Nursing Leadership and Management

BS NURSING / FOURTH YEAR

STUDENT ACTIVITY SHEET
Session # 12

LESSON TITLE: LEGAL ASPECTS AND THE NURSE (PART
1)
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:
1. Define Professional Negligence;
2. Enumerate legal aspects that a nurse can encounter; and,
3. Recognize legal responsibilities of a nurse.
Materials:
Book, pen and notebook, and index card/class list
References:
Lydia M. Venzon RN, MAN, FPCHA
Ronald M. Venzon RN MAN (2010), Professional
Nursing In The Philippines 11th Edition: C & E
Publishing, Inc. 839 EDSA, South Triangle,
Quezon City

LESSON PREVIEW/REVIEW
Based on the previous lesson, give the name of the following laws:

1. Republic Act 4226 -

2. Presidential Decree 442 -
3. Presidential Decree 603 -
4. Presidential Decree No. 626 -
5. Republic Act 6675 -
6. Republic Act No. 6713 -
7. Republic Act 7160 -
8. Republic Act 7600 -
9. Republic Act 7432 -
10. R.A. 7164 -

MAIN LESSON

AS NURSES BEGIN their professional obligations, their legal responsibilities begin as well. Their license to practice
attests that they are qualified under the law to practice their profession.
The Philippine Nursing Act of 2002 is the best guide the nurse can utilize as it defines the scope of nursing practice.
There are also standards of care that may be used as criteria in evaluating their work. Nurses are enjoined to be familiar with
the Philippine Nursing Law, the standards of nursing care, and other laws which affect nursing practice and their code of
ethics.
Nurses need not be afraid of laws. These should be understood so that their scope and limitations may be defined and
identified. When these are clarified, performance of daily tasks are assumed with more confidence and safety.

RESPONSIBILITY AND ACCOUNTABILITY FOR THE PRACTICE OF PROFESSIONAL NURSING

When nurses undertake to practice their profession, they are held responsible and accountable for the quality of
performance of their duties. Nurses employed in an agency, institution, or hospital are directly responsible to their immediate
supervisors. Private duty nurses, being independent practitioners, are held to a standard of conduct that is expected of
reasonably prudent nurses. A standard is the desired and achievable level of performance against which actual practice is
compared. Standards serve as benchmark against which to plan, to implement and assess quality of services and to show
that nursing is accountable to society, to consumers of nursing services and to governments as well as to the profession of
nursing itself and individual members.

PROFESSIONAL NEGLIGENCE
The term "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.

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 If a person charged with negligence shows that she meets or even surpasses this standard then there is no negligence
or carelessness. But if the defendant's actions fail to meet the standard, then there has been negligence.
The elements of professional negligence therefore are (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 foreseeability of harm resulting from
failure to meet the standard, and (4) the fact that the breach of this standard resulted in an injury to the plaintiff.
Failure to foresee harm to the person injured, following from ignorance of the admonition born of the provisions,
constitutes in fact a negligence. Article 19 of the Civil Code states that one shall act with justice, give every man his due,
observe honesty and good faith.
Article 20 states that those who, in the performance of their obligations through negligence cause any injury to another,
are liable for damages.
Liability for negligence therefore shall be imposed upon a nurse who has failed to behave as a reasonable, prudent
nurse would act in the particular circumstance.
Common acts of negligence are burns resulting from hot water bags, heat lamps, vaporizers, sitz bath; objects left inside
the patient's body such as sponges, suctions tips, loose dentures lodged in the patient's trachea; falls of the elderly,
confused, unconscious, sedated patients, or those who are not fully recovered from anesthesia; falls of children whose side
rails of beds were not pulled up and locked; and failure to observe and take appropriate action as needed. Incident reports
clarify cause and preventive actions, and are used for medico-legal purposes.
Nurses employed in government agencies are covered by the rules and regulations of the Civil Service Commission.
Administrative offenses and their corresponding penalties are found in Appendix U.

SPECIFIC EXAMPLES OF NEGLIGENCE

1. Failure to report observations to attending physicians, A nurse observed that the toes of a patient with leg
cast was cyanotic and cold to touch, but she failed to report this to the physician. The leg became gangrenous and
had to be amputated below the knee. The court found the nurse negligent in failing to inform the attending
physician of the patient's condition, and to advise the hospital authorities so that appropriate action could have
been taken.
2. Failure to exercise the degree of diligence which the circumstances of the particular case demands.' In
1975 a community health nurse attended the delivery of a patient who had no prenatal care. Although she was
reluctant to attend to the patient, she was informed that this was an emergency. The baby was born spontaneously
but the placenta was not expelled after 30 minutes. She advised that the mother be brought to the hospital. The
family left without the nurse who was attending to the baby. The patient died. The nurse was found guilty of
negligence.
3. Mistaken identity. Drugs could be given to the wrong person especially if the latter is confused or unconscious
and could not respond to the nurse's verification of identity.
4. Wrong medicine, wrong concentration, wrong route, wrong dose. There are many reported cases where
patients are inadvertently given the wrong medications or wrong doses simply because the nurse did not take time
to check the order.
5. Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients.
6. Errors due to family assistance. Suppose a nurse asked a relative to apply hot water bag to the body of a chilling
child and the latter suffered burns. The nurse would be held liable for failure to test the temperature of the water
and/or for failure to check whether the mother knew what was expected of her during such assistance.
7. Administration of medicine without a doctor's prescription. A case of negligence was filed against a
puericulture center nurse in 1979 for injecting Penstrep to a boy who had a swollen foot. The nurse informed the
parents that she was not a doctor. Upon insistence of the parents to have their child treated, she informed them
that the doctor usually gave Penstrep injections in such cases. She injected the medicine without a doctor's
prescription. The boy died of cardiorespiratory failure secondary to anaphylactic shock due to the injection of the
drug. The nurse was found guilty as charged.'

THE DOCTRINE OF RES IPSA LOQUITUR

Res Ipsa Loquitur means "the thing speaks for itself”. This means that the injury could not have happened if someone
was not negligent that no further proof is required.
Three conditions are required to establish a defendant's negligence without proving specific conduct. These are:
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;
2. that the injury was caused by an agency within control of the defendant; and
3. that the plaintiff himself did not engage in any manner that would tend to bring about the injury.

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 further proof is required.
Following are examples of such cases:

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 1. A patient came in walking to the out-patient clinic for injection. Upon administering the injection to his buttocks, the
patient experienced extreme pain. His leg felt weak and he was subsequently paralyzed. His sciatic nerve was
injured.
2. The presence of sponges in the patient's abdomen after an operation.
3. Fracture on a newly-delivered baby born by breech presentation.

MALPRACTICE
Malpractice in the usual sense implies the idea of improper or unskillful care of a patient by a nurse. Malpractice also
denotes stepping beyond one's authority with serious consequences.
Malpractice is the term for negligence or carelessness of professional personnel. To determine what is and what is not
careless, the law has developed a standard of care which can be determined by deciding what a reasonably prudent person
would do under similar circumstances.
Lesnik (1962) also states that the term malpractice is used properly only when it refers to a negligent act committed in
the course of professional performance.
An example of malpractice is the giving of anesthesia by a nurse or prescribing medicines. Under the Philippine Medical
Act, this will be classified as within the purview of the medical practice.
It is best to remember that if you become involved in a malpractice suit, either as a defendant or as a witness, a lawyer
should be consulted in order that you will know what to do. Do not accept any invitation by an adverse party to informally
discuss the case. Remember that the malpractice case may continue for an extended period of time.

DOCTRINE OF FORCE MAJEURE

The term "force majeure" means an irresistible force, one that is unforeseen or inevitable. Under the Civil Code of the
Philippines, no person shall be responsible for those events which cannot be foreseen, or which, though foreseen, are
inevitable, except in cases expressly specified by law.
Circumstances such as floods, fire, earthquakes and accidents fall under this doctrine and nurses who fail to render
service during these circumstances are not held negligent. However, habitual tardiness due to heavy traffic is not
considered an excuse for force majeure.

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 the master. Therefore, when a
person, through his negligence, injures another, he remains fully responsible. This doctrine applies only to those actions
performed by the employee within the scope of his employment.
Following are some examples:
1. The hospital will be held liable, if, in an effort to cut down on expenses it decides to hire underboard nurses or
midwives in place of professional nurses, and these persons prove to be incompetent.
2. The surgeon will be held responsible in case a laparatomy pack is left in a patient's abdomen.

Private duty nurses, however, are considered independent contractors. They are liable for their own negligent actions.

INCOMPETENCE
Incompetence is the lack of ability, or legal qualifications and being unfit to discharge the required duty. Although a nurse
is registered, if in the performance of her duty she manifests incompetency, there is ground for revocation or suspension of
her certificate of regisration.

LIABILITY FOR WORK OF NURSE TRAINEES AND NURSE VOLUNTEERS

There are thousands of nursing graduates each year. Ironically, there are not enough vacancies both in public and
private sectors to accomodate them. They flock to hospitals to work as "volunteers" or as "trainees." These volunteers pay a
minimum of P1,000 monthly as training fees. They are rotated in the various clinical areas and are under the direct
supervision of the nursing staff in the unit for basic nursing care to patients.
They go on training for at least three months to one year then apply again as "casual" or part-time nurses and if lucky,
they are taken in as regular staff nurses. Opportunities for work abroad often require experience of at least one year in
hospitals, hence their willingness to volunteer.
Many hospitals take advantage of the situation though. Instead of hiring replacements for staff who have resigned, they
take in volunteers to save money. If the volunteers have no experience at all then the quality of service to the patients suffer.
There are tertiary specialty hospitals that offer specialty training such as Philippine Heart Center for Critical Care
Nursing; the National Kidney and Transplant Institute for Renal Nursing, the Lung Center of the Philippines for Respiratory
Nursing. Other training hospitals offer Emergency or Trauma Nursing, Operating Room Nursing and the General Basic
Training Program for new or novice nurses. However, training in specialty hospitals are costly and rigorous. At least four to
six months of training is required.

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 Since nurses are responsible and accountable for their practice, nurse volunteers should exercise utmost caution,
critical thinking and independent judgment to prevent incurring liabilities which may be hard to get out of.

LIABILITY OF NURSES FOR THE WORK OF NURSING AIDES

Nursing aides perform selected nursing activities under the direct supervision of nurses. They are usually given
on-the-job training by the Training Staff. Their responsibilities usually pertain to the routine care of chronically ill patients.
They are therefore responsible for their own actions.
Nurses should not delegate their functions to nursing aides since the Philippine Nursing Act specifies the scope of
nursing practice of professional nurses. If a nurse delegates her functions to a nursing aide and the latter commits a mistake
then the person responsible is the nurse.
Nurses are enjoined to supervise their subordinates and see to it that they perform only those which they have been
taught to do and those which they are capable of doing.

LIABILITY FOR THE WORK OF NURSING STUDENTS

Under the Philippine Nursing Act of 2002 R.A. 9173, nursing students do not perform professional nursing duties. They
are to be supervised by their Clinical Instructors. In order that the errors committed by nursing students will be avoided and
or minimized, the following measures should be taken:
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 training, 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. Discussion of these problems will iron out doubts and possible solutions may be
provided.

However, it must be emphasized that although nursing students are not employees of the hospital they are entrusted
with the responsibility of providing supervised nursing care to the patients. The patients can expect that the care given by
these students will be in a manner consistent with that which a reasonably prudent person will give.
Both the clinical instructor and the staff nurse in the clinical area where nursing students are assigned should coordinate
in assessing the competence of nursing students before they are allowed to give care to patients so that the risks of injury to
the same will be avoided.

LEGAL DEFENSE IN NEGLIGENCE

The most common defense in a 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.
However, if the patient's careless conduct contributes to his own injury, the patient cannot bring suit against the nurse.
On the other hand, if the nurse has expressly given advanced consent in performing a duty that involves risk, such as caring
for a psychiatric patient or a patient with communicable disease, the nurse cannot bring suit against the patient if she gets
hurt or contracts the disease since upon accepting the case, the nurse agreed to assume the risk of harm or infection
thereby relieving the patient or his relatives from legal obligations. This is termed as "assumption of risk".
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

Republic Act 6675 states that only validly registered medical, dental and veterinary practitioners, whether in private
institution/ corporation or in the government, are authorized to prescribe 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 or the Dental Act, and R.A. 382 or the Veterinary Act.
In accordance with R.A. 5921,19 or the Pharmacy Act as amended, all prescriptions must contain the following
information: name of the prescriber, office address, professional registration number, professional tax receipt number,
patient's/client's name, age and sex, and date of prescription. R.A. 6675 requires that the drugs be written in their generic
names.
The dependent and coordinated function of the nurse pertains to the application and execution of written legal orders of
physicians concerning 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 are better understood and chances of error are
minimized if they are clear, specific, complete and legible.
Verbal orders can be minimized if the nurse seeks a clear understanding from the physicians in establishing a policy
concerning the importance of written orders.

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 The general rule requiring a nurse to execute all lawful orders of a physician is tempered by common sense. The nurse
must not execute an order if she is reasonably certain it will result in harm to the patient. In such case she must speak out
and risk incurring the physician's resentment or ire rather than a lawsuit.
It is preferable to raise the matter of carrying out the procedure as a point of clarification in a tactful, acceptable manner
such as "The patient is three years old, did you mean 500 or 100 mg?" or "Doctor, I will now give your order of 1 gram" and
state the name of the drug. Reminders, as in this case, the age of the child or the dose, may provide cues to possible errors.
It is on occasions such as these, that the nurse must demonstrate courage and determination in verifying orders which
are not clear or which, to her, seem erroneous. Good judgment and common sense will help avoid legal problems and
protect patients from harm.
The case of Norton vs. Argonaut Insurance Co. involved an ambiguous order of a physician when he ordered, "Give 3.0
cc Lanoxin today for 1 dose only." The nurse in the case was familiar with the injectable form of Lanoxin and was not aware
of the elixir form which was what the doctor meant. She believed the order was incorrect and asked two physicians present
in the unit whether the order could be given. The physicians did not interpret the order as the nurse did, and therefore
advised her to follow the attending physician's order. She did not contact the attending physician. Instead she administered
the medication according to her interpretation. The patient later died as a result of an overdose of the drug administered by
injection.
The most discussed case in Philippine nursing history in relation to following doctor's order is the Somera case. Miss
Lorenza Somera was condemned in May 1929 in Manila to one (1) year imprisonment in connection with the death of a
young girl in the Operating Room. She was accused of homicide through reckless imprudence.
The facts of the case in condensed form from the International Nursing Review published in 1930 read as follows:

Several days prior to May 26, 1929 Pedro Clemente took his daughter, Anastacia Clemente, to Dr. Gregorio Favis at
Manila. The latter decided to perform a tonsillectomy and instructed the father and daughter to go to St. Paul's Hospital
where he would perform the operation at 7:00 a.m. on May 26, 1929.

Assisting Lorenza Somera, a Head Nurse, were student nurses Valentina Andaya and Consolacion Montinola. The
assistant surgeon was Dr. Bartolome.

During the operation, Dr. Favis asked Dr. Bartolome for novocaine solution. Miss Montinola handed Dr. Bartolome a
syringe of solution which was handed in turn to Dr. Favis who injected the same to the patient. After a few minutes, Dr.
Bartolome noticed that the patient was becoming pale and acting as if dying. He called the attention of Dr. Favis to this
but the latter said that it was not unusual. A third syringe of solution was injected and a few minutes later, the patient
convulsed. Adrenalin was injected twice but the patient died in a few minutes.

Dr. Favis asked if the novocaine was fresh. Miss Somera replied that the solution was not novocaine but 10% cocaine.

In court, Miss Montinola testified she heard Dr. Favis order cocaine with adrenalin for injection and heard Miss Somera
to have verified the order. The autopsy report and testimony of the Medico-legal Officer showed that the patient was
suffering from status lymphaticus and that such patients were known to die even with so slight an injury as a
needle-prick.

Facts not brought in the trial were 1) that Miss Somera had finished her training only on May 20, 1929; 2) that she had
not received her registration certificate and was not an experienced graduate as stated in the prosecution; 3) that Dr.
Favis had performed tonsillectomy but once previously in St. Paul's Hospital. During that time Miss Somera was not on
duty at the Operating Room and that no order from Dr. Favis was given before his arrival.

The two accused doctors were absolved of the crime but Lorenza Somera was condemned to suffer one year and one
day imprisonment and to indemnify the heirs of Anastacia Clemente the sum of P1,000.00 with subsidiary
imprisonment in case of insolvency and to pay one-third of costs.

In view of the recommendation of two of the Justices of the Supreme Court who reviewed the case upon the appeal of
the counsel for the defense, the unanimous recommendation of the Board of Pardons, and the petition of the Philippine
Nurses Association for executive clemency, the Governor-General remitted the part of the sentence which called for
prison confinement provided that Lorenza Somera would not, in the future, violate any of the penal laws of the
Philippines.

Discussions of this case among nurses and nursing students led to remarks that the incident should not have happened
had Miss Somera asked, "Doctor, did you ask for cocaine or novocaine?" and if the doctor insisted on cocaine, she should
have directed the nursing student to dip a cotton pledget in cocaine and give such to the doctor since she knew that cocaine
was administered topically.

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 A nurse must see to it that she understands the action of a drug, its minimum and maximum dosages, route of
administration, and untoward effects so that she may skillfully, safely, and effectively carry them out. She should be able to
report and record the effects on the patient so that the doctor can judge its therapeutic value and know when to discontinue
its use.
Tests and treatments should be explained to the patient in accordance with the general plan of his care so that the
patient can give full consent and cooperate in its implementation. Any unfavorable psychologic or physical reaction should
be likewise reported so that the proper action may be taken. Sometimes, however, refusal may be due to inaccurate
presentation of facts. Patients must receive special sympathetic attention from the nurses. Every effort should be made to
correct inaccurate views and modify superficially-held beliefs.

INTRAVENOUS THERAPY AND LEGAL IMPLICATIONS

Nurses now participate in complex intravenous therapy procedures that were once performed only by doctors. Because
of this change, nurses must remember that their legal right to give intravenous injection is based on the Philippine Nursing
Act of 1991 Section 28 which states that "in the administration of intravenous injections, special training shall be required
according to protocol established.
Therefore nurses have to undertake a certified training course on intravenous therapy. Nurses should use the
Intravenous Nursing Standards of Practice developed by the Association of Nursing Service Administrators of the
Philippines.
In giving intravenous injections, nurses should also follow the policies of their agencies. Even if nurses have formal
training on intravenous therapy, if the hospital does not allow them to do so, then they may not do the procedure.
Board of Nursing Resolution No. 8 states that any registered nurse without such training and who administers
intravenous injections to patients, shall be held liable, either criminally under Sec. 30 (c) Art. VII of said law or
administratively under Sec. 21 Art. III or both (whether causing or not an injury or death to the patient).

SCOPE OF DUTIES AND RESPONSIBILITIES IN INTRAVENOUS THERAPY

The duties and responsibilities of nurses in intravenous therapy include the following:
1. interpretation of the doctor's orders for intravenous therapy;
2. performance of venipuncture, insertion of needles, cannulas except TPN and cutdown;
3. preparation, administration, monitoring and termination of intravenous solution such as additives, intravenous
medications, and intravenous push;
4. administration of blood/blood products as ordered by physicians;
5. recognition of solution and medicine incompatibilities;
6. maintenance and replacement of sites, tubings, dressings, in accordance with established procedures;
7. establishment of flow rates of solutions, medicines, blood and blood components;
8. utilization of thorough knowledge and proficient technical ability in the use/care, maintenance, and evaluation of
intravenous equipment;
9. nursing management of Total Parenteral Nutrition, out-patient intravenous care;
10. maintenance of established infection control and aseptic nursing interventions; and
11. maintenance of appropriate documentation, associated with the preparation, administration and termination of all
forms of intravenous therapy.

There are reported cases wherein wrong types of blood were infused to some patients, there were wrong intravenous
solutions, infiltrations causing ulcerations, or too rapid administration of these fluids causing deaths or serious injuries to the
patients. Nurses should remember that if they have not been taught venipuncture, they may refuse to carry out the
procedure until after they have received proper training. The law will not excuse the negligence of nurses because they
carried out a doctor's order. If they give intravenous injections without prior training, they may be criminally or
administratively charged even if no harm has happened to the patient.
Before the administration of blood transfusion, the Resident on Duty, the Head Nurse or Senior Nurse, and the Staff
Nurse should check that the blood is of the correct type and is properly crossmatched. They should sign their names as they
attest to these.
Proper documentation provides protection for nurses and the hospitals. The intravenous therapy may be documented
on the progress notes, a special I.V. therapy sheet or flow sheet or nursing care plan on the patient's chart.
Although this requirement is not mentioned anymore in RA 9173, most Nursing Service Administrators still require their
nurses to undergo this training program for the legal protection of the patients, the nurses, and the agencies.

TELEPHONE ORDERS
There are legal risks in telephone orders. These may be misunderstood or misinterpreted by the receiving nurse.
Sometimes, messages from telephones may sound unclear or garbled because of some trouble in the telephone lines or

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mispronunciation of words by the caller. Most importantly the handwriting of the nursing physician may be illegible, his
signature is not present and this order may later be denied in case errors happen or court litigations arise.
Doctors should limit telephone orders to extreme emergency situations where there is no alternative. The use of a
telephone in a non-emergency as a substitute for the physician himself can lead to serious errors and may border on
malpractice.
Only in an extreme emergency and when no other resident or intern is available should a nurse receive telephone
orders. The nurse should read back such order to the physician to make certain the order has been correctly received and
written on the patients' chart. Such order should be signed by the physician on his/her next visit within 24 hours. The nurse
should sign the name of physician per her own and note the time the order was received. Should any problem arise, the
order should be referred back to the ordering physician. It is safer that when a telephone order is given, another resident
physician or intern in the same service receive it since the latter can discuss with the former the actual condition of the
patient.
It is in the interest of safety that only those who have more experience and a greater knowledge of drugs should receive
the order. In this connection, there should be a clear hospital policy that is within the bounds of the medical and the nursing
laws regarding telephone orders to avoid misunderstanding not only for the individuals concerned but also for the hospital as
well.

CONSENT TO MEDICAL AND SURGICAL PROCEDURES

Consent is defined as a "free and rational act that presupposes knowledge of the thing to which consent is being given
by a person who is legally capable to give consent." The consent signed by the patient or his authorized representative/legal
guardian upon admission is for the initial diagnosis and treatment. Subsequent treatments/operations require individual,
informed consent. Before any medical or surgical procedure can be performed on a patient, consent must be obtained from
the patient or his authorized representative who may be his parent or guardian. It is only in case of emergency where the
consent requirement does not apply.
The physician should give as much information about a contemplated procedure and the patient should receive enough
information to allow him to give an informed consent for such procedure or treatment. The intentional touching or unlawful
beating of another person without authorization to do so is a legal wrong called battery.

Nature of Consent. Consent is an authorization, by a patient or a person authorized by law to give the consent on the
patient's behalf, that changes touching, for example, from non-consensual to consensual.
It is the nurse who actually secures the consent of the patient upon admission. This consent is usually for diagnostic
procedures and initial treatment deemed necessary by the medical staff. To substantiate the patient's consent, a written
authorization is needed as proof against any liability that may arise due to an alleged unlawful touching of a patient.

Informed Consent. Hayt and Hayt state that "it is established principle of law that every human being of adult years and
sound mind has the right to determine what shall be done with his own body. He may choose whether to be treated or not
and to what extent, no matter how necessary the medical care, or how imminent the danger to his life or health if he fails to
submit to treatment."
The essential elements of informed consent include (1) the diagnosis and explanation of the condition; (2) a fair
explanation of the procedures to be done and used and the consequences; (3) a description of alternative treatments or
procedures; (4) a description of the benefits to be expected; (5) material rights if any; and (6) the prognosis, if the
recommended care, procedure, is refused.

Proof of Consent. A written consent should be signed to show that the procedure is the one consented to and that the
person understands the nature of the procedure, the risks involved and the possible consequences.
A signed special consent is necessary before any medical or surgical treatment is done such as x-rays, special
laboratory tests, blood transfusions, operations, cobalt therapy or chemotherapy, and the like.

Who Must Consent. Ordinarily, the patient is the one who gives the consent in his own behalf. However, if he is
incompetent (such as in the case of minors or the mentally ill) or physically unable and is not an emergency case, consent
must be taken from another who is authorized to give it in his behalf.

Consent of Minors. Parents, or someone standing in their behalf, give the consent to medical or surgical treatment of a
minor. Parental consent is not needed, however, if the minor is married or otherwise emancipated.
Consent of Mentally Ill. A mentally incompetent person cannot legally consent to medical or surgical treatment. The consent
must be taken from the parents or legal guardian.

Emergency Situation. When an emergency situation exists, no consent is necessary because inaction at such time
may cause greater injury. A mother, who is on the advanced stage of labor, or a patient, who goes to the emergency room,

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gives an implied consent to an immediate treatment or attendance. However, if time is available and an informed consent is
possible, it is best that this be taken for the protection of all the parties concerned.
Refusal to Consent. A patient who is mentally and legally competent (sane mind and of legal age) has the right to
refuse the touching of his body or to submit to a medical or surgical procedure no matter how necessary, nor how imminent
the danger to his life or health if he fails to submit to treatment. Examples are patients who, because of their religious beliefs,
may refuse blood transfusion as in the case of Jehovah's witnesses.
As stated earlier a patient may refuse to consent due to inadequate information regarding the procedure to be done. If
after the explanation, he still refuses to sign the consent form he should be made to fill out the release form to protect the
hospital and/or agency and its personnel from any liability that may result from his refusal. If he refuses to sign the release
form, this should be noted in his chart. The competent person has a legal and ethical right to refuse treatment, and this right
is formally established.

Consent for Sterilization. Sterilization is the termination of the ability to produce offsprings. The husband and the wife must
consent to the procedure if the operation is primarily to accomplish sterilization. When the sterilization is medically
necessary and the sterilization is an incidental result such as in cases of abruptio placentae, ectopic pregnancies or ruptured
uterus, the patient's consent alone is sufficient.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You
are given 20 minutes for this activity:

Multiple Choice

1. The elements of professional negligence are the following. SATA

a. existence of a duty on the part of the person charged to use due care under circumstances
b. failure to meet the standard of due care
c. the foreseeability of harm resulting from failure to meet the standard
d. the fact that the breach of this standard did not result in an injury to the plaintiff.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

2. Which of the following is not an example of negligence?

a. Failure to report observations to attending physicians.
b. Mistaken identity.
c. Errors due to family assistance.
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

3. The doctrine that means “the thing speaks for itself”.

a. Res Ipsa Loquitur
b. Res Ipsa Loquitor
c. Respondeat Superior
d. Force Majeure
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

4. The term for negligence or carelessness of professional personnel.

a. Negligence
b. Incompetence
c. Malpractice
d. None of the above

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Education (Department of Nursing) 8 of 11
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. This means an irresistible force, one that is unforeseen or inevitable.

a. Res Ipsa Loquitur
b. Res Ipsa Loquitor
c. Respondeat Superior
d. Force Majeure
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

6. The term means "let the master answer for the acts of the subordinate."
a. Res Ipsa Loquitur
b. Res Ipsa Loquitor
c. Respondeat Superior
d. Force Majeure
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

7. This is the lack of ability, or legal qualifications and being unfit to discharge the required duty."
a. Negligence
b. Incompetence
c. Malpractice
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. What law states that "in the administration of intravenous injections, special training shall be required according to
protocol established."
a. Philippine Nursing Act of 1991 Section 21
b. Philippine Nursing Act of 1991 Section 30
c. Philippine Nursing Act of 1991 Section 28
d. Philippine Nursing Act of 1991 Section 20

ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. When taking a telephone order, which of the following if the least helpful?
a. The nurse should read back the physician’s order.
b. The physician must sign the order on his/her next visit within 48 hours.
c. The nurse should sign the name of physician per her own and note the time the order was received.
d. When a telephone order is being given there should be another resident physician or intern in the same
service to receive it.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

10. The essential elements of informed consent include the following. SATA
a. the diagnosis and explanation of the condition

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Education (Department of Nursing) 9 of 11
 b. a fair explanation of the procedures to be done and used and the consequences
c. a description of alternative treatments or procedures
d. a description of the benefits to be expected
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
7. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
8. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
9. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
10. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

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Education (Department of Nursing) 10 of 11
LESSON WRAP-UP
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: One-Minute Paper

This activity is to evaluate what the students learned after the discussion and the activity.

1) What was the most useful or the most meaningful thing you have learned this session?

2) What question(s) do you have as we end this session?

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 11 of 11