tHei Luna BSN IV A5
CORE COMPETENCIES
KEY AREA RESPONSIBILITY: A. SAFE AND
QUALITY NURSING CARE
Core Competency 1: Demonstrate
knowledge based on the health status of
individuals/groups
Indicators:
• Identifies the health needs of
patients/groups
• Explains the health status of the
patients/groups
Core Competency 2: Provide sound
decision making based on the
health/illness status of
individuals/groups.
Indicators:
• Identifies the problem
• Gathers data related to the problem
• Analyzes the data gathered
• Selects appropriate actions
• Monitors the progress of the actions
taken
Core Competency 3: Provides safety and
comfort of the patients
Indicators:
• performs age-specific safety measures
in all aspects of patient’s care
• Performs age-specific comfort
measures in all aspects of patient’s
care
Core Competency 4: Set priorities in
nursing care based on patients’ needs.
Indicators:
• Identifies the priority needs of the
patients
• Analyzes the needs of patients
• Determines appropriate nursing care
to be provided
Core Competency 5: ensures continuity of
care
Indicators:
• Refers identified problems to
appropriate individuals/agencies
• Establishes means of providing
continuous patient care
Core Competency 6: Administer
medications and other health
therapeutics
Indicators:
• Conforms to the 10 Golden rules in
medication administration and health
therapeutics
Core Competency 7: Utilizes yhe nursing
process as framework for nursing
: Performs comprehensive and systematic
nursing assessment
Indicators:
• Obtains consent
• Complete appropriate assessment
forms
• Performs effective assessment
techniques
• Obtains comprehensive client
information
• Maintain privacy and confidentiality
• Identifies health needs
Core Competency 8: Formulates a plan of
care in collaboration with patients and
other members of the health team
Indicators:
• Includes patient and family in care
planning
• States expected outcomes in nursing
interventions
• Develops comprehensive patient care
plan
• Accomplishes patient-centered
discharge plan
Core Competency 9: Implements nursing
care plan to achieve identified outcomes
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Indicators:
• Explains intervention to patient and
family before carrying them out
• Implements nursing interventions that
is safe and comfortable
• Acts according to clients’s health
conditions and needs.
• Performs nursing activities effectively
and in a timely manner.
Core Competency 10: Evaluates progress
toward expected outcomes
Indicators:
• Monitors effectiveness of nursing
interventions
• Revises care plan when necessary
Core Competency 11: Responds to the
urgency of the patient’s condition
Indicators:
• Identifies sudden changes in the
patient’s conditions
• Implements immediate and
appropriate interventions
Key Area of Responsibility: B.
MANAGEMENT OF RESOURCES AMD
ENVIRONMENT
Core Competency 1: Organizes work load
to facilitate patient care.
Indicators:
• Identifies tasks or activities that need
to be accomplished
• Plans the performance of tasks or
activities based on priority
• Finishes work assignment on time
Core Competency 2: Utilizes resources to
support patient care
Indicators:
• Determines the resources needed to
deliver patient care
• Controls the use of supplies and
equipments
Core Competency 3: Ensures the
functioning of resources
Indicators:
• Checks proper functioning of
equipments
• refers malfunctioning equipment to
appropriate units
Core Competency 4: Checks proper
functioning of equipment
Indicators|
• Determines tasks and procedures that
can be safely assigned to other
member of the health team
• Verifies the competency of the staff
prior to delegating the tasks
Core Competency 5; Maintains safe
environment
Indicators:
• Observes proper disposal of
wastes
• Adheres to policies, procedures.
And protocols on prevention and
control of infection.
• Defines steps to follow in case of
fire, earthquake, and other
emergency situations
Key Area of Responsibility: C. HEALTH
EDUCATION
Core Competency 1: Assesses the
learning needs of the patient and family
Indicators:
• Obtains learning information through
interview, observation and validation
• defines relevant information
• Completes assessment records
appropriately
• Identifies priority needs
Core Competency 2: Develops health
education plan based on assessed and
anticipated needs
Indicators:
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• Considers nature of learner in relation
to social, cultural, political, economic,
educational and religious factors
• Core Competency 3 develops
learning materials for health
education
• Indicators:
• Involves the patient, family, significant
others and other resources,
• Formulates a comprehensive health
education plan with the following
components: objectives, content, time
allotment, teaching-learning
resources, and evaluation parameters
• Provides for feedback to finalize the
plan.
Core Competency 4: Implements the
health education plan
Indicators:
• Provides for a conducive learning
situation in terms of time and place
• Considers client and family’s
preparedness
• Utilizes appropriate strategies
• Provides reassuring presence through
active listening, touch, facial
expression and gestures
• Monitors client and family’s responses
to health education
Core Competency 5: Evaluates the
outcome of health education
Indicators:
• Utilizes evaluation parameters
• Documents outcome of care
• Revises health education plan when
necessary
Key Area of Responsibility: D. LEGAL
RESPONSIBILITY
Core Competency 1: Adheres to practices
in accordance with the nursing law and
other relevant legislation including
contracts, informed consent.
Indicators:
• Fulfill legal requirements in nursing
practice
• holds current professional license
• Acts in accordance with the terms of
contract of employment and other
rules and regulations
• Complies with the required continuing
professional education
• Confirms information given by the
doctor for informed consent
• Secures waiver of responsibility for
refusal to undergo treatment and
procedure
• Checks the completeness of informed
consent and other legal forms
Core Competency 2: Adheres to
organizational policies and procedures,
local, and national
Indicators:
• Articulates the vision, mission of
the institution where one belongs
• Acts in accordance with the
established norms of conduct of
the institution/organization
• Core Competency 3: Documents
care rendered to patients
• Indicators:
• Utilizes appropriate patient care
records and reports
• Accomplishes accurate documentation
in all matters concerning patient care
in accordance to the standard of
nursing practice.
Key Area of Responsibility: E. ETHICO-
MORAL RESPONSIBILITY
Core Competency 1: Respect the rights of
individual/groups
• Renders nursing care consistent with
the Patient’s Bill of Rights
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Core competency 2: Accepts
responsibility and accountability for own
decisions and ctions
Indicators:
• Meets nursing responsibility
requirements as established in the job
descriptions
• Justifies basis for nursing actions and
judgment
• Protects a positive image of the
profession.
Core Competency 3: Adheres to the
national and international code of ethics
for nurses
Indicators:
• Adheres to the code of ethics for
nurses and abides by its provisions
• Reports unethical and immoral
incidents to proper authorities
Key Area of responsibility: F. PERSONAL
AND PROFESSIONAL DEVELOPMENT
Core Competency: Identifies own learning
needs
Indicators:
• Verbalizes strength, weaknesses,
limitations
• Determines personal and professional
goals and aspirations
Core Competency 2: Pursues continuing
education
Indicators:
• Participates in formal and non-formal
education.
• Applies learned information for the
improvement of care
Core Competency 3: Gets involved in
professional organizations and civic
activities
Indicators:
 Participates actively in professional,
social, civic and religious activities
• Maintains membership to professional
organizations
• Supports activities related to nursing
and health issues
Core Competency 4: Projects a
professional image of nurse
Indicators:
• Demonstrates good manners and right
conduct at all times
• Dresses appropriately
• Demonstrates congruence of words
and actions
• Behaves appropriately at all times
Core Competency 5: Possesses positive
attitude towards change and criticism
Indicators:
• Listens to suggestions and
recommendations
• Tries new strategies and approaches
• Adapt to change willingly
Core Competency 5: Possesses positive
attitude towards change and criticism
Indicators:
• Listens to suggestions and
recommendations
• Tries new strategies and approaches
• Adapt to change willingly
Core Competency 6: Performs functions
according to professional standards
Indicators:
• Assesses own performance against
standard of practice
• Sets attainable objectives to enhance
nursing knowledge and skills
• Explains current nursing practices,
when situations calls for it
Key Area of responsibility: G. QUALITY
IMPROVEMENT
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Core Competency 1: Gathers data for
quality improvement
Indicators:
• Demonstrates leadership of method
appropriate for the clinical problems
identified
• Detects variation in the vital signs of
the patient from day to day
• Reports necessary elements in the
bedside to improve patient stay at
hospital
• Solicits feedback from patient and
significant others regarding care
rendered
Core Competency 2: Participates in
nursing audits and rounds
Indicators:
• Contributes relevant information about
patient condition as well as unit
condition and patient current reactions.
• Shares with the team current
information regarding particular
patients condition
• Encourages the patient to speak about
what is relevant to his condition
• Documents and records all nursing
care and actions
• Performs daily check of patient
records/condition
• Completes patient records
• Actively contributes relevant
information of patients during rounds
through readings and sharing with
others.
Core Competency 3: Identifies and
reports variances
Indicators:
• Documents observed variance
regarding patient care and submits to
appropriate group within 24 hours
• Identifies actual and potential variance
to patient care
• Reports actual and potential variance
to patient care
• submits reports to appropriate groups
within 24 hours
Core Competency 4: Recommends
solutions to identified problems
Indicators|
• Gives appropriate suggestions on
corrective and preventive measures
• Communicates and discusses with
appropriate groups
• Gives an objectives and accurate
report on what was observed rather
than an interpretation of the event.
Key Area of responsibility: H. RESEARCH
Core Competency 1: Gathers data using
different methodologies
Indicators:
• Identifies researchable problems
regarding patient care and community
health
• Identifies appropriate methods of
research fro a particular
patient/community problem
• Combine quantitative and qualitative
nursing design thru simple explanation
on the phenomena observed
• Analyzes data gathered
Core Competency 2: Recommends action
for implementation
Indicators:
• Based on the analysis of data
gathered, recommends practical
solutions appropriate for the problem.
Core Competency 3: Disseminates results
of research findings
Indicators:
• Communicates results of findings to
colleagues/patients’ family and to
others
• Endeavors to publish research
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• Submits research findings to own
agencies and others as appropriate
Core Competency 4: Applies research
findings in nursing practice
Indicators:
• Utilizes findings in research in the
provision of nursing care to
individuals/groups/communities
• Makes use of evidence-based nursing
to ameliorate nursing practice
Key Area of Responsibility: I. RECORDS
MANAGEMENT
Core Competency 1: Maintains accurate
and updated documentation of patient
care
Indicators:
• Completes updated documentation of
patient care
Core Competency 2: Records outcome of
patient care
Indicators:
• Utilizes a record system. Ex. Kardex or
Hospital Information System
Core Competency 3: Observes legal
imperatives in recording keeping
Indictors:
• observes confidentiality and privacy of
the patient’s records
• Maintains an organized system of
filing and keeping patient’s records in a
designated area
• Refrains from releasing records and
other information without proper
authority.
Key Area of Responsibility: J.
COMMUNICATION
Core Competency 1: Establishes rapport
with patients, significant others, and
members of the health team
Indicators:
• Creates trust and confidence
• Listens attentively to client’s requests
and queries
• Spends time with the client to
facilitate conversation that allows
client to express concerns
Core Competency 2: Identifies verbal and
non-verbal cues
Indicators:
• Interprets and validates client’s body
language and facial expressions
Core Competency 3: Utilizes formal and
informal channels
Indicators:
• Makes use of available visual aids
Core Competency 4: Responds to needs of
individual, family, group, and community
Indications:
• Provides reassurance therapeutic,
touch, warmth, comforting words of
encouragement
• Readily smiles
Core Competency 5: Uses appropriate
information technology to facilitate
communication
Indicators:
• Utilizes telephone, mobile phone, e-
mail and internet and informatics
• Identifies a significant other so that
follow up care can be obtained
• Provides “Holding” or emergency
numbers of services
Key Area of Responsibility: K.
COLLABORATION AND TEAMWORK
Core Competency 1: Establishes
collaboration relationship with colleagues
and other members of the health team
Indicators:
• Contributes to decision making
regarding patient’s needs and
concerns
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• Participates actively in patient care

management including audit

• Recommends appropriate intervention

to improve patient care

• Respects the role of the member of

the health team

• Maintains good interpersonal

relationships with patients, colleagues
and other members of the health team

Core Competency 2: Collaborates plan of

care with other members of the health
team

Indicators:

• Refers patients to allied health team

partners

• Acts as liaison/advocate of the patient

• Prepares accurate documentation of

efficient communication of services

THE STRENGTHENED NTBCP

Scope: 10 years old & up w/ s/s of TB

Goals:

a. To control TB at year 2000 by

reducing

a1. Annual risk of infection

from 2.5 % to 1.0%

a2. Prevalence rate from 6-7 /

1000 to under 1 / 1000 population

b. To adequately & effectively treat all

sputum (+) Including those with mod to
far advanced X-ray with Cavitations for the last
6 mos. with scc use.

Coverage

A: case finding

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A1. Direct sputum microscopy for  NTP is a priority program of DOH

identified TB Symptomatic
 Partnership with international agencies
A2. X-ray of TB symptomatic who are
(-) after 2 More sputum exam  Collaboration with local TB
stakeholders for broad support and
A3. All DOH services outlets serves as
easier implementation
collection Points for sputum of all TB
Symptoms. Rapid DOTS expansion

DOTS element #2:

B: Screening : Complete X-ray Sputum Microscopy – based Diagnosis
exam, Mantoux
DOTS element #3

Uninterrupted Supply of Drugs

C. Treatment:
 High quality drugs
C1. Free & shall be on ambulatory or
domiciliary
 Free for all patients
C2. All shall sputum (+) and cavitary
cases shall be given priority  Complete supply for the patient must
be present before treatment is started

 Fixed dose combination preferred to

 One of the 22 high – burdened avoid monotheraphy. In particular, this
countries (WHO TB watchlist) is to protect Rifampacin

Treatment Regimes in the NTP

 3rd (151/100,000) in the Western
TB kit for Category II
 Pacific – Case notification of all cases
DOTS element #4:
 6th leading cause of deaths (2002)
Direct Observation of Treatment
 6th leading cause of morbidity (2002)
 Who will undergo DOT? All TB patients
 Prevalence of Sm(+) cases – 3.1/1,000
 Who can be treatment partner?
NTP objectives
 Staff of the health center or
 Case detection rate of 70 % or more clinic

 Cure rate of 85 % or more  Member of the community such

as the BHW, local government
Directly observed treatment short – course official or former TB patient.

 Political commitment  Member of the patient’s family

(last priority)
 Quality microscopy service
 Where to do DOT? In any
 Regular availability of drugs accessible and convenient
place (RHU, home, school)
 Standardized records & reports
 How long is the DOT? Whole
 Supervised treatment treatment

DOTS Element #1 NTP Strategies

Political Commitment TB Diagnostic Committees (TBDC)

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 To provide quality diagnosis for the
sputum smear (-) radiologic suspect
cases
 Group of experts: NTP Coordinator,
Pulmonologist/Clinicians, Radiologist
 Proven to reduce over-diagnosis and
over-treatment of smear (-)s by 40%
TB in children
 Pilot in urban and rural areas
 Guidelines are available
TB/HIV co – infection
 No existing data
 HIV prevalence in the general
population, and among TB patients,
remains low at <1 %
DOH initiative – TB/HIV co – infection
 Recognize the need for the
collaboration to address TB/HIV co –
infection
 Plan to establish TB/HIV committee
 Formulate policies and
guidelines
 Plan strategies
 Coordinate with two programs
(NTP and NAP) and partners
Increased the Demand for DOTS services
1. Inform and educated the community:
 Community participation
(Community-based DOTS)
 Task forces in the
community
2. Strengthen Advocacy:
 World TB day celebration –
March 24
 Nat’l TB day August
 MLQ DOTS achievers
award
 TB network
 TB Advocacy Writeshop:
 Development of “NTP Health
Promotion for Health Workers”
 Contents – 4 basic strategies of
Health Promotion:
Advocacy, HE
ROLES OF NURSES
 Manages the procedures for case
finding
 Maintains records and reports
 Supervise the midwives at the health
center
 Facilitate requisition and distribution of
drugs and NTP supplies
 Conducts training in coordination with
the physician
 Prepares, analyzes and submits reports
 Standard reader in the Childhood TB
program
PTB cases category
Category 1
1. Prescribed for:
 New pulmonary smear (+)
cases
 New seriously ill pulmonary
smear (-) cases with extensive
parenchymal involvement
 New severely ill extra-
pulmonary TB cases
2. Drugs and duration of treatment:
 Intensive Phase: 2 months
 Rifampicin 450 mg
 Isoniazid 300 mg
 Pyrazinamide 2 tablets
500 mg
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 Ethambutol 2 tablets  New extra – pulmonary TB (not

400 mg serious)

 Maintenance phase: 4 months 2. Drugs and Duration of treatment:

 Rifampicin 450 mg  Intensive phase – 1 month

 Isoniazid 300 mg Rifampicin 450 mg

Category 2 Isoniazid 300 mg

1. Prescribed for: Pyrazinamide 2 tablets 500 mg

 Failure cases  Maintenance pahse – 5 months

 Relapse cases Rifampicin 450 mg

 RAD (smear +) Isoniazid 300 mg

Minor side effects to be expected and nursing

 Other (smear +)
care:
2. Drugs and Duration of treatment:
Drug Side effects and Nursing Care
 Intensive Phase – 2 months

Rifampicin 450 mg Rifampicin Gastrointestinal disturbance – give

drug at bedtime
Isoniazid 300 mg
Orange or red urine – reassure
Pyrazinamide 2 tablets 500 mg patient it is not blood and advise to
continue medication
Ethambutol 2 tablets 400 mg
Flu like symptoms such as fever,
Streptomycin 1 gm muscle pain and inflammation of
respiratory tract
 Intensive phase – 1 month
Give antipyretics
Rifampicin 450 mg
Mild skin reactions – give
Isoniazid 300 mg antihistamine

Pyrazinamide 2 tablets 500 mg

Streptomy Pain at injection site – apply warm
Ethambutol 2 tablets 400 mg cin compress and rotate injection site.

 Maintenance pahse – 5 months Isoniazid Burning sensation in the feet caused

by peripheral neurophaty – Vitamin
Rifampicin 450 mg B6 or pyridoxine 100-200 mg
treatment and 10 mg for prevention
Isoniazid 300 mg

Ethambutol 2 tablets 400 mg Pyrazinam Hyperuricemia causing arthralgia –

id give aspirin or NSAID
Category 3

1. Prescribed for:

 New smear (-) but within

minimal pulmonary TB on
radiography as confirmed by a
medical officer

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FIXED DOSE COMBINATION

DRUG FDC – A FDC – B

4 – DRUG 2 – DRUG (RH)

(RHZE)

RIFAMPICIN 150 MG 150 MG

(R)

INH ( H ) 75 MG 75 MG

PZA ( Z ) 400 MG

Major side effects that indicates discontinuing ETHAMBUTH 275 MG

drug OL

treatment and requires prompt referral to

MHO.
BODY NO. OF TABLETS NO. OF TABLETS
Drugs Side effects and nursing care WEIGHT PERDAY PERDAY

INTENSIVE MAINTENANCE
Rifampicin Jaundice due to hepatitis PHASE PHASE
Oliguria and albuminuria due to renal (2 MONTHS (4 MONTHS )
disorder RHZE)
RH
Thrombocytopenia RHZE
Anemia
30-37 2 2
Shock

38-54 3 3
Streptomy Severe skin rash with any drug
cin
Hearing impairment – ringing of the 55-70 4 4
ear, dizziness due to damage to
eight cranial nerve
>71 5 5
Oliguria and albuminuria due to renal
disorder

Isoniazid Jaundice due to hepatitis Bod Intensive Phase Maintenanc

y e Phase
Psychosis and convulsion wei
ght

Pyrazinam Jaundice due to hepatitis (KG)

id

First 2 months Third

Ethambut Optic – neuritis – impairment of Month
ol visual acuity and color vision

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RHZE Streptomyc RHZE RH E

in
400
MG

30 – 2 .75 G 2 2 1
37

38 – 3 .75 G 3 3 2
54

55 – 4 .75 G 4 4 2
70

> 71 5 .75 G 5 5 3

BODY NO. OF TABLETS NO. OF TABLET

WEIGHT PER DAY PER DAY

(kg)
INTENSIVE MAINTENANCE
PHASE PHASE

(2 MONTHS) (4 MONTHS)

RH Z (400 MG) RH

30 – 37 2 2 2

38 - 54 3 3 3

55 - 70 4 4 4

> 71 5 5 5

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REPRODUCTIVE HEALTH PROGRAM

 A state of complete physical, mental,

and social well-being and not merely
the absence of disease or infirmity in
all matters relating to the reproductive
system and to its functions and
processes.

 Reproductive health programs are

highly dependent on the health
systems, human resource
requirements, and service needs of the
country or region. The health systems
are dependent on the structural and
functional systems of the region, taking
into account the resources available
and accessible. The human resource
requirements are dependent ob the
individual and institutional capacities of
the areas, coupled with their specific
training needs.

Reproductive Health implies that people:

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 Have the right to remain free of
disease, disability or death associated
with their sexuality and reproduction
 Have the right to decide fully and
responsibly the number and spacing of
their children
 Have the right to understand and enjoy
their own sexuality;
 Have the capability to reproduce; and
 Are able to have a satisfying and safe
sex life
How important is RH?
 RH is a crucial part of general health
since it has pronounced inter-
developmental and inter-generational
effects
 It is a key element of health during
infancy through adolescence and
adulthood
 It also affects the child in-utero as well
as sets the stage for health beyond the
reproductive years for both men and
women
CONCEPTS
 A married couple has the capability to
reproduce/procreate.
 Reproductive Health is the exercise of
reproductive right with responsibility
(e.g. it is the freedom to when and how
to do so).
 RH includes sexual health for the
purpose of enhancement of life and
personal relations (sexual health
means protection from STD, from
harmful reproductive practices and
violence, control and freedom over
sexual relations).
 RH means safe pregnancy and delivery.
The right of access to appropriate
health information and services to
enable women to go through
pregnancy and childbirth safely.
 RH includes protection from unwanted
pregnancy by having access to safe
and acceptable methods of family
planning (FP) of their choice.
 RH includes protection from harmful
reproductive practices and violence.
 RH assures access to information on
sexuality to achieve sexual enjoyment.
VISION
 Reproductive health practice as a way
of life for every man and woman
throughout life.
GOALS
 To achieve healthy sexual development
and maturation.
 To achieve their reproductive intention.
 To avoid illness/disease, injuries
disabilities related to sexuality and
reproduction.
 To achieve appropriate counseling and
care of RH problems.
 Every pregnancy should be
intended.
 Every birth should be healthy.
 Every sex act should be free of
coercion and infection.
 Achieve a desire family size.
STRATEGIES
 Increase and improve the use of more
effective or modern contraceptive
method. Increase the type of methods
offered available in the program.
 Provision of care, treatment and
rehabilitation for RH, if possible in all
facilities (clinic and hospital).
 RH care provision should be focused on
adolescent, men and unmarried and
other displaced people with RH
problem.
 Strengthen outreach activities and the
referral system. (Ask assistance of
community volunteer worker for
outreach activities. Enforce the use of
two-way referral system using referral
forms).
 Prevent specific RH problems. (through
information dissemination and
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counseling of clients with RH

problems).
ELEMENTS OF REPRODUCTIVE HEALTH
THE INTERNATIONAL AND NATIONAL / LOCAL
FRAMEWORK ON RH  Maternal and Child Health and Nutrition

 Family Planning

 Prevention and Management of

Abortion Complications
INTERNATIONAL
 Prevention and treatment of
 Focus on women’s health, not only as a
Reproductive Tract Infections (RTIs)
mother during her child bearing, but
including STDs, HIV and AIDS Education
throughout life, from infancy to post
and counseling on sexuality and sexual
reproductive health, with full exercise
health
of her reproductive life.

 Achievement of health among women  Breast and Reproductive Tract Cancers

is dependent upon their attitudes and other Gynecological conditions
towards health, their knowledge and
skills.  Men’s Reproductive Health

 Other factor that may affect women’s  Adolescent Reproductive Health

health are the general environment,
like poverty and under-employment,
powerlessness or gender
discrimination.
 Availability of social services to
promote and protect health of women,
affects their health a lot.
 Violence Against Women (VAW)
 Prevention and Treatment of Infertility
and Sexual Disorder
FACTORS/DETERMINANTS OF
REPRODUCTIVE HEALTH

1.SOCIO-ECONOMIC CONDITIONS
 Promotion and attainment of optimum
health contributes to achieve the
ultimate goal of “QUALITY OF LIFE”.
 EDUCATION

 EMPLOYMENT
LOCAL
 POVERTY
 The focus of Philippine framework is
the Reproductive Health Status in
 NUTRITION
terms of its element. It doesn’t only
address women but both men and
women.  LIVING CONDITION/ENVIRONMENT

 Several factors can affect the RH  FAMILY ENVIRONMENT

status, such as, Health services
2. STATUS OF WOMEN
delivery mechanism, other factors like
women’s health behavior. The national
3. SOCIAL AND GENDER ISSUES
framework status that women’s
attitude, knowledge, skills and behavior
4. BIOLOGICAL, CULTURAL AND PSYCHO-
of women. In general environment, the
SOCIAL FACTORS
Philippine framework focused on
sanitation, safe water supply,
employment/ working conditions like
the occupational safety standard, while
the International framework focus on
the economic value, powerlessness and
discrimination of women.

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PROMOTIVE/PREVENTIVE CARE OR
MANAGEMENT THAT CAN BE EXTENDED TO
INDIVIDUAL WITH RH PROBLEMS AT THIS
STAGE OF LIFE

 Counsel couples for Family Planning

acceptance, provide FP services.

 Provide appropriate maternal care to

mothers who are in need of the
services.

 Nutrition education

 Identification/case finding/diagnosis
and treatment/management or referral
to appropriate clinic, of diagnosed
STD/AIDS cases. Infertility diagnosis
and management

 The counseling of clients on human

sexuality

 The merging concerns on violence

against women/men and children

 The identification of reproductive

health concerns

 Early diagnosis and appropriate

management

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PROFESSIONAL ADJUSTMENT
SCOPE OF NURSING PRACTICE IN THE
Philippines
A person is deemed practicing Nursing:
- When he/she singly or in collaboration
with another, initiate and perform
services to individuals, families and
communities in any health care
settings.
- when he/she provides nursing care
during conception, labor, delivery,
infancy, childhood, toddler, school age,
adulthood and old age
- when as independent practitioner, the
nurse is primarily responsible
promotion of health and prevention of
illness
- when as a member of the health team,
the nurse collaborates with other
health care providers for the curative,
preventive and rehabilitative aspects of
care, restoration of health, alleviation
of suffering, and when recovery is not
possible towards peaceful death.
- Duties and Responsibilities
- 1. Utilization of nursing process,
assessment, planning, implementation
and evaluation of care.
-
- 2. Establishment of linkage with
community resources and coordination
of services with other members of the
health team
- requirements for registration in their
- 3. Motivation of individuals, families,
and communities to accept primary
responsibility for their own health care;
the utilization of indigenous resources
and appropriate technology in bringing
about improvement in the quality of
their lives.
4. Participation in teaching, guidance, and
supervision of the students in nursing
education programs; administration of nursing
services in varied settings.
5. Undertaking nursing and health manpower
development, training and research and
soliciting finances
In addition to the above, what are
expected of nurses in the practice of their
profession?
- Observe Code of Ethics and Code of
Technical Standards
for Nurses
- Uphold the standards for safe nursing
practice
- Maintain competence by continual
learning through
professional continuing education.
How can one practice nursing in the
Philippines?
A person can practice nursing in the
Philippines if he/she;
• Passed the written exams given by
the
Board of Nursing
• Registered by reciprocity
• Has a special or temporary permit
• What is Registration by
Reciprocity?
• Nurses who are registered in a foreign
country may be issued a certificate of
registration/professional license if
these conditions are met (1) the
country of origin are substantially the
same as those in our country, and, (2)
under their laws, Filipino nurses are
granted the same privileges and on the
same basis as their citizens.
• Who may be issued a
Special/Temporary permit?
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 tHei Luna BSN IV A5
• - Licensed nurses from foreign
countries/states whose service are
either for a fee or free if there are
internationally well known specialists
or outstanding experts in any branch
or specialty of nursing
• - licensed nurses from foreign
countries/states on medical mission
whose services shall be free in a
particular hospital, center or clinic, and
• insanity, or mind incapable of
•
• - Licensed nurses from foreign
countries/states employed by
schools/colleges of nursing as
exchange professors in a branch or
specialty of nursing
• Note: The temporary permit shall be
effective for the duration of the project,
medical mission or employment
contract.
What does the PRC issues to nurses who
passed the Board Exams?
- A certificate of registration/
professional license as a nurse that
show the full name of the registrant,
the serial number, the signature of the
Chairperson of the Commission and of
the Members of the Board and the
official seal of the Commission
- A professional identification card duly
signed by the Chairperson of the
Commission, bearing the date of
registration, license number, and the
date of issuance and expiration thereof
shall likewise be issued to every
registrant upon payment of required
fees.
Sec. 22 RA 9173 – non-registration and non-
insurance of certificate of
registration/professional license or
special/temporary permit.
1. moral turpitude – an act done
contrary to justice, honesty, modesty,
or good morals, and some particular
crimes identified under this definition
are: adultery, bigamy, blackmail,
bribery, criminal conspiracy to smuggle
opium, embezzlement, staff, extortion,
fabrication of evidence, forgery, libel,
murder and perjury, and seduction
under promise of marriage.
2. 2. Immoral or dishonorable conduct
– is one which is contrary to standards
of moral conduct, whether illegal or
not, obscene, indecent
3. 3. Unsound Mind – means mental
incapacity, idiocy, imbecility, lunacy,
reasoning.
Philippine Nursing Act of 2002 – RA 9173 =
basic law in the practice of nursing profession
in the Philippines.
Composition of the Board of Nursing
1. A Chairperson
2. 6 Members
E.O. No.496 – Instituting Procedures and
Criteria for the Selection and the
Recommendation of Nominees for the
Appointment to Vacant Positions in the
Professional Regulatory Boards under the
Supervision of the Professional Regulatory
Commission,
Qualification of the Chairperson and Members
of the Board
1. Be a natural born citizen and resident
of the Philippines.
2. Be a member of good standing of the
accredited professional organization of
nurses;
3. Be a registered nurse and holder of
master’s degree in nursing, education
or other allied medical profession
considered by a college or university
duly recognized by the Government;
Provided. That the majority of the
members of the Board shall be holders
of Master’s degree in Nursing; Provided
further, that the Chairperson shall be a
holder of master’s degree in nursing.
4. 4. Have at least ten (10) years
continuous practice of the profession
prior to appointment. Provided,
however, That the last five (5) years of
which shall be in the Philippines, and;
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5. 5. Not have been convicted by any
offense involving moral turpitude;
6. Provided, That the membership to the
board shall represent the three (3)
areas of nursing; nursing education,
nursing services and community health
nursing.
Requirements Upon Qualification as Member of
the Board of Nursing
1. To immediately resign from any
teaching position to any school, college
or university offering nursing degree
program and/or review program for the
local nursing board examination or in
ant office or employment in the
Government or any subdivision, agency
or instrumentality thereof, including
government-owned and controlled
corporations or their subsidiaries as
well as the employment in the private
sector, and
2. Not to have any pecuniary interest in or
administrative supervision over any
institution offering Bachelor of Science
in Nursing including review classes.
Who appoints, removes and suspends the
members of the BON?
- The President of the Republic of the
Philippines
Powers, Functions, and Duties of the BON
- - Conduct the licensure examination
for nurses.
- Issue, suspend or revoke certificates
of registration for the practice of
nursing
- monitor and enforce quality standards
of nursing practice in the Philippines
and exercise the powers necessary to
ensure the maintenance of efficient,
ethical and technical, moral and
professional standards in the practice
of nursing taking into account the
health needs of the nation
- Ensure quality nursing education by
examining the prescribed facilities of
universities or colleges of nursing or
departments of nursing education and
those seeking permission to open
nursing courses to ensure the
standards of nursing education are
properly complied with and maintained
at all times.
- Conduct hearings and investigations
to resolve complaints against nurse
practitioners for ethical and
unprofessional conduct and violation of
this Act, or its rules and regulations
and in connection therewith, issue
sobpoena ad testificandum and
subpoena duces tecum to secure the
appearance of respondents and
witnesses and the production of
documents and purnish with contempt
persons obstructing, impending and/or
otherwise interfering with the conduct
- Promulgate the Code of ethics in
coordination and consultation with the
accredited professional organization of
nurses
- Recognize nursing specialty
organizations in coordination with the
accredited professional organization ,
and
- Prescribe, adopt, issue and promulgate
guidelines, regulations, measures and
decisions as maybe necessary for the
improvement of the nursing practice,
advancement of the profession and for the
proper and full enforcement of RA 9173 subject
to the review and approval by the PRC.
What are the grounds for the removal or
suspension of the members of the BON?
- Continued neglect of duty or
incompetence
- Commission or tolerance of
irregularities in the licensure
examinations, and
- Unprofessional, immoral and
dishonorable conduct
Qualifications of Nursing Administrators
A person occupying supervisory or mangerial
positions requiring knowledge of nursing must;
- Be a registered nurse in the Philippines
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 tHei Luna BSN IV A5
- Have at least two (2) years experience
in general nursing service
administration
- posses a degree of bachelor of
Science in Nursing, with at least 9 units
in management and administration
courses at the graduate level; and
- Be a member of good standing of the
accredited Professional Organization of
Nurses;
- provided, that a person occupying the
position of chief nurse or director of
Nursing service shall, in addition to the
foregoing qualifications, possess:
- At least 5 years of experience in a
supervisory or managerial position in nursing;
and
- A Masters degree major in Nursing;
Maximum academic qualifications and
experiences for a chief nurse are:
- Be a registered nurse in the
Philippines
- Have at least two (2) years experience
in general nursing service
administration;
- Possess a degree of Bachelor of
Science in Nursing with at least nine
(9) units in management and
administration courses at the graduate
level; and
What are the qualifications of Faculty of
Nursing?
- Be a Registered Nurse in the
Philippines
- Have at least one (1) year of clinical
practice in a field of specialization;
- Be a member of good standing in the
accredited professional organization of
nurses, and;
- be a holder of a master’s degree in
nursing, education or other allied
medical and health sciences conferred
by a college or university duly
recognized by the Government of the
Republic of the Philippines
What are the qualification of deans of
colleges of nursing?
In addition to the abovementioned
qualifications of the faculty, the dean of a
college must:
- Have a master’s degree in nursing,
and;
- Have at least five (5) years of
experience in nursing
What are the grounds for the revocation
and suspension of certificate of
registration/professional license and
cancellation of special/temporary permit?
- Conviction by the final judgment of any
criminal offense including moral turpitude,
immoral or dishonorable conduct, or, having
unsound mind;
- For unprofessional and unethical
conduct
- For gross incompetence or serious
ignorance
- For the use of fraud, deceit, or false
statements in obtaining a certificate of
registration/professional license or a
temporary/special permit;
- For violation of RA 9173, the rules and
regulations. Code of Ethics for nurses
and technical standards for nursing
practice, policies of the Board and the
Commission, or the conditions and
limitations for the issuance of the
temporary/special permit, or
- For practicing his/her profession
during his/her suspension from such
practice
What are the requirements for the re-
issuance of revoked certifications and
replacement of lost certificates?
- Expiration of a maximum of four years
from the date of revocation of a
certificate
- the cause for revocation has
disappeared or has been cured and
corrected
- proper application
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 tHei Luna BSN IV A5
- payment of the required fees
- Can inactive nurses return to
practice?
- YES. Nurses who have not actively
practiced the profession for five (5)
consecutive years can return to
practice if they undergo one month of
didactic training and three months of
practicum. The Board of Nursing shall
accredit hospitals to conduct the said
training program.
- What are the prohibitions in the
practice of nursing in the country?
- - Those without a certificate of
registration/professional license and
professional identification card or
special temporary permit or without
having been declared exempt from
examination.
- Anybody who uses as his/her own the
certificate of registration, professional
license and professional identification
card or special temporary permit of
another.
- Anybody who uses an invalid
certificate of registration/professional
license, a suspended or revoked
certificate of registration/professional
license, or an expired or cancelled
special/temporary permit.
- Anybody who gives any false
evidence to the Board in order to
obtain certificate of
registration/professional license, a
professional identification card or
special/temporary permit
- Anybody who falsely poses or
advertises as a registered and licensed
nurse or uses any other means that
tend to convey the impression that
he/she is a registered and licensed
nurse
- Anybody who appends BSN, RN or
any similar appendage to his/her name
without having been conferred said
degree or registration
- Anybody who, as a registered and
licensed nurse, abets or assist the
illegal practice of a person who is not
lawfully qualified to practice nursing
- - Any person or the chief executive
officer of a judicial entity who
undertakes in-service educational
programs or who conducts review
classes for both local and foreign
examination without permit/clearance
from the Board and the Commission
- - Any person or employer of nurses
who violate the minimum base pay of
nurses and the incentives and benefits
that should be accorded them
- - Any person or the chief executive
officer of a judicial entity violating any
provision of this Act and its rules and
regulations.
- What are the provisions on
continuing professional education?
- Nurses are required to maintain
competence by continual learning
through continuing professional
education to be provided by the
accredited professional organization or
any recognized professional nursing
organization.
- The law also mandates the creation of
a comprehensive specialty program by
the Board of Nursing, the Philippine
Nurses Association and the
Department of Health to upgrade the
level of skill and competence of
specialty nurse clinicians in the
country.
LEGAL ASPEECTS AND THE NURSE
- AS NURSES BEGIN their first
professional obligations their legal
responsibilities begin as well.
Responsibility and Accountability for the
Practice of Professional Nursing.
1. They are held responsible and
accountable for the quality of
performance of their duties.
2. Nurses employed in an agency,
institution, or hospital are directly
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 tHei Luna BSN IV A5
responsible to their immediate
supervisors.
3. 3. Private duty nurses, being
independent practitioners, are held to a
standard of conduct that is expected of
reasonably prudent nurses.
4. Professional Negligence
5. Negligence – refers to the commission
or omission of an act, pursuant to a
duty, that a reasonably prudent person
in the same or similar circumstance
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.
Element of Professional Negligence
1. Existence of a duty on the part of the
person charged to use due care under
circumstances.
2. Failure to meet the standard of due
care.
3. The foreseeabilty 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.
Specific examples of Negligence
1. Failure to report observations to
attending physicians.
2. Failure to exercise the decree of
diligence which the circumstances
of the particular case demands.
3. Mistaken Identity
4. Wrong medicine, wrong
concentration, wrong route, wrong
dose, wrong time and frequency
5. Defects in the equipment such as
stretcher and wheelchairs may
lead to falls
6. 6. Errors due to family assistance
7. 7. Administration of medication
without a
8. doctor’s prescription
9. Res ipsa loquitur – the thing or
transaction speaks for itself
10. THE DOCTRINE OF IPSA LOQUITUR
11. Thee conditions are required to
establish a defendant’s negligence
without proving specific conduct.
12. 1. That the injury was of such nature
that it would not normally occur unless
there was a negligent act on the part of
someone
13. 2. That the injury was caused by an
agency
14. Within control of the defendant.
15. 3. The the plaintiff himself did not
engage in a
16. any manner that would tend to bring
about
17. the injury.
18. Note: Proof of the plaintiff that each of
these factors exists in a given situation
permits the courts to conclude that the
defendant is negligent. No other proof
is required.
Malpractice implies the idea of improper or
unskilled care of a patient by a nurse.
- Also denotes stepping beyond one’s
authority with serious consequences.
- Is the term for negligence or
carelessness of professional personnel
DETERMINING WHAT IS CARELESS AND
WHAT IS NOT CARELESS
- THE STANDARD OF CARE WHICH A
REASONABLY PRUDENT NURSE WOULD DO
UNDER SIMILAR CIRCUMSTANCES SPECIFIED IN
THE LAW.
Lesnik (1962) also states that the term
malpractice is used properly only when it refers
22
 tHei Luna BSN IV A5
to a negligent act committed in the course of
professional performance.
Note: Consult a lawyer when you are involved
in a malpractice.
DOCTRINE OF FORCE MAJEURE
Force majeure – an act of God or an
unexpected event which takes place by
accident and can neither be foreseen nor
resisted
NOTE: Under the Civil Code of the Philippines,
no person shall be responsible for these events
which cannot be foreseen, or which, though
foreseen, are inevitable, except in cases
expressly specified by law
Examples: FLOODS, FIRE EARHTQUAKES,
AND ACCIDENTS FALL, nurses who fail to
render services under these circumstances will
not be held negligent.
DOCTRINE OF RESPONDEAT SUPERIOR
- THE TERM MEANS ‘let the master
answer for the acts of the subordinate”
Under this Doctrine, the liability is expanded
to include the master as well as the employee
and not a shift of liability from the subordinate
to master.
- It applies only to those actions performed by
the employee within the scope of his
employment
INCOMPETENCE – is the lack of ability, legal
qualifications or fitness to discharge the
required duty.
LIABILITY OF NURSES FOR THE WORK OF
NURSING AIDES
- Nurses should not delegate their work
to nursing aides.
- supervise properly their subordinate
and be sure they only do what they are
taught.
LIABILITY OF NURSES FOR THE WORK OF
STUDENT NURSES
NOTE: Under the Philippine nursing Act Law of
2002, R.A. 9173, nursing students do not
perform professional nursing duties
- They are to be supervised by their
clinical instructors
Following measures should be taken in
order to avoid and minimize student’s
error
1. Nursing students should always be under
the supervision of their Clinical Instructors.
2. They should be given assignments that are
at their level of nursing experience, and
competency.
3. They should be advised to seek guidance
especially if they are performing a procedure
for the first time.
4. They should be oriented to the policies of
the nursing unit where they are assigned.
5. Their performance should be assessed
frequently to determine their strengths and
weaknesses
6. Frequent conferences with the students will
reveal their problems which they may want to
bring to the attention of their instructors or
vice versa.
LEGAL DEFENSE IN NEGLIGENCE
- Most common defense in negligent action is
when nurses know and attain that standard of
care in giving service and that they have
documented the care they give in a concise
and accurate manner
if the patient’s careless conduct contributes to
his own injury, the patient cannot bring suit
against the nurse.
ASSUMPTION OF RISK – the nurse gives an
advance consent , such as taking care of
psychiatric patient or patient with
communicable diseases, the nurse cannot file
suit against the patient, since upon accepting
the case he/she already agreed to assume the
risk of harm or infection thereby relieving the
patient or relatives from any legal obligations.
- Nurses therefore shall exercise their sound
judgment and utilize standards of care in order
to prevent lawsuits or harm to themselves.
MEDICAL ORDERS, DRUGS, AND
MEDICATIONS
R.A. 6675 states that only validly registered
medical, dental practitioners, whether in
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private institution/corporation or in the
government, are authorized to prescribed
drugs.
- Prescriptions made by unauthorized persons
constitute illegal practice of medicine, dentistry
or veterinary medicine and is punishable under
R.A. 2832 or the Medical Act of 1959, R.A. 4419
0r the Dental Act, R.A. 382 0r the Veterinary
Act
Execution of written legal orders of physician
regarding treatment and medications
- Only when these orders are legal in
writing and bear the doctor’s signature
does the nurse have the legal right to
follow them.
- written orders should be clear,
specific, complete and legible to
minimize errors.
- General rule requiring a nurse to follow
all lawful orders of a physician is
tempered by a common sense.
- What are intentional torts?
- - Assault and Battery – Assault is an
unjustifiable attempt to touch another
person or even the threat of doing so
while battery is the actual carrying out
of the threatened physical contact.
- - Defamation of character occurs
where a person discusses another
individual in terms that diminish
reputation. Libel is written defamation.
Slander is oral defamation.
- Invasion of privacy is the violation of a
person’s right to be left alone
- False Imprisonment si the
infringement of upon an individual
freedom of movement. It is making
someone wrongfully feel he or she
cannot leave the place.
What is an advance directive?
It is a document made by a competent
individual to establish desired health care for
the future or give someone else the right to
make health care if the individual becomes
incompetent
Living Will specifies the treatments a patient
wants or does not want if he becomes unable
to make decisions for himself.
Durable Power of Attorney. The patient
appoints a particular person to make medical
decisions for him if he becomes unable to do
so
What is an incident report?
An incident report is an administrative report
that is required of nurses if there are violations
of standards and policies whether or not injury
occurs
Common legal terms that nurses should know
• AFFIDAVIT – is a written statement
made under oath before a notary
public or person duly authorized.
• CONTEMPT OF COURT – is the
willful disobedience to, or open
disrespect for, the rules of court.
• DEFENDANT – The person being
accused of a wrongdoing, therefore
needs to defend himself.
• DUE PROCESS – is fair and orderly
process which aims to protect and
enforce a patient’s rights.
• FALSE TESTIMONY – is punishable
in both criminal and civil law
• INQUEST – is the legal inquiry into
the cause or manner of a death
• PERJURY - is the willful telling of a
lie under oath. This ca be committed
by a nurse who is a witness in a legal
case.
• PLAINTIFF – The person who files
the lawsuit and is seeking justice for a
perceived wrongdoing.
• PRIMA FACIE EVIDENCE – evidence,
which if unexplained or uncontradicted
would establish the fact alleged.
• PRIVILEGE COMMUNICATION – the
nurse is incompetent to testify on the
communications made to him by his
patients, all the advice given and all
the information gathered by
observation
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• SUBPOENA – is an order that

requires a person to attend at a
specific time and place to testify as
witness.

• SUBPOENA DUCES TECUM – is a

subpoena that requires a witness to
bring required papers/documents and
the like which may be in the
possession.

• SUMMONS – is a writ commanding

an authorized person to notify a party
to appear in court to answer a
complaint made against him

How can nurses protect themselves from

malpractice suit?

• Practice within the scope of the

nurse practice act.

• Follow established practice

standards.

- a standard is the desired and achievable

level of performance against which actual
practice is concerned.

• Observe agency policies and

procedures

• Always out patient rights and

welfare first.

• Be aware of relevant laws and

legal concepts/principles

• Upgrade technical skills

consistently

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