Leadership

LEADERSHIP is the way of behaving, an interpersonal ability to cause others to respond not because they have to but because they want to motivate, influence.

a process whereby a nurse influences one or more persons to achieve specific goals in the provision of nursing care for one or more patients/clients

THEORIES OF LEADERSHIP:

1. Trait Theory 2. Behavioural Theory 3. Situational Theory 4. Functional Theory 5. Transactional and transformational

Theory

1. Trait Theory assumes that leaders are born, not made This is probably the first academic theory of leadership. Trait theory tries to describe the types of behaviour and

personality tendencies associated with effective leadership.

a) Intelligence traits – judgement, decisiveness, knowledge and fluency of speech.

b) Personality traits – adaptability, alertness, creativity, cooperativeness, personal integrity, self – confidence, emotional balance, control and independence.

c) Ability traits – ability to enlist cooperation, popularity and prestige, sociability, social participation, tact and diplomacy.

2. Behavioural Theoryunderscores the significance of understanding human behaviour.

considers leadership as a relationship between the leader and the situation.

a particularly useful theory for addressing specific leader behaviours expected to contribute to organizational or unit effectiveness.

argues that the leader’s main job is to see that whatever is necessary to group needs is taken care of

5 broad functions of a leader performs when promoting organization’s effectiveness:

a leader can be said to have done their job well when they have contributed to group effectiveness and cohesion

functional leadership theory has most often been applied to team leadership, it has also been effectively applied to broader organizational leadership as weel.

a) environmental monitoring,b) organizing subordinate activities,c) teaching and coaching subordinates,d) motivating others, ande) intervening actively in the group’s work A variety of leadership behaviours are expected to

facilitate these functions. In initial work identifying leader behaviour, it was observed that subordinates perceived their supervisors’ behaviour in terms of two broad categories referred to as consideration and initiating structure.

5. Transactional and Transformational Theory

Consideration - includes behaviour involved in fostering effective relationships ( ie. showing concern for a subordinate or acting in a supportive manner towards others.)

Initiating Structure - involves the actions of the leader focused specifically on task accomplishment. This could include role clarification, setting performance standards, and holding subordinates accountable to those standards.

given power to perform certain tasks and reward or punish for the team’s performance.

It gives the opportunity to the manager to lead the group and the group agrees to follow his lead to accomplish a predetermined goal in exchange for something else.

Power is given to the leader to evaluate, correct and train subordinates when productivity is not up to the desired level and reward effectiveness when expected outcome is reached.

The transformational leader motivates its team to be effective and efficient. Communication is the base for goal achievement focusing the group on the final desired outcome or goal attainment. This leader is highly visible and uses chain of command to get the job done.

Transformational leaders focus on the big picture, needing to be surrounded by people who take care of the details. The leader is always looking for ideas that move the organization to reach the company’s vision.

Leadership and Emotions Leadership can be perceived as a particularly emotion –

laden process, with emotions entwined with the social influence process.

In an organization, the leaders’ mood has some effects on his group. These effects can be described in 3 levels:1.The mood of individual group members. Group members with leaders in a positive mood experience more positive mood than do group members with leaders in a negative mood. The leaders transmit their moods to other group members through the mechanism of emotional contagion. Mood contagion may be one of the psychological mechanisms by which charismatic leaders influence followers.

2. The affective tone of the group. Group affective tone represents the consistent or homogenous affective reactions within a group. Group affective tone is an aggregate of the moods of the individual members of the group and refers to mood at the group level of analysis. Groups with leaders in a positive mood have a more positive affective tone than do groups with leaders in a negative mood.

3. Group processes like coordination, effort expenditure, and task strategy. Public expressions of mood impact how group members think and act. When people experience and express mood, they send signals to others. Leaders signal their goals, intentions, and attitudes through their expressions of moods.

In research about client service it was found that expressions of positive mood by the leader improve the performance of the group, although in other sectors there were another findings.

Leaders shape workplace affective events. (ie. feedback giving, allocating tasks, resource distribution.) Since employee behavior and productivity are directly affected by their emotional states, it is imperative to consider employee emotional responses to organizational leaders.

Emotional intelligence- the ability to understand and manage moods and emotions in the self and others, contributes to effective leadership in organizations. Leadership is about being responsible.

Leadership Performance:

In the past, some researchers have argued that the actual influence of leaders on organizational outcomes is overrated and romanticized as a result of biased attributions about leaders. Despite these assertions however, it is largely recognized and accepted by practitioners and researchers that leadership is important, and research supports the notion that leaders do contribute to key organizational outcomes. In order to facilitate successful performance it is important to understand and accurately measure leadership performance.

A leader is a person who influences a group of people towards a specific result. It is not dependent on title or formal authority.

Leaders are recognized by their capacity for caring for others, clear communication, and a commitment to persist.

An individual who is appointed to a managerial position has the right to command and enforce obedience by virtue of the authority of his position.

A leader must possess adequate personal attributes to match his authority, because authority is only potentially available to him. In the absence of sufficient personal competence, a manager may be confronted by an emergent leader who can challenge his role in the organization and reduce it to that of a figurehead.

Leadership can be defined as one’s ability to get others to willingly follow.

Every organization needs leaders at every level

Management merely consists of leadership applied to business situations; or in other words management forms a subset of the broader leadership process.

They say: “Leadership occurs any time one attempts to influence the behavior of an individual or group, regardless of the reason. Management is a kind of leadership in which the achievement of organizational goals is paramount.” A good manager does things right. A leader does the right things.

One clear distinction could provide the following definition: -Management involves power by position.-Leadership involves power by influence.

Delineated differences between leadership and management – Leaders as inspiring visionaries concerned about substance while managers; as planners who have concerns with process.

Twelve distinctions between the leader and the manager:MANAGERS LEADERS

•Administer•ask how and when•focus on systems•do things right•Maintain•rely on control•have long-term perspective•accept the status-quo

•have an eye on the bottom line•Imitate•emulate the classic good soldier•copy

•Innovate•ask what and why•focus on people•do the right things•develop•inspire trust•have short-term perspective •challenge the status-quo (current decision)•have an eye on the horizon.•Originate•leaders are their own person•show originality

Distinction between leadership and management – managers concerned themselves with tasks while leaders concerned themselves with people.

Effective leaders create and sustain competitive advantage through the attainment of cost leadership, revenue leadership, time leadership, and market value leadership.

Managers typically follow and realize a leader’s vision. The difference lies in the leader realizing that the achievement of the task comes about through the goodwill and support of others (influence), while the manager may not.

This goodwill and support originates in the leader seeing people as people, not as another resource for deployment in support of “the task”. The manager treats people as just another interchangeable item.

Leadership does not only manifest itself as purely a business phenomenon. Management does not occur only as a purely business phenomenon.

A Leader optimizes upside opportunity; a Manager minimizes downside risk

“ Leadership without Management yields steps forward, but as many if not more steps backwards. Management without Leadership avoids any step backwards, but doesn’t move forward

Leadership by a group- more than one person provides direction to the group as a whole.

Some organizations have taken this approach in hopes of increasing creativity, reducing costs, or downsizing. Others may see the traditional leadership of a boss as costing too much in team performance.

In some situations, the maintenance of the boss becomes too expensive – either by draining the resources of the group as a whole, or by impending the creativity within the team, even unintentionally.

A common example of group leadership involves cross-functional teams. A team of people with diverse skills and from all parts of an organization assembles to lead a project. A team structure can involve sharing power equally on all issues, but more commonly uses rotating leadership.

The team member(s) best able to handle any given phase of the project become(s) the temporary leader(s).

“Effective leadership is the ability to successfully integrate and maximize available resources within the internal and external environment for the attainment of organizational or societal goals”; an individual with the capacity to consistently succeed in a given condition and be recognized as meeting the expectations of an organization or society.”

Additionally, as each team member has the opportunity to experience the elevated level of empowerment, it energizes staff and feeds the cycle of success.

Leaders who demonstrate persistence, tenacity, determination, and synergistic communication skills will bring out the same qualities in their groups. Good leaders use their own inner mentors to energize their team and organizations and lead a team to achieve success.

Leadership among primates In Demonic Males: Apes and the Origins of Human

Violence present evidence that only humans and chimpanzees, among all the animals living on earth, share a similar tendency for a cluster of behaviours: violence, territoriality, and competition for uniting behind the one chief male of the land. Many animals beyond apes are territorial, compete, exhibit violence, and have a social structure controlled by a dominant male (lions, wolves, etc.), evidence is not empirical.

It would be beneficial, to examine that most accounts of leadership over the past few millennia (since the creation of Christian religions) are through the perspective of a patriarchal society, founded on Christian literature.

The Leadership ModelLeadership models help us to understand what makes

leaders act the way they do.

The ideal is not to lock yourself in to a type of behavior discussed in the model, but to realize that every situation calls for a different approach or behavior to be taken.

Two models will be discussed, the Four Framework Approach and the Managerial Grid.

Four Framework Approach

leaders display leadership behaviors in one of four types of frameworks: Structural, Human Resource, Political, or Symbolic.

Structural FrameworkStructural Framework Structural Leaders focus on structure, strategy, environment, implementation, experimentation, and adaptation.

Human Resource Framework Human Resource Framework Human Resource Leaders believe in people and communicate that belief; they are visible and accessible; they empower, increase participation, support, share information, and move decision making down into the organization.

Political FrameworkPolitical Framework-Political leaders clarify what they want and what they can get; they assess the distribution of power and interests; they build linkages to other stakeholders, use persuasion first, then use negotiation and coercion only if necessary.

-In an effective leadership situation, the leader is an advocate, whose leadership style is coalition and building. While in an ineffective leadership situation, the leader is a hustler, whose leadership style is manipulation.

Symbolic FrameworkSymbolic Framework-Symbolic leaders view organizations as a stage or

theater to play certain roles and give impressions; these leaders use symbols to capture attention; they try to frame experience by providing plausible interpretations of experiences; they discover and communicate a vision.

-This model suggests that leaders can be put into one of these four categories and there are times when one approach is appropriate and times when it would not be. Any one of these approaches alone would be inadequate, thus we should strive to be conscious of all four approaches, and not just rely on one or two.

STYLES OF LEADERSHIP1) Autocratic • Involves centralized decision making, with the leader making

decisions and using power to command and control others.• decisions are characterized• refuse to utilize ideas and opinions of subordinate• are greedy in publication• very high productivity but low satisfaction• their subordinates are not happy

AUTOCRATIC LEADER

FOLLOWER FOLLOWER FOLLOWER

2. Democratic • is participatory, with authority delegated to others• consider ideas• subordinates have a freedom to carryout order• high productivity, high satisfaction

DEMOCRATIC OR PARTICIPATIVE

LEADER

FOLLOWER FOLLOWER FOLLOWER

3. Bureaucratic The bureaucrat acts as the

representative of the power and prestige of the entire structure irrespective of his position within the hierarchy.

BUREAUCRATIC LEADER

FOLLOWER FOLLOWER FOLLOWER

4. Laissez-Faire: This is permissive and passive style and the leader defers decision making.

• happy go leader• let alone policy• low productivity, low satisfaction

SERVANT LEADERSHIP-it puts serving first, takes a holistic approach,

shares decision making and builds a community. focus on services (IN NURSING): It is a selfless commitment and devotion to

duty recognizing the necessity of providing a holistic care to the patient.

1. Listening2. Empathy3. Healing4. Awareness5. Persuasion6. Conceptualization7. Foresight8. Stewardship9. Commitment to the growth of people10. Building a community 

FILIPINO STYLES OF LEADERSHIP1. It is dynamic not static2. It is side by side paternalistic type

(autocratic) and more professional style (democratic) of leadership and management

3. More of personalism. It is who he is, not on what he does, not so much on what he knows but whom he know, not so much on reality but the way things are perceived

4. It is guided by values that affect behavior of Filipinos (utang na loob)

5. Sometimes it employs bureaucracy

THE NURSE ADMINISTRATOR’S GRID(THE LEADERSHIP GRID)

CONCERN FOR PRODUCTION (Hospital Services)1.1Minimal concern for both 5.5Moderate concern for both 9.1Primary concern is for hospital services, minimal, if any, for staff 1.9Maximal concern for staff, minimal for hospital services

9.9 Ideal approach: maximum concern for both

DIFFERENCES/SIMILARITIES BETWEEN A LEADER AND A MANAGER

LEADER MANAGERWith or without appointment With appointment

Leadership is broader Management is working for an organization

Remains a leader as long as there are willing followers

Remains as a manager as long as appointment holds

Does the right thing Directs willing and unwilling followers

Innovates AdministerFocuses on people Focuses on systems and structure

Develops MaintainsRelies on trust Relies on control

Has a long term view Has a short term viewInspires others to follow Requires others to follow

The Path-Goal Approach to Leadership EffectivenessThe Path – Goal Theory suggest that the main function of the leader is to clarify and set goals with subordinates, helps them find the best path for achieving the goals, and remove obstacles. Proponents of this approach have studied leadership in a variety of situations.

The theory builds on various motivational and leadership theories of others.

In addition to the expectancy theory variables, other factors contributing to effective leadership should be considered. These situational factors include (1) characteristics of subordinates, such as their needs, self-confidence, and abilities; and (2) the work environment, include such proponents as the tasks, the reward system, and the relationship with co-workers. (see illustration below)

Characteristics of subordinates

Functions of the leader Leader behavior

Motivated subordinates

Effective organization

Work environment

Leader Behavior is categorized into four groups

1. Supportive leadership behavior gives consideration to the needs of subordinates, shows a concern of their well-being, and creates a pleasant organizational climate. It has the greatest impact on subordinates’ performance when they are frustated and dissatisfied.

2. Participative leadership allows subordinates to influence the decisions of their superiors and can result in increased motivation.

3. Instrumental leadership gives subordinates rather specific guidance and clarifies what is expected of them; this includes aspects of planning, organizing, coordinating, and controlling by the leader.

4. Achievement-oriented leadership involves setting challenging goal, seeking improvement of performance, and having confidence that subordinates will achieve high goals. 

When subordinates are confused, then the leader may tell them what to do and show them a clear path to goals. On the other hand, for routine tasks, such as those found on the assembly line, additional structure (usually provided by a task-oriented leader) may be considered redundant; subordinates may see such efforts as over controlling, which, in turn, may be dissatisfying. To put it differently, employees want the leader to stay out of their way because the path is already clear enough.

The theory proposes that the behavior of the leader is acceptable and satisfies subordinates to the extent that they see it as a source for their satisfaction.

Another proposition of the theory is that the behavior of the leader increases the effort of subordinates, that is, it is motivating, insofar as (1) this behavior makes satisfaction of the needs of subordinates dependent on effective performance and (2) the behavior enhances the subordinates’ environment through coaching, directing, supporting, and rewarding.

The key to the theory is that the leader influences the paths between behavior and goals. The leader can do this by defining positions and task roles, by removing obstacles to performance, by enlisting the assistance of group members in setting goals, by promoting group cohesiveness and team effort, by increasing opportunities for personal satisfaction in work performance, by reducing stresses and external controls, by making expectations clear, and by doing other things that meet people’s expectations.

The path-goal theory makes a great deal of sense to the pr for personal satisfaction in work performance, by reducing stresses and external controls, by making expectations clear, and by doing other things that meet people’s expectations.

The path-goal theory makes a great deal of sense

to the practicing manager. At the same time, one must realize that the model needs further testing before the approach can be used as a definite guide for managerial action.

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EXERCISES/ACTION STEPS1. Analyze a situation in which you were the leader. Which

leadership approach discussed in this chapter helps explain why you were a leader?

2. Analyze a case in this book by using the group approach. Specifically, the class should be divided into groups of about five students. Each group should select a spokesperson who should present the analysis of the case to the class. For each group, one observer (this person should not be a participant in the case discussion) should describe the interactions in the group. Was there a leader in the group? If the answer is “yes,” why was he or she considered a leader? Was it due to the leader’s personality, the other group members (followers), or the nature of the task (situation)? Explain the group processes in light of any leadership theory or concepts discussed.

CASE:ICONNECT E-SERVICES, INC.

Iconnect E-services, Inc. has encountered hard times, not only because of an economic recession but also because of competition from products imported from Japan. In the past, labor relations have been rather poor. The unions usually asked for big pay increases for the workers and got them. But things have changed during the last few months, and labor and management have realized that they are in for some bad times ahead.

The company, maintaining it is in a precarious (liferkely ro fall/not stable) condition, has asked labor for concessions (agreed allowance/referential) and givebacks. The union has called a membership meeting to discuss the situation. While Jun Alzona, an assembler, thinks that he is overpaid and argues for a wage reduction, the majority of those present disagreed and do not want to make any concessions. In fact, there is a great mistrust of management’s intentions and the workers feel that giving concessions will encourage the company to ask for additional ones. After a long discussion some workers are more agreeable to concessions if management makes similar sacrifices. But management does not make any commitments.

During the next few weeks the situation gets worse; faced with a layoff (reduction of workers-temporary or permanent), the union agrees to some cutbacks (reduce in expenditure) with the understanding that employees will share in some way in the profits of the company when things get better.

One month later, a national-magazine survey of executives’ salaries at major companies shows that the executives at Palmer received a substantial increases in compensation. One worker remarks: “You just can’t trust top management. I wish our situation was like the one in Japan, where in hard times the dividends are cut first, then the salary of top management is reduced, and later middle-level managers get a pay cut; the workers’ pay is affected last.”

Questions:

1. Do you think the workers should have made concessions and agreed to givebacks?

2. If you were the president of the company, how would you have handled the situation?

3. What do you think of the Japanese approach to dealing with economic problems?

MANAGEMENT is the process of working with and through other people to

accomplish organizational goals.

1. Scientific: It refers to the type of management that is characterize and guided by the application of scientific approaches to solve managerial problems in business and industry.

Proponent: Fredrick Taylor: The father of scientific management.

 2. Bureaucratic: it refers to the type of management ruled

by bureaucracy - a highly structured form of administration and usually includes no participation the governed.

Characteristics of bureaucracy include: 2.1 formality

2.2 low autonomy2.3 a climate of rules and conventionality2.4 division of labor2.5 specialization2.6 written specifications2.7 memoranda and minutes2.8 centralization2.9 controls2.10. emphasis on a high level of efficiency

Proponent: Max Weber

3. Human relation: It refers to the integration of people to work productively and cooperatively and with economic, psychological and social satisfaction. 

Proponents: - Mary Parker Follett: The prophet

Management the first suggested the principles of participative decision-making.

- Elton Mayo -- who experimented on the relationship of social factors to productivity and reactions of workers toward varying physical condition.

- F.J; Roethisberg -- introduced the case method where each situation/particular case experienced is considered and analyzed.

4. Theory X -- Y it theorized that human nature and behavior affect every management decision or action.

Management Theories: Theory X manager assumes that the average

person;- has an inherent dislike for work and will avoid it if possible (that employees are basically lazy)- must be coerce, controlled, directed and threatened with punishment to get the work done (that they need constant supervision and direction)- prefers to be directed, wishes to avoid responsibility, has relatively little ambition and wants security above all (they are indifferent to organizational needs)

The Y manager assumes that:- workers enjoy their work- man will exercise self-direction and self-control in the service of objectives to which she is committed.- the average human being not only accepts but seeks responsibility.- workers are self-motivated and are willing to work hard to meet personal and professional goals.

 Theory M: Allen

Managers avoid extremes in their belief about people. People are motivated to work by highly complex factors. Some dislike responsibilities and prefer to be led while others are ambitious, majority fall somewhere in between.

Theory Z: It is essentially a participative management model based on the Japanese concept of organization and is recently appearing in the American management.

Proponent: W.G. Ouchi

TQM: it is a philosophy that is focused on total quality management and continuous, quality improvement.

Proponent W. Edwards Deming who - developed the 14 point program for transforming organization to a customer needs and expectations driven.

FOUNDATIONS FOR TM:FOUNDATIONS FOR TM: Focus on the customer Continuous improvement Improve the quality of everything in the organization Measure accurately Involve employees

PRINCIPLES OF MANAGEMENT1. Unity of command. This presents the concept of

one person to one boss. Each person receives orders from only one superior

2. Proper Channels of communication. Communications should follow the scalar chain.

3. Scalar Chain. This represents the line of authority from top management to the lowest ranks in the organization.

4. Division of Labor. The sum total of work by which the supervisor s responsible is divided in the best possible ways into jobs that can be effectively supervise.

5. Span of control. it is the number of people reporting to any manager.

6. Esprit de Coprs. Promotion of team spirit that buld harmony and unity within the organization

7. Authority and respnsibility. Authority is the right to give ordes. Responsibility is the duty or the obligation to do ones duty.

8. Discipline. It is obedience and respe for the agreements between the firm and its employees

9. Unity of Diretion. It means one head aand one plan for a roup of activities having the same objetive

10. Subordination of Individual interest to General Interest. This means that the interest of one emloyee or group of employees should not prevail over that of the company

11. Remuneration of Personnel. It means that workers should be given fair wages for services rendered.

12. Centralization. Indicates that decisions are made by top management

13. Order. This means that there is a place for everything and everything is in its place

14. Equity. It is the combination of kindness and justice15. Stability of tenure. Workers are assured of their

positions because high turnover breeds inefficiency.16. Initiative. This is the ability to introduce a land and

ensuring its success

NURSING MANAGEMENTNURSING MANAGEMENT

It is the process of working through staff members to achieve organizational goals of the healthcare delivery system

LEVELS OF SKILLS MANAGEMENT:1. Conceptual - mental ability2. Interpersonal - ability to work well in coordination with other

peolple3. Technical - ability to use expertise to perform task with

proficiency

 ROLES OF A NURSE MANAGER:

1. Interpersonal Role1.1 Symbol1.2 Leader1.3 Liaison

2. Informational2.1 Monitors information2.2 Disseminates information2.3 Acts as a spokesperson

 3. Decisional Role

3.1 Entrepreneur, innovator, problem discoverer3.2 Trouble shooter3.3 Negotiator 

NURSING MANAGEMENT FUNCTIONS:NURSING MANAGEMENT FUNCTIONS:Planning, Organizing, Directing, Controlling

PLANNING -- It is deciding/predetermining a course of action in advance in order to arrive at a desired result.

PRINCIPLESPRINCIPLES1. Management planning should reflect relevant legislation,

policies, and formal agreements and establish an approach for achieving the objectives

2. Management plans should establish a long range vision3. Management planning strives for consensus building

involving on going dialogue both internal and external to ensure that professional expertise and the public are involved in the achievement of primary objectives

4. Management planning is undertaken through a multi - disciplinary team approach

CHARACTERISTICSCHARACTERISTICS1. It is deliberate and analytical2. It is process oriented3. It is hierarchical in nature4. It is future directed5. It is multidimensional

 

BARRIERS TO PLANNINGBARRIERS TO PLANNING1. Attitudes/Agency Culture2. Regulatory/Legal Issues3. Resources4. Political/Public Concerns5. The planner

 

STRATEGIES TO OVERCOME BARRIERS TO STRATEGIES TO OVERCOME BARRIERS TO PLANNINGPLANNING1. Education and information dissemination2. Plans should be flexible3. Plans should be specific simple and realistic4. Plans should include people and units affected by the plan5. Know when to plan and when not to plan6. Good plans should have evaluation checkpoints

ELEMENTS/COMPONENTS OF PLANSELEMENTS/COMPONENTS OF PLANS1. Written statements of vision, mission or purpose, philosophy, objectives2. Detailed management/operational plans3. Forecasting/Estimates/Predicting4. Budgeting - estimating the future cost5. Developing and scheduling of programs6. Time Management

I. Written statements of vision, mission or purpose, I. Written statements of vision, mission or purpose, philosophy, objectivesphilosophy, objectivesVISION - outlines the organizations function. It is a mental image that gives the agency something to strive forMISSION - purpose of the agency.PHILOSOPHY - what they perceived about the agency.GOALS - what the organization wanted to attain.OBJECTIVES - specific pronouncements on the performance of the employees.

II. DETAILED MANAGEMENT/OPERATIONAL II. DETAILED MANAGEMENT/OPERATIONAL PLANNINGPLANNING

TYPES OF PLANNING:1. Strategic Planning

- reserved for top management- involves determining the overall plan of the organization- long range planning (5 years)

2. Tactical Planning- reserved for middle managers- involves in allocation of available resources- short range planning (1 year)

3. Operational Planning- reserved for first level supervisors- deals with day - to - day operations- very short plans

  III. FORECASTING - estimating, predicting, anticipatingIII. FORECASTING - estimating, predicting, anticipatingIV. BUDGETING - estimating future costIV. BUDGETING - estimating future cost

Types of budget:- Operating budget- Project budget- Cash- Capital budget

  V. DEVELOPING AND SCHEDULING OF PROGRAMSV. DEVELOPING AND SCHEDULING OF PROGRAMS

Program is a plan / layout of future events- a project - a planned undertaking- a project - a planned undertaking

VI. TIME MANAGEMENT - technique for allocating ones time, VI. TIME MANAGEMENT - technique for allocating ones time, assigning priorities and eliminating time wastersassigning priorities and eliminating time wasters

V. DEVELOPING AND SCHEDULING OF PROGRAMSV. DEVELOPING AND SCHEDULING OF PROGRAMSProgram is a plan / layout of future events

- a project - a planned undertaking

VI. TIME MANAGEMENTVI. TIME MANAGEMENT - technique for allocating ones time, assigning priorities and

eliminating time wasters

STANDARDS:STANDARDS:Definition: It is desirable level of performanceCharacteristics:1. They are predetermined2. They are established by authority3. They are communicated to and accepted by people affected by the standards4. They are objective, measurable and achievable

Sources:Sources:1. PNA2. PR3. BON4. CHED5. DOH6. Nursing Law

 Functions of standardsFunctions of standards

1. They increase objectivity2. They are measurement tools3. They serve as guide for practice4. They communicate clearly to everyone involved in

the organization what level of service is expected in that organization.

 

FOR DISCUSSION FOR DISCUSSION PLANNINGPLANNING

1. Is managing a science or an art? Could the same explanation apply to engineering or accounting?

2. Identify the various approaches to management.3. Planning is looking ahead, and control is looking back.

Please comment4. If planning involves a rational approach to selected

goals, how can goals or objectives be a type of plan?5. Using as an example a planning decision with which

you are familiar, show to what extent, and how, the commitment principle applies to it.

6. Planning theory, illustrates the open - system approach to management. Please comment.

ORGANIZING:1. Organization - is the structure and process which allow the agency to enact its philosophy and utilize its conceptual framework to attain its goals.2. Organizational structure is the process by which a group is formed, its channels of authority, span of control and lines of communication3. Organizational chart - an illustration that shows how the parts of the organization linked.4. Organizing - is the way in which work it arranged and allocated among the members of an institution so that the goals can be efficiently achieved. 5. Merger - the combination of 2 or more companies into I company6. Hierarchy - a group of persons arranged in a rank, grade or class7. Bureaucracy - administration through departments and subdivisions managed by officials following an inflexible routine.

Principles of Organizing are the same as the principles of Management

Elements of Organizing:1. Setting up of the organizational structure2. Staffing3. Scheduling4. Developing job descriptions

The organogram/organizational chartsThe organogram/organizational chartsImportance

1. It expresses several principles of management2. It outlines administrative control3. It serves as a guide for policy making4. It is used in planning5. It is used to evaluate strengths and weaknesses of the current structure.6. It shows relationships with other agencies.7. It is used for orienting new personnel

Organizational relationship (line and staff)Organizational relationship (line and staff)

Line authorityIt is the authority that entitles a supervisor to direct and individuals work

Staff authority It is an authority created to support, assist, recommend and generally reduces the supervisors informational responsibilities

Types of Organization (hierarchical, dual, pyramid, centralization vs decentralization)

HierarchicalHierarchicalAn organization where there are several layers of An organization where there are several layers of

positions between the Chief and the rank and filepositions between the Chief and the rank and file

DualDual- an organization that separates technical and administrative responsibilities- it has one hierarchy in which technical professionals make technical decisions and control technical matters and another hierarchy in which management makes decisions about, issues such as personnel and budget- it gives equal status to managers and technical professionals- it provides a set of titles and job descriptions for each hierarchy

PyramidPyramidThe traditional Pyramid organizational structure reveals a formal organizational system where there is a monopoly of authority by an individual or a group of individuals at the apex of the system

Professionals, Staff, Technicians, Supervisors

Semi skilled, and unskilled workers

MANAGEMENT

Centralization vs. DecentralizationDecentralization -is an arrangement in which decisions are pushed down the

organization to the level where the functional expertise lies

 - It is the degree to which decision making is diffused

throughout the organization.- It is used when there are competent personnel to whom

the manager can delegate authority.- It is used in larger organizations where the decisions are

more complex thus there is decentralization so as not to overburden top management and not to delay decisions.

- Production, marketing, and personnel are decentralized- It increases morale and promotes interpersonal

relationships. If people have a voice in governance, they feel more important and are more willing to contribute

- It fosters informality and democracy in management and brings decision making to the action

- Its type of organization is flat- It develops managers

Centralization- is an organizational arrangement in which all decisions are passed along to top management before being implemented.

- The type of organization is tall- The span of management is narrower- is used by agencies during their early, formative years- Finances, accounting, data processing of statistics, purchasing of capital

equipment are usually centralized.

Staffing- it is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients demands- it provide the manpower for the organization

it involves:1. selection of qualified and competent personnel2. system of assignment3. staffing schedules

it includes therefore:1. hiring2. defining the requirements of the job3. finding the right person for the job4. training5. appraising6. encouraging the person to stay on his job7. encouraging the person to accept higher responsibility when qualified8. selection of qualified and competent personnel for employment through the following methods:

8.1 Recruitment - process of enlisting personnel for employment though *advertising*word of mouth and*employee recommendaation

8.2 Screening: Its philosophies*screen out applicants who do not fit the image of the agency*try to fit the job to a promising applicant

8.3 Interview: Purposes8.3.1 To obtain further information about the applicant8.3.2 To give information8.3.3 To determine if the applicant qualifies for the position.

8.4 Orientation: It is the process of becoming familiar with the new environment an adapting well to it. It includes:8.4.1 A tour of the physical facilities8.4.2 Introduction to co-workers8.4.3 Description of the organizational structure of the institution8.4.4 Information on the philosophy, goals, policies, and standards of the institution8.4.5 Function of the members of the health team

Staffing Formula1. Categorize the number of patients according to the levels of care needed. Multiply the total number of patients by the % of patient at each level of care

PERCENTAGE (%) OF PATIENTS IN VARIOUS LEVELS OF CARE

1. Thus if it is a tertiary hospital with 250 beds:250 x 30% (0.30) = 75 patients needing minimal care250 x 45% (0.45) = 112.5 patients needing moderate care250 x 15% (0.15) = 37.5 patients needing intensive care250 x 10% (0.10) = 25 patients needing highly specialized nursing care 250

2. Find the number of Nursing Care Hours (NCH) needed by the patient at each level of car per day. Find the sum of the NCH hours

 75 patients x 1.5 = 112.5 NCH/day112.5 x 3 = 337.5 NCH/day37.5 x 4.5 = 168.75 NCH/day25 x 6 = 150 NCH/dayTOTAL = 768.75 NCH/day

 3. Find the total NCH needed by 250 patients per year

768.75 x 365 days per year = 280, 593 NCH needed by 250 patients per year

4. Find the actual working hours rendered by each nursing personnel per year8(hrs/day) x 21 - (working days/year) = 1704 (working hours/year)

5.Find the total number of nursing personnel neededTotal NCH/year = 280.593 = 165 Nursing PersonnelWorking hours/year 1704Relief x total number of nursing personnel = 165 x 0.15 = 25Total nursing personnel needed = 165 + 25 = 190

 6. Categorize to professional and non - professional ratio

in tertiary is 65:35190 x 0.65 = 123 Prof190 x 0.35 = 67 Non - Prof

  7. Distribution by shifts:

Nurses123 x 0.45 = 55 on AM123 x 0.37 = 46 on PM23 x 0.18 = 22 on NightNursing Attendants:67 x 0.45 = 30 on AM67 x 0.37 = 25 on PM67 x 0.18 = 12 on Night

8. Notes on Staffing:

- The computation is only for in-patients- Additional personnel should be hired for the supervisory, administrative and for those in the special areas - OR, ER, DR, and OPD- A head nurse is provided for every nursing unit- A supervisor is provided:*to cover every shift in each clinical department or area/specialty unit*for each geographical area in hospitals beyond 100 beds*for each functional area - Training, research, Infection control- Roomed in babies are given services as bathing, diaper changes, therefore additional staffing should be provided for them- Hospitals are now centers for wellness therefore a nurse educator should be provided.

 

SchedulingSchedule - is a time table indicating:1. planned work days and shifts of nursing personnel2. working days and off-days to the nursing personnel3. the fair treatment provided for every member of the nursing personnel

 Objective for schedulingObjective for scheduling: To assign working days and

days-off to the nursing personnel so that adequate patient care is assured.

Factors to consider in Scheduling:1. Different levels of nursing staff2. Adequate coverage for 24 hours, 7 days a week3. Staggered vacation and holidays; weekends4. Long stretches of consecutive working days, evening and night shifts and floaters

Methods of Scheduling Staff / Types of Scheduling:1) Centralized Scheduling - when schedules

are done by the chief nurse or her designate2) Decentralized Scheduling - when managers

are given authority and assume responsibility to staff their own units. Supervising nurse of Senior nurse are usually does the arrangements of shifts of duty and off duties

3) Cyclic scheduling - when the schedule observes an established basic time pattern for a certain number of weeks and is repeated thereafter

JOB DESCRIPTIONS

It is a statement that sets the duties and responsibilities of a specific job.

Contents:1. Identifying data

- position data: staff nurse- department: Nursing- Supervisors Title: Head nurse/ Senior nurse

 2. Job summary. This includes the essential features of the job that

distinguish it from others. 3. Qualification requirements- educational preparation, training

and experience necessary to fill the position. 4. Job relationship -- Source of workers 5. Specific and Actual Function and Activities

Uses:1. For recruitment and selection of qualified

personnel. 2. To orient new employees to their jobs. 3. for job placement.

TYPES OF PATIENT ASSIGNMENT:TYPES OF PATIENT ASSIGNMENT:Types of patient assignment (case, primary, functional,

team, case)Management

1. Functional -- This is the oldest nursing practice modality. This is a task oriented method in which particular nursing function is assigned to each staff member.

2. Total Care or Case Method Nursing. The complete care if one or more patients is assigned to a nurse for a specific shift or period of time.

 

3. Team Nursing. It is a decentralized system where the total care of a group of patients is the responsibility of a team of professionals and non-professionals who work together to give comprehensive, quality and individualized care.

4. Primary Nursing. A professional nurse has a 24-hour responsibility for the care of the assigned patients.

5. Case management. System of patient care delivery where the case manager directs care and is responsible for the assessment of the patient and family, establishes nursing diagnosis, develops NCP, delegates nursing care to associates, activates interventions, coordinates and collaborate with interdisciplinary team and evaluates outcome of care.

FOR DISCUSSION- Organizing1) Since people must occupy organization positions, and since an effective organization depends on people, it is often said that the best organization arises when a manager hires a good people and lets them do a job in their own way. Please comment

2) A formal organization is often conceived as a communications system. Is it? How?

3) Construct a diagram depicting the formal organization of an enterprise or activity with which you are familiar. How does this organization chart help or hinder the establishment of an environment or performance?

4) Using the same enterprise or activity question 3, chart the informal organization. Does it help or hinder the formal organizations? Why?

5) When you become a manager, what criteria will you favor to determine your span?

DIRECTING-it is the heart of the managerial process that involves:

1) It includes supervision and guidance.2) It actuates efforts to accomplish goals.3) When written, complete, understandable and given in

logical order will prevent confusion and poor performance and misunderstandings.

4) Clear directions, follow-up and supervision help maintain quality of work.

5) When direction is given verbally and in a nice way, the workers will accept and will be challenged to exert effort to do the job.

6) Courteous directions encourage cooperation, interest and better performance in their jobs.

Elements of Directing:1) Leadership2) Delegation of work to be performed3) Utilization of Policies and procedures4) Supervision of personnel5) Coordination of services6) Motivation7) Communication8) Staff development 9) Decision making In our course syllabus, the only elements included,

are: Communication Delegation Problem solving / Decision making Management conflict --- Conflict management

COMMUNICATIONCOMMUNICATION It is the transmission of

information, opinions, and intentions between and among individual.

Reasons for communicating:• To inform• To persuade • To command• To inquire• To entertain• To facilitate work• To effect change • To increase workers satisfaction • To optimize care• To facilitate coordination

Steps in the Communication Process:Ideation -> Encoding -> Transmission -> Receiving

-> Decoding -> Response Response <- Decoding <- Receiving <-

Transmission <- Encoding1) Ideation – when the sender decides to share the content

of her message with someone2) Encoding – putting meaning into symbolic forms3) Transmission of the message – sending the message 4) Receiving – is when the receiver sees and hears the

message. 5) Decoding – is when the receiver defines words and

interprets gestures during the transmission of the speech

6) Response or feedback when the receiver replies to the

sender.

Lines of Communication1) Downward – traditional line from superior to subordinate which may pass from various channels.

2) Upward – emanates from the subordinates and goes upward.

3) Horizontal – or lateral flow between peers, personnel and departments on the same level.

4) Outward – information that flows from caregivers to the patients, their familiesm relatives, visitors and the community.

5) Diagonal – occurs between individuals or department’s that are not on the same hierarchy.

6) Grapevine – rumor.

TYPES OF COMMUNICATION: Verbal Non-verbal Written Abstract

DELEGATIONIt is the process by which a manager

assigns specific task/ duties to workers with commensature authority to perform the job.

Reasons for delegating: To1) Assign routine task 2) Assign task for which the nurse manager does

not have the time3) Solve problems4) To assign someone to do th work when there is a

change in the nurse manager own’s a job emphasis

5) Build capability to supervise

Steps to a successful delegation1) Assessa) environmentb) organizationc) practiced) selfe) the delegate

2) Plana) gather information what needs to be doneb) prioritize

3) Intervene1) decide on what tasks can be appropriately delegated2) communicate effectively3) resolve conflict

4) Evaluate1) oversee the performance of the delegated task – supervise2) give feedback3) solve problems to improve task performance4) evaluate to ensure delegates competence

Principles of Delegation:1) Select the right person to whom the job is to be delegated.2) Delegate both interesting and uninteresting tasks.3) Provide subordinates with enough time to learn.4) Delegate gradually.5) Delegate in advance.6) Consult before delegating.7) Avoid gaps and overlaps.

What Cannot Be Delegated:1) Overall control2) Duties involving trust and confidence3) Authority to sign one’s name is never delegated.4) Evaluating the staff and/or taking necessary

corrective or disciplinary action.5) Responsibility for maintaining morale.

DECISION MAKING AND PROBLEM SOLVING:

Decision – is the course of action that is consciously taken from available alternatives for the purpose of achieving results.

Decision making – is the systematic, sequential process of choosing among alternatives and putting the choice of action.

Problem Solving and Decision Problem Solving and Decision making are almost the same making are almost the same with the following differences:with the following differences:Decision making requires definition of a clear

objective to guide the processDecision making is value-based while problem

solving is more scientific processDecision making relies on the scientific

problem solving processDecision making may not be the result of an

immediate problem

Process of Decision Making:1) Identify the problem and analyze the situation2) Develop and explore the alternatives3) Compare all alternatives and rate the risk4) Select the best alternative

Steps in Problem Solving:Steps in Problem Solving:1) Identify the problem2) Gather and analyze the data3) Generate alternatives and select the

alternatives4) Implement5) Evaluate

Models of Decision Making:1. Normative modelA1. (Autocratic Variant) You solve the problemA2 you obtain the necessary information from your

subordinates the problem yourself.C1. (Consultative) You share the problem with relevant

subordinates individually, getting their ideas and suggestions without bringing them as a group.

C2. You share the problem with the subordinates as a group

G. you share the problem with your subordinates as a group and reach a consensus on the solution

2. Decision Tree ModelIt depicts decision trees as a starting with a basic problem

and making event folks represented as branches.3. Descriptive ModelSimon developed this model with the assumption that

decision maker is a rational person looking for acceptable solutions based on the known information.

UTILIZING/ REVISING/ UPDATINGNURISNG SERVICE POLICIES AND PROCEDURES

Policies – are broad guidelines for the managerial decisions that are necessary in organizational and departmental planning.

Importance: 1) It is an effective tool for orienting new employees.2) It is used as reference.3) It is the basis for developing administrative procedures4) It is affirm basis for discussion when differences occur.

Examples of Nursing Service Policies1. Accidents – care, reporting precautions to prevent

occurrence2. Admissions – receiving, consent notifying doctor, care of

patients3. Autopsies – obtaining informed consent

4) Breakage – Classification, responsibility, reporting5) Bulletin boards – location, posting of information6) Committees – Types, membership, functions7) Complaints – handling, action taken8) Consent – Informed consent, taken by whom, from

whom, shared decision making with patient and family and/or significant others together with members of health team.

9) Death – notification, care and identification, care of personal belongings, death certificate

10)Discharge – Time, clearance, discharge planning, accompaniment by patient

11)Doctors order – written, verbal by telephone12)Equipment and supplies – list of expandable and

non-expandable items, care, lending, requesting, repairing.

13. Fire regulations – drill, prevention; brigade14. Nursing Care:

• Administration and preparation of Oral meds, IV, infusions, BT.• Charting – forms used, color of ink, format considering legal implication• Daily assignments – by whom, where, when• Emergency drug and supply – contents, responsibility, location• Kardex – Use, sample form• Medications – card system, responsibility, checking, dosages, errors,

reporting corrections • Property of Patients – responsibility, placement• PDN – Engaging, obligations to hospital, supervisions, evaluation,

enumeration• Reasonable and due care – definition, explanation, legal implications• Referrals – within and outside of agency• Safety devices – side rails, restraints

15. Reports – forms, responsibility16. Reporting on or off duty – information given when leaving the

unit17. Meetings – frequency, purpose, types, membership, minutes

 

Nursing Service Policy Manual The manual is a tool for orienting the staff or new employees and reference guide when problems or conflicts arise.

Nursing Service ProceduresNursing Service ProceduresProcedures are specific directions from implementing written policies.

Purposes of Procedure Manuals:Purposes of Procedure Manuals:1) For communication, understanding, standardization and

coordination2) For reference for reviewing procedures especially when

a personnel has not done the procedure for some time.3) They are used to teach and evaluate students and new

employees.4) To orient new employees to distinguish characteristics

of an institution’s procedures. They can be effective tool in ensuring that procedures is done according to agency’s protocol.

5) To update employees in developing technologies.

Examples of Consents in Procedure Manual:

SUPERVISION:› Supervise – to inspect, to guide, to evaluate and improve

work performance of employees though a criteria against the quality and quantity work of production and utilization of time and resources are made.

› Supervision – means overseeing the activities of others.

Supervisory techniques:Supervisory techniques:1) Observation of the worker while making her rounds2) Spot checking of charts through nursing audits3) Asking the patient about the care they receive4) Looking at the general condition of the unit5) Getting feedback from co-workers or other supervisors or

relative,6) Asking questions discretely to find out the problems they

encounter in the wards7) Drawing out suggestions from the workers for improvement

of their work or work situation

COORDINATION

› this is the synchronization of activities among the various services and departments.

Importance:1) It prevents overlapping of functions2) It promotes good working relationship3) It accomplishes work schedules as targeted4) With whom do we coordinate?5) Medical Service6) Administrative Service7) Laboratory Service8) Radiology Service9) Pharmacy Service10) Dietary Service11) Medical Social Service12) Community Agencies / other institutions / Civic

Organizations

MOTIVATION

It is a process aimed to arouse, excite or influence another person to behave in the same role or perform some action the person would not ordinarily do.

Theories: 2 will be discussedMaslow’s Theory of Human Motivation:

1. Survival (physiological needs)2. Security (safety) needs3. Social (love, affection, belonging) needs4. Status (Esteem, Self-worth) needs5. Self- actualization (self-fulfillment) needs

Herzberg’s Theory of Job Satisfaction- Frederick Herzberg proposed a two-factor

motivational theory. He claimed that 2 types of needs motivate the workers:

Hygiene factors or needs are associated with working conditions such as pay, quality of supervisions, job security and agency policy

Motivation factors or needs are associated with the work itself – challenges, added responsibility, opportunities for personal growth and opportunities from advancement

Ways to increase staff motivation:1. Manage change properly2. Assign undesirable jobs on rotation basis3. Job redesign through job rotation, job enlargement and

job enrichment4. Provide productive climate and high morale5. Eliminate demotivators

STAFF DEVELOPMENT- The training staff in coordination with the clinical/rotating supervisors and head nurses determines the training needs of the Nursing Service personnel

Staff development programs:1. Participation in seminars/case conferences/CE courses2. “Shadowing” or “by being a sister” or a “buddy”3. Formal schooling4. Reading professional publications5. Orientation/In Service training programs/certification

classes

CONFLICT MANAGEMENT- Conflict is a clash between two opposing and oftentimes hostile parties

Sources of Conflict:1. Differences in knowledge skills values interest Scarcity of

resources Intergroup rivalry for rewards role ambiguity unworkable organizational structure, Shift in organizational climate and unacceptable leadership styles

2. Factors that provoke – failure to provide assistance or complete information on patient care, disagreement over policies

3. Differences in position in the hierarchy can give rise to significant differences in perception

Types of Conflict1. Overt – manifested conflict2. Covert – un-manifested3. Vertical – between a supervisor and a subordinate4. Horizontal – between departmentsConflict resolution: Common Approaches:1. Avoidance is used by groups who do not want to do

something to interfere with other relationships.2. Accommodation – Self sacrifice. The person neglects his own

needs to meet the goals of the other party.3. Compromise – Both parties seek expedient acceptable

answers for short periods when the goals are moderately important and the parties have equivalent power.

4. Collaboration – inspires mutual attention to the problem and utilizes the talents of all parties. It focuses on problem solving to find mutually satisfying solutions. Most effective method.

5. Competition – supervisor exerts power at the subordinate’s expense. Uses authority obedience approach.

Other approaches:1. Smoothing – disagreements are ignored so that

surface harmony is maintained in a state of peaceful co-existence. This is accomplishment by complimenting one’s opponent. Issues may be minor, remain unsolved and may later resurface.

2. Withdrawing – one party is removed – as smoothing3. Forcing – there is an immediate end to the conflict

because a superior can issue orders

MANAGEMENT CONFLICT

-There is a conflict between management and the labor groups because of the customary ideas about what the manager performs compared to the traditional role of the worker.

LEADERSHIP (Has been discussed previously)FOR DISCUSSION – Directing 1. Why is the function of directing seldom approached

logically? Briefly describe the systems approach to directing. How is directing related to managerial functions and activities?

2. List and evaluate external factors affecting staffing. Which ones are most critical today? Explain.

3. What are the dangers and difficulties in applying a policy of promotion?

CONTROLLING- It is a process that involves setting standards, measuring performance against those standards, reporting the results and taking corrective actions

Basic Components of the Control Process: Setting/establishment of standards, objectives and methods

for measuring performance Measurement of actual performance Evaluating the difference between actual results and hoped

for results. Planning for and implementing corrective measures to

remedy the deficiencies

Principles of Control: Principle of “setting the fox to watch the henhouse”. Principle of “measured behavior” drives out “unmeasured

behavior” Principle of “paradox of control”

Performance Appraisal

- It is a periodic formal evaluation of how well the nurse has performed her duties during a specific period

Methods of Measuring Performance:

1. Informal appraisal through:1. informal observation of worker’s performance2. documenting responses made by the worker during

conferences3. documenting the worker’s interaction with clients,

their families, visitors and co-workers2. Formal appraisal collecting objective facts that can

demonstrate the difference between what is expected and what was done.

* Essay: the appraiser/rater writes a paragraph or more about the worker’s strengths, weaknesses and potentials.Drawbacks,

1. the lengths and varying contents of the essays.2. difficult to make comparisons because the essay touches

on a different aspects of a worker’s performance

* Checklists The rater marks the appropriate column in the checklist whether the worker does or does not show the desired behavior. The checklist is a compilation of all nursing performances expected of a worker.

* Ranking: The rater ranks the employees according to how she/he faired with co-workers with respect to certain aspects of performance or qualifications.

* Rating Scales: The rater assess the ratee based on the rating scale with a series of items representing the different tasks or activities in the nurse’s job description or the absence or presence of desired behaviors and the extent to which these are possessed

Example: On a scale of 0-5, indicate the degree of the nurses’ skill in assessing

the patient’s condition where each of the corresponding number means:

5 – Excellent4 – Very satisfactory3 – Average2 – Minimally satisfactory1 – UnsatisfactoryGraphic rating scale may be used to describe punctuality in reporting

for duty such as:1 – Oftentimes late2 – Sometimes late3 – Always reports on time

* Forced-Choiced Comparison: The rater is asked to choose the statement that best describes the nurse being evaluated.

Example; Select the statement that best describes the nurse being evaluated and the statement that least describes him/her:

1 – Respects the ideas of others2 – Communicates ability is limited3 – Even tempered4 – Capable of enduring long hours of hard work5 – Tends to be a loner* Anecdotal recording: are objective descriptions of behavior

recorded on a form. The rater accomplishes this record that describes the nurse’s experience with a group or a person, or in validating technical skills and interpersonal relationships

The report should include:1. description of the particular occasion2. delineation of behavior noted by whom when and where3. the rater’s opinion or assessment of the incident or

behavior

QUALITY ASSURANCE- it is the process of establishing standards of excellence of nursing intervention and taking steps to ensure that each patient receives the expected of level of care.

Differences between QA and PE’sPerformance Evaluation focuses on the worker and how well he/she performs the duties that the position requires while QA focuses on the care and the service the patient receives.

Developing QA Criteria 1. Structure Criteria – includes the physical setting, instrumentalities and

conditions through which nursing care is given such as the philosophy and objectives, the building, organizational structure, financial resources, and equipment.

2. Process Criteria – includes the steps in the nursing process in compliance with established standards of nursing practice. These may include;› application and execution of doctor’s order› observation of symptoms and reactions› supervision of the patient› supervision of those participating in care

2.5 reporting and recording2.6 application and execution of nursing procedures and techniques2.7 promotion of physical and emotional health by direction and teaching

3. Outcome Criteria – identifies desirable changes in the patient’s health status such as modification of symptoms, signs, knowledge, attitudes, satisfaction, skill level, and compliance with the treatment regimen.

Nursing Audit/Process- It is a systematic and official examination of a record, process or account to nursing performance

Nursing Audit Committee Composition representative from all levels of the nursing staff:

+ A member of the training staff+ Nurse Supervisor+ Head Nurse+ Staff Nurse+ Chief nurse/asst (in a small hospital)

Procedure for Nursing Audit:1. The audit team usually designates a day when to

audit.2. The team picks a ward at random so that the unit’s

activities will not deliberately change because they know that they are being observed.

3. The audit team assesses the ward/evaluates nursing care through the developed process or outcome criteria.

4. The staff nurse/senior nurse participates during the audit and are shown the findings – both strong and weak points.

5. The staff in the audited unit signs the audit form to confirm the authenticity of the findings of the audit team.

Patient Care Audits: Concurrent or Retrospective

- A concurrent audit is one in which the patient care as observed and evaluated Through:

1. Review of the patient’s charts while the patients are still confined in the hospital.

2. Observation of the staff as patient care is given.3. Inspection of patients and/or observation of the effects of

patient care where the focus is on the patient (done during doctor’s rounds/patient interview)

A retrospective Audit - an in-depth assessment of the quality of care after the

client has been discharged, having the patient’s chart as a source of data

Peer ReviewWhen peers (employees of the same profession, ranks,

setting) do patient care audits and they evaluate another’s job performance against accepted standards.

Quality Circle a group of workers doing similar work who meet regularly,

voluntarily, on normal working time, under the leadership of their supervisor, to identify, analyze, and solve work-related problems and recommend solutions to management.

DISCILPLINEDefinitions:1. Past definition: rigid obedience to rule and regulations,

the violation of ethic resulted in punitive actions.2. Present definitions: It is self discipline --- a

constructive and effective means by which employees take personal responsibility for their own performance and behavior.

Disciplinary Act cm: Progresses from1. Counseling and oral warning2. Written warning3. Suspension4. Reprimand5. Dismissal

MANAGEMENT LABOR RELATIONSDefinition of terms:1) Worker --- any person working based on labor

contract2) Employer --- any agency, person or organization

employing workers3) Labor Relations --- relationship between the

Employees and management in an organization4) Labor problem --- a difficulty caused by the loss of

harmonious relationship between employees and management resulting from misunderstanding or dissatisfaction

5) Labor Union --- group of workers who act together, seeks to promote and protect the mutual interest of every member through collective bargaining

6.) Collective bargaining is a process through which the management and the union meet and decide terms and conditions of employment which will determine and govern the conduct of their relationship during the effectivity of the agreement

7.) Collective Bargaining Agreement --- agreement reached between management and the union in relation to the term ~ and conditions of employment and working

conditions8.) Union busting --- when an employer unjustly

terminates the services of an employee because of union activities

STRIKES AND LOCKOUTS

Strike is a concerted work stoppage characterized by slowdown, mass leave, sit-down, attempts to destroy or sabotage plant and equipment and facilities and similar activities.

MANAGEMENT – LABOR RELATIONS: IMPLICATIONS TO NURSING:

1. Nursing Administrators should learn to understand and live with the unions

2.Nursing administrators should be knowledgeable and familiar with the union’s organization, objectives and programs

3.Nursing Leaders as well as other professionals hold appreciate the union

4.The nurse manager should integrate the concerns and interests of the union with the interest of the nursing department

5.The nurse manager should do the following:a. Treat all employees with dignity and respectb. Encourage participation in decisionsc. Select, train and develop effective frontline leadershipd. Communicate openly and honestly with employeese. Resolve workplace concerns and issues in a timely mannerf. Compensate employees consistent with marketplace philosophyg. Recognize and reward exemplary performanceh. Review processes to ensure one that will fit the culture and values of the clientsi. Ensure that policies and practices are applied consistently

 

DOCUMENTATION IN NURSINGDocumentation

anything that is written or printed that is relied upon as a proof for authorized persons

Purposes of records:1) Communication2) Financial billing3) Education4) Assessment5) Research6) Auditing7) Legal Documentation

Legal guidelines for recording:1. Draw a single line through error, write the word

“error” above it and sign your name or initials. Never erase entries or use correction fluid and never use a pencil.

2. Enter only objective descriptions of client’s behavior

3. Be sure that information is accurate4. Be certain that entry is factual5. Chart consecutively, line by line6. Do not record “physician made error”7. Never chart for someone else8. Do not wait until end of the shift to record

important changes

9. Use SOAP Listen and observe Learn to analyze data Know clinical information and proper

terminology Plan and organize information

COMPUTERS AND INFORMATION MANAGEMENT

Clinical Information System: a collection of software program and associated hardware that supports the entry, retrieval, update and analysis of patient care information and associated clinical information related to patient care.

Implications to Nursing Education and Practice:1. Nurse managers should be aware of the 5

information processing --- input, processing, storage, output and distribution/communication

2. The nurse manager should encourage nurses to take formal education in nursing informatics --- a specialty that integrates nursing science, computer science and information science in identifying, collecting, processing and administration, education and research.

3. With computers the nurse manager will be compelled to develop systems that have the ultimate goal of improving patient outcomes

4. Computer phobia can be conquered through the following:

› Do not procrastinate› Seek a non-threatening environment› Maintain a positive attitude that learning will take place› Encourage hands-on opportunities› Indicate that knowing how to type is helpful but not

essential› Encourage note taking› Do not allow the use of computer jargon› Insist that learning sessions last less than 2 hours› Do not allow interruptions› Encourage practice› Encourage everyone to relax

CURRENT ISSUES AND TRENDS IN NURSING MANAGEMENTTrends affecting nursing practice that have an impact in nursing management:

1. Nursing will assume an undisputed role in the health care delivery system

2. Care of the geriatric population will become prominent, respected nursing specialty

3. Nurses will play a major leadership role in determining and implementing health care policies

4. Nurses will provide expertise to integrate the multiple facets of health care

5. Technological advances will assist the nurse in providing high quality that is cost effective

6. Specific outcome criteria will be important in determining the quality of c are and will become healthcare facilities’ overriding concern in the future

7. Case-managed care will replace the traditional sick-care approach

8. Increased number of women, nurses will soon be making policies and governmental decisions affecting health care

9. Nursing professionals will begin sharing health care beliefs, cultural practices, resources and the expanding body of nursing knowledge on an international level as globalization occurs

 

COMMUNITY HEALTH NURSING PRACTICE UTILIZING COPAR

Situational Analysis of the Philippine Health Situation in terms of population

Population: 84,241,34142,401,391 (M) – 50.3%41,839,950 (F) – 49.7%Crude birth rate: 20.6/1000 populationCrude death rate: 4.9/1000 populationInfant death rate: 14.2/1000 populationMaternal death rate: 1.1/1000 populationLife expectancy: 67.2 (M) 72.5 (F)

Leading Causes of Morbidity1. ARI & Pneumonia2. Diarrheas3. Bronchitis/Bronchiolitis4. Influenza5. Hypertension6. TB respiratory7. Diseases of the heart8. Malaria9. Measles10. Chicken Pox

Leading Causes of Mortality

1. Diseases of the heart2. Diseases of the vascular system3. Malignant neoplasm4. Accidents5. Pneumonia6. TB, all forms7. NEC8. Chronic lower respiratory diseases9. Diabetes Mellitus10. Certain conditions originating in the

perinatal period

THE HEALTH RESOURCE DEVELOPMENT PROGRAM

Nature: It is a program aimed at developing the faculty, staff and students so that they in turn can train the community residents to be self-reliant in their health concerns.

 Levels of students who were given assignments in the CHN in relation to what they have taken in the classroom: BSN I, II, III and IV

What did the HRDP require?1. Modification of the curriculum2. Modification of the objectives if the clinical

instruction program3. Revision of the contents and objectives of the

CHN4. Increase and arrangement of the number of

RLE hours5. Inclusion of COPAR in the CHN course6. Inclusion of different methods and techniques

of adult learning in the subject and principles and methods of teaching

COPAR AS A STRATEGY IN HRDP

COPARis a social development approach that aims to transform

the apathetic, individualistic and voiceless poor into dynamic participatory and politically responsive community

It is a process that is collective participatory transformative liberated sustained systematic

OBJECTIVES:1. To develop the community and empower the people2. To prepare the people to eventually take over

3. To maximize community participation PRINCIPLES:1. People, especially the most oppressed,

exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change

2. COPAR should be based on the interests of the poorest sectors of society

3. COPAR should lead to a self-reliant community and society

BASIC COMMUNITY ORGANIZING PROCESS:

1. Entry to the community1.1 recognize the role and position of the local authoritie1.2 adopt a lifestyle that keeps up with the communitY1.3 choose a modest dwelling1.4 adopt a low-key approach and profile

2. Integration with the people: establishing rapport with the people in the community through the following activities:2.1 Participating in actual livelihood activities 2.2 Conducting house to house visit2.3 Seeking out and conversing with people where they

gather2.4 Lending a hand in household chores2.5 Avoiding gambling and too much drinking

3. Social Investigation/Community Study: process of systematically learning and analyzing the various structures and force in the community study – economic, political and socio-cultural.

4. Participatory approach in social investigation: The people should be involved in the collection and consolidation of data.

Importance of participatory data gathering: To provide4.1 a demographic profile of the community4.2 an inventory of community resources4.3 picture of network of service and organization in the

area4.4 an opportunity for raising the level of consciousness

of leaders and member of the community

5. Problems/issues identification and analysis: process of defining, analyzing and ranking community problems and needs

6. Planning and strategizing: Planning is the process of translating goals/objectives into specific activities to meet the community needs or solve community problems.

Planning involves:6.1Identification of perceived problems6.2Identification of existing resources6.3Study on the block of the utilization of their

resources6.4Formation of possible solutions6.5Setting plans of actions

Strategy overall direction that the organizing process will take course to attain the long range goal

7. Core group formation: Identifying potential leaders.

8. Organization development: Forming a community organization that will facilitate wider participation and collective action on community problems

9. Mobilization: Refers to the activities undertaken by the community on people’s organization to solve problems confronting the community and which serves to build and strengthen the people’s self-confidence and their collective spirit.

10. Reflection and evaluation: Reflection is analyzing the finished action. Evaluation is the process of discovering by the people the way it has been accomplished, what has been left out and what remains to be done.

CAREER PLANNING

LICENSE TO PRACTICE:License is a special privilege, a permission or authority, a legal document given by the government that permits a person to offer to the public his skills and knowledge in a particular jurisdiction where such practice would otherwise be unlawful without a license

NEED FOR LISENCE:1. For the protection of the health of people2. For legal control and enforcement for nursing practice3. For gathering statistical data about nurses and nursing

country

REGISTRATION Is the recording of names of persons who have qualified

under the law to practice their respective professions.

Registration by 2 means1. By examination2. By reciprocity – mutuality in the grant and enjoyment of

privileges between persons and nations.

The Licensing Board: The Professional Regulatory Board of Nursing

Composition: Chairperson and 6 membersAppointment: By the President of the Republic of the Philippines

Team of Office: 3 years and can be reappointed for another term

Powers and duties of the BON:1. Conduct the licensure examination for nurses2. Issue, suspend and or revoke certificates of

registration for the practice of nursing3. Monitor and enforce quality standards of

nursing practice in the Philippines4. Ensure quality nursing education5. Conduct hearings and investigations to resolve

complaints against nurse practitioners for unethical and unprofessional conduct and violations of the Nursing Act

6. Promulgate a Code of Ethics7. Recognize nursing specialty organizations

in coordination with the accredited professional organization

8. Prescribe, adopt, issue, promulgate guidelines, regulations measures and decisions as may be necessary for the improvement of nursing practice.

REVOCATION AND SUSPENSION OF CERTIFICATE:

Revocation of certificates is the confiscation of a licence either temporarily or permanently

Reasons for revocation of certificates:1.When a person is convicted by final judgment of any criminal offense involving moral turpitude2.For unethical and unprofessional conduct3.For gross incompetence or serious ignorance4.For malpractice or negligence in the practice of nursing

5. For the use of fraud, deceit, false statements in obtaining a certificate of registration/professional license or a temporary/special permit

6. For the violation of the Nursing Act, rules and regulations, Code of Ethics for nurses, technical standards for nursing practice, policies of the Board, of the Commission

7. For practicing her profession during her suspension for such practice

SUSPENSION a nurse is not allowed to practice temporarily until final judgement of case against him or her is rendered. License is NOT confiscated

RE-ISSUANCE of revoked certificate and replacement of lost certificates:

After the expiration of a maximum of 4 years from the date of revocation of a certificate, for reasons of equity and justice and when the cause of revocation has disappeared or has been cured or corrected, upon proper application therefore and payment of the required fees, issue another copy of certificate or registration/professional license

CAREER PATHING

It is a strategic plan for one’s career:

STEPS:1. Make a thorough self assessment

2. Determine your career goal-what you wish to be

3. Draw a career plan/career map- a process by which you pattern and orchestrate your separate but related work activities to prepare you together with the organization to take greater job and personal responsibility for your future

4. Pursue strategies to maintain you career map

5. Make sure your organization perfectly matches you hard earned soul searching and hard earned degree

− Utilizes a career growth cycle

− Operates career plan for their personnel

6. Ascertain that you belong to a nursing service that will nurture you

CAREER PATHWAYS:• Management• Education• Clinical• Research

APPROACHES TO CAREER PATHING:1. The classic career “Climbing the ladder of

success” vertical growth2. The concentric career- lateral growth3. The concurrent career- You are specialist and

you are up there4. The crazy quilt career- “anything goes with

anything”

WAYS TO PREPARE YOURSELF FOR THE TRANSITION ROLE:

1. Think positive2. Find a mentor3. Get organized4. Know what is expected5. Stay healthy6. Have some fun7. Be flexible

EMPLOYMENT BENEFITS AND REQUIREMENTS

Attendance Uniform Leaves

Hours of work Hospital policies Hiring

procedures

Disciplinary

procedures

Promotional

policies

Paydays,

salaries &

benefits

PERSONAL POLICIES

REWARDS: intrinsic and extrinsicIntrinsic: Those related to the job itself- the motivators

1. worker’s involvement in decision making2. greater job freedom and discretion3. challenging work4. opportunities for personal growth5. diversity of activities

Extrinsic: Those components outside of the job i.e pay

1. Direct2. Indirect3. Non-direct

Basic

wage/salary

OT and

holiday pay

Performance

bonus

Profit sharing

Pensions Retirement

pay

Business

payment

Stock options

Direct:

Protection plans Pay for time and not

worked

Services and

perquisites

Fringe benefits

Safety and security

plans like insurance

Worker goes off earlier

than prescribed time

because of a pressing

matter

Scholarships,

counselling services,

discount for goods and

counselling services,

cultural and

recreational events,

club membership

Rest period

Holidays

Leaves

insurance

Non-formal training

program

Tuition refunds

Indirect:

Tenure During floods,

typhoons

Bus services

Car and gasoline

allowances

Security guards Snack time Housing

Burglar alarms Rice and groceries

Clothes

Safety gear

Health and safety

plans

Day care centers

for worker’s

children

Credit union

Office furnishing Special lunch hour Parking space

Work assignments

in ‘s consonance

with one’s abilities,

interests, and work

hours

Exclusive salary Titles symbolizing

prestige

Personalized

stationery

Non-financial

CHOOSING, RETAILING, RESIGNING, DISMISSAL FROM POSITION

SELF-EVALUATION AND SELECTING A JOB

Things to consider in self evaluation:1. Qualification2. Years of experience3. Age and physical condition4. Emotional stability and goals in life

Factors in selecting a field of nursing:1. Kind of work to perform2. Availability of work3. Hours of work4. Opportunities for advancement5. Method of entering6. Earning7. Fringe benefits

DIFFERENT FIELD OF NURSING:1. Hospital or institutional nursing2. Public health nursing or Community Health

Nursing3. Private duty nursing or Special Duty Nursing4. Industrial or Occupational Health Nursing5. Nursing Education6. Military Nursing7. School Nursing8. Clinic Nursing9. Independent Nursing Practice

POINTERS IN CONSTRUCTING AN APPLICATION LETTER:

1. Use clean, white, unlined paper2. Use ink, or ball pen in writing3. Use proper salutation4. Observe proper margin and paragraphing5. Write in a courteous manner6. Enclose return postage

CONTENTS OF AN APPLICATION LETTER:

1. First paragraph: Source information concerning vacancy and intention to apply

2. Second paragraph: Course you finished and where and when you graduated

3. Third paragraph: experience and training

4. Why do you believe you are an asset to this institution?

5. At least 3 references (with permission)

6. Fourth paragraph: request for personal interview and how you can be contacted

SUBMITTING FOR PERSONAL INTERVIEW:Interview- face to face conference between 2 people about something

Reasons for the interview:1. For the employer to get further information

from the applicant2. For the employer to assess the applicant3. For the applicant to get to know the

institution

Pointers for an interview:1. Make an appointment2. Be at place at the appointed time3. Know something about the institution4. Be at your best5. Knock before you enter6. Bring credentials7. Ask questions8. Speak clearly9. Never boast about your achievements10. Don’t argue with the interviewer11. Avoid using slang 12. Avoid frequent use of some phrases and words13. Be natural14. Thank the interviewer for his time15. Give yourself time to think about the position16. Follow-up in writing

CONTINUING PERSONAL EVALUATIONThis is the rating of the employees from the time

they are screened and selected as applicants up to the time they leave the organization.

RETAINING A POSITION: HOW??1. Have an adequate knowledge and preparation for the job2. Develop good interpersonal relationship with your co-

workers3. Develop proficiency in communication4. Be able to adjust to working conditions and to life

patterns5. Keep abreast with the advantages in medicine, nursing

and related sciences

RESIGNING FROM A JOB:

Reasons:1. To seek better positions in the Phil. or

abroad2. Inability to adjust to the work situation3. Family4. Marriage5. Children6. Relocation of the family

Things to remember when resigning:1. Keep your position for at least 2 years2. If advantages outweigh disadvantages, make a

move3. Involve your family in deciding4. If offered a better position, talk it over with your

employer 5. Use prudence in accepting another position6. Do self analysis7. Give advance notice8. Leave with a clean record

Writing a resignation letter, remember the following:

1. Give the date of resignation2. State the reason for resigning3. Express gratitude for kindness and

consideration4. Attach clearance

DISMISSAL:

Reasons:1. Negligence2. Incompetence3. Malpractice4. Unprofessional behaviour5. Breach of contract

PERSONAL IMAGE BUILDING

Imagethe way you look, sound, talk, and act

Ways to build personal image:1. Maintain professional decorum- the way you

carry yourself2. Maintain good professional hygiene and good

grooming3. Align your appearance with the norm of

professionals in your work setting4. Be flexible

MEMBERSHIP IN PROFESSIONAL ORGANIZATION

Advantages of being a member:1. To empower you2. To facilitate networking with colleagues3. To demonstrate your professional commitment.4. To update you with the new trends in nursing5. To express your concerns regarding the nursing

practice6. To be recognized for new exemplary performance7. To be given assistance

PROFESSIONAL ORGANIZATION1. PNA – Philippine Nurses Association2. ANSAP – Association of Nursing Service Administration of the

Philippines3. ADPCN – Association of Deans of Philippine College of Nursing4. The Military Of Nurses’ Association of the Philippines5. The Occupational Health Nurses’ Association of the Philippines6. PND (Private Duty Nurses’) Association of the Philippines7. International Nursing Foundation of Japan Alumni Association of

the Philippines, Inc. (IAAPI)8. IRNUP – integrated registered Nurses of the Philippines9. MCNAP – Maternal and Child Nurses Association of the

Philippines10. CNGP Catholic Nurses’ Guild of the Philippines

ISSUES CONCERNS & FUTURE DIRECTIONS OF NURSING SELF GOVERNANCE

This is allocation of control, power and authority to nurses themselves so they have the freedom to set within broad limits their own standards and to enforce these standards among their members.

This is where the nurse is self-employed and provides professional nursing services to clients and their families.

Characteristics of an independent nursing practitioner:

1. Performs both independent and collaborative roles2. Reaches out and offers her services rather than

expect her clients to seek her help.3. Makes referrals and collaborates with physicians and

other discipline as needed by the client and the family

4. Scope of practice includes:4.1 Health care assessment4.2 Formulating plans for health

maintenance4.3 Prevention strategies4.4 Continuation of supportive

activities in critical and complex health problems

SPECIALIZATIONis nursing with specialized education and

experience beyond the basic nursing program

Advantages of independent nursing practice:

1. Substantial increase in income2. Increase professional autonomy3. More control of personal life4. Flexibility as to working hours5. Can choose patient, where and

when to practice

Disadvantages of Independent nursing Practice:

1. No work, no client, no pay2. Not all are qualified3. Greater responsibility4. Networking is needed

EVIDENCE BASED PRACTICE It is using research methodology to identify

best practices for quality. It solves the problems encountered by

nurses by means of the four steps:1. Clearly identify the problem2. Search literature3. Evaluate research evidence4. Choose intervention and justify the

selection with the most valid evidence

ENTERPRENEURSHIP

When a nurse becomes a proprietor of a business offering nursing services.

The nursing services can be:1. Direct care2. Educational services3. Research services4. Consultative services5. Health care products and devices

Characteristics of a nursing entrepreneur:

1. Creative and independent2. Responsive to a perceives need3. Assumes responsibility being her

own boss.4. Has a good financial foresight5. Has a good common sense6. Should face the possibility of

success or failure7. Takes opportunity brought about

by change

Benefits:1. Job satisfaction2. Flexibility in choosing opportunities3. Being able to do exactly what you

want to doDownsides:1. Tough competition2. Riding the highs and lows of the

market3. Finding the right product and services

to sell4. Providing your own health insurance

GLOBALIZATION It is increasing global connectivity thus

increasing interdependence, integration and interaction among nurses around the world.

TRANSCULTURAL NURSING

It is the comparative study and analysis of different cultures and subculture in the world.

FOR DISCUSSION – Controlling1. Planning and control are often thought of as

a system; control is also often referred to as a system. What is meant by these observations? Can both statement can be true?

2. Why is real-time information not good enough for effective control?

3. If you were asked to institute a system of controls in a company how would you go about it? What would you need to know?

4. Develop a set of standards for any area of interest to you over which you might wish to exercise effective control.

NURSING JUDISPRUDENCE

1. WHAT IS JURISPRUDENCE?Jurisprudence is the science of law or

philosophy of law. Recorded thinking about the source, nature, end and efficiency of law, substantive and adjective, and of legal institutions.

2. WHAT IS NURSING JURISPRUDENCE?Nursing jurisprudence maybe defined

as a branch of law that comprises all the Rules and Regulations; Policies and Principles, which affects the Nursing Practice in general.

3. WHAT IS ETHICS?Refers to the study of human acts

conduct on the moral perspective as to whether they are good or evil. It pertains to Science of Morality.

4. WHAT IS NURSING ETHICS?Nursing ethics is branch of moral

science that deals with the principles, standard, policies, rules and regulations that a nurse is duty bound to observe as member of the profession.

5. WHAT IS LEGISLATION?Is the process by which the law-making

body enacts a law.

6. WHAT IS ETHICS?-the study of moral conduct or the

principles underlying the desirable types of human conduct.

-Science of ideals- a science which guides our judgement concerning the morality of human acts.

7. WHAT IS MORALS?-Ordinarily refers to human conduct

itself-Human conduct in the light of ethics; it

is the application of ethics.

A felony refers to an offense which have been made such by statute or which, at common law, carried on conviction the penalties of death and forfeiture or property.

Offense in general is that which equivalent to a crime.

Felony if it is punished by special law, it is called as an offense; and if it is punished under an ordinance, it is properly termed as an infraction of an ordinance.

8.WHAT IS A CRIME? HOW DOES IT DIFFER WITH FELONY OR ANY OFFENSE?

Crime- is an act of omission resulting from human conduct which is considered in itself or in its outcome to be harmful.

MORAL PRINCIPLESAUTONOMY

Refers to the right to make one’s own decisions.

Nurses who follow this principle recognize that each client is unique, has the right to be what that person is, and has the right to choose personal goals.

Honouring the principle of autonomy means that the nurse respects a client’s right to make decisions even when those choices seem to the not to be in the client’s best interest.

It also means treating others with consideration.

Finally, respect for autonomy means that the people should not be treated as an impersonal source of knowledge or training. This principle comes into play, for example, in the requirement that clients provide informed consent before tests, procedures, research, or being a teaching subject can be carried out.

NONMALEFICENCEDuty to do no harm.Harm can mean intentionally

causing harm, placing someone at risk of harm, and unintentionally causing harm is never acceptable.In nursing, intentional harm is never acceptable.However, placing a person at risk of harm has many facets, a client may be at risk.

Moral Responsibilities of Nurse

Nurses must be:God-lovingGod-fearingMust realize that the nursing profession

commitment both to God and people.They should emphasize the importance of

providing care and vital aspect of nursing care.

Moral Principles

1. The Golden Rule

God said “Do unto others what you would like others do unto you.”

Nurses like others to treat them kindly and with respect, they should be willing to do the same to others too.

2. The Two-fold EffectBasis of Action:

That the action must be morally good.

That the good effect must be wiled and the bad effect merely allowed.

That the good effect must not come from an evil action but from the initial action itself directly.

That the good effect must be greater that the bad effect must be greater than the bad effect.

3. The Principle of Totality the whole is greater than any of

its part.

4. 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.

5. One who acts through an agent is himself responsible.

6. No one is obliged to betray himself/herself.

7. The end does not justify the means.

8. Defects of nature may be corrected.

9. If one is willing to cooperate in the act, no injustice is done to him/her.

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

11. The greatest good for the greatest number.

12. No one held to the impossible.

13. The morality of cooperation.

14. Principle relating to the origin and destruction of life.

A Patient’s Bill of RightsBill of Rights

These rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.

1. The patient has the right to considerate and respectful care.

2. The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.

 

3. The patients has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action.

4. The patient has the right to have and advance directive (such as living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of the directive to the extent permitted by law and Sunday hospital policy.

5. The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and the treatment should be conducted so as to protect each patient’s privacy.

6. The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, expect in cases such as suspected abuse and public health hazards when reporting is permitted or required by law.

7. The patient has the right to review the record pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law.

8. The patient has the right to expect that, within its capacity and policies, a hospital will make a reasonable response to the request of the patient for appropriate and medically indicated care and services.

9. The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or prayers that may influence the patient’s treatment and care.

10. The patient has the right to consent to or decline to participate in the proposed research studies or human experimentation affecting care and treatment or requiting direct patient involvement, and to have those studies fully explained prior to consent.

11. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care opinions when hospital care is no longer appropriate.

12. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment and responsibilities.

The effectiveness of care and patient’s satisfaction with the course of treatment depends, in part, on the

patient fulfilling certain responsibilities.

Patients are responsible for providing information about past illnesses, hospitalizations, medications, and other matters related to health status.

Patients are also responsible for ensuring that the health care institution has a copy of their written advance directive if they anticipate problems in following prescribed treatment.

Patient should also be aware of the hospital’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.

Patients and their families are responsible for making reasonable accommodations to the needs of the hospital, other patients, medical staff, and hospital employees.

Patients are responsible for providing necessary information for insurance claims and for working with the hospital to make payment arrangements, when necessary.

Patients are responsible for recognizing the impact of their life-style on their personal health.

CODE OF ETHICS FOR NURSES

Nurses and people: Nurses must consider the

individuality and totality of their clients when administering care.

Nurses must respect the spiritual beliefs and practices of their clients regarding diet and treatment.

They must not be instruments in the violation of individual rights.

Nurses must hold in confidence personal matters committed to their care.

They must take into consideration the culture and values of clients in providing nursing care but in the event of conflict, the client’s welfare must take precedence.

Nurses and practice:The definition and scope of nursing

practice is that which is within the provision of the Philippines Nursing Act 2002.

Nurses must know their responsibilities in the practices of their profession. They must adhere to the highest standards of nursing practice.

Nurses must acquire and develop the necessary competence (knowledge, skill, and attitudes) to effectively render proper nursing services through formal, non formal, structured and unstructured learning situations.

Continuing education aims for the achievement of competence of the individual nurse in terms of knowledge, attitude, and skills.

Nurse administrators are responsible for providing favourable environment for the growth and development of nurses in their charge.

Accreditation for professional programs shall be undertaken by the PRC.

Nurses shall be answerable for culpable negligence, malpractice, and wrongful act or omission in the performance of their duties.

Accountability for nursing and treatment of human responses as evidenced by the patient’s ability to cope with the following: A) Activities of daily living; B)Development/maturation and adaptive functions; C) Stresses

Nurses shall respect the following rights of patients when rendering care (Cultural and religious beliefs, privacy, confidentiality of information.)

Nurses shall provide the patient all pertinent information except those which may be deemed harmful to their well being.

They shall ensure that patients’ records are available only to those who are professionally directly involved in their care except when required by law.

When conflicts arise regarding management of patients care, the patients’ rights are upheld.

Nurses shall perform their professional duties in conformity with existing laws and generally accepted principles of moral conduct and proper decorum.

Solicitation and advertisement shall not be allowed for personal gains and other purposes that would be detrimental to the profession.

Nurses may cause the listing of their names in directories or professional publications, or use the traditional calling cards.

They shall not demand and receive any commission fee or any emolument for recommending of referring a patient to a physician, a co-nurse or another health care worker.

Nurses and Co-workers:

Nurses must establish their professional role/identity while working with other member of the health team.

Conformity with group activities such as those of health team shall be based on acceptable, ethico-legal standards.

Nurses contribute to the professional growth and development of the other members of the health team.

Active participation in organization within the hospital and outside the hospital is encouraged.

Nurses should honor and safeguard the reputation and dignity of the members of the nursing and other professions.

Nurses shall respect the rights of their co-worker.

Nurses and Society:They must be conscious of their

obligations as citizens and as such be involved in community concerns.

Being equipped with knowledge of health resources within the community, they take active roles in primary health care such as health information, dissemination. Referral. And rendering of actual care.

Nurses must actively participate in programs that answer the problems of society.

Nurses must lead their lives in conformity with the principles of right conduct and proper decorum.

Nurses must be aware of the issues in the community and must have their stand.

Nurses must project an image that will uplift the nursing profession.

Nurses must be actively involved in socio-civic organization of the community.

NURSE’S RESPONSIBILITIES IN RESEARCH ON HUMAN SUBJECTS:

1. Employment in Settings Where Research is conducted.

2. Vigilant Protection of Human Subject’s Rights

3. Scope of Application

4. Supporting Accrual of Knowledge

5. Informed Consent

6. Representation on Human Rights Committee

BASIC HUMAN RIGHTS OF RESEARCH SUBJECTS

1. Right to Informed Consent

2. The Right to Refuse and/or Withdraw from Participation

3. Right to Privacy

4. Right to Confidentiality or Anonymity of Data

5. Right to be protected from Harm

RESPONSIBILITIES OF NURSES TO THEMSELVES

Since nurses carry personal responsibility for nursing practice and for maintaining competence by continuous learning, it is expected that every people means shall be utilized by to develop theft skills.

RESPONSIBILITIES TO THE PATIENT

1. Primary responsibility is to carry out the physician’s orders concerning the patient’s treatment.

2. The nurse can plan with the patient and family a specific nursing care of the patient according to his or her family’s needs and requirements.

3. The nurse should promote learning for the patient.

4. When giving care, she should not forget that patients and human beings not just bodies afflicted with illness.

5. A nurse is expected to show more compassion to the patient than the physician.

6. Her primary consideration is assuming care in concern for the

patients welfare and safety.

7. A nurse is responsible to give facts or information to the patient and his family which they are entitled to know.

8. A nurse should guard as a sacred trust any confidential or private information from the patient even after the death of the patient except when it is required to show the interest of justice, public health or public safety.

RESPONSIBILITIES TO THE PHYSICIAN

1. Primary duty id to carry out conscientiously and accurately all the legitimate orders of a physician.

2. She should call the physicians attention when he makes mistakes before carrying out his prescriptions otherwise she may be held liable for the consequence.

3. In emergencies, a nurse may recommend or give medical

treatment without physician’s order and to report the action taken to the to the physician immediately.

4. A nurse should inspire the patient and instil in him faith and confidence in the competency of the physician.

5. If the patient has complaint against the physician, the nurse should explain and mitigate the grounds of his complaint and to bring the matter to the attention of the physician.

DUTIES OF NURSES TO THE PUBLIC

1. A nurse should cooperate with the proper authorities in the enforcement of sanitary laws and regulations and in the education of the masses on the promotion of

individual and community health involved in community concerns.

2. Being equipped with the knowledge of health resources within the community, they take active roles in primary health care such as health information, dissemination, referral and rendering of actual care.

3. Nurses must actively participate in programs that answer the problems of society.

4. Nurses must lead their lives in conformity with the principles of

right conduct and proper decorum.

5. Nurses must be aware of the issues in the community and must have their stand.

6. Nurses must project an image that will uplift the nursing profession.

7. Nurses must be actively involved in socio-civic organizations of the community.

NURSE’S RESPONSIBILTIES IN RESEARCH ON HUMAN SUBJECTS

1. Employment in Settings Where Research is conducted.

2. Vigilant Protection of Human Subject’s Rights

3. Scope of Application

4. Supporting Accrual of Knowledge

5. Informed Consent

6. Representation on Human Rights Committee

BASIC HUMAN RIGHTS OF RESEARCH SUBJECTS

6.1 Right to Informed Consent6.2 The Right to Refuse and/or Withdraw from Participation

6.3 Right to Privacy6.4 Right to Confidentiality6.5 Right to be protected from Harm

VULNERABLE SUBJECTS

Subjects who are mentally ill or legally incompetent such as the unconscious, or are in unique situations, like foetuses, requires special offense in general is that which equivalent to a crime.

WHAT IS A RIGHT? A RESPONSIBILITY?

- A right refers to something that a person has a just or lawful claim, one that is legally demandable and enforceable, the violation of which is a legal wrong entitling the aggrieved party for a cause. Court for a redress of the infraction.

-Responsibility on the other hand refers to an obligation which one has been entrusted a duty to perform a specific act that makes him accountable for the consequence or the result of such specific an act

WHAT IS JURISDRICTION AND VENUE?

- Jurisdiction refers to the inherent power of the court to hear, try, and decide a case.

-Venue refers to the place where the case is to be tried.

CRIMES AND FELONIES COMMITED:

Among other felonies or crimes committed by ordinary individuals, the following are the most common and related in our practice where we are compelled to be aware of under our Revised Penal Code

HOMICIDEShall kill another without the attendant of

any of the circumstances enumerated.

FELONIESAre acts and omissions punishable by law,

and are committed only by means of, Deceit (dolo)- when act is performed with

deliberate intent. Fault (culpa)- when the wrongful act results

from imprudent, negligence, lack of foresight, or lack of skills.

Three Elements of Felony

1.There must be an act or omission2.Such act or omission must be done

voluntarily.3.Such act or omission must be

punishable by law at the time of commission.

REQUISITES OF CRIMINAL INTENT

1. There: musty be freedom of the person committing the felony

1. There must be intelligence on the part of the person committing the felony

There is no freedom to act in the following instances:A)Under compulsion of an irresistible force.B)Under the impulse of uncontrollable fear or an equal or greater injury

Instances that exempts a person because of lack of intelligence:

a)An imbecile or an insane (unless acting during lucid interval)b)Under nine years oldc)Over nine and under fifteen (unless he has acted with discernment)

THREE STAGES OF EXECUTION

OF A CRIME

1. Attempted Crime 1. Frustrated Crime 1. Consummated Crime

When the offender

commences the commission

of the felony directly by

overact, and does not

perform all the acts of

execution which should

produce the effect by reason

of some causes or accident

other than his own

spontaneous desistance

When the offender performs

all the act of execution which

would produce a felony as a

consequence but which

nevertheless , do not

produce it by reason of

causes independent of the

will of the perpetrator.

When all the elements

necessary for its execution

and accomplishment is

present.

THREE PERSONS CRIMINALLY LIABLE

1. PRINCIPAL 1. ACCOMPLICE 1. ACCESSORIES

..Those who take direct part in the execution of the act(principal by direct participation)..Those who directly force to induce others to commit it(principal by inducement)..Those who cooperate in the commission of the offense by another act without which it would not have been accomplished (principal by cooperation)

..The persons who have a common criminal purpose with the principal.Must have the intention to help morally or materially in the commission of the crime.

..Those having knowledge of the commission of the crime, without having participated therein, take part subsequently to its commission-by profiting themselves-by concealing or destroying the body of the crime, or instrument thereof, in order to prevent its discovery-by harboring, concealing or assisting in escape of the principal.

FOUR CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY

ABCD OF MALPRACTICE

A- An injury occurred within theB- Breadth of duty of the nurseC- Cause of injury is the failure to perform theD- Duty!

Tort is an injury that somewhat incurs as a result

of another (intentionally or unintentionally inflicted)

Negligence results from injury that is unintentionally due to failure to take the usual precautions expected of the legal standards of care.

I. ELEMENTS1. That the person was killed.2. That the accused killed him without any

justifying circumstances.3. That the accused had the intention to kill, which

is presumed4. That the killing was not attended by any of the

qualifying circumstances of murder, or by that of parricide or infanticide

II. PARRICIDEAny who shall kill his father, mother or

child whether legitimate, illegitimate, or any of his ascendants or his spouse

ELEMENTS1. That the person was killed2. That the deceased is killed by the accused3. That the decease is the father, mother, or

child, whether legitimate, illegitimate, or a legitimate other ascendants or descendants, or the legitimate spouse of the accused.

III.INFANTICIDE

ELEMENTS:1. That the child was killed2. That the deceased child was killed less than three

days of age(72 hours)3. That the accused killed the said child.

IV.ABORTIONS

ACT PUNISHED: 

1. Using violence upon the person of the pregnant woman;

2. Acting, but without using violence, without the consent of the woman:

3. Acting (by administering drugs or beverages), with the consent of the pregnant

TWO TYPES OF ABORTION:

A. INTETIONAL ABORTION:

ELEMENTS:1. That there is a pregnant woman

2. That violence is exerted, or drugs or beverages, administered, that h the accused otherwise acts upon such pregnant woman.

3. That as a result of the use of violence or drugs or beverages upon her, or any other act of the accused, the fetus dies, either in the womb or after having been expelled there from.

4. That the abortion is intended

B. UNINTENTIONAL ABORTION

1. That there is pregnant woman

2. That violence is used upon such pregnant

3. woman without intending an abortion.

4. That violence is intentionally exerted

5. That as a result of the violence the fetus dies, either in the womb or after giving been expelled there from.

C. ABORTION PRACTICED BY A PHYSICIAN OR MIDWIFE AND DISPENSING OF ABORTIVES

 ELEMENTS:

1. That there is pregnant woman who has suffered an abortion

2. That abortion is intended

3. That the offered, who must be a physician or midwife, causes or assists in causing the abortion.

4. That said physician or midwife takes advantage of his or her scientific knowledge or skill.

 

ACT PUNISHABLE:1. Assessing another to commit suicide,

whether the suicide is consummated or not;

2. His assistance to another to commit suicide to the extent or killing himself

V. PHYSICAL INJURIES:

1. MUTILATION› Is the lopping or clipping off some part of the body of

the offende3d party, other than the essential organ of reproduction, to deprive him of that part of the body.

2. SERIOUS PHYSICAL INJURIES› Committed by wounding, beating or assaulting

another which injury shall have cause the illness or incapability for labor of the injured person for more than thirty (30) days.

3. ADMINISTERING INJURIES SUBSTANCES OR BEVERAGES

› Committed by one who, without intent to kill, shall inflict upon another any serious physical injury by knowingly administering injurious substances or beverages or by faking advantage of his weakness of mind of credulity.

ELEMENTS:1. That the offender inflicted upon another resort any serious

physical injury;

2. That it was done knowingly administering to him any injurious substances or beverages or by taking advantages of his weakness of mind or credulity.

3. He had no intent to kill.

4.  LESS SERIOUS PHYSICAL INJURY-His/her will incapacitate the victim for the labor for ten

(10) days or more shall require medical assistance for the same period.

5. SLIGHT PHYSICAL INJURIES OR MALTREATMENT ---- -Usually when it incapacities the offended party or requires medical assistance for one to nine days or ill treat another by deed without causing an injury.

VI.ILLEGAL DETENTIONa) Kidnapping and serious illegal detention

b) Slight illegal detention

LEGAL GROUNDS FOR THE DETENTION OF A PERSON:

a) Commission of a crime

b) Violent insanity or another ailment requiring compulsory confinement of the patient in a hospital

c) Escaped prisoner

FALSE IMPRISONMENT these occur when there is unjustified detention.

VII.ROBBERYAny person who, with intent to gain, shall

take any personal property belonging to another, by means of violence against or intimidation of any person using force upon anything.

ELEMENTS:1. That there is personal property belonging to another2. That there is unlawful taking of that property3. That the taking must be with intent to gain; and4. That there is violence against or intimidation of any

person, or force upon anything

VIII.THEFTTheft is committed by arty person who

with intent to gain but without violence against or intimidation of neither persons nor force upon things shall take personal property of another without the latter’s consent.

IX. SWINDLING (estafa)ELEMENTS:1. That the accused defrauded another2. By abuse of confidence3. By means of deceit4. That damage or prejudice capable of pecuniary

estimation is caused to the offended party of third person.

 X. DIRECT BRIBERY

A. Indirect BriberyELEMENTS:

1. That the offender is a public officer 2. That he accepts gifts3. That the said gifts are offered to him by

reason of his office

XI.CORRUPTION OF PUBLIC OFFICIALS

ELEMENTS:1. That the offender makes, offers or promises or gives

gifts or present to a public officer

2. That the offers or promises are made or the gifts or presents given to a public officer, under circumstances that will make the public officer liable for direct bribery or indirect bribery.

XI.ADULTERYIs committed by any married woman who shall

have sexual intercourse with a man not her husband and by the man who has no carnal knowledge of her, knowing her to be married, even if the marriage be subsequently declared void.

 

XII. CONCUBINAGECommitted by any husband who shall keep a

mistress in the conjugal dwelling or shall have sexual intercourse under certain circumstances with a woman who is not his wife and cohabit with her in any place.

ELEMENTS:1. That the man must be married 2. That he committed any of the following acts:

Keeping mistress in the conjugal dwelling Having sexual intercourse under scandalous

circumstances with a woman who is not his wife; Cohabiting with her in any place.

3. That, as regards the woman she must know him to be married

XIII. ACTS OF LASCIVIOUSNESS

ELEMENTS:

1. That the offender commits any act of lasciviousness or lewdness

2. That it is done under any of the following circumstances:

By using force or intimidation When the offended party is deprived of reason

or otherwise unconscious. That the offended party is another person of

either sex.

XIV. QUALIFIED SEDUCTION

TWO CLASSES OF QUALIFIED SEDUCTION:

1. Seduction of virgin over 12 and under 18 years of age by certain persons, such as a person in authority, priest, teachers, etc.

2. Seduction of a sister by her brother or descendant by her ascendant, regardless of her age or reputation. This is termed also as incestuous seduction.

XV. RAPE

RAPE COMMFIED:1. By a man who have carnal knowledge of a

woman under any of the following circumstances:A. Through force, threat or intimidationB. When the offended party is deprived of

reason or otherwise unconsciousC. By means of fraudulent machination or grave

abuse of authority.D. When the offended party is under 12 years of

age or is demented, even though none of the circumstances mentioned above be present.

2. By any person who, under any of the circumstances mentioned in part hereof, shall commit an act of sexual assault by inserting:

A. His penis into another person’s mouth or anal orifice; or

B. Any instrument or object, into the genital or anal orifice of another person.

XVI. SIMULATION OF BIRTHS, SUBSTITUTION OF ONE CHILD FOR ANOTHER, AND CONCEALMENT OR ABANDONMENT OF A LEGITIMATE CHILD.

ACTS PUNISHED:1. Simulation of births2. Substitution of one child for another3. Concealing or abandoning any legitimate

child with the intent to cause such child to lose its civil status.

ELEMENTS:1. Child is baptized or registered in the registry of

birth or hers;2. Child loses its real status and acquires a new one.3. Actor’s purpose was to cause the loss of any trace

as to the child’s true filiations. WHEN DOES SIMULATION OF BIRTH

OCCUR? Simulation of birth takes place when a woman

pretends to be pregnant when in fact she is not, and on the day of the supposed delivery, she takes the child of another and declares the child to be her own. This is done by entering in the birth certificate of the child, that, the offender is the alleged mother of the child when in fact the child belongs to another.

XVII. BIGAMYThis is committed by any person who shall contract a second or subsequent marriage before the former marriage has been legally dissolved, or before the absent spouse has been declared presumptively dead by means of a judgement rendered in the proper proceedings.

ELEMENTS:1. The offender has been legally married.2. The marriage has not been legally dissolved or,

in case his or her spouse is absent, the absent spouse could not yet be presumed dead according to the civil code;

3. He contracts a second or subsequent marriage;4. The second or subsequent marriage has all the

essential requisites for validity.

XVIII. DEFAMATIONDefamation consists in making derogatory remarks about one person by another. It is constitutive of Libel and slander.

ORAL DEFAMATION OR SLANDER – is punishable if it is not of a serious and insulting in nature and light insult or defamation which is not serious in nature. Under Article 358 of the Revised Penal Code punishing the Act, it gives two kinds of Slander, these are:

1. Grave insult or defamation;2. Light insult or defamation

SLANDER BY DEED. – is punished under Article 359 or the RPC. It is imposed upon any other person who shall perform any other person not included and punished in this title (refers to any crime against honor) which shall casts dishonor, discredit or contempt upon another person

ELEMENTS:1. That the offender performs any act not

included in any other crime against honor.2. That such act is performed in the presence

of other person or persons; and3. That such act casts dishonor, discredit or

contempt upon the offended party.

XIX. LIBELIs a public and malicious imputation of

a crime or of a ice or defect, real or imaginary, or any act, omission, condition status, or circumstances tending to cause the dishonor, discredit, or contempt of a natural or juridical person, or to blacken the memory of one who is dead.

ELEMENTS:1. There must be an imputation of a crime, or of

a vice or defect, real or imaginary, or any act, omission, condition, status or circumstance

2. The imputation must tend to cause the dishonor, discredit or contempt of the person defamed;

3. The imputation must be made publicly;

4. That it must be malicious in law or in fact;5. Person defamed must be identifiable and6. That the imputation must be directed at a

natural juridical person, or to blacken the memory of one who is dead.

XX.  DIRECT ASSAULTELEMENTS:1. The offender

A. Makes an attackB. Employs forceC. Makes serious intimidationD. Makes a serious resistance

2. The assault or physical force or intimidation should hove been executed upon a person in authority or his agent;

3. At the time of the assault the person in authority or his agentA. Is engaged in the actual performance of official duties,

or that he is assaulted

B. By reason of the past performance of official duties.

4. The offender knows that the one he is assaulting is a person in authority or his agent in the exercise of his duties.

INDIRECT ASSAULTAny person who shall make use of force

or intimidation upon any person coming to the aids of the authorities or their agents on occasion of the commission of any of the crimes.

ELEMENTS:1. The direct assault is committed against an agent

of a person in authority;2. The offended party comes to the aid of the agent

of a person in authority; and3. The offender uses force or intimidation upon the

said offended.

XXI. FALSE TESTIMONYFalse Testimony is defined as the declaration under oath of a judicial proceeding which is contrary to what eccentricity of the truthPERJURY – refers to the willful assertion of falsehood under oath of affirmation. It is a distinguished with false testimony in the latter the testimony is given a judicial proceeding meaning it is given in the court. In perjury, the testimony is given in non – judicial proceedings.

CRIMINAL NEGLIGENCEAny person who by reckless imprudence or by

simple negligence shall commit any act which has it been intentional would constitute a grave felony.

RECKLESS IMPRUDENCE – Reckless imprudence consists in voluntary but without malice doing or failing to do an act from which material damage results by reason of inexcusable lack of precaution on the part of the person performing or falling to perform such act

 SIMPLE IMPRUDENCE – simple imprudence

consists in the lack of precaution displayed neither those cases in which the damage impending to be caused is not immediate nor the danger clearly manifest.

LAWS GOVERNING THE PRACTICE OF NURSING

Definition and Meaning of Law  LAW is defined as “the sum total of rules and regulations

by which society is governed. It is man-made and regulates social conduct in a formal and binding way. “it reflects society’s needs attitudes and more.” 

Law may also be defined as a rule of conduct proununced by controlling authority and which may be enforced. There are three essential characteristics of every law. The first one is the authority or the right to declare that the rule exists. The second is that such rule is pronounced or expressed and that its source can be identified. Lastly, a right to enforce the same must be provided.

The first essential to a pronounced law is that it must be declared in writing. The reason for this is to be able to enforce control. The principal sources of these pronouncements are (1) the Constitution, (2) the statutes of legislations, (3) the regulations issued by the Executive Branch of the governmement, (4) case decisions ojudicial opinions, (5) Presidential Decrees, and (6) Letters of Instrruction.

Congress enacted The Philippine Nursing Law, otherwise known as Republic Act 877, on June 9, 1953. Provisions included the organization of the Board of Examiners for nurses, provisions regarding nursing schools and colleges, examination, registration of nurses including sundry provisions relative to the practice of nursing.

A Brief History of the Philippine Nursing Law

The first law that had to do with the practice of nursing was contained in Act no. 2493 of 1915, which regulated the practice of medicine. This act provided for the examination and registration of nurses in the Philippine Islands.

  In 1919, Act 2808 was passed. This was known as the First True

Nursing Law. It created, among others; a board examination in the Philippines was given.

Sec. 16, ART IV. Inhibitions against practice of nursing. Unless exempt from registration, no person shall practice or offer to practice nursing in the Philippines as defined in this Act, without a valid certificate of registration as nursed issued by the Board of Examiners for Nurses: provided, however, that for the protection of life and promotion of health, or for the prevention of illness and any communicable disease any person practicing or offering to practice professional nursing in the Philippines must submit evidence that she/he is qualified to practice, and shall be licensed as hereinafter provided.

SEC 30 ART V. Not only prohibits the practice of nursing without a certificate of registration issued by the Board of Nursing but also provides the penalty for doing so.

Prohibition in the practice of nursing. Penal Provision. Any person who shall practice who shall practice nursing in the Philippines within the meaning of this Act, without a certificate of registration issued in accordance with the provisions of this Act, or without having been declared exempt examination and registration, or any person presenting or using as his or her own the certificate of registration of another, or any person giving any false or forged evidence to the Board in order to obtain a certificate of registration or any person assuming, using or advertising as a registered nurse, or appending to his/her name the letters R.N. or BSN without having been conferred such titles or degree in a legally constituted school, college university or Board of Examiners duly authorized by the government to confer the same or advertising any title or description tending to convey the impression that she./he is a nurse, e.g. using the nurse’s uniform and cap without holding a valid certificate of registration from the Board, or any person violating any provision of this Act, shall be guilty of misdemeanor and shall upon conviction, be sentenced to a fame of not less than one year or more than five years, or both in the discretion of the court.

On June 18, 1966 Republic Act 4704 amended certain portions of RA 877

Following are among the most salient changes.1. The membership of the Board Examiners for Nurses was

increased from three to five members.2. Members of the Board were to be appointed by the

President of the Philippines with the consent of the Commission on Appointments and no longer ”upon recommendation of the Commission of Civil Service”

3. The requisite academic degree for members of the Board was a Master’s Degree, instead of a Baccalaureate Degree in nursing.

4. A disqualifying age limit for a Board Member was fixed. No person was eligible for membership in the board if he/she was over 65 years of age, heretofore, no such age disqualification was provided by law.

5. The maximum total compensation which a member of the Board of Examiners for Nurses could receive was raised from P12,000.00 per annum, as provided in the 1965 – 1966 Appropriation Act (Republic Act No. 4642) to P18,000.00 yearly.

6. The academic qualification for Deans, Directors and principals of Colleges and Schools of Nursing was raised from the level of Baccalaureate Degree to that of Master’s Degree in Nursing.

7. The areas of study required for entrance to colleges and schools of nursing were generalized to include courses in physical, biological, social and behavioral sciences, as well as humanities, chemistry, psychology and zoology.

8. The scope of nursing practice was broadened to circumscribe the whole management of the care of patients and the acts constituting professional practice of nursing were spelled out to include such services as reporting, recording and evaluation of a patient’s case, supervision of persons contributing to the nursing care of patients, execution of nursing procedures and techniques, direction and education to secure physical and mental care and application and exectuation of physician’s orders concerning treatment and medication.

9. The date of holding of nurse’s examination was no longer fixed but adjusted to the official closing of the semestral term of classes in colleges and schools of nursing..

10. The minimum are required of applicants for administration to the nurse’s examination was lowered from 21 to 18 years of age, but no candidate who passed the examination was permitted to practice the profession until he or she reached the age of 21 years.

Prior to this amendment, the National League of Government Nurses and the Philippine Nurses Association were the two nursing associations that recommended candidates to the Board of Nursing. It is only the Philippine Nurses Association that is accredited by the Professional Regulation Commission to certify that the candidates to the Nursing Board possess the qualifications required for appointment.

Before, students took specific liberal arts subjects prior to entrance to the school of nursing. Students now enroll to the college of nursing of their choice after graduation from high school but, as required but the Philippine Nursing Act of 1991, RA 7164, they must belong to the upper 40 percent of the graduating class in their high school.

 

On August 31, 1970 sub-paragraph 7 of Section 17 of RA 877 was amended by RA 6136 which stated.

“The application and execution of legal orders in writing of physicians concerning treatments and medications including the application of hypodermic and intramuscular injection; provided that intravenous and other injections may be administered under the direction and in the presence of the said physician. Provided, further, that a previous order in writing shall not be necessary if the application and execution of such order is made in the presence of the said physician”. 

“This section shall not apply to students in schools and colleges of nursing who perform nursing services under supervision of their instructors and professors of nursing and to exchange professors of nursing.”

Republic Act 7164, introduces by Senator Heherson Alvarez, codified and revised all the laws regulating the practice of nursing in with the following changes.

1. Redefinition of the scope of nursing practice to emphasizeA. The use of the nursing process as a scientific discipline

in arriving at an appropriate nursing action and care;B. The teaching, management, leadership and decision

making roles of the nurse; andC. The undertaking of a participation in studies and

research by nurses;2. Requiring a faculty member was appointed to the

Board of Nursing to resign from his/her teaching position at the time of appointment and not one year preceding his/her appointment as provided in Republic Act 877, as amended;

3. Updating a faculty’s educational qualification by requiring a Master’s Degree in Nursing or related fields or its equivalent in terms of experience and specification as pre-requisite to teaching

4. Specification of qualifications of administrators of nursing services; and

5. Inclusion of the phrase ”Unethical conduct” as one of the reasons for revocation and suspension of certificate of registration.

 

One of the landmarks in the history of the nursing profession in the Philippines was the Presidential Proclamation of a Nurse’s Week. Under Proclamation No. 539 dated October 17, 1958 the President of the Philippines designated the last week of October of every year, beginning in 1958, as Nurses’ Week.

Presidential Decree No. 223 issued on June 23, 1973 created the Professional Regulation Commission and prescribed its powers and functions. Where before the function to regulate the different professions were under the Civil Service Commission, this now belonged to the Professional Regulation Commission. This office was directly under the Office of the President of the Philippines.

In1972, RA 6511 was enacted to amend Republic Act 465 which standardized the national registration fees charges by the various Boards of Examiners. Republic Act 6511 took effect on July 1, 1972. In so far as registered nurses were concerned, the important changes and the additional provisions affected by thee set were the following:

1. The fee for the nurse’s examination was increased from P50.00 to P75.00 and the fee for registration as nurse after passing the examination was increased from P20.00 to P40.00

2. An applicant for registration as nurse without examination had to pay statutory fee equal to the sum of the examination fee and a registration fee, or a total amount of P115.00

3. The annual registration fee should be paid in or before the __ of January of the year. Failure to pay entailed a surcharge of 20 percent and such additional charge was imposed for each year that the annual registration fee was not pair, and if non-payment of the fee lasted for five consecutive years, the nurse concerned was deemed as not of good standing and her certificate of registration should thereby be considered suspended and her name revoked from the annual roster.

4. Nurses in inactive status were exempted from paying the annual registration fee, provided they properly informed the Nursing Board that they had stopped practicing in the annual roster of an inactive nurse could be effected by a request in writing and the payment of the annual registration fee for the current year.

However, PRC Memorandum No. 90 -11 dated August 20, 1990, provided the new rates for examination and registration”

A. Fee. For professions needing a Baccalaureate Degree the examination fee was P350.00 and for those with less than a Baccalaureate Degree it was P250.00

B. Initial Registration Fee. For professions needing a Baccalaureate Degree, the initial registration fee was P250.00 while for those with less than a Baccalaureate Degree the fee was P175.00

C. Annual Registration Fee. For professions needing a Baccalaureate Degree the annual registration for new registrants was P40.00. For those with less than a Baccalaureate it was P30.00. However, for renewal, a processing fee P10.00 was charged. This registration fee was paid on the professional’s birth month.

Letter of Instruction No. 1000 from then President Ferdinand Marcos, dated March 20, 1980, required that members of accredited professional organization shall be given priority in the hiring of employees in the government service and in the engagement of professional services. 

. Republic Act 1612 stated that a privilege tax shall be paid before any business or occupation can be lawfully begun or pursued. The occupation or professional tax for nurses was P50.00 payable annually on or before January 31. Any person who pursued any occupation without paying the tax required by law liable to pay a fine not exceeding P1,000.00 or imprisonment, for a term not exceeding six months or both. Any person who did not pay his annual privilege tax for the current year was fined not less that P200.00 and not more than P500.00. Nurses working in the government service were exempted from paying the privilege tax.

Previously, a nurse had to take the Civil Service Examination to enter government service. With the passage of RA 1080 those who passed the bar and board examinations were declared to be civil service eligible. Nurses need to apply to the Civil Service Commission for the conversion of the passed board examination. They just presented a photostatic copy of their professional license to the government agency where they were applying.

RA 7392 amended RA 2644 known as Midwifery Law, on June 18, 1960. It provided that only those who were licensed midwives could practice. Nurses, according to this Act, should pass the Boar examination for Midwives and be registered as such upon payment of the prescribed fee and submit to the Midwifery Board a certification from the Chief of Hospital or the Municipal or Provincial or City Health Officer that they actually had attended at least twenty (20)deliveries. They should pay the corresponding fees for examination and registration (Article III Section 19 & 20 Philippine Midwifery Act, RA 7392

Several arguments arose among nurses as a result of the passage of this Act.

1. Do nurses really have to register as midwives before they can attend to deliveries?

The Philippine Nursing Act of 1991 stated that a person shall be practicing nursing “… who shall for a fee, salary, reward or compensation, singly or in collaboration with another, initiate and perform nursing services to individuals, families and communities in various stages of development…” Since the act of being born is part of the development process, then attending to deliveries, nurses contend, is still part of the purview of nursing. In the implementing Rules and Regulations of RA 7164 formulated by the Board of Nursing, Chapter IV Section 14b, performing internal examination and delivery of babies are within functions of nurses.

2. Should hilots or the unlicensed midwives from the barrios be allowed to continue to practice their trade?

Section 28 Article IV or R.A 2644 specifically allowed them to do so. However, in the same Article and Section or RA 7392 no mention was made about hilots.

3. Are the midwives properly trained on their school to assume the roles provided for in RA 7392? Does this law not infringe on the Philippine Medical Act or the Philippine Nursing Act?

  To prepare midwives to give intravenous

injections and suture perinea lacerations, these procedures are already incorporated in the Midwifery curriculum.

Republic Act 2382, act as the Philippine Medical Act, defines the practice of medicine in the Philippines

Sec.10 Act constituting the practice of medicine. A person shall be considered as engaged in the practice of medicine who shall for compensation, fee, salary, or reward in any form paid to him directly or through another or even without the same may physically examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental, physical condition or ailment, real or imaginary, regardless of the nature of the remedy or treatment oadministered, prescribed or recommend.

Republic Act 5181. This act prescribes permanent residence and reciprocity as qualifications for any examination for any examination or registration for the practice of any profession in the Philippines.

SEC 1. No person shall beallowed to practice any profession in the Philippines unless he has complied with the existing laws and regulations, is a permanent resident therin for at least three years, and, if he is an alien, the country of which he is a subject or citizen permits Filipinos to practice their respective professions within its territories. Provided, that the practice of said profession is not limited by oaw to citizens of the Philippines: provided, further, that Filipinos become American nationals by reason of service in the Armed Forces were admitted to the practice of their profession before July 4, 1946, shall be exempted from the restriction provided herein.

Presidential Decree 541 allows former Filipinos professionals to practice their respective profession in the Philippines. Balikbayans, therefore, although not residents of the Philippines anymore, may practice their profession during the period of their stay in the country.

In 1972, Republic Act 6425 kinown as the Dangerous Drugs Act was passed. Article II, Section states that sale, administration, delivery, distribution, and transportation of prohibited drugs are punishable by law. The penalty of imprisonment ranging from twelve (12) years and one (1) day to twenty (20) years and fine ranging from twelve thousand to twenty thousand pesos shall be imposed upon any person who, unless authorized by law, shall sell administer, deliver, give way to another, distribute, dispatch in transit, or transport any prohibited drug, or shall act as a broker in any sic transactions. Incase of practitioner, the maximum penalty herein prescribed and the additional peanalty of revocation of his/.her license to practice his/her professin shall be imposed . If the victim of the offense is a minor, the maximum penalty shall be imposed.

Should a prohibited drug involved in any offense under this section be the proximate cause of death of the victim thereof, the penalty of life imprisonment to death and a fine ranging from twenty thousand to thirty thousand pesos (P20,000.00 – P30,000.00) shall be imposed upon the pusher.

SEC.8 Possession or Use of Prohibited Drugs. The penalty of imprisonment ranging six(6) years and one (1) day to twelve (12) years and a fine ranging from six thousand to twelve thousand pesos (P6,000.00 – P12,000.00) shall be imposed upon any person, who unloess authorized by law, shall possess any prohibited drug, except Indian hemp as to which the next following paragraph shall apply.

The penalty of imprisonment ranging from six months and one day to six years and a fine ranging from six hundred to six thousand pesos (P600.00 – P6,000.00) shall be imposed upon any person who, unless authorized by law, shall possess or use Indian hemp.

SEC 15. Sale, Administration, dispensation, delivery, transportation, and distribution of regulated drugs.

The penalty of imprisonment ranging from six (6) years and one (1) say to twelve (12) years and a fine ranging from six thousand to twelve thousand pesos (P6,000.00 – P12,000.00) shall be imposed upon any person, who, unless authorized by law, shall sell, dispense, deliver, transport, or distribute any regulated drugs. In case of a practitioner, the maximum penalty herein prescribed and the additional penalty of revocation of his license to practice his profession shall be imposed.

  SEC. 16. Possession or Use of Regulated Drugs. The

penalty of imprisonment ranging six (6) months and one (1) day to four (4) years and a fine ranging from six hundred to four thousand (P600.00 – P4,000.00) pesos shall be imposed upon any person who shall possess or use any regulated drug without corresponding license or prescription.

Act No. 3573 in 1929 declared that all communicable diseases shall be reported to the nearest health station, and that any person may be inoculated, administered or injected with prophylactic preparations. No person shall refuse as to hinder or obstruct these protective measures deemed advisable by the Secretary of Health or the authorized representatives.

Republic Act 1082 which was approved on June 1954 and amended by RA 1891 on June 22, 1957 provides for the creation of rural health units, public health nursing in the Philippines is in great demand particularly in the rural areas. For this reason and to provide these areas with competent public health nursing service the government has established rural health units staffed with technical personnel, including public health nurses. The creation of rural health units all over the Philippines was authorized by RA 1082, which was approved in June 15, 1954.

 As amended by RA 1891 in June 22, 1957 the law provides for the creation of rural health units of eight different categories corresponding to eight population groups of municipalities to be served. RA 4405, approved on June 16, 1965 enlarged the staff by integrating into these units the provincial, city, and municipal sanitary inspectors, nurses and midwives covered by the act.

Republic Act 4073 liberalizes the treatment of leprosy. Except when the disease requires institutional treatment, no persons afflicted with leprosy shall be confined in a leprosarium. Patients shall be treated in a government skin clinic, rural health unit or by a duly licensed Physician.

Presidential Decree 996 requires compulsory immunization for all children below eight years old against communicable diseases. Circular No. 14 of 1965 requires health examination and immunization of all prospective Grade 1 pupils against smallpox, diphtheria and tuberculosis as a pre-requisite for enrollment.

Presidential Decree 825 provides penalty for improper disposal of garbage and other forms of uncleanliness.

Presidential Decree 856, the Code of Sanitation, provides for control of all factors in man’s environment that affect health including the quality of water, food, milk, control of insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, unpleasant odors and control of nuisance.

Presidential Decree No. 148 amending RA 679 (Woman and Child Labor Law), states that the employable age shall be 16 years. This decree provides for the minimum employable age and for privileges of working women.

Republic Act 6365 established a National Policy on Populationand created the Commission on Population (POPCOM).

Presidential Decree No. 791 is the revised Population act. It defines the objectives, duties and functions of the POPCOM. Among others, it empowers nurses and midwives to provide, dispense and administer acceptable methods of contraception after having undergone training and having been granted authorization by the POPCOM in consultation with the appropriate licensing bodies.

Presidential Decree No. 166 amending Presidential Decree No. 791. This decree strengthens family oplanning programs though participation of private organizations and individual in the formulation and implementation of the program planning policies.

 General Order No. 18 enjoins all citizens of the

Philippines, universities, colleges, schools, government offices, mass media, voluntary and religious organizations of all creeds, business and industrial enterprises to promote the concept of family welfare, responsible parenthood and family planning.

Letter of Instruction No. 47 directs all schools of medicine nursing, midwifery and allied medical professions and social work to prepare, plan and implement the integration of family planning in their curricula and to require from their graduates sufficient appropriate licensing examination.

 Department of Labor Order No. 7 requires all industrial

establishments to provide family planning services.

Presidential Decree No. 48 limits paid maternity leave priveleges to four children.

 Presidential Decree No. 69 limits the number of children

to four (4) for tax exemption purposes. 

Presidential Decree No. 965 requires that couples intending to get married must first undergo a family planning and responsible parenthood instruction prior to the issuance of a marriage license

Republic Act No. 1054 requires the owner, lessee or operator of any commercial, industrial or agricultural establishment to furnish free emergency, medical and dental attendance to his employees and laborers.

Republic Act 4426 known as the Hospital Licensure Act requires all hospitals in the Philippines before it can offer to serve the community. This licensing agency is the Office for Hospital and Medical Services, Department of Health.

Nurses working in agencies with 100-bed capacity and / or above and are working in an area of one million populations are supposed to work only forty (40) hours a week per RA 5901.Presidential Decree 442 known as the Labor Code of the Philippines provides workers the right to self-organization and collective bargaining. It promotes the rights and welfare of workers.

Presidential Decree 603, Child and Youth Welfare Code, protects and promotes the rights and welfare of children and youth. Employment of children below 16 years of age is limited to performing light work not harmful to their safety, healthy or normal development and which is not prejudicial to their studies.

Presidential Decree 651 decrees the registration of birth of a child within 30 days with the Civil Registrar.

 ILO Convention No. 149 provides for the

improvement of life and work conditions of nursing personnel.

Employees insured with the GSIS and SSS are entitled to hospitalization privileges under Program I of the Philippine Medical Care (MEDICARE) Act (RA 6111 of 1969). Medicare benefits of GSIS members or their legal dependents must be filed with the GSIS Medicare Claims Department.

Following are the features of Medicare under Program I:1. Benefits are extended only in cases of actual confinement

in hospital due to illness or bodily injury.2. There is freedom of choice of hospitals or physician and

drugstore concerned3. Benefits are paid directly to the hospital, attending

physician and drugstore concerned.4. The member is entitled to 45 days hospitalization per year

while their legal dependents are entitled to a total 45 days among them.

5. Hospitalization privileges include medical and surgical services; vasectomy and caesarean section are included while cosmetic surgery, optometric services, psychiatry, normal delivery and diagnostic services on an out-patients basis are not included.

Dependent parents of single members are given Medicare benefits if they are 60 years old and above.

Presidential Decree 1519 gives Medicare benefits to all government employees regardless of status of appointment. Retirees, regardless of age, are also entitled to Medicare privilege by virtue of their membership in the GSIS or SSS 

Effective January 1980, Presidential decree No. 1636 requires compulsory membership in the GSIS or SSS Retirement Fund. Presidential Decree No. 626 or the Employee Compensation and State Insurance Fund provide benefits to workers covered by SSS or GSIS for immediate injury, illness or disabilities.

Salient aspects in the Constitution of the Philippines affecting the practice of nursing include full respect for human rights; recognition of the sanctity of family life; protection and promotion of the rights to form unions, association or societies; making health services available to the people at affordable cost; protection of working women; rights of people’s organizations and recognition of the family as the foundation of the nation.

Republic Act 6675 or the Generics act of 1988 is an act to promote, require and ensure the production of an adequate supply distribution, use and acceptance of drugs and medicines identified by their generic names. Medicines are prescribed in generics.

Nurses are the patient’s advocates. Their role is not only as drug administrators but also as educators by giving information; as evaluators though monitoring, verifying and reporting of usage and problems encountered, and as coordinators with physicians, pharmacist, dentist, and concerned groups.

 Republic Act 6758 standardizes the salaries of

government employees which include the nursing personnel. Their new position titles, salary grades and schedules are found in Appendix J. However, these are still under negotiations so the positions of equal importance will have the same salary grade levels and schedules.

 

Republic act No. 6713 known as the “Code of Conduct and Ethical Standards or Public Officials and Employees” upholds a time-honored principle that public office is a public trust.

It is the policy of the state to promote to a high standard of ethics in public service. Public officials and employees shall discharge their duties with utmost responsibility, integrity, competence and loyalty, and shall act with patriotism and justice.

Republic Act 7160 or the Local Government Code transfers responsibility for delivery of basic services and facilities of the national government to local government units. This involves devolution of powers, functions and responsibilities to the local government both provincial and municipal.

Another law approved by Pres. Corazon C. Aquino on March 26, 1992, and authored by Senator Edgardo Angara is RA 7305 entitled “Magna Carta for Public Health Workers”. Its significant objectives are:

1. To promote and improve the social and economic well-being of health workers;

2. To develop their skills and capabilities; and3. To encourage those qualified and with abilities to

remain in government service.

Republic Act 7600 or the Rooming – in and Breastfeeding Act of 1992 provides that babies born in private and government hospitals should be roomed-in with their mothers to promote breastfeeding and ensure safe and adequate nutrition to children. This is enforced by the Milk Code (Executive Order No. 51)

 

Republic Act 7432 or the Senior Citizen’s Act does honor and justice to out people’s long tradition of giving high regard to our elderly. It entitles the elderly to a twenty percent (20%) discount in all public establishments such as restaurants, pharmacies, public utility vehicles and hospitals. It also entitles the elderly to free medical and dental check-up and hospitalization in all government hospitals.

REPUBLIC ACT 7035 THE MAGNA CARTA OF THE PUBLIC HEALTH WORKERS

Be it enacted by the Senate and House Representative of the Philippines in the Congress assembled.

Sec. 1 Title - This act shall be known as the Magna Carta of the Public Health Workers.

Sec. 2 Declaration of Policy and Objectives – The state shall in still health consciousness among our people to effectively carry out the health programs and projects of thee government essential for the growth and health of the nation Toward this end, this act aims:a) To promote and improve the social and economic

well-being of the health workers, their living, and working conditions and terms of employment.

b) To develop their skills and capability in order that they will be more responsive and better equipped to deliver health programs.

c) To encourage those with proper qualification and excellent abilities to join and remain in the government service.

Sec. 3 Definition – For the Purposes of this act “health workers” shall mean all persons who are engaged in health and health related work, and all persons employed in all hospitals. Sanitaria, health infirmaries, health centers, rural health units, barangay health actions, clinics and other health related establishments owned and operated by the government or its political subdivisions with original charters and shall include medical, allied health professional administrative and support personnel employed regardless of their employment status.

Sec.4 Recruitment and Qualification – Recruitment policy and minimum requirement with respect to the selection and appointment of the public health worker shall be developed and supplemented by the appropriate government agencies concerned in accordance with policies and standards of Civil Service Commission. Provided, that in the absence of appropriate eligible and it becomes necessary in the public interest to fill a vacancy, a temporary appointment shall be issued to the person who meets all the requirements for the position to which he/she is being appointed except the appropriate civil service eligibility: Provided further that such temporary appointment shall not exceed twelve (12) months not less than three (3) months renewable thereafter but the appointee may be replaced sooner if (a) a qualified civil service eligible becomes available. Or (b) the appointee is found wanting in performance or conduct be fitting a government employee.

Sec. 5 Performance Evaluations and Merit Promotion – The Secretary of Health, upon consultation with the proper government agency concerned and the management health workers consultative councils. As established under Section 33 of this Act shall prepare a uniform career and personnel development plan which shall include provisions and merit promoting. Performance evaluations, in service training grant job rotation, suggestions and intensive award system.

The performance evaluation plan shall consider foremost the improvement of individual employee efficiency and organizational effectiveness. That each employee, shall be informed regularly by his/her supervisor of his/her evaluation.

The merit promotion plan shall be in consonance with the rules of the Civil Service Commission.

Sec. 6 Transfer of Geographical Reassignment of Public Health Workers:

1. Transer is a movement from one position to another which is of equivalent rank, level of salary without break in service.

2. A geographical reassignment. Hereinafter referred to as “reassignment” is a movement from one geographical location to another, and

3. A public health worker shall not be transferred and//or reassignment of the public health worker and his/her immediate family shall be paid for by the Government.

Sec. 7 Married Public Health Workers – Whenever possible the proper authorities shall take steps to enable married couples, both of whom are public workers, to be employed and assigned in the same municipality, but not in the same office.

Sec. 8 Security of Tenure – In case of regular employment of a public health workers, their services shall not be terminate except for cause provided by law and after due process: Provided that public health worker is found by the Civil Service Commission to be unjustly dismissed from work, he/she shall be entitled to reinstatement to his/her work without loss of seniority rights and to his/her work payment of back wages with twelve percent (12%) interest computed from the time his/her compensation was withheld from him/her up to the time of reinstatement.

Sec. 9 Discrimination Prohibited - A public health worker shall not be discriminated against with regard to gender, civil status, health workers organizations or unions the necessary rules and regulations to implement the provisions of this Act shall take effect thirty (30) days after publication in a newspaper of general circulation.

Sec. 10 No Understaffing/Overloading of Heath Staff - There shall be no understaffing or overloading of public health workers. The ratio of health staff to patient load shall be such as reasonably effect a sustained delivery of quality health care at all time without overworking the public health worker and over extending his/her duty and service. Health students and apprentices shall be allowed only for the purposes of training and education.

In line with the above policy, substitute offices or employees shall be provided in place of officers or employees who on leave over (3) months. Likewise, the Secretary of Health or the proper government official shall assign it medico-legal in every province.

Sec. 11 Administrative Charges - Administrative charges against public health worker shall be heard by the committee composed of the provincial health officer of the province Where the public health worker belongs, as a chairperson, a representative of any existing national or provincial public workers organization or in its absence its local counterpart and a supervisor of the officer mentioned above. The committee shall submit its findings recommendations to the Secretary of Health within thirty (30) days from the termination of the hearings.

Where the provincial health officer is the interested party, all the members of the committee shall be appointed by the Secretary of Health.

Sec. 12 Safeguards in Disciplinary Procedures - In every disciplinary proceeding, the public health worker shall have:

1. the right to be informed, in writing, to the charges;2. the right to full access to the evidence in the case;3. the right to defend himself/herself and to be defended by a

representative of his/her choice and/or by his/her organization, preparation of his/her defense.

4. the right to confront witness presented against him/her and common witness in his/her behalf:

5. the right to appeal to designated authorities :6. the right to reimbursement of reasonable expenses incurred by

his/her defense in case of ex-operation or dismissal of the charges; and

7. other rights as will ensure fairness and impartiality during the proceedings.

Sec. 13 Duties and Obligations - The public health worker shall:a) discharge his/her duty humanely with conscience and dignity:b) perform his/her duty utmost respect for life; and dignity;c) perform his/her functions without consideration to race, gender,

religion, nationality, party-politics, social standing or capacity to pay.

Sec. 14 Code of Conduct - Within Six (6) months from the appropriate agencies of this Act, the Secretary of Health, upon consultation with other appropriate agencies, professionals and health workers organization shall formulate and prepare a Code of Conduct for Public Health Workers which shall be disseminated as widely as possible.

Sec. 15 Normal Hours of Work - The normal hours of work of any public health worker shall not exceed eight (8) hour a day or forty (40) hours a week.

Hours worked shall include: (a) all the time during which a public health worker is required to be on active duty to be at a prescribed workplace: and (b) all the time during which a public health worker is required or permitted to work: Provided. That, the time when a public health worker is placed on On Call status shall not be considered as hours equivalent to fifty percent (50%) of his/her regular wage, On Call status refers to an urgent or immediate need for health/medical assistance or relief work during emergencies such that he/she cannot devote the time for his/her own use.

Sec. 16 Overtime Work – Where the exigencies of the service so require, any public health worker may be required to render service beyond the normal eight (8) hours a day/ in such a case, the workers shall be paid an additional compensation in accordance with existing laws and prevailing practices.

 Sec. 17 Work during Rest Day –a) Where a public health worker is made to work on his/her

scheduled rest day, he/she shall be paid an additional compensation in accordance with existing laws.

b) Where a public health worker is made to work in any special holiday he/she shall be paid additional compensation in accordance with existing laws. Where such holiday work falls in the worker’s scheduled rest day he/she shall be entitled to an additional compensation as may be provided by existing laws.

Sec. 18 Night Shift Differential –a) Every public health worker shall be paid a

night-shift differential of ten percent (10%) if his regular wage for each hour of work performed during the night-shift customarily adopted by the hospitals/

b) Every health workers who is required to work on the period covered after his regular schedule shall be entitled to his/her regular wage plus the regular overtime and an additional amount often ten (1) o’clock in the evening and six (6) o’clock in the morning.

Sec. 19 Salaries – In the determination of the salary scale of the health workers, the provisions of Republic Act No. 6758 shall govern except that the benchmark for the Rural Health Physicians shall be upgraded to Grade 24;

Salary Scale – salary scale for the public health worker shall be provided in progression. Provided, that the progression from the minimum to maximum of the salary scale shall not extend over a period of ten (10) years; Provided, further, That the efficiency rating of the public health worker concerned is at least satisfactory.

Equality in Salary Scale – the salary scale if the public health worker whose salaries are appropriated by a city, municipality, district or municipality, district or provincial government shall not be less that those provided for public health workers of the National Government shall subsidized the amount necessary to pay the difference between that received by nationally-paid and locally paid health workers or equivalent positions.

Salaries to be Paid in Legal Tender- salaries of public health workers shall be paid in legal tender of the Philippines or the equivalent in checks or treasury warrants; Provided, however, That such checks or treasury warrants shall be convertible to cash in any banking institutions operating under the laws of the Republic of the Philippines.

Deductions Prohibited. No person shall make any deduction whatsoever from the salaries of the public health workers except under the specific provision of law authorizing such deductions. Provided, however, that upon written authority executed by the public health worker concerned.

(d.1) lawful dues or fees owing to any organization/association where such public health worker is an officer or member, and

(d.2) premiums on property due all insurance policies retirement and medicare shall be considered deductible.

Sec. 20 Additional Compensation – Not withstanding section 12 of Republic Act No. 6758, public health worker shall receive the following allowances: hazard allowance. Subsistence allowance, longevity pay, laundry allowance, and remote assignment allowance.

  Sec. 21 Hazard Allowance – Public Health workers, in hospitals,

sanitaria, rural health stations, clinics and other health related establishments located in difficult areas. Strife-torn or embattled area, distressed or isolated stations, prison camps, mental hospitals, radiation-exposed clinics, laboratories or disease-infested areas declared under the state of calamity or emergency for the duration thereof which expose them to greater danger containing radiation, volcanic activity/eruption, occupational risks or perils to life as determined by the Secretary of Health or the Head of the units with approval of the Secretary of Health, shall be compensated hazard allowances equivalent to at least five percent (25%) of the monthly basic salary if the health worker receiving salary grade 19 and below, and five percent (5%) for health workers with salary grade 20 and above.

Sec. 22 Subsistence Allowance – Public health workers who are required to render service within the premises of hospitals, sanitaria, health infirmaries, main health centers, rural health units and barangay’s health stations, or clinics and other health-related: establishments in order to make their services available at any, and all times, shall be entitled to full subsistence allowance of three (3) meals which may be computed in accordance with prevailing circumstances as determined by the secretary of health in consultation with the Management0Heakth Worker’s Consultation and travel allowance shall be given to rural health physicians as enjoyed by municipal agriculturists, municipal planning and development officers and budget officers.

Sec. 23 Longevity Pay – A monthly longevity pay equivalent to five percent (5%) of the monthly basic pay shall be paid to health workers for every (5) years of continuous, efficient and meritorious services rendered as certified by the chief of the office concerned commencing with the service after the approval if this Act.

  Sec. 24 Laundry Allowance – All public health workers who

are required to wear uniforms regularly shall be entitled to laundry allowance equivalent to one hundred twenty-five pesos (125.00) and increased accordingly by the Secretary of Health in consultation with the appropriate government agencies.

Sec. 25 Remote Assignment Allowance – Doctors, dentists, nurses, and midwives who accept assignments as such in remote areas or isolated stations, which for reasons of far distance or hard accessibility, such positions had not been filled for last two (2) years prior to the approval of this Act, shall be entitled to reimbursement of the costs of reasonable transportation to and from such remote post or stations, upon assuming or leaving such position and during official trips.

In addition to the above such doctors, dentists, nurses and midwives mentioned in the preceding paragraph shall be given priority in promotion or assignment to better areas. Their tour of duties in the remote area shall not exceed two (2) years, except when there is no position for their transfer or they prefer to stay in such excess of two (2) years.

 Sec. 26 Housing – All public health workers who are on tour of duty

and those who, because of unavoidable circumstances are forced to stay in the hospital, sanitaria or health infirmary premises, shall be entitled to free living quarters and shall receive quarters allowance as may be determined by the Secretary of Health in consultations with the appropriate government agencies concerned.

 For purposes of this Section, the Department of Health is

authorized to develop housing projects in its own land, not otherwise devoted for other uses, for public health workers, in coordination with appropriate government agencies concerned.

Sec. 27 Medical Examinations – Compulsory medical examination shall be provided free of charge to all public health workers before entering the services in the Government or its subdivisions and shall repeated once a year during tenure of employment of all public health workers; Provided, That where medical examination shows that medical treatment and/or hospitalization including medicines shall be provided free either in a government or a private hospital by government entity paying the salary of the public health workers: Provide, further, That the cost of such medical examination and treatment shall be included as an automatic appropriation in said entity’s annual budget.

  Sec. 28 Compensation for Injuries – Public health workers shall

be protected against the consequences of employment injuries in according with existing law’s. Injuries incurred while doing overtime worked shall be presumed work-connected.

Sec. 29 Leave Benefits for Public Health workers – Public health workers are entitled to such vacation and sick leaves as provided by existing and prevailing practices: Provide, That in addition to the leave privilege now enjoyed by public health workers, women health workers are entitled to such maternity leaves a provided by existing law and prevailing practices: Provided, further, That upon separation of the public health workers from service, they shall be entitled to all accommodated leave credits with pay.

Sec. 30 Highest Basic Salary upon Retirement – Three (30 months prior to the compulsory retirement, the public health worker shall automatically be granted one (1) salary range or grade higher that his/her basic salary and his/her retirement thereafter, computed on the basis of his/her highest salary; Provided, That he/she has reached the age fulfilled service requirement under existing laws.

Legal Aspects and the NurseThe Philippine Nursing Act of 2002 is the best guide the nurse can utilize as it defines the scope of nursing practice. There are also standards of care that may be used as criteria in evaluating their work. Nurses are enjoyed to be familiar with the Philippine Nursing Law, the standards of nursing care, and other laws which nursing practice and their code of ethics.

Responsibility and Accountability for the Practice ofProfessional Nursing

When nurses undertake to practice their profession they are held responsible and accountable for the quality of performance of their duties. Nurses employed in an agency, institution, or hospital is directly responsible to their immediate supervisors. Private duty nurses, being independent practitioners, are held to a standard of conduct that is expected of reasonably prudent nurses. The standard is a clearly defined, legal expectation to which nurses are held accountable.

Professional NegligenceThe term “negligence” refers to the

commission omission of an act pursuant to a duty, that a reasonably person in the same or similar circumstance would or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his prosperity.

If a person charged with negligence shows that she meets or even surpasses this standard then there is no negligence or carelessness. But of the defendant’s actions fail to meet the standard, and then there has been negligence.

The element/s of professional negligence therefore is:a) existence of a duty on the part of the person charged to use due

care under circumstances,

b) failure to meet the standard of meet the standard of due care,c) the foresee ability of harm resulting from failure to meet the

standard, andd) the fact that the breach of this standard resulted in an injury to

the plaintiff

Article 19 of the Civil Code states that one shall act with justice, Give every man his due, observe honesty and good faith.

Article 20 states that those who, in the performance of their obligations through negligence cause any injury to another are liable for damages.

 Liability for negligence therefore shall be

imposed upon a nurse who has failed to behalf as a reasonable, prudent nurse would act in the particular circumstance.

Common acts of negligence are burns resulting from hot water bags, heat lamps, vaporizers, sits bath, objects left inside the patient’s body such as sponge, suctions tips, loose dentures lodge in the patients, or those who are not fully recovered from anesthesia; falls of children whose side rails of beds were not pulled up and locked; and failure to observe and take appropriate action as needed, Incident reports clarify cause and preventive actions and are used for medico-legal purposes.

Specific examples of negligence

Failure – to report observation to attending physicians, A nurse observed that the toes of a patient with leg cast were cyanotic and cold to touch, but she failed to report this to the physician. The leg became gangrenous and had to be amputated below the knee. The court found the nurse negligent in failing to inform the attending physician of the patient’s condition, and to advise the hospital authorities so that appropriate action could have been taken.

Failure to exercise the degree of diligence which the circumstances of the particular case demands. In 1975 a community health nurses attended the delivery of a patient who had no prenatal care. Although she was reluctant to attend to the patient, she was informed that this was an emergency. The baby was born spontaneously but the placenta as not expelled after 30minutes. She advised that the mother be brought to the hospital. The family left without the nurse was found guilty of negligence.

Mistaken identity. Drugs could be given to the wrong person especially if the latter is confused or unconscious and could not respond to the nurse’s verification of identity.

Wrong medicine, wrong concentration, wrong route, and wrong dose. There are many reported cases where patients are inadvertently given the wrong medications or wrong doses simply because the nurse did not take time to check the order.

Defects in the equipments such as stretchers and wheelchairs may lead to falls this injuring the patients.

Errors due to family assistance. Suppose a nurse asked a nurse a relative to apply hot water bag to the body of a chilling child and the latter suffered burns. The nurse would be held liable for failure to test the temperature of the water and/or for failure to check whether the mother knew what was expected of her during such assistance.

Administration of medicine without a doctors prescription. A case of negligence was filed against a sericulture center nurse in 1979 for injecting Penstrep to a boy who had a swollen foot. The nurse infirmed the parents that she was not a doctor usually gave Penstrep injections in such cases. She injected the medicine without doctors prescription, the boy died of cardio-respiratory failure secondary to anaphylactic shock due to the injection of the drug. The nurse was found guilty as charged.

The Doctrine of Res ipsa loquitorThree condition are required to establish defendants negligence without proving specific conduct. These are:

1. That the injury was of such nature that it would not normally occur unless there was as negligent act on the part of someone.

2. That the injury was caused by an agency within control of the defedant; and

3. any manner that would tend to bring about the injury.

Proof of the plaintiff that each of these factors exists a given situation permits courts to conclude that the defendant is negligent. No further proof is required.

Following are examples of such cases:1. A patient came in walking to the outpatient clinic for

injection. Upon administering th injection to h buttocks, the patient experienced extreme pain. His legal left weak and he was subsequently paralyzed.

2. The presence of sponges in the patients abdomen after an operation

3. Fracture on a newly-delivered baby born by breech presentation.

MalpracticeMalpractice in usual sense implies the idea of improper or

unskillful care of a patient by a nurse. Malpractice also denotes stepping beyond ones authority with serious consequences.

Malpractice is the term or negligence or carelessness of professional personnel. To determine what is and what is not careless, the law has developed standard of care which can be determined by deciding what a reasonably prudent person would do under similar circumstances.

Lesmk (1962) also states that the term malpractice is used properly only when it refers to a negligent act committed in the course of professional performance.

 An example of malpractice is the giving of anesthesia by a

nurse or prescribing medicines. Under the Philippine Medical Act, this will be classified as within the purview of the medical pratice.

Doctrine of Force MajeureThe term force majeure means an irresistible

force, one that is not foreseen or inevitable under Civil Code of the Philippines no person shall he responsible for those events which cannot be foreseen, or which, though foreseen, are inevitable, except in cases expressly specified by law.

Circumstance such as floods, fire, earthquake and accidents fall under this doctrine and nurses who fail to render service during these circumstances are not held negligent. Habitual tardiness due to heavy traffic is not considered an excuse for force majeure.

Doctrine of Respondent Superior - The term means the master for the acts the subordinate. Under this doctrine, the liability is expand is to include the master as well as the employee and bit shift of liability from the subordinate to the master. Therefore, when a person, though his negligence, injuries another, he remains fully responsible, This doctrine applies only to those actions performed by the employee within scope of his employment.

Following are some examples:1. The hospital will be help liable, of, in an effort to cut down

on expenses it decides to hire under board nurses or midwives in place of professional nurses, and these persons prove to be incompetent.

2. The surgeon will be help responsible in case a laparatomy pack is left in a patients abdomen.

Private duty nurses, however, are considered independent contractors. They are liable for their own negligent actions.

Incompetene - is the lack of ability, legal qualifications or fitness to discharge the required duty.Liability for the Work of Nursing Students - Under the Philippine Nursing Act of 2002 R.A. 9173, nursing students do not perform professional nursing duties. They are to be supervised by their Clinical Instructors. In order that the errors committed by nursing students will be avoided and/or minimized, the following measures should be taken:

a) Nursing Students should always be under the supervision of their Clinical Instructors

b) They should be given assignments that are at their level of training, experience and competency.

c) Their should be oriented to the policies of the nursing unit where they are assigned.

d) Their performance should be assessed frequently to determine their strength and weakness.

e) Frequent conferences with the students will reveal their problems which they my want to bring to the attention of their instructors or vie-versa, Discussion of these problems will iron out doubts possible solutions may be provided.

Both the clinical instructor and the staff nurse in the clinical area where nursing students are assigned should coordinate in assessing the competence of nursing students before they are allowed to give care to patients so that the risks of injury to the same will be avoided.

 Legal Defense in Negligence - The most common defense in a negligence action is when nurses know and attain that standard of are in giving service and that they have documented the care they give in a concise and accurate manner,

 If the patients careless conduct contributes to his own injury, the

patient cannot bring suit against the nurse. On the other hand, if the nurse has expressly given advanced consent in performing or a patient with communicable disease, the nurse cannot bring suit against the patient f she gets hurt or contract the disease since upon accepting the case, the nurse agreed to assume the risk of harm or infection thereby relieving the patient or his relatives from legal obligations. This is termed as Assumption of Risk.

Nurses therefore shall exercise their sound judgment and utilize standards of care in order to prevent lawsuits or harm to themselves.

Medical Orders, Drugs and Medication-

Republic Act 6675 states that only validity registered medial, dental and veterinary practitioners, whether in private institution/corporation or in the government, are authorized to prescribe drugs. Prescriptions made by unauthorized persons constitute illegal practice of medicine, dentistry or veterinary medicine and is punishable under R.A. 2832 or medical Act of 1559. R.A. 4419 or the Dental Act and R.A 382 or the Veterinary Act.

R.A 5921 or the Pharmacy Act as amended; all prescriptions must contain the following information: name of the prescriber, office address, professional registration number, professional tax receipt number, patient/clients name, age and sex, and date of prescription. R.A. 6675 requires that the drugs be written in their generic names.

Verbal orders can be minimized if the nurse seeks a clear understanding from the physicians in establishing a policy concerning the importance of written orders.

 

The general rule requiring a nurse to execute all lawful orders of a physician is tempered by common sense. The requiring a nurse to execute all lawful order if she is reasonably certain it will result in harm to the patient. In such case she must speak out and risk incurring the physicians resentment or ire rather than a lawsuit.

Intravenous Therapy and Legal Implication - Nurses now participate in complex intravenous therapy procedures that were once performed only by doctors. Nurses must remember that their legal right to give once performed only by doctors. Nurses must remember that their legal right to give intravenous injection is based on the Philippine Nursing Act of 1991 Section 28 which states that in the administration of intravenous injections, special training shall be required according to protocol established.

Therefore nurses should use the Intravenous Nursing Standards of Practiced developed by the Association of Nursing Service Administration of the Philippines.

 In giving intravenous injections, nurses should

also follow the policies of their agencies. Even if nurses have formal training on intravenous therapy, if the hospital hoes not allow them to o so, then they my not do the procedure.

 Board if Nursing resolution No. 8 states that any

registered nurse without such training and who administers intravenous in ejections to patient shall be held liable, either criminally under Sec, 30 Art, VII of said law or administratively under Sec 21 Art III or both (whether causing or not an injury or not injury or death to the patient.)

Scope of Duties and Responsibilities in intravenous Therapy

A. Interpretation of the doctors orders for intravenous therapy.B. Performance of venipuncture, insertion of needles, cannulas except TPN and cut

down;C. Preparation, administration, monitoring and termination of intravenous solution

uh additives, intravenous medications, and intravenous push;D. Administration of blood/ blood products as ordered by physicians;E. Recognition of solution and medicine incompatibilities;F. Maintenance and replacement of sites, tubings, dressings, in accordance, with

established procedures;G. Establish of flow rates of solutions, medicines, blood and blood components;H. Utilization of through knowledge and proficient technical ability in the use/care,

maintenance, and evaluation of intravenous equipment;I. Nursing management of Total Parental Nutrition, out-patient intravenous care;J. Maintenance of established infection control and aseptic nursing intravenous:

andK. Maintenance of appropriate documentation, associated with the preparation,

administration and termination of all forms intravenous therapy.

Before the administration of blood transfusion, the resident on Duty, the Head Nurse or Senior Nurse, and the Staff Nurse should check that the blood is of the correct type and is properly cross matched. They should sign their names as they attest to those.

Proper documentation provides protection for nurses and the hospitals. The intravenous therapy may be documented on the progress notes, a special I.V therapy sheet or flow sheet or nursing care plan on the patients chart.

Although this requirement is not mentioned anymore in R.A. 9173, most Nursing Service Administrators still require their nurses to undergo this training program for the legal protection of the patients, the nurses, and the agencies.

Telephone OrdersThere are legal risks in telephone orders, These may be

misunderstood or misinterpreted by the receiving nurse.

Doctors should limit telephone orders to extreme emergency situations where there is no alternative. The use of a telephone in a non-emergency as a substitute fir the physician himself can lad to serious errors and may border on malpractice.

Only in an extreme emergency and when no other resident or intern is available should a nurse receive telephone orders The nurse should read back such order should be signed by the physician on his/her next visit within 24hours. The nurse should receive the order. There should be a clear hospital policy that is within the bounds of the medical and the nursing laws regarding telephone orders to avoid misunderstanding not only for the individuals concerned but also for the individuals concerned but also for the hospital as well.

 Consent to Medical and Surgical Procedures

Consent is define as free and rational at the presupposes knowledge of the thing to which consent is being given by a person who is legally capable to give consent.

Before any medical or surgical procedure an be performed on a patient, consent must be obtained from the patient or his authorized representative who may be his parent or guardian. It is only in case of emergency where the consent requirement does not apply.

The physician should give as much information about a contemplated procedure and the patient should receive enough information to allow him to give an informed consent for such procedure or treatment.

Nature of Consent. Consent is an authorization, by a patient or a person authorized by law to give the consent on the patients behalf, that changes touching, for example, from non-consensual to consensual.

Informed Consent. It is established principle of law that every human being of adult years and sound mind as the right determine what shall be done with his own body. He may choose whether to be treated or no and to what extent, no matter how necessary the medical care, or how imminent the danger to his life or health if he fails to submits to treatment.

The essential elements of informed consent include

a) the diagnosis and explanation of the conditionb) a fair explanation of the procedure to be done and used and

the consequences;c) a description pf alternative treatment or proceduresd) a description of the benefits to be expected;e) material rights if any; andf) the prognosis, if the recomendation care, procedure is

refused.

Proof of Consent. A written should be signed to show that the procedure is the one consented to and that the person should be signed to show that the procedure, the risks involved and the possible consequences.

A signed special consent is necessary before any medical or surgical treatment is done such as x-rays, special laboratory tests, blood transfusions, operations, cobalt therapy or chemotherapy, and the like.

 Who Must Consent. The patient is the one who gives the consent on his own behalf. If he s incompetent (such as in the case of minors or the mentally ill or physically unable and is not an emergency case, consent must be taken from another who is authorized to give it in his behalf.

 Consent of Minors. patients, or someone standing in their behalf gives the consent to medical or surgical treatment of a minor. Parental consent is not needed however, if the minor is married or otherwise emancipated.

 Consent of Mentally Ill. A mentally incompetent person cannot legallyconsent to medical or surgical treatment. The consent must be taken from the parents or legal guardian.

 Emergency Situation, When an emergency situation exists, no consent is necessary because inaction at such time may cause greater injury.

  A mother, who is on the advanced stage stage of labor, or a patient, who

goes to be the emergency room; Gives an implied consent to an immediate treatment or attendance.

Refusal to Consent. A patient who is mentally and legally competent (sane mind and of legal age) has the right to refuse the touching of his body or to submit to a medical or surgical procedure no matter how necessary, nor how imminent the danger to his life or health if he fails to submit to treatment. Examples are patients who, because of their religious beliefs, may refuse blood transfusions as in the case of Jehovahs Witness.

Consent for Sterilization. Sterilization is the termination if the ability to procedure offspring. The husband and the wife must consent to the procedure if the operation is primarily o accomplish sterilization. When the sterilization is medically necessary and the sterilization is an incidental result such as in cases of abruption placentae, ectopic pregnancies or ruptured uterus, the patients consent alone is sufficient.

A Sample Consent FormName of Hospital: ________________________________________________________Address: _________________________________________________________________Patients Name: (Last,______________First,________________Middle____________Age:___________Sex:____________________CS:___________________Room No.:______________Bed No.:______________Hospital Unit No.:__________________ 1. I, the undersigned, hereby authorize Dr/s_______________________to administer/perform upon myself/my__________________________(State the Name of Treatment/Proedure / Operation) proedure 2. The nature and purpose of the treatment / operation / procedure and / or risks

involved and the possibility of complications have been explained to me. I acknowledge that no guarantee or assurance has been made as to the result that be obtained there from.

 3. It is further expressly agreed that I hereby release the hospital, its personnel and

Medical Staff from all responsibility and liability for consequences, if any resulting from the above-mentioned treatment/operation and proceure(s).

 

Signature of WitnessSignature of Patient

_________________________________________

 Date and Time:__________________Patient is a minor:______________year of

age:______________Patient is unable to sign

because_____________________________________________________

 Signature of Witness Signature of Patients

Representative

Date and Time:___________ Relationship to patient:______________

Medical RecordsThe value of medical records is both scientific and legal. As a record of illness and treatment, it saves duplication in future cases and aids in prompt treatment. The record supplies rich material for medical and nursing research. It serves as a legal protection for the hospital, doctor, and nurse by reflecting the disease or condition of the patient and his management. Nurses must remember the rule, If it was not charted, it was not observe or done.

Nurses are responsible for safeguarding the patients record from loss or destruction or from access by persona who are not legally authorized to read such.

Charting Done by Nursing StudentsWhen a nurse or a clinical instructor countersigns the charting of a nursing student, he/she has personal knowledge of information and that such is accurate and authentic. Anyone who countersigns without verification commits herself to possible legal risks.

Medical Records in Legal ProceedingsMedical records are usually used to give

important evidence in legal proceedings such as police investigations, determining cause of death, extent of injury uncured by the patient, among others.

 

Local Government Code

IntroductionOver the past two decades, the health are industry has been undergoing profound transformational events, not only within the Philippines, but also in other country worldwide. These are spawned by the multitudes of forces converging in the national as well as international levels, which impact on the quality of nursing practice in the country.

 Due to the foregoing, new expectations for contemporary

nursing practice contemporaries are emerging, which is heightened by the escalating complexity of globalization, the dynamic of health science and information technology, demographic, changes, health care. Makeover, the surge of overseas employment opportunities for Filipino nurses creates depletion in the reservoir o competent professionals to serve th health needs of the country.

  

The Board of Nursing created the Committee on Core Competency Standards Development in collaboration with the commission on Higher education Technical Committee on Nursing Education with primary goal to develop the competency standards for nursing practice in the country. The committee was composed of leaders from nursing education, nursing practice and nursing regulation.. The whole gamut of developing the standards were made possible through the participation of representatives of professional nursing organizations, consumer of nursing practice such as doctors, administrators and patients, senior nursing students, and in consultation with nurse executives from regulatory authorities in three countries.

The project was conceptualized in April 2001 as one the key projects of the Board of Nursing as a commitment to the call for the development of regional ore competency standards for the Western Pacific and South East Asian Regions, as well as the International Council of Nurses.

The initial of the Competency Standards for Nursing Practice was presented to the Board of Nursing and technical committee on Nursing Education in June 2003 and was subsequently presented in various national nursing conferences for consultation purposes. The subsequently presented presented in various national nursing conference for consultation purposes. The last phase of the refinement was done in January 18, 2005 by integrating comments, suggestions and recommendations for the improvement of the standards.

Legal Bases:Article 3 Se.9 (C) of R.A 9173 known as the Philippine Nursing Act 2002 - States that the Board shall monitor and enforce quality standards of nursing practice necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation. it is incumbent upon the Board of Nursing therefore to take the lead in the development and implementation of the competency standards to warrant the health of the public, maintain the public trust and promote the integrity of the nursing profession.

TILE NATURALISTIC MODEL: Phases of Developing

Competency Standards

The key phases in the development of competency standards involved the following: the first phase involved identifying the competencies through with the participation of nurse experts, and consumers of nursing practice such as administrators, doctors and clients. The second phase included verification of the identified competencies among nursing experts from the different regions of the country. The third phase was pilot testing the competencies among senior nursing students of eight colleges of nursing and the fourth phase was benchmarking with existing standards from three countries as well as with the International Council of Nurses. This Model was adopted from the Naturalistic Model in curriculum Development, which was developed by Decker Walker.

SIGNIFICANCE OF THE CORE COMPETENCY STANDARDSThe competencies standards will serves as a unifying framework for nursing education, regulation and practice. Specifically, it will serve as:

 a) Guide in developing curriculum in nursingb) Framework in developing test syllabus for entrants into the

nursing professionc) Tool for performance evaluationd) Basis or advanced practice and specializatione) Framework for developing a training curriculum for nursesf) Protect the public from incompetent practitionersg) Yardstick for unethical and unprofessional practice of

nursing 

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The end!!

Thank you for Listening

and Good luck to the

future Nurses!!!

Thank you!! God bless you all!!

CONCEPCION L. GALICIA,RN,MAN

Lecturer