Four-dimensional Flow of Communication in
Nursing Nursing Jurisprudence
Lines of Communication
- described as a 2 way process, yet in an
organization, it is four dimensional
1. Downward Communication
- the traditional line of communication is for
Superior to Subordinate which may pass
through different various levels of
management.
- communication is primarily directive and
activities and coordinated at various levels
of the organizations
- aims to impart what the personnel need to
know, what they are to do, and why they
are to do these.
Examples
policies, Rules and Regulations, memoranda,
handbooks, interviews, job description, and
pertormance appraisal.
2. Unward Communication
- Emanates from subordinates and goes
upward.
- Usually in the form of feed back to show
the extent to which downward
communication has been received,
accepted, and implemented
Examples:
discussion between subordinates and superiors,
grievance procedures, written reports, incident
reports, and statistical reports.
3. Horizontal Communication /Lateral
- Flows between peers, personnel or
departments on the same level.
- Used most frequently in the form of
endorsements, between shifts, nursing
rounds, journal meetings and conference,
or referrals between departments or
services.
4. Outward Communication
- Deals with information that flows from the
caregivers to the patients, their families,
relatives, visitors and the community.
- Patients should understand the nature of
their illness, the medical, and the
prescribed nursing plans of care so that
- they could participate in the decisions
regarding these.
- Outward communication also involves how
employees value their work.
NURSING LAW
- department of law which comprise all legal
rules and principles affecting the practice
of nursing.
Nursing Legislation
- the making laws or the body of laws
already enacted affecting the practice of
nursing.
Law
- a rule of civil conduct prescribed by the
supreme power in a state commanding
what is right and prohibiting what is wrong.
Legal right
- a claim which can be enforced by legal
means against a person whose duty is to
respect it.
Court Mechanism:
Lawsuit - proceeding in court for a purpose
- to enforce a right
- to enforce a wrong
Civil case
- complainant / defendant
Criminal case
- Plaintiff / accused
Statute of Limitations
- the length of time following the event
during which the plaintiff may file a
lawsuit.
Example:
Negligence - filed within 2-3 years from occurrence.
Due Process
is fair and orderly process which aims to protect and
enforce a person's right.
Fundamental Requirements of Due Process
1. Right to be informed.
2. Right to remain silent.
3. Right to have competent counsel.
4. No use of violence, threat torture.
Trial end.
- facts are presented and determined; Law
is applied at the
Summon
- is a writ commanding an authorized person
to notify a party to appear in court to
answer a complaint made against him.
Subpoena
- is an order that requires a person to attend
at a specific time and place testify as a
witness.
Subpoena Tecum
- is a subpoena that requires a witness to
bring documents papers in his possession
Witness
- person giving necessary details .
Nurses as witness:
- Could not divulge PRIVILEGED
COMMUNICATION in civil case, means
that the nurse is incompetent to testify on
the communications made to him by the
 patient, all the advice given and all
information gathered by observation.
Duration of seal of secrecy except :
1. Criminal case
2. With patient's consent
3. Patient sued doctor for damages
Testimonies of fact
- factual information
- no opinion unless an expert witness
Perjury
- is the willful telling of a lie under oath.
Hearsay evidence
- rumors not admissible in evidence
Dying declaration
- considered hearsay unless the dying
person is a victim of crime
Nurses and criminal liability
Felonies - acts of omissions punishable by law.
Elements:
1. Deceit (dolo) - deliberate inten
2. Fault (culpa) - results from imprudence,
negligence, lack of foresight
Stages of Crimes:
1. Consummated - all elements executed and
there is successful result.
2. Frustrated - all elements executed, no
successful result.
3. Attempted - attempts to start commission
of offense but no successful result .
Degree of Crimes
1. Grave - capital punishment or penalty of
above 6 years and one day, or fine of more
than 6 thousand pesos.
2. Less grave - penalty of 1 month and 1 day
-6 years or fine of not more than thousand
but not less than 200 pesos.
3. Light - penalty of 1 day to 30 days, or fine
of not more than 200 pesos.
Classification of persons criminally liable
1. Principal
 by direct participation - doer of the act
 by inducement - induces or pays another to
commit the crime
 by indispensable cooperation - participation is
necessary for the commission of the crime
2. Accomplice " accessory before the fact"
3. Accessory " accessory after the fact”
 profiting themselves or assisting
others to profit.
 concealing destroying the evidence of
the crime
 harboring or assisting the escape of
the principal.
Circumstances affecting criminal liability
1. Justifying circumstance - deemed to have acted
in accordance withlaw.
a. Lawful self-defense
Elements :
 unlawful aggression
 reasonable necessity of the means
employed by
 lack of sufficient provocation
b. Obedience to a lawful order of superior
2. Exempting circumstance - exempted from
criminal liability.
 Imbecile/insane, except lucid interval
 Person below 9 years old
 Person above 9 and below 15 unless
acted with discernment.
 Performance of a lawful act
3. Mitigating circumstance - reduces penalty
 below 18 y/o. or over 70 y/o.
 does not meet all requisite circumstances
under justifying and exempting
 offender is deaf, dumb, blind or with
physical defect
 voluntary surrender
 illness diminishing exercise of the will
power
4.Aggravating circumstance - increase liability
 Take advantage of public position
 Committed with abuse of confidence
 on occasion of earthquake, epidemic,
calamity
 For price or reward
 fire, poison, explosion
 Evident premeditation
 craft, fraud or disguise
 treachery
5. Alternative circumstances - either aggravating or
mitigating
 Relationship
 Intoxication
 Degree of instruction / education
Crimes concerning nurses
 Parricide
- the offender or victim is the father, mother,
brothers or sisters legitimate or illegitimate,
ascendant, descendant or the spouse.
 Homicide
- the killing of another person
 Murder
 - the killing of another person with any of the
enumerated aggravating circumstances
provided by law.
 Infanticide
- the killing of an infant less than three days
old from delivery.
 Abortion
- Termination of pregnancy
 Illegal detention/ false imprisonment
- deprive another of freedom of movement
or space.
 Simulation of birth
- preventing that a woman gave birth when
in truth and in fact she did not.
 Misdemeanor
- an act less than a felony
 Robbery
- taking of the personal property of another
by means of force violence or intimidation.
 Theft
- taking the personal property of another
without his/her consent.
 Assault
- threat to cause bodily harm.
 Battery
- actual body contact without consent of
patient
 Invasion of privacy
 Defamation - character assassination
- Slander – oral
- libel - written
GUIDELINES TO PREVENT CRIMINAL LIABILITY
1. Be familiar with Philippines Nursing law
2. Be familiar with laws affecting the nursing
practice
3. Know agency rules, regulations, policies
4. Upgrade skills and competence
5. Develop good IPR
6. Consult superior as needed
7. Verify vague / erroneous orders
8. Always keep doctor updated regarding
patient
9. Ensure accurate recording and reporting
10. Check informed consent
Legal consideration in charting;
1. Don't tamper with medical records
2. Observe agency's standards on
documentation
- Complete, concise, specific, use standard
abbreviations
- Telephone orders
Tips for avoid in legal pitfalls :
1. Patient falls
- do proper assessment
- appropriate assistance is give
- use protective measures
- document all nursing interventions
2. Medication error
- observe R's of drug administration
- check dr's order
- consult drug handbook/pharmacy
- not exempt from liability for following
dr's order
3. Equipment Injuries
- report adverse events to superiors
- monitor patient regularly
- refuse to use a device not know how to
operate
Nurses and Contracts /Wills
Contract - Agreement between at least two parties
which create an obligation recognized by law. There
must be acceptance of the obligation.
Elements of valid contract:
1. given freely
2. competent parties
3. lawful object
4. valid consideration
Types of contracts:
1. Implied - terms are inferred from the
actions of the parties
2. Expressed - Verbal / written, terms are
specified
BREACH OF CONTRACT: failure without legal
Excuse to perform any promise which forms the
whole or part of the contract.
Will- an act whereby a person is permitted with
formalities of law to control to a certain degree the
disposition of a state to take effect after his death.
Decedent - person whose property is transmitted
through succession
Testator - a decedent who left a will
Two kinds of wills ;
1. Notarial will - done before a lawyer,
requires at least three witnesses
2. Holographic will- entirely dated, written and
signed by the testator himself.
Nurse's obligation in the execution of will:
1. Note the soundness of clients mind
2. That the wall is signed by the testator
3. That the witnesses shall be present at the
time and sign by the presence of the
testator.
Gifts mortis Causa - Disposing of gifts by a person
in anticipation of death / belief in approaching
death.
 Limited to personal properties
 Acceptance by the recipient
Gifts are revocable and subject to the
claims of creditor's without proof of intent
of defrauding them.

NEGLIGENCE AND MALPRACTICE

Negligence - doing of that which a reasonably

prudent person would not have done: or the failure
to do that thing which a reasonably prudent person
would have done in like or similar circumstances .

Three Essential Conditions for actionable

Negligence :
1. Existence of a duty on the part of the
person charged to protect the complaining
party from the injury received.
2. Failure to perform that such failure
3. Injury resulting form such failure
4.
- Burden of Proof : complaining or injured party.