Ethico-Legal and Moral Considerations in Nursing Leadership & Management PDF

Ethico-Legal and Moral Considerations in Nursing Leadership & Management Prepared By: MA. DIOSUL D. ROQUE, MAN,RN Unit Expected Outcomes At the end of this unit, the students are expected to: 1. Explain the importance of legal aspects in the nursing practice, specifically its a...

Ethico-Legal and Moral Considerations in Nursing Leadership & Management Prepared By: MA. DIOSUL D. ROQUE, MAN,RN Unit Expected Outcomes At the end of this unit, the students are expected to: 1. Explain the importance of legal aspects in the nursing practice, specifically its application on patient’s will and consent. 2. Discuss the different criminal liabilities and legal responsibilities that may affect the nursing practice, 3. Specify the ethico-legal bases for providing safe, quality and professional nursing care. 4. Make professional decisions within ethical and legal parameters  CODE OF ETHICS FOR REGISTERED NURSES ◦ approved July 14, 2004 thru Board Resolution No. 220, Series of 2004 ◦ succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. Code of Ethics Article I Preamble SECTION 1. Health is a fundamental right of every individual. The Filipino registered nurse, believing in the worth and dignity of each human being, recognizes the primary responsibility to preserve health at all costs. This responsibility encompasses promotion of health, prevention of illness, alleviation of suffering, and restoration of health. However, when the foregoing are not possible, assistance towards a peaceful death shall be his/her obligation. SECTION 2. To assume this responsibility, registered nurses have to gain knowledge and understanding of man’s cultural, social, spiritual, physiological, psychological, and ecological aspects of illness, utilizing the therapeutic process. Cultural diversity and political and socio- economic status are inherent factors to effective nursing care. SECTION 3. The desire for the respect and confidence of clientele, colleagues, co-workers, and the members of the community provides the incentive to attain and maintain the highest possible degree of ethical conduct.  Code of Ethics Article II: Registered Nurses And People SECTION 4. Ethical Principles 1. Values, customs, and spiritual beliefs held by individuals shall be respected. 2. Individual freedom to make rational and unconstrained decisions shall be respected. 3. Personal information acquired in the process of giving nursing care shall be held in strict confidence. SECTION 5. Guidelines to be observed: REGISTERED Nurses must a. consider the individuality and totality of patients when they administer care. b. respect the spiritual beliefs and practices of patients regarding diet and treatment. c. uphold the rights of individuals. d. take into consideration the culture and values of patients in providing nursing care. However, in the event of conflicts, their welfare and safety must take precedence. Code of Ethics Article III Registered Nurses And Practice SECTION 6. Ethical Principles 1. Human life is inviolable. 2. Quality and excellence in the care of the patients are the goals of nursing practice. 3. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability SECTION 7. Guidelines to be observed: REGISTERED Nurses must a. Know the definition and scope of nursing practice which are in the provisions of R. A. No. 9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of 2003, the “Rules and Regulations Implementing the Philippine Nursing Act. of 2002”, (the IRR). b. Be aware of their duties and responsibilities in the practice of their profession as defined in the “Philippine Nursing Act of 2002” and the IRR. c. Acquire and develop the necessary competence in knowledge, skills, and attitudes to effectively render appropriate nursing services through varied learning situations. d. If they are Article III (continuation) SECTION 8. Ethical Principle 4. Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and privileges. SECTION 9. Guidelines to be observed: REGISTERED Nurses must a. respect the “Patients’ Bill of Rights” in the delivery of nursing care. b. provides the patients or their families with all pertinent information except those which may be deemed harmful to their well-being. c. upholds the patients’ rights when conflict arises regarding management of their care. Article III (continuation) d. If they are administrators, be responsible in providing favorable environment for the growth and developments of Registered Nurses in their charge. e. Be cognizant that professional programs for specialty certification by the BON are accredited through the Nursing Specialty Certification Council (NSCC). g. Sees to it that quality nursing care and practice meet the optimum standard of safe nursing practice. h. Ensure that modification of practice shall consider the principles of safe nursing practice. i. If in position of authority in a work environment, be normally and legally responsible for devising a system of minimizing occurrences of ineffective and unlawful nursing practice. j. Ensure that patients’ records shall be available only if they are to be issued to those who are professionally and directly involved in their care and when they are required by law Article III (continuation) SECTION 11. Guidelines to be observed: REGISTERED Nurses must: a. perform their professional duties in conformity with existing laws, rules regulations measures, and generally accepted principles of moral conduct and proper decorum. b. not allow themselves to be used in advertisement that should demean the image of the profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.). c. decline any gift, favor or hospitality which might be interpreted as capitalizing on patients. d. not demand and receive any commission, fee or emolument for recommending or referring a patient to a physician, a co-nurse or another health care worker; not to pay any commission, fee or other compensations to the one referring or recommending a patient to them for nursing care. e. avoid any abuse of the privilege relationship which exists with patients and of the privilege access allowed to their property, residence or workplace  Code of Ethics Article IV Registered Nurses And Co-workers SECTION 12. Ethical Principles 1. The Registered Nurse is in solidarity with other members of the healthcare team in working for the patient’s best interest. 2. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and other health care providers. SECTION 13. Guidelines to be observed: REGISTERED Nurses must a. maintains their professional role/identity while working with other members of the health team. b. conform with group activities as those of a health team should be based on acceptable, ethico legal standards. Code of Ethics Article V Registered Nurses, Society, And Environment SECTION 14. Ethical Principles 1. The preservation of life, respect for human rights, and promotion of healthy environment shall be a commitment of a Registered Nurse. 2. The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse.  Code of Ethics Article V Registered Nurses, Society, And Environment SECTION 15. Guidelines to be observed: REGISTERED Nurses must a. be conscious of their obligations as citizens and, as such, be involved in community concerns. b. be equipped with knowledge of health resources within the community, and take an active role in primary health care. c. actively participate in programs, projects, and activities that respond to the problems of society. d. lead their lives in conformity with the principles of right conduct and proper decorum e. project an image that will uplift the nursing profession at all times Code of Ethics Article VI Registered Nurses and The Profession SECTION 16. Ethical Principles: 1. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal. 2. Compliance with the by-laws of the accredited professional organization (PNA), and other professional organizations of which the Registered Nurse is a member is a lofty duty. 3. Commitment to continual learning and active participation in the development and growth of the profession is commendable. 4. Contribution to the improvement of the socio-economic conditions and general welfare of nurses through appropriate legislation is a practice and a visionary mission. Article VI Continuation SECTION 17. Guidelines to be observed: Registered Nurses must a. be members of the Accredited Professional Organization (PNA). b. strictly adheres to the nursing standards. c. participates actively in the growth and development of the nursing profession. d. strives to secure equitable socio-economic and work conditions in nursing through appropriate legislation and other means. e. assert for the implementation of labor and work standards Code of Ethics ARTICLE VII ADMINISTRATIVE PENALITIES, REPEALING CLAUSE, & EFFECTIVITY SECTION 18. The Certificate of Registration of Registered Nurse shall either be revoked or suspended for violation of any provisions of this Code pursuant to - Sec. 23 (f), Art. IV of R. A. No. 9173 and… Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR. regulatory- check professionals gagawa ng batas Suspension or Revocation of License Suspension - the nurse is not allowed temporarily to practice nursing until final judgment of her case is resolved; license is not confiscated Revocation - license to practice is confiscated either temporarily or permanently. Re-Issuance of Revoked Certificate Upon proper application and payment of required fees: 1. After the expiration of the maximum period of 4 years from the date of revocation 2. When the cause for revocation has disappeared, cured or corrected  THE INTERNATIONAL COUNCIL OF NURSES (ICN) CODE OF ETHICS FOR NURSES - first adopted by the International Council of Nurses (ICN) in 1953. - latest revision completed in 2012 - has four principal elements that outline the standards of ethical conduct. 1. Nurses and people 2. Nurses and practice 3. Nurses and the profession 4. Nurses and co-workers PROFESSIONAL NURSING ART. VI SEC. 28 of RA 9173 (THE PHILIPPINE NURSING ACT OF 2002) A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families, and communities in any health care setting. It includes, but is not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, pre school, school age, adolescence, adulthood, and old age. IT SHALL BE THE DUTY OF THE NURSE TO: 1.Provide nursing care through the utilization of the nursing process in the following: a.) Traditional and innovative approaches b.) Therapeutic use of self c.) Executing health care techniques and procedures d.) Essential primary health care e.) Comfort measures f.) Health teachings g) Administer written prescription for treatment and therapies (oral, topical and parenteral medications h.) do Internal examination during labor (in the absence of prenatal bleeding) and delivery i.) Suturing of perineal laceration (requires special training) Special Considerations A. Medical Orders – execution is a dependent function written orders are legal orders must be clear, specific, and legible B. Telephone Orders – should be limited only in cases of extreme emergency and, when there is no doctor around How does the nurse protect herself? -Nurse reads back the order to the doctor -Nurse writes the name of the physician who made the order per his/her own and note the time when the order was made - Such order should be signed by the physician on his visit within 24 hours -If problem/s arise, refer back to the ordering physician 2.Establish linkages with community resources and coordinate with the health team 3.Provide health education to individuals, families and communities 4. a) Teach, guide and supervise students in nursing education b) Administration of nursing services in varied settings, c) c.) undertake consultation services, d.) engage in such activities that require the utilization of knowledge and decision making skills of a registered nurse, and 5. Undertake nursing and health human resource development training and research towards the development of advancements in nursing practice *The abovementioned shall not apply to nursing students. *The nurse is also duty bound to observe the Code of Ethics for Nurses and to uphold the Standards of Nursing Practice. *The nurse is also required to maintain competence through continuing professional education provided by an accredited professional organization or any recognized professional nursing organization; provided that the program and activity for the continuing professional education shall be submitted to and approved by the Board. CONTRACTS What is a Contract - a meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to render some service. - A contract is a promise or a set of promises which the law recognizes as a duty and when that duty is not performed, the law provides a remedy Requisites of a Contract 1. Two or more persons must participate. 2. Consent 3. The object/subject matter of the contract such as: ◦ a. all things which are not outside the commerce of man ◦ b. all rights which are not in transmissible ◦ c. future inheritance in cases expressly authorized by law ◦ d. all services which are not contrary to law, morals, good customs, public order, and public policy. 4. The cause of obligation is established ( time, price, and subject matter). Requisites of a Contract 5. Contracting parties must have the legal capacity to enter into a contract. a. be of legal age (18 y.o. and above) b. be of sound mind c. not under the influence of intoxicating drugs, or fear of bodily harm; d. not suffering from physical disability such as those who are mentally incompetent. e. literate Kinds of Contracts 1. Formal Contract – Refers to an agreement among parties involved and is required to be in writing by some special laws. Examples are marriage contracts, mortgages, and deeds of sale or work contracts 2. 2. Informal Contract -Is one which is concluded as the result of a written document or correspondence where the law does not require the same to be written, or as the result of oral and spoken discussion between the parties or conduct between the parties, evidence and intention to contract.  : Kapag ang pahintulot ay hindi malayang ibinigay, ang kontrata ay maaaring mapawalang-bisa. Mananatili itong balido hangga’t hindi napipili ng isang partido na ipawalang-bisa ito dahil sa pamimilit, panlilinlang, o maling representasyon 3. Voidable Contract - where consent is not freely given may void a contract. It therefore continues to be valid till the party whose consent is caused by coercion, undue influence, fraud or misrepresentation choose to avoid the contract within a reasonable time. 4. Void Contract – ceases to be enforceable by law ; is null from its inception. - A contract may also be originally valid when entered into but subsequently due to change in the events or circumstances, it may become void.. The right expression therefore is void agreement and not void contract 5. Unenforceable Contract - A contract which cannot be enforced is a valid contract in law, but is incapable of proof, and therefore cannot be enforced in the Court of Law Bagama't balido ito sa mata ng batas, hindi ito maipapatupad sa korte dahil sa kakulangan ng ebidensya.  4. Ang kontrata ay walang bisa mula sa simula, o dahil sa pagbabago ng pangyayari, nagiging walang bisa. Hindi ito mapipilit ipatupad sa batas. 6. Executed Contract -Where either or both the parties have performed their obligation Ang isa o parehong partido ay nakatupad na ng kanilang obligasyon. 7. Executory Contract - Neither party to the contract has yet to perform his share of the obligation, for example Wala pang isa sa mga partido ang tumutupad sa kanilang obligasyon. 8. Express Contract - written or oral ito ay malinaw na kasunduan, maaaring nakasulat o pasalita. 9. Implied Contract - terms of a contract are inferred from the conduct or dealing between the parties. When the proposal or acceptance of any promise is made otherwise than in words, the promise is said to be implied Ang kasunduan ay makikita sa kilos o mga pakikitungo ng mga partido, hindi kinakailangang salita. 10. Quasi-Contract -Certain relations resemble those created by a contract. Certain obligations which are not contracts in fact but are so in the contemplation of law.Mga sitwasyon na parang may kontrata kahit wala. Halimbawa, kung ang isang private duty nurse ay umatras sa kontrata dahil sa mas magandang trabaho, kailangan niyang maghanap ng kapalit Ex. Private duty nurse who begs off from contract due to a better work opportunity must find her replacement 11. Contingent Contract -A contingent is one in which a promise is conditional and the contract shall be performed only on the happening of some future uncertain event Contingent Contract: Ang kontrata ay nakadepende sa isang hindi tiyak na pangyayari sa hinaharap. Halimbawa, ang isang pangako ay magkakaroon ng bisa kapag natupad ang isang kondisyon for me parang yung lupain magiging sa'yo yan kapag nawala na lola mo ILLEGAL CONTRACTS - obtained through use of fraud (deception and trickery,) undue (unlawful) influence or duress (coercion) in securing such, and those that are expressly prohibited by law are illegal: 1. Those that are made in protection of the law. If a nurse sutures a laceration 2. Consent obtained by fraud. Mga kontratang nakuha sa pamimilit o banta ng karahasan. Ex. misrepresentation that she/he is licensed although she/he is not 3. Those obtained under duress. Duress means actual or threat of violence or imprisonment in order to obtain consent. A nurse may be forced to sign a contract under threat of dismissal. 4. Those obtained under undue influence. If a nurse who has been taking care of an elderly patient uses her close relationship to acquire high salary or other options as property, such contract is invalid as it is illegal. 5. Those obtained through material misrepresentation. BREACH OF CONTRACT Hindi pagtupad sa napagkasunduan - failure to perform an agreement, whether expressed or implied, without cause. Examples: prevention of performance failure to perform because of inconvenience or difficulty; failure of cooperation in performance abandonment of duty (i.e., leaving unconscious patients, going off-duty without endorsement, loafing while on duty) substitution of performance failure to use due care.  LEGAL EXCUSES IN REFUSING, NEGLECTING OR FAILURE TO PERFORM A CONTRACT discovery of material misrepresentation made and relied upon; where performance would be illegal; where performance is made impossible by reason of illness; where performance is made impossible by death of patient or nurse; where performance is made for other reasons; and where contract is insufficient. Natuklasan na may maling impormasyon na batayan ng kontrata. Hindi na legal o posible ang pagsunod sa kontrata dahil sa sakit, pagkamatay, o iba pang dahilan WILL - a legal declaration of person’s intentions upon death - 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. 1. Holographic Will - entirely written, dated, and signed by the hand of the testator himself. - In the probate of a holographic will, it is necessary that there is at least one witness who knows the handwriting and signature of the testator and explicitly declares that the will and the signature are in the handwriting of the testator. 2. Oral Will spoken/oral, rather than written and usually made before at least 2 witnesses. Restrictions to the oral will are that such will be made during the person’s last illness, that it be done in the place in which he died, that he asked one more witnesses to the will, that the will be put in writing within a given number of days, and that it be offered to probate within a specified time Related Terms Testator/Testatrix Probate Testate Administrator Intestate  Testamentary Capacity And Intent Essentials of a will to meet legal requirements: 1. The testator must have the expressed intention of making a will. 2. 18 years old and above. 3. ….of sound mind and must be free from undue influence. 4. The testator shall name the person who will be in charge of carrying out the provisions of the will. (Administrator) Testamentary Capacity And Intent 5. Properties must be disposed of in accordance with legal requirements. 6. The will must be signed by the testator, attested, and signed by at least three witnesses in his presence and of one another. 7. Every will must be acknowledged before a notary public by the testator and witnesses. 8. Witnesses to the wills shall be of sound mind, 18 years old & above, not blind, deaf or dumb, and able to read and write. THE NURSE’S OBLIGATIONS IN THE EXECUTION OF A WILL - notethe soundness of the patient's mind (that he/she understood the act of making a will) - there was freedom from fraud or undue influence (he/she was not induced to make someone the beneficiary of the will) - that the patient was above 18 years of age. - should note that the will was signed by the testator, that the witnesses were all present at the same time and signed the will in the presence of the testator. GIFTS Another way of disposing of property The gift must consist of personal property There must be an intention to make the gifts; There must be an indication of transfer of control over such property; and There must be acceptance by the recipient ***Gifts made by a person because of anticipation of death or belief in approaching death are called gifts causa mortis or donation causa mortis. LEGAL PROCEDURE AND TRIAL COMMENCEMENT OF THE ACTION to determine what kind of legal action to take. ex. Negligence. breach of contract. STATUTES OF LIMITATION Complaint must be filed within a specific time or the right to complain may be lost forever. - Witnesses become less reliable after passage of time - negligence or malpractice vary from two (2) to three (3) years - In criminal cases, statutes of limitation vary from two (2) to six (6) years except in cases where murder is committed in which there is no time limit. PLEADING The defendant is informed about a complaint that he had committed a crime. The court checks if there’s enough evidence Where it is determined whether there is prima facie evidence or probable cause to charge someone… could either plead guilty or not guilty PRE-TRIAL PROCEDURES informal discussion between the judge and attorney to eliminate matters not in dispute, agree on issues, and settle procedural matters relating to the trial. Cases are often settled at this point TRIAL facts of the case are determined, the principles of law are applied and a conclusion as to liability is reached. laws are applied to reach a decision on whether the defendant is liable (responsible) or not. WITNESS Subpoena a court summons is served directing 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- testify only on what she knows -- Testimony of Opinion - given by expert witnesses who is qualified to testify based on special knowledge, skill, experience, and training; has the privilege against self-incrimination. -***Dying declarations or ante-mortem statements are considered hearsay evidence except when made by a victim of a crime  If the losing party is not satisfied with the trial’s outcome, they can take the case to an appellate court for review. Once the appellate court decides, the case is usually concluded. APPEALS An appellate court reviews the case, and when the case is decided by it, the final judgment results and the matter is ended. EXECUTION OF JUDGMENT Generally, lawsuits against hospitals or physicians and nurses involve recovery of money damages. The defendant is compelled to execute the judgment. Failure to obey will be regarded as contempt of court and will result in fine or imprisonment. If the court rules against the defendant (like a hospital or a doctor), they might be ordered to pay damages (money) to the plaintiff. If the defendant refuses to follow the court’s decision, they can be punished for contempt of court (resulting in fines or imprisonment). CONSENT TO MEDICAL AND SURGICAL PROCEDURES - a “free and rational act ” The consent signed by the patient or his authorized representative/legal guardithe right to determine what shall be done with his own body. Essential Elements: The diagnosis and explanation of the condition A fair explanation of the procedures to be done and used and the consequences of A description of alternative treatments or procedures A description of the benefits to be expected Material rights if any The prognosis, if the recommended care, procedure, is refused Proof of consent A written consent should be signed Who Must Consent? - patient is the one who gives the consent in his own behalf. - Parent/legal guardian for incompetent (minors or mentally ill) or physically unable and is not an emergency case - Emancipated minor Emergency Situation – No consent is necessary because inaction at such time may cause greater injury. Refusal to Consent – A patient who is mentally and legally competent has the right to refuse the touching of his body or to submit to a medical or surgical procedure no matter how necessary, nor the imminent danger to his life or health if he fails to submit to treatment. Consent for Sterilization – The husband and the wife must consent to the procedure if the operation is primarily to accomplish sterilization. CHARTING DONE BY NURSING STUDENTS - Clinical instructor countersigns the charting of a nursing students - Attests that he/she has personal knowledge of information and that such is accurate and authentic. - Anyone who countersigns without verification commits herself to possible legal risks. RELATED TERMS Responsibility Accountability Liability Professional Negligence omission or commission of an act, that a reasonably prudent person in similar circumstances would or would not do and the action or inaction is the proximate cause of injury to another person or his property Failure to meet the standard That cause death Napabayaan Nag cause ng injury Dapat nakikita yung forseability of harm Civil Code, Article 19 One shall act with justice, give every man his due, observe honesty and good faith. Civil Code, Article 20 Those who, in the performance of their obligations through negligence cause any injury to another, are liable for damages. Elements of Professional Negligence Existence of a duty Failure to meet the standard of due care Foreseeability of harm Injury to the plaintiff 3 conditions required to establish a defendant’s negligence Injury was of such nature that it would not normally occur unless there was a negligent act on the part of someone Injury was caused by an agency w/in control of the defendant Plaintiff himself did not engage in any manner that would tend to bring about the injury * immediately inform or make actions/interventions if the patient complaint Examples of Negligence - Failure to report observations to attending physicians - Failure to exercise the degree of diligence which the circumstances of the particular case demands - Mistaken identity - Wrong medicine, wrong concentration, wrong route, wrong dose - Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients - Administration of medicine w/o a doctor’s prescription - Errors due to family assistance * the thing speaks for itself- means yung injury yung mag sasabi kung ano yung nangyayare sa patient may negligence na nangyare DOCTRINE Of RES IPSA LOQUITUR “the thing speaks for itself” May negligence the injury could not have happened if someone was not negligent ; that no further proof is required. Examples: forceps left inside the abdominal cavity after a TAHBSO procedure Injury to the sciatic nerve after injection to the buttocks. Patient was subsequently paralyzed The presence of sponges in the patient’s abdomen after an operation. Fracture on a newly-delivered baby born by breech presentation. MALPRACTICE - Improper or unskillful care of the patient by a nurse; also denotes stepping beyond one’s authority with serious consequences - Term of negligence of professional personnel (Professional Negligence) They failed to do their job bec. Of some events DOCTRINE OF FORCE MAJEURE Yung mga incidents na di inaasahan -An irresistible 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. Ex. floods, fire, earthquakes and accidents fall under this doctrine and nurses fail to render service during this circumstance are not held negligent  Pag nagkamali yung under sayo, may papanagutan aa ginawaa niya DOCTRINE OF RESPONDEAT SUPERIOR at ikaw din yung supervisor lagot ka, lalo na kapag nag uutos ka na di naman sure sa ipapagawa mo if alam niya orr scope sa work nia “Let the master answer for the acts of the subordinate.” The liability is expanded to include the master as well as the employee and not a shift of liability from the subordinate to the master. Example: - Hiring under board nurses or midwives in place of professional nurses, and these persons prove to be incompetent. - The surgeon will be held responsible in case a laparotomy pack is left in a patient’s abdomen. - Note: Private duty nurses as independent contractors are liable for their own negligent actions. INCOMPETENCE Lack of ability, or legal qualifications and being unfit to discharge the required duty. It is a ground for the revocation and suspension of her certificate of registration. Ex. A nursing assistant giving IV medication to the patient. LIABILITY FOR WORK OF NURSE TRAINEES AND NURSE VOLUNTEERS Nurses are responsible and accountable for their practice, nurse volunteers should exercise utmost caution, critical thinking and independent judgment to prevent incurring liabilities which may be hard to get out of. LIABILITY OF NURSES FOR THE WORK OF NURSING AIDES Nurses should not delegate their functions to nursing aides since the Philippine nursing act specifies the scope of nursing practice of professional nurses. Nurses are enjoined to supervise their subordinates and see to it that they perform only those which they have been taught to do and those which they are capable of doing. Nursing aides are responsible for their actions Nurses should not delegate their functions to nursing aides. Nursing aides perform selected nursing activities under the direct supervision of nurses. LIABILITY FOR THE WORK OF NURSING STUDENTS Nursing students should be under supervision of their clinical instructors. They should be given assignments that are their level of training experience and competency. - They should be advised to seek guidance if they are performing a procedure for the first time. - - They should be oriented to the policies where they are assigned. - Their performance should be assessed frequently to determine their strengths and weaknesses. Legal Defense in Negligence Malalaman m naman iff maganda or mali kang ginawa. When Nurses know and attain the standard of care giving service and that they have documented the care they give. If the patient’s careless conduct contributes to his own injury INTRAVENOUS THERAPY AND LEGAL IMPLICATIONS Philippine Nursing Act of 1991 RA 7164 Art. V Section 28 S. 1994 “ & BON Res. No.8 in the administration of intravenous injections, special training shall be required according to protocol established”. 7164- law dati na bawal mag iv insertation and iv injection *****Repealed by Art. VI Sec 28 RA 9173 and BON Res 38 S. 2016 ang mga nurses https://www.prc.gov.ph/uploaded/documents/PRB_BON%20Reso%202016- 38_IntravenousTherapyTraining_e.pdf CRIMES AFFECTING NURSING PRACTICE/ REGISTERED NURSES TORT legal wrongdoing committed by one person against another person or their property 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 a. Assault Naka- feel ng anxiety Imminent threat of a harmful or offensive bodily contact. Or Verbal threat Ex: A nurse threatens a geriatric patient when he will take his medications Hinawakan mo talaga siya or nag cause suta ng haram b. Battery physically Intentional, unconsented touching of another person. Ex. When the patient refuses the IM injection of medication but the nurses give it anyway, he can be charged with battery Holding someone against their will without a valid reason or legal authority. c. False Imprisonment or Illegal Detention Unjustifiable detention of a person without legal warrant within boundaries fixed by the defendant by an act or violation of duty intended to result in such confinement with false imprisonment However, if patient has a communicable disease, hospital cannot be charged with false imprisonment in order to protect the public. Kuha sila indigency Need ng dr oder, bawal yung bibigyan mo siya agad ng gamot para ma sedate. If nag wawala tapos wlang dr order. Tignan yung hospital policy or call the doctor or isolate the patient d. Invasion of Right to Privacy and Breach of Confidentiality The right to be left alone, right to be free of unwanted publicity and exposure to public view Damaging someone's reputation through false statements. d. Defamation When you write or spoken words against a person Character assassination, be it written or spoken. Slander –oral or spoken defamation Libel –written defamation (cartoon characters, words written or essay). ***** There must be a third person who hears or reads the comment  1. Criminal Act: The action of committing the crime. 2. Criminal Intent: The intention to commit the crime. CRIMES, MISDEMEANORS, AND FELONIES an act committed or omitted in violation of the law has 2 elements: (1) criminal act and (2) evil or criminal intent Conspiracy to commit a crime - exists when 2 or more persons agree to commit a crime or felony and decide to do it. Principal - Has committed a direct part in the execution of the act; the mastermind of the crime Accomplices Cooperates in the execution of the offense by previous or simultaneous act and has knowledge of the criminal intention of the principal Accessory - Have knowledge of the commission of the crime - Take part subsequent to its commission by profiting themselves or assisting the offender to profit from the effects of the crime - Provides exit strategy helps after the crime A person who helps in committing the crime, either before or during the act, and knows about the criminal plan.  Accesorry- outside the crime scene Accomplices- yung katulong sa crime scene A misdemeanor is a less serious crime compared to a felony. It’s a criminal offense but doesn’t amount to a very severe crime. Punishment for a misdemeanor usually involves paying a fine or spending less than one year in jail. Example: Minor offenses like petty theft or disorderly conduct. MISDEMEANOR - a criminal offense which does not in law amount to felony Punishment is usually fine or imprisonment in term of less than one year FELONY Pinakamabigat na crime ( yung mga may “people of the ph vs..) tas mas mabigat yung parusa sa kanya - Public offense for which a convicted person is liable to be sentenced to death or to be imprisoned in a penitentiary Is committed with deceit and fault. Deceit exists when the act is performed with deliberate intent and there is fault when the wrongful acts result from imprudence, negligence, or lack of skill or foresight.  The person performs an action voluntarily but without thinking it will cause harm. unintentionally causes harm through careless or reckless behavior. Criminal Negligence may be classified into: Reckless Imprudence when a person does an act or fails to do it voluntarily but without malice, from which material damage results immediately. Homicide due to reckless imprudence- pag mali yung gamot na naibigay mo sa pt. Ito yung pwede mo maging kaso Example: A driver speeding through a red light causing a car accident. Simple Imprudence the person or nurse did not use precaution and the damage was not immediate or the impending danger was not evident or manifested immediately Example: A nurse fails to double-check a patient’s medication, leading to the wrong dosage being given, but the effects are seen later. Criminal Intent State of mind of a person at the time of the criminal act is committed. The person is aware that the act is unlawful but commits it anyway. Deliberate intent includes two elements without which there can be no crime. These are freedom and intelligence. Freedom: The person is not being forced to commit the act. Intelligence: The person understands that the act is unlawful but still proceeds A. SELF DEFENSE- unlawful aggression, reasonable defense, no provocation B. DEFENSE FOR OTHERS C. FULFILLMENT OF DUTY CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY 1.Justifying circumstances – no criminal liability is incurred by the accused A. When he/she acts in defense of his/her person or rights provided that: - There is an unlawful aggression on the part of the offended or injured party The attacker was the first to use force or aggression. - There is reasonable necessity for the means employed by the person defending hi himself/herself to prevent such aggression - There is lack of sufficient provocation on the part of the person defending himself. B. When he/she acts in defense of the person or the rights of his/her spouse, ascendants, descendants, or legitimate or natural or adopted brothers or sisters, or relatives C. Fulfillment of a duty or lawful exercise of right or office, Ex: police officers shooting a drug addict to defend oneself from getting shot back A. Imbecile or insane person B. Children under 9 years old C. Children 9-15 years old D. Accidents E. Irresistible force Walang papanagutan baka kasi siya ay F. Uncontrollable fear G. Lawful or insuperable cause Minor, matanda na talaga (senile) 2. Exempting circumstances Kung nasa tama ba yung pag iisip nila sa oras na nagawa nila yung crime or hindi a. Imbecile or insane person, unless the latter has acted during a lucid interval. b. Person less than 9 years’ old (the ability to understand right and wrong). c. Person over 9 years of age and under fifteen unless he/she acted with discernment d. Any person while performing a lawful act with due care he/she causes merely an accident without fault or intention or causing it e. Any person under compulsion of an irresistible force E. Irresistible force: If someone was forced to commit a crime due to overwhelming force, they are not liable. f. Any person who acts under the impulse of an uncontrollable fear of an equal or greater I injury g. Any person who fails to perform an act required by law when prevented by some lawful or insuperable cause. If a lawful reason or an unavoidable situation prevents a person from acting, they are exempt. A. Lesser intent B. Age C. Provocation OR THREAT D. Voluntary surrender E. Physical or mental defects F. Illness lessen the criminal liability of the offender, meaning the punishment is reduced 3. Mitigating circumstance- those which lessen the criminal liability of the offender - When the offender has no intention to commit so grave a wrong as the one committed - When the offender is under eighteen years of age or over seventy years old. - When sufficient provocation or threat on the part of the offended party immediately precedes the act. If the crime was committed after a provocation or threat by the victim. - Offender voluntarily surrenders himself to a person in authority - Defender is deaf and dumb, blind or otherwise suffering from some physical defects which does restricts his/her means of actions, defense or communication with fellow beings. - Suffering from such illness as would diminish the exercise of his/her will power without, depriving him/her consciousness of his/her acts A. Abuse of public position B. Crime in a sacred place C. Premeditation or unlawful entry D. Abuse of confidence E. Crimes for reward F. Committing a crime during calamities G. Craft, fraud, or disguise 4. Aggravating circumstancesmore increase the criminal liability of the offender or make his severe, leading to harsher punishment guilt or penalty more severe. Gabi ginawa, sa loob ng simbahan a. When the offender takes advantage of his public position. b. Crime is committed in place of worship c, Act is committed with evident premeditation or after an unlawful entry Planning the crime in advance or breaking into a property makes the crime worse. d. Act committed with abuse of confidence or obvious ungratefulness e. When the crime committed in consideration of a price, reward, or promise f. Crime is committed on occasion of a conflagration, shipwreck, earthquake, epidemic or other calamity or misfortune g. When craft, fraud or disguise was employed A. RELATIONSHIP B. INTOXICATION C. ILLITERACY lessen or increase criminal liability depending on the situation 5. Alternative circumstances T - Taken as either aggravating or mitigating according to the nature and effects of the crime and other conditions attending to its commission Relationship is aggravating in physical injuries inflicted by a descendant upon an ascendant. - It is mitigating when an accused aided his/her brother in the fight against the offended party  Intoxication of the offender as mitigating when the offender committed the felony in a state of intoxication. - When intoxication is habitual or intentional, it can be an aggravating circumstance. Illiteracy is mitigating if there is lack of sufficient intelligence and knowledge of the full significance of one’s act. - Lack of education is not mitigating in: rape, force abduction, arson, treason, crimes against chastity like seduction and acts of lasciviousness and acts committed in merciless or heinous manner,  Things To Remember In Order To Avoid Criminal Liability 1. Familiarity with the Philippine nursing law. 2. Know other laws affecting nursing practice 3. At the start of employment, get a copy of your job description, the agency’s rules, regulations and policies. 4. Upgrade skills and competence 5. Accept only such responsibility that is within the scope of your employment and your job description. 6. Do not delegate your responsibilities to others. 7. Determine whether your subordinates are competent in the work you are assigning them. 8. Develop good interpersonal relationships with your co-workers, whether they be your supervisors, peers or subordinates. 9. Consult your superior for problems that may be too big for you to handle. 10. Verify orders that are not clear to you or those that seem to be erroneous. 11.The doctors should be informed about the patient's conditions. 12. Keep in mind the values and necessity of keeping accurate and adequate records 13. Patients are entitled to an informed consent.