Professional Adjustment

Roberto C. Sombillo RN, RM,

MAN
Profession

A calling in which members

profess to have acquired special
knowledge, by training or
experience or both, so that they
may guide, serve or advice
others in that special field
Characteristics of a profession

Special Education
Code of ethics
Research Orientation
Autonomy, Authority, Accountability
Body of knowledge
Service Orientation
Professional organization
Professional
Nursing
The performance for salary or
remuneration, of professional
nursing service, particularly that
of diagnosing and treating
human responses and potential
health problems.
Legal Basis of Professional
Nursing Practice

Republic Act 9173 or the nursing law

of 2002

> Defines nursing, set standards for the

nursing profession and give guidance in
the scope of practice.
> Contains general statements of
appropriate nursing actions
> Goal: protection of the general public
 As a registered nurse, which of the following can
be performed within the meaning of the Nursing
Act of 2002?
1. Internal examination during labor and delivery in
the absence of ante natal bleeding
2. Suturing of perineal lacerations
3. Nursing care of pregnant mothers during labor and
delivery
4. Administration of medications and therapies
including IV
a. 1,2,3
b. 1,3,4
c. 2,3,4
Answer: B
 Petra chose nursing as her life-long career. It is
necessary that she must understand this
profession as to guide her practically and
professionally as a nurse. Which among the
following phrases best describes what
professional nursing is all about?
a. A nurse has always experienced proper community
health training
b. Has independence towards the proactive of her
nursing profession
c. Always observe ethical and professional practice
d. Provide diligent care for all regardless of their
financial status
Answer: C
 To avoid legal embarrassment, the nurse
should do the following?
a. He must have basic knowledge regarding
the new Philippine Nursing Law
b. He is aware of the laws affecting nurses
c. Upgrade one’s skills and competence as a
nurse
d. All of the above
Answer: D
 Carmelita is a nurse who just passed the
local licensure examination for nurses.
She knows that professional practice of
nursing involves all the following, except:
a. Administration of intravenous injection after
completion of training
b. Motivation of individuals, families and
communities
c. Undertaking consultation services
d. Participation in teaching, guidance and
supervision of students
Answer: C
 Common Law
is derived from principles or
social mores rather than from rules
and regulations. It consists of
broad, interpretative principles
based on reason, traditional
general and common sense.
 Nursing
Jurisprudence
Department of law which
comprises all the legal rules and
principles affecting the practice of
nursing the study and interpretation
of rules and principles and their
application in the regulation on the
practice of nursing
Law
Are rules and regulations established
by a governing authority (sovereign
power) to institute and maintain
orderly coexistence by commanding
what is right and prohibiting what is
wrong.
Functions of Law in the Society

1. define relationships among

members of a society and state
which activities ate permissible or
not
2. describe what forces maybe
applied to maintain rules and by
when is to be applied.
3. provide solutions to problems
4. refine relationship between person
and group when conditions of life
change.
Basic Principle of Law

• Based on concern for justice and

fairness
• Characterized by change
• Actions are judged on basis of
universal standards of what is similarly
trained, reasonable and prudent
person would done rather in similar
circumstances
• Each individual has right and
responsibilities
 Types of Law

Law govern the relationship of private

individuals with government.

Public Law

Refers to the body of law that deals with

relationship between individual and the
government and the governmental agencies. An
important segment of public law is criminal law
which deals with actions against the safety and
welfare of the public Examples are homicide,
manslaughter and theft.
Private Law or Civil Law

Is the body of law that deals with

relationship among private
individuals. It can be categorized
into a variety of legal specialties
such as contract law and tort law
Contract law involves the
enforcement of agreements
among private individuals

Torts laws define and enforce

and enforce duties and right
among private individuals that
are not based on contractual
agreement.
Sources of Law

Constitution

The constitution of the Philippines is the

supreme law of the country. It established
the general organization of the
government, grants certain powers to the
government, and places limits on what
government may do. The constitution
created legal rights and responsibilities
and the foundation for a systems of
justice.
Legislation (Statutory law)
Laws enacted by any legislative body
are called statutory laws.

Administrative Law

When a state legislature passes a

structure, an administrative agency is
given the authority to create rules and
regulation to enforce the statutory laws.
Functions of law in the
profession

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.
 Nurses and legal offenses

Crimes

Actions/behaviors which violate law

and is punishable by fine,
imprisonment or death

There 2 types according to severity:

felonies and misdemeanor
Felonies

Relatively serious offenses punishable

by imprisonment, fines or even death.
Offenders lose their civil rights.

Misdemeanor
Is less serious crime punishable by fine
and short-term jail sentence.
 Board Question!
 When the law attaches the capital
punishment, the felony is
considered:
a. grave
b. less grave
c. light felony
Answer: A
 Which of the following is a grave
felony?
a. Guilty of committing euthanasia
b. Untidy appearance while on duty
c. Reporting a wrong doing of a
colleague
Answer: A
 Felony is considered consummated when:
a. All the elements necessary for its execution are present
b. The offender performs all the acts of execution which
would produce the felony as a consequence but
nevertheless do not produce it by reason of causes
independent of the will of the perpetrator
c. The offender commences the commission of a felony
and does not perform all the acts of execution which
should produce the felony
d. None of these
Answer: A
Criminal liabilities can be
classified according to:

Manner of commission

Dolo – deceit; deliberate intent

Culpa - fault; product of

imprudence, negligence, lack of
foresight or skills
Stage of execution

Consummated – all elements for execution

of the crime has been completed

Frustrated – offender performs everything

as intended but fails due to external causes

Attempted – overt actions to commit crime

has been commenced, but the elements
were not completed due to reactions other
than this own spontaneous desistance.
Degree of participation

Principals – direct part in the execution of a

crime; cooperate in committing an act which
crime will not be accomplished

Accomplice – cooperate in execution of

offences by previous/stimulation acts

Accessories – profit or assist offenders to

profit from crime; conceals, destroy the body
of crime, effects, instruments to prevent
discovery of crime; harbor, conceals, and
assists in escape of principal with abuse of
authority
 Board Question!
 Situation: Vivian is two months pregnant.
Her friend Donna referred her to Sandra, an
abortionist. Vivian without the consent of
Carlo had an abortion.
 If those involved be charged legally, who is
considered as the principal of the crime?
a. Vivian
b. Sandra
c. Donna
Answer: B
 Who is to be charged as an
accomplice?
a. Donna
b. Sandra
c. Vivian
Answer: A
 A nurse becomes liable as an
accomplice in an abortion if she:
a. performs the act
b. refers the pregnant mother to
abortionist
c. conceals the evidence of the
crime
Answer: B
 If during the investigation, the pieces of
evidence were not found because
Carling, the maid of Juaning burned it.
Carling is considered as:
a. Accomplice
b. Accessory
c. Principal
d. Co-Principal
Answer: A
Contract
- An agreement between two or more
persons upon sufficient consideration to
do or not to do some lawful act.

- One binds self with respect to other

give something or to render some
service.

- An agreement which creates an

obligation

- Can be written or oral

Expressed contract

When two parties discuss and agree orally

in writing to its terms

Implied contract

- One in which there has been no

discussions between parties, but the law
considers that a contract exists

- Law ascribes an objective intention to

enter a contract “facio ut des” ( I do that
you may give)
 Elements of a valid contract

Agreement/ Mutual consent – contracts

must be binding for both parties

Legal Subject matter – nothing in the

contacts is contrary to law or public order

Cause of the obligation which is

established

Contractual capacity – parties are

eligible to enter a contract
Objects of contracts

• All things which are within the

commence of man

• All rights which are

transmissible

• Future inheritance
Prerequisites in entering a contract

 Be of legal age

 Be sound of mind

 Not under the influence of

intoxicating substances or fear of
bodily harm

 Mentally competent
Termination of Contract

Most nurse – patient contracts end

when

• Treatment is complete
• Bills
• Has been paid
• Waiver to discharge against
medical advise has been signed
 An agreement between two or more
persons to do or not to do a
particular thing is known as:
a. agreement
b. contract
c. subpoena
Answer: A
 A contract is:
a. A bond gathered by a nurse from the
patient
b. A document that permits two person to
offer the same services
c. A written agreement between the nurse
and the patient
d. An agreement which creates an obligation
Answer: D
 When a patient enters a doctor’s
clinic for treatment, this is an
example of:
a. formal contract
b. implied contract
c. single contract
Answer: B
 Which of the following statement is
false about an implied contact?
a. Its agreement is presumed
b. Its agreement is inferred from the
acts of the parties
c. It must still have consent by the
parties
d. It is a formal contract
Answer: D
 A verbal agreement where one
undertake to render service to another
in which either party agrees to give for
a fee or renumeration is enforceable:
a. Formal written contract
b. Contract that is null and void
c. Form of an informal contract
d. Form of an implied contract
Answer: D
Legal offense

Breach of Contract

is the failure to perform an

agreement whether expressed or
implied, without cause
Legal excuse or defense

Torts

• A civil wrong committed against a

person or property, excluding
breach of contact, which calls for
compensation in damages
• The wrongdoing can be inflicted
by commission or omission
• Can be intentional or
unintentional
See Intentional Torts Table
Unintentional Torts

Negligence

Doing an act which a prudent person

would not do or not taking an act which a
prudent person would do in the same
situation
 Can be considered as grave felony if
done with obvious disregard of the safety
of others, or indifference to injury that is
bound to fallow one’s act, specifically
when it results to injury or death

Nurses are liable for poor outcomes if

and only if there conduct is negligent.
Gross Negligence/ Reckless
Imprudence
Involves extreme breach of care, in
which the damage caused was not
immediate or danger is not evident or
manifested

Simple Negligence
Manifesting lack of precaution in which
the damage caused was not immediate
or the danger is not evident or
manifested.
Malpractice

Professional negligence
Failure to meet the standards of
acceptable care which results to harm
to other person
Negligence that occurred while the
person was performing as a
professional
Elements of Negligence and
Malpractice

1. Duty
2. Breach of Duty
3. Foreseeability & Causation
4. Harm or injury
5. Damages
 Doctrines Applicable To
Negligence Suits

Respondeat Superior

“let the master answer for the

subordinates”
where an agent acts through the
agency of another (superior), the latter
is himself acting through the former
 Res Ipsa Loquitor

• “ the thing speaks for itself”

• when a thing which has caused an injury is

shown to be under the management of the party
charge with negligence, the accident is as such
as in the ordinary course of thing will not happen
if those who have such management used
proper care, the accident itself affords
reasonable evidence in the absences of an
explanation by the parties charge that is those
from the want of proper care.
• Three elements

(1) the event would have not

occurred if the nurse exercised
prudent care,

(2) the accident occurred within

exclusive control of the nurse,

(3) no voluntary action was done

by the injured party.
 Force Majeure

• “irresistible or superior force”

• no one shall be held liable for

negligence done due to an event that
human prudence cannot foresee,
prevent or control
• pertains to act of God and of nature
 Situation: Nurse Robert is the scrub nurse in the
surgical team which performed exploratory
laparotomy. Dr. Leonard was the surgeon, Nurse Cha
was the circulating nurse and Dr. Siony was the
anesthesiologist. After the operation, the patient
complained of severe abdominal pain while in the
recovery room. X-ray showed a mosquito forceps left
in the patient’s abdomen.
 The nurses are considered guilty based on the
doctrine of:
a. Res ipsa loquitur
b. Respondeat superior
c. Force majeure
 Answer: A
 The thing speaks for itself
 The doctrine of respondent superior
applies:
a. Where the injury occurs while the servant is
not within the legitimate scope of his
authority
b. When the injury occurred in the course of his
employment
c. When the injury occurred outside the
commerce of man
d. When the instrumentality was with in the full
control of the servant
Answer: B
 The test for liability under the doctrine
of respondent superior is the:
a. Power of master servant
b. Inquire itself
c. Extent of damage caused
d. Circumstances surrounding the act
Answer: A
 The nurses were guilty of professional
negligence, which of the following are the
elements of the act?
1. existence of a duty on the part of the person
charged
2. failure to meet standards of care
3. foreseeability of harm resulting from failure to
meet standards
4. the power to control over the circumstances
a. 1,2,4
b. 1,3,4
c. 1,2,3,4
Answer: D
 The following are possible penalty
of the act except:
a. revocation of license
b. life imprisonment
c. monetary penalty
Answer: A
 The professional license that has
been revoked means:
a. suspension to practice nursing
b. removal of license number
c. cancellation of the license
Answer: A
 A nurse who executes a doctors order,
which to her honest belief or judgment
may endanger the life of the patient
can be accused of:
a. Malpractice
b. Accessory
c. Accessory
d. Criminal negligence
Answer: D
 Negligence means failure to:
a. Observe the behavior of an
unscrupulous person
b. Behave properly as a professional
nurse
c. Carry out one’s duties and function
d. Do what is supposed to do
Answer: C
Definition of Terms

Murder – killing of another person other

than relative with proven malice or
premeditation

Parricide – killing of father, mother or child,

whether legitimate or illegitimate, or any of
his ascendants or descendants including the
spouse.

Homicide – killing of any human creature. It

is not necessarily a crime, committed
without criminal intent and without criminal
consequence.
Infanticide – killing a child less than 3 days
of age

Abortion – expulsion of fetus so early that it

has not yet acquired the power of sustaining
independent life

Simulation of Birth – substituting one child

to another, falsification of birth favoring
adoption

Burglary – entry into building with intent to

commit a theft or felony inside the building
Robbery – direct taking of property from
another by the use of force, intimidation or fear

Arson – burning a building or structure with

malicious intent

Rape – Forcible penetration of organ o

copulation or any inanimate object to any body
orifice of the offended party

Child molestation – engaging in any sexual act

with a person under age 18

Drug charges – possession and/or trade of

control substance
 The essential element to determine
parricide is:
a. Presence of the body of the crime
b. Kind of weapon used
c. Part of victim’s body at which the
weapon is aimed
d. The relationship of the offender with
the victim
Answer: D
 Infanticide is the unlawful killing of
an infant under:
a. Three days old
b. Three months old
c. Under 3 lbs. baby weight
d. Three years old
Answer: A
 Any person who kills his father is
guilty of:
a. Parricide
b. Murder
c. Infanticide
d. Abortion
Answer: A
Considerations to Criminal Liability

Justifying Circumstances (there is no

crime in the eye of the law)

unlawful aggression on the part of the

offended or injured party

reasonable necessity of the means

employed by the offender

lack of sufficient provocation on the part

of the offender
Exempting Circumstances (there is
crime committed but no criminal on account of
absence of free will or voluntariness)

imbecile or insane person, unless

the latter has acted during a lucid
interval

under nine years old

over nine and under fifteen years

old (unless acted on discernment)
 under the compulsion of an
irresistible force
any person who while a
performing a lawful act with due care,
causes an injury by mere accident,
without fault or intention of doing it
acting on impulse of an
uncontrollable fear of an equal or
greatly injury
failure to perform an act required
by law when prevented by some
insuperable cause
Mitigating Circumstances (penalty is
lessened)

circumstances otherwise justifying

or exempting
under 18 years of age; over 70
years old
offender had no intention to
commit so grave a wrong as that
committed
sufficient provocation or threat on
the part of the offended party
immediately preceded the act
 the act was committed in the
immediate vindication of a grave
offense to the committing felony, his
spouse, relatives whether legitimate
or not

acted on impulse so powerful as

naturally to have produced passion or
obfuscation

surrendered himself or voluntarily

confessed his guilt
• deaf, dumb, blind or other physical
defects that restricts better
communication

• illness that would diminish the

exercise of his will power without
however depriving him of
consciousness of his acts
Aggravating Circumstances (penalty
is increased)

advantage taken by the offender of

his public possession
crime committed in contempt or
with insult to public authorities
act committed with abuse of
confidence or obvious ungratefulness
crime committed during
conflagration, shipwreck, earthquake,
epidemic or misfortune
 crime committed in consideration
of a piece, reward, or promise

crime committed by means of

inundation, fire, poison, explosion,
standing of a vessel or anything
involving great waste or ruin

act committed with evident

premeditation

fraud or disguise are employed

 Circumstances or actions which are
said to be in accordance with law is
said to be:
a. Justifying
b. Exempting
c. Mitigating
d. Aggravating
Answer: A
 All of the following are exempting
circumstance except:
a. Imbecile
b. 8 years old
c. performance of a lawful act
d. offender id deaf and dumb
Answer: A
 When a politician takes advantage
of his power in the performance of
lawful actions this is considered as:
a. justifying circumstances
b. exempting circumstances
c. mitigating circumstances
d. aggravating circumstances
Answer: D
 Which of the following is a
mitigating circumstances?
a. Act committed during epidemic or
calamity
b. Obeying a lawful order of the
superior
c. Accidental killing
d. None of the above
Self-Protection of the Nurse

familiarity with the laws, code of

ethics, rules and regulation, and
standards of practice
clinical competence
cultural sensitivity and respect
self-awareness
sound management
concept of personal liability
documentation/recording
Documentation

Principles of documentation

Records are legal documents and are

admissible as evidence in a court of law
Nurses must accurately document each
step of the Nursing Process in the client’s
records
Records entries should be brief,
accurate, legible chronologic, made on
consecutive lines and appropriately signed
Falsification is illegal, including omission
of relevant information
Incidents Reports
Purpose of incident reports:

to memorize in writing any unusual event at time

of its occurrence by a person who was a direct
personal witness. It is generally used for
management and documentation purposes only.

The whole purpose of incident reporting is to

LEARN from the mistakes and how to eliminate,
reduce and manage the risks we have to deal
with on a daily basis. It cannot be used as
evidence in lawsuits.
What an incident report should
contain

> The date

> The place
> The position of the individual
reporting (not necessarily the name)
> A description of the incident or
issue
> Whom it is reported to
What should be done to correct it

What has been done to correct it

A space for follow up reporting

The signature of the individual

reporting

The date and time the reporting is

received by the Risk Manager

> Action of the Risk Manager

Common situations that
require Incident report

• Break in aseptic technique

• Incorrect sponge count in surgery
• Medical – legal incident
• Client or family refuses treatment
as ordered and refuses to sign
consent
* Client or family voices
dissatisfaction with care and
situation, cannot be or has not been
resolve
• Complication from diagnostic or
treatment procedures ( e.g. blood
sample stick, biopsy, x-ray, invasive
procedure. Bronchoscopy)
• Failure to report change in
patient’s condition
• Falls
• Patient is burned
 Each professional nurse must be legally
accountable in all his action which involves
proper monitoring and recording. The legal
implication of this is due to:
a. That regardless if the nurse re recorded his
observation or not, he shall still be accountable and
liable
b. If the nurse did not document anything, he shall be
liable
c. If it was not written although it was performed, it is
considered as not having been done at all
d. Because a chart needs to be completed by
handwritten words
Answer: C
Nursing Ethics

Morality - usually refers to private,

personal standard of what is right
and wrong. Moral issues involve
important social values and norms
Ethics – refers to a method of inquiry
about the rightness or wrongness as
a human actions; the practices or
beliefs of a group; and the standards
of moral behavior described in the
group’s formal code of ethics
Bioethics – ethics as applied to
“life situations “(e.g. decisions
about euthanasia, prolonging
life, abortion)
Nursing ethics – ethical issues
that occur in the context of
nursing practice – questions that
must address with regard to
their own actions
Values - freely chosen, long-
lasting beliefs or attitudes about
the worth of something (e.g. a
person or an idea)
Value system – a personal set
of beliefs on a continuum from
most to least important, thus
providing the basis for decisions
and choices
Moral theories guide nurses
in ethical decision making

Consequence based – judge

the rightness of the action
based on the consequences it
produces (the end justifies
the means)
Utilitarianism – views a good
act as one that brings the
least harm and the most
good to the people “choose
the lesser evil”
Principle based – emphasis
on individual rights, duties
and obligations. An action is
moral if it follows an
impartial, objective principle
Relationship based –
stresses courage, generosity,
commitment and the need to
nurture and maintain
relationships, promote the
common good or the welfare
of all group, rather than
stressing the individual
rights.
Bioethical Principles

Autonomy – from the Greek

work “autos” meaning self
and “nomos” meaning rule
or law, thus refers to self
law. Implies individual
rights, privacy and choice.

Autonomy entails the ability

to make a choice from
external constraints.
Beneficence - the duty to do
good and the active
promotion of benevolent acts
(e.g. goodness, kindness,
charity)
Confidentiality – relates the
concept of privacy.

Information obtained from

an individual will not be
disclosed to another unless it
will benefit the person or
there is a direct threat to the
social good.
Double effect – a principle
that may morally justify
some actions that some may
produce both good and evil
effect.
Fidelity – promise keeping;
duty to be faithful to one’s
commitments and promises
Justice – fair, equitable and
appropriate treatment
according to what is due or
owed to persons.
Nonmaleficence – the duty
not to inflict as well as to
prevent and remove harm.
Sanctity of Life – the
perspective of that life is the
highest good.

Thus all forms of life

,including mere biologic
existence should take
precedence over external
criteria for judging quality of
life.
Veracity – the obligation to
tell the truth and not to lie or
deceive others
 Which of the following principles apply
to the action of the nurse to refrain
from discussing the condition of the
patient with those who are not
involved in his care?
a. beneficence
b. non maleficence
c. autonomy
Answer: B