Ethico-Moral Responsibility PDF

Ethico-moral responsibility ○ One must have the right motivation disposition, and Ethics traits for being good and doing right such as courage, greek word ethos = moral duty...

Ethico-moral responsibility ○ One must have the right motivation disposition, and Ethics traits for being good and doing right such as courage, greek word ethos = moral duty magnanimity, honesty, justice, and beneficence Refers to a standard to examine and understand moral life 4. Divine command ethics Ethical theories, principles, and codes of conduct serve as ○ based on the theory that there is a supreme or divine guides of human conduct provided by ethical systems being that sets down the rules to provide guidance to About making choices that are best for the individual or moral decisions society at certain times and in particular situations Basic Ethical Principles Morals assist the health professionals to determine the right or wrong specific ways of behavior or of accomplishing ethical in regard to value issues in pursuit of health, alleviation of practices suffering, and assisting patients towards peaceful death Morality is derived from the greek word moralis = refers to social consensus about moral conduct for human beings Universal Principles of Biomedical Ethics and society Autonomy Human decency, right or wrong, good or evil, proper or Involves self determination & freedom to choose & improper, cruel or benevolent acts are explained in terms of implement one’s decision, free from deceit, duress, morality constraint or coercion, Called informed consent. Provides patients & family within their level of understanding to evaluate risks & other options open to Ethicists Ethics Moral them. Allows the patient to refuse treatment if he decides, Joseph Critical reflection about What you believe is ailment disclosure, prognosis, mode of treatment & Fletcher morality and rational right and good analysis about it confidentiality. Restrictions on autonomy may occur when there is a potential harm to others such as communicable diseases Nursing Ethics or violence acts related to all principles of right conduct as they apply to the profession Reinforces the nurses’ ideal and motives in order to Veracity maximize the effectivity of their service To maximize the efficiency of healthcare, the patient & Examination of all ethical and bio-ethical issues from the healthcare providers are bound to tell the truth. perspective nursing theory and nursing ethics Patient has the responsibility to provide accurate & The field of nursing ethics focused on the needs and complete information about his complaints, past illness, experiences of practicing nurses, exploration of its meaning and that of ethical practice in terms of the perception of previous hospitalizations, medications, allergies, religious these nurses restrictions, & other matters relevant to his health. Physicians should tell the patient & his family his Ethical approaches diagnosis, plan of care, treatment & possible risks 1. Theological approaches involved, length of treatment, possible expenses, & other ○ greek word telos = goal or end options they may take if any. ○ Focuses on making decisions that produce the benevolent deception greatest good for the greatest number of people ○ Physician or health practitioner is requested not to tell ○ Utilitarianism where the good resides in the promotion the relative the exact nature of the patient’s illness. of happiness ○ Relatives request the physician not to tell the patient ○ “If the act helps people, then it is a good act, and if it his true diagnosis or condition. hurts people then it is a bad one.” ○ The practitioner himself intentionally withholds 2. Deontological approach or duty oriented theory information according to his sound judgment when ○ greek word deon = beauty such revelation would do more harm to an emotionally ○ Immanuel kant; german philosopher: even when unstable or depressed person individuals do not want to fulfill their duty, they are required to do so Beneficence ○ Concerned with duties and rules, where actions are Refers to acts of kindness & mercy that directly benefit the deemed right or wrong based on adherence to ethical patient. principles rather than their outcomes promote the healing of patients, prevent illness or 3. Virtue ethics approach complications, alleviate suffering & assist towards peaceful ○ virtues ethics greek word arete = focused primarily on death. the heart of the person performing the act Nurses must be committed to helping patients and seeking ○ Focuses on the traits and virtues of a good person out the best possible healthcare outcomes for them such as courage, temperance, wisdom, and justice Patient’s Bill of Rights: Helps practitioners provide more Code of ethics for nurses effective patient care. The patient has the right to: Systematic guides for developing ethical behavior; Answer 1. Receive considerate, respectful and compassionate normative questions of what beliefs and values should be health care morally accepted 2. Relevant, current & understandable information concerning diagnosis, specific procedures, treatment Code of good governance prognosis, procedures, treatments, risks involved, Promulgated by the PRC on July 23, 2003 reasonable alternative benefits needed to make informed States that the hallmark of all professionals is their consent. willingness to accept a set of professional & ethical 3. Make decisions regarding his plan of care, in case of principles which they will follow in the conduct of their daily refusal, he is entitled to other appropriate care & service lives. or be transferred to another hospital. This code is adopted by the prc & the 42 professional 4. Have advance directive such as living will concerning regulatory board to cover an environment of good treatment or designating a surrogate decision maker governance in which all filipino professionals shall perform 5. Privacy considerations such as in case of discussion, their duties consultation & treatment. 6. Confidentiality of treatments & records. General Principles in Nursing Ethics 7. Review records concerning medical care & have these 1. Service to others - Implies a commitment to a life of explained to him except when restricted by law. sacrifice & genuine selflessness in carrying out their 8. Be informed of the existence of business relationships professional duties even at the expense of personal gain. among the hospital, educational institutions, other health 2. Integrity & objectivity - Professional should perform care providers, or payers that may influence the patient’s responsibilities with the highest sense of integrity, imbued treatment and care with nationalism & spiritual values, maintain objectivity, 9. Consent to or decline to participate in proposed research free from conflicts of interest, refrain from engaging in any studies or human experimentation affecting care and activity that would prejudice their abilities to ethically carry treatment out their duty 10. Reasonable continuity of care when appropriate and to 3. Professional competency - A certain level of be informed by physicians and other caregivers of competence is necessary, ex; knowledge, technical skills, available and realistic patient care options when hospital attitudes & experience; Keep up with new knowledge & care is no longer appropriate. techniques, upgrade level of competence, taking part in 11. Informed of hospital policies and practices that relate to lifelong continuing education program. patient care, treatment, and responsibilities 4. Solidarity & teamwork - Each professional shall maintain & support one professional organization that promotes a Nonmaleficence deep spirit of solidarity & teamwork among its members The principle of nonmaleficence is similar to beneficence. 5. Social & civic responsibility - Carry out professional The distinction lies in the fact that beneficence is stated in duties with due consideration of the broader interest of the a positive form while non maleficence is stated as an public, serve them with professional concern consistent admonition in the negative form to remind health with their responsibilities to society & as filipinos practitioners to do no harm. 6. Global competitiveness - Remain open to challenges of Ex; not assisting in or performing abortion, not performing a more dynamic & interconnected world; Rise up to global euthanasia, not willfully subjecting patients to experimental standards fully aligned with global best practices drugs whose potential harm may be greater than the 7. Equality of all professionals - Treat their colleagues with expected benefit, not harming a person’s reputation by respect & strive to be fair in their dealings with one revealing confidential information another; All professions are equal & therefore every one shall treat others with respect & fairness Justice Refers to the right to demand to be treated justly, fairly & Ethical Decision-making according to Joseph Fletcher equally. 1. Consideration for people as human beings Article xiii of the Philippine constitution guarantees that the 2. Consideration of consequences state shall adopt an integrated & comprehensive approach 3. Proportionate good to come from the choices to health development & to make essential goods, health 4. Propriety of actual needs over ideal or potential needs & social services available to all people at affordable cost. 5. A desire to enlarge choices & reduce chance Priority for the needs of the underprivileged, the sick, the 6. A courageous acceptance of the consequence of the elderly, disabled, women & children. decision Justice in healthcare refers to fairness and equity in the distribution of resources, ensuring that all patients and Professional Autonomy staff are treated fairly, especially when resources are a key concept in understanding nurses' roles in delivering limited patient care Bill of Rights for RN Care shall be based on needs, physician’s orders, & the 1. Right to practice in a manner that fulfills their ailment, and shall involve patients & Families so that that obligations to society & to those receiving nursing can participate in their care. care. acknowledges the nursing profession’s agreement Nurses are advised to become familiar with the patient’s with the public to uphold a high standard of care. remove bill of rights & observe it’s provisions. any barriers that would prevent nurses from adequately Role fidelity- nurses commit themselves to the welfare of caring for patients and the community at large. those entrusted to their care & should be loyal to their 2. Right to practice in environments that allow them to sworn duty act in accordance with professional standards & legally authorized scope of practice. in order to provide Confidentiality of information safe, competent, and evidence-based care, nurses need confidential information to be continually educated and trained on best practices Termed as privileged communication because it is given 3. Right to a work environment that supports & based on trust. facilitates ethical practice. The code of ethics requires Patients & relatives are expected to give the necessary nurses to adhere to certain duties and professional information so that proper diagnosis & treatment could be standards based on the principles of autonomy, made. beneficence, justice, and nonmaleficence. Having Patients & families are entitled to know information within workplaces that support nurses in following these ethical the limits determined by the physician guidelines is essential for their professional success. Confidential information may be revealed only when: 4. Right to freely & openly advocate for themselves & ○ Patients permit such revelation as in the case of their patients without fear of retribution. They can claim for hospitalization, insurance benefits, etc voice mistakes and errors, challenge outdated practices, ○ Case is medico-legal such as attempted suicide, and advocate for their patients. This not only creates safe gunshot wounds which have to be reported to the spaces, but also enables others to learn. This can local police or nbi. potentially prevent further damage and allow systems to ○ Ill of communicable disease & public safety may be be put in place to prevent a repeat of the same mistake in jeopardized. the future ○ Given to members of the health team if information is 5. Right to fair compensation for their work, consistent relevant to his care with their knowledge, experience & professional Patient’s responsibilities: responsibilities. Nurses should be encouraged to ○ Providing information. negotiate fair wages with their employers and to feel free ○ Complying with instructions. to seek employment elsewhere if they do not believe they ○ Informing the physician of refusal to treatment are being compensated at the market rate. Each nurse ○ Paying hospital charges should be familiar with the average salary for nurses in ○ Following hospital rules & regulations their area ○ Showing respect & consideration 6. Right to a work environment that is safe for themselves & their patients. right to be treated equally, Nurses’ Bill of Rights fairly, and justly. From the hiring process to nursing Nurses’ responsibilities on human subjects assignments, nurses should not be discriminated against Employment in settings where research is conducted or mistreated; This statement calls upon employers to Vigilant protection of human subject’s rights create a positive work environment for nurses, where Scope of application tangible steps are being taken to disassemble racism; safe Supporting actual of knowledge environment that is free from hazards that could cause Informed consent harm or death; This includes not only their physical safety, Representation of human right’s committee but also their psychological well-being; Nurses should have the necessary tools — such as a computer to access Basic human rights of research subjects the electronic medical record (EMR) — to perform their job 1. Right to informed consent 7. Right to negotiate the conditions of their employment, 2. Right to refuse & or withdraw from participation either as individuals or collectively, in all practice 3. Right to privacy settings. includes negotiating your salary; request to have 4. Right to confidentiality or anonymity of data schedule, wages, and conditions in writing; the right to 5. Right to be protected from harm form or join a nursing union Vulnerable subjects Personal Work Ethics Subjects who are mentally ill or legally incompetent such Responsibility of Nurses to patients as the unconscious, or are in unique situations, like The primary responsibility of nurses to patients is to give fetuses, require special attention. them the kind of care their condition needs regardless of Mentally ill/retarded, unconscious, minors are incapable of their race, color, nationality or status. evaluating the risks involved & cannot be given consent on their own behalf.  Consent of parents or guardians are required. Responsibility of nurses to themselves Students are vulnerable as their participation or non Every possible means shall be utilized by them to develop participation may affect their grades their skills Look neat and attractive (minimal makeup, good hygiene, Investigate studies and medical regimen clean Uniform) When the medical regimen of a research subject will be Dining in public, shopping or going out while in uniform is affected, it is best that there be proper coordination with discouraged. the physician in charge. Jewelry must not be worn (except for wedding rings, It shall not in any way, be in conflict with the medical school rings/pins) regime. Nurses’ cap must be only worn on duty Ex; use of banana leaves to promote healing in bed sores for bedridden patients Moral and spiritual responsibilities of nurses Nurses, whatever their religion, must be god loving & & god Experimental subject’s bill of rights fearing. They must realize that the nursing profession is a 1. Be told what the study is trying to find out commitment both to god & people. They should emphasize the 2. Be told what will happen & whether the procedure, drugs, importance of providing spiritual care as a vital aspect of or devices are different from what is used in standard nursing care. They must uphold the sanctity of human life practice. 3. Be told of frequent risks, side effects or discomfort. Guiding Principles for Moral Judgment 4. Be told of the benefit from participation. When a nurse is confronted with situations where moral 5. Be told what other choices become better or worse in the judgment is necessary, the nurse may be guided by the study. following principles or rules: 6. Be allowed to ask regarding the study, before or during 1. The golden rule – do not do unto others what you do not the course of study. want to do unto you 7. Be told what sort of treatment is available if complications 2. Two-fold effect – an act is foreseen to have both good arise. and bad effects 8. Refuse/change mind about participation. That the action must be morally good 9. Receive a copy of the signed & dated consent form. That the good effect most be willed and the bad 10. Be free from pressure when considering to agree to be in effect merely allowed the study That the good effect must not come from an evil action but from the action itself directly Professional Responsibilities That the good effect must be greater than the bad Responsibility of the nurse to the physician effect Will not only carry out doctor’s orders but help plan & Ex. Cancer patient remove uterus implement patient care. 3. Principle of totality - The whole is greater than any of its Patient’s condition should be reported including results of parts.Ex. If a foot amputation will save the patient’s life & therapies. can still be able to walk, he can consent to an operation. If any orders were not carried out, Ex; medicines are The nurse can help the patient understand this unavailable, patient’s refusal, must be noted to the doctor 4. Epikia - exception to the general rule. Ex. allowing a and noted on the patient’s chart. relative to see a seriously ill patient who expresses the Shall familiarize with various routines, methods or desire to see the former although it is nit yet visiting hours idiosyncrasies or physicians so that smooth relationships 5. Ordinary means – basic duty of a person in case of can be maintained. serious illness to take necessary means to preserve life If a patient has a complaint against the physician, this and health. shall be tactfully brought to the doctor’s attention. 6. Subsidiarity – making the highest authority respect and Any case of illegal, incompetent or unethical practice by protect the common good. Ex. Practices in hospital = any member of the health team shall be brought to the advocate; policies attention of authority 7. One who acts under an agent is himself responsible - Ex. a patient wants to have an abortion & asks a nurse to Responsibility of nurses to their colleagues do it but the nurse refuses, but then recommends Nurses are expected to be able to get along smoothly with someone who is capable to do it their colleagues. 8. No one is obliged to betray himself - No one can force Shall establish good working relationships with any person to answer a question if such will incriminate co-workers. him/her When nurses see their colleagues, neglect or are 9. The end doesn't justify the means. Ex. Giving sleeping incompetent with their duties must be brought to attention tablets to someone who has chronic illness to immediate supervisors 10. Defects of nature may be corrected. Ex. Corrected by plastic surgery 11. If one is willing to cooperate in an act, no injustice is Philippines Nursing Law done. Ex: With patient’s consent Law Meaning 12. A little more or less does not change the substance of an act. Ex; stealing Act No. 2493 (1915) Regulated the practice of medicine End of life care Provided for the examination & Standard vii end of life care (ansap standards of nursing registration of nurses in the practice 2008) states that: “The nurse provides an end of life Philippines. care through the provision of optimum comfort & respect for the patient's dignity.” Act 2808 (1919) First true nursing law Created board of examiners for Miserable elements nurses Respect for the patient’s religion & cultural preferences & practices is evident. First board of examination was given in 1920 The good Samaritan act Based on the biblical story of a man who aided an injured RA 877 The Organization of the board of person who was waylaid by thieves & was left for dead. The Philippine Nursing examiners for nurses Law (June 19, 1953) Samaritan took care of him with compassion, bound up his Provisions regarding nursing wounds, brought him to an inn & took care of him schools & colleges Nurses and Suffering Examinations, registration of nurses Nurses who have emotional & spiritual maturity are more able to assist patients who are depressed, fearful or confused about Under Proclamation The President of the Philippines the outcome of hospitalization or illness. No. 539 dated designated the last week of October 17, 1958 October every year beginning in Life in God's service 1958 as Nurses' Week. Nurses can use their gifts in accordance with the grace that Presidential Decree Issued on June 23, 1973 God has given them. If their gift is to speak god’s message, 223 they should do it according to the faith that they have, if it is to Created the PRC and prescribed its serve, they should serve, if it is to teach, they should teach, if it power and functions is to encourage others, they should do so Republic Act 7164 the Philippine Nursing Act of 1991 Legal Responsibility introduced by Senator Heherson Law Alvarez, codified and revised all sum total of rules and regulations which society is governed; the laws regulating the practice of rule of conduct pronounced by controlling authorities which nursing in the Philippines. may be enforced; characteristics: 1. The authority or the right to declare the rule exists r.a. 9173 The philippines nursing act of 2002 2. Such rule is pronounced or expressed and that its source can be identified Rule V nursing practice, section 28, 3. A right to enforce the same must be provided scope of nursing practice Nursing Legislations department of law which comprises all legal rules and principles affecting the practice of nursing; includes the study and interpretation of rules and principles and their application in the regulation of the practice of nursing. Functions of Law in Nursing a framework for establishing what nursing actions in the care of patients are legal delineates the nurse’s responsibilities from those of other professionals helps to establish the boundaries of independent nursing actions assists in maintaining a standard of nursing practice by making nurses accountable to the Law  Presidential decree the labor code of the Philippines Health Related Laws Affecting Nursing and Health 442 provides workers the right to r.a. 2382 Philippine medical act self-organization/promotes the right & welfare of workers. Defines the practice of medicine in the Philippines. Presidential decree medicare benefits to all government 1519 employees regardless of status of appointment. R.a. 7600 rooming in & breastfeeding act of 1992 R.a. 7432 senior citizen’s act. Prc resolution no re-implemented continuing 2004-17 series of professional education requiring 60 2004- credit units for 3 years for professionals with bachelor’s degree. r.a. 6425 dangerous drug act PRESIDENTIAL The Labor Code of the Philippines DECREE 442 Act no. 3573 in 1929 all communicable diseases shall be Provides workers for the right to self reported to the nearest health organization and collective station. bargaining that promotes the rights & welfare of the workers. r.a. 1082 creation of rural health units RA 7305 r.a. 4073 treatment of leprosy Presidential decree compulsory immunization for all 996 children below 8 y/o against communicable diseases. Presidential decree Allowing former filipino 541 professionals to practice their respective professions in the philippines provided they register with PRC and pay their income tax on all earnings while on the country Presidential decree penalty for improper disposal of 825 garbage & other forms of RA No. 9173 an act providing for a more cleanliness responsive nursing profession Presidential decree code of sanitation, control of all 856 factors in the environment that Legal Aspects and the Nurse affect health includes quality of As nurses begin their professional obligations, their legal water, food, milk, control of insects, responsibilities begin as well. Their license to practice animal carriers, transmitters of attests that they are qualified under the law to practice disease, sanitary & recreation their profession. facilities, noise, unpleasant odors. The Philippine Nursing Act of 1992 is the best guide the nurse can utilize as it defines the scope of nursing Presidential decree minimum employable age (16y/o) 148 and privileges of working women. practice. The nurses are enjoined to be familiar with the Philippine R.a. 6365 established a national policy on Nursing Law, and the standards of nursing care, other population & created a commission laws which affect nursing practice and their code of ethics on population. Responsibility and Accountability For the Practice of Presidential decree strengthen family planning Professional Nursing 166 programs. 1. Responsibility - refers to the execution of duties R.a. 4226 hospital licensure act, requires all associated with a nurse’s particular role. That is, hospitals to be licensed before they the nurse is responsible for providing care can offer to serve the community. within established standards of the profession.  The responsible nurse demonstrates Negligent act committed in the course of professional characteristics of reliability and dependability. performance. 2. Accountability - refers to the ability to answer for Malpractice in the usual sense implies the idea of one’s own actions. The nurse is accountable to improper or unskillful care of a patient by a nurse. It herself most of all. He/she also balances would also see that malpractice also denotes stepping accountability to the patient, the profession, the beyond one's authority with serious consequences. employing institution, and society. Ex; giving of anesthesia by a nurse or prescribing 3. Liability - an obligation one has incurred or might medicine incur through any act or failure to act.-When the nurse fails to meet the legal expectations of care, → Doctrine of Force Majeure the client can initiate action if harm or injury is Force majeure means an irresistible force, one that is incurred by the client unforeseen or inevitable. Circumstances such as floods, fire, earthquakes & Breach of contract accidents fall under this doctrine and nurses who fail to Failure to perform an agreement, whether expressed or render service during these circumstances are not held implied, without cause. The following constitute breach of negligent. contract for nursing services: Habitual tardiness due to heavy traffic is not considered an 1. Prevention of performance. excuse for force majeure 2. Failure to perform because of inconvenience or difficulty. 3. Failure of cooperation in performance. → Doctrine of Respondeat Superior 4. Abandonment of duty (i.e. leaving unconscious patients, Let the master answer going off duty without endorsement) The liability is expanded to include the master as well as 5. Substitution of performance. the employee and not shift of liability from the subordinate 6. Failure to use due care to the master. When a person, through his negligence, injures another, Professional Negligence he remains fully responsible. Negligence Ex; hospital will be held liable, if, in an effort to cut down Refers to the omission of an act, pursuant to duty, that a on expenses, it decides to hire underboard nurses or reasonably prudent person in the same or similar midwives in place of professional nurses, and these circumstance would or not do. persons prove to be incompetent. Acting or the non acting of which is the proximate cause of Ex; The surgeon will be held responsible in case a injury to another person or his property laparotomy pack is left in a patient’s abdomen Specific Principles of Negligence 1. Failure to report observations to attending physicians. Medical Orders, Drugs, and Medications 2. Failure to exercise the degree of diligence which the R.A. 6675 states that only validly registered medical, circumstances of the particular case demands. dental and veterinary practitioners, whether in private 3. Mistaken identity. institutions/ corporations or in the government, are 4. Wrong medicine, wrong concentration, wrong route, authorized to prescribe drugs. wrong dose. Prescriptions made by unauthorized persons constitute 5. defects in the equipment such as the stretchers & illegal practice of medicine, dentistry or veterinary wheelchairs may lead to falls thus injuring the medicine and is punishable under R.A. 2832 of the patients. Medical Act of 1959, R.A. 4419 of the Dental Act, and R.A. 6. Errors due to family assistance. 382 or the Veterinary Act 7. Administration of medicine without a doctor’s In accordance with R.A. 5921, or the Pharmacy Act as prescription amended, all prescriptions must contain the following information: name of the prescriber, Doctrines office address, professional registration number, → Doctrines of Resipsa Loquitor professional tax receipt number, patient’s/client’s name, Means “the thing speaks for itself.” age and sex, and date of prescription. R.A. 6675 The injury could not have happened if someone was not requires that the drugs be written in their generic names negligent and no further proof is required. The dependent and coordinated function of the nurse Ex: presence of sponges in the patient’s abdomen after an pertains to the application and execution of written operation. legal orders of physicians concerning treatment Ex. fracture on a newly delivered baby born by breech and medications. Only when these orders are legal in presentation writing and bear the doctor’s signature does the nurse have the legal right to follow them. Written orders are → Malpractice better understood and chances of error are minimized if The term for negligence or carelessness of professional they are clear, specific, complete and legible. personnel.  Verbal orders can be minimized if the nurse seeks a telephone lines. Most importantly, the signature of the clear understanding from the physicians in establishing a ordering physician is not present and this order may later policy concerning the importance of written orders. be denied incase errors exist or court litigations arise The general rule requiring a nurse to execute all lawful orders of a physician is tempered by common Consent to Medical and Surgical Procedures sense. The nurse must not execute an order if she is Consent reasonably certain it will result in harm to the patient. is defined as a “free and rational act that presupposes In such case she must speak out and risk incurring knowledge of the thing to which consent is being given by the physician’s resentment or ire rather than a lawsuit a person who is legally capable to give consent.” It is preferable to raise the matter of carrying out the procedure as a point of clarification in a tactful, Consent signed by the patient or his authorized acceptable manner. representative/legal guardian upon admission is for the initial A nurse must see to it that she understands the diagnosis and treatment. Subsequent treatments/operations action of a drug, its minimum and maximum dosages, require individual, informed consent. Before any medical or route of administration, and untoward effects so that she surgical procedure can be performed on a patient, consent may skillfully, safely, and effectively carry them out. She must be obtained from the patient or his authorized should be able to report and record the effects on the representative who may be his parent or guardian. It is only in patient so that the doctor can judge its therapeutic case of emergency where the consent requirement does not value and know when to discontinue its use. apply. Tests and treatments should be explained to the patient in accordance with the general plan of his The physician should give as much information about a care so that the patient can give full consent and contemplated procedure and the patient should receive cooperate in its implementation. Any unfavorable enough information to allow him to give an informed psychologic or physical reaction should be likewise consent for such procedure or treatment reported so that the proper action may be taken. Sometimes, however, refusal may be due to inaccurate Nature of Consent presentation of facts. Patients must receive special Consent is an authorization, by a patient or a person sympathetic attention from the nurses. Every effort should authorized by law to give the consent on the patient's be made to correct inaccurate views and modify behalf that changes a touching from non-consensual to superficially-held beliefs consensual. It is the nurse who actually secures the consent of Intravenous Therapy and Legal Implication the patient upon admission. This consent is usually Nurses now participate in complex intravenous therapy for diagnostic procedures and initial treatment procedures that were once performed only by doctors. deemed necessary by the medical staff. To substantiate Because of this change, nurses must remember that the patient’s consent, a written authorization is needed their legal right to give intravenous injections is based on as proof against any liability that may arise due to an the Philippine Nursing Act of 1991 Section 28 which states alleged unlawful touching of a patient that "in the administration of intravenous injections, special training shall be required according to protocol Informed Consent established. "Therefore, nurses have to undertake a It is an established principle of law that every human certified training course on intravenous therapy. being of adult years and sound mind has the right to In giving intravenous injections, nurses should also determine what shall be done with his own body. follow the policies of their agencies. Even if nurses He may choose whether to be treated or not and to have formal training on IV therapy, if the hospital what extent, no matter how necessary the medical care, or does not allow them to do so, then they may not do the how imminent the danger to his life or health if he fails to procedure. submit to treatment Board of Nursing Resolution no. 8 states that any The essential elements of informed consent include: registered nurse without such training and who 1. the diagnosis and explanation of the condition; administers IV injections to patients, shall be held 2. A fair explanation of the procedures to be done liable, either criminally under Sec. 30 ( c) Art. VII of said and used and the consequences; law or administratively under Sec. 21 Art. III or both 3. a description of alternative treatments or (whether causing or not injury or death to the patient) procedures; 4. a description of the benefits to be expected; 5. material rights if any; and Telephone Orders 6. the prognosis, if the recommended care, procedure, is There are legal risks by telephone orders. These may be refused misunderstood or misinterpreted by the receiving nurse. Sometimes too, messages from telephones may sound Proof of Consent unclear or garbled because of some trouble in the  A written consent should be signed to show that the abruptio placenta, ectopic pregnancies or ruptured uterus, procedure was the one consented to and that the person the patient's consent alone is sufficient understood the nature of the procedure, the risks involved and the possible consequences. Medical Records A signed special consent is necessary before any It serves as a legal protection for the hospital, doctor and medical or surgical treatment is done such as x-rays, nurse by reflecting the disease or condition of the patient special laboratory tests, blood transfusions, operations, and his management. cobalt therapy, or chemotherapy and the like Nurses must remember the rule. "If it was not charted, it was not observed or done. ” Who Must Consent: Ordinarily, the patient is the one who gives Nurses are expected to record fully, accurately, legibly, and consent on his own behalf. However, if he is incompetent promptly their observations from admission to the time (such as in the case of minors or the mentally ill) or of the patient’s discharge. physically unable and is not an emergency case, consent must Daily notes should include not only medications and be taken from another who is authorized to give it on his treatments given or rendered but also the physical and behalf. emotional symptoms exhibited by the patient. The Consent of Minors: Parents, or someone standing in their nurses’ notes are aids to medical diagnosis and in behalf, give the consent to medical or surgical treatment understanding the patient’s behavior. of a minor. Parental consent is not needed however, if the Since patients have the right to confidentiality of these minor is married or otherwise emancipated. records, nurses are legally and ethically bound to protect the patient’s chart from unauthorized persons. Permission Consent of Mentally ill: A mentally incompetent person cannot has to be taken from the hospital authorities for legally consent to medical or surgical treatment. The authorization to secure any information from the patient’s consent must be taken from the parents or legal guardian chart Nurses are responsible for safeguarding the patient’s Emergency Situation: When an emergency exists, no record from loss or destruction or from access by persons consent is necessary because inaction at such time may who are not legally authorized to read such cause greater injury. Ex; A mother who is in the advanced stage of labor or a patient who goes to the emergency room Legal Responsibilities of Students gives an implied consent to an immediate treatment or Nursing students are responsible for acquiring the attendance. However, if time is available and an informed knowledge and skills necessary to become a safe consent is possible, it is best that this be taken for the practitioner. Included in this knowledge and skill protection of all parties concerned development is the awareness of ethical principles and the process of ethical decision making. Nursing students must Refusal to Consent act as reasonably prudent persons, equivalently with A patient who is mentally and legally competent (sane mind education and experience, when performing nursing duties. and of legal age) has the right to refuse to permit touching They must perform only those tasks that they are competent of his body or to submit to a medical or surgical procedure to perform no matter how necessary, nor how imminent the danger to his life or health if he fails to submit to treatment. Ex; Liability for the Work of Nursing Student patients who, because of their religious beliefs, may refuse Under the Philippine Nursing Act of 2002 R.A. 9173 blood transfusion. nursing students do not perform professional nursing. A patient may refuse to consent due to inadequate - Supervised by their Clinical Instructors. In order that the information regarding the procedure to be done. If after errors committed by nursing students will be the explanation, he still refuses to sign the consent form, he avoided/minimized, the following measures should be taken: should be made to fill out the release form to protect the 1. Nursing students should always be under the hospital and/or agency and its personnel from any liability supervision of their Clinical Instructors. that may result from his refusal. If he refuses to sign the 2. They should be given assignments that are in the release form, this should be noted in his chart. The level of their training, experience and competency. competent person has a legal and ethical right to refuse 3. They should be advised to seek guidance especially treatment, and this right is formally established if they are performing a procedure for the first time. 4. They should be oriented to the policies of the Consent for Sterilization nursing unit where they are assigned. Sterilization is the termination of the ability to produce 5. Their performance should be assessed frequently to offspring. determine their strengths and their weaknesses. The husband and the wife must consent to the procedure if 6. Frequent conferences with the students will reveal the operation is primarily to accomplish sterilization. their problems, which they may want to bring to the When the sterilization is medically necessary, the attention of their instructors or vice-versa. Discussions sterilization is an incidental result such as in cases of of these problems will iron out doubts and possible solutions may be provided  → Invasion of right to privacy & breach of confidentiality Charting Done by Nursing Students Nurses may become liable for invasion of right to privacy if When a nurse or a clinical instructor countersigns the they divulge information from a patient’s chart to improper charting of a nursing student, she attests that she has sources or unauthorized persons personal knowledge of information and that such is - Ex; publication of any picture of a patient or a malformed accurate and authentic. Anyone who countersigns without baby without the consent of the parents or revelation of the verification commits herself to possible legal risk contents of the records of the patient without his consent - Ex; when a nurse permits a non-professional person(usual Advocacy a male helper) to view a woman in labor inside the delivery Helping others to grow and self-actualize by informing them of room their rights and ascertaining that they have the right information on which to base their decisions; → Defamation Code of ethics for Registered Nurses, Art. III, Sec. 8 Character assassination, written or spoken.There must be a third person who hears or reads the comment before it can be considered defamation a. Slander- oral defamation of a person by speaking unprivileged or false words by which his reputation is damaged. b. Libel- defamation by written words. Nurses should be careful in their statements especially regarding patients & co-workers. If the statements are, however justifiable & not a malicious purpose, truth is an available defense. Ex; a head nurse tells the chief nurse her opinion regarding the Legal Risks for Defective Equipment inefficiency of one staff nurse who has not been doing well in Ensure that the equipment used in procedures and their job. treatments is not defective Nurses should see to it that all pieces of equipment are Crime regularly inspected, maintained, and are functioning defined as an act committed or omitted in violation of the law properly (wheelchairs, stretchers, suction machines, characterized by two elements (1) Criminal act and evil or (2) anesthesia apparatus, X-ray tables, etc.) criminal intent Nurse should document the times she requested these to show that she was able to foresee the improper Conspiracy to commit crime functioning of equipment which might cause possible When 2 or more persons agree to commit a felony & decide to injury to patient do it. Either principals, accomplices, accessories. 1. Principals- those who take a direct part in the execution Torts of the act. legal wrong committed against a person or property 2. Accomplices- those who cooperate in the act independent of a contract which renders the person who 3. Accessories- those who having the knowledge of the commits it liable for damages in civil action commission of the crime, take part or assisting the offender to profit from the effects of the crime by → Assault concealing or destroying the body of the crime, or the imminent threat of harmful or offensive bodily contact. It is effects or instruments thereof, in order to prevent its unjustifiable to touch another person, or to threaten to do so in discovery or by harboring, concealing or assisting the such circumstances as to cause the other to reasonably escape of the principal of the crime believe that it will be carried out. Criminal Actions → Battery Deal with acts or offenses against public welfare. intentional, unconsented touching of another person. If consent has not been secured, the person performing the procedure → Misdemeanor may be liable for battery. is a general name for a criminal offense which does not in law amount to felony. → False imprisonment or illegal detention Unjustifiable detention of a person without a legal warrant → Felony within boundaries fixed by the defendant by an act or violation is a public offense for which a convicted person is liable to be of duty intended to result in such confinement sentenced to death or to be imprisoned in a penitentiary or prison. It is committed with deceit & fault; a deceit exists when the act is performed with deliberate intent and there is a fault It is a crime against the civil status of a person. when the wrongful acts result from imprudence, negligence, or Substitution of one child for another or concealing or lack of skill or foresight abandoning any legitimate child with intent to cause such child to lose civil status shall be punishable → Criminal negligence may be classified into reckless imprudence & simple POINTS TO REMEMBER IN AVOIDING CRIMINAL imprudence. LIABILITY 1. Reckless imprudence- when a person does an act or 1. Be familiar with the Philippine nursing law. fails to do it voluntarily but without malice, from which 2. Be aware of laws that affect nursing practice. damage results immediately. 3. At the start of employment, get a copy of your job 2. Simple imprudence- the person or nurse did not use description, agency’s rules, regulations and policies. precaution and the damage was not immediate or the 4. Upgrade skills & competence. impending danger was not evident 5. Accept only responsibility that is within the scope or employment & job description. → Criminal Intent 6. Do not delegate responsibility to others. The state of mind of a person at the time the criminal act is 7. Determine whether your subordinates are competent committed, that is he knows that an act is not lawful & still in the work you are assigning to them decided to do it anyway; To be criminal, an act must be defined 8. Develop good interpersonal relationships with your as a crime co-workers. 9. Consult superiors for problems that may be too big for → Murder you to handle. unlawful killing of a human being with intent to kill. Nurses 10. Verify orders that are not clear to you or those that should keep in mind that death resulting from a criminal seem to be erroneous. abortion is murder. Euthanasia is also called a murder. 11. Doctors should be informed about a patient's condition. → Homicide 12. Keep in mind the value & necessity of keeping is the killing of a human being by another. It may be committed accurate & adequate records. without criminal intent, by any person who kills another, other 13. Patients are entitled to an informed consent than his father, mother, or child or any of his ascendants or descendants, or his spouse, without any of the circumstances Wills attendant the crime of murder enumerated above being 1. Testate- a person who dies leaving a will. present 2. Intestate- one who dies without a will. 3. Holographic will- will which is written, dated & → Abortion signed by the testator. means the expulsion of the product of conception before the 4. Nuncupative will or nuncupation- oral will age of viability. Nurse’s Obligation in the Execution of a Will → Infanticide Nurse should note the soundness of the patient’s killing of a child less than 3 days of age. mind (he/she understood the act of making a will) There was freedom from fraud or undue influence → Controlled substances (was not induced to make someone the beneficiary of R.a. 6425 known as the dangerous act of 1972 covers the the will) administration & regulation of the manufacture, distribution Patient was above 18 y/o. & dispensing of controlled drugs. Patient should note that the will was signed by the Persons authorized to prescribe or dispense these drugs testator, that the witnesses were all present at the are required to register & have a special license for this same time & signed the will in the presence of the purpose. testator. Doctors with such license prescribe these drugs in a yellow For protection of the nurse, she should make notation form. on the patient’s chart of the apparent mental & Nurses may administer these drugs only upon the written physical condition of the patient at time of making the order of a physician duly licensed to prescribe such. will Controlled drugs are kept locked in cabinets & only authorized persons shall access them. Nurses and Evidence These are counted & endorsed every shift Anti mortem statements or dying declarations Considered hearsay evidence except when made by → Simulation of Birth, Substitution of One Child for a victim of a crime. Another, or Abandonment of a Legitimate Child If a nurse receives a dying declaration she should Simulation of a birth is a crime committed by one who write down the person’s actual words. enters in a birth certificate a birth that did not occur.  If possible, these statements are to be signed by the ➔ Resourcefulness & creativity as well as a balanced person making the declaration emotional condition. ➔ Capacity & ability to work cooperatively with others. Medical Records ➔ Initiative to improve self & service. Usually used to give important evidence in legal ➔ Competence in performing work through the use of proceedings such as police investigations, nursing process. determining cause of death, extent of injury incurred ➔ Skills in decision making, communicating & relating by the patients among others. with others & being research oriented. Only complete accurate records are accepted in court ➔ Active participation in issues confronting nurses & nursing. Nurses as Witness When a nurse is invited to become a witness, she License to Practice Nursing should also seek the aid or counsel of a lawyer so A legal document given by the government that permits a that she may be guided accordingly. person to offer to the public his skills & knowledge In a In the witness stand, she should face the judge or jury particular jurisdiction, where such practice would otherwise & speak clearly, adequately & intelligently. be unlawful without a license. Should testify only on what she knows based on facts The license to practice nursing is granted by the or testimony of facts. appropriate authority to applicants who have fulfilled certain Should use words and terms that the average person established requirements. will understand. Such a license permits the nurse to practice within the Should speak only the truth, otherwise will be liable country & gives them the privilege of representing for perjury or false swearing under oath. themselves as a licensed nurse Should neither hesitate to say she does not know, nor answer any question that might incriminate her. BSN curriculum (known as the privilege against self incrimination.) The 4 year bachelor of science in nursing program offers a competency-based community oriented curriculum to Personal & Professional Responsibility educate future-nurses practitioners to assume their roles & Nursing as a Profession responsibilities in the Philippine health care system. Profession It aims to prepare nurses for entry level positions in any An occupation or calling requiring advanced training & healthcare setting in the country (hospitals, clinics, experience in some specific or specialized body of knowledge healthcare centers, homes & communities). which provides service to society in that special field. Registration Nursing Is the recording of names of persons who have qualified under An occupation requiring a unique body of knowledge & skills & the law to practice their respective professions. Nurses’ names which serves society. are recorded in a registry which contains the following information: Professional Nurse 1. Full name of registrant A person who has completed a basic nursing education 2. Number & date of registration program & is licensed in his country or state to practice 3. Age, sex & place of birth professional nursing. 4. place of business Nurses carry personal responsibility for nursing practice & 5. Post office address for maintaining competence by continuous learning. 6. Name of school from which he graduated or has studied Every possible means shall be utilized by them to develop 7. Date of such graduation or terms of study, together with their skills. the time spent in the study of the profession elsewhere if Conduct must bring credit to the profession. any Nurses are looked upon with respect in the community, we 8. All other degrees granted to him or her from other shall therefore endeavor to live a life that will uphold their institution of learning self respect. Registration Required Qualifications & Abilities of a Professional Nurse Under the Philippine nursing act of 2002, R.a. 9173, section 1. Professional Preparation 12 & 20 state that the license to practice nursing shall be ➔ Have a license to practice nursing in the country issued to those who pass the licensure examination or by ➔ Have a bachelor of science degree in nursing reciprocity. (mutuality in the grant & enjoyment of privileges ➔ Be physically & mentally fit. between persons or nations.) 2. Personal Qualities & Professional Proficiencies ➔ Interest & willingness to work & learn with individuals/groups in a variety of settings. ➔ A warm personality & concern for people.  ➔ In order to pass the succeeding examination, an Practice Through Special Permit examinee must obtain a rating of at least seventy-five percent (75%) in the subject or subjects repeated. 5. Section 15. Oath - all successful candidates in the examination shall be required to take an oath of profession before the board or any government official authorized to administer oaths prior to entering upon the nursing practice. Registration Through Examination 1. Section 12. Licensure Examination. - All applicants for 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." 2. 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 Professional Decorum the subject or citizen of such country: Provided, That the Female Nurses requirements for the registration or licensing of nurses in Look neat and attractive said country are substantially the same as those minimal makeup prescribed in this Act; neat hair style b. He/she is of good moral character; and clean Uniform, neither too short nor tight fitting that will c. He/she is a holder of a Bachelor's Degree in Nursing tend to restrict movement nor expose unnecessarily any from a college or university that complies with the part of the body while tending to patients.(ansap dress standards of nursing education duly recognized by the code Appendix q) proper government agency. Jewelry must not be worn (except for wedding rings, 3. Section 14. Scope of Examination - The scope of the school rings/pins) examination for the practice of nursing in the Philippines Nurses’ cap must be only worn on duty. Either carried in shall be determined by the Board. The Board shall take into bags or are left in places of assignment. consideration the objectives of the nursing curriculum, the broad areas of nursing, and other related disciplines and Male Nurses competencies in determining the subjects of examinations. It Look neat and attractive draws knowledge from the 5 broad areas of nursing: Hair clipped close to the nape (1) Fundamentals of nursing Clean shaven (2) Maternal & child nursing clean Uniform, neither too short nor tight fitting that will (3) Community health nursing tend to restrict movement nor expose unnecessarily any (4) Nursing of adolescents, adults & aged part of the body while tending to patients.(ansap dress (5) Mental & psychiatric nursing code Appendix q) 4. Section 15. Ratings Jewelry must not be worn (except for wedding rings, ➔ In order to pass the examination, an examinee must school rings/pins) obtain a general average of at least seventy-five percent (75%) with a rating of not below sixty percent General (60%) in any subject. Good body hygiene, clean shoes ➔ An examinee who obtains an average rating of Dining in public, shopping, or going out while on uniform is seventy-five percent (75%) or higher but gets a rating discouraged below sixty percent (60%) in any subject must take Sincere & compassionate attitude towards patients the examination again but only in the subject or Good, respectful & proper relationship with colleagues subjects where he/she is rated below sixty percent (60%) Roles & Responsibilities of a Beginning Nurse Practitioner  1. Patient Care: Nurses are responsible for providing direct up-to-date with the latest advances in healthcare and patient care to individuals of all ages. They perform a range improve patient outcomes. of tasks, including administering medications, dressing wounds, monitoring vital signs, and providing emotional Career Development support to patients and their families. Job Search 2. Care Coordination: Nurses are responsible for coordinating - Once nurses become registered, they would want to find a the care of patients with other healthcare providers, including job. physicians, therapists, and social workers. They - Positions can be located through friends, newspapers, communicate with other healthcare providers to ensure that magazines, employment or placement services, etc patients receive the best possible care. - Application for position may be done in writing or through 3. Patient Education: Nurses are responsible for providing interview. patient education on various health issues, including - A letter of application is important because it enables the medication management, disease prevention, and healthy employer to judge the applicant’s scholarship ability. lifestyle choices. - Employers take interest in a well written letter of application 4. Advocacy: Nurses are responsible for advocating for their & usually arrange for an interview when they see one. patients and ensuring that their patients’ rights are respected. They work to ensure that patients receive the Application Letter best possible care and treatment. The letter of application enables the prospective employer to 5. Administration: Nurses are responsible for managing the form an opinion about the nurse. Observe the following when administrative aspects of patient care, including charting writing a letter of application: patient progress, ordering medications and supplies, and 1. Use clean, white, unlined paper. scheduling appointments. 2. Use ink or ballpen in writing. You may want to type the 6. Research: Nurses are responsible for conducting research letter if you prefer. to improve patient care and outcomes. They use research 3. Use proper salutation. findings to develop evidence-based practice guidelines and 4. Observe proper margin & paragraphing. to improve patient care. 5. Write in a courteous manner. Duties Application Letter contains the following 1. Assessing and monitoring patients: Nurses are 1. Source & purpose. The first paragraph usually contains the responsible for assessing and monitoring the physical and source of information concerning the vacancy & the nurses’ mental health of patients, including their vital signs, intent to apply to the position. These two points may be symptoms, and overall condition interchanged. 2. Administering medications: Nurses are trained to 2. Qualifications. The second & third paragraph must contain administer medications to patients as prescribed by a the applicant’s qualifications, the school or college from physician or other healthcare provider. where he graduated, & the year of graduation. Experience & 3. Creating care plans: Nurses develop care plans based on training along the field applied for may also be included. patient needs and health status, which may include goals, 3. Reference. At least 3 names of persons who have given interventions, and expected outcomes. consent to the use of their names may be used as 4. Collaborating with healthcare providers: Nurses work references. These persons must know the applicant well with other healthcare providers to ensure that patients enough in order to serve as good reference background. receive the appropriate care and treatment. Among the preferred preferences are former principals or 5. Educating patients and their families: Nurses educate deans, leading person in the community, a parish priest or a patients and their families about their health conditions, minister of one’s church, a professional nurse or one’s treatments, and medications, as well as how to manage former instructor. symptoms and prevent complications. 4. A request for personal interview. If time & distance 6. Documenting patient care: Nurses keep detailed records of permits, is usually indicated in the last paragraph. patient care, including assessments, medications, treatments, and any changes in condition. Resume 7. Advocating for patients: Nurses advocate for the best Basic Components: interests of their patients, ensuring that they receive the care ➔Name address, phone number (landline or cellphone), and treatment they need. education, experience, continuing education, 8. Responding to emergencies: Nurses are trained to respond honors/awards (if any), & professional affiliation. to emergencies and provide immediate care to patients who ➔Should be checked for typographical error or misspelled are in critical condition. words. 9. Maintaining equipment and supplies: Nurses ensure that ➔All information should be accurate. medical equipment and supplies are properly maintained ➔The cover letter that accompanies the resume should be and in good working order. addressed to the right person, usually the chief nurse, 10. Continuously learning and improving: Nurses are committed nursing director, or assistant director for nursing to ongoing learning and professional development to stay depending on the position title which varies from one  institution to another.(e.g., government hospitals, private, 7. Testimonials or references: Including testimonials or etc.) references from clients or colleagues can help provide ➔The cover letter, like the resume, should be flawless & evidence of your skills and expertise from a third-party typed neatly on a white paper. perspective. Professional Portfolio Preparing for an Interview - a collection of materials that demonstrate your knowledge, 1. Make an appointment either by mail or telephone. skills, abilities, and accomplishments. 2. Be at the place at the appointed time. - may include examples of your work, certificates, awards, 3. Know something about the institution where you will testimonials, and any other valuable material that supports apply so that you can answer questions intelligently. your professional development. 4. Be at your best. - provides potential employers with a comprehensive view of 5. Be courteous & at ease. your skills set, experiences, and achievements. 6. Bring credentials such as your registration card, - Importance residence certificate, tax account number, and the (1) Provides potential employers with tangible evidence like. of your skills and achievements, which can be an 7. Ask questions about the job. influential factor in the hiring process. It shows 8. Thank the interviewer for giving you some time. employers that you have experience in your 9. Give yourself time to think about the position. respective field and that you take your professional 10. If the prospective employer does not answer, you may development seriously. write a follow up letter stating your interest in the (2) Having a professional portfolio demonstrates your position. ability to organize your work and plan your career. can help reflect and evaluate your past achievements and Emerging Opportunities experiences, which can help you identify your Fields of Specialization strengths and weaknesses. 1. Hospital or institutional nursing. (3) Can help you to stand out from the competition. If you 2. Public health nursing or community health nursing. are up against other candidates with similar 3. Private duty or special duty nurse. qualifications and experience, having a diverse and 4. Industrial or occupational health nursing. well-presented professional portfolio can set you 5. Nursing education. apart. 6. Military nursing. (4) An essential tool for advancing your career prospects. 7. School nursing. you can demonstrate your skills, knowledge, 8. Clinic nursing. experiences and increase your chances of landing 9. Independent nursing practice. your desired job. - Essential Components Factors in Selecting a Field of Nursing 1. Cover page: Your cover page should be visually ➔ Kind of work to be performed. Are you prepared for the appealing and include your name, profession, and job? Can you work under stress? Do you get along well contact information. with people? Are you interested in it? What kind of skills are 2. Introduction and personal statement: This section needed? Is it hazardous? should introduce yourself and include a personal ➔ Availability of the work. Will you choose a field of nursing statement that highlights your goals and objectives as that is crowded? Or where there is a shortage of workers? a professional. ➔ Hours of work. How many hours a day a week? Shifting? 3. Resume/CV: Your resume or curriculum vitae should Pay for extra hours? be included in your portfolio and should provide a ➔ Qualifications. Requirements in terms of educational detailed overview of your work history, education, and qualifications, experience? Trainings? skills. ➔ Opportunities for advancement. Promotions, allow to go 4. Work samples and project descriptions: This to school, attend professional meetings/seminars on official section is where you can showcase examples of your time? work and provide detailed descriptions of your role in ➔ Method of entering. Examination? Recommendations each project. ➔ Earning. Initial salary, maximum, overtime pays 5. Professional development and certifications: In ➔ Fringe benefits. vacation days, sick leave, maternity, this section, you can include any professional education leaves development courses, workshops, or certifications ➔ Other benefits. Insurances, medicare, retirement benefits you have earned to demonstrate your commitment to ongoing learning and growth. New nurses are advised to serve the country first before 6. Awards and recognition: If you have received any planning to go abroad. The reasons for this are: awards or recognition for your work, be sure to 1. To acquire a better perspective of the actual health status include them in your portfolio as they serve as a of the people in the country. testament to your abilities and accomplishments.  2. To be able to participate in & contribute to the - Nurses also play a critical role in promoting health implementation of the national health programs for the literacy, ensuring that patients understand their health people. conditions and treatments. 3. To develop skills not only in the cure & preventive aspects of care but also in the art of good working relationships Continuing Education in Nursing with the health team & the community. Nursing practitioners assume a lifelong commitment to 4. To gain more experience in a variety of situations & enable learning in order to cope with rapid technological advances, them to be more mature in judgment the changes in science & technology, the delivery of health 5. Acquire the satisfaction of having been able to serve our care services in the country, & the expectations of the people first before serving others. public. Graduation from a school or college of nursing marks only Expanded Roles of Nurses the beginning of a lifelong process of enriching one’s Nursing, a profession that was once solely focused on patient knowledge, skills & attitudes. care, has evolved to become a multifaceted role in healthcare. Responsibility for the maintenance of safe & competent The expanded role of nurses in healthcare has had a practice rests on the individual practitioner through significant impact on patient care, healthcare administration, continual learning. research, and education. It is essential to recognize and support the vital role that nurses play in healthcare to ensure Formal Studies Leading to Degree Courses that patients receive the best possible care. 1. Baccalaureate degree in nursing 1. Clinical Practice - Former graduates of the three year basic program will - The nursing profession has evolved beyond bedside have to enroll in the regular BSN course under the nursing, and nurses now diagnose and manage acute new curriculum. and chronic illnesses, prescribe medications, and 2. The graduate education in nursing manage patient care plans. Collaborating with - Graduate study is education beyond the physicians, pharmacists, and other healthcare baccalaureate degree program leading to a master’s professionals, nurses provide comprehensive patient degree in a chosen area of study. care. - It’s major purpose is the preparation of nurses - Promoting health and preventing diseases is another capable of improving nursing care through significant role that nurses play. They provide patient advancement of nursing theory & science. education, develop health promotion programs, and - Nurses who take the master’s degree pursue an area conduct health screenings. of clinical specialization & elect an area of clinical - Nurses are also involved in community outreach specialization & elect an area of role development programs aimed at improving the health of the - Most master’s degree programs offer study of a population clinical area, such as medical-surgical nursing, 2. Administration maternal-child nursing, community health nursing, or - Nurses are critical to healthcare administration, and psych