Competency Standards in Nursing Practice

- prepared by the Committee on Core Competency

Standards Development for the Professional Regulation Commission - Board of Nursing (PRCBON) and the Commission on Higher Education Technical Committee on Nursing Education (CHED TCNE)

- Aim: to improve further the quality standards of nursing

practice in the Philippines and to ensure the global competitiveness of Philippine Registered Nurses 11 Core competency areas (pursuant to PRC-BON Resolution 112, s. 2005) 1) Safe and quality nursing care 2) Management of resources and environment 3) Health education 4) Legal responsibility 5) Ethico-moral responsibility 6) Personal and professional development 7) Quality improvement 8) Research 9) Record management 10) Communication 11) Collaboration and teamwork

Functions of the Competency Standards for

Nursing Practice

a) guide in developing curriculum in nursing b) framework in developing test syllabus for entrants into the nursing profession c) tool for performance evaluation among nurses d) basis for advanced nursing practice and specialization e) framework for developing a training curriculum for nurses f) protection for the public from incompetent practitioners g) yardstick for unethical and unprofessional practice of nursing

Bases of the competency standards

- sec. 9,art. 3 RA 9173 (function of the BON) Development Model of Competency Standards - Naturalistic Model in Curriculum Development by Decker Walker 4 phases: 1) Identifying the competencies; 2) Verifying the identified competencies; 3) Pilot testing the competencies 4) Benchmarking with existing standards

Career Pathway for Nurse Practitioners

- developed by ANSAP - Based on Patricia Benners theory; 5 stages of skills acquisition - Provides the basic infrastructure for nurses as to their nursing career and to advance nursing practice - As nurses move only from supporting roles into leadership and management functions, they are required to have: a) higher level of education b) knowledge, c) skills, and d) decision making competence - leads to expanded roles, accountability for actions and more responsibilities in the health care system

Law and Jurisprudence in Nursing Practice

Three Basic liabilities in the Nursing Practice are: Civil Criminal Administrative

Civil Action
2 Types of Civil Liability :

Culpa Contractual Culpa Aquiliana

Culpa Contractual

Culpa contractual ( breach of contract) - when a nurse is contractually obligated to perform a particular health service or intervention to a patient and caused death or injury to the latter Contract ( Art. 1305, Civil Code) - is a meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to do some service.

Culpa Aquiliana (Tort/Quasi-delict)

Culpa- aquiliana - absence of contractual relationship, a nurse may be liable for damages or injuries arising from negligent conduct The fault or negligence of a person, who by his act or omission, connected or unconnected with, but independent from, any contractual relation, causes damage to another person.

Criminal Action Arises when a person perpetrates a crime or violates a special penal law or local government ordinance
Felony- violations of crimes listed under the Revised Penal Code; crimes Mala- in se (deceit/dolo) Offense violation of a Special law; crimes Mala prohibita

Infraction violation of an Ordinance Criminal Negligence- commission of a crime fault (culpa)

through

Criminal Negligence - also called Imprudence - a kind of negligence suit which arises from the failure of the nurse or health care professional to apply to his profession that degree of care and skill which is ordinarily employed by his profession under similar conditions - may also pertain to a criminal action for malpractice against a nurse

Administrative (Salalima vs. Guingona [1996]) An administrative Offense means every act or omission which amounts to, or constitutes, any ground for disciplinary action - An administrative disciplinary action against a nurse may arise from an administrative offense or any ground for disciplinary action - For purposes of determining the administrative liability of a nurse, it is important to know whether he/she is employed in government or private hospitals/ institutions

Government complaints against nurses may be filed at the Civil Service Commission, Ombudsman, Head of Government Office (Mayor/Governor) Private filed with the private employer/hospitals Administrative cases against nurses working in the Government The Three-fold Lawsuit Rule - pertains to three-fold liability - the offended party can file civil, criminal, and administrative cases against a nurse, for the same negligent act or omission - However, the nurse cannot be compelled to pay damages twice for the same negligent act because the law prohibits double recovery, it being an unjust enrichment at the expense of another

Administrative Cases against Nurses working in Private Hospitals

- The private employer has an in-house mechanism for

the disciplinary action of its employees - An employer employee relationship must first be established

FOUR-WAY Test: 1) Selection and engagement of the employee 2) Payment of wages 3) Power of dismissal 4) Power to control the employees conduct

Contracts
- A meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to render some service

Contracts Statutory Requisites of a Contract Object certain - which is the subject matter of the contract Cause of the obligation - which is established (Art 1318 Civil Code ) Consent Consent-Manifested by the meeting of the offer and the acceptance upon the thing and the cause which constitute the contract Approval of what is proposed by another May be express or implied Should not be given through mistake, violence, intimidation, undue influence or fraud Object Must be within the commerce of man

Must be licit, or not contrary to law, morals, good customs, public policy or public order Must be possible Must be determinate as to its kind

Cause the why of the contract The immediate and most proximate purpose of the contract The essential reason which impels the contracting parties to enter into the agreement Explains and justifies the creation of the obligation through such consent

Breach of Contract Unjustified failure to perform all or part of the contractual duty If the breach is substantial, the entire agreement may be broken anddamages may result If only part of the contract is breached, the remaining part of the contract maybe in effect Employment Contract Need not be in writing Oral contracts though can cause problems since memories fail

 Criminal action Criminal negligence- committed by means of fault or culpa Mala in se committed by means of dolo or deceit Mala prohibita those which are punished by special laws Kinds of Criminal Negligence Reckless imprudence- doing or failing to do an act resulting to injuries or death due to an inexcusable lack of precaution
Simple imprudence is a mere lack of precaution in a situation where the threatened harm is not immediate or the impending danger is not openly visible or manifest

Negligence The omission of that degree of diligence which is required by the nature of the obligation Failure to exercise the care that a prudent person usually exercises Negligence Test

- would a prudent man, in the position of the person to

whom negligence is attributed, foresee harm to the

person injured as a reasonable consequence of the course about to be pursued?; - if so, the law imposes a duty on the actor to refrain from that course or to take precaution against its mischievous results.

Other form of the Negligence Test

- Did the defendant in doing the alleged negligent act

use the reasonable care and caution which an ordinary prudent person would have used in the same situation? if not, then he is guilty of negligence

Malpractice - Defined as any professional misconduct or any unreasonable lack of skill or fidelity in the performance of professional duties - Improper or unethical conduct by a professional, resulting in harm, injury, or death of another - Practice contrary to established rules and standards Elements of Malpractice 1. Duty duty of a nurse to employ her training, care, and skill in the care of the patient commences at the time her employment is engaged by the patient 2. Breach breach of professional duties, skill, and care, or their improper performance by the nurse

3. Damage or injury caused to the body or health of the patient 4. Proximate causation a) whether the nurses actions causes harm to the patient b) whether these actions are the proximate cause of the injury

Misdemeanor - Applied to all crimes and offenses for which the law has not provided a particular name
Ex. Any person who practices nursing in the Philippines without a certificate of registration

Criminal liability is incurred by: Any person committing a felony although the wrongful act done be different from that which he intended;
Any person performing an act which should be an offense against persons or property, were it not for inherent impossibility of its accomplishment or on account of the employment of inadequate or ineffectual means.

Classification according to

Gravity

- Grave felonies- those which the law attaches the capital punishment (death) or penalties which in any of their periods are effective ( imprisonment from 6 years and 1 day to life imprisonment, or a fine exceeding 6,000.00)

- Less Grave - those which the law punishes penalties that are correctional; imprisonment of 1 month and 1 day to 6 years or fine not exceeding Php 6,000.00 but not less than Php 200.00 - Light - 1 day to 30 days or fine of not exceeding Php 200.00 or both

Justifying Circumstances - the act/crime of the person is in accordance with the law; person is free from both criminal and civil liability 1. Self-Defense 2. Defense of Relatives 3. Defense of Stranger 4. Avoidance of Greater Evil or Injury 5. Fulfillment of Duty or Lawful Exercise of Office

Exempting Circumstances - grounds for exemption from punishment because there is lacking in the offender any of the conditions

which makes the act voluntary (lack of intelligence, freedom of action or intent) 1. Insanity 2. Person under 9 years of age 3. Person over 9 years and under 15 years without discernment (mental capacity to appreciate the consequences of an act) 4. Person who acts under the compulsion of an irresistible force 5. Accident without fault or intention of causing it Mitigating Circumstances - circumstances which does not entirely free the offender from criminal liability but only reduces the penalty 1. Under 18 or over 70 years old 2. No intention to commit so grave a wrong 3. Provocation or threat 4. Passion (acted upon impulse) 5. Surrender and confession of guilt

Aggravating Circumstances - increase the penalty of the offense 1. Taking advantage of public position 2. Crime is committed in the presence of public authorities

3. Crime is committed in the palace of the Chief Executive 4. Crime is committed in the nighttime or in an uninhabited place 5. Crime is committed on the occasion of an earthquake, epidemic, shipwreck or calamity 6. Crime is committed with the aid of armed men

7. Crime be committed in consideration of a price, reward, or promise 8. The act be committed with evident premeditation 9. Superior strength 10. Means are employed to weaken the defense 11. That as a means to the commission of a crime, a wall, roof, door, or window is broken 12. Crime is committed by means of motor vehicles, airships, or other similar means

Other criminal actions and

offenses

Parricide - the highest form of destruction of human life; committed when one kills his father, mother or child, whether legitimate or illegitimate, or any of his ascendants or descendants, or his spouse

Murder- committed when a person kills another, other than his father, mother, or child, whether legitimate or

illegitimate, or any of his ascendants or descendants, or his spouse, which killing is attended by treachery, abuse of superiority, employment of means to weaken defense, evident premeditation, cruelty, price, reward or promise and other qualifying circumstances Homicide- the killing of a human being which is neither parricide nor murder. Infanticide - the killing of any child less than three days old, whether the killer is the parent or grandparent, or any relative of the child, or even a stranger Abortionintentional- if the intent is present because the offender acted purposely to expulse the fetus to bring about the abortion; unintentional- not intended but the violence inflicted upon the pregnant woman is intended; if the violence is due to negligence, imprudence, lack of foresight or lack of skill---unintentional abortion through reckless imprudence

Giving Assistance to Suicide - Assists another to commit suicide to the extent of doing the killing himself Illegal Detention - May arise in the enforcement of quarantine regulations; isolation of patients

- Not allowing patients to leave the hospital if not cleared with payable account Simulation of Birth Crime against the civil status of persons punishable acts: 1) substitute one child for another or who shall conceal or abandon any legitimate child with intent to cause such child to lose its civil status 2) Any physician or surgeon or public officer who in violation of the duties of his profession or office shall cooperate in the commission of the crime Rapetraditional: carnal knowledge of a woman against her will and sexual assault: committed when (1) penis inserted into the anal orifice of a male or female; (2) an instrument or object is inserted into the genital or anal orifice Sexual harassment is committed in the work place, school, or training environment, by someone who has authority, influence, or moral ascendancy over the victim. Committed by the former who demands, requests or otherwise requires any sexual favor from the latter, regardless of whether such demand, request or requirement for submission is accepted Mutilation - is the lopping or clipping off of some parts of the body resulting to the deprivation, whether totally or partially of some essential organs for reproduction Physical Injury - committed when a person wounds, beats, or assaults another resulting to serious, less serious or slight injuries

Physical Injuries Serious - ill or incapacitated for labor for more than 30 days, or lost any part of the body Less serious - incapacity lasted 10 days or more/ required medical attention during said period Slight - incapacitated from 1 9 days Evidence Required: 1. Preponderance of evidence Civil actions - means evidence which is of greater weight, or more convincing, that that which is offered by the opposing party 2. Proof beyond reasonable doubt Criminal actions - proof which produces conviction in an unprejudiced mind or produces absolute certainty, without any possibility of error 3. Substantial evidence Administrative actions - such relevant evidence as a reasonable mind might accept as adequate to support a conclusion Wills An act whereby a person is permitted, with the formalities prescribed by law, to control to a certain degree the disposition of his/her estates or properties, to take effect after his/her death (Art. 783, New Civil Code) Succession a mode of acquisition by virtue of which the property, rights, and obligations to the extent of the value of the

inheritance, of a person are transmitted through his death to another either by will or by operation of law. 3 Elements of Succession: 1.) Death of the decedent 2.) Inheritance 3.) Successors Testamentary Capacity the capacity to make or execute a will Requirements: At least 18 years of age Sound mind Two kinds of wills 1) Notarial wills signed by the testator himself or by the testators name written by another person in his presence and by his express direction - requires an attestation clause and an acknowlegement before a notary public - needs at least 3 credible witnesses to testify that the testator signed the will

Attestation Clause a record of facts wherein the witnesses certify that the will has been executed before them, and that it has been executed in accordance with the formalities required by law Requirements for Witnesses to Notarial Wills

1) Of sound mind 2) Able to read and write 3) Not blind, deaf or dumb 4) At least 18 years old 5) Domiciled in the Philippines 6) Has not been convicted of falsification of document or perjury 2) Holographic will a will which is entirely written, dated, and signed by the testator - does not need an attestation or acknowledgement - does not need 3 witnesses, as long as one witness can prove that the signature belongs to the testator

JURISPRUDENTIAL DOCTRINES 1) Accountability the nurse is responsible for her own acts as well as those that affect her patients in relation to the care that is given to the latter 2) Respondeat superior let the master answer for the acts of his subordinates - the negligence of the employee is presumed to be the negligence of the employer 3) Bonus pater familias good father of a family - the employer becomes liable on his own upon a finding that he has been negligent in the selection and supervision of his employees 4) Res ipsa loquitor - the thing or transaction speaks for itself - the injury itself is a proof of negligence

5) Damnum absque injuria although therewas physical damage, there was no legal injury 6) Force majeure an act of God - an event which is unforeseen or inevitable which causes damage or injury to a patient may exempt a nurse from any criminal liability 7) Nolo Contendere - a plea of guilty or a plea of no contest - considered as an admission of guilt for a crime charged 8) Malfeasance, misfeasance, nonfeasance Malfeasance the performance of some act which ought not to be done Misfeasance the improper performance of some act which might lawfully be done Nonfeasance the omission of some act which ought to be performed 9) Doctrine of Informed Consent two parts of the consent: a) information b) consent 10) Doctors order rule - may be made verbally or in writing - it is legally safe to follow a written order because the physician cannot deny what he has written or signed 11) Nurse as a witness rule - as a witness, a nurse can only testify on matters he/she has direct or personal knowledge of

- a nurse can be an ordinary or expert witness 12) Hospital records as evidence 13) Duties of Doctors - a physician who holds himself out as a specialist should be held to the standard of care and skill of the average member of the profession practicing the specialty, taking into account the advances in the profession 14) Captain of the Ship Doctrine - the head surgeon is made liable for everything that goes wrong within the four corners of the operating room 15) Doctors are not Warrantors principle - physicians are not warrantors of cures or insurers against personal injuries or death of the patient

16) Liability of Hospitals and consultants - there is no employer-employee relationship between the hospital and a physician admitted in the said hospitals medical staff as an active or visiting consultant which would hold the hospital liable solidarily liable for the injury suffered by a patient. - principle of respondeat superior will not apply

Other Related Laws

Week

1) Proclamation No. 539 (Oct 17, 1958) declared the last week of October every year as Nurses

2) RA 2383 Philippine Medical Act; defined the practice of medicine in the Philippines 3) RA 6425 Dangerous Drugs Act; prohibited the sale, administration, delivery, distribution, and transportation of prohibited drugs 4) Act No. 3573 (1929) declared that all communicable diseases shall be reported to the nearest health station, and that any person may be inoculated or injected with prophylactic preparations 5) RA 1891 provides creation of rural health units 6) PD 996- requires compulsory immunization for all children below 8 years old 7) RA 4073 liberalizes the treatment of leprosy 8) PD 856 Code of Sanitation; provides for control of all factors in the environment that affect the health of persons 9) RA 6365 established a National Policy on Population; creation of the POPCOM 10) Letter of Instruction 47 integration of family planning in the curriculum of schools of nursing, medicine, midwifery, and allied health sciences

11) PD 965 requires couples intending to get married to undergo family planning counseling 12) RA 4226 Hospital Licensure Act; requires all hospitals in the Phils to be licensed 13) PD 442 Labor Code of the Phils 14) PD 626 Employee Compensation and State Insurance Fund; SSS or GSIS 15) RA 6675 Generics Act of 1988 16) RA 6758 standardizes the salaries of government employees, including nursing personnel 17) RA 7160 Local Government Code; transfers responsibilities for delivery of basic services from the national government to the local government units 18) RA 7600 Rooming-in and Breastfeeding Act of 1992 19) RA 9262 Violence against women and their Children Act

Matthew 17:20 : It was because you do not have enough faith, answered Jesus, I assure you that if

you have faith as big as a mustard seed, you can say to this hill, Go from here to there! and it will go. You could do anything!