Priorities in Nursing Practice and Nursing Standards of Care

 Establishing Nursing Priorities

1. Prioritizing - decisions of which needs or problems require immediate attention or action and which ones could be delayed until a later time since they are not urgent.
2. Needs that are life-threatening or could result in harm to the client if left untreated are high priorities.
3. Actual problems or needs have higher priority than potential problems or needs.
4. Problems or needs identified by the client are of a higher priority.
5. Principles of Maslow's Hierarchy of Needs or the ABCs may guide decisions.
6. Mutual decision-making for priorities may be made with the client based on the client's needs, desires and safety.

NURSE PRACTICE ACTS

• Definition: passed by each state legislature to regulate the practice of nursing in that state
• Nurse Practice Acts define:
• Scope of Practice
• Education
• Licensure
• Professional Misconduct:
• Negligence
• The 'Impaired Nurse'
• The nurse who violates boundaries
• Administered by the Board of Nursing in each state:
• The nurse must know how their state defines professional misconduct
• For Professional Misconduct, the State Board of Nursing imposes penalties (in order of severity):
• On Probation
• Censured
• Reprimanded
• License Suspended
• License Revoked

STANDARDS OF NURSING PRACTICE AND STANDARD OF CARE

Nursing Charting and Documentation

 EFFECTIVE DOCUMENTATION

• Legal Guidelines for Charting
1. Record the facts legibly, in ink
2. Never erase, scratch out or apply correction fluid. Cross through an error once, date and initial the change.
3. Do not leave black spaces in your nursing notes.
4. Never chart for another person
5. Avoid interpreting patient statements. Record exactly what the patient said in quotation marks.
6. Correct all errors in a timely manner.
7. Chart in a timely manner.
• Computerized Charting
1. Never lend access your ID to another person.
2. Maintain confidentiality of documented information printed from the computer.

TYPES OF DOCUMENTATION

Normal Growth and Development: Infancy

An infant is a baby who is 1 month to 1 year old. Most infants will learn to walk, talk, eat, and interact with others within the same general time frame. This is called normal growth and development.

Infants grow faster while he is in infancy than at any other time in his life. Caregivers will keep a record of his growth. They will write down the following changes each time you bring him in for a checkup:

• Weight: Infants double their birth weight by the time they are 6 months old. They will triple their birth weight by the time they're 1 year old. They will gain about 1 to 2 pounds per month. They will weigh close to 22 pounds by 1 year old. By 2 months, infants may look chubby. Their muscles will get stronger the more they learn to use his legs and arms.
• Length: Infants grow about 1 inch per month for the first 6 months of life. They will grow 1/2 inch per month between 6 months and 1 year of age. They should be 2 times longer than their birth length by the time they are 10 to 12 months old. Most of their growth happen in their trunk (mid section).

Jean Piaget's Cognitive Development Theory

Jean Piaget’s prominent work is his Theory on the four stages of cognitive development. 

He was one of the most influential researchers in the area of developmental psychology in the 20th century whose primary interest was in biological influences on how we come to know, and the developmental stages we move through as we acquire this ability (Singer & Revenson, 1997).

Piaget (1973) believed that the child plays an active role in the growth of intelligence and learns by doing. He regarded the child as a philosopher who perceives the world only as he has experienced it. 

Therefore, most of Piaget’s inspiration in cognitive and intellectual development came from observations of children. In fact, Piaget observed and studied his own three children through each stage of their cognitive development.

The Theory of Cognitive Development focuses on mental processes such as perceiving, remembering, believing, and reasoning. Reasoning is the essence of intelligence, and reasoning is what Piaget studied in order to discover “how we come to know” (Singer & Revenson, 1997). Piaget believed that cognitive development is cumulative; that is, understanding a new experience grows out of a previous learning experience.

Erick Erikson's Theory of Psychosocial Development

Erik Erikson's theory of psychosocial development is one of the best-known theories of personality. Much like Sigmund Freud, Erikson believed that personality develops in a series of stages. Unlike Freud's theory of psychosexual stages, Erikson's theory describes the impact of social experience across the whole lifespan.

One of the main elements of Erikson's psychosocial stage theory is the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experiences and information we acquire in our daily interactions with others.


Identity refers to all of the beliefs, ideals, and values that help shape and guide a person's behavior. The formation of identity is something that begins in childhood and becomes particularly important during adolescence, but it is a process that continues throughout life. Our personal identity gives each of us an integrated and cohesive sense of self that endures and continues to grow as we age.

Kohlberg's Theory of Moral Development

Moral development is a major topic of interest in both psychology and education. One of the best known theories was developed by psychologist Lawrence Kohlberg who modified and expanded upon Jean Piaget's work to form a theory that explained the development of moral reasoning.

Piaget described a two-stage process of moral development, while Kohlberg's theory of moral development outlined six stages within three different levels. Kohlberg extended Piaget's theory, proposing that moral development is a continual process that occurs throughout the lifespan.

Normal Growth and Development

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Patterns of Growth and Development

• Cephalocaudal - head to toe
• Proximodistal - near to far
• Differentiation - from simple to complex

Growth Measures

• Height
• Weight
• Frontal-Occipital Circumference

Research Designs and Research Proposal

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Research Designs

• refer to the way in which the investigator plans and structures the research process
• the design provides flexible guideposts that keep the research headed in the right direction
• Qualitative - one in which the investigator plans to observe, discover, describe, compare and analyze the characteristic attribute, themes and underlying dimensions of a particular unit
• Qualitative - concerned with measuring the magnitude, size or extent of a phenomenon
• Descriptive-Exploratory - observes, describes, explores and assembles new knowledge
• Documentary-Historical - the investigator examines records and documents already in existence, major sources of data include official and unofficial documents, statistics, audiovisual media and general historical data

Research

Research

• means delving into a problem
• systematic, controlled, empirical and critical investigation of hypothetical propositions about the presumed relations among natural phenomena
• general system is followed whose elements are:
1. identification of the problem
2. extensive review of literature
3. formulation of the conceptual framework and hypotheses
4. designing its design and methodology
5. data collection
6. data analysis through the use of statistics and interpretation and drawing conclusions
7. giving recommendations

Roles of Nursing Practice

Roles

• organized set of behaviors that are attributed to a specific office or position
• a set of prescription for the expected behavior of an individual in a position or status category
• sum total of the behavior expected from a person who occupies a particular position and status in a social pattern

 Role Problems

• arise from unclear or ambiguous messages

 Role Conflict

• arise when one receives different directions from several sources

Management

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Management

• art of getting things done through people
• process of getting activities completed efficiently and effectively with and through people in order to attain goals of the organization

Principles of Management

• Division of Labor - specialization leads to efficient work performance
• Authority - managers give orders to make things done
• Discipline - members of organization respect rules and agreements that govern organization
• Unity of Command - a member receives instruction from only one superior
• Unity of Direction - common objective(s) for the entire organization

Leadership

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Leadership

• use of one's skill to influence others to perform to the best of their ability toward goal achievement
• an interpersonal process of influencing the activities of an individual or a group toward goal attainment in a given situation (Maloney)
• the state where a person, a group of persons, a subsystem or an organization is able to influence others to agree on a goal and work towards it

Influence Tactics

• Assertiveness - standing up for one's rights and rights of others without violating the rights of others
• Ingratiation - making one feels important and feels good before making a request
• Rationality - relying on a detailed plan, reasoning or logic
• Sanctions - giving or preventing pay increases or promotions until one gives in to a request

Republic Act 9173 or Philippine Nursing Act of 2002

AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION, REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE KNOWN AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR OTHER PURPOSES

Be it enacted by the Senate and the House of Representatives of the Philippines in Congress assembled: 

ARTICLE I: Title

• Section 1. Title 

• This Act shall be known as the "Philippine Nursing Act of 2002." 

ARTICLE II: Declaration of Policy

• Section 2. Declaration of Policy.

• It is hereby declared the policy of the State to assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses.
• The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system throughout the country.

Board of Nursing Resolution No. 220 (2004)

PROMULGATION OF THE CODE OF ETHICS FOR REGISTERED NURSES

• Whereas, the Board of Nursing has the power to promulgate a Code of Ethics for Registered Nurses in coordination and consultation with the accredited professional organization (Sec. 9, (g), Art. III of RA 9173, known as "Philippine Nursing Act of 2002);
• Whereas, in the formulation of the Code of Ethics for Registered Nurses, the Code of Good Governance for the Professions in the Philippines was utilized as the principal basis therefore: All the principles under the said Code were adopted and integrated into the Code of Ethics as they apply to the nursing profession;
• Whereas, the promulgation of the said Code as a set of guidelines, regulations or measures shall be subject to approval by the Commission (Sec. 9, Article II of RA 9173); and
• Whereas, the Board, after consultation on October 23, 2003 at Iloilo City with the accredited professional organization of registered nurses, the Philippine Nurses Association, Inc. (PNA), and other affiliate organizations of Registered Nurses, decided to adopt a new Code of Ethics under the afore-mentioned new Law;
• Now, Therefore, the Board hereby resolved, as it now resolves, to promulgate the hereunder Code of Ethics for Registered Nurses.

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