Introductory concept  Article VIII section 35: Prohibition in
the practice of nursing
Scope of nursing practice based on article
9173
 Article VI sec, 28 Scope of nursing
- A person is practicing nursing
within the meaning of this act
when he is singly or in
collaboration with another,
initiates and performs nursing
services to individuals, families
and communities in any health
care setting.
- It includes nursing care from
conception to old age.
- As independent practitioners,
nurses are primarily responsible
for the promotion of health and
prevention of illness.
- Nurses shall collaborate with
other health care providers for
the curative, preventive and
rehabilitative aspects of care.
(a) Provide nursing care through the
utilization of nursing process
(b) Establishes linkages with
community resources and
coordination with the health team
(c) Provide health education to
individuals, families and
communities.
(d) Teach, guide and supervise
students in nursing education
programs including the
administration of nursing
services such as hospitals and
clinics.
(e) Undertake nursing and health
human resource development
training and research… to the
development of advance nursing
practice.
 Sec. 29. Qualification of nursing
services administrators.
(a) A registered nurse in the
Philippines
(b) Have at least 2 years of
experience in general nursing
service administration
(c) Possess a degrees of bachelor
of science in nursing with at least
9 units In management and
administration courses at the
graduate level
(d) A good standing of the
accredited professional
organization of nurses.
- A fine 50,000 pesos and no
more than 100,000 pesos
- Imprisonment of not less than 1
year or not more than 6 years
based upon the discretion of the
court.
(a) Without a certificate of
registration or professional
licence and professional
identification
(b) Uses other’s own certificate of
registration/professional licence
and professional identification or
special temporary permit.
(c) Uses invalid certificate of
registration/professional license,
suspended or revoked certificate
of registration/professional
license or expired or cancelled
temporary permit
(d) False evidence to the board in
order to obtain a certificate of
registration/professional license
or professional identification card
(e) Falsely pose or advertises as a
registered nurse or uses other
means that tend to convey the
impression that he/she is a
registered and licensed nurse.
(f) Appends BSN/RN or any similar
appendage at the end of his/her
name
(g) Who as a registered nurse abets
or assist with illegal practice of
a person who is not lawfully
qualified
- Any person or the chief
executive officer of a juridical
entity who undertakes in-service
educational program/conducts
review classes for both for both
local and foreign examination
without permit
- Person or employer of nurses
who violate the minimum base
pat of nurses and the incentives
and benefits in section32 and 34
- Chief executive officer violating
any provision of this act and its
rule and regulation
 Professional decorum
-it is an unwritten code of conduct regarding
the interactions among the members in a
healthcare setting
 Professional decorum or etiquette
- About expressing yourself with
polish and professionalism that
demonstrates that you are
trusted
- Being comfortable around
people and making them feel
comfortable around you
 Professional nurse
- Must have high standard of
professional ethics, behaviour
and work activities while
performing one’s profession
- Required to put the interest of
- client ahead of his/her own
- Appropriate treatment with
colleagues and must show
consideration to elderly, junior or
inexperienced colleagues
 Student nurse
- A person who is training to
become a professional nurse at
a nursing school or the hospital
STUDENT NURES EXPECCTED
ETIQUETTE
-introduce yourself
- Dress properly
- Smile
- Act accordingly to hospital’s protocol
- Wear your name bade at all times
- Constantly show respect and courtesy.
Patient’s bill of rights
-is a document that provides patients with
information on how they can reasonable
expect to be treated during the course of
their hospital stay.
- First adopted by the American Hospital
association in 1973 and revised in October
1992. It is developed with the expectation
that hospitals and health care institution
would support these rights.
- A patient’s rights can be exercised on his
or her behalf by a designated surrogate or
proxy decision maker if the patient lacks
decision making capacity, legally
incompetent and is a minor
 Right to appropriate medical care
and humane treatment
- Has right to appropriate health
and medical care of good quality
without any discrimination. His
human dignity, convictions,
integrity and individual needs
should be respected.
 Right to informed consent
- A right to s clear, truthful and
substantial explanation in a
manner and language
understandable to the patient
- It is obtained from the patient
concerned if he is of legal age of
sound mind
Exceptions to informed consent:
(a) Patient is incapacitated
(b) Life threatening emergencies with
inadequate time to obtain informed
consent
(c) Voluntary waved consent
(d) Px is a minor (consent is obtained by
parents and legal guardian)
(e) Legally incompetent (third arty is
required)
Order of priority:
(1) Spouse
(2) Son/daughter of legal age
(3) Parent
(4) Brother/sister of legal age
(5) Guardian
 Right to privacy and confidentiality
- Privacy (right of an individual to
keep his/her information private)
- Confidentiality (duty of anyone
entrusted with health information
to keep it private)
 Right to information
- Right to be informed of hospital
policies and practices that
relates to the px care and
treatment. Right to be informed
of available resources for
resolving disputes, grievances
and conflicts such as ethics
committees, patient
representative. Right to be
informed with hospital charge for
services.
 Right to choose health care provider
and facility
  Right to religious belief
- Right to liberty express freedom
of religion in teaching, practice,
worship
 Right to self-determination
- Expect reasonable continuity of
care when appropriate and to be
informed by physicians and other
caregivers of available and
realistic patient care when
hospital care is no longer
appropriate.
 Right to medical records
- Right to review the records
pertaining to his/her medical
care and to have the information
explained or interpreted as
necessary.
 Right to leave
- Right to make decisions about
the plan of care prior to and
during the course of treatment
and to refuse recommended
treatment to the extent permitted
by the law and hospital policy
and to be informed of the
medical consequences of this
action. In such refusal, the
patient is entitles to other
appropriate care and services.
 Right to have advanced directive.
- Such as a living will, healthcare
proxy or durable power of
attorney for health care
Filipino culture values and practices in
relation to the care of the at risk and sick
adult clients
-Filipino older adults tend to cope with
illness with the help of the family and friends
and by the faith of god.
- Complete cure and even the slightest
improvement is considered as miracle
- Filipino families greatly influence patient’s
decisions about health care
- Patient subjugate to personal needs and
tend to go along with the demands of the
more authorative family figure in order to
maintain group harmony
- Before seeking professional help. Filipino’s
tend to manage their illness by self-
monitoring of symptoms and ascertaining
possible cause considering to the financial
and emotional burden
- Seeking medical advice from family/friends
who are health professionals is a common
practice especially if severe somatic
symptoms arise.
- Utilizing traditional home remedies such as
alternative or complementary means
Coping styles:
 Patience and endurance
- Ability to tolerate uncertain
situation
 Flexibility
- Being respectful and honest to
oneself
 Humor
- Laugh at oneself in times of
adversity
 Fatalistic resignation
- View that illness and suffering
are unavoidable and predestined
will of god
 Conceding to the wishes of the
collective
- Maintain group harmony
Ethical principles of nursing
 Autonomy
- Autos (self)
- Nomos (rule/law)
- Prefers self-rule.
- Broad meanings including
individual rights, privacy and
choice. Ability to make a choice
free from external constraints.
 Beneficence
- Duty to do good (eg. Goodness,
kindness and charity)
 Nonmaleficence
- Duty to not inflict harm as well as
to prevent and remove harm. It
may be included within the
principle of beneficence but
nonmaleficence are more
binding.
 Justice
- Treating patient’s freely and
equally
 Veracity
- Obligation to tell the truth and
not lie or deceive others
 - But it can be violated in so many
ways.
- Omission (critical relevant facts
are intentionally left out when
disclosing the patient’s medical
condition)
- Commission (medical personnel
intentionally tell the patient/family
a lie.)
- A more subtle way to violate the
principle veracity is the cloak
the truth in so much medical
jargon that they will not be able
to understand it.
 Fidelity
- Promise keeping, being faithful
to one’s commitments
Perioperative nursing care
Safe and comprehensive perioperative
nursing care
 Preoperative phase
- Begins when the decision to
proceed with surgical
intervention is made amends
with the transfer of the patient
onto the operating room.
 Intraoperative phase
- Begins when the patient is
transferred onto the or bed and
ends with the admission to the
PACU (post anaesthesia care
unit)
 Postoperative phase
- Admission of the patient to the
PACU and ends with a follow-up
evaluation in the clinical setting
or home
Assessment and care during the
perioperative period
- Nurses who are caring for
patients undergoing surgery
needs to take various genetic
consideration when assessing
patients throughout the
perioperative care. Surgical
outcomes may be altered by
genetic conditions that may
cause complications with
anesthesia
 Malignant hyperthermia
- Severe reaction to certain drugs
used for anesthesia
 Central core disease
- Genetic disorder that affects the
muscle used for movements that
causes muscle weakness
 Duchenne muscular atrophy
- Genetic disorder by progressive
muscle degeneration and
weakness due to the alternations
of a protein called dystrophin
that helps the muscle cells keep
intact.
 Hyperkalemic periodic paralysis
- Genetic disease that causes
episode of extreme muscle
weakness and an increase of the
potassium levels in the blood.
 King-denborough syndrome
- Congenital myopathy associated
with susceptibility to malignant
hyperthermia, skeletal
abnormalities and dysmorhic
features.
Nursing assessment and responsibilities
 Perioperative family history
assessment
- Obtain thorough assessment of
personal and family history,
inquiring about prior problems
with surgery or anesthesia.
- Inquire about history of
musculoskeletal complains,
history of heat intolerance,
fevers of unknown origin.
- Assess history of family
experiencing sudden death or
unexplained death especially
during participation in athletic
events.
 Patient assessment
- Assess for subclinical muscle
weakness
- Assess for other physical
features suggesting of
underlying genetic condition
 Nutritional and fluid status
- Assessment of nutritional status
identifies factors that affects the
patient’s surgical course such as
obesity, weight loss, malnutrition
- Determined by measurement of
Body mass index and waist
circumference.
 - Any identified fluid and
electrolyte imbalances should be
corrected prior to surgery.
 Dentition
- Dental carries, dentures and
partial plates are particularly
significant to the
anaesthesiologist because