NURSING

ETHICS
 Nursing Ethics

• ETHICS came from the Greek word ethos which means moral duty. Ethics
refers to a standard to examine and understand moral life. Ethical theories ,
principle and codes of conduct serve as guide of human conduct provided
by ethical system. Ethics studies how people make judgement in regard to
right or wrong .
• Morals, on the other hand, are specific ways of behavior or of
accomplishing ethical practices . Morality is derived from the Greek word
moralis which refers to social consensus about moral conduct for human
being and society . Human decency , right or wrong , good or evil, proper or
improper , cruel or benevolent act are explained in terms of morality.
• Ethics is about making choices that are best for the individual or society at
certain times and in particular situations and then evaluating such choices
and outcomes. Ethicist Joseph Fletcher differentiates morality from ethics.
He states that morality is what you believe is right and good while ethics is
the critical reflection about morality and rational analysis about it.
• Professional ethics is a branch of moral science concerned with the
obligations that a member of the profession owes to the public. Health care
ethics, on the other hand, is the division of ethics that relates human health.
It resides in the realm of human values , moral, custom, personal beliefs,
and faith.
• bio-ethics is a specific domain of ethics that focuses on moral issues in the
field of health care . It revolved into a discipline all on its own as result of life
and death dilemmas faced by health care practitioner . It is systematic study
of human behavior in the field of life science and health care in the light of
moral values and principles . While originally , bio-ethics was concerned
with ethical issues described with medical practice, it has expanded to
issues surrounding health and biological science and social issues including
environmental concern .
• As member of the health team, nurses have to make independent decisions
in the performance of their daily duties. Within in the health team , however ,
many decisions are also made interdependently . Also, nurses are expected
to exhibit bio-ethical behavior in their professional duties. Knowledge of
ethical challenges enable them to hone their skill in decision making
regarding their patients life-and-death issues and integrate ethical principles
and theories into their practice thereby helping them resolve moral conflicts.
• Nursing ethics is related to all the principles of right conduct as they apply
to the profession. Nursing ethics reinforces the nurses ideals and motives in
order to maximize the effectivity of their service.
• Oftentimes, nurses find it difficult to resolve ethical issues partly because
they do not have the sensitivity to recognize ethical problems and conflicts
or to display the needed knowledge and experience in every situation that
they face .
• Johnstone define nursing ethics as the “ examination of all ethical and bio-
ethical issues from the perspective of nursing theory and nursing ethics”.
Vercoe, et.al,. Emphasize that “ the field of nursing ethics be focused on the
needs and experiences of practicing nurses , the exploration of its meaning
and that of ethical practice in terms of the perception of these nurses”.
ETHICAL PRINCIPLES
AND
OTHER APPROACHES
 Teleological Approach

• Teleological comes from the Greek word telos or “ goal or end”. This is
expressed in the maxim, “ the right to do is the good thing to do “. The
teleological approach is also termed as act utilitarianism where the good
resides in the promotion of happiness or the greatest net increase of
pleasure over pain.

• In recent formulation of act utilitarianism , Joseph Fletcher , a situation

ethicist , holds that good is agape , the general goodwill or love for humanity
. In the final analysis human need determines what is or what is not ethical .
If the act helps people , then it is good act , and if it hurt people, then it is a
bad one .
 In his writings , Fletcher provides the guidelines for making ethical
decisions: these are :
1. Consideration for people as human being;
2. Consideration of consequences;
3. Proportionate good to come from the choices;
4. Propriety of actual needs over ideal or potential needs;
5. A desire to enlarge choices and reduce chance; and
6. a courageous acceptance of the consequence of the decisions.
•An example may be given of a City Health Department planning for their
annual budget. To which program should they allot a bigger budget the
modernization of the city hospital or the nutrition and immunization program of
the poverty stricken families of the city? Will promotion of health and prevention
of illness have priority over treatment of illness and rehabilitation?
Deontological Approach or
Duty-Oriented Theory
• The word deontology came from the Greek word deon which means duty. In
theory , the ethicist feel that the basic rightness or wrongness of an act
depends on the intrinsic nature rather than upon the situation or its
consequences.
• Immanuel Kant , a German philosopher and ethicist in the 18 th century ,
defines a person as a ” rational human being with freedom and social worth”.
A person is morally good and admirable if his action are done from a sense of
duty and reason. He states that it is only through dutiful actions that people
have moral worth . Even when individuals do not want to fulfill their duty, Kant
believes that they are required to do so.
• Suppose a nurse is assigned to care for a patient with AIDS. Could she
reasonably refuse to care for the patient on the ground that the patient’s
condition may threaten her health? As practitioners of the art of healing,
nurses are to take care of the sick even if patient have condition that treaten
their personal health. Nurses, must observe the necessary precuation to
protect their health.
 Virtue Ethics Approach

• Virtue ethics, known as aretaic erhics ( from the Greek word arete), is focused
primarily on the heart of the person performing the act . It focuses in the trait
and virtues of a good person such as courage , temperance , wisdom, and
justice.
• However, doing the right thing is not all that is needed. One must have the
right motivation , disposition and traits for being good and doing right such as
courage , magnanimity, honesty, justice and beneficence.
• Intellectual virtue is the power to deliberate about things good for oneself.
Moral virtue, on the other hand, must be lived over time in order to be learned .
Nurses, when faced with a particular situation must be able to know what to do
. They must be able to integrate virtue ethics with duty
• Supposed a students is requested by her classmate, who is also her best
friend , to let her copy in their examination so that she will pass. The students
should not allow this to happen as formal cooperation in an evil act is never
allowed. She will be as equally quilty as the one who will cheat as she be
serving as an accomplice to the evil act.
Divine Commands Ethics

• Divine commands ethics is based on the theory that there is a Supreme or

Divine being that sets down the rules to provide guidance to moral
decisions. For Christians, these rules are found in the Ten Commandments .
Difference in religion, however, pose problem such as what to do when the
decision would conflict with one’s religious beliefs. For example, member of
the Jehovah’s witnesses will not receive blood transfusion even if their lives
will be put in danger.
• Suppose a nurse is approached by a friend who request for an abortion .
The nurse refuse but refers the friend to a doctor who can perform it . This is
a violation of the divine command, “ thou shall not kill”. It violates the
principle relating to the origin and destruction of life which states , “ the
owner of life is man , but it is God who gave him that life , therefore no one
has a right to take life except GOD.”
• The divine command is also applicable to cases of euthanasia, which is the
direct killing of people who may not have committed any crime deserving of
death, but because of mental, or physical conditions are considered
worthless to society . Example of these are patients in persistent vegetative
state whose relatives request that the respiratory ventilators be turned off or
the feeding tubes be removed to put an end to both the patients’ and the
relatives’ suffering.
 Universal Principles of
Biodemical Ethics

• In health care delivery , basic ethical principles assist the health

professional to determine right or wrong in regard to value issues involving
the pursuit of health, alleviation of suffering, and assisting patient towards
peaceful death . These are autonomy , veracity, beneficence,
nonmaleficence, and justice.
 Autonomy

• Autonomy comes from the Greek word autos meaning self and nomos
meaning governance. It involves self-determination and freedom to choose
and implement one’s decision, free from deceit, duress, constraint or
coercion. This is called informed consent. The kind of information provided
the patient and his family is within their level of understanding that they may
evaluate the risks and the other options open to them. This includes
allowing the patient to refuse treatment if he so decides; disclosure of his
ailment, prognosis, mode of treatment; and maintaining confidentiality.
Restriction on autonomy may occur when there is potential harm to others
such as communicable diseases or acts of violence.
 Veracity

• To maximize the efficiency of healthcare, the patient and the health care
providers are bound to tell the truth. The patient has the responsibility to
provide, to the best of his knowledge, accurate and complete information
about his complaints, past illness, previous hospitalization, medication being
taken, allergies, religious restriction, and other matters relevant to his
health. If the patient cannot provide the information, his family or significant
other should do so in order that accurate diagnosis could be arrived at and
immediate treatment provided.
• The physician should tell the patient and his family his diagnosis, plan of
care, treatment and possible risk involved, length of treatment, possible
expenses, other option they make take if there be any.
• There are times, however, that the physician or health practitioner is
requested not to tell the relatives the exact nature of the patient’s illness,
sometimes, the relatives request the physician not to tell the patient his true
diagnosis or condition. At times the practitioner himself intentionally
withholds information according to his sounds judgement when such
revelation would do more harm to an emotionally unstable or depressed
person. This is called a benevolent deception.
• Several cases are therein cited”
1. A young married who was diagnosis to have AIDS request the doctor not
to tell his diagnosis to his wife.
2. The children of an aged grandmother suffering from metastatic cancer
request the doctor not to tell their mother her diagnosis and instead proceed
with the chemotheraphy
• In the case cited above of the young, married man who has AIDS, telling the
wife would be far more advantageous so that she can bs examined,
protected or treated as the case may be.
• In the case of the grandmother, gently telling her the truth would help
convince her participate in the treatment plan including spiritual preparation
toward peaceful death/
• It is very important that health care workers be very discreet in providing
information. While telling the truth increases their credibility, it is oftentimes
how they say this information that makes then acceptable or not.
 Beneficence

• The principle of beneficence refers to acts of kindness and mercy that directly
benefit the patient. These acts promote the health of the patient, prevent illness
or complication, alleviate suffering, and assist towards peaceful death if the
inevitable comes .

• The patient bill rights helps the health practitioners provide more effective
patient care . The patient has the right to

1. Considerate and respectful care;

2. Relevant, current and understandable information concerning diagnosis,
treatment prognosis, specific procedures , treatment, risks involved , medically
reasonable alternative benefits needed to make informed consent;
3. Make decisions regarding his plan of care; in case of refusal, he is entitled
to other appropriate care and service or be transferred to another hospital;
 4. Have advance directive ( such as a living will) concerning treatment or
designating a surrogate decision maker;
5. Every consideration of his privacy such as in case discussion,
consultation, and treatment.
6.confidentiality of communication and records;
7. Review his records concerning his medical care and have these
explained to him except when restricted by law;
8. Be informed of business relationship among the hospital, educational
institution, health care providers that may influence the patient’s treatment and
care;
9. Consent or decline to participate in experimental research effecting his
care;
10. Reasonable continuity of care when hospital care is no longer
appropriate, and
11. Be informed of hospital policies and practices that relative to patient
care.
 Nonmaleficence

• In some way the principle of nonmaleficence is similar to the principle of

beneficence. The distinction lies in the fact that the principle of beneficence
is stated in a positive form while nonmaleficence is stated as an admonition
in the negative form to remind health practitioners to do no harm .
• Example of nonmaleficence is not assisting in or performing abortion, not
assisting person to commit suicide, not performing euthanasia or mercy
killing, or not willfully subjecting patient to experimental drugs whose
potential harm may be greater than the expected benefit, and not harming a
person’s reputation by revealing confidential information.
• What benefit does it give a patient who is in persistent vegetative state to be
attached to a respirator, or for a dying person to be given cardiopulmonary
resuscitation? Should a dying person in pain be given a sedative, when the
health practitioner knows it would cause respiratory depression or arrest?
• Nurses should remember that human life is inviolable. They should do not
what is best for the patient. When biological death is imminent, they should
not abandon the patient. Treating them with respect, providing nursing
measures safely, gently and with kindness, and providing psychological and
spiritual support allow the patient to die with dignity and in peace. Nurses
should not participate in treatment or procedures that will harm the patient.
They should make their stand known and should withdraw from the team if
what is to be done is against their conscience .
 Justice

• In healthcare, justice refers to the right to demand to be treated justly, fairly

and equally.
• Article XIII of the Philippine Constitution guarantees that the state shall adopt
an integrated and comprehensive approach, to health development and shall
endeavor to make essential goods, health and social services available to all
people at affordable cost. There shall be priority for the needs of the
underprivileged, the sick, the elderly and the disabled, the women and
children . The state shall endeavor to provide free medical care to paupers,
establish and maintain an effective food and drug regulatory system, and
undertake appropriate health manpower development and research
responsive to the country’s health needs and problems. It shall establish a
special agency for disabled persons for their rehabilitation.
• To this end , the Department of Health affirms that health is a basic human
right. To make this right a reality , the DOH shall work to make equality
health services available and affordable by mobilizing resources, providing
means to better health, and arousing community participation.
• The National Health Insurance Act of 1995 provides for a universal
compulsory health insurance program in the country. Employees from
private and public sector are covered with Medicare privileges . Even the
self-employed such as drivers , vendors, beautician, may become members
of the Social Security System and will be entitled to insurance benefits,
hospitalization, and discounted out-patient services.
• Republic Act 7432 called the Senior Citizen Act, given honor and justice to
the elderly by giving 20 percent discount in the public establishment such as
restaurant, and pharmacies; public utility vehicles; and hospital including
free medical and dental check-up and free hospitalization in all government
hospitals.
• In allocating budget for the promotion of health , prevention of illness, and
for health education and immunization, more benefits can be expected in
terms of lessened morbidity and mortality rates.
• Common methods for distribution of goods and resources are based on fair
opportunity rule where every person is given an equal share according to
need, merit, contribution, effort and social worth .
• The fair opportunity rule is based on the egalitarian theory that emphasize
equal access to goods and services . The utilitarian theory employs the
maxim, “ The greatest good for the greatest number”. Thus government
authorities should carefully think about the dilemma of whether the
government should spend more for the case of one child with congenital
defect over the needs to protect the lives of thousands of children who
would benefit from the mas immunization against communicable diseases.
• Hospitals put up triage schemes to determine who should be served first.
One criterion often put up is that of medical prognosis or medical utility or
social value or worth, the ability to pay or first-come-first-served basis.
• To be ethically sound, the criteria selected must favor more the socially
disadvantaged, and those incapacitated by illness . Nurses should utilize
their critical thinking ability and skills, listen carefully and objectively and
analyze facts . Ethical principle and values should be used in making moral
decision. Open communication between patients, their families, and the
health team results in acceptance of decision and congenial relationship.
Ethics Committees in Hospital
And
The Role of Medical Ethicist
• There is growing trend for hospitals to have formal ethics committees.
These may be composed of philosopher, doctors, nurses, lawyers, clergy, or
social workers. They discuss sensitive issues such as when to withdraw or
withholds treatment for an adult and the treatment of severely handicapped
newborn. Some may include topics such as the right to die , informal
consent , right to choose or refuse treatment, right to know who is treating
the patient.
• Discussion usually begins with a description of the patient’s condition and
medical history. Most often, conflict involve families and doctors; and where
doctors want to treat or continue to treat a patient and the family wants to do
nothing . Research proposals involving human subject are also reviewed.
 Some cases that have reached worldwide attention are:
1. The removal of Terri Schiavo’s stomach feeding tube upon his
husband’s request to the Court as she was in a persistent vegetative state for
15 years;
2. The Nancy Beth Cruzan case in Missouri , United States where the
Supreme Court denied her parent’s request to remove her feeding tube . She
was in vegetative state for seven years;
3. The California couple who concieved a child in the hope that the baby
would be a bone marrow donor for its seventeen year-old sister who acutely ill
of leukemia;
4. the couple convicted of manslaughter for the death of their 2-1/2 year-
old son because they failed to seek medical attention and the baby died of
intestinal obstruction;and
5. The doctor who assisted a woman sick of Alzheimer’s diseases to
commit suicide.
Responsibilities of Nurses
To The Patients
• The primarily responsibility of nurses to the patient is to give them the kind
of care their condition needs regardless of their race, creed, color,
nationality or status . In so doing the patients care shall be based on needs,
the physicians’ orders, and the ailment,; and shall involve the patients and
their families so that they or any number of the family can participate in their
care .
• Nurses are advised to become familiar with the patient’s Bill of Right and
observed its provisions ( see Appendix O).
• Because nurses are given compensation for their services , they should not
accept tips or expensive gifts that may induce them to give more care to
favored patients and neglect those who cannot give. It is advocated that
they treat patients in a manner that will show concern whether the patient is
rich or poor
• When nurses are engaged by patients or any agency, they shall complete
said service on the length of the time stipulated in the contract. They may
not leave their patients or any agency without proper permission or
resignation or without relief.
 Confidentiality Of
Information
• Confidential information is also termed as privileged communication
because it is given based on trust . Patients and/or their relatives are
expected to give the necessary information so that proper diagnosis and
treatment could be made.
• Patient and their families are entitled to know information or facts within the
limits determined by the physician . If the patient insist on knowing their
diagnosis, nurses may only repeat what doctors wish to disclosed.
• Any information gathered by nurses during the course of caring for their
patients should always be treated confidential. This duty extends even a:fter
the patients death. Confidential information may be revealed only when

1. Patients themselves permit such revelation as in the case of claim for

hospitalization, insurance benefits, among others;
2. the case in medico-legal such as attempted suicide, gunshot wounds
which have to be reported to the local police NBI or constabulary;
 3. The patients are ill of communicable disease and public safety may be
jeopardized; and
4. Given to members of the health team if information is relevant to his
care.

•Confidential information may also be revealed as provided for by law in Article

IV, Section 4(1) of the New Constitution, which state that:

“ The privacy of communication and correspondence shall be

Inviolable except upon lawful order of the court or when public
safety and order require otherwise.”
Patient’s Responsibilities

• Just as the agency and the staff are expected t inform the patients of their
rights, they are also expected to inform these patients of their responsibilities
which include the following ‘

1. Providing Information - A patients has the responsibility to provide to the

best of his/her knowledge accurate and complete information about his/her
complaints, past illnesses, hospitalization, medication and other matters
relating to his/her health. Changes in status and level of understanding must
be also be communicated. If the patients cannot provide said information ,
the family is responsible for doing so in his/her behalf.
2. Complying with instructions – A patients responsible for complying
with the treatment plan recommended by the attending physician or health
team that is primarily responsible for his/her health care . He/she is expected
to keep his/her appointments, abide by the hospital rules, and inform those
concerned if he/she cannot keep them.
 3. Informing the physician of refusal to treatment - A patient who
refuse treatment or to be complaint with the treatment regimen must inform the
physician of his decision.
4. Paying hospital charges – If the patients is in the pay Service, he/she
is responsible for ensuring that financial obligations of his/her health care are
fulfilled as promptly as possible .
5. Following hospital rules and regulation - The patient is responsible
for following the hospital’s rules and regulations and shall advise his/her family
to do so , too .
6. Showing respect and consideration - The patient must be
considerate of the rights of the other patient and hospital personnel and shall
assist in the control of noise , smoking, and/or playing of loud music on radio.
The patient must respect the property of other persons and that of the hospital .
Since the nurses are the closest caregivers, they are the most logical guardian
of the patient’s rights . It shall also be part of their duties to inform the patients
and their relatives , upon admission, of the responsibilities expected of them.
 Nurses’ Bill Of Rights

• Registered nurses promote and restore health care , prevent illness, and
protect the people entrusted to their care . They work to alleviate the
suffering experienced by individuals, families, groups and communities. In
so doing, nurses provide services that maintain respect for human dignity
and embrace the uniqueness of each patient and the nature of his or her
health problems, without restriction in regards to social or economic status.
To maximize the contribution nurses make to society , it is necessary to
protect the dignity and autonomy of nurses in the workplace .
 The following rights must be afforded:

1. Nurses have the rights to practice a manner that fulfills their obligation to
society and to those who receive nursing care.
2. Nurses have the right to practice in environment that allow them to act in
accordance with professional standard and legally authorized scopes of
practice.
3. Nurses have the right to a work environment that supports and facilities
ethical practice, in accordance with the Code of Ethics for Nurses and its
interpretive statements.
4. Nurses have the right to freely and openly advocate for themselves and
their patients , without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with
their knowledge, experience, and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves
and their patients.
7. Nurses have the right to negotiate the conditions of their employment,
either as individuals or collectively, in all practice setting.
Nurses’ Responsibilities
in Research
On Human Subjects
• The Helsinki Declaration of 1964 issued guidelines on medical research . In
1975 it differentiated two major types of research: that which is essentially
therapeutic and that which is directed towards developing scientific
knowledge and has no therapeutic value for this subject . The declaration
emphasizes that the research subjects must be informed when a clinical or
non-clinical study will be of no personal benefits to them to avoid any
suspicion to the contrary
 The American Nurses Association’s Human Rights Guidelines for Nurses
in Clinical and Other Research specified several important entities:

1. Employment in Setting Where Research is Conducted -

Employees in work setting that carry potential risks shall be informed about
these, how to recognize these risks and how to take the proper precautions to
counteract harmful effects and unnecessary danger.
2. Vigilant Protection of Human Subject’s - Prior to participation in
any activities that go beyond established and accepted procedures, the
prospective subject must be informed .Special mechanism shall be devised to
safeguard the confidentiality of information and protection of human dignity.
3. Scope of Application – These guidelines apply to all individuals
involved in research activities, including patient, organ donors, informants,
normal volunteers, students and vulnerable populations, such as the mentally
retarded and prisoners
 4. Supporting Accrual of Knowledge - Nurses have an obligation to
support the accrual of knowledge that broadens scientific underpinning of
nursing practice and delivery of nursing services.
5. Informed Consent - consent to participate in researches safeguards
the basic rights to self-determination . There shall be no direct nor indirect
coercion. He should be given in detail the full benefits or possible harm that
may happen to him. If possible , the investigator shall secure the consent
himself so that any questions or clarifications can be made immediately
6. Representation on Human Rights Committee - A Human Right
Committee is formulated to ensure that the individuals rights of patients are not
denied . The nursing profession has an obligation to publicly support the
inclusion of nurses to these committee .
 Basic Human Rights of
Research Subjects

• Adequate protection of human subject includes their legal as well as moral

rights . They must be given the right to informed consent , the right to refuse
or withdraw from participation, privacy , confidentiality, or anonymity of data
and protection from harm.
Right to Informed consent

• Recognition of self-determination and thorough comprehension of the

proposed participation are the two components of self-determination . Self-
determination means free consent is pre-requisite to any human
involvement . The subject must also understand the risks involved, the
benefits anticipated , time and energy requirements and any anticipated loss
of dignity or autonomy ; any anticipated pain or discomfort , psychological
stress or embarrassment; and the way the data will be handle and reported.
 The Right to refuse and/or
withdraw from participation

• The person has the right to refuse the participate . There shall be neither
recrimination for refusal not for withdrawing from participation . Nurses shall
explore the subject’s reason for refusing . Refusal to participate can be
minimized, if at the on set the subject has been given careful and honest
opinion on what is to be done.
 Right and Privacy

• This right includes privacy of one’s thoughts , opinions and physical

presence and privacy of one’s records . The subject has the freedom to
decide the time , the extent and circumstance he/she will willingly share
his/her presence , thoughts , beliefs, attitudes and behavior with others.
Right to Confidentiality or
Anonymity of Data

• Data about The research subject shall be handled confidentially . Data shall
be available only to the research staff and shall be reported anonymously .
Data shall not be used other than for the specific purpose for which the
subject gave consent and shall not be made public or available to others .

• The identity of the agency shall be protected . This shall be done unless
knowledge about the setting is necessary in the interpretation of the data.
After the report is written, all data by which individuals can be identified shall
be destroy. They shall be burned or shredded and not dropped into the
wastebasket as someone may find and use them for other purpose.
Right to be Protected from
Harm

• There shall be appropriate balance between potential benefits of the

research and the risks assumed by the subject . This is called the risk-
benefits ratio in which the benefits outweigh the harm. Minimal risk is
defined as exposure to the possibility of injury going beyond everyday
situations. These include physical, legal, emotional, financial and social
harm.
• Sometimes, the subject may experience undue anxiety if the instruments
evokes disturbing feelings. Debriefing is a process of disclosing to the
subject all information that was previously withheld . Referral to counselling
shall be included in the study protocol if necessary .
 Vulnerable Subjects

• Subject who are mentally ill or legally incompetent such as the

unconscious , or are in unique situations , like fetuses, require special
attention. Those who are mentally retarded, unconscious and minor are
incapable of evaluating the risks involved and cannot be given consent in
their own behalf. Consent of parent or guardians are required.
• Investigative studies regarding fetuses shall have the consent in the
presence of a third person because of the possible danger or injury to it.
The Philippines Constitution guarantees the protection of the life of the
mother and the life of the unborn.
• Students are vulnerable as their participation or non-participation may affect
their grades . Employees may participate because of the influence it may
bring to their promotion, salary increases or bonuses . It must be explained
to them that this is not so .
 Investigate Studies and
Medical Regimen
• When the medical regimen of a research subject will be affected, it is best
that there be proper coordination with the physician in charge . The
investigative study shall not, in any way, be in conflict with the medical
regimen . Drugs to be used by the investigator must have a medical
prescription .
• An example of this was an experiment done in a government hospital where
banana leaves were used to promote healing of decubitus ulcers of
bedridden patients. This study was coordinated with the physicians in the
unit . Even though the treatment method which consisted of cleaning,
massaging the area around the wound, relief of pressure , and putting
banana leaves beneath the area with ulcer were all within the scope of
nursing practice, the success of the study was further enhanced since the
doctors refrained from ordering topically-applied medications.
Experimental Subject’s Bill
of Rights
• Below are the rights of every person who is asked to participate in a
research study
• An experimental subject has the right to:

1. Be told what that study is trying to find out;

2. Be told what will happen to himself/herself and whether the procedure ,
drugs, or devices are different from what are used in standard practice;
3. Be told of the frequent or important risks, side effects or discomforts of
the things that will happen to himself/herself for research purposes;
4. Be told if he/she can expect any benefits from participating, and if so ,
what the benefits may be;
5. Be told the others choices he/she has and hoe he/she may become
better or worse than being in the study .
 6. Be allowed to ask my question concerning the study both before
agreeing to be involved and during the course of the study ;
7. Be told what sort of treatment is available if any complication arise;
8. Refuse to participate at all or to change his/her mind about participation
after the study is started. This decision will not affect his/her right to receive the
care he/she would receive if he/she were not in the study ;
9. Receive a copy at the signed and dated cosent form; and
10. Be free from pressure when considering whether he/she wishes to
agree to be in the study .
Responsibilities of the Nurse
to the Physician
• Section 28 ( a ) of R.A. 9173 states that:
• It shall be the duty of the nurse to:
( a) Provide nursing care through the utilization of the nursing process.
Nursing care includes, but not limited to, traditional and innovative
approaches, therapeutic use of self, executing health techniques and
procedures, comfort measures, health techniques, and administration of
written prescription for treatment , therapies, oral , topical during labor in the
absence of antenatal bleeding and delivery . In case of suturing of perineal
laceration, special training shall be provided according to protocol
established.

• It is therefore expected that nurses will not only carry out doctor’s order but
help plan and implement patient care as well. Patient’s condition should be
reported including results of therapies so that management of care be
properly monitored and modified as necessary .
• If any of the medical orders were not carried out for some reason ( e.g.,
medication are unavailable, or a patient refuses to accept them), such shall
not only be brought to the attention of the physician but also noted properly
in the patient’s chart . Explore patient’s reason for refusal . Clarify
misconceptions as needed.
• Nurses familiarize themselves with the various routines , methods or
idiosyncrasies of physician, so that smooth relationships can be maintained.
In case the patient has a complaint against the physician, this shall be
tactfully brought to the latter’s attention.
• Any case illegal, incompetent or unethical practice by any member of the
health team shall be brought to the attention of the appropriate authority
through channels within the institutional or agency setting.
• Nurses shall remember that any medical act relegated to them is illegal
because it is specified in the Medical Law that any licensed nurse who does
this, even if supervised, can be held for illegal practice of medicine.
Responsibilities of Nurses to
their Colleagues
• Nurses are expected to be able to get along smoothly with their colleagues.
There may be instances where a nurse may have a different opinion, or may
not like certain people. This shall be the exception rather than the rule. A
mature person easily blends in any situation. Nurses shall adjust
themselves to the organization and know its policies and procedures. They
shall establish good working relationship with co-workers . If one has a
grievance he/she should bring it to the attention of the proper authority
rather than talk about it with others who may not be able to help . Most
agencies have grievance procedures to be followed.
• It is important that nurses know their place in the total organization so that
they may cooperate , coordinate and maximize their work . Loyalty and
consideration of others while at work will foster these relationship further.
• Nurses who are cranky, too sensitive, who “ backbite”, who do not see any
good in their colleagues, are the type of nurses who will not be happy in
their work.
• Situations, such as when nurses see their colleagues neglect their studied
or are incompetent shall be brought to the attention of the immediate
supervisor or appropriate authority within the agency setting before any life
could be endangered. Constructive criticism is always welcome but not
fault-finding. Fault-finders , gossipers, and those who are fond of intrigues
will surely resent it too if they become the target of their own practices.
Responsibilities of Nurses to
Themselves
• Since nurses carry personal responsibility for nursing practice and for
maintaining competence by continuous learning, it is expected that every
possible means shall be utilized by them to develop their skills. Their
conduct must bring credit to the profession. Just like any other professional ,
nurses are looked upon wit respect in the community. They shall therefore
endeavor to live a life that will uphold their self respect.
• Especially when nurses are on duty, they shall try to look neat at attractive.
Female nurses are advised to use moderate make-up and have a neat hair
style . They shall wear uniforms that are neither too short nor tight-fitting that
will tend to restrict movement, nor expose unnecessarily any part of the
body will giving care to the patients. Clean uniforms and clean bodies tend
to enhance the image of nurses . Use of anti-perspirant is advised most
especially during hot summer months ( refer to ANSAP Dress Code in
Appendix P). Male nurses are likewise advised to be clean –shaven, with
hair clipped close to the nape instead of flowing to the shoulder.
• The use of the uniform shall be specified in the policy of the hospital/agency
. It shall be worn only when on duty. Dining in public, shopping or going to
the market while in uniform is discourage. Nurses’ caps are worn only while
in duty. These are either carried in bags or are left in their places of
assignment. Jewelry such as earrings, necklaces or bracelets are not worn
while on duty. However, wedding rings school rings or school pins may be
worn.
• Nurses are looked upon by nursing students are their role models.
Therefore, especially while they are on duty , they must act in manner that is
worth emulating . Sincere and compassionate attitudes towards patients are
caught by those around theme . Soon their working environment becomes
permeated with a good working relationship that is so vital in dealing with
patients.
 Living Wills or Advance
Directives
• There is trend in the use of living wills or advance directives. While this is
not yet widely used in the Philippines, it is used extensively in the United
States. Hospital are required to provide health-care proxy forms to patients
being admitted. These are called living wills and advance directives. The
patients designates a health care representative , usually a member of the
family, a friend , or a family physician to make decisions for him/her when
he/she is unable , due to physical or mental incapacity , to make his/her own
health care decision. This includes decision to accept or refuse any
treatment , service or procedure used to diagnose or treat his/her physical
or mental condition or decisions to provide , withholds or withdraw life-
sustaining measures.
• Circumstances are stated in which various forms of medical treatment
including life-sustaining measures shall be provided , withheld or
discontinued. The desire to make anatomical gifts after death are also
indicated in the will , if the patient desire to do so.
• This living will is signed by the patient . It is witnessed by two other persons
who declared that the patient signed the will, that the latter appear to be of
sound mind, free of duress or undue influence . The witnesses must be 18
years of age or older , and are not designated as the person’s health care
representative or alternate as such. This living will is attached to the
patient’s chart. This directive has a force of law.