NURSING JURISPRUDENCE

Review

Atty. Anabelle C. De Veyra, RN, MM

Instructor
 Learning objectives
• In preparation for the board examination, this review
class will help the students retain basic information
related to nursing practice and develop broader
perspectives through:
– Knowing the concepts of jurisprudence, theories,
principles, and laws in relation to the practice of nursing
– Understanding the legal, moral and ethical responsibilities
and liabilities of the professional nurse
– Discussing the nursing law especially the scope of nursing
practice
– Identifying the doctrines in determining negligence
– Hopefully, applying or observing some of these laws and
principles even as nursing students, at the clinical areas.
 Order of Presentation
• Introduction
• Nursing Jurisprudence, sources, functions
• RA 9173
• Negligence
• Relevant legal doctrines in nursing
practice
• Ethics
Roles and functions of the Nurse
• Leader
Caregiver
• Communicator
Manager
• Teacher
Case manager
• Client advocate
Research Consumer
• Counselor
Other expanded roles
• Change agent
CAREGIVER

Assist the client physically and

psychologically while preserving the
client’s dignity
Full care, partial care, supportive-
educative care, direct care or delegated care
Care giving encompasses the physical,
psycho-social, developmental, cultural, and
spiritual levels
COMMUNICATOR
• Communication is integral in nursing
• Communicate with the client, support persons, other
health professionals, people in the community
• Quality communication to meet client’s health care
needs
• Clear
• Accurate
TEACHER
• Helps client learn about their health and the
health care procedures they need to perform to
restore or maintain their health
• Assesses the clients’ learning needs and
readiness to learn
• Sets specific learning goals together with the
client
• Enacts teaching strategies and measures learning
• Teacher to other health care providers
CLIENT ADVOCATE
• Advocate is one who expresses and the
defends the cause of another
• Acts to protect the rights and dignity of the
client
• Relay clients’ wishes for information to the
physician
• Supports clients in their decision, giving them
full or at least mutual responsibility in decision
making
COUNSELOR
• Counseling is a process of helping a client to
recognize and cope with stressful psychological or
social problems, to develop improved interpersonal
relationship and promote personal growth.
• Counseling aims to help healthy individuals with
normal adjustment difficulties and focuses on helping
the person develop new attitudes, feelings and
behaviors by encouraging the client to look at
alternative behaviors, recognize the choices and
develop a sense of control.
CHANGE AGENT
• Assists client modify in their own behavior
• Acts to make changes in a SYSTEM such as
clinical care system
• Initiates, innovates, motivates, influences
others
• “status quo syndrome”
LEADER
• Influences others to work together to
accomplish a goal
• Initiative and the ability and confidence
to innovate change, motivate, facilitate
and mentor others
MANAGER
• Given the authority, power and responsibility
for planning, organizing, staffing, directing,
controlling, budgeting
• Establish and evaluate standards
• Control human, financial and material
resources.
• Sets goals, make decisions and solve problems
CASE MANAGER
• The nurse case manager works with the
multidisciplinary health care team to
measure the effectiveness of the case
management plan and to monitor
outcomes
• Works with primary or staff nurses to
oversee the care of a specific caseload.
RESEARCH CONSUMER
• Uses research to improve client care
• Need to have awareness of the process and
language of research
• Sensitive to issues related to protecting the
rights of the human subjects
• Participate in the identification of significant
researchable problems
• Be a discriminating consumer of research
findings
 The professional Nurse
POLITICS ETHICS

NURSE

Authority Autonomy Accountability

Authority
• Specialized education program
• Satisfy an indispensable social need
• Theories, principles, models, frameworks
• Core values
• Body of knowledge
• Well defined and well organized body of specialized
knowledge
• Well developed scientific techniques which is the result
of tested experience
• Constantly enlarges the body of knowledge it uses and
improves its techniques of education and service by the
use of scientific method.
• Give evidence of needed skills which the public does
not posses.
 Nursing theories and models
Nursing Theorist Year Nursing Theory/model
Florence Nightingale 1859 Environmental Theory

Hildegard Paplau 1952 Interpersonal model

Faye Abdellah 1960 Patient-centered approaches to

nursing

Ernestine Weidenbach 1964 Compassion and sensitivity

 Nursing theories and models
Nursing Theorist Year Nursing Theory/model
Virginia Henderson 1966 Nature of Nursing Model

Myra Levine 1969 Four Conservation Principles

Ida Jean Orlando 1972 Nursing’s unique and

independent concerns

Dorothea Orem 1980 Self-care Deficit Theory

 Nursing theories and models
Nursing Theorist Year Nursing Theory/model
Dorothy E. Johnson 1980 Behavioral System Model

Imogene King 1981 Goal Attainment Theory

Betty Newman 1982 Health Care System Model

Sister Calista Roy 1984 Adaptation Model

 Nursing theories and models
Nursing Theorist Year Nursing Theory/model
Martha E. Rogers 1984 Unitary Human Beings

Lydia Hall Model of Nursing: Care, Core

and Cure
Jean Watson 1988 Human Caring Theory
Rosemarie Risso-Parse 1981 Man-Living Health Model
 Theories and models
• Focus on health not merely on sickness
• Clientele that includes people of all ages, as
individuals, families, and communities
• The identification of “human responses to all
actual or potential health problems” as nursing
phenomena of concern
 Theories and models
 Core values
• Competence
• Commitment
• Compassion
• Confidence
• conscience
AUTONOMY
• Regulates itself and sets standards
• Defines the scope of nursing practice
• Describes its particular functions and roles
• Determines goal and responsibilities in the
delivery of services
• Independence at work, responsibility and
accountability
ACCOUNTABILITY
• Hold on to a standard of conduct that is
expected of reasonably prudent nurses
• Directly responsible to their immediate
supervisors
• Directly answerable or liable for any
mistake/misdeed committed to the client.
 The professional Nurse
POLITICS ETHICS

NURSE

Authority Autonomy Accountability

 Why study nursing jurisprudence?
• Nursing deals with human lives requiring total
quality patient care.
• She is faced with critical decisions and critical
actions or interventions
• The nurse in her practice needs to be guided of
what is and what is not nursing.
• She has to understand her professional
accountability, responsibility and liability.
Why study nursing jurisprudence?
• “Ignorance of the law excuses no one from
compliance.”
– Conclusive presumption
– Public policy
– Public necessity
– Expediency
 Functions of Nursing Jurisprudence
• Provides a framework for establishing which
nursing actions in the care of clients are legal.
• Differentiates the nurse responsibilities from
that of the other health professionals.
• Helps establish the boundaries of independent
nursing action
• Assists in maintaining a standard of nursing
practice by making nurses accountable under
the law.
 Elements of Law
– Authority
– Expressed or pronounced
– Right to enforce
Nursing Jurisprudence: Sources
• Formal
InformalInstruments
Instruments
• Directives
Constitution
•• Pronouncements
General laws
• Resolutions
• Special laws
• Memorandums
• Ordinances
• Theories
•• Executive Orders
Customs and traditions
• Court decisions
 Law
• Law
– Rule of conduct promulgated by a controlling
authority which may be enforced.
– Governs the relationship of private
individuals with government, and with each
other.
– Commands us to do what is good and
prohibits us to do what is wrong
 Kinds of Law
• according to authorship
• Divine Law
• Human Laws
 Human Laws
• Public – laws that deals with the relationship
between individuals and the government and
governmental agencies
– Criminal Law
– International Law

• Private - laws that deals with the relationship among

private individuals
– Civil Law
– Contracts
– Remedial law
 History of the Nursing Law
• Act 2493 of 1915
• Act 2808 0f 1919
• RA 877 of 1953
• RA 4643
• RA 4704 of 1966
• RA 6136
• RA 7164 of 1991
• RA 9173 of 2002
 Specific Law: RA 9173
• Nursing law in the Philippines
• October 21, 2002 signed into law by PGMA
• December 31, 2003 – effectivity of the
implementing laws, rules and regulations thru
PRC Resolution No. 425 s. 2003.
• Primary duty to implement the law:
• Profession Regulation Commission (PRC)
• Professional Regulatory Board of Nursing (PRBON)
 Parts of RA 9173

Article Description Number of

Number Sections
I Title Section 1
II Declaration of Policy Section 2
III Organization of the Board of Nursing Sections 3-11
IV Examination and Registration Section 12-24
V Nursing Education Sections 25-27
VI Nursing Practice Sections 28-29
VII Health Human Resource Production, Sections 30-34
Utilization and Development
VIII Penal and Miscellaneous Provisions Sections 35
IX Final Provisions Sections 36-41
 State Policy on the Nursing Profession

• Policy of the State to assume responsibility for

the protection and improvement of the
nursing profession.
• Measures of protection and improvement of
the nursing profession:
– Relevant nursing education
– Humane working conditions
– Better career prospects
– Dignified existence of the Philippine nurses
Examples of measures of protection instituted
by the State
• Nursing education program shall provide a sound
general and professional foundation for the practice
of nursing.
• Delivery of quality basic health services
• Delivery of quality basic health services through an
adequate nursing personnel system.
• People’s right to health (Constitution)
• Social justice and human rights (Constitution)
 Nursing Regulation
• Professional Regulatory Board of Nursing
• Composition, qualification, and term of office
• Powers, duties and functions of the Board
• Legal liabilities of board members
» Administrative
» Criminal
» Civil
• Examination and Registration
• Licensure examination
• Qualification and requirements for licensure examination
• Scope and rating rule of examination
• Refresher course
• Oath-taking requirements
• Registration by reciprocity
• Special/temporary permit
• Grounds for suspension and revocation of license
 Nursing Practice
• Scope of Nursing practice (Sec. 28)
• Scope of nursing means the extent and range of
health care activities which a nurse can do or perform
pursuant to law.
• Areas of nursing practice
• Nursing education
• Nursing service
• Community Health Nursing
 Scope of Nursing practice
• When is a person deemed to be practicing
nursing?
• When he/she singly or in collaboration with another,
initiates and performs nursing services to individuals,
families and communities in any health care setting.
» Singly refers to a nurse who is an independent practitioner
» In collaboration with another refers to a nurse who is a
member of a health team
• The law does not distinguish between services for free
and for fee, hence both services are included as nursing
practice.
 Scope of Nursing practice
• What nursing practice include?
• Nursing practice includes but not limited to nursing care
during the following:
» Conception
» Labor
» Delivery
» Infancy
» Childhood
» Toddler
» Pre-school age
» School age
» Adolescence
» Adulthood
» Old age
 Scope of Nursing practice
• Primary responsibility of an independent nurse
practitioner?
• Independent nurse practitioner is one who singly
initiates and performs nursing services to individuals,
families and communities in any health care setting.
• Primary responsibilities of an independent nurse
practitioner
» Promotion of health
» Prevention of illness
 Scope of Nursing practice
• Primary responsibility of a health team member nurse?
• A health team member nurse practitioner is one who, in
collaboration with another, initiates and performs nursing
services to individuals, families and communities in any
health care setting.
• Primary responsibilities of a health team member nurse
practitioner:
– Must collaborate with other health care providers for the
following:
» For the curative, preventive and rehabilitative aspects
of care
» For the restoration of health
» For the alleviation of suffering, and
» When recovery is not possible, towards a peaceful
death.
 Duty of the nurse
• Provide nursing care through the utilization of
the nursing process
• What is the nursing process?
– A way of thinking as a nurse
– Framework of interrelated activities resulting in competent
nursing care
– Dynamic and cyclical in nature, requiring repeated review
– A scientific problem-oriented approach to patient
– Step by step activities embodied in a nursing care plan for the
effective, competent and responsible management of
patient’s health problem
 Steps in the nursing process
• Nursing assessment – objective and subjective observation using
the 5 senses
• Nursing diagnosis – preparing a description of actual and potential
health problems that changes the patient’s life processes or
functions based on subjective and objective observations
• Nursing plan – pertains to the blueprint for action developed by a
nurse based on nursing diagnosis. It contains the patient’s health
goal the course of actions intended to help the patient achieve his
goal.
• Nursing implementation – or intervention is the carrying out of
actions as stated in the nursing care plan or the patient’s plan of
care
• Nursing evaluation – is the critical assessment of whether the
patient’s goal has been achieved within the time frame and what
changes are made in the patient’s plan of care, if
 Nursing care, what does it include?
• Traditional and innovative approaches
• Therapeutic use of self
• Executing health care, techniques and procedures
• Essential primary health care
• Comfort measures
• Health teachings, and
• Administration of written prescription for:
• Treatment
• Therapies
• Oral, topical and parenteral medications
• Internal examinations during labor in the absence of antenatal bleeding
and delivery
• Suturing of perineal lacerations
 Other duties of the nurse
• Duty of the nurse to establish linkages with
community resources and establish
coordination with the members of the health
team
• Duty of the nurse to provide health education
to individuals, families and communities
 Other duties of the nurse

• Duty of the nurse to teach, guide and

supervise nursing students:
• Nursing education programs
• Administration of nursing services in varied settings
such as hospitals and clinics
 Other duties of the nurse
• Duty of the nurse to undertake consultation
services
• Duty of the nurse to engage in activities
requiring nursing knowledge and decision
making skills
• Duty of the nurse to undertake nursing and
human resource development, training and
research for the development of advance
nursing practice
 Duties of the nurse while in the practice of
nursing in all settings:
• Observe the Code of Ethics for Nurses
• Uphold the standards for safe nursing practice
• Observe the Code of Technical Standards for
Nurses
• Maintain competence by continual learning
through continuing professional education
 Prohibited acts (Section 35 RA 9173)
• Practice without a professional license or
permit or not declared exempt from
examination
• Using the license or permit of another
registered nurse
• Using invalid or suspended or revoked or
expired professional license or permit
 Prohibited acts (Section 35 RA 9173)
• Giving any false evidence to the Board of
Nursing to obtain a professional license or
permit or not declared exempt from
examination
• Falsely posing or advertising as a registered
nurse or using any other means that tend to
convey the impression that he/she is a
registered and licensed nurse
 Prohibited acts (Section 35 RA 9173)
• Appending to her/his name BSN, RN
without actually having been conferred
the degree or registration
• Abetting or assisting the illegal practice
of a person who is not lawfully qualified
to practice nursing
 Prohibited acts (Section 35 RA 9173)
• Undertaking in-service educational programs
without permit or clearance from the Board of
Nursing and the Professional Regulation
Commission
• Conducting review classes for both local and
foreign examination without permit or
clearance from the PRBON and PRC
 Practice without a license, exception

• Nursing students perform any or all acts set

forth in Sec 28 provided the following
conditions are present:
• The nursing student performs a nursing
function(s)
• Under direct supervision of a nursing
faculty
• Faculty is qualified
 Imposable Penalties
Upon the discretion of the Court, the imposable
penalties are:
• Fine – Php50,000 to 100,000.00
• Imprisonment – 1 year to 6 years
• Both fine and imprisonment
Areas of legal responsibilities and liabilities:

• Criminal
• Violations of the Nursing Law and general and special laws
• Civil
• Negligence
• Torts – malfeasance, misfeasance, non-feasance
• Administrative
• Violations of office policies, rules and regulations
• Violations of contractual obligations
• Disciplinary actions
• Malpractice
• Unethical misconduct
 Criminal offenses
• Crimes against persons:
• Parricide
• Murder
• Homicide
• Giving assistance to suicide (euthanasia)
• Infanticide
• Abortion of all kinds
• Mutilation
• Physical injuries
 Criminal offenses
• Crimes against chastity:
• Rape
• Acts of lasciviousness
• Seduction
• Abduction
• Adultery
• Concubinage
• Sexual Harassment (special law)
 Criminal offenses
• Crimes against personal liberty:
• Kidnapping
• Illegal detention/false imprisonment
• Abandonment of persons in danger
• Abandonment of one’s own victim
• Threats
• Grave coercion
• Assault/battery
 Criminal offenses

• Crimes against property:

• Robbery
• Theft or larceny
• Swindling or estafa
• Malicious mischief
 Criminal offenses

• Crimes against the civil status of person:

• Simulation of birth
• Substitution of one’s child for
another
• Concealment or abandonment of a
legitimate child
• Usurpation of another’s civil status
• Bigamy
 Criminal offenses

• Crimes against honor:

• Libel
• Oral defamation or slander
• Slander by deed
NEGLIGENCE
 Neglect
• Failure
• Omit/miss
• Absence
• Disregard
• Forget, overlook
• Error, exclude, ignore
 Negligence
• Fault to use reasonable care
• Failure to do or not to do in observing the
necessary protection of interests and wellness of
the client
• The degree of care, precaution and
vigilance which a reasonably prudent
person would do under like circumstances
but because of deficiency or excess of the
demandable action, such client or patient
suffers an injury or death
 Prudent
• Just
• Alert
• Careful, vigilant, watchful,
• Safe
• Rational
• Circumspect
• Considerate
 Who is a reasonably prudent person?

• Foresee harm as a reasonable

consequence of the course to be pursued.
• Refrain from that course or take
precautions against harmful results
• Avoid inflicting injuries on others
• Anticipate the harm
 Elements of Negligence
• Duty of care
• Breach or failure of duty of care
• Resulting damage (injury or death)
• Factual and causal connection between
the failure of duty of care and the
resulting injury (proximate cause)
 Characteristics of “Duty of Care”
• Commensurate to the patient’s
needs
• The more vulnerable the patient,
there is a higher the risk of harm,
requires greater care to protect the
patient from harm
 Duty of Care
• Standards of Care
• Skills and learning commonly
possessed by the nurse
• Standards are used to evaluate the
quality of care nurses provide
• Also used as legal guidelines for
nursing practice
 Categories of Standards of Care
•• External
InternalStandards of Care
Standards of Care
–
– Nursing Lawdescription
Nurse’s job – scope of nursing practice
–
– Standards
Education issued by the PNA, ANSAP, ORNAP,
– MCNAP,
Expertise
etc
– Code of Ethics
– Institutional policies and procedures
 Proximate Cause
• that act or omission
• which is the natural and continuous
sequence,
• unbroken by any efficient intervening
cause
• produces an injury, and
• without which the result would not have
occurred
 Types of Negligence
• As a crime (culpa criminal)
• Felony committed by culpa or fault due to
imprudence, lack of foresight, lack of skills,
negligence
• As torts (culpa contractual)
• Negligence – malfeasance, misfeasance, non-
feasance
• As quasi-delict (culpa aquiliana)
• No pre-existing contractual relations
• Negligence, lack of due care
 Culpa criminal
Negligence is direct, substantive, independent of a contract
No pre-existing obligation except the duty to never harm
others
Proof needed is proof beyond reasonable doubt
Defense of a good father of a family in the selection and
supervision of employees is not a proper defense because
the employee’s guilt becomes the employer’s civil guilt, if
the former is insolvent
Accused is presumed innocent until the contrary is proven,
so the burden of proving negligence of the accused is at the
prosecution side
 Culpa contractual
Negligence is merely incidental to the performance of an
obligation already existing because of a contract
There is a pre-existing obligation (a contract – express or
implied)
Proof needed is only preponderance of evidence
Defense of a good father of a family in the selection and
supervision of employees is not a proper and complete
defense because we follow the respondeat superior rule or
command responsibility or master-servant rule
Contract must be proven and that it was carried out
 Culpa aquiliana
Negligence is direct, substantive and independent
No pre-existing obligation except the duty to be careful in
all human actuations
Proof needed is only preponderance of evidence
Defense of a good father of a family in the selection and
supervision of employees is a proper and complete defense
as employers or guardians are concerned (vicarious
liability)
Ordinarily, the victim has to prove negligence of the
defendant because his action is based on the alleged
negligence of the latter.
 Nursing Negligence
A nurse may be considered negligent in the care
of her patient if, as required in the due
performance of her duties, she neglected to do
that which she ought to have done, or did that
which she ought not to have done, or if she
failed to exercise that degree of care which a
reasonable prudent nurse, in the practice of her
profession, would have exercised under like
circumstances.
 Doctrines in Negligence
• Respondeat superior
• Respondeat Superior as Bonus
pater familias
• Damnum absque injuria
• Doctrine of Force Majeure
• Doctrine of Stare Decisis
 Other common errors
• Malfeasance
• Misfeasance
• Nonfeasance
• Doctor’s order rule
• Advance directives or living will
 Doctrine of Respondeat Superior
• “Let the master answer for the acts of the
subordinate”

• Bonus pater familias – the relationship of the nurse

and her employer as her good father of a family,
whereby the employer ultimately becomes liable on
his own negligence in selecting employees
 RESPONDEAT SUPERIOR

• Master-servant rule
• The liability is not only to the
employee but also expanded to the
employer upon finding that he has
been negligent in the selection of his
employees
 RESPONDEAT SUPERIOR

• Doctrine of vicarious liability

– When one acts through the agency of
another, then, in contemplation of the law,
he himself is acting so as to make him
responsible for the acts done by his agent or
subordinate.
• Captain of the ship rule
 Example of Respondeat Superior
• Hiring under board nurses as a measure to cut
down hospital expenses
• Captain of the ship rule – surgeons are liable if
an abdominal pack is left inside the abdomen
of patient
 Res Ipsa Loquitor

• “the thing speaks for itself:

• Doctrine of common knowledge
whereby the injury itself is a
sufficient proof of the negligent act
• There is no further explanation beyond
the obvious facts as shown
 How determined
• The thing causing the accident lies within the
exclusive control of the person complained of
(defendant).
• That the defendant has a better opportunity to know
the condition and management of the thing under his
control than the victim (complainant/plaintiff)
• That the accident would not have happened had the
defendant use the thing in the proper and careful
manner.
Examples of negligence – REs Ipsa Loquitor

• Scalpel or sponge left inside the abdomen

• Burns
• Defective equipment
• Infection/bedsore
• Contractures
• Falls
Elements required to prove negligence under this
res ipsa doctrine:

• The harm would not ordinarily have

occurred without someone’s negligence
• The instrumentality of the harm was
under the exclusive control of the
defendant at the time of the likely
negligent act, and
• The plaintiff did not contribute to the
harm by his own negligence
 Damnum Absque Injuria
• Although there was physical damage, there
was no legal injury
• The victim is not entitled to recover for
damages or compensation for the loss or injury
• There is intervention of extraordinary
circumstance beyond her control when
performing the lawful act prudently, hence no
liability
 Doctrine of Force Majeure
• Refers to an event which cannot be
foresee, or which being foreseen is
inevitable
• Event is independent of the will of the
actor
• The victim is not entitled to recover for
damages or compensation for the loss or
injury
 Doctrine of Stare Decisis

• To stand by that which is decided

• This means that the court stands
by its previous decision or
precedent
• Stay in decision is applied to
cases with similar facts as the
decided case
 Other common mistakes

• Malfeasance – performance of an act

which ought not to be done
• Misfeasance – improper performance
of some act which might lawfully be
done
• Nonfeasance – omission of some act
which ought to be performed
 Other common mistakes

• Doctor’s order rule

• Verbal or telephone or text
message orders
• Written orders
• Advance directives or living will
• DNR
Best legal defenses of a nurse in negligence

• Prevention to commit negligent acts

• Knowing and understanding and following
with care the standards of safe nursing
practice, established protocols and hospital
policies
• Proper documentation of actions or
observations with clarity and accuracy
• Exercise necessary protection and precaution
as they assume all risks of harm, infections
and contaminations
 Some cases to read
Reference: Philippine Nursing Law, Jurisprudence and Ethics by A. Dionesio

• Somera Case
• Maki v. Murray Hospital
• Ybarra v. Spanggard
• Ales v. Ryan et al
• Nicholson v. Sisters of Charity of Providence
• Ratliffe v. Wesley Hospital
• Aderhold v. Bishop
• Borwege v. City of Owatonna
 Other sources of negligence:
• Doctor’s order rule
• Verbal or telephone or text message orders
• Written orders
• Advance directives or living will
• DNR
• Breached of confidentiality
• Documentation
• Abbreviation
 Seal of Secrecy
• Information obtained forever remains secret even
after death of the patient
• It can only be broken in any of the following:
• Criminal cases
• Consent of patient
• Patient sued the physician
• Communicable diseases
• Members of the health team, if such
information is relevant to his care
Best legal defenses of a nurse in negligence
• Prevention to commit negligent acts
• Knowing and understanding and following with care
the standards of safe nursing practice, established
protocols and hospital policies
• Proper documentation of actions or observations
with clarity and accuracy
• Exercise necessary protection and precaution as they
assume all risks of harm, infections and
contaminations
 Ethical Responsibilities
• Health is a fundamental right of every individual.
• The Filipino nurse believes in the worth and dignity
of each human being
• Responsibilities encompasses promotion of health,
prevention of illness, alleviation of sufferings and
restoration of health.
• However, when recovery is not possible, assistance
towards a peaceful death shall be the obligation of
the nurse
Ethical Responsibilities: Nurses and People

• Values, customs, and spiritual beliefs held by

individuals shall be respected.
• Individual freedom to make rational and
unconstrained decisions shall be respected.
• Personal information acquired in the process
of giving nursing care shall be held in strict
confidence.
Ethical Responsibilities: Nurses and Practice

• Human life is inviolable.

• Quality and excellence in the care of patients
are the goals of nursing practice.
• Accurate documentation of actions and
outcomes of delivered care is the hallmark of
nursing accountability.
Ethical Responsibilities: Nurses and Practice

• Registered nurses are the advocates of the

patients: they shall take appropriate steps to
safeguard their rights and privileges.
• Respect the patient’s bill of rights.
 Rights of the patient
• Right to competent care
• Freedom from harm
• Right to informed consent
• Right to withdraw from participation
• Right to privacy
• Right to confidentiality
Ethical Responsibilities: Nurses and Practice

• Registered nurses are the aware that their actions

have professional, ethical, moral and legal
dimensions.
• They strive to perform their work in the best interest
of all concerned.
• Perform their professional duties in conformity with
existing laws, rules and regulations, measures and
generally accepted principles of moral conduct and
proper decorum.
Ethical Responsibilities: Nurses and Practice

• Registered nurses do not allow themselves to be

used in advertisement that should demean the image
of the profession (indecent exposure, violation of
dress code, seductive behavior, etc)
• Decline any gift, favor or hospitality which might be
interpreted as capitalizing patients.
Ethical Responsibilities: Nurses and Practice

• Not demand and receive any commission, fee

or emolument for recommending or referring
a patient to a physician, a co-nurse or another
health care worker, not to pay any
commission, fee or compensation to the one
referring or recommending a patient to them
for nursing care.
Ethical Responsibilities: Nurses and Practice

• Avoid any abuse of the privilege relationship

which exists with patients and of the privilege
access allowed to their property, residence or
workplace.
 Ethical Responsibilities: Nurses and Co-
workers
• The Registered Nurse is in solidarity with other
members of the health care team in working for the
patient’s best interest.
• Maintains collegial and collaborative working
relationships with colleagues and other health care
providers.
• Honor and safeguard the reputation and dignity of
the members of nursing and other professions.
 Ethical Responsibilities: Nurses and Co-
workers
• Refrain from making unfair and unwarranted
comments or criticisms on their competence,
conduct, and procedures or not to do anything
that will bring discredit to a colleague and to
any member of other professions.
• Respect the rights of the co-workers.
 Ethical Responsibilities: Nurses and Society
and Environment:
• The preservation of life, respect for human rights,
and promotion of health environment shall be a
commitment of a Registered Nurse.
• The establishment of linkages with the public in
promoting local, national and international efforts to
meet health and social needs of the people as a
contributing member of society is a noble concern of
the Registered Nurse.
 Ethical Responsibilities: Nurses and Society
and Environment:
• Be conscious of the obligations as citizens and, as
such, be involved in community concerns.
• Be equipped with knowledge of health resources
within the community, and take active roles in
primary health care.
• Lead their lives in conformity with the principles of
right conduct and proper decorum.
• Project an image that will uplift the nursing
profession at all times.
 Ethical Responsibilities: Nurses and the
Profession:
• Maintenance of loyalty to the nursing
profession and preservation of its integrity
and ideal.
• Compliance with the by-laws of the accredited
professional organization (PNA), and other
professional organizations of which the
Registered Nurse is a member.
 Ethical Responsibilities: Nurses and the
Profession:
• Commitment to continual learning and active
participation in the development and growth of the
profession are commendable obligations.
• Contribution to the improvement of the socio-
economic conditions and general welfare of nurses
through appropriate legislation is a practice and a
visionary mission.
 Ethical Responsibilities: Nurses and the
Profession:
• Nurses must be members of accredited professional
organization.
• Strictly adhere to the nursing standards.
• Strive to secure equitable socio-economic and work
conditions in nursing through appropriate legislation
and other means.
• Assert for the implementation of labor and work
standards.
 Consent
• Free and rational act that presupposes
knowledge of the thing to which consent is
partly given to a person who is legally capable
to give consent.
• It is an authorization by a patient or person
authorized law to give consent on the patient’s
behalf, that changes a touching from non
consensual to consensual.
Other Related Laws to the practice of
nursing:

• Nurses benefits and privileges

• Nurses responsibilities
• Blood and Organ Donation
• Drugs and Medicines
• Environmental Welfare
• Research
Related Laws to the practice of nursing:

• Nutritional Concerns
• Lifestyle
• Women and Children
• Elderly
 Laws related to nurses benefits and privileges

• RA 7305 – The Magna Carta of Public

Health Workers (March 26, 1992)
• RA 7305 Implementing Rules and
Regulations by DOH (May, 1999)
• RA 7883 – Barangay Health Workers
Benefits and Incentives Act of 1995
• RA 7875 – National Health Insurance Act
of 1995 (February 14, 1995
 Laws related to nurses benefits and privileges

• RA 6713 – Code of Conduct and Ethical

Standards for Public Officials and
Employees (March 25, 1989)
• PRC Resolution - Code of Ethics for Nurses
(July 14, 2004)
 Laws related to nurses responsibilities:

• BP Bilang 702 – An Act Prohibiting the Demand of

Deposits or Advance Payments for confinement or
treatment of patients in Hospitals and Medical Clinics
in certain cases.
• RA 8344 – An Act Penalizing the Refusal of Hospitals
and Medical Clinics to Administer Initial Medical
Treatment and Support in Emergency of Section
Cases, Amending for the purpose BP 702. (June 5,
1997)
• RA 9173 – The Philippine Nursing Law of 2002
(October 21, 2002).
 Blood/organ Donation:
• RA 7805 – An Act to Advance Corneal
Transplantation in the Philippines
• RA 7719 – National Blood Services Act of 1994
(May 5, 1994)
 Drugs and Medicines:
• RA 3720 – Food, Drug and Cosmetic Act (June 22,
1963)
• RA 6675 – Generics Act of 1988 (September 13,
1988)
• RA 8203 – Special Law on Counterfeit Drugs
(September 4, 1996)
• RA 8423 – The Traditional and Alternative Medicine
Act of 1997 (December 9, 1997)
 Environmental Welfare:
• Sanitation Code of the Philippines
• RA 8749 – The Philippine Clean Air Act of 1999
(June 23, 1999)
• RA 9003 – Ecological Solid Waste
Management Act of 2000 (January 26, 2001)
 Research:
• RA 9245 – Philippine Ear Research Act of 2003
(February 19, 2004)
 Nutritional Concerns:
• ASIN Law
• RA 8976 – Philippine Food Fortification Act of
2000 (November 7, 2000)
 Lifestyle:
• RA 9211 – Tobacco Regulation Act of 2003
(June 23, 2003)
• RA 8504 – Philippine AIDS Prevention and
Control Act of 1998
 Women and Children:
• RA 7600 – Rooming-in and Breastfeeding Act of 1992
• RA 9298 – Anti-Trafficking in Persons Act of 2003
(May 26, 2003)
• RA 9231 – Amending RA 7610: Special Protection of
Children Against Child Abuse, Exploitation and
Discrimination Act (December 19, 2003)
• RA 9255 – An Act Allowing Illegitimate Children to
Use the Surname of their Father (February 24, 2004)
 Women and Children:
• RA 9262 – Anti-Violence Against Women and the Children Act
of 2004 (March 8, 2004)
• RA 9288 – Newborn Screening Act of 2004 (April 7, 2004)
• Dept. Order No. 333 s. 2004 – Implementing Rules and
Regulations of RA 9288 (October 22, 2004)
• RA 9165 – Comprehensive Dangerous Drugs Act of 2002
• RA 7877 – Anti – Sexual Harassment Act
 Elderly:
• RA 7432 – An Act to Maximize the Contribution of
Senior Citizens to Nation Building, Grant Benefits and
Special Privileges, and for Other Purposes (April 23,
1992)
• RA 7876 – Senior Citizens Center Act of the
Philippines (February 14, 1995)
• RA 9257 – Expanded Senior Citizens Act of 2003
(February 26, 2004)