NCM 103L- FUNDAMENTALS OF NUSING PRACTICE BS NURSING (1ST YEAR – 2ND SEMESTER)
BATANGAS STATE UNIVERSITY – THE NATIONAL ENGINEERING UNIVERSITY
CHAPTER 4
LEGAL ASPECTS IN NURSING
LAW - It can be defined as “the sum total” of
rules and regulations by which a society is
governed.
FUNCTIONS OF LAW IN NURSING:
1. Provides framework for establishing which
nursing actions in the care of clients are legal.
2. It differentiates the nurse’s responsibilities
from those of other health professionals.
3. It helps establish the boundaries of
independent nursing action.
4. It assists in maintaining a standard of nursing
practice by making nurses accountable under
the law.
COMMONLY-USED TERMS IN LEGAL
ASPECTS OF NURSING
 Plaintiff – the one who claims that his/her
legal rights have been infringed
 Defendants – one or more persons or entities
accused of infringement of rights.
 Burden of proof – the duty of proving an
assertion or wrongdoing.
 Expert witness – has special training,
experience, or skill in relevant area and is
allowed by the court to offer an opinion on
some issue within their area of expertise.
 Credentialing – process of determining and
maintaining competence in the nursing
practice.
 License - a legal permit that a government
agency grants to individuals to engage in the
practice of a profession and to use a particular
title.
 Liability – quality or state of being legally
responsible for one’s obligations and actions
and to make financial restitution for wrongful
acts.
 Right – a privilege or fun given fundamental
power to which an individual is entitled unless
it is revoked by law or given voluntarily.
 Responsibility – obligation associated with a
right.
NURSING PRACTICE ACTS
 In the Philippines, the law that regulates the
nursing profession is the RA 9173 most
known as “Philippine Nursing Act of 2002.”
CONTRACTUAL ARRANGEMENTS IN
NURSING
 Contractual obligations – refer to the nurse’s
duty of care, that is, to render care, established
by the presence of an expressed or implied
contract.
Respondeat superior or “let the master
answer” – a doctrine where the employer assumes
responsibility for the conduct of the servant
(employee) and can also be held responsible for
the malpractice of the employee.
Res ipsa loquitur or “the thing speaks for
itself” – Refers to situations when it's assumed
that a person's injury was caused by the negligent
action of another party because the accident was
the sort that wouldn't occur unless someone was
negligent.
INFORMED CONSENT - An agreement by a
client to accept a course of treatment or a
procedure after being provided complete
information.
General Guidelines that must be disclosed in an
informed consent:
1. The purpose/s of the treatment
2. What the client can expect to feel or experience
3. The intended benefits of the treatment
4. Possible risks or negative outcomes of the
treatment
5. Advantages and disadvantages of possible
treatments (including no treatment)
2 TYPES OF CONSENT
1. Express consent – maybe either oral or written
agreement.
2. Implied consent – exists when the individual’s
nonverbal behavior indicates agreement.
NOTE: Obtaining informed consent for specific
medical and surgical treatments is the
responsibility of the person who is going to
perform the procedure.
MAJOR ELEMENTS OF INFORMED
CONSENT
 It must be given voluntarily
 It must be given by a client or individual with
the capacity and competence to understand
 The client or individual must be given enough
information to be the ultimate decision-maker.
EXCEPTIONS of people who can’t provide
informed consent:
1. Minors
2. Persons who are unconscious or injured in such
a way that they are unable to give consent.
3. Mentally-ill persons who have been judged by
professionals to be incompetent.
AREAS OF POTENTIAL NURSING
LIABILITY
 Crime – an act of committed violation of
public law and punishable by fine or
imprisonment.
 Felony - a crime of serious nature, such as
murder.
 Manslaughter – second degree murder.
 Misdemeanor – offense of a less-serious
nature, and is usually-served by a fine or
short-term imprisonment or both.
 Torts – civil wrong committed against a
person or person’s property.
CLASSIFICATION OF TORTS
Unintentional Torts
Examples:
2. Slander – defamation by the spoken word,
stating unprivileged or false words by which a
reputation is damaged.
UNPROFESSIONAL CONDUCT
 Includes incompetence or gross
negligence, conviction, for practicing
without a license, falsification of client
records, and illegally obtaining, using, or
possessing controlled substances.
GOOD SAMARITAN ACTS
 Laws designed to protect health-care
providers who provide assistance at the
scene of an emergency against claims of
malpractice unless there was a gross
departure from the normal standard of
care or willful wrongdoing on their part.

 Negligence – a misconduct or practice that is GUIDELINES FOR NURSES IN

below the standard expected of an ordinary, RENDERING EMERGENCY CARE
reasonable and prudent person.  Limit actions to those normally
 Malpractice - a professional negligence, that considered first aid, if possible.
is, negligence that occurred while the person  Do not perform actions that you do not
was performing as a professional. know how to do.
6 ELEMENTS FOR NURSING  Offer assistance, but do not insist.
MALPRACTICE TO BE PROVEN  Have someone call or go for additional
help.
1. Duty
 Do not leave the scene until the injured
2. Breach of duty person leaves or another qualified person
takes over.
3. Foreseeability  Do not accept any compensation.
4. Causation
5. Harm or injury
CHAPTER 5
6. Damages
VALUES, ETHICS AND ADVOCACY
Intentional Torts
VALUES - Those are freely-chosen, enduring
Examples: beliefs or attitudes about the worth of a person,
object, idea or action.
 Assault – attempt or threat to touch another
person unjustifiably. Value set – small group of values held by an
 Battery – willful touching of a person that individual.
may or may not cause harm. Beliefs (or opinions) – are interpretations or
 False imprisonment – unjustifiable detention conclusions that people accept as true.
of a person without legal warrant to confine
the person. Attitudes – mental positions or feelings toward a
 Invasion of privacy - a direct wrong of person, object, or idea.
personal nature.
ESSENTIAL NURSING VALUES AND
 Defamation – a communication that is false, BEHAVIORS
or made with a careless disregard for the truth,
and results to the injury to the reputation of  Altruism – concern for the welfare and well-
the person. being of others.
 Autonomy – right to self-determination.
Examples:
 Human dignity – respect for the inherent
1. Libel – defamation by means of print, writing, worth and uniqueness of individuals and
or pictures. populations.
 Integrity – acting in accordance with an
appropriate code of ethics and accepted
standards of practice.
 Social justice – upholding moral, legal and
humanistic principles.
FOUR (4) IMPORTANT VALUES OF
NURSING
1. Strong commitment to service.
2. Belief in the dignity and worth of each person.
3. Commitment to education.
4. Professional autonomy.
VALUES CLARIFICATION
 It is a process by which people identify,
examine, and develop their own individual
values.
THE VALUING PROCESS:
1. Choosing (Beliefs are chosen)
2. Prizing (Chosen beliefs are prized)
3. Acting (Chosen beliefs are enacted)
ETHICS
1. A method or inquiry that helps people to
understand the morality of human behavior.
2. Practices or beliefs of a certain group.
3. Expected standards of moral behavior of a
particular group.
BIOETHICS – ethics applied to life.
NURSING ETHICS – refers to ethical issues that
occur in the nursing practice.
MORALITY – refers to private, personal
standards of what is right and wrong in conduct,
character and attitude.
UTILITARIANISM – views a good act that
brings the most good and least harm to the greatest
number of people.
MORAL PRINCIPLES
1. Autonomy – the right to make one’s own
decisions.
2. Nonmaleficence – the duty to “do no harm”.
3. Beneficence – means “doing good”.
4. Justice – often referred to as “fairness”
5. Fidelity – to be faithful in agreements and
promises.
6. Veracity – refers to telling the truth.
7. Accountability – answerable to one’s self and
others for own actions.
8. Responsibility – the specific accountability or
liability associated with the performance of duties
of a particular role.
CODE OF ETHICS
 It is a formal statement of a group’s ideals and
values. It has higher requirements than legal
standards, and is also a set of principles that:
1. Shared by members of the group;
2. Reflects their moral judgments over time;
3. Serves as a standard for their professional
actions.
International Council of Nurses’ Code of Ethics
 Part 1 – Preamble (states the 4 fundamental
responsibilities of the nurses)
 Part 2 – The Code (states the 4 principal
elements that outline the standards of ethical
conduct.)
4 PRINCIPAL ELEMENTS IN ICN CODE OF
ETHICS:
1. Nurses and the people
2. Nurses and practice
3. Nurses and the profession
4. Nurses and co-workers
THE PHILIPPINE PATIENTS’ BILL OF
RIGHTS
 Right to humane care and treatment
 Right to informed consent
 Right to privacy and confidentiality
 Right to information
 Right to choose health-care provider and
facility
 Right to self-determination
 Right to religious belief
 Right to medical records
 Right to leave
 Right to refuse in participating to medical
research
 Right to correspondence to receive visitors.
 Right to express grievances.
 Right to inform the patient about his/her rights
or obligations.
SPECIAL ETHICAL ISSUES
 AIDS (Acute immune deficiency syndrome)
 Abortion
 Organ transplantation
 Euthanasia  Advances in technology
o a. Passive euthanasia  Economics
o b. Active euthanasia  Women’s health
 Uneven distribution of services
ADVOCACY
 Access to healthcare
 Advocate – one who expresses or defends the  The homeless and the poor
cause of another.  Demographic changes
 Client advocate – one who advocate for
FRAMEWORKS FOR CARE
client’s rights.
Managed care – a healthcare system with goals to
provide cost-effective, quality care that focuses on
CHAPTER 6 the decreased costs and improved outcomes for
groups of clients.
HEALTHCARE DELIVERY SYSTEMS
Case management – range of models for
HEALTHCARE SYSTEM - It is the totality of integrating healthcare services for individuals or
services offered by all health disciplines. groups.
TYPES OF HEALTH CARE SERVICES: Patient-focused care – brings all services and
1. Primary Prevention care providers to the clients.

2. Secondary Prevention Differentiated practice – makes the best possible

use of nursing personnel based on their
3. Tertiary Prevention educational preparation and resultant skill sets.
TYPES OF HEALTHCARE AGENCIES AND Shared governance – focuses in encouraging
SERVICES participation in decision-making at all levels of the
organization.
 Public Health
 Physicians’ offices Case method – or “total care”; here 1 nurse is
 Ambulatory care centers assigned and is responsible for the comprehensive
 Occupational health clinics care of a group of clients during an 8-12 hour
 Hospitals shift.
 Rural Care Functional Method - focuses on the jobs to be
 Crisis centers completed.
 Mutual support and self-help groups
 Extended Care (long term) care facilities Team nursing – delivery of an individualized
nursing care to clients by a team led by a
 Hospice services
professional nurse.
PROVIDERS OF HEALTH CARE
Primary Nursing – a system in which one nurse
 Nurse is responsible for the total care of a number of
 Alternative care provider clients 24/7.
 Dentist
 Dietitian or Nutritionist
 Occupational therapist CHAPTER 7
 Paramedical technologist
COMMUNITY-BASED NURSING & CARE
 Pharmacist
CONTINUITY
 Physical therapist
 Physician PRIMARY HEALTH CARE
 Physician assistant
 Defined as essential health care based on
 Podiatrist practical, scientifically-sound and socially-
 Respiratory therapist acceptable methods and technology made
 Social worker universally accessible to individuals and
 Spiritual support person families in the community, through their full
 Unlicensed assistive personnel participation and at a cost that the community
and country can afford to maintain at every
FACTORS AFFECTING HEALTH CARE
stage of their development in the spirit of
DELIVERY
SELFRELIANCE & SELF-
 Increasing number of elderly DETERMINATION. (WHO, 1978, P.35)
 3. Plans to ensure the client’s and the caregivers’
needs are met.
PRIMARY CARE
REFERRALS
 It is the provision of integrated, accessible
healthcare by clinicians who are accountable  The REFERRAL PROCESS is a systematic
for addressing a large majority of personal problem-solving approach that helps clients to
health services, developing a sustained use resources that meet their healthcare needs.
partnership with patients, and practicing in the
Home care referrals are often made before
context of family and community. (IOM,
discharge for the ff. clients:
1194, p.15)
1. Elders
COMMUNITY-BASED HEALTH CARE
2. Children with complex conditions
 A PHC system that provides health-related
services within the context of people’s daily 3. Frail persons who live alone
lives – that is, in places where people spend
their time, for example, in the home, in 4. Those who lack or have a limited support
shelters, in long-term care residences, at work, system
in schools, in senior citizens’ centers, in 5. Those having a caregiver whose health is failing
ambulatory settings, and in hospitals.
6. Those whose home presents barriers to their
COLLABORATIVE HEALTHCARE safety
Collaboration – a collegial working relationship
with another health care provider in the provision
of patient care.
COMPETENCIES BASIC TO
COLLABORATION:
1. Communication
2. Mutual respect and trust
3. Decision-making
CONTINUITY OF CARE

 It is the coordination of healthcare services by

healthcare providers for clients moving from
one healthcare setting to another and between
and among healthcare professionals.
To provide continuity of care, nurses need to
accomplish the following:
1. Initiate discharge planning for all clients, when
they are admitted to any healthcare setting.
2. Involve the client and the client’s family or
support persons in the planning process.
3. Collaborate with other health care professionals
as needed.
DISCHARGE PLANNING

 It is the process of preparing a client to leave

one level of care for another within or outside
the current healthcare agency.
Effective discharge planning involves:
1. On-going assessment to obtain client’s
information about the client’s on-going needs.
2. Statements of nursing diagnoses