Nurse and Contracts

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Contract

• Meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to render some service
• An agreement between two or more competent persons upon sufficient consideration to do or not do some lawful act
• Can be written or oral

Nurses and Crimes

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Crime

•  an act committed or omitted in violation of societal law and punishable by a fine and/or imprisonment or death
• Two elements:
1. Criminal act
2. Evil/Criminal intent

Legal Aspects and the Nurse

Professional Negligence

Negligence

• refers to the commission or omission of an act, pursuant to a duty , that a reasonably prudent person in the same or similar situation would or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property

Elements of a Professional Negligence

1. Existence of a duty on the part of the person charged to use due care under circumstances
2. Failure to meet standard of due care
3. The foreseeability of harm resulting from failure to meet the standard
4. The fact that the breach of this standard resulted in an injury to the plaintiff

Nursing Jurisprudence

Nursing Jurisprudence

• Department of law which comprises all the legal rules and principles affecting the practice of nursing
• Includes the study and interpretation of rules and principles and their application in the regulation of the practice of nursing

Functions of Law of Nursing

• provides a framework for establishing what nursing actions in the care of patients are legal
• delineates the nurse's responsibilities from those of other professionals
• helps to establish the boundaries of independent nursing actions
• assists in maintaining a standard of nursing practice by making nurses accountable to the law

History of Nursing Law

Act No. 2493 (115)

• An act to amend No. 310 regulating the practice of medicine in the Philippines
• Provided for the examination and registration of nurses
• Nurses must apply for registration to the Director of Health
• Requirements: Good moral character, good health and 21 years old

Act No. 2808 (1919)

• An act regulating practice of nursing profession
• the first "True Nursing Law"
• created the board of examiners composed of 3 members
• Examination date on the 2nd Monday of June and December
• First board exam: 10920

Act No. 3025 (1922)

• Amplification of the definition of the nursing profession
• Granting the privilege of registering as nurses without exams the Registered Nurses from the United States
• Change the date of exam: 2nd Monday of April and October

Act No. 4007 (1932)

• Reorganization law of 1932
• Conduct of examination was placed under the direct supervision of Bureau of Civil Service
• Change of jurisdiction over the Board of Examiner under the Department of Public Instruction

Executive Order No. 317 (1941)

• Pursuant to Commonwealth Act 430, transfer of jurisdiction of the board to the Department of Health and Public Welfare

Republic Act No. 546 (1953)

• Organization of the Board of Examiners of nurses
• Provisions regarding nursing schools and colleges, examinations, registration of nurses including sundry provisions relative to the practice of nursing
• Two important sections pertained to the need for registration as nurse before anyone could practice nursing in the country
1. No person shall practice or offer to practice nursing in the Philippines as defined in the Act, without holding a valid certificate of registration as nurse issued by the Board of Examiners for Nurses
2. Not only prohibit the practice of nursing without a certificate of registration issued by the Board of Nursing but also provides the penalty for doing so

Republic Act 4704 (1966)

• Amended certain portions of Republic Act 877
• The membership of the Board of Examiners for nurses was increased 3 to 5 members
• 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 the recommendation of the Commission of Civil Service
• The requisite academic degree for members of the Board was a Master's Degree instead of Baccalaureate Degree in Nursing
• No person was eligible for membership in the board if he/she was over 65 years of age
• The academic qualification for Dean, Directors and Principals of colleges and schools of nursing was raised to that of Master's Degree in Nursing
• The minimum age required of applicants for admission 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/she reached the age of 21 years

Republic Act 6136 (1970)

• 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 injection may be administered under the direction and in the presence of the said physician

Republic Act 7164 or the "Philippine Nursing Act of 1991

• Redefinition of the scope of nursing practice to emphasize
1. The use of nursing process as a scientific discipline in arriving at an appropriate nursing action and care
2. The teaching, management, leadership and decision making roles of the nurse
3. The undertaking of and participation in studies and research by nurses
• Requiring a faculty member who 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
• 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
• Specification of qualifications of administrators of nursing services
• Inclusion of the phrase "unethical conduct" as one of the reasons for revocation and suspension of certificate of registration

Republic Act 9173 or the "Philippine Nursing Act of 2002"

• The Board is now composed of a Chairman and 6 members instead of a Chairman and 4 members
• Submission of names of qualified nominees by the Accredited Professional Organization (APO) to the Commission, three (3) nominees per vacancy, not later than three months before the vacancy
• The Commission submits to the Office of the President two (2) nominees per vacancy not later than two months before the vacancy occurs. The appointment must be issued not later than thirty (30) days before scheduled licensure examination
• Qualifications of Board Members
1. Educational requirement for members of the Board is not limited to registered nurses with Master's Degree in nursing but also to registered nurses with master's degrees in education, or other allied medical profession provided that the Chairperson and majority of the members are holders of a Master's degree in nursing
2. Of the ten years of continuous practice of the profession prior to appointment, the last five (5) years must be in the Philippines
• Added the powers and duties of the Board
1. Adopt and regulate a Code of Ethics and Code of Technical Standards for the practice of nursing within one year from the effectivity of this act
2. Recognize specialty organization in coordination with accredited professional organization
• Licensure Examination and Registration
1. Specific age of applicants has been deleted
2. Specific dates of examination has been deleted
• Specific dates of examination - not earlier than one (1) month and not later than 2 months after the closing of each semestral term
• Ratings
1. Specific number of times an examinee may take the licensure examination has been deleted
2. Added: removal examination shall be taken within two (2) years after the last failed examination
• Revocation and Suspension of Certificate of Registration
1. Added: Implementing Rules and Regulations, Code of Ethics, Code of Technical Standards, for nursing practice and policies of the Board and the Commission
2. Added: Section 28 for practicing the profession during the period of suspension
3. Period of Suspension of the certificate of registration/professional license not to exceed four (4) years
• Nursing Education
1. Added: requirement for inactive nurses returning to practice - nurse who have not actively practiced the profession shall undergo one (1) month of didactic training and three (3) months of practicum
2. Qualifications of Faculty - requirement of clinical experience in a field of specialization has been reduced from three (3) years to one (1) year in a field of specialization
3. The Dean of the College of Nursing must have at least five (5) years of experience in teaching and supervising a nursing education program
• Nursing Practice
1. Scope of Nursing - Duties and responsibilities of the nurse
• Deleted: special training for intravenous injections but Nursing Service Administrators still require formal training for the safety of the patient and the protection of the nurse and of the institution
• Added: special training for suturing the lacerated perineum. (Note: This is being undertaken by the Association of Nursing Service Administrators of the Philippines (ANSAP) with the Maternal and Child Association of the Philippines (MCNAP))
• Added: observe the Code of Ethics and the Code of Technical Standards maintain competence through continual professional education
• Health human resource production and utilization additions
• Comprehensive Nursing Specialty Program
1. The Board is mandated to formulate and develop a comprehensive nursing specialty program that would upgrade the level of skills and competency of specialty nurse clinicians in the country
• Salary. Minimum base pay of nurses in public health institutions shall not be lower than the first step or hiring rate prescribed for Salary Grade 15 pursuant to Republic Act 6758, otherwise known as Compensation and Classification Act of 1989
• Funding for the comprehensive Nursing Specialty Program. The annual financial requirements to rain at least ten (10) percent of the nursing staff of the participating hospital shall be chargeable against the incomes of the Philippine Charity Sweepstakes
• Incentives and Benefits. Incentives and benefits shall be limited to non-cash benefits such as free hospital care for nurses and their dependents and scholarship grants
• Penal and Miscellaneous Provisions
• Penalty for violation of this Act in fines has been increased to not less than fifty thousand pesos (P50,000) not more than one hundred thousand pesos (P100,000)
• Imprisonment of not less than one (1) year nor more than six (6) years or both fine and imprisonment upon the discretion of the Board

COMPREHENSIVE NURSING SPECIALTY PROGRAM

• Nursing Specialty Certification Program has been adopted and a Nursing Specialty Certification Council has been created on the basis of Republic Act No. 7164
• It was done through Resolution No. 14 of the Board of Nursing on February 18, 1999
• The adoption and creation were perceived to oversee the administration of the program by the Specialty Certification Board
• These Specialty Certification Boards were scheduled for creation in each of the four major groups of nursing specialties with the assistance of the Clinical Nurse Association of the Philippines Inc.
• The purpose of this program is to upgrade the level of skill and competence of specialty nurse clinicians in the country

Resolution No. 14 

• contained developments that served as premises and justifications for its issuance
• includes:
1. increasing emphasis on the climate for specialization - advances in science and technology direct initiatives toward high quality performance in a field of choice
2. emergence of the concept of globalization - as imposed by the national laws of countries all over the world, this facilitates the removal of barriers in trade, industry and services
3. response to increasing demands of developments - impels people in the service sector to address the challenges imposed by changes resulting from advancement and innovations in facilities and strategies of healthcare delivery
4. adoption of a system of incentives and benefits - recognizes individual and collective efforts as a process in inspiring nurses and other stakeholders toward preparing practitioners to acquire expertise in delivering service to their clientele
5. current trend of specialization in nursing practice recognized by the International Council of Nurses - the deepening and refining of nursing practice and applying it to the Philippine setting enhances the quality of nursing care and consequently benefits the Filipino clientele
6. the need for a framework of the program, and detailing the mechanics, guidelines and procedures for its implementation - the consultation of the Board of Nursing with the leaders of national nursing association and other concerned nursing groups led to the decision of tasking a special group of nurses to study and prepare a position paper that captures the process of implementing the Nursing Specialty Certification Program. As a consequence, resolution no. 14, series of 1999, details the mechanics, guidelines and procedures for its implementation
• the scope of Resolution 14 is covered in the following headings:
1. the framework
2. definition
3. assumption
4. nursing specialty certification council
• the term, Specialty Certification, in the Resolution is defined in three (3) perspectives:
1. a process
2. as a mechanism
3. as an act
• Special Certification
1. the process whereby qualified agents based on a variety of measures and assessment strategies, confirm or attest that individual nurses who underwent training and instruction for advanced nursing practice in specialized nursing services meet minimum standards set at specified times
2. It is a mechanism that is used to validate achievement of a level of clinical specialty of functional expertise and competence that goes beyond the level of basic licensure
3. the act of a competent authority, embodied in a document certifying that one has fulfilled the requirements of and may practice in a particular level and field of specialization
• Nursing Specialty Certification Council is described in Resolution No. 14 under nine (9) sub-topics, including:
1. Mission
2. Commitment of the Board of Nursing
3. Function of the Nursing Specialty Certification Council
4. Creation of the Sub-specialty Boards
5. Organizational structure
6. Creation of the Appeals panel
7. Creation of the Specialty Certification Board
8. Formulation of the criteria for the selection and qualifications of committee members
9. Levels of certification
• The three (3) levels subject to certification are:
1. Level 1 - Nurse Clinician
2. Level 2 - Nurse Clinician II
3. Level 3 - Clinical Nurse Specialist

Professional Adjustment as a Nurse

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Adjustment

• an educational process referring to changes in  behavior towards better life, better relationships and better contribution to society

Profession

• a calling by which members profess to have acquired special knowledge by training, by experience or both so that they may guide or advice or serve others in that field
• an occupation usually involving relatively long and specialized preparation on the level of higher education and governed by its own code of ethics

Professional Adjustment

• the growth of the whole individual and development of all his/her capacities, physical, mental, social and spiritual towards efficient and effective performance of his/her profession

NURSING AS A PROFESSION

• Education
• with a well-defined knowledge and expertise
• a profession requires an extended education of its member, as well as basic liberal foundation
• Code of Ethics
• required integrity of its members, that is, a member is expected to do what is considered right regardless of the personal cost
• means to monitor professional behavior
• Mastery of the Craft
• depth of knowledge and skills that others without similar education
• expected to make independent decisions using this body of knowledge
• Theory - a profession has a theoretical body of knowledge leading to defined skills, abilities and norms
• Professional Organization
• need to be aware of the issues confronting nursing and the trends in nursing practice
• Accountability
• nurses participates in making decisions and learns to live with these decisions
• responsibility
• Service
• a profession that provides basic service
• Autonomy
• members of a profession have autonomy in decision making and in practice
• Caring
• The most unique characteristic of nursing as a profession is that, it is a caring profession

I. Fundamentals of Nursing Practice

1. Ethics - system of moral principles or moral standards governing conduct; a system of rule of practice applied to a single class of human action (e.g. legal ethics, medical ethics, nursing ethics); a standard to examine and understand moral life
2. Professional Ethics - a branch of moral science concerned with the obligations that member of the profession owes to the public
3. Health Ethics - division of ethics that relates to human health
4. Bioethics - a specific domain of ethics that focuses on moral issues in the field of health care
5. Nursing Ethics - system of principles governing the conduct of nurses; her relationship to the patient, patient's family, fellow nurses and society. Reinforces the nurse's ideals and motives in order to maximize the effectivity of their service. Johnston defines nursing ethics as the "examination of all ethical and bioethical issues from the prospective of nursing theory and nursing ethics"

II. Difference between Ethics and Moral

1. Ethics - moral conduct of the principles underlying the desirable types of human conduct. It is a science of ideals which guides our judgment concerning morality of human acts. Whereas;
2. Moral - refers  to the human conduct of ethics; the application of ethics

• Ethicist Joseph Fletcher differentiates morality from ethics. He states that morality is what you believe is right and good while ethics is the critical reflection about morality and rational analysis about it

III. Importance of Ethics

1. Ethics makes clear why one act is better than another
2. Ethics keep an elderly social life by having agreements, understanding, principles or rules of procedures
3. Moral conduct and ethical system must be intelligently and appraised and criticized
4. Ethics seeks to point out to men the true value of life and attempts to stimulate the moral sense, discover true values of life and inspire men to gain in for quest for these values
5. Ethics is a requirement for human life. It is our means of deciding a course of action. Without it, our actions would be random and aimless. There would be no way to work towards a goal because there would be no way to pick between a limitless number of goals. Even with an ethical standard, we may be unable to pursue our goals with the possibility of success. To the degree which a rational ethical standard is taken, we are able to correctly organize our goals and actions to accomplish our most important values. Any flaw in our ethics will reduce our ability to be successful in our endeavors. (Jeff Landauer and Joseph Rowlands, 2001)

IV. Importance of the Code of Ethics for Nurses

• the four elements of the Code of Ethics for Nurses: nurses and people, nurses and practice, nurses and coworkers, nurses, society and environment and, nurses and the profession give a framework for the standards of conduct. Nurses and nursing students can therefore,

1. Study the standards under each element of the Code
2. Reflect on what each standard means to you. Think about how you can apply ethics in your nursing domain: practice, education, research or management
3. Discuss the Code with coworkers and others
4. Use a specific example from experience to identify ethical dilemmas and standards of conduct as outlined in the Code. Identify how you would resolve the dilemmas
5. Work in groups to clarify ethical decision making and reach a consensus on standards of ethical conduct
6. Collaborate with your national nurses' association, coworkers and others in the continuous application of ethical standards in nursing practice, education, management and research

• Excerpts from ICN - International Council of Nurses, 3, place Jean-Marteau, 1201 Geneva, Switzerland

V. Concept of Nursing

• aspect of moral philosophy which serves as guide in one's judgment or appraisal of the goodness or badness of acts relative to the practice of nursing
• Guiding principles:

1. Nursing practice is predicated on the ideals of service
2. Premised or personal sacrifices and devotion to duty for the benefit of the people
3. As a practitioner, her primary object is to render satisfactory professional service
4. A profound devotion to her professional duties and genuine concern in the advancement of her profession for the promotion of public health and public welfare
5. Primary responsibility is to help in the promotion of health and conversation of human lives commensurate with her knowledge, training, and experience, serve and care with utmost solicitude and giving him always the best of her talent and skill
6. Assumes IPSO-FACTO - the obligation to uphold the noble traditions of the profession
7. As a citizen, a nurse is bound to fulfill her civic duties to abide by the laws, to sufficient knowledge of nursing and medical laws and to cooperate with the state promotion of public health and welfare
8. As a professional practitioner, the nurse should safeguard the reputation and dignity of her co-workers

VI. Responsibilities to the Patient

1. The primary responsibility of the nurse to the patient is to give him/her the kind of care his/her condition needs regardless of his/her race, creed, color, nationality or status. In doing so, the patient's care shall be based on needs, the physician's orders, and the ailment; and shall involve the patient and/or his/her family so that he/she or any of the family can participate in his/her case
2. The nurse can plan with the patient and family a specific nursing care of the patient according to his or family's needs and requirements
3. The nurse should promote learning for the patient
4. When giving care she should not forget that patient and human beings not just bodies afflicted with illness (treatment of person not symptom)
5. A nurse is expected to show more commission to the patient than the physician
6. Her primary consideration in assuming care is a concern for the patient's welfare and safety
7. A nurse is responsible to give facts or information to the patient and his family which they entitled to know
8. A nurse guard as a sacred trust any confidential or private information from the patient even after death of the patient except when it is required to show the interest of justice, public health or public safety
9. Nurses are advised to become familiar with the patient's bill of rights and observe its provisions
10. Nurses should commit themselves to the welfare of those entrusted to their care. They should be loyal to their sworn duty

VII. Responsibilities to the Physician

1. It is expected that nurses will not only carry out doctor's orders accurately and conscientiously but help plan and implement patient care as well
2. He/She should call the physician's attention when he makes mistakes before carrying out his prescriptions otherwise he/she may be liable for the consequences
3. Nurses must report patient's condition including results of therapies so that management of care can be properly monitored and modified as necessary
4. Nurses should familiarize themselves with the various routines, methods or idiosyncrasies of physicians, so that smooth relationships can be maintained. In case the patient has a complaint against the physician, this shall be tactfully brought to the latter's attention
5. Any case of illegal, incompetent or unethical practice by any member of the health team shall be brought to the attention of the appropriate authority through channels within the institutional or agency setting
6. Nurses should remember that any medical act relegated to them is illegal because it is specified in the Medical Law that any licensed nurse who does this, even if supervised, can be held for illegal practice of medicine

VIII. Responsibilities 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
2. Takes part in enlightening the public regarding communicable disease (prevention and cure)
3. Must be active in the performance of her duties as a citizen

IX. Responsibilities to Colleagues

1. Nurses are expected to be able to get along smoothly with their colleagues
2. Nurses shall adjust themselves to the organization and know its policies and procedures. They shall establish good working relationships with coworkers
3. It is important that nurses know their place in the total organization so that they may cooperate, coordinate and maximize their work
4. Situations such as when nurses see their colleagues neglect their duties or are incompetent shall be brought to the attention of the immediate supervisor or appropriate authority within the agency setting before any life could be endangered
5. Nurses should observe utmost caution, tact and prudence with respect to the official conduct of his/her superiors or another nurse
6. Should refrain from making unfair and unwarranted criticisms against another nurse or doing anything that would discredit her colleagues
7. Should not interfere with or take over the nursing care of a patient already under the care of another nurse unless in case of emergency

X. Responsibilities to the Profession

1. A nurse should be zealous in her professional growth by keeping abreast with the least trends in nursing science, act and practice (join a bona fide professional organization)
2. Should be upright, diligent, sober, modest and well versed in both science and the act of her profession
3. Should not solicit patient by any means such as through advertisements, solicitors or agents
4. Must refrain from performing any act or any transaction that may be a discredit to herself or to the profession and to bring to the attention of proper authorities any unethical conduct of any registered nurse

XI. Responsibilities to Other Profession

1. She ought to cooperate in safeguarding the reputation and dignity of the members of other profession

Code of Nursing Ethics

• Under the Philippine Nursing Act, the Board of Nursing is vested with authority to study the conditions affecting the practice of nursing in the Philippines and to exercise powers necessary to insure the maintenance of efficient ethical standard in the practice of nursing, taking into consideration the health needs of the nation
• By necessary implication from this authority and its power to promulgate such rules and regulations may be necessary to carry out the provisions of the Nursing Act, the board has likewise the power to adopt a code of nursing ethics for the guidance of registered nurses in the Philippines in the observance of ethical principles that should govern their nursing practice, conduct and professional relationships
• the professional code of ethics for Filipino nurses provides direction for the nurses to act morally
• strongly emphasizes the four-fold responsibility of nurse, the universality of the nursing practice, the scope of their responsibility to the people they serve, to their coworkers, to society and environment, and to their profession
• prior to 1984, the Code of Ethics used by Filipino nurses was the code promulgated by the International Council of Nurses
• in 1982, the Philippine Nurses Association Special Committee, under the chairmanship of Dean Emeritus Julita V. Sotejo, developed Code of Ethics for Filipino nurses
• the 1982 Proceedings of the Third Annual Convention of the PNA House of Delegates (HOD), published in October 1983, contains a detailed transcript of discussion and eventual unanimous approval of the PNA Code of Ethics for Filipino Nurses
• in 1984, the Board of Nursing, Professional Regulations Commission adopted the Code of Ethics of the International Council for Nurses through Board Resolution No. 633 dated March 21, 1984 adding "promotion of spiritual environment" as the fifth-fold responsibility of the nurse and was enforced in 1989
• in 1989, the Code of Ethics promulgated by the Philippine Nurses Association was approved by the Professional Regulations Commission and though Board Resolution No. 1955 was recommended for use and was approved by the general assembly of the Philippine Nurses Association during the Nurses Week Convention in October 25, 1990
• Pursuant to Section 3 of Republic Act No. 877, known as Philippine Nursing Law, and Section 6 of Presidential Decree 223, the amended Code of Ethics for Nurses recommended and endorsed by the Philippine Nurses Association was adopted to govern the practice of nursing in the Philippines
• A new Code of Ethics for Registered Nurses has been promulgated by the Board of Nursing, in coordination  and in consultation with the Accredited Professional Organization (PNA); in its formulation, the Code of Good Governance for the Professions was adopted and integrated, as they apply to the Nursing Profession
• After consultation on October 23, 2003 at Iloilo City with the accredited professional organization of registered nurses, the PNA, and other affiliated organizations of registered nurses, the Code was adopted under Republic Act 9173 and promulgated by the Board of Nursing under Resolution No. 220 Series of 2004 last July 14, 2004

Philippine Nurses Association

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Vision

• The caring and fortifying light giver committed to providing opportunities for the professional growth and development of world class Filipino nurses

Mission

1. Zealously provide strategic directions and programs that enhance the competencies of nurses to be globally competitive
2. Passionately sustain the quality work life and collegial interactions with and among nurses
3. Continuously strengthen the internal capacity and capabilities for quality care and services to the nurses
4. Enthusiastically explore possibilities of collaboration towards unification of nurses

Proclamation No. 539

• Granted national status to Philippine Nurses Association and the last week of October was designated as the Nurses Week
• to develop consciousness and availability of nursing resource in the Philippines

Letter of Instruction 1000

• compulsory membership to professional association by the Professional Regulations Commission

Fields of Nursing

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Institutional Nursing (Hospital Nursing)

• Wide range of specialization and areas of work (OB, Trauma, Surgery, Internal Medicine, Nuclear, Recovery Room, Critical Care, etc.)

Public Health Nurse

• Main concern is prevention of diseases, promotion of health and vigor of the people in the rural areas (Clinics, RHU, Communities, Mobile Clinics, Diagnostic Centers)

Industrial Nursing

• Looks after the health of the employees
• Function is to maintain a high standard of nursing service in the company, interpret, develop and administer the health programs emanating from the health unit

Republic Act 1054

• requires employment of nurse in a commercial, industrial or agricultural establishment having employee not less than 30 or not more than 200 permanent employees and laborers (but the main duty is mainly to take charge of the emergency medicines for use of the employees)

Special Employment

• employment of nurses on certain vessels
• required by law
• (Republic Act 10 as amended by Republic Act 233) no such vessels with a carrying capacity of 75 passengers or more but less than 150, regularly making voyages lasting more than 24 hours without touching port, any lawfully sail from any Philippine port unless it has a  male nurse in its complement
• To be enforced by bureau of customs
• Penalty - not more than 1000 or not more than 2 years of imprisonment

Military Nursing

Brief History

• National Defense Act - 1940 (Commonwealth Act No. 386)
• Under this law, the Army Nurse Corps was created as component of the medical service of the Philippine Army
• Later the name was changed to Nurse Corps
• Qualifications
1. Single
2. Female
3. Bachelor of Science in Nursing graduate
4. Registered Nurse
5. 21-26 years old
6. Regular or reserve

Nursing Education

• the career leader in nursing education starts with a Clinical Instructor's position up to the Dean of a College of Nursing

School Health Nursing

• must like children a lot
• often work alone, out of touch with other nurses, the hospital and all professional supports they have known
• responsible for the school's activities in the areas of health service, health education and environmental health and safety

Private Duty Nursing

• expected to be expert clinicians as well as expert generalist in nursing
• renders comprehensive nursing care to a client on a one-to-one ratio
• an independent contractor
• patient may be provided care in the hospital or in the home

Clinic Nursing

• requires that nurse possess general skills
• usually a doctor has been in general practice for a number of years - with him, nurse acts as a receptionist, answers phone, does the billing, takes x-rays and ECGs, changes dressing, gives injections and assist in physical examinations
• may do autoclaving of instruments, keep records, order and store supplies, make follow up calls and referrals for patients

Professional Nursing

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Professional Nursing - the performance for a fee, salary or other reward or compensation of professional services

• Undertaking responsible nursing care and supervision of patients involving the whole management of care, requiring or application of principles of the biologic, physical and behavioral sciences
• Observation of the signs of physical as well as mental conditions and needs requiring evaluation or application of principles of biologic, physical and behavioral sciences
• Accurate reporting and recording of facts including evaluation of the whole case
• Supervision of others contributing to nursing care of patients
• Execution of nursing procedures and techniques
• Direction and education to secure physical mental care
• Application and execution of legal orders in writing of physician's orders concerning treatment and medication

Determinants of Professional Practice

• Problems and needs of the people
• Policies and regulations
• Current socio-economic-political and cultural systems

Levels of Care of Nursing Practice

• Promotion of Health
• Prevention of Illness
• Restoration of Health
• Consolation of Dying

NURSING FUNCTIONS

• Independent Functions

1. Involve actions which the nurse initiates herself
2. Autonomous actions based on scientific rationale that is executed to benefit the client in a predicted way related to the nursing diagnosis and client-centered goals
3. Can solve client's problems without consultation to other health care professionals
4. E.g. Health teachings

• Dependent Functions

1. Based on the physician's response to a medical diagnosis
2. The nurse intervenes by carrying out physician's written orders, but requires nursing judgment or decision making
3. E.g. Administration of medications

• Interdependent or Collaborative

1. Therapies that require the knowledge, skill and expertise of multiple health care professionals

CLASSIFICATION OF NURSES

• According to types of position held
1. Administrator or administrative assistant
2. Consultant
3. Supervisor or assistant supervisor
4. Professor, lecturer or instructor
5. Dean or college secretary
6. Head nurse or assistant head nurse
7. Chief nurse
8. General duty nurse or staff nurse
• According to Professional Status

1. Active
2. Inactive

• According to Types of Duty

1. General duty nurses
2. Private duty nurses

• According to the Fields of Nursing where they Devote their Practice

1. Hospital or institutional nurse
2. Public health nurses
3. Nurse educators

Roles and Functions of the Nurse

• Care Provider.  The nurse supports the client by attitudes and actions that show concern for client welfare and acceptance of the client as a person. The nurse is primarily concerned with the client's needs
• Communicator. The nurse communicates with clients, support persons and colleagues to facilitate all nursing actions
• Teacher.  The nurse provides health teaching to effect behavior change which focuses on acquiring new knowledge or technical skills. This role gives emphasis on health promotion and health maintenance
• Counselor. The nurse helps the client to recognize and cope with stressful psychological or social problems, to develop improved personal relationships and promote personal growth. This role includes providing emotional, intellectual and psychologic support
• Client Advocate. The nurse promotes what is best for the client, ensures that the client's needs are met and protect client's rights
• Change Agent. The nurse initiates changes and assist the client make modifications in the lifestyle to promote health
• Leader. The nurse through the process of interpersonal influence helps the client make decisions in establishing and achieving goals to improve his well-being.
• Manager. The nurse plans, gives directions, develops staff, monitors operations, gives rewards fairly and represents both staff members and administration as needed. The nurse manages the nursing care of individuals, groups, families and communities. The nurse manager delegates nursing activities to ancillary workers and other nurses and supervises and evaluates their performance.
• Researcher. The nurse participates in scientific investigation and sues research findings in practice. The nurse helps develop knowledge about health and the promotion of health over the full life span; care of persons with health problems and diasbilities; and nursing actions to enhance people's ability to respond effectively to actual or potential health problems
• Case Manager. The nurse coordinates the activities of other members of the health care team, such as nutritionists and physical therapists, when managing a group of client's care
• Collaborator. The nurse works in a combined effort with all those involved in care delivery, for a mutually acceptable plan to be obtained that will achieve common goals. The nurse initiates nursing actions within the health team.

Nursing Board Resolution on Oathtaking

Ethics in Nursing

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• Ethics
1. Science that deals with principles of right and wrong, good and bad
2. It governs our relationship with others
3. Based on personal beliefs and values
• Principles
1. Respect for persons
2. Respect for autonomy
3. Nonmaleficence and benificence
4. Justice
5. Truthfulness
6. Confidentiality
7. Fidelity

• Nursing practice is governed by legal restrictions and professional standards
• What a nurse can do depends on the nurse practice act in the state in which the nurse is licensed
• Each state defines what constitutes professional misconduct
• The state board of nursing has the authority to impose a penalty for professional misconduct
• Penalties include probation, censure, reprimand, suspension or revocation of the license
• Standards of nursing practice apply to all nurses in all practice settings
• Standards of care are based on facility policy and procedure, nursing education, experience, and publications of professional nursing associations and accrediting groups
• To avoid negligence:

1. Know the standard of care
2. Deliver care that meets the standard and follows the facility's policies and procedures
3. Document care accurately and in a timely manner

• The only employee of a health care organization who may be the legal witness to the signing of an advance directive is a clinical social worker. It is at the discretion of each health care facility as to whether or not this is done. Always check the policy of your facility. A relative or heir to the estate should never be the witness to the signing of an advance directive
• Ethics guide the nurse toward client advocacy and the development of a therapeutic relationship
• Ethical dilemmas result from conflicts in values
• An effective leader modifies his/her style according to the situational requirements
• Final responsibility for any delegated task resides with the Registered Nurse
• The Registered Nurse must monitor delegated tasks and evaluate the outcomes

Client/Patient Rights

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I. Privacy

• Confidential information may only be released by signed consent of the client
• Unauthorized release of client data may be an invasion of privacy
• The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides clients with access to their medical records and more control over how their personal health information is used. Provides privacy protection for consumers of health care.
• You must release information when a court orders, or when statutes require it (as in child abuse or communicable diseases)
• Special regulations apply to release of information about psychiatric illness or HIV

II. Advance Directives (ADs)

• As part of the Omnibus Budget Reconcilliation Act (OBRA), congress established the Patient Self-Determination Act:
• requiring every Health Care Facility receiving Medicare and Medicaid funds to provide written information to adult clients outlining their rights to make health care decisions

OMNIBUS BUDGET RECONCILLIATION ACT of 1990 (OBRA)

• requires that states provide advanced directives as options for clients
• Advance Directives:

1. Document that allows clients to make legal decisions about how they wish to receive future medical treatment
2. May indicate who the client wishes to make medical decisions in situations in which the client is unable to do so
3. Needs to be signed and witnessed and copies kept on file in the physician's office and the hospital
4. Implementation varies among states. In many states the witness to this document should not be a hospital employee, relative or heir to the client's estate. Medical social workers are usually acceptable as witnesses in many states.

• Rights include:
1. right to refuse or accept treatment
2. right to formulate advance directives
• Nurses and other members of the health care team are required to:
1. assess the client's knowledge of advance directives and their status regarding the advance directives process
2. provide information and assistance to the client in developing advance directives
3. plan care that incorporates the client's decisions regarding advance directives
• Three common advance directives are:
• Living Will
• living will indicates the client's wishes regarding:
1. prolonging life using life support measures
2. refusing or stopping medical interventions
3. making decisions about their medical care
• living will is executed while the client is competent and able to make sound decisions
• as conditions change, a living will needs to be reevaluated for relevance
• living wills may differ as based on state laws
• Durable Power of Attorney for Health Care Decisions
• legal document allowing the client to name an adult to act as a personal advocate and make health care decisions if the client becomes incompetent
• can be used to accept or refuse treatment
• in the absence of a living will or a durable power of attorney the health care providers often turn to the family members
• however, in many states a family member does not have the legal authority to make health care decisions unless they are legally appointed guardians or parents
• Do Not Resuscitate (DNR) Status
• follow the facility policy on obtaining and implementing DNR orders
• generally the order must be written by a physician, some facilities may have a policy to allow verbal orders under specific conditions
• the order must be communicated clearly to all personnel caring for the client
• the client or their health care proxy can withdraw the order at any time
• a nurse who attempts to resuscitate a client with a valid DNR order may be committing battery

III. Refusal of Treatment - competent clients may refuse treatment, even life-sustaining treatment

IV. Freedom from Safety Devices/Restraints

• Physical restraints/safety devices require a signed, dated physician's order specifying the type of restraints/safety device and a time limit
• Types of restraints/safety devices

1. chemical
2. physical

• Use the least restrictive form of restraint/safety device
• Know agency guidelines for use of restraints/safety devices
• You must document three factors:

1. why you used restraints/safety devices
2. how the client responded
3. whether the client needs continued restraints/safety devices

• Restraining clients without consent or sufficient justification may be interpreted as false imprisonment

GUIDELINES FOR SAFETY DEVICES

• Health care providers can legally restrain a client under certain conditions defined by the law and by the health care facility's policies and procedures
• The safety devices/restraints must be necessary to meet the client's therapeutic needs or to ensure the safety of the client or others
• The least restrictive type of safety device/restraint must be used first
• Use of safety devices/restraints must be accompanied by the health care provider's orders except in emergency
• The client must be closely monitored when in safety devices/restraints
• Safety devices/restraints should be released periodically and the skin integrity of the area checked for breakdown
• Document all pertinent details including why the safety devices/restraints are being used and client's response
• Make sure that the orders for safety devices/restraints are written and updated according to the policy of the facility; more commonly every 24 to 48 hours

V. Informed Consent

• Mentally competent adult client must give his/her own consent; parents or legal guardians may give consent for minors
• Clients need to understand:

1. Purpose of the procedure
2. Any reasonable alternatives
3. Risks, consequences and benefits of the procedure and the alternatives
4. Risks and consequences if the treatment is refused

• The physician caregiver has the legal obligation of obtaining a client's informed consent to medical/surgical treatment
• The nurse may be assigned the task of obtaining and witnessing the client's signature
• The nurse who is concerned about the validity of an informed consent has a legal obligation of telling the physician and the nursing supervisor about the concern
• Basic Requirements

1. Capacity
2. Voluntarism
3. Information

• The client must understand:

1. purpose of the procedure and expected results
2. anticipated risks and discomforts
3. potential benefits
4. any reasonable alternatives
5. that client may withdraw consent at any time

• The care provider has the legal obligation to obtain informed consent for medical treatment but the nurse should confirm the consent and answer the client's questions

VI. Transition Planning

• recognizes that clients are not discharged from care but moved across the continuum to another level