PROFESSION

o An occupation or calling requiring advance training Experience in some specific or specialized body of knowledge Provides service to society in that special field The term profession is honoric and should be carried with pride and honor o o o

Therapies Oral Topical Parenteral medications Internal examination during labour in the absence of antenatal bleeding and delivery Suturing of perineal laceration

NURSING

o o

An occupation requiring a unique body of knowledge and skills and which serves society

Establish linkages with community resources Coordination with the health team Provide health education to individuals, families and communities Teach, guide and supervise students in nursing education programs The nurse is required to maintain competence by continual learning through continuing professional education

PROFESSIONAL NURSE Completed a basic nursing education program Licensed in his/her country or state to practice professional nursing

NURSING PRACTICE Primary responsibility promotion of health and prevention of illness Collaborate with other health care providers o o o o o o Curative

QUALIFICATIONS AND ABILITIES OF A PROFESSIONAL NURSE Professional Preparation o Have a license to practice Bachelor of science degree in nursing Be physically and mentally fit

Preventive o Rehabilitative aspects of care o Restoration of health Alleviation of suffering o Towards a peaceful death o

Personal Qualities and Professional Proficiencies Interest and willingness to work and learn Warm personality and concern for people Resourcefulness and creativity, well balanced emotional condition Capacity and ability to work cooperatively with others Skill in decision making

Provide nursing care through the utilization of the nursing process o o o o o o o Therapeutic use of self o Executing health care techniques and procedures o Essential primary health care Comfort measures Health teachings Administration of written prescription for treatment

DEFINITION OF LICENSE A legal document given by the government that permits a person to offer to the public his or her skills and knowledge in a particular jurisdiction

CONTRACT

Meeting of minds between two persons whereby one binds himself, with respect to other, to give something or to render some service A promise or a set of promise which the law recognizes as a duty and when that duty is not performed the law provides a remedy

Greek word TELOS or goal or end The right thing to do is the good thing to do Act utilitarianism- good resides in the promotion of happiness or the greatest net increase of pleasure over pain If the act helps people, then it is a good act If the act hurts people then it is a bad act

NURSING ETHICS Ethics came from the Greek word ETHOS moral duty Standard to examine and understand moral life Guides of human conduct provided by ethical systems

FLETCHERS GUIDELINES FOR MAKING ETHICAL DECISIONS How people make judgement in regard to right or wrong Critical reflection about morality and rational analysis about it JOHNSTON- examination of all ethical and bio-ethical issues from the prospective of nursing theory and nursing ethics VERCOE- the fields of nursing ethics be focused on the needs and experiences of practicing nurses, the exploration of its meaning and that of ethical practice in terms of the perception of these nurses

1. 2. 3. 4. 5. 6.

Consideration for people as human beings Consideration of consequences Proportionate good to come from the choices Propriety of actual needs over ideal or potential needs A desire to enlarge choices and reduce chance A courageous acceptance of the consequence of the decision

Morals Specific ways of behaviour or of accomplishing ethical principles Greek work MORALIS Social consensus about moral conduct for human beings and society Morality is what you believe is right and good

DEONTOLOGICAL APPROACH OR DUTY ORIENTED THEORY Basic rightness or wrongness of an act depends on the intrinsic nature rather than upon the situation or its consequences Greek word DEON meaning DUTY Immanuel Kant- rational human being with freedom and social worth A person is morally good and admirable if his actions are done from a sense of duty and reason

Health Care ethics Division of ethics that relates to human health Realm of human values, morals, customs, personal beliefs and faith

W.D ROSS- PRIMA FACIE DUTIES- WHAT ONE SHOULD DO WHEN OTHER RELEVANT FACTORS IN A SITUATION ARE NOT CONSIDERED Duties of fidelity- telling the truth, keeping promises Duties of reparation- righting the wrong we have done to others Duties of gratitude- recognizing the service others have done for us Duties of justice- preventing distribution of pleasure or happiness that is not in keeping with the merit of people involved Duties of beneficence-helping to better the condition of other beings

Bioethics

Specific domain of ethics that focuses on moral issues in the field of health care Result of life and death dilemmas faced by health care practitioners Systematic study of human behaviour in the field of life science and health care in the light of moral values and principles

TELEOLOGICAL APPROACH

Duties of self improvement- bearing ourselves with respect to virtue or intelligence Duties of nonmaleficence- avoiding or preventing injury to others

o o

Confidentiality of communications and records Review his records concerning his medical care Be informed of business educational institution relationship among the hospital

VIRTUE ETHICS APPROACH ARETIC, Greek word ARETE, heart of the person performing the act Traits and virtues of a good person, courage, temperance, wisdom, and justice

Consent or decline to participate experimental research affecting his care Reasonable continuity of care when appropriate and be informed of other care options Be informed of hospital polices and practices

DIVINE COMMAND ETHICS o Supreme or divine that sets down rules to provide guidance to moral decisions

NONMALEFICENCE-

UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS To determine right or wrong in regard to value issues Autonomyo o o o o o Greek word AUTOS meaning self and nomos meaning governance Self determination Freedom to choose and implement ones decision Informed consent Allowing the patient to refuse treatment if he decides so The person making the decision must be deemed competent, intellectual capacity, legal age

o
o o o JUSTICE o

To do no harm Not assisting in or performing abortion Not to assist people to commit suicide Be involved in mercy killing

The right to demand to be treated justly, fairly and equally

NURSES BILL OF RIGHTS o o o o o Registered nurses promote and restore health Prevent illness Protect the people entrusted to their care Alleviate suffering Provide services that maintain respect for human dignity

Veracity o Health care providers are bound to tell the truth

Beneficence o Promotes the doing acts of kindness and mercy that directly benefit the patient

LVING WILLS OR ADVANCE DIRECTIVE o Accept or refuse any treatment, service or procedure used to diagnose or treat physical or mental condition Decision to provide or withhold life-sustaining measures This living will is signed by the patient Witnessed by two other persons who is not designated as the persons health care representative Directive has force of law

PATIENTs BILL OF RIGHTS o o o o o Considerate and respectful care Relevant, current and understandable information Make decisions regarding his care plan Have advance directive (living will) Every consideration of his privacy o o o

MORAL PRINCIPLES o The golden rule o Do unto others what you would like others do unto you

The greatest good for the greatest number Have more good effects for more people than a smaller group

No one is held to the impossible Do not promise impossible things

The two fold effect May have bad and good effect Must be morally good Good effect must be willed and the bad effect merely allowed Good effect must not come from an evil action Good effect must be greater than the bad effect o The morality of cooperation Formal cooperation is an evil act and never allowed

Principle relating to the origin and destruction of life Thou shall not kill

GOOD SAMARITAN LAW A nurse who renders first aid or treatment at the scene of an emergency and who does so within the standard of care, acting in good faith, is relieved of the consequences

The Principle of Totality The whole is greater than any of its parts

Epikia Exception to the general rule

CODE OF GOOD GOVERNANCE Service to others o Commitment to a life of sacrifice and genuine selflessness in carrying out their professional duties

One who acts through an agent is himself responsible Ex. Nurse recommends patient to another clinic for abortion but does not want to perform

Integrity and Objectivity o Perform their responsibilities with the highest sense of integrity

No one is obliged to betray himself/herself No one can force any person to answer a question if such will incriminate him/her

Professional Competence o Knowledge, technical skills, attitudes and experience

The end does not justify the means Giving sleeping tablets to someone who has chronic illness

Solidarity and teamwork o Maintain and support one professional organization

Defects of nature may be corrected Corrected by plastic surgery

Social and Civic Responsibility o Shall always carry out their professional duties consideration of the broader interest of the public with due

If one is willing to cooperate in the act, no injustice is done to him/her With patients consent

Global Competitiveness o Shall remain open to challenges of a more dynamic and interconnected world

A little more or less does not change the substance of an act Stealing

Equality of All professions o Shall treat their colleagues with respect and strive to be fair in their dealings with one another

AMENDED CODE OF ETHICS FOR NURSES Section 3 Republic Act No. 877 known as the Philippine Nursing Law and Section 6 of P.D No. 223 the amended Code of Ethics of Nurses Article I o Preamble- health is a fundamental right of every individual

Rule of conduct pronounced by controlling authority and which may be enforced o o o o Authority or right to declare that the rule exists Rule is pronounced or expressed Source can be defined A right to enforce the same must be provided

Article II o Values, customs and spiritual beliefs held by individual shall be represented Consider the individuality and totality of patients when they administer care

Controlling authority in our system is the government Fundaments law of the government is the constitution Principal sources of pronouncements o o o o o o Constitution Statutes or legislations Executive branch Case decision/judicial opinions Presidential decrees Letters of instructions

Article III o o Human life is inviolable Quality and excellence in the care of patients are the goals of the nursing practice Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability

Article IV o The registered nurse is in solidarity with other members of the healthcare team in working for the patients best interest

RESONSIBILITY AND ACCOUNTABILITY FOR THE PRACTICE OF PROFESSIONAL NURSING Professional Negligence o Commission or omission of an act, pursuant to a duty Existence of a duty on the part of the person charged to use due care under circumstances Failure to meet the standard of due care The foresee ability of harm resulting from failure to meet the standard The fact that the breach of this standard resulted in an injury to the plaintiff

Article V o Preservation of life, respect for human rights and promotion of healthy environment Promotion in local, national, and international efforts to meet health and social needs of the people

Article VI o Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal

Article VII o The certification of registration of the registered nurse shall either be revoked or suspended for violation of any provisions of this code.

Article 19 of the civil code o One shall act with justice, give every man his due, observe honest and good faith

DEFINITION AND MEANING OF LAW The sum total of rules and regulations by which society is governed Man mad regulates social conduct in a formal and binding way

Article 20

Those who in the performance of their obligations through negligence causes any injury to another, are liable for damages

No person shall be responsible for those events which cannot be foreseen Floods fire, earthquakes

Common acts of negligence o Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath Objects left inside the patients body; sponges suction tips, loose dentures lodged in the patients trachea Falls of the elderly; confused, unconscious, sedated patients Falls of children whose bed rails were not pulled up and locked Failure to observe and take appropriate action Failure to report observations to attending physicians

DOCTRINE OF RESPONDEAT SUPERIOR Let the master answer for the acts of the subordinate The liability is expanded to include the master as well as the employee

o
o o o o o

INCOMPETENCE Lack of ability, legal qualifications or fitness to discharge the required duty

CONSENT TO MEDICAL AND SURGICAL PROCEDURES Consent o Free and rational act that presupposes knowledge of teh thing to which consent is being given by a person who is legally capable to give consent Signed by the patient or authorized representative/legal guardian An authorization by a patient or a person authorized by law to give the consent on the patients behalf Nurse secures the consent of the patient upon admission

Failure to exercise the degree of diligence circumstances of the particular case demands Mistaken identity- drug given to the wrong patient

which

the o o

o o o o o

Wrong medicine, wrong concentration, wrong route, wrong dose Defects in the equipment Errors due to family assistance Administration of medicine without a doctors prescritption

Informed Consent o Established principle law that every human being of adult years and sound mind has the right to determine what shall be done with his own body May choose whether to be treated or not

THE DOCTRINE OF RES IPSA LOQUITUR Injury was of such nature that it would not normally occur unless there was negligent act Injury was caused by an agency within control of the defendant Plaintiff himself did not engage in any manner that would tend to bring about the injury TORTS o

Proof of Consent o A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of the procedure

MALPRACTICE The idea of improper or unskilful care of a patient by a nurse Stepping beyond ones authority with serious consequences Carelessness of professional personnel LESNIK- negligent act committed in the course of professional performance

A legal wrong, committed against a person or property Assault and Battery o o Imminent threat of harmful or offensive bodily contact Unjustifiable to tough another person or to threaten to do so

DOCTRINE OF FORCE MAJEURE Irresistible force; unforeseen or inevitable

Battery o An intentional, unconsented touching of another person

False Imprisonment of Illegal Detention o Unjustifiable detention of a person without a legal warrant within boundaries

Acts or offenses against public welfare

Criminal negligence o Reckless imprudence- person does an act or fails to do it voluntarily but without malice Simple imprudence- did not use precaution and the damage was not immediate or the impending danger was not evident or manifest

Invasion of Right to Privacy and breach of confidentiality o o o o Right to privacy is the right to be left alone Right to be free from unwarranted publicity Exposure to public view Divulge information from patients chart to improper sources or unauthorized person o

Criminal Intent o States of mind of a person at the time the criminal act is committed that he/she knows that an act is not lawful and still decide to do it anyway

Defamation o o o o Character assassination Slander-oral defamation Libel-written words There must be a third person who hears or read the comment before it can be considered defamation WILLS CRIMES, MISDEMEANORS, AND FELONIES An act committed or omitted in violation of the law Two elements o o Criminal act Evil/criminal intent A legal declaration of a persons intentions upon death Testamentary document takes effect after the death of its maker Decedent- person whose property is transmitted through the succession whether or not he left a will If he left a will he is called a testator Woman is testatrix Heir- called to succession either by the provision of a will or by operation of law A person who dies leaving a will is said t have died testate One who dies without will is said to have died intestate Validation of the will in a court is known as probate A will which is written, dated and signed by the testator is called holographic will An oral will is called nuncupative will or nuncupation- made during the persons last illness, that it be done in the place in which he died, one or more witnesses to the will Testator must have the expressed intention of making a will Must be right of age Under 18 cannot make a will Required to have sound mind

CRIME

Conspiracy to commit a crime o Two or more persons agree to commit a felony Principals- who take a direct plan/part Accomplices- cooperate in the execution Accessorieshaving knowledge commission of the crime of the

Criminal Actions

Think clearly ability at the time of its execution

NURSES OBLIGATIONS IN THE EXECUTION OF A WILL The nurse should note the soundness of the patients mind There was freedom from fraud or undue influence Make a notation on the patients chart of the apparent mental and physical condition of the patient at the time of making the will

independent of such assistance as soon as possible. (Virginia Henderson, 1958; 1978) Nursing is putting the patient in the best condition for nature to act. This description/definition was given by Florence Nightangle, dubbed as the first nursing theorist. She made use of the environment (clean and healthy surrounding) in the recovery of an ill patient. Nursing- is the diagnosis and treatment of human responses to actual and potential health problems (ANA). The common focus of nursing is the need to provide humanistic and holistic care that includes the four areas related to health: 1. Health Promotion 2. Health Maintenance 3. Health Restoration 4. Care of the Dying RA 9173 or the Philippine Nursing Act of 2002 gives the meaning of nursing practice through the following: -alone or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting that includes: 1. nursing care during conception, labor, delivery, childhood, adulthood and old age 2., promotion of health and prevention of illness. 3. collaboration with other health care providers for the curative, preventive, and rehabilitative aspects of cares, restoration of health, alleviation of suffering and when recovery is not possible towards a peaceful death. Nursing Practice covers the three areas of nursing, namely: nursing education, nursing service, and community health nursing (Rule 1 Sect. 3 (d) IRR RA 9173). Professional Nurse a person whose name and registration/professional license number is entered in the Commissions registry book and computerized database as legally authorized to practice the nursing profession (Rule 1 Sect. 3 (e) IRR RA 9173). Practicing Professional Nurse- a person who is engaged in the practice of nursing profession or is performing acts or activities, whether regularly or occasionally, including one who is employed in a government office or in a private firm, company or corporation whose duties require knowledge and application of the nursing profession (Rule 1 Sect. 3 (f) IRR RA 9173). Foreign Professional Nurses foreign nationals who, being licensed professional nurses in their own countries, are authorized by existing laws to practice their profession either as holders of a certificate of registration and professional identification card or a special/temporary permit in the Philippines subject to some provisions of RA 9173 (Rule 1 Sect. 3 (g) IRR RA 9173). Nursing Specialty Program a training and development program intended to develop/enhance the skills, to which a registered nurse devotes himself /herself whether as a vocation or profession to enable him/her to provide nursing service in specific areas in accordance with the ethics of the profession and applicable law. THEORETICAL FOUNDATION OF NURSING APPLIED IN HEALTH CARE SITUATIONS

NURSING AS A PROFESSION Profession - an occupation or calling requiring advanced training and experience in some specific or specialized body of knowledge which provides service to society in that special field.

It is a calling that requires special knowledge, skill and preparation.

a calling in which its members profess to have acquired special knowledge, by training or by experience or by both, so that they may guide or advice or serve others in that special field. A profession is generally distinguished from other kinds of occupations/vocations by: 1. Requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed usually entrusted to higher education. 2. An orientation of the individual toward service, either to a community or to an organization. 3. The members must be united and identified through their membership and they must be clearly separated from the laypeople or the ordinary congregations. 4. The society which it intends to serve has an indispensable need for such services and which others cannot provide and the society accepts it. 5. The techniques or skills applied are the product of scientifically proven and long experience. 6. Requirement to exercise discretion and judgment as to the time and manner of the performance of the duty. 7. The presence of common values, cultures, and norms uniquely found among its members which are also being guided by its own code of ethics. 8. The ability to continue its research to expand constantly its body of knowledge. Characteristics of a profession: 1. Autonomy (independence and self-governance) the ability to chart or carve its own destiny independent from others. 2. Authority possession of highly advanced and competent skills/mastery of such knowledge and skills not available to the general public. 3. Accountability responsibility/liability to own up its actions. Nursing- is primarily assisting the individual (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. It is likewise the unique contribution of nursing to help individual to be

Purposes of Nursing Theories and Conceptual Frameworks (Kozier et al.,45)

Provide direction and guidance for: a. structuring professional education and research b. Differentiating the focus of professions. Assist nurses to describe, explain experiences.

nursing nursing and

practice, from other

predict everyday

Serves to guide assessment, intervention, and evaluation of nursing care Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation. Help to establish criteria to measure the quality of nursing care Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and works defined. Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions. Provide a general focus for curriculum design Guide curricular decision making Offer framework for generating knowledge and new ideas Assist in discovering knowledge gaps in the specific field of study

Offer a systematic approach to identify questions for study, select variables, interpret findings, and validate nursing interventions Concepts are abstract ideas or mental images of phenomena or reality. It can be concrete ideas that can be mentally pictured (eg. Cars, cellphones, house); or it can be abstract ideas (eg. Powerlessness, adaptation, nursing). Nursing theories addresses the following four major concepts: 1. Person or client 2. Environment 3. Health/illness 4. Nursing Conceptual Framework group of related concepts. It can also be viewed as an umbrella under which many theories can exist (Cresia & Parker 1991,p7). Conceptual Model- is a system of related concepts or a conceptual diagram. Model- graphic illustration of relationships. Theory- is made up of concepts and propositions; however, a theory accounts for phenomena with much greater specificity. GENERAL THEORIES IN NURSING Nightangles Environmental theory Florence Nightangle, the mother of modern nursing espoused her theory focusing on the environment. She linked health with five environmental factors: 1. pure or fresh air 2. pure water 3. efficient drainage 4. cleanliness 5. light

Hendersons Definition of Nursing- The definition of nursing given by Virginia Henderson in 1955 became a milestone in the development of nursing as discipline apart from medicine. The focus on her Nursing Concept is to help individuals and families gain independence in meeting the 14 fundamental needs; 1. Breathing normally 2. Eating and drinking adequately 3. Eliminating body wastes 4. Moving and maintaining desirable position 5. Sleeping and resting 6. Selecting suitable clothes 7. Maintaining body temperature within normal range by adjusting clothing and modifying the environment 8. Keeping the body clean and well-groomed to protect the integument 9. Avoiding dangers in the environment and avoiding injuring others (10)Communicating with others in expressing emotions, needs, fears, or opinions (11)Worshipping according to ones faith (12) Working in such a way that one feels a sense of accomplishment (13) Playing or participating in various forms of recreation (14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities. Rogerss Science of Unitary Human Beings - Martha Rogers views the person as an irreducible whole, the whole being greater than the sum of its parts. Her Key concepts in describing the individual are energy fields, openness, pattern and organization, and multidimensionality. She described the Unitary Man as: 1. Irreducible, four-dimensional energy field identified by pattern. 2. Manifesting characteristics different from the sum of the parts 3. Interacts continuously and creatively with the environment 4. Behaving as a totality 5. Participating creatively in change Orems Self Care Deficit Theory Dorothy Orem developed the self-care deficit theory that includes self-care, self-care deficit and nursing system. She believed that the self-care of the individuals and the self-care of dependents are learned behaviors that individuals initiate and perform on their own behalf to maintain life, health, and well-being. According to Rogers, there are three kinds of self-care requisites: 1. Universal requisites ( common to everybody like maintenance of air, water etc) 2. Developmental requisites 3. Health deviation requisites Roys Adaptation Model Sister Callista Roy focuses on the individual as a biophysical adaptive system. Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an ongoing purposive response. Roy identified three classes of stimuli: 1. Focal Stimulus: the internal or external stimulus most immediately confronting the person and confronting the behavior. 2. Contextual stimuli: all other internal or external stimuli present

Residual Stimuli: beliefs, attitudes, or traits having an intermediate effect on the persons behavior but whose effects are not validated. Kings Goal Attainment Theory Imogene King based her theory from the conceptual framework of three dynamic interacting systems: 1. personal system concepts: perception, self, body image, growth and development, space and time 2. Interpersonal system concepts: interaction, communication, transaction, role, and stress. 3. Social system concepts: organization, authority, power, status, and decision making. Neumans Health Care Systems Model Betty Neuman views the client as an open system consisting of a basic structure or central core of energy resources (physiologic, psychologic, sociocultural, developmental, and spiritual) surrounded by two concentric boundaries or rings referred to as lines of resistance. She identified individuals response to stress and the nursing interventions to be carried out on three preventive levels: 1. Primary prevention 2. Secondary prevention 3. Tertiary Prevention Johnsons Behavioral System Model - Dorothy Johnson defines a system as a whole that functions as a whole by virtue of the interdependence of its parts. A behavioral system is patterned, repetitive and purposeful. Johnsons key concepts describes the individual as a behavioral system composed of seven subsystems: 1. attachment-affiliative subsystem provides survival and security. 2. Dependency subsystem promotes helping behavior that calls for a nurturing response. 3. Ingestive system satisfies appetite. 4. Eliminative subsystem excretes body wastes. 5. Sexual subsystem functions dually for procreation and gratification. 6. Achievement subsystem attempts to manipulate the environment. 7. Aggressive subsystem protects and preserves the self and society within the limits imposed by the society. Peplaus Psychodynamic Nursing Theory- Hildegard Peplau introduced and defined psychodynamic nursing as understanding ones own behavior to help others identify felt difficulties and applying principles of human relations to problems arising during the experience. She also described the nurse-patient relationship in four phases: 1. Orientation patient seeks help and the nurse assists patient to understand the problem and the extent of need for help. 2. Identification - patient assumes a posture of dependence, interdependence, and independence in relation to the nurse 3. Exploitation - patient uses available services on the basis of self interest and needs 4. Resolution - old needs and goals are put aside and new ones adopted. Leiningers Transcultural Care Theory Madeleine Leininger established the transcultural nursing which she defined as a major area of nursing that focuses on comparative study and

3.

analysis of different cultures and subcultures in the world, with respect to their: 1. Caring behavior 2. Nursing care 3. Health values 4. Beliefs 5. Patterns Watsons Philosophy and Science of Caring Jean Watson believes the practice of caring is central to nursing; it is a unifying focus for practice. According to her, there are two major assumptions that underlie human care (carative factors): 1. care and love constitute the primal and universal psychic energy 2. care and love are requisite for our survival and the nourishment of the society FIELDS OF NURSING The Fields of Nursing may be classified in general as follows: 1. Hospital Nursing or the Institutional Nursing 2. Public Health Nursing 3. Community Health Nursing 4. School Nursing or Nursing Education 5. Occupational Health Nursing or Industrial Nursing 6. Military Nursing 7. Clinic Nursing 8. Independent Nursing Practice 9. Private Duty Nursing Institutional Nurses- those employed as staff nurses or nursing personnel in a hospital setting or similar institutions. Public Health Nurse is one who provides nursing care and counsel to persons and families, either to individual or groups in clinics, in their homes, in school, and at their place of work, and cooperates with others in health promotion. Community Health Nurse a nurse whose work combines the element of nursing and public health practice and takes place outside the therapeutic institutions. School Nurse a registered nurse employed to work in educational institutions to participate in health programmes for school-aged children. Responsibilities include monitoring growth and development, screening health problems and supporting those pupils with special needs. Occupational Health Nurse/ Industrial Nurse one employed in industry that gives immediate care to ill or injured workers, follows up on the sick and the injured, and helps develop accident prevention and health programs for the workers. Maternal and Child Health Nurse one who cares for and safeguards the health of mothers and children. Nurse Educator a nurse employed in the teaching or administrative staff of a school of nursing or other educational institution for nurses. Pediatric Care Nurse a registered nurse qualified in the nursing care of the sick child. Private Duty Nurse is a registered nurse who independently contracts with a patient; a private duty nurse is responsible for the total nursing care of the patient during the period she is with him. Nursing Administrator is a professional nurse who is a member of the administrative staff of a hospital, medical center, public health agency, or a similar institution and who, as a

member of the administrative staff, participates in formulating the policy and objectives of such. Clinical Nurse Specialist A professional nurse, who has had special training and experience in a particular clinical specialty, often holds a degree, and is prepared to give expert care to the acutely or chronically ill and to assist clients to maintain health. ETHICO-MORAL RESPONSIBILITY Ethics part of philosophy that deals with systematic approaches to questions of morality. - a term for the study of how we make judgments regarding right and wrong. a system of MORAL PRINCIPLES or moral standards governing conduct. Morals- human conduct in the application of ethics. Concerned with JUDGMENT PRINCIPLES of right and wrong in relation to human actions and character. Nursing Ethics the code governing the NURSES BEHAVIOR, especially towards patients, employing authority and to the profession. Beneficence - any action that would BENEFIT others. The principle that imposes upon the practitioner to seek the good for the patients under all circumstances. Beneficence connotes positive action toward preventing or removing harm and promoting good such as: 1. One ought to prevent evil or harm 2. One ought to remove evil or harm 3. One ought to do or promote good. Nonmaleficence states the idea to REFRAIN from inflicting harm. one ought NOT to inflict evil or harm. The admonition of nonmaleficence is stated in the negative manner while the beneficence is in the positive. Justice The basic principle that deals with FAIRNESS, just deserts, and entitlements in the distribution of goods and services. In health care, justice seems to point to distributive justice that deals with the allocation of scarce resources. ARTICLE XIII of the 1987 Constitution provides: The State shall adopt an integrated and comprehensive approach to health development and shall endeavor to make essential goods; health and social services available to all people at affordable cost. There shall be priority for the needs of the underprivileged, the sick, the elderly and the disabled, the women and the children. The State shall endeavor to provide free medical care to paupers, establish and maintain an effective food and drug regulatory system, and undertake appropriate health manpower and development and research responsive to the countrys health needs and problems. It shall establish a special agency for disabled persons for their rehabilitation. Some methods of distributing goods and services in our society are as follows: 1. To each, an equal share 2. To each, according to need 3. To each, according to effort 4. To each, according to contribution 5. To each, according to merit 6. To each, according to ability to pay Autonomy - In health care, it means the form of personal LIBERTY, where the individual is free to choose and implement ones own decisions, free from deceit, duress, constraint, or coercion. Three Basic elements involved:

1. ability to decide 2. power to act upon your decisions 3. a respect for the individual autonomy of others. Stewardship refers to the actions made for by the health practitioner IN BEHALF of the patient and for the greater benefit of the patient. Truth Telling/Veracity The patient must tell the truth in order that appropriate care can be provided. The health practitioner needs to disclose FACTUAL INFORMATION so that the patient can exercise personal autonomy. Confidentiality - is also known as PRIVILEGED COMMUNICATION which refers to any information obtained by the nurse or the health team during the course of caring for the patient. The information gathered may only be disclosed under the following: 1. the patient agrees to divulge such information with written consent 2. the information is material in a criminal case investigation 3. if public safety is jeopardized (communicable disease) 4. such information is relevant to his care to be utilized by other health team Priviliged Communication may be divided into two classes: 1. Absolute privileged communication is one made in the interest of the public service or the due administration of justice and is practically limited to legislative and judicial proceedings and other actions of the state. 2. Qualified privileged communication is a slanderous statement uttered in good faith, and made on a proper occasion, from a proper motive, based upon a probable cause and in honest belief that such statement is true. MORAL PRINCIPLES

GOLDEN RULE Do unto others what you would like others do unto you. It is a basic moral principle that if you want others to respect you, you must also accord respect to them. THE TWO FOLD-EFFECT - facing a situation which would have good and bad effects requires the following basis for arriving a decision: a. that the action must be morally good b. that the good effect must be willed and the bad effect merely allowed c. that the good effect must not come from an evil action but from initial action itself directly; and d. that the good effect must be greater than the bad effect. THE PRINCIPLE OF TOTALITY states that the whole is always greater than its parts. To save the patients life as a whole, it is justified under this principle to surgically cut-off a disease body part of the patient.

EPIKIA exception to the general rule. It is reasonable presumption that the authority making the law will not wish to bind a person in some particular case, even though the case is covered by the letter of the law. If a mentally ill patient becomes berserk and the doctor could not be contacted, the patient may be restrained by virtue of epikia. Another example of this is allowing a relative to see a seriously ill patient who expresses the desire the relative although it is not yet visiting hours

THE END DOES NOT JUSTIFY THE MEANS giving a sleeping tablet to a chronically ill person so he/she can de in peace is morally wrong. THE GREATEST GOOD FOR THE GREATEST NUMBER during an epidemic, immunization against communicable diseases is administered to the people. Although there may be some who may have slight reactions to the vaccine, the greater majority of the population shall be considered. NO ONE IS HELD TO THE IMPOSSIBLE the doctors and nurses are not guarantors of life. They cannot be held liable as long as they have done everything that modern medicine can afford to save a patient from dying. THE MORALITY OF COOPERATION formal cooperation in an evil act is never allowed. A nurse shall not participate upon immoral operations such as abortion even if the doctor commands it.

PRINCIPLE RELATING TO THE ORIGIN AND DESTRUCTION OF LIFE mercy killing or euthanasia is not allowed because it will lessen the incentive to medical research. The state recognizes the sanctity of life. It shall protect the life of the mother and the unborn since conception. Any direct attack on the life of a fetus for whatever cause is immoral. A fetus shall be buried in consecrated grounds. If it is dead and came from dead mother, it shall be buried with the mother. Privacy the right to be left alone or be apart from others. This right is guaranteed by most civilized state laws and enshrined also in the patients bill of rights. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. This right also includes privacy of ones thoughts, opinions and physical presence and privacy of ones records. Informed Consent The patient UNDERSTANDS the reason for the proposed intervention, with its benefits and risks, and agrees to the treatment by affixing his signature in the consent form. It generally contains the following elements: 1. disclosure 2. understanding 3. voluntariness 4. competence 5. permission giving

In our present jurisdiction under the 1987 Constitution, the age of majority is 18 years old. It means that only 18 years old and above can sign for themselves in legal matters such as the signing of consent (hospital admission, contracts, will etc..)

The Patients Bill of Rights (Filipino) 1. The patient has the right to considerate and respectful care, irrespective of socioeconomic status 2. The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected and understand. When it is not

medically advisable to give such information to the patient, the information should be made available to an appropriate person in his behalf. He has the right to know by name and in person, the physician and nurse responsible in coordinating his care. 3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include but not necessarily limited to the specific procedure and/or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient has also the right to know the name of the person responsible for the procedures and/or treatment. 4. The patient has the right to refuse treatment/lifegiving measures, to the extent permitted by law, and to be informed of the medical consequences of his action. 5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. 6. The patient has the right to expect that all communication and records pertaining to his care should be treated confidential. 7. The patient has the right to expect that within its capacity, a hospital must make reasonable response to the request of patient for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of care. When medically permissible a patient may be transferred to another facility only after he has received complete information concerning the needs and the alternatives to such transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer. 8. The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. The patient has the right to obtain information as to the existence of any professional relationship among individuals, by name, who are treating him. 9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research project. 10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby his physicians or a delegate of the physician of the patients continuing health care requirements following discharge informs him. 11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.

12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient. The PATIENTS RESPONSIBILITIES towards his care in the hospital: 1. P r o v i d i n g i n f o r m a t i o n I t i s a r e s p o n s i b i l i t y o f the patient to provide the staff with accurate and complete information, to the best of his knowledge, about the history of his illness, complaints. If the patient is unable to do so, then her immediate family member may give such information. 2. C o m p l y i n g w i t h i n s t r u c t i o n s t h e p a t i e n t i s responsible for complying with the treatment recommended by the attending physician or health team that is primarily responsible for his care. 3. I n f o r m i n g the physician of refusal to treatment A patient who refuses treatment or to be compliant with the treatment regimen must inform the physician of his decision. 4. P a y i n g t h e h o s p i t a l c h a r g e s u p o n a d m i s s i o n , the patient understands that he or she must pay the charges that he or she may incur in th course of her treatment. The exception is of course if the patient is admitted on charity hospitals giving everything for free. 5. A d h e r e n c e t o h o s p i t a l r u l e s a n d r e g u l a t i o n s the patient is also governed by the rules and regulation of the hospital which he or she is seeking medical help for his/her condition. The patient or the immediate family member must read the rules or must be informed about the policy of the hospital and must adhere to them. 6. C o n s i d e r a t i o n a n d r e s p e c t f o r o t h e r s t h e patient must also show respect for other patients admitted in the hospital. NURSES BILL OF RIGHTS 1. Nurses have the right to practice in a manner that fulfills their obligation to society and to those who receive nursing care. 2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. 3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the code of Ethics for nurses and its interpretive statements. 4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear or retribution 5. Nurses have the right to a fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities. 6. Nurses have the right to a work environment that is safe for themselves and their patients.

7.

Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.

BASIC HUMAN RIGHTS ON RESEARCH SUBJECTS: 1. Right to informed consent 2. Right to refuse and/or withdrawal from participation 3. Right to privacy 4. Right to confidentiality 5. Right to be protected from harm CODE OF ETHICS IN NURSING

The fundamental responsibility of the nurse is fourfold: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is respect for life, dignity and the rights of man. It is unrestricted by consideration of nationality, race, creed, color, age sex, politics, or social status.

Nurses render health services to the individual, the family and the community and coordinate their services with those of related groups. The following Code for Nurses, adopted by the Council of National Representatives of the International Council of Nurses was also adopted by the Board of Nursing and became an integral part of the amended Code of Nursing Ethics in the Philippines: Nurses and People The nurses primary responsibility is to those people who require nursing care. The nurse, in providing care, promotes an environment in which the values, customs and spiritual beliefs of the individual are respected. The nurse holds in confidence personal information and uses judgment in sharing this information. Nurses and Practice The nurse carries personal responsibility for nursing practice and for maintaining competence by continual learning. The nurse maintains the highest standards of nursing care possible within the reality of a specific situation The nurse uses judgment in relation to individual competence when accepting and delegating responsibilities. The nurse when acting in a professional capacity, should at all times maintain standards of personal conduct which reflect credit upon the profession. Nurses and Society The nurse shares with other citizens the responsibility for initiating and supporting action to meet the health and social needs of the public. Nurses and the Profession The nurse plays the major role in determining and implementing desirable standards of nursing practice and nursing education. The nurse is active in developing a core of professional knowledge.

The nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing. AMENDED CODE OF ETHICS FOR NURSES Their conduct should be such that would bring credit to the profession. Just like any other professional, nurses are looked upon with respect in the community. They should therefore endeavor to live a life that would uphold their self-respect. Especially when nurses are on duty, they should try to look neat and attractive. Female nurses are advised to use moderate make-up and have a neat hairstyle. They should wear uniforms that are not too short or tight fitting that would tend to restrict movements, nor expose unnecessarily any part of the body while giving care to the patients. Clean uniforms and clean bodies tend to enhance the image of nurses. Use of anti-perspirant is advised most specially during hot summer months. Male nurses are likewise advised to be clean, shaven, hair clipped close to the nape of the neck instead of flowing to the shoulders. The use of the uniform should be specified in the policy of the hospital/agency. It should be worn only when on duty. Dining in the public, shopping or going to the market while in uniform is discouraged. Nurses caps are worn only while on duty. These are either carried in bags or are left in their places of assignment. Jewelry, such as earrings, necklaces or bracelets are not allowed while on duty. However, wedding rings, school rings or school pins may be worn. Nurses are looked upon by nursing students as their role models. Therefore, especially while they are on duty, they should act in a manner that is worth emulating. Sincere and compassionate attitudes toward patients are caught by those around them. Soon their working environment becomes permeated with good working relationships that are so vital in dealing with patients. LEGAL RESPONSIBILITY Legal Aspects in the Practice of Nursing The law has always governed the practice of modern nursing. This what makes the every erroneous nursing action liable to the law, either answerable to the Civil Law or the Criminal Law or both. The key word to remember in the legal responsibility of nurses is ACCOUNTABILITY. The professional nurse is expected to render reasonably competent nursing care to avoid getting entangled with the long arm of the law. Anything short of such standard required that would cause harm or injury to the patient makes the nurse responsible or liable to the law by way of negligence or even malpractice suit. The safe way to avoid such potential legal problems is amplified in the Philippine Nursing Act of 2002 (RA9173) that is, for nurses to utilize the nursing process in the performance of their function and observe the provision of RA 9173 which governs the practice of nursing in the Philippines. The Philippine Nursing Act of 2002 (RA 9173) Article VIII Section 35 enumerates the prohibitions in the practice of nursing: A fine of not less than 50,000.00 nor more than 100,000.00 or imprisonment of not less than 1 year nor more than 6 years, or both, upon the discretion of the court, shall be imposed upon:

a. 1.

2. 3.

4. 5.

6. 7. b.

c.

d.

any person practicing nursing in the Philippines within the meaning of RA 9173 of 2002: without certificate of registration/professional license and professional identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of this Act; or who uses as his/her own certificates of registration/ professional license and professional identification card or special/temporary permit of another; or who uses an invalid certificate of registration/professional license, a suspended or revoked certificate of registration/professional license, or an expired or cancelled special/temporary permit; or who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a professional identification card or special permit; or who falsely poses or advertises as a registered and licensed nurse or uses any other means that tend to convey the impression that he/she is registered and licensed nurse; or who appends B.S.N./R.N. or any similar appendage to his/her name without having been conferred said degree or registration; or who, as a registered and licensed nurse, abets or assists the illegal practice of a person who is not lawfully qualified to practice nursing. any person or the chief executive officer of a juridical entity who undertakes in-service educational programs or who conducts review classes for local and foreign examination without permit/clearance from the board and the Commission; or any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or any person or the chief executive officer of a juridical entity violating any provision of this Act and its rules and regulations.

SUCCESSION is a mode of acquisition by virtue of which property, rights, and obligations to the extent of the value of the inheritance, of a person are transmitted through his death to another or others either by his will or by operation of law. (774 NCC) DECEDENT is the general term applied to the person whose property is transmitted through succession, whether or not he left a will. If he left a will, he is also called the testator. TESTATOR a male decedent DEVISEE is a person to whom a gift of real property (eg. Land, house) is given by virtue of a will LEGATEE is a person whom a gift of personal property (eg. Money, Jewelry) is given by virtue of a will

The inheritance includes all property, rights obligations which are not extinguished by his death

and

and has the power to define and punish an act or omissions as a crime. The Chief Executive has also the prerogative.

The rights to succession are transmitted from the moment of death of the decedent. the the the be

An HEIR is a person called to succession either by provision of a will or by operation of the law. WIILL is an act whereby a person is permitted, with formalitie NOTARIAL WILL is a will that must be signed by testator or if written by some other person, it must done in his presence and under his express direction

Limitations in enacting Penal Laws 1. GENERALITY 2. TERRITORIALITY 3. IRRETROSPECTIVITY OR PROSPECTIVITY Limitations in enacting Penal Laws it cannot enact an ex post facto law nor a bill of attainder it must be of general application it cannot provide for a cruel, degrading or inhuman punishment nor can it impose excessive fines. Theories of Criminal Law Classical Theory a. man is essentially a moral creature with an absolutely free will to choose between good and evil and therefore more stress is placed upon the result of the felonious act b. Basic criminal liability is human free will and the purpose of penalty is retribution. c. Crime is a juridical entity and penalty is an evil and a means of juridical tutelage Positivist Theory Man is subdued occasionally by strange and morbid phenomenon which conditions him to do wrong in spite of or contrary to his volition. The basis of criminal responsibility of the criminal is his dreadfulness or dangerous state. The major source of our criminal law is Act # 3815 otherwise known as the Revised Penal Code of the Philippines that took effect on January 1, 1932. Crime consists of internal and external acts. Internal acts are not punished in our jurisdiction. Voluntariness is an element of felony because if an act is committed or performed with deliberate intent then it implies that the act is voluntary or freely committed. Felony is an act or omission punishable by the law A felony may be committed by means of DOLO (deceit) or CULPA (fault) The distinction of dolo and culpa: while both are voluntary, dolo is intentional, whereas culpa is not. Where there is intent there can be no negligence. In culpable felonies, intent is replaced by fault. Dolo (deceit) involves malice or deliberate intent; culpa (fault) results from negligence , imprudence, lack of foresight or lack of skill. Imprudence is deficiency in action Negligence is deficiency of perception.

1. 2. 3.

1.

HOLOGRAPHIC WILL is a will entirely written dated and signed by the testator

Any person of sound mind and of the age of eighteen years or more, and not blind, deaf or dumb, and able to read and write, may be a witness to the execution of a will. The following are disqualified from being witnesses to a will: 1. any person not domiciled in the Philippines 2. Those who have been convicted of falsification of a document, perjury or false testimony A will may be revoked by the testator at any time before his death. Any waiver or restriction of this right is void The following Will shall be disallowed in any of the following cases: 1. If the formalities required by law have not been complied with; 2. If the Testator was insane, or otherwise mentally incapable of making a will, at the time of its execution 3. If it was executed by undue through force or under duress, or the influence of fear, or threats; 4. If it was procured by undue and improper pressure and influence, on the part of the beneficiary or of some other person; 5. If the signature of the testator was procured by fraud; 6. If the testator acted by mistake or did not intend that the instrument he signed should be his will at the time affixing his signature thereto. The law provides for the following kinds of Will: 1. Ordinary or Notarial Will 2. Holographic will 3. Mixed will Criminal law is that branch of law which defines crime and treats of their nature.

2.

Ignorance therewith

of

the

law

excuses

no

one

from

compliance

Laws take effect after 15 days from the publication in the official gazette or any newspaper of national circulation. It serves as a constructive notice to all persons so that no one is exempted from complying with the law or to claim that he or she is ignorant from the passage of that law. The power to define and punish an act is within the powers of the Legislative Department (House of Congress) where the legislative power is vested in the fundamental law

Negligent act must be voluntary- example ( an incidental dropping of pistol and fired and hit someone, there is no liability ) Elements of Dolo: 1. Freedom 2. Intelligence 3. Intent Elements of Culpa:

1. 2. 3.

Freedom Intelligence Negligence or imprudence Intelligence is the moral capacity to determine what is right from what is wrong and to realize the consequences of ones acts. Intent is a mental state, the existence of which is shown by the overt acts of a person. A crime may be committed without criminal intent by means of culpa and offenses punishable by special laws. Criminal liability shall be incurred by any person committing a felony although the wrongful act done be different from that which he intended. By any person performing an act which would be an offense against persons or property, were it not the inherent impossibility of its accomplishment or on account of the employment or inadequate or ineffectual means.

STAGES OF FELONY 1. C o n s u m m a t e d a l l e l e m e n t s n e c e s s a r y f o r e x e c u t i o n a n d accomplishment are pesent. 2. F r u s t r a t e d t h e o f f e n d e r h a s p e r f o r m e d a l l t h e a c t s o f execution to produce the felony as a consequence but the crime does not result due to some cause independent of the will of the offender. 3. A t t e m p t e d t h e o f f e n d e r b e g i n s t h e c o m m i s s i o n o f t h e felony by direct overt acts but does not perform all the acts of execution which should produce the felony as a consequence by reason of some cause or accident other than his own spontaneous desistance SUBJECTIVE & OBJECTIVE PHASE OF FELONY: The subjective phase is that portion of execution of the crime starting from the point where he still has the control of his acts. If it reaches the point where he has no more control over his acts, the subjective phase has passed. If the subjective phase is not yet passed, the felony would be mere attempt. If it has already passed but the felony is not yet produced, as a rule it is frustrated. Objective phase is the result of the acts of execution that is the accomplishment of crime. Consummated.

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY 1. J u s t i f y i n g C i r c u m s t a n c e t h e a c t s o f t h e a c t o r a r e i n accordance with the law , hence he incurs no criminal and civil liability ( no crime, no criminal). 2. E x e m p t i n g C i r c u m s t a n c e t h o s e w h e r e i n t h e r e i s a n absence in the agent of the crime any of all the conditions that would make an act voluntary and hence, although there is no criminal liability, there is civil liability ( no criminal but there is crime ). 3. M i t i g a t i n g C i r c u m s t a n c e s t h o s e t h a t h a v e t h e e f f e c t o f reducing the penalty due to the lesser perversity of the offender.

Aggravating Circumstance those which increases the penalty. 5. A l t e r n a t i v e C i r c u m s t a n c e e i t h e r a g g r a v a t i n g o r mitigating depending on the facts of the situation. JUSTIFYING CIRCUMSTANCES: 1. Self- defense 2. Defense of Relative 3. Defense of stranger 4. State of necessity 5. Fulfillment of duty 6. Obedience to superior order EXEMPTING CIRCUMSTANCE 1. Imbecility and Insanity 2. Minority 3. Accident 4. Compulsion of Irresistible force 5. Lawful causes 6. Instigation and entrapment MITIGATING CIRCUMSTANCES 1. Passion or obfuscation 2. Voluntary Surrender 3. Voluntary plea of guilty 4. Deaf, and dumb, blind 5. Illness that diminishes the exercise of will power 6. Lack of instruction 7. Incomplete self-defense 8. Offender is below 18 or over 70 years old 9. When the act is committed in the immediate vindication of a grave offense AGGRAVATING CIRCUMSTANCES 1. Taking advantage of official position 2. Crime is committed in contempt of or with insult to public authorities 3. Crime committed with insult or disregard due to offended by age, sex or rank 4. Crime is committed in the dwelling of the offended 5. Abuse of confidence or obvious ungratefulness 6. Nighttime 7. Band 8. Uninhabited place 9. Crime committed during calamity 10. Recedivism 11. Habituality 12. Crime committed in consideration of price, promise or reward. 13. By means of fire,explosion,poison and stranding of a vessel 14. Evident premeditation 15. Craft, fraud or disguise is employed 16. Advantage taken of superior strength 17. Means employed to weaken defense 18. Treachery 19. Adds ignominy to the natural effects of the crime 20. Unlawful entry ALTERNATIVE CIRCUMSTANCE 1. degree of relationship 2. intoxication 3. illiteracy or lack of education * CLASSIFICATION OF FELONIES

4.

1. GRAVE 2. LESS GRAVE 3. LIGHT FELONIES PERSONS CRIMINALLY LIABLE FOR FELONIES

When several persons take part in the commission of a crime it does not necessarily follow that their participation in it is equal. Some may have a greater or more important in it than others. Consequently, their liability also varies according to the position they occupy in the commission of the felony, that is, whether they are principals, accomplices, or accessories This classification of offenders does not apply when there is conspiracy to commit a crime because of the rule that the act of one is the act of all.

A Juridical person cannot be punished like a natural person because they are only acting through their officers, generally, an officer of a corporation who commits a violation is the one criminally liable. 1. (Art. 16) The following are criminally liable for grave and less grave felonies: A. PRINCIPAL B. ACCOMPLICE C. ACCESSORIES for light felonies: a. principals b. accomplices 2. The following are considered Principals (Art. 17) : a. those who take a direct part in the execution of the act; *to be considered as a principal by direct participation, it is essential that the offender (a) participated in the criminal resolution as shown by his prior or simultaneous acts (b) carried out the plan and personally took part in its execution, and (c) performed acts tending directly to the same end. Accordingly, if he was not present at the scene of the crime, he cannot be deemed to be a principal by direct participation. b. those who directly force or induce others to commit it; * Principal by inducement presupposes that the offender himself is determined to commit the felony; he must have persistently clung to his determination; he offers the strongest of temptations sufficient to induce the commission or exercises ascendancy to compel obedience and the inducement must be the determining cause for the commission of the crime. Where the inducer only made remarks or gave an order after the fatal blow had been struck, he cannot be punished as a principal by inducement. c. those who cooperate in the commission of the offense by another act without which it would not have been accomplished; * principal by indispensable cooperation must have concurred in the criminal resolution and cooperated by performing another act indispensable for the commission of the felony agreed upon. His cooperation is similar to that of an accomplice but is of greater degree because of its indispensability to the accomplishment of the offenders objective, while that of an accomplice is of a lesser and minor importance.

3. Accomplices (Art. 18) - are those persons who, not being included in article 17, cooperate in the execution of the offense by previous or simultaneous acts * Under American law, accomplices are accessories before the fact * to be considered an accomplice, the offender must have known of the criminal design of the principal by direct participation and concurs therein. The acts of the accomplice should not produce the most serious effect on the victim, otherwise he will be a principal. The acts of an accomplice is similar to those of a principal by cooperation, but may be distinguished from the latter in that, although the acts of the accomplice are necessary for the commission of the crime, they are not indispensable. An example would be if a nurse agrees to prepare a 20 cc lethal drug to be used by the nurses friend on victim A and did inject a 10 cc killing victim A but the other 10 cc was injected on another victim B to which the nurse does not know about, the nurse cannot be held criminally liable to the second victim B but an accomplice to victim A only. 3. A c c e s s o r i e s ( A r t . 1 9 ) a r e t h o s e w h o , h a v i n g k n o w l e d g e of the commission of the crime, and having participated therein, either as principals or accomplices, take part subsequent to its commission in any of the following manners: a. by profiting themselves or assisting the offender to profit by the effects of the crme. * the acts of an accessory are always performed after the commission of the crime by the principal and that the accessory had no participation therein in any form (accessory after the fact). An example is a daughter who stole an earrings and the mother pawned them, the mother is guilty as an accessory. b. by concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery. * The prescribed acts of the accessory must have been intended to prevent discovery of the crime , hence mere silence does not make one an accessory. The body of the crime is equivalent to the corpus delicti. c. by harboring , concealing, or assisting in the escape of the principal of the crime, provided the accessory acts with abuse of his public functions. * this provision distinguishes a person either as a public officer or a private individual. They may have different penalties. NURSES AND CRIMES The professional practice of a nurse entails with it the legal responsibilities that he or she must know and understand in order to avoid liabilities in the discharge of her functions. The following are crimes that a nurse must be familiar with: ASSAULT An unlawful attempt or offer to beat or to do bodily injury to another. BATTERY The unlawful beating or touching of another person. The unlawful beating or use of force upon a person without his consent. MURDER is the unlawful killing of a human being by another with intent to kill (DOLO is an element).

HOMICIDE is the killing of a human being by another without deliberate intent to kill. ABORTION Termination or expulsion of the product of conception even before the age of viability. Abortion is a crime penalized in our jurisdiction. A nurse who advises a woman on what drugs to take is criminally liable. INFANTICIDE - killing of a child less than three days of age. PARRICIDE is committed by one who kills his/her father, mother or child whether legitimate or illegitimate, or any of his/her ascendants or his/her espouse. SEXUAL HARASSMENT is committed by a person who, having authority, influence or moral ascendancy over another in a work, training or education environment, demands, requests or otherwise requires any sexual favor from the other regardless of whether such demand, request or requirement for submission is accepted. ILLEGAL DETENTION any private individual who shall detain another or, in any other manner, deprive him of his liberty. ARBITRARY DETENTION any person in authority (public officer) who shall detain another or, in any other manner, deprive him of his liberty. SIMULATION OF BIRTH any person who shall 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.

If such negligence is the proximate cause of the injury or harm, then the person causing such negligence is liable for damages under the law A failure of the nurse to apprise or report to the physician his/her observation like sudden increase in BP or sudden drop of vitals signs and such failure to report resulted to the death or injury to the patient, then the nurse is liable for negligence. Observance of the standard of care as prescribed by RA 9173 is the only for nurses to avoid negligence/malpractice suits in the practice of their profession in the Philippines. Wrong medication or wrong drug given to another patient constitute negligence on the part of the nurse MALPRACTICE - refers to a negligent act committed in the course of professional performance. Any professional misconduct, unreasonable lack of skill or fidelity in professional or fiduciary duties; evil practice; or illegal or immoral conduct; improper discharge of professional duties, or failure to meet the standard of care of a professional which results in harm to another.

CRIMINAL NEGLIGENCE is negligence of such character or occurring under such circumstances, as to be punishable as a crime by statute. PROFESSIONAL NEGLIGENCE breach of professional duty. Negligence committed in the practice of a profession. NEGLIGENCE - is often referred to as that doing of a thing which a reasonably prudent man would not have done and not doing a thing which a reasonably prudent man would have done. It also refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would do or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property The elements of professional negligence are: existence of a duty on the part of the person charged to use due care under circumstances failure to observe such duty such failure resulted to injury or harm The test for negligence: would a prudent man, in the position of the person to whom negligence is attributed, foresee harm to 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, and the failure to do so constitutes negligence. Reasonable foresight of the harm and foresight is constitutive fact in negligence. ignoring such

to go beyond the practice of nursing as prescribed by RA 9173, like for example, the nurse suturing in a surgical procedure without special training or the nurse prescribing medicine or drugs, is malpractice. It means encroaching on the practice of other profession where the nurse is not supposed to perform as prescribe by the law.

Negligence is malpractice Malpractice is determined if the nurse owed a duty to the client and did not carry out the duty, and the client was injured because the nurse failed to perform the duty. If a nurse gives care that does meet appropriate standards, he or she may be held liable for negligence. Negligence encompasses (includes) the concepts of foreseeability of harm to the person injured and of a duty of care toward that person. Article 20 of the New Civil Code of the Philippines provides that every person who, contrary to law, willfully or negligently causes damage to another shall indemnify the latter for the same. This means that negligent acts resulting to injuries must be indemnified in monetary terms. INCOMPETENCE- is the lack of ability, legal qualifications or fitness to discharge the required duty. Incompetence is now included as a ground for revocation/suspension of the certificate of registration as a nurse.

1. 2. 3.

DOCTRINE OF RES IPSA LOQUITOR it literally means, let the thing speak for itself. This is a legal doctrine usually used in litigations involving negligence or malpractice suits. If the plaintiff (the one bringing an action in court) offers such evidence under this doctrine, then no other evidence is necessary. An example would be sponges left inside the abdomen of the patient after surgery the fact that there is the sponge left is evidence by itself that can speak that negligence was indeed committed

and the court may no longer ask for other evidence to prove the occurrence of such negligence. There are three conditions for the application of this doctrine: 1. the accident must be of a kind which ordinarily does not occur in the absence of someones negligence 2. the accident must be caused by an agency or instrumentality within the exclusive control of the defendant ( one being sued in a civil case) 3. the accident must not have been due to any voluntary action or contribution on the part of the plaintiff ( injured party ) DOCTRINE OF RESPONDEAT SUPERIOR it means let the master answer; let the principal answer for the acts of his agent. Respondent superior simply provides that where one acts through the agency of another , then , in the contemplation of the law , he is himself acting so as to make him responsible for the acts of his servant. This doctrine is founded on the principle that he who expects to derive advantage from an act which is done by another must answer for any injury which a third person may sustain from it. Master-servant or employer-employee relationship must exist for this doctrine to apply. DOCTRINE OF FORCE MAJEURE vis major, an act of God, irresistible force, one that is unforeseen, inevitable. Natural calamities like strong typhoons or floods that would deter the nurse to report for duty in the hospital for her shift is an example of this doctrine. Even if the hospital needs her to report or some untoward incidents happened in the hospital, which would not happen if the nurse were there does not constitute any liability on the part of the nurse because of this doctrine. NURSE AS A WITNESS Any information obtained in the course of caring for the patient by the health team ( doctor, nurses, medtechs) or any matters communicated by the patient to the nurse is considered privilege. The nurse cannot testify in a civil case for any privilege communication except when the patient allows such testimony or the patient himself offered such information first in a court hearing or when the health of the many will be jeopardized. This seal of secrecy will remain forever until removed by the patient. However, any privileged communication may be divulged in a criminal proceeding even without the consent of the patient where such information was obtained. LIABILITY FOR FALSE TESTIMONY any person who shall give false testimony in any criminal case, either against or in favor of the defendant, shall be liable to punishment as provided by the law. The punishment, depending on the case, ranges from imprisonment to paying fines and/or both. The nurse can commit this violation if he/she is negligent on charting or erroneously altering her entry in the charts.

needed may also be summoned to appear hearing through the service of subpoena.

in

court

A patients chart that is correctly and accurately accomplished is not only valuable as evidence in legal proceedings but also useful as guide in the proper treatment of the patient. Doctors Orders as mandated by law, nurses must execute such orders for the treatment of the patient, deviation or failure to perform this lawful duty can make the nurse criminally and civilly liable and her license may be revoked or suspended. The nurse must exercise certain degree of judgment in carrying out the doctors order. If in the assessment of the nurse that such order may cause some injury to the patient, then she is morally obligated to verify such orders before carrying them out. The verification must be made to the person giving such order. The nurse must be assertive enough to protect the welfare of the patient (stewardship) and also to protect his/her professional career from lawsuits arising from erroneous carrying out of doctors orders. Should the doctor insist in carrying out a questionable order, the nurse must refer the matter to her immediate superior and must properly document the actions taken. Telephone Orders the following guidelines may be observed in carrying out orders of the physician given through telephone: a. the nurse must chart the date and exact time when the order was given b. the nurse must repeat and record the telephone order c. the nurse must sign the order; begin with t.o. (telephone order) write the doctors name, and then signature the order d. if another nurse witnessed the order, then her signature must also follow e. if another physician or intern or resident is present in the station where such order was given, then it is prudent that the phone call is given to that doctor so they can discuss the order properly and that doctor can sign the orders given in a telephone. f. The physician must sign the telephone order as soon as he is around or within 24 hours depending on the policy of the hospitals. Reporting Responsibilities the nurse are required to report certain communicable diseases or criminal activities such as abuse, gunshot wounds, assaults, homicides, and suicides to the appropriate authorities. Incidental Report the nurse must write incidental report to protect themselves from sanctions. The matters that must be reported are those that deviate from the norms or standard in the performance of their duties. This is also done so that proper remedy can be reached in a given crisis or situation. The report must always be addressed to the immediate superior or proper authorities ( eg. DSWD,PNP,RITM etc). Charting Done by students the clinical instructor or the nurse on duty must sign the charting done by the

The hospital records, even if the patient was already discharged are part of public documents, which can be summoned in any court hearing should the need arises. Most of the time, it is the record custodian of the institutions who is given the subpoena duces tecum or subpoena ad testificandum by the court. However, the nurses who made the entries in the chart, if clarification is

student as required by RA 9173. Those persons signing such charting attests that the charting made by the student are accurate and authentic and consequently takes or assumes the r