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NURSING REASEARCH, LEADERSHIP AND is done for richer

MANAGEM ENT familiarity and is carried out by mere active observation of a


phenomenon.
I. Nursing research 2. Exploratory purpose : 50 % of the answer is already known.
3. Experimental purpose : you determine the cause and effect
a. Definition of terms ratio by applying active
b. Characteristics manipulation bec you are doing active intervention.
c. Purpose 4. Developmental purpose : done to improve the system or
d. Ethics of Scientific Research quality of care for our patients.
e. Steps in Nursing Research * The main purpose of nursing research is to improve the quality
of patient care.(**CBQ)
II. Nursing Leadership
Ethics of a Good Scientific Research : (SCIENTIFIC)
a. Definition of Terms S cientific objective : the study should have an objective
b. Elements of Leadership beneficial to your patients.
c. Nursing Leadership Consent : consent should be secured when obtaining all data
d. Reasons for the Study of Nursing Leadership needed in the study.
e. Theories of Leadership **CBQ : If the patient is dead : the hospital legally owns the
f. Leadership Style records.
g. Powers of a Leader The information in the patient’s records : owned by the patient.
h. Skills and qualities of a Leader If the patient wants an explanation about information in his
chart, ONLY
III. Nursing M anagement the physician is legally allowed to explain the diagnosis,
prognosis,
a. Definition of Terms treatment etc.
b. Theories of M anagement Integrity : should be based on honesty and soundness; no “short-
c. M anager/ Types cuts”, no withholding of
d. M anagement Process information for personal benefit.
e. Sample Questions or Post-test Equity / Equitable : it should include spaces for appropriate
** CBQ : Common Board Question acknowledgement for the
contribution of others as well as consent for references used.
I. Nursing Research : **CBQ :
Plagiarism / Illegal replication : unauthorized use of another’s
Definition : according to Kerlinger, nursing research is the : work /study.
a. systematic Noble / Nobility : the researcher must respect the rights of
b. empirical his/her subjects.
c. controlled, and
d. critical investigation Three basic rights of a research participant:
of a hypothetical proposition in relation with a phenomenon. 1. Right not to be harmed
2. Right to self-determination
* First thing to do in nursing research is to choose a problem 3. Right to privacy
related to a phenomenon.
Nursing problem : is anything that influences the human lives / I. Types of harm or injury :
existence. 1. Physical : may happen during the experimental process
Ex. : diseases, infections, pollution etc through
negligence :
Example of a problem : Tuberculosis a. by commission : through performance of wrong intervention.
1. You need to apply a hypothetical proposition. b. by omission : by not doing what was rightfully expected of
Hypothesis : represents not the final answer to the nursing him/her from the very start.
problem being studied BUT is : Ex : omitting to do CPR to someone who fainted in your
a. an educated guess presence.
b. a scientific guess * CPR :
c. a tentative answer only. Adult : compression-blow ratio : 15 : 2
* IS a big question mark in the researcher’s mind. Infants : compression-blow ratio : 5 : 1
2. Hypothesis for the problem of TB : 2. M ental : may be two kinds :
“ Environmental pollution in M anila increases the cases of TB at a. assault : subjecting one to mere mental fear or threat.
San Lazaro b. battery : forcible or illegal physical introduction of a
General Hospital”. substance
e.g. an invalid administration of a drug or injection.
Four M ajor Characteristics of a Scientific Research : 3. M oral : may either be :
1. Systematic : the study must follow a step -by-step a. slander : when you orally destroy the moral reputation of the
process/procedure.(**CBQ) patient.
2. Empirical/ Empiricism : the study should be dealt with b. libel : when the defamation is published, written, or recorded.
objectivity : the data related to
the problem should be readily observable or gathered through II. Right to self-determination : the patient personally
the senses. determines whether to join
3. Controlled/ Appropriate Research Design : study should be or not in the research; subject must be free from coercion,
directed, designed or restraint, force,
manipulated by appropriate system, method or process to control undue influence. It must be voluntary. Informed consent should
all variables of be sought.
the study.
4. Based on a Critical investigation : the study should be a fact- III. The right to privacy may either be :
finding investigation on a a. anonymity : refers to privacy as regards the identity of the
population or human beings to gather data to answer the Informant; identity may not be disclosed.
hypothesis. b. confidentiality : refers to privacy as regards to the information
or data obtained; information acquired must not be
Four Basic Purposes of Nursing Research : disclosed.
1.Descriptive purpose : 100 % knowledge on the subject; study ** CBQ : In the process of doing research, the researcher is very
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careful determining whether
not to disclose the name of her subjects. This is : or not a problem is researchable?
a. protection of client a. time factor
b. confidentiality b. availability of a research instrument
c. anonymity c. nationality of the researcher
d. informed consent d. cost of the investigation.
Truthfulness : should only contain facts not mere fabrications. 3. Variable : anything that is subject to change or manipulation.
Importance : significance to the nursing profession. Two types of variables :
Factual : a nursing research is a fact-finding study (facts not 1. Independent : or the causal variable; the cause of the study.
fiction) 2. Dependent : the effect of the manipulation on the target
Ideal : must proceed following the 10 formal steps in nursing population/variable
research process. reaction..
Courageous : the research should embody the courage to get all Ivan Pavlov : formulated the theory that a stimulus when applied
the pertinent facts/data to a certain
organism will elicit a corresponding response.

* CBQ : The main contribution of research towards the Stimulus ---------Organism --------------Response
improvement of nursing (Independent Cause) (Target Population)
profession is which of the following? (Dependent Cause)
a. provide a scientific basis for nursing care 4 Definition of terms :
b. assist the nurse administrator in planning nursing staff 1. Conceptual : taken in its ordinary /common meaning;
requirements. dictionary-based meaning
c. assist the faculty in developing the nursing curriculum. 2. Operational : how the researcher used the definition in his
d. facilitate the development of staff development. study.
Ex. The word “toxic”:
Ten M ajor Steps in Nursing Research : Conceptual meaning : poisonous; hazardous
1. Identification of a research problem. Operational meaning : heavy workload for an undermanned staff
2. Review of related literature II. Review of related literatures :
3. Formulation of a conceptual and theoretical framework. **CBQ : What is the main purpose of review of related
4. Choose an appropriate hypothesis literatures?
5. Choose an appropriate research design. Ans.: to form a conceptual and theoretical framework.
6. Sampling or obtaining a sample from the population Two sources of the researcher’s review of related materials :
7. Collection of data phase
8. Analysis of data phase Conceptual Research
9. Interpretation of the data
10. Dissemination of conclusion or recommendations. Examples Books, Research papers
.** CBQ : The correct sequence of steps in research process is : internet
1. Formulate problem information. Who were the Authors Researchers
2. Review literature information sources?
3. Analyze data. For what For general For future research
4. Determine research design purpose/s? use studies only
5. M ake conclusions and recommendations.
a. 1,2,4,3,5
b. 1,3,2,4,5 III. Formulation of a conceptual and theoretical framework :
c. 1,2,4,5,4 A. Theoretical framework : the theories involved in the
d. 2,1,3,5,4 researcher’s study.
B. Conceptual framework : the structural relationship (in an
I. Identification of a research problem : illustrated form) between the
A research problem is anything that requires solution through a independent and dependent variables.
scientific investigation. C. Paradigm : the structural or diagrammatic presentation of the
1. Sources of problems for nursing research : researcher’s conceptual
C : different nursing concepts. framework.
L : health literatures
I : issues affecting the profession Ex. # 1 : A study on the difference in the professional
E : essays opportunities of Filipino nurses
N : Nursing assessment working in the Philippines and those working abroad.
T : Nursing theories (** CBQ) Purpose : “Is to compare the professional opportunities of
2. Characteristics of a good nursing research problem : Filipino nurses working abroad
(GReFIN) and those working in the Philippines.
General applicability : the study is helpful and advantageous for Independent Target Dependent Variable
the common
Variable Population
good and not just for a selected few.
Place of work Filipino Opportunities for
Based on applicability, a problem may be :
nurses professional growth
a. Basic/ Pure : applicable only to the researcher and done
(subject to (result of
primarily to :
manipulation) manipulation)
1. Answer personal querries or curiosity
2. To increase personal knowledge.
b. Applied : focused on solving the problems of other people.
Researchable : the problem is capable of being investigated
through observation, IV. Choose an appropriate hypothesis :
manipulation, etc Kinds of hypotheses :
Feasible : measureable as to : 1. Null/ Statistical hypothesis : any statement that has NO
1. Time 3. Experience of the researcher 5. Population relationship or difference between 1
2. M oney 4. Research instruments availability variable to another single variable. This is mostly used because
Importance it is aesy to reject or
Novelty : originality (** CBQ) accept a null hypothesis.
S ignificance to the nursing profession
*CBQ : Which of the following criteria is least considered in
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“ There is no difference regarding the professional opportunities determine its
of Filipino nurses effectiveness (of the manipulation/intervention).
working in the Philippines from those working abroad”. 3. It is done in a more controlled setting like labs, research units
etc.
2. Simple/ Operational hypothesis : states the anticipated
relationship or difference between 1 Types of non-experimental research design :
independent variable to another single dependent variable. 1. According to time : past, present and future.
A. Past :
“ Filipino nurses working abroad have more professional growth a. Ex-post facto : retrospective style : a study done on a group of
opportunities than those people who
working in the Philippines”. had naturally experienced a natural phenomena (after
a fact)
3. Complex hypothesis : states the anticipated relatioship but is a subject of a present study.
between 2 or more variables to other b. Historical type : involves a study of things that happened in
variables (intervening variables) the past
which are already :
Ex. # 2. “Filipino nurses who worked for 5 years and passed the 1. written about
CGFNS, TOEFL, TSE, 2. documented
and NCLEX have greater opportunities to acquire immigrant 3. published, and
visas, higher 4. recorded
starting salaries, insurance benefits and study grants“. Ex. : charts of patients’ data.
Two sources of historical data :
4. Directional hypothesis : specifies the direction of the 1. Primary sources : nurse’s notes / diaries which give f irsthand
relationship between variables. information.** You rely only on this type of source.*CBQ
2. Secondary sources : second hand information : information is
Ex. # 3. “Filipino nurses working in the USA have more supplied by a person other than the one who experienced it.
professional opportunities than B. Present :
those working in the Philippines” Descriptive : based on present occurrence or happening.
C. Future :
5. Non-directional hypothesis : only predicts the relationship, Prospective : the study is done in the present, the result of which
but has no specific direction will be
between variables. known only in the future; based on a future
** CBQ : can lead to ambiguity or confusion. occurrence/happening.

Ex. # 4. “ There is a big difference between a Filipino nurse 2. Based on the number of participants involved :
working in the USA and Survey type of research design : based on the answer of the
those working in the Philippines.” majority
(majority = 50% + 1)
V. Selecting an appropriate research design : Types of surveys :
A systematic, controlled plan for finding answers to a problem; 1. According to groups:
it is a roadmap, blueprint to a. small group : face-to-face interview method where you have
provide a result; a plan, structure or strategy of conducting an the
investigation. advantage of immediately getting the answer / response.
* it is used to control the researcher’s variable/s;the skeletal b. large group : utilization of mailed survey forms where you
framework in his research. may
have problems with feedback.
Three basic classifications of research designs : 2. According to methods
1. According to applicability : 3. According to orientation :
a. Basic / pure a. Cross-sectional type :
b. Applied 1. Involves two or more evidential groups.
2. According to data collected : 2. Done only once.
a. Qualitative : refers to the quality of the data : these are not 3. For the purpose of comparative study
subject to numerical
interpretations; can’t be measured quantitatively; based on
subjective data b. Longitudinal type :
such as : 1. Involves one core group only
a. perception d. feelings 2. Entails doing an initial survey and follow-up survey/s.
b. understanding e. emotions 3. For the study on the progress/ development of the group
c. attitudes & beliefs f. behaviors *CBQ : Ex. Is the Sangkap Pinoy movement.
b. Quantitative : readily observable by the senses; can be
numerically interpreted; Experimental Type of Research Design
based on objective data. Four compulsory steps of exp erimental research design :
1. Control stage : the population is divided into two groups :
a. control population : no intervention or manipulation is done to
3. According to method : the
a. Non-experimental method : when the method presents no group.
need for any b. experimental population : the group subjected to manipulation
intervention or manipulation : or
1. Passive participation intervention.
2. Researcher simply has to observe, describe and record the 2. Randomization stage : choosing the data by chance where
results. each member of the
3. It is usually done in the natural setting : where the people group is given equal chance to be chosen as a sample.
(sample) 3. M anipulation
naturally exist. 4. Evaluation of effects.
Ex. : homes, community, schools etc. * CBQ :
b. Experimental type of research design : Quasi-experimental research design : if a researcher did not
1. Active participation perform all the
2. M anipulation is needed to get the cause and effect ratio to procedures of an experimental research design.
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Implication : cannot properly evaluate your results bec of lack of with
comparative data. regards to certain characteristics such as age, sex or economic
Characteristics of a good research tool or instrument : status. The
1. Reliability : refers to the accuracy or precision of the tool- if it selection is based on the common knowledge/understanding of
is administered twice, the
the instrument should provide identical data. researcher.
2. Validity : refers to the relevance of the measurement to the Ex. Study on poor prostitutes : samples are taken fron Ermita,
study being done. M la.
3. Sensitivity : means that the fine lines of difference amomg the Study on TB patients : you go to San Lazaro Gen Hosp.
study subjects can be 3. Snowball / Network sample : a kind of convenience sampling
determined from the measurements, examples of which are that involves
ratings and subjects suggesting or referring other subjects who meet the
thermometers. researcher’s
4. M eaningfulness : the measurement must have a practical eligibility criteria; last referral to gain momentum- those
application. qualified but not
5. Appropriate : if it is applicable to the subjects being tested. referred will not get the chance to participate.
6. Objective : one that is free from bias. 4. Cross-cultural sampling : study is done in a variety of cultural
7. Ethical : tools should not violate the human rights of clients. settings.
Ex. Getting samples from Tagalogs, Ilocanos, Visayans etc.
VI. Sampling/Sample from the population : 5. Longitudinal sampling : a given group of subjects are studied
Population : refers to the largest body of the case or individuals for an extended
being researched that conform to period of time, which may either be retrospective or prospective.
a specific set of particulars or eligibility criteria. Examples :
Sampling : the process of selecting a portion of the population to Prospective : M astectomy patients are studied from operation to
represent the entire population. 3
Sample : a group of people coming from the population that will years after discharge.
become the recipients of the Retrospective : Growth of newborns two years ago to the
experimentation treatment in an experimental type of research. present.
6. Cross-sectional sampling : subjects are only observed at only
Factors that determine the sample size : one point in time.
1. Accessibility of sample participants : when it is not feasible to Ex. Asking high school students their choices of career after
study a whole graduation.
population, a sample is taken. 7. Quota sampling : the researcher identifies the strata of the
2. Cost : funds available limit the size of the sample. population and
3. Amount of time available : if the time is limited, only a small determines the proportion of elements needed in the various
sample may be segments
gathered.
Two major types of sampling and selection techniques : VII. Collection of data phase : the most time- and budget-
I. Probability Sampling : randomization is applied and each consuming part of research.
member of the population is Different methods of collecting data :
given an equal opportunity to be a participant in the study. 1. Questionaire : a form prepared and distributed to secure
1. Simple random sampling : the selection of the sample is done responses to questions that are
by chance; used intended to obtain information about conditions or practices on
only for a smaller population made up of identical groups. which the respondents is
Ex. : fishbowl technique, lottery draws or table of random presumed to have knowledge; method of collecting data using
numbers pen and paper.
2. Stratified random sampling : the population is subdivided into Different types of questionnaires :
areas, sections, a. dichotomous : those that require only two answers e.g. Yes or
then random samples are taken from each. This is used for No, True or False
unidentical b. rating/checklist : ratings of variables are asked e.g. 1,2,3,4,5,
groups. (Sub-strata before randomization is done). * CBQ or poor,fair,good
Ex. Divide the students into year levels : first, second, third, and c. multiple choice : diff alternatives are given as choices :
fourth a,b,c,d, or e.
year, and then get random samples from each. 2. Written records : utilization of those pre-recorded or pre-
3. Systematic random sampling : using a tool called a “sampling existing data.
frame” wherein a Ex. Patient’s charts (written, documented and recorded)
sample is taken every nth number. This is used in a big / large 3. Interview : the oral method of collecting data; oral
population. communication is used.
Sampling frame : a list of names appearing inyour population. Types of interviews :
Ex. : yellow pad technique. a. structured interview : one wherein specific or pre-seleted
4. Cluster random sampling : a small sample is taken from questions are asked
various sections of the wherein an interview schedule is read to the respondent.
total population. (sub-areas before randomization) b. non-structured : one where open-ended or generalized
Ex. In studying the attitudes of nurses in M etro M anila towards questions are asked by
their work, way of an interview guide and the respondent is allowed to
a small sample from each hospital will be taken. pursue
relevant ideas in depth.
II. Non-probability sampling : involves the study of a pre- 4. Observation : by employing the senses or occular inspection
selected group (bias group) wherein the researcher may be :
since the start. a. Participant : active participation is required of the researcher.
1. Accidental/Convenience sampling : data is collected from The researcher may be
anyone most disguised as a patient, nurse, or just a plain eager learner taking
conveniently available -- accessibility is the main factor for part in the
sample choice. activity. The attractions and repulsions of the group members
* This is the weakest form of sampling (bias) *CBQ are assessed by
2. Purposive / Judgmental sampling : researcher selects and plotting their interactions on a devoce called a sociogram.
studies a specific b. Non-participant : the researcher stands outside the phenomena
number of a special group that represents the target population being studied and
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records the data as objectively as possible even with a passive towards patient care without getting the inputs of his
participation only. subordinates.
>Also called “centric” bec the leader makes decision for the
Two basic problems under data collection : group, he/she, being
1. Hawthorne effect : people may deliberately change their the only center of attention.
behavior bec they know that > Also called “Theory X” by M cGregor, meaning, this is boss-
they are being studied or observed. centered.
* Common in experimental study and is not reliable bec the Possible character traits of an autocratic/authoritarian leader :
behavior of the Apathy : insensitive toward others
subjects are consciously altered. Boisterous speech
*CBQ : How to avoid ? By the use of double-blind research. Consistency
2. Halo effect : the observer may have the tendency to rate Demanding attitude
certain subjects consistently Egoistic and self-centerde
high or low on everything bec of the overall impression the Ferocious behavior
subjects give the rater. * Generally not a good leader; may be acceptable ONLY during
The data collected is untrue bec of a special emergency/crises.
relationship/treatment between the
researcher and his sample. 2. Laissez-faire Style / Freestyle / Permissive / Ultraliberal style
of leadership : one in
VIII. Analysis and interpretation of data phase : which there is excessive freedom /liberalities and the leader
The stage where the researcher is forming a body of knowledge abdicates the
or conclusion out of the data leadership responsibility and leaces workers without direction,
collected either to affirm or negate his hypothesis. The supervision or
researcher can answer the coordination.
hypothesis with finality; the presentation of data relevant to the > “let alone” style of leadership
problem and sufficient to *Implication : there could be breakdown of power control and
answer the hypothesis. responsibility and
* Tabulation of tha data is necessary before an analysis can be may result to high incidents of negligence.
done. > This is effective when working with highly motivated
professionals, like those
Different methods of tabulating or measurement of data in research, where independent thinking is rewarded..
collected : > Not useful in highly structured organizations e.g. the health
1. Nominal : data are tabulated per category (used in surveys) care delivery system
2. Ordinal : data are classified according to characteristics as where organization and control form the baseline of most
ranked. operations.
3. Interval : data are tabulated per space, distance or
measurement using numerical values. 3. Democratic / Participative / Consultative leadership : is
Ex. Temperature : 150/90 - 120/80 mm H g people oriented; focuses on
human aspects and builds effective teamwork; mutual style of
Two methods of interpreting data : (conclusions are made) leadership.
1. Quantitative style : data collected are presented in numerical >The nurse leader gets the opinions, inputs, and suggestions
or graphical forms ; from the staff and
a. pie graph members of the team.
b. line graph : usually utilized in longitudinal studies. > Performance standards exist to provide guidelines and permit
c. bar graph performance
2. Qualitative style : interpretation by the use of the narrative appraisal.
form or approach. > Also called “Theory Y” by M cGregor : the leader sees the
workers as ambitious
IX. Dissemination of conclusion and recommendations : and she/he does not resist change, is creative and exercises self-
A. Conclusion : final answer to the problem. direction
B. Recommendations : suggestions on how to affect the results and self-control.
of the study positively. > Also called “radic” bec he radiates out to encompass the needs
Different methods of dissemination : of others.
1. You can write a book about the study > The most desirable form of leadership and leads to high
2. You can hold symposium/symposia productivity.
3. Publish the study
4. Through the internet. Different types of leader powers :
II. Leadership 1. Formal/Legitimate/Exclusive power : the power or authority
to give orders or tasks to
Leader his subordinates.
2. Referrent power : a charismatic power: the leader uses his/her
charm. *CBQ
Group 3. Expert power : power attained by virtue of his/her extra-
Followers ordinary skills, trainings and
I abilities.
4. Reward power : the positive power on the part of the leader to
Leadership : is a style or a process whereby a person called a compensate or
nurse leader will influence a group remunerate staff members by rewards, incentives, promotions,
of people known as the followers for the purpose of attaining a commendations etc
single goal or objective 5. Coercive power : the negative power of a leader to implement
towards the good of his patients. sanctions, suspensions
* If doing the independent roles : the person is a leader. and or terminations as a form of disciplinary power.
* General rule :
Different styles of leadership : “Whoever is at the top, has the right to implement discipline.”
1. Autocratic/ Authoritarian / Dictatorial / Bureaucratic or Ex. Co-member of the team caught with alcohol breath : report
Traditional : a unilateral style to the supervisor nurse.
of leadership; the leader and only the leader himself performs Theories :
the decision-making 1. Great man Theory : to become a leader, such person must be
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born to be a leader. 4. Certification from a duly authorized nursing organization.
2. Trait or Character Theory : one must have the following to ANSAP : Assoc. of Nrsg Services and Administrators of the
become a leader : Phils.
A. The personality : In RA 9173 (Oct 21, 2002) : qualifications are :
a. Adaptability : to cope or adjust to the assessed needs of the 1. M ust be a registered nurse
community 2. 1-week didactic training
b. Independence : capable of critical thinking Patient-centered behavior
c. Creative/assertive : must be able to utilize the resources Accountability
available to Confidentiality : breaking this is “Invasion of Privacy” or
deliver primary health care to the community. “Breach of Privacy”
d. Advocate : he must be a defender of the rights of the patients; General Rule : Everything heard and read should be dealt with
performance of duties should be within the realm of the Patient’s confidentiality.
Bill of Rights. Exceptions to the rule :
B. Intelligence : Patient’s consent
a. Proper judgment } a leader should be more Inform/report to the health care team as a precautionary measure
knowledgeable than *CBQ
b. Proper decision-making }the patient : use Communicable + standing order from DOH
assessment skills. Crime : to fulfill a duty to the society e.g. in cases of child abuse
c. Fluency of speech : one should be able to use proper which is
communication to be reported within 24 hours.
*CBQ : When dealing with tribal groups, the most important Basic things to do in case of child abuse/crime :
skill a nurse S afety : most important thing to do first
leader must possess is proper communication skills. Report
C. Leadership ability : Referral: for further assessment like trauma management.
a. Influence others : *CBQ : you can properly influence others Ethics : (to be discussed later)
through
health teachings. III. Communication Skills : the ability to transfer information
b. Command : should have the aura of power w/o being bossy with understanding.
c. Respect : should be respectable in any way to be able to gain Communication barriers or backlogs : hinders the
respect. communication process.*CBQ
d. Participates }esp in performing care for the comatose patients.
A leader The communication process :
e. Cooperates }should also be willing to do any job in any 1. Sender : the one who initiates the communication
contingencies. 2. M essage : the data that is to be transmitted
3. Charismatic Theory : one can become a leader by virtue of 3. Encoding : both verbal and non-verbal method of transmitting
his/her charm or charisma. the message
4. Situational/Contingency : one can be a leader in a situation 4. Receiver : the intended recipient of the message
when his style of 5. Decoding : the process/manner of interpretation of the data
leadership, managing skills, and expertise matches the needs of being transmitted
a situation 6. Feedback : action in return by the receiver to the sender.
> A good leader in one situation but only a follower in other
situations. IV. Decision-making : involves the independent judgment of the
> This is a case-to-case basis kind of leadership. nurse leader.
*CBQ : Advantage of this style of leadership : you can have the
BEST person for Step-by-step process of scientific decision-making :
the needs of the situation. 1. Identify the problem.
2. Identify the person/s affected : patients, nurses, members of
Skills and Qualities of a Good Leader : the health team
Appropriate authority
Leadership Behavior 3. Collect options or alternative solutions :
Communication skills a. Brainstorming : scrutiny of the problem within the
Decision-making skills group.*CBQ
Ethics b. Delphi technique : seeking for other experts’ advice/opinions
Ability to Face conflicts 4. Choose the BEST option and implement it.
5. Evaluation : if possible should always be done.

* Note : V. Ethics : In essence is good manners and right conduct.


RA 3573 : Law on Notifiable Diseases : Principles of ethics :
1. Report within 24 hours : Polio and M easles 1. Autonomy : independent judgment and decision-making; self-
2. Report within 1 week : Severe Acute Diarrhea, HIV, Tetanus determination. The nurse
Neonatorum should respect the client’s / patient’s decision.
*CBQ : 1. Who would decide for the care of the patient?
I. Appropriate authority : the basis of the leader to issue tasks, a. the doctor
responsibilities, and orders to b. nurse
his/her subordinates. c. patient himself
Types : d. relatives
1. Centralized : when flow of authority is from the top to the 2. Informed consent should always be obtained in invasive
bottom procedures.
2. Decentralized : when authority does not necessarily come Failure to do so would constitute battery.
from the top. 3. In cases where a patient refuses to give his informed consent
II. Five leadership behaviors : :ra waiver
Specialized body of knowledge and skills and training. must be signed by him stating his refusal.
Ex.: Who is allowed to do IV insertion? *CBQ 4. In cases where the patient is profusely bleeding and refuses to
Ans. : In RA 7164 (1991) : qualifications for IV insertion are the undergo
following blood transfusion, you should :
1. M ust be a registered nurse (RN) 1. Respect the patient’s decision
2. 1-week didactic training 2. Physician should explain the risk to the patient (consequence
3. Completion form of 50 IV insertions of
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the refusal of the procedure) problem. *CBQ
3. Let the patient sign a waiver.
5. An Islamic patient died, the relatives request to do the post III. Management
mortem: > the process of judicious use of available human and material
* Respect the patient’s cultural tradition. resources, directing their tasks
6. A nurse is doing a health teaching in a squatters’ area in towards the achievement of a goal or objective.
M anila, > the process of coordinating and supervising personnel and
suddenly, a mother stood up and said she is against condom use resources to accomplish
: organizational goals.
respect mother’s views. Theories :
1. Human Resource Theory : there must be proper relationship
2. Principle of Double-effect : if one is made to choose between between the manager and
two alternatives, he/she his members.
should choose the one with more of good effects and less of the 2. Frederick Taylor’s Scientific M anagement Theory : the best
evil effects. manager is a person who
* CBQ : This principle frees the health practitioner of legal has the following :4 T’s :
liabilities. Tao
Tools
3. Principle of Veracity : telling the truth or not intentionally Trainings
deceiving or misleading Treatment
patients. The patient has the right to know the truth regarding his 3. Douglas M cGregor’s M otivational Theory :
state of health. Theory Y assumes that people are self-directed and will accept
> Avoid false reassurance : it is non-therapeutic. responsibility
Principle of Beneficence : this allows the doing of anything that under favorable conditions. Individual goal are emphasized.
is good and avoiding These people
harm to the patient. need minimal supervision bec they are :
Exceptions : Efficient
1. If the intervention is non-therapeutic Effective
2. If the confidentiality is violated. Diligent and love their jobs.
Theory X assumes that people dislike their work and must be
4. Non-maleficence : “Do no evil or harm” principle. directed and
5. Justice : refers to the obligation to be fair to all people. controlled. Organizational goals are emphasized. These people
Prioritize needs of all patients need more
under one’s care bec different patients have different needs and motivation (negligent) and close supervision.
levels of care. 4. Henry Fayol’s Theory : management principles :
*CBQ : How can justice be achieved ? By applying the nursing a. Unity of Command : one group should only get orders from
care process. one manager.
b. Unity of Direction : the whole team should have only one
Characteristics of the Nursing Care Process : goal/objective.
*Acceptable universally *CBQ : NCP should be universally c. Esprit de corps/Team Spirit : the achievement or fault of one,
acceptable. is the
Based on patient’s assessed needs. achievement or fault of all.
*Client-centered
*Dynamic : based on ever-changing needs of the clients’ *CBQ : A teenaged patient who had appendectomy, complained
situations of pain. There
Equitable : interventions should be always based on what you was no standing orders for pain medications.
see is the patient’s need a. don’t give medications without doctor’s orders
Familiarity b. positioning : YES
*Goal-oriented : should always be geared towards solving the 4. Respondeat Superior : command responsibility principle :
patient’s health care needs “Let the master answer for
*CBQ : A dynamic NCP would prioritize the need of which the negligent subordinate who caused injury, harm or death”.
patient? * Note : Head nurse can only delegate the responsibility but not
a. asthmatic patient who had an attack 2 days ago. the accountability.
b. CVA patient needing discharge instructions 5. Subordination of general over personal interest : in case of
c. patient with head injury emergency such as in fire :
d. 2-year old patient with high fever. Rescue your patient.
* This is an exception to the ABC rule (airway, breathing and Alert : sound the fire alarm
circulation) bec Contain the fire in one area
although asthma is an airway and breathing problem, the patient Extinguish the fire.
had the 6. Proper remuneration of your personnel :
attack 2 days ago.Patient c would need immediate attention bec Start of work : probationary for the 1st 6 mos
of the head Regular employee : work 8 hours/day for 5 days or 40 hours/
injury (may have increased ICP). week.
* Dynamism can also be done in the choice of patients’ food. Overtime pay : + 25%
Night shift differential : + 10%
VI. Face conflicts : Spec Non-working holiday : + 30%
A conflict is any clash of ideas resulting to crisis in the Legal holidays : + 100%
organization. Work-related disability :
Different methods of resolving conflicts : a. gov’t. employees : GSIS : ECC (Employees Compensation
Avoidance behavior : putting the problem aside but not paying Com)
any attention to it which is b. private employees : SSS : ECC
not actually solving the conflict. Both work and non-work-related diseases : PHILHEALTH
S moothing behavior : a temporary relief by appealing to a (Nat’l Health Ins Act)
person’s kindness. > benefits do not include dental, aesthetic and cosmetic
Unilateral action : by application of force, inflicting fear and procedures.
threats. M aternal/paternal leave allowances :
Negotiation : the best way to solve conflicts : both parties M other Father
mutually discuss and solve the NSD 60 days 7 days with
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pay 1. Traditional : 8 hours/day, 40 hours/week
CS 78 days 2. Non-traditional : 10 hours/day, 40 hours/wk, 4 working
* Note : allowed only on the 1st 4 pregnancies of the legitimate days/wk
spouse. 3. On call : utilized when there is a sudden increase of number
Senior Citizen’s Act : gives 20% discounts for people 65 yrs and of patients
above. with less number of nurses.
4. Baylor Plan :
Five steps of management process : a. weekdays : one works only on weekdays for 8 hours (M -F)
Planning b. weekends : one works only on weekends for 12 hours
Organizing (Sat/Sun)
Directing
Coordinating Styles of Nursing Care Delivery (M odalities of Nursing Care) :
Evaluation 1. Primary Nursing : the nurse cares for the patient for 24 hours.
* The only type that provides 240care for one patient from the
I. Planning : defined as pre-determining a course of action in time of
order to arrive at a desired admission until the patient is discharged.
result; forecasting of events and based on which decisions are * Done by private duty nurse.
made, goals are set 2. Functional method : practiced in congested agencies such as
and prioritized and policies and standards are developed. PGH.
No actual intervention yet; mere conceptualization stage : Duty/task : specific task is assigned to
One nurse : to be done to all or to the majority of patients
1. Planning process should be clear. Highly recommended : when there’s a shortage of nursing staff
Vision : states what the organization wants to achieve in the and budget
future. * The poorest method of giving care.
*DOH : Health for all Filipinos. 3. Case nursing/ Case method :
M ission : describes and reflects the organization’s core value. It Total care to a patient per shift
is the present One-on-one handling : in extreme shortage of nurses : 1:2
reason why the organization was formed. .
Philosophy : the set of values and beliefs of the organization; a III. Directing / Delegation :
statement of The process by which a manager assigns specific tasks, duties,
beliefs that influence the nursing practice. or procedures to workers
Goal : the general statement of the organization’s mission. with commensurate authority to perform the job (someone else
Objective : more specific statement of the team’s mission. performs a
Policies : set of rules and regulations in the organization. job/task in behalf of the person delegating with authority).
*CBQ : One can only delegate the responsibility but NEVER the
accountability.
2. Budgeting : planning, controlling, and proper allocation of all Ex. : The nurse delegates the preparations for the celebration of
resources for the the hospital’s
patients/clients : anniversary but she’s responsible for the outcome of the
a. operational : refers to the everyday use of the patients (gowns, preparations.
caps, etc) Two important criteria in delegation :
b. personnel : for the salaries and compensation of staff 1. The ability of the worker to carry out the task
c. capital : allocations for long-term use equipments. 2. Fairness not only to the employee but to the team as a whole.
Exceptions to the power to delegate :
II. Organizing Stage : structuring the team to accomplish the 1. Disciplinary tasks : the authority to discipline erring staff such
tasks necessary to meet its goals. as sanctions,
* for the purpose of managing the care of patients. suspensions etc cannot be delegated.
Organizing your team : 2. Technical tasks : highly technical procedures which require
Nurse manager Tasks Staff special trainings or
Style skills should never be delegated.
xx xx xx 3. Confidential tasks : tasks which are strictly personal duties /
xx confidential cannot
be delegated. Ex. : charting should be done by the attendant
Nursing tasks are as follows : health care
Assessment : only the nurses should assess the patients, never provider and cannot be delegated.
the
subordinates.*CBQ IV. Coordinating / Collaboration Stage :
Teaching : health teachings should be done upon admission, Unites personnel and services toward a common objective.
orientation or initial Synchronization of activities
contact with the patient. among the various services and departments enhances
Explaining of procedures collaborative efforts resulting in
Preparation of patients : for procedures to be undertaken efficient, smooth and harmonious flow of work.
Administration of : Ex. : At the unit level, Supervising Nurses and Head Nurses
Treatment and medication coordinate their work
Evaluation with the other departments, services or units by conveying
Judgment clearly-defined
Subordinates’ tasks : policies, standard operating procedures, policies, and guidelines
Routinary tasks : include standard, unchanging procedures e.g. using the
toileting & bathing proper channels of communication.
Stable patients : they may handle patients with predictable *CBQ : M ost common instances of collaboration are in cases
outcomes. where referrals for some
S upervision of nurses : they should be directly supervised by aspects of the patient’s care such as :
RN’s. a. In patients with tophi, dietary considerations are made to the
dietician
Staffing : refers to the correct ratio or mix of nursing personnel bec we always employ the interdisciplinary approach.
in a nursing unit for a b. Food rich in purines :
period of 24 hours. a. canned foods
Different types of staffing schedules : b. sardines
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c. anchovies Caring : nursing is a “caring profession”
d. vegetables Ethics : the nursing practice is governed by a Code of Ethics
Types of collaboration : which embodies its
1. Intradepartmental/Interpersonal : a collaboration between one professional and social values
single person to S ervice : as a caring profession, it should be service-oriented.
another person under one and the same unit or department. Specialized body of knowledge /skills : nurses, as professionals
Ex. : endorsement between shifts. should have expertise in
2. Interdepartmental : a collaboration between 2 or more units or their fields of practice and show a degree of competency.
two or more *CBQ : What is the most important attribute of a professional
departments but under one and the same institution. nurse?
Ex. : A woman admitted for CS will be referred to the DR, RR, Ans. : to observe ethical practice.
etc
3. Interagency/Interinstitutional : collaboration between two or Is nursing a profession?
more health care Ans. : YES, nursing is a profession. It has all the characteristics
institutions for the benefit of the patient. of a profession.
Ex. : A patient from a health center is referred to a district
hospital. The informed consent form is a contract between :
*CBQ : Reasons why the nurses have the responsibility to 1. The patient and the members of the health care team
coordinate : 2. The patient and the hospital
1. The patient is entitled to continuous care by a nurse.
2. Nurse should provide holistic care.

V. Evaluation / Controlling Stage :


the stage wherei the nurse will determine whether his/her plan, RA 9173 : The Philippine Nursing Law (promulgated on Oct.
goal or objective for the patient is 21, 2002)
achieved or met according to the standards of care.
Expanded roles of a nurse :
Different types of evaluation : 1. Promotive, preventive, curative and rehabilitative care of
1. Nurses’ rounds : done twice per shift (short term plan) patients in all health care settings and
Illustration of proper evaluation : If you are working in the 6-2 in the event that recovery or rehabilitation is not possible, to
shift, you do 2 rounds : provide for a peaceful death.
a. Around 6am, your team does an ocular inspection around the Promotive : through health teachings
ward/unit after 2. Appropriate health education
which, you do a nurses’ conference (First rounds). 3. Utilization of the nursing care process : part of the duties of a
b. around 2 pm, you evaluate the effectiveness of the shift’s plan nurse.
of care for the 4. Collaboration of patients’ care
patient.( Second rounds) 5. Link of patients to the different community resources.
*CBQ : Nurses’ rounds are not done/contraindicated in the 6. Supervision and training of nursing students
following areas : *CBQ : A nursing student affiliated in a ward gave an erroneous
a. Emergency room medication killing the
b. OR/DR patient. Who is liable for the patient’s death?
c. Inensive care unit (ICU) a. the nursing student
d. Psyche ward : bec it may not be safe to do so. b. the clinical instructor of the student
2. By the use of a checklist : use of ratings scale such as when c. the staff nurse of the ward
the HN, UM or NM uses scales of d. the hospital
their staff’s evaluation. 7. Supervision of other personnel such as midwives, nursing
3. Peer evaluation : evaluation done by co-workers. aides etc.
*CBQ : This is the poorest method of evaluation bec it might be 8. Accurate reporting or recording of patient’s care
affected by halo effect. 9. Proper execution of valid doctor’s orders : the only dependent
4. By the use of performance appraisal sheet/form : this is done duty of a professional nurse.
by the client or patient, being the * CBQ : What is the liability of a nurse if he/she gives
recipient of care as in the evaluation forms given to patients prescriptions?
immediately after/before Ans. : Malpractice
discharge from the hospital.
*CBQ : This is the best method of bec the recipient of care does Valid doctor’s order : only when an order put into writing and
the evaluation. duly signed by the prescribing
physician.
IV. Professional Adjustments and Ethico-Legal Nursing Rationale : Whatever wasn’t put into writing and signed by the
doctor is considered as not
Profession : it is a calling, in which its members profess to have being ordered at all.
acquired a unique or specialized * CBQ : Whenever a patient solicits a medical advice : refer to
body of knowledge or skiils for the purpose of properly guiding the doctor.
or caring for others.
* Nursing is a profession. General Rule : A nurse should never prescribe any medication
noe administer drugs without a
Calling : nurses should always be service-oriented. valid doctor’s order.
Specialized body of knowledge /skills : there should be a degree Exceptions to the general rule :
of expertise for competency. 1. In case of emergency
Others : refers to the patients or clients; nurses should be 2. In cases of national calamity
“others-oriented.” 3. In cases of epidemic
PLUS : there’s no doctor around and the patient is in grave
Primary characteristics of a profession : danger of death.
Accountability : being liable for the results of one’s actions and
responsible for their Good Samaritan Act : the universal doctrine that protects from
practice decisions. any liability, any person who will
Competency : one must know what he/she is doing (practice give an aid to another person whose life is in danger.
should be backed-up with * This law provides immunity from civil liability when a person
scientific rationale) provides assistance in an
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emergency. community?
* This doctrine is the basis of RA 8344 which mandates the “NO `` Ans. : Active community
DEPOSIT POLICY” in partnership or participation.
any health care facility or hospital in emergency cases only.

*CBQ : An emergency case where a child had ingested a


considerable amount of Aspirin,
what should the nurse do?
Ans. : induce vomiting. RA 7160 : Local Government Code : Decentralization/
What would the discharge health teaching include ? Devolution of Health Care
Ans. : ways on childproofing the house.
What is the most common form of poisoning? It’s a partnership :
Ans. : Lead poisoning from chipped paints bec paint chips taste
sweet and are DOH DILG } Local
conducive for a child’s PICA : appetite for eating non-food Health Board : public health
items. Active community } care
services/local gov’t.
Partnership } unit; headed
In emergency poisoning cases : by the city or
1. Determine the poisonous material involved. Participa } municipal mayor or the
2. If non-corrosive : induce vomiting tion } governor.
If corrosive : NEVER induce vomiting bec it will cause irritation }
of the LGU : barangay
esophageal mucosa and may lead to aspiration. city
* give calcium EDTA municipality
province
Different areas of professional nursing practice : Rationale for RA 7160 : it makes quality public health care
1. Institutional Nursing Practice : done in the hospital setting. services accessible in
Characteristics : accordance with the present vision of DOH.
Direct supervision of a head nurse or nurse manager.
Acquire different technical skills/learning 3. Occupational/Industrial/Company Health Nursing : done in
Confidence in your practice. factories, companies or
2. Public Health Nursing : the functions of which encompass the industrial zones with the following functions :
4 P’s : a. Curative and rehabilitative :
Promotion of public health. Care : provide immediate care for both the sick and injured
Prevention of disease worker
Psychological and social adjustments : bec one will be taking Referral : proper referrals should be done for clients who need
care of numerous clients. higher
Public relations is maintained with all members of the levels of care.
community, the health care team Visit : home visits should be done for follow up care.
and the family. b. Promotive and preventive :
*CBQ : The main thrust toward promotive and preventive Nutritional health teaching : given to the workers for optimal
nursing practice is Primary functioning
Health Care (PHC). and productivity.
*CBQ : The most important consideration when doing health
LOI 949 : the PHC Law of 1979 adapting the concepts of the teachings to these workers :
First International Ans. : income of employees /financial status.
Conference on PHC held in Alma Ata, USSR on Sept 6-12, S afety and sanitation in the workplace
1978. Counseling : appropriate health counseling can be provided to
Signed into law by Pres Ferdinand E M arcos on Oct 19. 1979. avoid or
prevent occupational diseases/hazards.
Coverage of LOI 949 are the following : *CBQ : Health teaching considerations : use of contraceptives.
1. Preventive Nursing Law : What health hazards should the nurse’s study focus on?
PD 996 : the EPI Law : mandating the compulsory Ans. : Past trends of frequent diseases in the workplace.
immunization of children
below 8 years old to reduce the morbidity and mortality among 4. Clinical Instructor :
infants and Four major qualifications of a clinical instructor (per RA 9173) :
children caused by the six childhood immunizable diseases : Accredited member of a nursing organization such as PNA.
1. Diphtheria 4. Polio MAN : a masters degree in nursing or other allied courses
2. Pertussis 5. Hepatitis B One year clinical nursing experience.
3. Tetanus 6. M easles Registered nurse
* Not included is chicken pox bec the vaccine is expensive.
2. M icronutrient Supplementation Law : RA 8976 : to fight LOI 1000 : requires compulsory membership of professionals to
childhood malnutrition an accredited
PD 825 : Environmental Sanitation Law : promotion of professional organization such as PNA, PM A etc
cleanliness and sanitation
in everything outside of one’s environment. Facts about the Philippine Nurses Organization :
PD 856 : Sanitation Code of the Philippines : promulgates PNA : founded on October 22, 2002
sanitation : Founder : Anastacia Giron-Tupas
1. Within an establishment : covers food and water sources Present President (2005) : Ruth Padilla
e.g. carinderia and canteen food. Objective of PNA : Reasons why they give trainings :
2. Commercial Sex workers : mandatory and proper screening : 1. Advancement of the knowledge and skills of the Filipino
a. Syphilis : every 6 weeks nurses.
b. Gonorrhea : every 2 weeks
Red ID : health clearance of CSW who had undergone screening Professional well-being : it is a professional organization
issued by composed and headed
the city health officer. by nurses
*CBQ : How can you handle health care delivery in the Unity : it promotes professional unity
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Promotes reciprocity even from outside the Philippines permitted by law to have a control in the
Advancement of the knowledge and skills of the nurse manner of disposing his estate but will take its effect at the time
Ethics : it promulgates its own Code of Ethics of his death.

First College of Nursing (BSN) in the country : UP Decedent : a deceased person


First nursing schools : Testator : the dead person who made the will (male)
Iloilo M ission Hospital School of Nursing (1906) Testatrix : the dead person who made the will (female)
Two types of succession by heirs :
Philippine General Hospital (1907) 1. Testate succession : the mode of succession wherein the heirs
Luke : St Luke’s Hospital School of Nursing (1907) inherit by virtue
Mary Johnston Hospital School of Nursing (1907) of a last will and testament.
St. Paul’s Hospital School of Nursing, Iloilo (1907) 2. Intestate : succeeding by law and not governed by a will.
S an Juan de Dios Hospital School of Nursing (1907) * Without a last will and testament : heirs should divide estate in
equal
Proclamation order # 539 : proclaimed the last week of October sharing.
as Phil. Nurses’ Week.
Two types of last will and testament :
Legal responsibilities of a nurse : these applies in almost all
kinds of settings : Concerning properties Concerning body / life
1. Consent : it is the responsibility of the nurse to see to it that
the client’s informed 1. Notarial/Ordinary will 1. Advanced directives
consent was taken before any procedure is done.
2. Last will and testament 2. Holographic will
3. Illegal detention
4. M edication and prescription
5. Charting, documentation/recording Notarial or Ordinary Wills :
The following are the nursing considerations :
I. Consent : the legal permission given by the client before any 1. Check the patient’s level of consciousness : the nurse must
procedure or treatment after ascertain that the patient is
receiving proper information or explanation about the treatment capacitated to make a will
or procedure to be done. 2. Check the proper locations of the signatures :
a. at the end of the will written by the patient
Characteristics of a valid consent : b. in all pages at the sides of the paper, by the testator/testatrix
Voluntariness : the consent form must have been signed with the and 3 witnesses.
absence of fear, force, 3. Presence of three witnesses.
coercion, or threat.
Opportunity : the patient should be given ample opportunity to Holographic Will : wills that are executed during emergencies
ask for further but the patient is still conscious.
explanations if he needs it. Requisites of a holographic will :
Treatment, surgery, or procedure should be properly explained : 1. It should be entirely handwritten
By the surgeon : whoever is primarily performing the procedure 2. It should be dated and signed
has the using the hands of the testator/testatrix.
responsibility to explain it fully to the patient. * If nobody witnessed the writing of the will, comparison to
The nurses only act as witnesses to the signing of the consent other documents made by the
which involves: testator/testatrix is necessary to ensure its validity.
1. Witnessing the exchange between the client and the physician
2. Witnessing the client affix his signature Advanced directives : are directions or instructions made by the
3. Establishing that the client really understood patient in advance with what to do with
Understood by the patient the patient’s body, such :
Matured both physically and mentally : the signatory should be 1. Living will
at least 18 y/o or older. 2. Instructions for DNR, cremation, organ donation, and funeral
* Consent may not be given by the patient in cases of : services
1. Insanity
2. Imbecility III. Legal rights of a nurse and illegal detention :
3. Unsound mind Illegal detention is a crime if a person, such as a nurse, will limit
EXCEPT if the patient signs it in his lucid intervals. the freedom of a patient
*CBQ to move or travel from one position / place to another
* CBQ : Who can give consent in behalf of a mentally ill child? Exception : when there are quarantine regulation orders such as
Proxy consent may be given by the following : what happen in migration
1. Parents
2. Guardians IV. M edications and prescriptions :
General rules :
3. Guardian ad litem : 1. Only the following have the right to prescribe medications :
a. Social welfare personnel : in cases where the child is MD, DMD, DVM
abandoned. 2. Do not follow unless 3 vital informations are present :
b. Surgeon or the attending physician : in cases of emergency a. name of physician, location of office, PTR/PRC license no.
b. Patient’s name, age, sex,
Example : A psychiatric patient needs a stat appendectomy : c. Name of the drug itself : both generic and brand name (RA
surgeon or attending 6675)
physician signs the consent for the patient’s behalf.
In vasectomy, who gives the consent ? RA 6675 : the Generics Act of 1988 which requires that all
a. both the husband and wife prescriptions of drugs
b. husband only :bec although the issue of vasectomy affects should include the generic name and the brand name or the
both spouses, generic name
the procedure is done on the husband only (Vas deferens is not a alone.
conjugal property) Purpose : to let the patient choose among the different brand
names available of a
II. Last Will and Testament : an act whereby a person is
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specific generic drug name. Legal documentation
Impossible prescription : are prescriptions written by a doctor in Statistics : are good bases for studies since they are deemed
which the generic accurate and true.
and brand names do not correspond to each other.
Exception to RA 6675 : The physician can only be allowed to *Ownership of the charts/records belongs to the
write only the brand hospital/institution although the
name if only one brand is available for the particular drug being information in it belongs to the patient.
prescribed. * Charts, being confidential records cannot just be used by
Ex. : Alaxan, M inocin anybody even for legal
3. Responsible for the 10 R’s of giving medications : purposes EXCEPT when the court issues a subpoena.
1. The right drug
2. The right storage Subpoena : an order from the court which is of two types :
3. In the right dose 1. Subpoena duces tecum : issued against documents, papers,
4. By the right route materials/orders
5. To the right patient Ex. : patient’s chart
6. At the right time 2. Subpoena ad testificandum : issued for somebody to act as a
7.With the right documentation witness.
8.
9. DO’s and DON’T’s of charting :
10.
DO’s DON’T’s
For accuracy and safety, the nurse should do the three checks :
1. When choosing the medication to take out of the drawer or Full, factual & objectively Language :avoid
cupboard accurate language/words/jargons
2. When the dose is in hand and can be held side-by-side with Legible handwriting unacceptable in nursing
the record to Immediately upon doing Improper corrections : follow
compare the label and the medication administration record the procedure. the agency’s policy
(MAR) Addendum : late entries on corrections; or the std way
3. One last time after all drugs have been located and before entered in the chart Space/skips : avoid leaving
leaving the Personal/confidential spaces/skips in
medication cart or room for the patient’s bedside. document between every charting.
*CBQ : What is the method to identify the right patient in all *Proper way to terminate Avoid frequent use of
health care settings? chart : write the abbreviations : some words
a. ask his name and let him spell it : only possible if patient is profession, not the position if abbreviated will result to diff
conscious definitions
b. through the patient’s wristband Ex. : Ambulated pt to BR
c. through the name hung on the door (wrong bec the BR
d. confer with the doctor intended to mean bathroom
4. Oral/ Telephone orders : may be taken
General Rule : Generally, an order done orally or through the another way by others)
telephone is not a
valid order EXCEPT in emergency cases where the nurse should Doctrines affecting the professional nurse :
simul- 1. Professional negligence
taneously write the order, the physician’s name and time it was 2. Professional malpractice
given and 3. Res ipsa loquitor
repeat it to the ordering physician and have it signed by the 4. Force majeure
prescribing
physician when he/she arrives later. 1. Professional Negligence : refers to the failure to do something
which a reasonable and prudent
5. Doubtful medications and prescriptions : nurse should have done, under a particular situation.
General Rule : In case there is doubt on the correctness of the Types :
prescription or in 1. Commission :doing something which a prudent or reasonable
cases where the medication is wrong, the nurse has the right to person would not do.
object to 2. Omission : not doing something which a reasonable or
such and call the attention of the prescribing authority and let prudent person would do.
him rectify
the wrong order. This is for the protection of your patient Three elements to prove negligence :
(Advocacy) 1. There must be the existence of duty
6. IV training 2. There must be a failure to to do the duty
3. Injury or harm has resulted from the failure to do the duty.
V. Charting / Documentation / Recording : in the patient’s chart *CBQ : This is a major reason for suspension/revocation of
which is legally, absolutely a license.
legal document. 2. Professional M alpractice :
Nurse’s responsibility : to write chronologically, truthfully and Elements in order for malpractice to exist :
accurately on the patient’s 1. RN
clinical record what he/ she has seen, encountered or observed in 2. Acts or conducts self
connection with 3. Does something for which he/she is :
the care and treatment of the patient. a. not authorized
A fundamental legal principle about medical record : b. not licensed to do
“If information is not charted, it was not done or observed”. c. not trained or skilled to do.
4. And has resulted in injurious or non-injurious consequences.
Purposes of charting : *CBQ : RN can do the following :
Communication : it was created as a means of communicating 1. Episiorrhaphy : after training but not episiotomy
among the health 2. Internal exam (IE) : but only in the absence of antenatal
care providers. bleeding and abnormal
Assurance of quality care : records the patient’s whole treatment complications.
and care regimen 3. Res ipsa loquitur : “The thing speaks for itself”: when the
Research purposes harm that resulted from negligence
Nursing Research, Leadership and Management
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and the responsibility for the harm are clear that anyone would which are mere
agree on it. results of negligence.
*CBQ : This principle accelerates the identification of the last 7. M urder : intentional killing of a person
person attending to the 8. Simulation of birth : committed by any person who shall
patient which caused the negligence. substitute one child with
4. Force majeure : An act of God or nature; an irresistible or another child or alter a child’s identities for the purpose of
superior force, one that cannot be losing the child’s civil
foreseen or prevented; fortuitous event. status.
Principle : Ex. : M ara and Clara
“No person shall be hels liable or accountable for non- *CBQ : Non-registry of a live birth : constitutes simulation of
performance of what was birth bec a birth
expected of him/her if the cause of the non-performance was a certificate is a symbol of identity.
force PD 651 : M andatory reporting :of any incidence of live birth
majeure or for those events beyond one’s control”. within 30 days to the local
Civil Registrar’s Office.
Classifications of crimes affecting nurses :
I. According to the manner of its commission : Different laws affecting nurses in the Philippines :
1. Dolo (Deceit) : one which is done with real criminal intention. RA 2808 (1919) : the first official Nursing Law in the
Ex. : putting poison in a medication to kill the patient. Philippines.
2. Culpa (Fault) : one in which there is no real criminal intent Board of Nursing composition : 3-man-team :
and is merely just a result 1. The Chairman }
of one’s negligence. 2. Two members } all nurses
Ex. : inadvertently poisoning a pateint bec of erroneous drug 1920 : the official Licensure Examination was given to nurses
administration. one year after the
first BON was created.
II. According to the degree/level of execution : RA 7164 (1991) : the second to the last nursing law : the
1. Consummated crime : when all the elements to fully commit Philippine Nursing Act of 1991
the crime were all present Board of Nursing composition : 5-man-team :
and the crime was committed or executed. 1. The Chairman } all nurses chosen from 12 nominees and
2. Frustrated crime : when one performed everything to appointed
consummate the crime but failed. 4. Four members } by the President.
3. Attempted crime : consists only of overt acts to commit the
crime; it is merely showing
the intent to commit the crime.

III. According to the degree of participation :


1. Principal : one who performs a very important or Board of Nursing : 1991 (RA 7164) : OLD
indispensable role in the crime, being Master of Arts in Nursing holder
the “author of the crime” itself. Accredited member of a nursing organizations like PNA
2. Accomplice : one who performs a dispensable role, appearing Five-man-team :
only before or during the 1 Chairman
time the crime was committed. 4 members
3. Accessory : one who ONLY appears after the crime was S ixty-five years old and sits for a term of not > 3 years
committed : One-year interim period
a. by profiting from the effects of the crime committed Not convicted of any crime in the Philippines
b. by concealing/destroying any evidence relating to a crime to Pecuniary/monetary interest : absence of
prevent its Ten years of nursing experience/practice
discovery. Citizen of the Philippines
c. by assisting in the escape of the criminal.
NEW Board of Nursing : RA 9173 :
Different crimes affecting the Filipino nurses : Master of Arts in Nursing
1. RA 7877 : Anti-Sexual Harassment Law : Accredited member of a nursing organization e.g. PNA
Protects employees against sexual harassment. Sexual S even-man team :
harassment is committed by 1 Chairman
….any person who exercises authority, influence or moral 6 M embers
ascendancy over Immediately resigned only assumption of office
another… by demanding, requesting or requiring sexual favor Not convicted of any crime in the Philippines
regardless of Pecuniary/monetary interest : absence of
whether or not…is accepted by the object of sexual solicitation. Ten years of nursing experience/practice, the last 5 yrs should
* CBQ : M ere indecent proposal constitutes sexual harassment. be in the Phil.
2. Rape : there are two types of rape, namely : Citizen and resident of the Philippines
a. Ordinary rape : any forcible penetration of an organ for
copulation : a sexual Duties and responsibilities of the BON :
organ penetrating another sexual organ (only female victims) Licensure Examinations formulation
b. Sexual assault : results from anything inserted to any body Issue certificates of registration
orifice with sexual * CBQ : Just a privilege not a right
malice (both genders can be victims). Monitor the standards of nursing practice in the Phil
3. Abortion : termination of the products of conception before Education quality evaluation :
age of viability *CBQ : Inspect and recommend to the CHED :
(3-6 mos/12-24 weeks) 1. Opening of a nursing school
4. Infanticide : killing of a person less than 3 days or less than 2. Closure of a non-performing nursing school
72 hours of life. Code of Ethics formulation
5. Parricide : killing of a person to whom one has familial Hear and decide cases of negligence and malpractice :
relationship : parents / siblings. 1. Suspension of license
*CBQ : adopted children are included. 2. Revocation of license
6. Homicide : unintentional killing of a person more than 3 days Qualifications of a Dean of a College of Nursing :
old to whom one has no 1. M ust be a registered nurse (RN)
familial relationship. M ost cases in nursing involve drug errors 2. M ust be hold a M AN
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3. M ust have 5 yrs nursing experience examination due to:
Dishonorable conduct
Qualifications of nursing service administrators : Unsound mind
A. Hospital setting : Moral torpitude crime involvement
1. Nursing supervisors/ M anagers/Head : responsible for a unit, Indecent, immoral conduct
ward or department :
BSN and RN Grounds for revocation of license :
Accredited member of a nursing organization e.g. PNA Malpractice acts
Nine (9) units of post-graduate Nursing M anagement Unprofessional conduct
Two (2) years of general nursing practice Negligence
2. Nursing Chief or Director : Immoral, indecent conduct
RN and MAN Dishonesty, deceit, and fraud
Five (5) years of supervisory nursing experience Ethics : violations of the Code of Ethics
B. Community nursing Supervisors/M anagers : S uspended license but continues to work
BSN and RN
Accredited member of a nursing organization e.g. PNA After five (5) years of inactivity (non-practice profession), one
MAN or M PH (Public Health) cannot go back to practice
Five (5) years of experience as PHN/CHN at once. To do so, one needs to comply with the following
requirements :
Present requirements for a Nursing Licensure examinee : 1. One (1) month didactic training
1. Good moral conduct 2. Three (3) months practicum
2. Proof/s of citizenship
3. Proofs that applicant is a valid holder of BSN degree whose Prohibited Practice of Nursing : Illegal nursing practice :
curriculum is approved by License : practicing without the necessary license
CHED. Owns another RN’s license/COR as his/hers
Invalidated license/COR
Other relevant laws of nursing practice : S igns name and affix the title of RN illegally
PD 223 : Creation of PRC (professional Regulation Advertisement that is false
Commission) Falsification of school/nursing documents
RA 1080 : Civil Service Act Assist another person in the illegal practice of nursing
RA 6425 : Dangerous Drugs Act : covers two types of drugs : Underwaging subordinates/nurse employees
1. Prohibited drugs : totally prohibits the sale, administration Review/training center operations without gov’t. accreditation
and use by human Any person violating the Phil Nurses’ Act
beings. Ex. : shabu, marijuana, opium derivatives
2. Regulated drugs : can be used provided it is covered with a Penalties for illegal nursing practice :
prescription from a 1. Fines of Php50,000 - Php100,000. } for conviction of any of
licensed physician authorized by BFAD and PDEA. the ten illegal
Ex. : Dormicum, Ativan 2.1-6 years imprisonment } nursing practice

Liabilities of a health care provider :


1. Fines : depends on the weight /grams
2. Imprisonment
3. Revocation of license
RA 7600 : M other-Baby Friendly Hospital Act : requires early
bonding through :
1. Breastfeeding
2. Rooming-in technique
SSS : S ariling S alat sa S uso
GSIS : Galing S a Ina ang S ustansya
* CBQ : How to promote bonding between fathers and
newborns?
1. Cuddling
2. Embracing

PRC Licensure Examination


RA 8981 : New PRC Computerization and M odernization Act :
mandates that
examination results be out by at least the 5th day after the
examination date.

Results are available at :


1. www.prc.gov.ph
2. PRC rating Family name,First name
Registration :
1. Take an oath
2. Pay the registration fee
3. Sign the book of RN’s in the Philippines
Two types of registration :
1. Regular /Ordinary : by those who passed and are qualified
already
2. Special : registration by reciprocity :
a. need to show proofs that one is an RN in a foreign country
b. that foreign country offers employment opportunities for
Filipino RN’s in return.

Grounds for disqualification as RN :


A person may be denied a license after passing the licensure
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