The Law and Nursing Practice

7/30/2019 The Law and Nursing Practice

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The Law and Nursing

Practice

NCM 100 Part II



Laws affecting Nursing Practice

On Nursing

On Family, Women, and Children

On Environment

On labor and work settings



RA 7160 Local Government Code Transfers the responsibility for delivery

of basic services and facilities of the

national government to local

government units

RA 3572 Communicable Disease Act

of the Philippines

All communicable diseases should be

reported

RA 4073 Leprosy Act of the Philippines

Treatment of leprosy in local level

RA 3720 Food, Drugs, and Cosmetics

Act

Creation of BFAD

RA 6675

Generics Act of 1998

Promote, require, and ensure theproduction, supply, distribution, use,

and acceptance of drugs and medicines

identified by their generic names.

RA 8423 The Philippine Alternative

Medicine Act

Created the Philippine Institute of

Traditional and Alternative Medicine



RA 9165 Comprehensive Dangerous

Drugs Act of 2002

Sale, administration, delivery,

distribution, and transportation of

prohibited drugs are punishable by law

RA 7305 Magna Carta for Public Health Workers

Benefits and privileges of health workers working in the government

RA 5901 Forty Hours Law Requires that nurses working in a 100-

bed and above hospital or in an area of

one million population should work

forty hours a week

RA 1054 Occupational Health Act Free emergency medical and dental

services to employees

RA 7875 National Health Insurance

Act

Creation of PhilHealth

RA 8344 Medical Emergency Response

Act of the Philippines

Mandatory treatment of emergency

cases referred to hospitals

RA 7392 Midwifery Law Nurses may be licensed as midwives by

submitting 20 delivery cases and pass

the examination



RA 8749 Clean Air Act of 1999 An act regulating the use of incinerators and

plant-based fume systems

PD 825 Garbage Disposal Code Provides penalty for improper disposal of

garbage and other forms of uncleanliness

PD 856 Code of Sanitation Control of all factors in man‟s environment that

affects health

PD 996 EPI Code Compulsory immunization of children below

eight years old against CD

PD 1204

Family Planning Code

Participation of other government agencies inthe formulation and implementation of policies

in family planning

EO 51 Milk Code of the Philippines Prohibition of advertisement on milk formulas

for babies under two years of age

LOI 949 Primary Health Care Delivery Basic services to be delivered at the barangay.

LOI 1000 CPE programs Members of APO are priorities in hiring of

employees

LOI 47 Responsible Parenthood Education Directs all schools of medicine, nursing, midwifery,

and allied medical services and social work to integrate

family planning in their curricula



RA 1000 Civil Service Act of the

Philippines

Eligibility of board and bar passers to

civil service

RA 7600 Rooming – in and Breastfeeding

Act of 1992

Provides that babies born in private and

government hospitals should be roomed-in with their mothers

BON

Resolution

No. 110

Safe Nursing Practice

evaluation standards

Standardization of evaluation tools for

nurses

BONResolution

No. 220

Code of Ethics for Filipino Nurses

Promulgation of COE

BON

Resolution

459 series of 2002

Maternal and Child Nursing

Standards of Practice

RN-RM registrations

Proclamation

No. 539

Nurses’ week celebration Last week of October as the official

nurses‟ week

PD 651 Birth Registry Code Requires registration of birth within 30

days after delivery



Professional roles and

accountabilities

Act of commission – something was doneincorrectly and unreasonable.

Act of omission – something that should be

done was not done. Professional negligence – when a person

committed negligence while practicing hisprofession.

Prudence – refers to habitual carefulness toavoid errors and following the most polite andprofitable course of action.




accountabilities

Liability – the quality or state of being responsible to

account for one‟s obligation and actions and to make

financial restitution for wrongful acts.

Accountability – one‟s liability to answer for his act or

conduct.

Responsibility – refers to the obligation to answer for

an act done and to repair any injury it may have

cause.

Sanction – punishment for violation of accepted

norms of social conduct.



Legal roles and responsibilities

Nursing functions:

Independent Function – nursing actions

initiated by the nurse herself

Dependent Function – concerned with carryingout legal orders of the physician in relation to

the medical plan of care

Interdependent Function – involves carrying

out activities that have been decided upon inconsultation or collaboration with other

members of the health team



Legal roles and responsibilities

Code of Good Governance for theProfessions (EO 220)

Service to others

Integrity and objectivity Professional competence

Solidarity and teamwork

Social and civic responsibility

Global competitiveness Equality of all professions




accountabilities

Contractual relationships – the relationship of nurse

and the patient which depends on the settings of a

particular workplace.

Independent NursePractitioner

Nurse employed by ahospital

Contractual relationship

with the client isindependent.

The nurse represents and

acts for the hospital andtherefore must functions

within the policies of the

agency.



Contractual relationships

Contracts – a meeting of the minds between two

parties wherein one binds himself with respect to the

other, to give something or to render some service. It

is also an obligation whereby an agreement is

entered into upon sufficient consideration to do or notto do a particular thing. A valid contract consist all the

following elements:

Consent

Object or subject matter of the contract

Cause of contract



Contractual relationships

Breach of contract – violation or non-performance of anexpressed or implied agreement without ground or just cause.

Note: A contract is considered annulled if one of the parties isincapable of giving consent to contract or when the consent isinitiated by mistake, violence, intimidation, undue influence, or fraud.

Express contract Implied contract

The agreement is formal and mentioned

either verbally or in writing

Concluded or inferred agreements from

the overt acts or conduct of the parties,

which the law presumed or ascribed as

the manifestation of intention of parties

to enter into contract



PROFESSIONAL NURSE

1.Function within the scope of education and job description

2.Follow procedure and policies of the employing agency

• Take appropriate steps to obtain complete nursing histories •Observe and monitor the client adequately. Communicate and record

significant changes in client‟s condition to the physician

•Carry out physician‟s orders promptly and correctly, provided that the

orders are not ambiguous or considered dangerous for the client

•Check any order that the client questions

•Identify clients before initiating any interventions or nursing actions

•Perform procedures appropriately

•Protect clients from falls and preventable injuries

•Document all nursing assessment and interventions accurately andpromptly

• Ask for assistance and supervision in situation for which they feel

inadequately prepared.

1.Build and maintain a good rapport with clients



STUDENT NURSE

1. They are responsible for their own actions and liable for their own acts of negligence

committed during the course of clinical experiences 2. The student in her late teen and mentally competent is treated by the law as an adult

and as such is not free form potential liability

3. They are not usually considered as employees of the agencies in which they receive

clinical experience since this nursing service program contract with agencies to provide

clinical experience for students

4. In the negligence involving nursing students, the hospital or agency and the educational

institution will be held potentially liable for negligent actions by the students

5. Students in clinical situations must be assigned activity within their capabilities and be

given reasonable guidance and supervision. Failure to provide reasonable supervision

and or assignment of a client to a student who is not prepared and competent can be a

basis for liability 6. Nursing students need to comply with the policies of the agency in which they obtain

their clinical experience

7. Nursing students need to comply with the policies and definitions of responsibility

supplied by the school of nursing



Common liabilities

Crime – an act

committed in violation of

law and punishable by a

fine and/or

imprisonment. An actdoes not have to be

intended to be classified

as a crime.

Classifications:

Felony – a crime of

serious in nature, such

as murder, punishable

by a term in prison.

Misdemeanor – an

offense of a less

serious in nature and is

usually punishable by afine or short term jail

sentence or both.



Common liabilities

Tort – a civil wrong committed against a

person or a person‟s property and can be an

act of commission or omission.



Tort

Intentional torts: Fraud – the false presentation of some facts with the intention that it will

b acted upon by another person.

Invasion of privacy – direct wrong of personal in nature. The effect of revealed information may injure the feelings of the person.

Defamation – may be a false communication or truth that results to

damage the reputation of a person. May be classified as libel (anyprinted material) or slander (spoken).

Assault – described as an attempt or threat to touch another personunjustifiably.

Battery – the willful touching of a person or his part that may or may notcause harm.

False imprisonment – unjustifiable detention that deprives a person of personal liberty for any lengths of time.

Note: The client has the right to insist of leaving the hospital premisesthough it may be detrimental to his health. Detention should only beimposed to protect the public or protect the individual from possibleharm.



Tort

Unintentional tort:

Negligence – the commissionor omission of an act, pursuantof duty that a reasonablyprudent person in the same or similar circumstance would or

would not do. It is also actacting or non-acting of which isthe proximate cause of injury toanother person or his property.

Malpractice – improper or unskillful care of a patient by a

nurse. It also denotes steppingbeyond one‟s authority withserious consequence.

Example forms of negligence:

Failure to report observation toattending physician

Failure to exercise the degree of

diligence which thecircumstances of the particular case demands

Mistaken identity

Medication errors

Defects in equipments that may

cause falls or harm to thepatient

Errors due to family assistance



Common legal concerns

Confidentiality – any information that the

patient communicates to the nurse should not

be disclosed.

Consent to treatment – assumes that all adultindividuals are legally capable of consenting

to treatment.

Right to refuse treatment – as a basic human

right, the nurse must respect the refusal of a

treatment from a patient‟s point of view.



Points to observe to avoid criminal

liability:

Be very familiar with the Philippine

Nursing Law

Be aware of the laws that affects the

nursing practice

Obtain a copy of job description andagency’s rules and regulations

Upgrade skills and competence

Accept responsibilities that are

within the scope of job description

Do not delegate responsibilities to

others

Determine the competence of the

subordinates



Ethico-moral and legal aspects

Code of Ethics for Registered Nurses (BONResolution 220 of 2004)

Code Ethical principles Guidelines

Registered Nurses and People Individuality must be

respected

Confidentiality of

information

Consider thedifference of the

individual

Respect the rights of

the person

Registered Nurses and Practice Maintain quality

delivery of care

Know the definition

and scope of nursing

practice through the

laws

Be legally responsible

to any actions



Registered Nurses and Co-

workers Respect co-nurses

Build rapport to the

other health team

members

Conform with the

culture

Act in a civil manner

Registered Nurses and Society

and Environment Build linkages

Promote health

Active community

participation

Registered Nurses and the

Profession Maintain loyal to the

profession Contribute to the

improvement

Support organizations

Code of Ethics for Registered

Nurses



Universal doctrines

Res ipsa loquitur Respondent superior Force majeure

„The thing speaks

for itself‟

The accident itself

affords reasonableevidence

The event which

caused the damage

would not have

occurred without

some fault of theperson sought to

be held responsible

“The servant

represents the

master”

Applies only whenthe relation of the

master and servant

is show to exist

Does not apply

where the injury

occurs while theservant is acting

outside the

legitimate to scope

of his authority

“Act of God”

Irresistible or

superior force

A fact or accident which human

prudence can

neither foresee nor

prevent

No persons shall

be responsible forthese events which

could not be

foreseen, or though

foreseen, were

inevitable



Universal doctrines

Good Samaritan Act – protects health care

providers who provide assistance at the

scene of an emergency against claims of

malpractice, provided this is not willful wrongdoing or gross departure from every standard

of care.

Note: The nurse may also be held liable as

an individual in case of inappropriatebehavior.



Common ethical principles

Ethics – the study of morality andphilosophical reflection on its norms andpractices. It also addresses the question“what should I do in this situation?”

Nursing ethics – moral principles governingthe nurse‟s behavior towards her patients,colleagues, society, and the profession.



Common ethical principles

Informed consent – process by which after the health providersinformed the possible outcomes, alternatives, and risks of atreatment, the patient is given the opportunity to autonomouslychoose a course of action.

Non-compliance – unwillingness of the patient to participate inhealth care activities.

Beneficence – nurses are expected to do the beneficial good for the patient.

Non-maleficence – to do no harm or intentional harm for thepatient

Veracity – the practice of telling the truth

Confidentiality – non-disclosure of private or secret informationwith which one is entrusted.

Justice – relates to fair, equitable, and appropriate treatment inlight of what is due or owed to persons

Fidelity – related to the concept of faithfulness and keeping of promises.



Death and nursing practice

Advance health care directive – a living will which states thehealth care preferences, including the types of specialtreatments that the patient may or may not want at the end of life, desire for diagnostic tests, surgery, cardiopulmonaryresuscitation, or organ donation.

Will – an act whereby a person (decedent or testator) ispermitted with the formalities of prescribed by law, to control tocertain degree the disposition of his estate to take effect after hisdeath. Persons who can make a will include:

All persons who are not expressly prohibited by law

At least 18 years of age

Persons of sound mind at the time of execution of the will



Kinds of Will

Notarial Holographic Nuncupative

Subscribed or

signed by the

testator or by someother person in the

presence of the

testator.

Expressed direction

and attested by thetestator and a

witness

Entirely written,

dated, and signed

by the testatorhimself.

It is not subject to

any specific form

and need not be

witnessed but needsto be authenticated

by authorities.

Oral will

Direction of the

testator prior to hisdeath



Elements of a valid notarial will:

It must be in writing It must be executed in language known to the testator

It must be subscribed by the testator‟s presence and by hisexpress direction to provide testamentary capacity. (Thecapacity to comprehend the nature of the transaction in whichthe testator is engaged.)

It must be attested and subscribed by three or more crediblewitnesses in the presence of the testator and of one another

It must be signed on the left margin, on each and every pagethereof except the last, by the testator as well as theinstrumental witnesses

All its pages must be numbered correlatively in letters place onthe upper part of the page

It must contain an attestation clause. (The witnesses certify thatthe instrument has been executed before them)

It must be acknowledge before a notary public by the testator and the witnesses.




DNR – stands for „do not resuscitate,‟ also called

„compassionate care‟ which means the health

providers will not perform cardiopulmonary

resuscitation in case of the situation permits it.

Advantage Disadvantage

Client may decide Good prognosis

Clients ability to cope

The benefits outweighs burden

Will not provide benefit due toterminal debilitating disease

The quality of life is not acceptable

Will just prolong suffering

The deterioration caused by CPR

would be unacceptable to them




Euthanasia – the practice may indicate

liability on the part of the health providers.

Usually involves withdrawal of life sustaining

measures, especially nutrition and hydration.



End!

The Law and Nursing Practice

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