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Professional adjustment
A"y. Arlene capili

• Bioethical principles
o Autonomy
§ “Auto” it means self.
§ “Nomos” it means governance.
§ It allows the pa3ent to decide for his/her treatment.
§ Right of the pa3ent to decide for their decision.
§ If decision making is involved à AUTONOMY
§ Right to self-determinaAon so kapag nag decide ang pa9ent to refuse any
treatment, the nurse must accept.
§ Note:
• No need to let the pa9ent sign a waiver when they refuse a
treatment because it is the decision of the doctor.
• Explana9on should be done by the doctor and the nurse should only
do the follow-up.
§ Priority of nurse: Document immediately the refusal of the pa3ent.
Because if anything happens to the pa9ent the first thing that will be
checked is the chart. Thus, if not documented à nurse is held liable à legal
basis: Code of ethics (BON res. 220 series of 2004)
§ REMEMBER: Documenta3on is the hallmark of nursing accountability.
§ Example:
• if the medica9on is new and the pa9ent refuses to take the drugs,
the nurse should not explain the medica9on because it is the job of
the doctor. à but the nurse can educate on the consequences of
the refusal but that is aAer documenta3on of refusal.
§ In connec9on to principle of – Paternalism – from the root word of
“paternal” which means “father” head of the family. Who makes the
decision. à in the health care team head is the doctor
• Paternalism à withholds the autonomy of the pa3ent for the
benefit of the pa3ent because the pa3ent’s condi3on is unstable.
à DOCTOR who makes the decision for the pa9ent.
• With paternalism, INFORMED CONSENT (it is a contract) is used.
o PaAent is the one who gives the consent of all the
procedure to be done.
o Doctor explains the content of the consent form and the
procedure.
o Nurse is to witness 5 things:
1. Actual conversaAon dapat nag usap muna ang
doctor and pa9ent.
2. Full and sufficient explanaAon coming from the
doctor.
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3. PaAent should have fully understood the

explanaAon. Therefore, if there is ques9on the
doctor should answer them properly.
4. PaAent voluntarily consented. There should be no
in9mida9on, force, and should have consented
freely, coherent, and no juris.
5. PaAent voluntarily signed the consent.
o Requirements for the paAent to sign informed consent:
§ Legal age (18 and above)
• Minor child cannot give the consent but on
behalf of the pa3ent which is the NEXT OF
KIN à can make the consent for the minor
pa3ent.
o Hierarchy for those who can decide
for the minor:
§ Parents
§ Siblings 18 and above
§ Grandparents
§ Rela3ves or guardians
• Example:
o Minor child with minor mother à
the minor mother cannot make the
decision for their child, instead the
NEXT OF KIN can sign the consent
form for the child.
o Remember:
§ in the Philippines there is no
emancipated minor. because
emancipated starts at 18
years old which is at legal age
already and not considered
minor. à thus, there is no
emancipated minor.
§ Sound minds the pa9ent should be conscious,
coherent, and there is absence of force, violence and
in9mida9on.
• Inability or can write and read. S9ll
applicable to sign informed consent as long
as there is someone who can explain the
procedure.
• Example:
o What if the paAent who is legal but
not in sound mind à NEXT OF KIN
can s9ll make the consent.
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o Hierarchy for those who can decide

for this pa9ent
§ Legal Spouse
§ Child 18 and above
§ Parents
§ Siblings 18 and above
§ Other guardians
o We cannot waive the informed consent of the paAent.
When there is ample 9me, the important thing is to get the
informed consent of the pa9ent.
§ ExcepAon: if 3me is off the essence or
emergency/no 3me to spare especially the life of the
pa3ent is in danger already. à doctor usually
decide during at those 3me thus applies the
principle of PATERNALISM.
o Veracity
§ Truthfulness and honesty but remember nurses cannot tell everything to
the pa9ent.
§ In connec9on to principle of – Benevolent decepAon withhold the truth to
the pa9ent for the benefit of the pa9ent because the pa9ent’s condi9on is
at stake/unstable.
§ The nurse is not burdened to tell the truth to the pa3ent but rather the
doctor has the burden to tell the truth.
o Beneficence and Non-maleficence
§ Beneficence – to do ma ginawa ka sa pa9ent for the benefit of the pa9ent.
• Example:
o doing TSB to the pa3ent
o giving pain reliever PRN with pa3ent that has headache.
§ Non-maleficence – to prevent or to protect the pa3ent.
• Example:
o Withholding the medica3on supposed to be given to the
pa3ent and asked the doctor about this medica3on.
o There is banana peel in the corridor of the ward, and you
picked it up and throw it at the garbage, you prevented
accident.
§ In connec9on to principle of – double effect which means there is double
effect such as the (1) good and (2) bad effects aka SIDE EFFECTS and
ADVERSE EFFECTS
• Remember:
o The good effect should overcome the bad effect. When this
happens, the treatment is conHnued since it has more good
effects for the pa9ent.
o Once the bad effects overcome the good effect à STOP
IMMEDIATELY
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o Usually, nurse cannot stop the medica3on without the

consent of the doctor à except if covered by double effect
meaning the bad effect overcomes the good effects. This is
also protected code of ethics.
o ConfidenAality, anonymity and Privacy
§ ConfidenAality – do not disclose any informa3on or the case of the pa3ent
• The only people who are allowed to have the informa3on of the
pa3ent are those professionally and directly involved.
• Falls under the 2 types of subpoenas: whenever there is breached
of confiden9ality or when nurse are held liable.
1. Subpoena tesAficandum – court order asking a
person to tes3fy.
2. Subpoena duces tecum – court order asking a
person to appear in court to bring along records,
reports, and documents within his controls. it is in
his possession and has the power of disposal.
a. Both are court orders.
b. Remember: during nurses cases being
subpoena is the hospital or in charge of
records are the ones who is subpoena by
the course. In shorts, those who have the
authority of the records.
§ Anonymity – “anonymous” it means name is not known; nurse do not
disclose the name of the pa3ent to protect their iden3ty.
• Example: case presenta3on which is a form of research where in no
disclosure of pa9ent name rather changed to ini9als.
§ Summon – when a person is asked to appear in specific date and 3me, this
is a requirement of due process there are twin requirements of this.
• (1) NoAce – if no no3ce is received then à (2) Hearing will not
pursue.
• Include here is the details of the case. The other person can file
counter affidavit whenever summon is given. The reply is 15 days.
• Remember that if no summon occurs then hearing will not push
through.
• SubsAtute service – if personal service is not available, the summon
may be given to any person involved such as family members, thus
most people hide properly including the family à aAer 3x of
summon and s3ll no presence then the hearing will not pursue.
• Hearing – should be public or anyone can enter and watch the
hearing.
§ privacy – private moments, parts, or private proper3es
• private moments – giving the pa3ent to be alone or give them the
3me to be himself/herself.
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• Private parts – covering the pa3ent with curtains à PROVIDING

PRIVACY to the pa9ent.
o JusAce
§ If both is not in the same posi3on, then jus3ce is not applicable; you cannot
always apply jus3ce because it defeats the purpose of triage. à nurses use
PRIORITZATION there are difference in the triage of hospital or when
catastrophic event.
§ Only apply jus3ce if the pa3ents is similarly situated.
o Fidelity
§ Faithfulness or loyalty if fidelity these are people who already
“sumakabilang buhay” na.
o Advocacy
§ Code of ethics, Ar3cle 3 sec3on 8
§ The ac3ve support of idea or because which can be related to the pa9ent.
In short, support the pa3ent.
§ Ensure the following:
• Rights of the pa3ent must be protected.
• Needs are met.
• Privileges are given.
• Negligence/malpracAce
o Negligence
§ This is the omission of an act or pursuant to a duty that a reasonable
prudent person would not do.
• Layman’s term: carelessness hindi ka nag ingat due to diligence;
meron kang ginawa or wala kang ginawa.
§ 4 elements: it is a requirements for negligence
1. Existence of a duty
2. Failure to meet the standard
3. Foreseeability of the harm/proximate causa3on
4. Injury. MOST MATERIAL absence of injury no case of negligence
because nothing happened, or no harm done to the pa9ent. Thus,
even case if filed then it will only be dismissed since NO HARM
occurred.
o Remember: everyone can commit negligence because
everyone has a duty to do something. Might be in hospital,
family, or as a friend.
o Criminal liability – begins at age of 15 years old, so if crime
commi_ed at this age then there is possibility of
imprisonment.
§ Minor child such as 10 years old below – the child
will not be imprisoned, since the child is not
criminally liable then they will not be imprisoned.
“walang makukulong” although there will be no
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criminal liability but à civil liability is applied which

means mag babayad from the damages. It will be the
father who will pay.
o MalpracAce
§ Professional negligence à with injury à then the nurse or any health care
is guilty of malprac9ce.
§ Stepping beyond one’s authority gumawa ka ng trabaho outside of nursing
prac9ce.
§ Improper or unskillful care of a pa3ent
§ Incompetence – is liable for suspension of the license.
§ Doctrines of negligence it is a defense once negligence occurs.
• Respondeat superior such as being head nurse thus there is
accountability once a nurse is a head nurse even if he/she is not in
work
o Superior exercises power of control over his subordinates.
o Kapalpakan ng nurse pwede madamay ang hospital as long
there is à employer and employee relaHonship.
o Vicarious liability
• Res ipsa loquitor
o The thing speaks for itself – thing means the evidence of the
negligence such as the injury.
o Before it happens, there are 3 elements should happen:
§ Injury would not normally occur unless there is
negligence.
§ Agency/instrumentality within control of
doctor/nurse à assump3on of risk there should be
prior knowledge
o Plain3ff did not par3cipate.
• Force majeure – irresis3ble, inevitable, and unforeseeable act,
although some3mes foresee but it cannot be prevented.
o AOG or known as the “acts of God”
• Torts
o Civil wrong or wrongful act commi_ed by a person against another where in the
person is liable for damages.
o 8 types of torts
1. Assault and badery
a. Assault – imminent threat of bodily harm or contact this means the
threat is there and it can happen any9me, or the threat is bound to
happen. It should be IMMINENT!
b. Badery – unconsented touching of another person which resulted
to physical harm.
2. False imprisonment and illegal detenAon
3. Breach of confidenAality and invasion of privacy
4. DefamaAon
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a. Libel – defamatory statement that is wri_en.

b. Slander – defamatory statement that is oral and by deed