine what shall be done with his body. He may choose whether to be treated or not and to what extent Essential elements of informed consent a. The diagnosis and explanation of the condition b. A fair explanation of the procedures to be done and used and the consequences c. A description of alternative treatments or procedures d. A description of the benefits to be expected e. Material rights f. Prognosis Consent for minors ▪ parents or someone standing on their behalf, gives the consent to medical or surgical treatment of a minor. Parental consent is not needed, however, if the minor is married or otherwise emancipated Emergency Situation when it exists, no consent is necessary because inaction at such time may cause greater injury Consent for sterilization (termination of the ability to produce offspring) the husband and wife must consent to the procedure if the operation is primarily to accomplish sterilization Torts – a legal wrong, committed against a person or property independent of a contract which renders the person who commits it liable for damages in a civil action Assault − is the imminent threat of harmful or offensive bodily contact − it is unjustifiable to touch another person or to threaten to do so in such circumstances as to cause the other to reasonably believe that it will be carried out Battery − intentional, unconsented touching of another person − it is important that once a patient can be touched, examined, or treated, he must first give a consent False Imprisonment 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 Invasion of Rights to Privacy it is the right to be left alone, the right to be free from unwarranted publicity and exposure to public views as well as the right to live one’s life without having anyone’s name, picture, or private affairs made public against one’s will Defamation – character assassination be it written or spoken Slander – oral defamation Libel – written words Crime – an act committed or omitted in violation of the law Conspiracy to commit a crime 1. Principals – are those who take a direct part in the execution of the act; who directly force or induce others to commit it 2. Accomplices – are those persons who cooperate in the execution of the offense by a previous or simultaneous act 3. Accessories – are those knowing the commission of the crime, either as principals or accomplices take part after its commission by profiting themselves or assisting the offender to profit from the effects of the crime by concealing or destroying the body of the crime, or the effects or instruments thereof, to prevent its discovery or by harboring, concealing or assisting in the escape of the principal of the crime Murder – is the unlawful killing of a human being with intent to kill. It is a very serious crime. Abortion and euthanasia are considered murder Homicide – the killing of a human being by another. It may be committed without criminal intent, by any person who kills another other than his father, mother or child or any of his descendants Abortion expulsion of the product of conception before the age of viability  The constitution of the Philippines protects the life of the unborn child Section 12. The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the development of moral character shall receive the support of the Government (Article II, Section 12 of the PC) Infanticide – the killing of a child less than 3 days of age Parricide – the killing of his/her father, mother, or child Robbery – a crime against a person or property. The taking of personal property of another person Controlled Substances – Comprehensive Dangerous Drugs Act of 2002 (REPUBLIC ACT NO. 9165, OTHERWISE KNOWN AS THE “COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002”) – covers the administration and regulation of the manufacture, distribution, and dispensing of controlled drugs Persons authorized to prescribe or dispense these drugs are required to register and have a special license for this purpose Doctors with such licenses prescribe these drugs in a yellow form. Nurses may administer these drugs only upon the written order of a physician duly licensed to prescribe such Controlled drugs are kept locked in cabinets and only authorized persons shall have access to them Simulation of birth – is a crime committed by one who enters in a birth certificate that did not occur WILLS – is a legal declaration of a person’s intentions upon death It is called a testamentary document because it takes effect after the death of its maker. It is an act whereby a person is permitted with the formalities prescribed by law, to control to a certain degree the deposition of his estate, to take effect after his death  Decedent – is a person whose property is transmitted through succession whether or not he left a will. If he left a will, he is also called a testator. If the person making the will is a woman, she is called a testatrix Heir – a person called to succession either by the provision of a will or by operation of law Testate – a person who dies leaving a will  Intestate – a person who dies without a will Probate – validation of a will in court Administrator – one who administers the provision of the will Holographic will – a will that is written, dated, and signed by the testator An oral will is AKA nuncupative or nuncupation Trials – facts of the case are determined, the principles of law relating to those facts are applied and a conclusion as to liability is reached Witness A subpoena is served to direct a witness to appear and give testimony on the date and time ordered Subpoena duces tecum – is served to a witness requiring him to bring records, papers, and the like which may be in his possession and which may help clarify the matter in issue  Testimony of facts – the witness should testify only on what she knows based on facts Testimony of opinion – only given by an expert witness Expert witness –is qualified to testify based on special knowledge skills, experience, and training. He/she should use words and terms that the average person can understand. Since her testimony is under oath, he/she should speak only the truth, otherwise, she will be liable for perjury  Perjury – false swearing under oath Hearsay evidence – repetition of what the witness has heard others say, is not admissible in court Privilege communications – statements uttered in good faith. These are not permitted to be divulged in the court of justice Ante-mortem statements – are considered hearsay evidence except when made by a victim of a crime. If a nurse receives a dying declaration, she should write down the person’s actual words. She should repeat back what she wrote to determine if it is correct. If possible, these statements are to be signed by the person making the declaration Contract – is a meeting of minds between 2 persons whereby one binds himself, concerning the other, to give something or to render some service Kinds of Contract a. Formal contract – refers to an agreement among parties involved and is required to be in writing by some special laws Example: marriage contract, deeds of sale, or work contract b.An informal contract –is concluded as the result of written document or correspondence where the law does not require the same to be in writing or as the result of oral and spoken discussion between the parties or conduct between the parties, evidence, and intention to contract b. Express contract – one in which the condition and terms of the contract are given orally or in writing by the parties concerned c. An implied contract –is concluded as a result of acts of conduct of the parties to which the law ascribes an objective intention to enter into a contract Breach of Contract – is failure to perform an agreement, whether expressed or implied, without cause Laws Governing the Practice of Nursing RA 877 - the first nursing law, enacted by Congress on June 19, 1953. Provisions included the organization of the board of examiners for nurses, provisions regarding nursing schools and colleges, examination, registration of nurses RA 7164 – introduced by Senator Heherson Alvarez, codified and revised all the laws regulating the practice of nursing in the Philippines. It was known as the PNA of 1991 which include the following changes a. Redefinition of the scope of nursing practice to emphasize b. The use of the nursing process as a scientific discipline c. The teaching, management, leadership, and decision making roles of the nurse d. The understanding of and participation in studies and research by nurses e. Requiring a faculty member who was appointed to the Board of Nursing to resign from his/her teaching position at the time of appointment and not one year preceding his/her appointment f. Updating a faculty’s educational qualification by requiring a Master’s Degree in Nursing or related fields or its equivalent in terms of experience and specification as a pre-requisite to teaching g. Specification of qualifications of administrators of nursing services h. Inclusion of the phrase “Unethical Conduct” as one of the reasons for revocation and suspension of the certificate of registration PD 223 – issued on JUNE 23, 1973 created the Professional Regulations Commission and prescribed its powers and functions. This office was directly under the Office of the President of the Philippines RA 1080 – those who passed the bar and board examinations were declared to be civil service eligible RA 7392- amended RA 2644 known as the Midwifery Law on June 18, 1960 RA 2382 – Philippine Medical Act defines the practice of medicine in the Philippines RA 5181 – this act prescribes permanent residence and reciprocity as qualifications for any examinations or registration for the practice of any profession in the Philippines PD 541 – allows former Filipino professionals to practice their respective professions in the Philippines. Balikbayans, therefore, although not residents of the Philippines anymore may practice their profession during the period of their stay in the country provided they register with the PRC and pay their income tax on all earnings while in the country  RA 9165 – Dangerous Drugs Act AN ACT INSTITUTING THE COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002, REPEALING REPUBLIC ACT NO. 6425, OTHERWISE KNOWN AS THE DANGEROUS DRUGS ACT OF 1972, AS AMENDED, PROVIDING FUNDS THEREFOR, AND FOR OTHER PURPOSES It is the policy of the State to safeguard the integrity of its territory and the well-being of its citizenry particularly the youth, from the harmful effects of dangerous drugs on their physical and mental well-being, and to defend the same against acts or omissions detrimental to their development and preservation.  PD NUMBER 442 Labor code of the Philippines It prescribes the rules for hiring and termination of private employees; the conditions of work including maximum work hours and overtime; employee benefit such as holiday pay, thirteenth month pay and retirement pay and the guidelines in the organization  PD 856 Code of Sanitation of the Philippines Sanitation requirement for food, water establishments and disposal system of cities and municipalities  PD NO. 651 Birth and Death Registration Act This decree requires that deaths and births be registered within 30 days from the occurrence. If a person's birth was not registered within this period, a delayed registration of birth can be filed, which will be annotated on the birth certificate.  PD 996 Expanded Program on Immunization Immunization of School Entrants. It shall be the duty of all schools, public and private, to provide basic immunization services to all pre-school and primary school entrants who have not received such immunization, subject to rules and regulations as the Secretary of Health may promulgate.  Section 2. Scope. Basic immunization services shall include: (a) BCG Vaccination against tuberculosis; (b) Inoculation against diphtheria, tetanus, and pertussis; (c) Oral poliomyelitis immunization; (d) Protection against measles; (e) Immunization against rubella; and (f) such other basic immunization services for infants and children below eight years of age which the Council for the Welfare of Children may recommend to the Secretary of Health.  PD 825 Proper Garbage Disposal Act Prohibits littering in public places and making it the responsibility of residents, institutions, and commercial and industrial establishment to clean their surroundings, including streets and canals adjacent to their properties.  RA 11332 SURVEILLANCE AND RESPONSE TO NOTIFIABLE DISEASES, EPIDEMICS AND HEALTH EVENTS OF PUBLIC HEALTH CONCERN RA 11332 aims, among others, to establish effective mechanisms for strong collaboration with national and local government health agencies to ensure proper procedures are in place to promptly respond to reports of notifiable diseases and health events of public health concern, including case investigations, treatment, and control and containment, including follow-up activities.  RA 8344 NO-DEPOSIT POLICY DURING EMERGENCY AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS "AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES"  RA 7160 Local Government Code Section 18. Power to Generate and Apply Resources. - Local government units shall have the power and authority to establish an organization that shall be responsible for the efficient and effective implementation of their development plans, program objectives and priorities; to create their own sources of revenues and to levy taxes, fees, and charges which shall accrue exclusively for their use and disposition and which shall be retained by them; to have a just share in national taxes which shall be automatically and directly released to them without need of any further action; to have an equitable share in the proceeds from the utilization and development of the national wealth and resources within their respective territorial jurisdictions including sharing the same with the inhabitants by way of direct benefits; to acquire, develop, lease, encumber, alienate, or otherwise dispose of real or personal property held by them in their proprietary capacity and to apply their resources and assets for productive, developmental, or welfare purposes, in the exercise or furtherance of their governmental or proprietary powers and functions and thereby ensure their development into self-reliant communities and active participants in the attainment of national goals.  RA 8981 PRC MODERNIZATION ACT OF 2000 The roles of professionals in nation building and promotes the sustained development of a reservoir of professionals whose competence has been determined by honest and credible licensure examinations and whose standards of practice are internationally recognized.  RA 10606 NATIONAL HEALTH INSURANCE ACT Its mandate is to administer the National Health Insurance Program which was created to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines. This social insurance program shall serve as the means for the healthy to help pay for the care of the sick and for those who cannot afford medical care to subsidize those who cannot  RA 9288 NEWBORN SCREENING ACT The National Newborn Screening System shall ensure that every baby born in the Philippines is offered the opportunity to undergo newborn screening and thus be spared from heritable conditions that can lead to mental retardation and death if undetected and untreated.  RA 7600 BREASTFEEDING AND ROOMING-IN ACT The State adopts rooming-in as a national policy to encourage, protect and support the practice of breastfeeding. It shall create an environment where basic physical, emotional, and psychological needs of mothers and infants are fulfilled through the practice of rooming-in and breastfeeding.  RA 11210 EXPANDED MATERNITY LEAVE BENEFITS ACT An Act Increasing the Maternity Leave Period to One Hundred Five (105) Days for Female Workers With an Option to Extend for an Additional Thirty (30) Days Without Pay, and Granting an Additional Fifteen (15) Days for Solo Mothers, and for Other Purposes  RA 8187 PATERNITY LEAVE ACT AN ACT GRANTING PATERNITY LEAVE OF SEVEN (7) DAYS WITH FULL PAY. TO ALL MARRIED MALE EMPLOYEES IN THE PRIVATE AND PUBLIC. SECTORS FOR THE FIRST FOUR (4) DELIVERIES OF THE LEGITIMATE. SPOUSE WITH WHOM HE IS COHABITING AND FOR OTHER PURPOSES.  RA 1080 CIVIL SERVICE ACT The Republic Act 1080 states that the bar and other professional examinations given by the various board of examiners of the government are declared as civil service examinations shall be appointed to positions in the classified service the duties which involve knowledge of the respective profession be considered as equivalent to the first-grade regular examination given by the Bureau of Civil Service.  RA 7170 ORGAN DONATION ACT AN ACT AUTHORIZING THE LEGACY OR DONATION OF ALL OR PART OF A HUMAN BODY AFTER DEATH FOR SPECIFIED PURPOSES