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Professional Adjustment and Nursing Jurisprudence

JAY LAPAZ ANDRES, RN, BSN, MAN, MAEd. I. PERSONAL AND PROFESSIONAL GROWTH AND DEVELOPMENT a. Historical Perspectives in Nursing The Philippine Nurses Association (PNA) established in 1922 was responsible in lobbying our government for the adoption of the recommendations made by the International Labor Organization in 1977 with regard the status of the economic and social welfare of our nursing personnel. The Professional Regulation Commission of the Philippines duly recognizes the PNA as the leading Association of nurses in the country. In 1924, it published a standardized curriculum for schools of nursing to adopt. The following were the first groups interested and registered with the Philippine Nurses Association (PNA), to wit: Academy of Nursing of the Philippines, Inc. (ANPHI) Association of Deans & Principals of Schools and Colleges of Nursing of the Philippines (ADPSCNP) Association of Nursing Administrators of the Philippines ( ANSAP) Association of Private Duty Nurse Practitioners of the Philippines (APDNPP) Critical Care Nurses Association of the Philippines (CCNAP) Catholic Nurses Guild of the Philippines (CGNP) Golden Age Nurses Association (GANA) Ministry of Health National League of Nurses (MHNLN) Occupational Health Nurses Association of the Philippines (OHNAP) Operating Room Nurses Association of the Philippines (ORNAP) Philippine Nurse Midwifery Society Philippine Nursing Students Association (PNSA) Philippine Orthopedic Nurses Society Psychiatric Nursing Specialists Foundation of the Philippines, Inc. (PNSI) Philippine School Nurses Association (PSNA) The following are the later members of the PNA: Association of Diabetes Nurse Educators of the Philippines (ADNEP) Graduate Nurses Christian Fellowship (GNCF) Integrated Nurses Association of the Philippines (IRNUP) National League of Philippine Government Nurses (NLPGN) Maternal and Child Nurses Association of the Philippines (MCNAP) Military Nurses Association of the Philippines (MNAP) Philippine Oncology Nurses Association (PONA) Philippine Orthopedic Nurses Society (PONS)

TIMELINE IN THE NURSING HISTORY: In the early dawn of human history, diseases or illness were often related to superstitious beliefs and the treatment also often involved magical cures. The Sumerian Civilization is believed to have recorded in a clay-tablet 4,000 years ago some healing prescriptions but did not specify the illnesses. The Code of Hammurabi traceable to the Babylonian empire in 1900 BC documented regulations pertaining to sanitation and public health, the practice of surgery, differentiation in the practice of human against veterinary medicine, a table of fees for operations and penalties for violation of the code. During these early days, nursing practice was vaguely described as those who render comfort and support to patient. In the Old Testament, it made mention of women as nurses who provided care for infants and children, the sick and dying The Greek and Roman empires related the care of the sick and those injured to the mythologies that they have created and believed that the gods and goddesses possessed special healing powers. Hygeia, daughter of Greek god Asklepios, the chief healer, was revered to be the embodiment of the nurse. Ancient India Nursing functions were being carried out by male nurses provided they meet the four qualifications: 1. knowledge of the manner in which drugs should be prepared for administration 2. cleverness 3. devotedness to the patient 4. purity of mind and body Christian Benevolence- love thy neighbor as thyself had a significant impact on the development of Western Nursing. The principle of Good Samaritan is the basis of caring for most Christians that eventually laid down some principles of nursing. During the time of the Roman Empire, rich matrons such as Fabiola used their wealth to provide houses of care and healing that served as the early hospitals for the poor, sick and the homeless. The Time of Crusades ( Holy mission or pilgrim to regain the Holy land by the Christians), knights were trained to provide care for the wounded soldiers in the battle this is perhaps the earliest recognition of men providing nursing care. Camillus De Lellis considered the patron saint of nurses was the founder of the Nursing Order of the Ministries who provided care to the sick and the poor. Florence Nigthangle born from a wealthy family chose to dedicate her life in providing care for the sick and injured especially during the Crimean War. She also started a school to train nurses in 1860, which eventually sparked the development of Modern Nursing. NURSING AS A PROFESSION

Profession - an occupation or calling requiring advanced training and experience in some specific or specialized body of knowledge which provides service to society in that special field. - It is a calling that requires special knowledge, skill and preparation. - a calling in which its members profess to have acquired special knowledge, by training or by experience or by both, so that they may guide or advice or serve others in that special field. A profession is generally distinguished from other kinds of occupations/vocations by: 1. Requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed usually entrusted to higher education. 2. An orientation of the individual toward service, either to a community or to an organization. 3. The members must be united and identified through their membership and they must be clearly separated from the laypeople or the ordinary congregations. 4. The society which it intends to serve has an indispensable need for such services and which others cannot provide and the society accepts it. 5. The techniques or skills applied are the product of scientifically proven and long experience. 6. Requirement to exercise discretion and judgment as to the time and manner of the performance of the duty. 7. The presence of common values, cultures, and norms uniquely found among its members which are also being guided by its own code of ethics. 8. The ability to continue its research to expand constantly its body of knowledge. Characteristics of a profession: 1. Autonomy (independence and self-governance) the ability to chart or carve its own destiny independent from others. 2. Authority possession of highly advanced and competent skills/mastery of such knowledge and skills not available to the general public. 3. Accountability responsibility/liability to own up its actions.

Nursing- is primarily assisting the individual (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. It is likewise the unique contribution of nursing to help individual to be independent of such assistance as soon as possible. (Virginia Henderson, 1958; 1978)

Nursing is putting the patient in the best condition for nature to act. This description/definition was given by Florence Nightangle, dubbed as the first nursing theorist. She made use of the environment (clean and healthy surrounding) in the recovery of an ill patient. Nursing- is the diagnosis and treatment of human responses to actual and potential health problems (ANA). The common focus of nursing is the need to provide humanistic and holistic care that includes the four areas related to health: 1. Health Promotion 2. Health Maintenance 3. Health Restoration 4. Care of the Dying RA 9173 or the Philippine Nursing Act of 2002 gives the meaning of nursing practice through the following: -alone or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting that includes: 1. nursing care during conception, labor, delivery, childhood, adulthood and old age 2., promotion of health and prevention of illness. 3. collaboration with other health care providers for the curative, preventive, and rehabilitative aspects of cares, restoration of health, alleviation of suffering and when recovery is not possible towards a peaceful death. Nursing Practice covers the three areas of nursing, namely: nursing education, nursing service, and community health nursing (Rule 1 Sect. 3 (d) IRR RA 9173). Professional Nurse a person whose name and registration/professional license number is entered in the Commissions registry book and computerized database as legally authorized to practice the nursing profession (Rule 1 Sect. 3 (e) IRR RA 9173). Practicing Professional Nurse- a person who is engaged in the practice of nursing profession or is performing acts or activities, whether regularly or occasionally, including one who is employed in a government office or in a private firm, company or corporation whose duties require knowledge and application of the nursing profession (Rule 1 Sect. 3 (f) IRR RA 9173). Foreign Professional Nurses foreign nationals who, being licensed professional nurses in their own countries, are authorized by existing laws to practice their profession either as holders of a certificate of registration and professional identification card or a special/temporary permit in the Philippines subject to some provisions of RA 9173 (Rule 1 Sect. 3 (g) IRR RA 9173).

Nursing Specialty Program a training and development program intended to develop/enhance the skills, to which a registered nurse devotes himself /herself whether as a vocation or profession to enable him/her to provide nursing service in specific areas in accordance with the ethics of the profession and applicable law.

THEORETICAL FOUNDATION OF NURSING APPLIED IN HEALTH CARE SITUATIONS

Purposes of Nursing Theories and Conceptual Frameworks (Kozier et al.,45) Provide direction and guidance for: a. structuring professional nursing practice, education and research b. Differentiating the focus of nursing from other professions. Assist nurses to describe, explain and predict everyday experiences. Serves to guide assessment, intervention, and evaluation of nursing care Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation. Help to establish criteria to measure the quality of nursing care Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and works defined. Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions. Provide a general focus for curriculum design Guide curricular decision making Offer framework for generating knowledge and new ideas Assist in discovering knowledge gaps in the specific field of study Offer a systematic approach to identify questions for study, select variables, interpret findings, and validate nursing interventions

Concepts are abstract ideas or mental images of phenomena or reality. It can be concrete ideas that can be mentally pictured (eg. Cars, cellphones, house); or it can be abstract ideas (eg. Powerlessness, adaptation, nursing). Nursing theories addresses the following four major concepts: 1. Person or client 2. Environment 3. Health/illness 4. Nursing

Conceptual Framework group of related concepts. It can also be viewed as an umbrella under which many theories can exist (Cresia & Parker 1991,p7). Conceptual Model- is a system of related concepts or a conceptual diagram.

Model- graphic illustration of relationships. Theory- is made up of concepts and propositions; however, a theory accounts for phenomena with much greater specificity. GENERAL THEORIES IN NURSING Nightangles Environmental theory Florence Nightangle, the mother of modern nursing espoused her theory focusing on the environment. She linked health with five environmental factors: (1) (2) (3) (4) (5) pure or fresh air pure water efficient drainage cleanliness light

Hendersons Definition of Nursing- The definition of nursing given by Virginia Henderson in 1955 became a milestone in the development of nursing as discipline apart from medicine. The focus on her Nursing Concept is to help individuals and families gain independence in meeting the 14 fundamental needs; (1) Breathing normally (2) Eating and drinking adequately (3) Eliminating body wastes (4) Moving and maintaining desirable position (5) Sleeping and resting (6) Selecting suitable clothes (7) Maintaining body temperature within normal range by adjusting clothing and modifying the environment (8) Keeping the body clean and well-groomed to protect the integument (9) Avoiding dangers in the environment and avoiding injuring others (10)Communicating with others in expressing emotions, needs, fears, or opinions (11)Worshipping according to ones faith (12) Working in such a way that one feels a sense of accomplishment (13) Playing or participating in various forms of recreation (14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities.

Rogerss Science of Unitary Human Beings - Martha Rogers views the person as an irreducible whole, the whole being greater than the sum of its parts. Her Key concepts in describing the individual are energy fields, openness, pattern and organization, and multidimensionality. She described the Unitary Man as: (1) Irreducible, four-dimensional energy field identified by pattern.

(2) (3) (4) (5)

Manifesting characteristics different from the sum of the parts Interacts continuously and creatively with the environment Behaving as a totality Participating creatively in change

Orems Self Care Deficit Theory Dorothy Orem developed the self-care deficit theory that includes self-care, self-care deficit and nursing system. She believed that the self-care of the individuals and the self-care of dependents are learned behaviors that individuals initiate and perform on their own behalf to maintain life, health, and well-being. According to Rogers, there are three kinds of self-care requisites: (1) Universal requisites ( common to everybody like maintenance of air, water etc) (2) Developmental requisites (3) Health deviation requisites Roys Adaptation Model Sister Callista Roy focuses on the individual as a biophysical adaptive system. Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an ongoing purposive response. Roy identified three classes of stimuli: (1) Focal Stimulus: the internal or external stimulus most immediately confronting the person and confronting the behavior. (2) Contextual stimuli: all other internal or external stimuli present (3) Residual Stimuli: beliefs, attitudes, or traits having an intermediate effect on the persons behavior but whose effects are not validated. Kings Goal Attainment Theory Imogene King based her theory from the conceptual framework of three dynamic interacting systems: (1) personal system concepts: perception, self, body image, growth and development, space and time (2) Interpersonal system concepts: interaction, communication, transaction, role, and stress. (3) Social system concepts: organization, authority, power, status, and decision making. Neumans Health Care Systems Model Betty Neuman views the client as an open system consisting of a basic structure or central core of energy resources (physiologic, psychologic, sociocultural, developmental, and spiritual) surrounded by two concentric boundaries or rings referred to as lines of resistance. She identified individuals response to stress and the nursing interventions to be carried out on three preventive levels: (1) Primary prevention (2) Secondary prevention (3) Tertiary Prevention Johnsons Behavioral System Model - Dorothy Johnson defines a system as a whole that functions as a whole by virtue of the interdependence of its parts. A behavioral system is patterned, repetitive and purposeful. Johnsons key concepts describes the individual as a behavioral system composed of seven subsystems:

(1) (2) (3) (4) (5) (6) (7)

attachment-affiliative subsystem provides survival and security. Dependency subsystem promotes helping behavior that calls for a nurturing response. Ingestive system satisfies appetite. Eliminative subsystem excretes body wastes. Sexual subsystem functions dually for procreation and gratification. Achievement subsystem attempts to manipulate the environment. Aggressive subsystem protects and preserves the self and society within the limits imposed by the society.

Peplaus Psychodynamic Nursing Theory- Hildegard Peplau introduced and defined psychodynamic nursing as understanding ones own behavior to help others identify felt difficulties and applying principles of human relations to problems arising during the experience. She also described the nurse-patient relationship in four phases: (1) Orientation patient seeks help and the nurse assists patient to understand the problem and the extent of need for help. (2) Identification - patient assumes a posture of dependence, interdependence, and independence in relation to the nurse (3) Exploitation - patient uses available services on the basis of self interest and needs (4) Resolution - old needs and goals are put aside and new ones adopted. Leiningers Transcultural Care Theory Madeleine Leininger established the transcultural nursing which she defined as a major area of nursing that focuses on comparative study and analysis of different cultures and subcultures in the world, with respect to their: (1) Caring behavior (2) Nursing care (3) Health values (4) Beliefs (5) Patterns Watsons Philosophy and Science of Caring Jean Watson believes the practice of caring is central to nursing; it is a unifying focus for practice. According to her, there are two major assumptions that underlie human care (carative factors): (1) care and love constitute the primal and universal psychic energy (2) care and love are requisite for our survival and the nourishment of the society FIELDS OF NURSING The Fields of Nursing may be classified in general as follows: 1. Hospital Nursing or the Institutional Nursing 2. Public Health Nursing 3. Community Health Nursing

4. 5. 6. 7. 8. 9.

School Nursing or Nursing Education Occupational Health Nursing or Industrial Nursing Military Nursing Clinic Nursing Independent Nursing Practice Private Duty Nursing

Institutional Nurses- those employed as staff nurses or nursing personnel in a hospital setting or similar institutions. Public Health Nurse is one who provides nursing care and counsel to persons and families, either to individual or groups in clinics, in their homes, in school, and at their place of work, and cooperates with others in health promotion. Community Health Nurse a nurse whose work combines the element of nursing and public health practice and takes place outside the therapeutic institutions. School Nurse a registered nurse employed to work in educational institutions to participate in health programmes for school-aged children. Responsibilities include monitoring growth and development, screening health problems and supporting those pupils with special needs. Occupational Health Nurse/ Industrial Nurse one employed in industry that gives immediate care to ill or injured workers, follows up on the sick and the injured, and helps develop accident prevention and health programs for the workers. Maternal and Child Health Nurse one who cares for and safeguards the health of mothers and children. Nurse Educator a nurse employed in the teaching or administrative staff of a school of nursing or other educational institution for nurses. Pediatric Care Nurse a registered nurse qualified in the nursing care of the sick child. Private Duty Nurse is a registered nurse who independently contracts with a patient; a private duty nurse is responsible for the total nursing care of the patient during the period she is with him. Nursing Administrator is a professional nurse who is a member of the administrative staff of a hospital, medical center, public health agency, or a similar institution and who, as a member of the administrative staff, participates in formulating the policy and objectives of such.

Clinical Nurse Specialist A professional nurse, who has had special training and experience in a particular clinical specialty, often holds a degree, and is prepared to give expert care to the acutely or chronically ill and to assist clients to maintain health.

ETHICO-MORAL RESPONSIBILITY

Ethics part of philosophy that deals with systematic approaches to questions of morality. - a term for the study of how we make judgments regarding right and wrong. - a system of MORAL PRINCIPLES or moral standards governing conduct.

Morals- human conduct in the application of ethics. Concerned with JUDGMENT PRINCIPLES of right and wrong in relation to human actions and character. Nursing Ethics the code governing the NURSES BEHAVIOR, especially towards patients, employing authority and to the profession. Beneficence - any action that would BENEFIT others. The principle that imposes upon the practitioner to seek the good for the patients under all circumstances. Beneficence connotes positive action toward preventing or removing harm and promoting good such as: (1) One ought to prevent evil or harm (2) One ought to remove evil or harm (3) One ought to do or promote good. Nonmaleficence states the idea to REFRAIN from inflicting harm. one ought NOT to inflict evil or harm. The admonition of nonmaleficence is stated in the negative manner while the beneficence is in the positive. Justice The basic principle that deals with FAIRNESS, just deserts, and entitlements in the distribution of goods and services. In health care, justice seems to point to distributive justice that deals with the allocation of scarce resources. ARTICLE XIII of the 1987 Constitution provides: 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 the 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 and development and research responsive to the countrys health needs and problems. It shall establish a special agency for disabled persons for their rehabilitation. Some methods of distributing goods and services in our society are as follows: (1) To each, an equal share (2) To each, according to need (3) To each, according to effort (4) To each, according to contribution (5) To each, according to merit (6) To each, according to ability to pay

Autonomy - In health care, it means the form of personal LIBERTY, where the individual is free to choose and implement ones own decisions, free from deceit, duress, constraint, or coercion. Three Basic elements involved: (1) ability to decide (2) power to act upon your decisions (3) a respect for the individual autonomy of others.

Stewardship refers to the actions made for by the health practitioner IN BEHALF of the patient and for the greater benefit of the patient. Truth Telling/Veracity The patient must tell the truth in order that appropriate care can be provided. The health practitioner needs to disclose FACTUAL INFORMATION so that the patient can exercise personal autonomy. Confidentiality - is also known as PRIVILEGED COMMUNICATION which refers to any information obtained by the nurse or the health team during the course of caring for the patient. The information gathered may only be disclosed under the following: (1) the patient agrees to divulge such information with written consent (2) the information is material in a criminal case investigation (3) if public safety is jeopardized (communicable disease) (4) such information is relevant to his care to be utilized by other health team Priviliged Communication may be divided into two classes: (1) Absolute privileged communication is one made in the interest of the public service or the due administration of justice and is practically limited to legislative and judicial proceedings and other actions of the state. (2) Qualified privileged communication is a slanderous statement uttered in good faith, and made on a proper occasion, from a proper motive, based upon a probable cause and in honest belief that such statement is true.

MORAL PRINCIPLES GOLDEN RULE Do unto others what you would like others do unto you. It is a basic moral principle that if you want others to respect you, you must also accord respect to them. THE TWO FOLD-EFFECT - facing a situation which would have good and bad effects requires the following basis for arriving a decision: a. that the action must be morally good b. that the good effect must be willed and the bad effect merely allowed

c. that the good effect must not come from an evil action but from initial action itself directly; and d. that the good effect must be greater than the bad effect. THE PRINCIPLE OF TOTALITY states that the whole is always greater than its parts. To save the patients life as a whole, it is justified under this principle to surgically cut-off a disease body part of the patient. EPIKIA exception to the general rule. It is reasonable presumption that the authority making the law will not wish to bind a person in some particular case, even though the case is covered by the letter of the law. If a mentally ill patient becomes berserk and the doctor could not be contacted, the patient may be restrained by virtue of epikia. Another example of this is allowing a relative to see a seriously ill patient who expresses the desire the relative although it is not yet visiting hours THE END DOES NOT JUSTIFY THE MEANS giving a sleeping tablet to a chronically ill person so he/she can de in peace is morally wrong. THE GREATEST GOOD FOR THE GREATEST NUMBER during an epidemic, immunization against communicable diseases is administered to the people. Although there may be some who may have slight reactions to the vaccine, the greater majority of the population shall be considered. NO ONE IS HELD TO THE IMPOSSIBLE the doctors and nurses are not guarantors of life. They cannot be held liable as long as they have done everything that modern medicine can afford to save a patient from dying. THE MORALITY OF COOPERATION formal cooperation in an evil act is never allowed. A nurse shall not participate upon immoral operations such as abortion even if the doctor commands it. PRINCIPLE RELATING TO THE ORIGIN AND DESTRUCTION OF LIFE mercy killing or euthanasia is not allowed because it will lessen the incentive to medical research. The state recognizes the sanctity of life. It shall protect the life of the mother and the unborn since conception. Any direct attack on the life of a fetus for whatever cause is immoral. A fetus shall be buried in consecrated grounds. If it is dead and came from dead mother, it shall be buried with the mother.

Privacy the right to be left alone or be apart from others. This right is guaranteed by most civilized state laws and enshrined also in the patients bill of rights. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. This right also includes privacy of ones thoughts, opinions and physical presence and privacy of ones records.

Informed Consent The patient UNDERSTANDS the reason for the proposed intervention, with its benefits and risks, and agrees to the treatment by affixing his signature in the consent form. It generally contains the following elements: (1) disclosure (2) understanding (3) voluntariness (4) competence (5) permission giving In our present jurisdiction under the 1987 Constitution, the age of majority is 18 years old. It means that only 18 years old and above can sign for themselves in legal matters such as the signing of consent (hospital admission, contracts, will etc..)

The Patients Bill of Rights (Filipino) 1. The patient has the right to considerate and respectful care, irrespective of socioeconomic status 2. The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected and understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person in his behalf. He has the right to know by name and in person, the physician and nurse responsible in coordinating his care. 3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include but not necessarily limited to the specific procedure and/or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient has also the right to know the name of the person responsible for the procedures and/or treatment. 4. The patient has the right to refuse treatment/lifegiving measures, to the extent permitted by law, and to be informed of the medical consequences of his action. 5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. 6. The patient has the right to expect that all communication and records pertaining to his care should be treated confidential. 7. The patient has the right to expect that within its capacity, a hospital must make reasonable response to the request of patient for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of care. When medically

permissible a patient may be transferred to another facility only after he has received complete information concerning the needs and the alternatives to such transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer. 8. The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. The patient has the right to obtain information as to the existence of any professional relationship among individuals, by name, who are treating him. 9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research project. 10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby his physicians or a delegate of the physician of the patients continuing health care requirements following discharge informs him. 11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment. 12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.

The PATIENTS RESPONSIBILITIES towards his care in the hospital: 1. Providing information It is a responsibility of the patient to provide the staff with accurate and complete information, to the best of his knowledge, about the history of his illness, complaints. If the patient is unable to do so, then her immediate family member may give such information. 2. Complying with instructions the patient is responsible for complying with the treatment recommended by the attending physician or health team that is primarily responsible for his care. 3. Informing the physician of refusal to treatment A patient who refuses treatment or to be compliant with the treatment regimen must inform the physician of his decision. 4. Paying the hospital charges upon admission, the patient understands that he or she must pay the charges that he or she may incur in th course of her treatment. The exception is of course if the patient is admitted on charity hospitals giving everything for free. 5. Adherence to hospital rules and regulations the patient is also governed by the rules and regulation of the hospital which he or she is seeking medical help for his/her condition. The patient or the immediate family member must read the

rules or must be informed about the policy of the hospital and must adhere to them. 6. Consideration and respect for others the patient must also show respect for other patients admitted in the hospital. NURSES BILL OF RIGHTS (1) Nurses have the right to practice in a manner that fulfills their obligation to society and to those who receive nursing care. (2) Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. (3) Nurses have the right to a work environment that supports and facilitates 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 or retribution (5) Nurses have the right to a 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 settings. BASIC HUMAN RIGHTS ON RESEARCH SUBJECTS: (1) (2) (3) (4) (5) Right to informed consent Right to refuse and/or withdrawal from participation Right to privacy Right to confidentiality Right to be protected from harm

CODE OF ETHICS IN NURSING The fundamental responsibility of the nurse is fourfold: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is respect for life, dignity and the rights of man. It is unrestricted by consideration of nationality, race, creed, color, age sex, politics, or social status. Nurses render health services to the individual, the family and the community and coordinate their services with those of related groups.

The following Code for Nurses, adopted by the Council of National Representatives of the International Council of Nurses was also adopted by the Board of Nursing and became an integral part of the amended Code of Nursing Ethics in the Philippines: Nurses and People - The nurses primary responsibility is to those people who require nursing care. The nurse, in providing care, promotes an environment in which the values, customs and spiritual beliefs of the individual are respected. The nurse holds in confidence personal information and uses judgment in sharing this information. Nurses and Practice - The nurse carries personal responsibility for nursing practice and for maintaining competence by continual learning. The nurse maintains the highest standards of nursing care possible within the reality of a specific situation The nurse uses judgment in relation to individual competence when accepting and delegating responsibilities. The nurse when acting in a professional capacity, should at all times maintain standards of personal conduct which reflect credit upon the profession. Nurses and Society - The nurse shares with other citizens the responsibility for initiating and supporting action to meet the health and social needs of the public. Nurses and the Profession - The nurse plays the major role in determining and implementing desirable standards of nursing practice and nursing education. The nurse is active in developing a core of professional knowledge. The nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing.

AMENDED CODE OF ETHICS FOR NURSES Their conduct should be such that would bring credit to the profession. Just like any other professional, nurses are looked upon with respect in the community. They should therefore endeavor to live a life that would uphold their self-respect. Especially when nurses are on duty, they should try to look neat and attractive. Female nurses are advised to use moderate make-up and have a neat hairstyle. They should wear uniforms that are not too short or tight fitting that would tend to restrict movements, nor expose unnecessarily

any part of the body while giving care to the patients. Clean uniforms and clean bodies tend to enhance the image of nurses. Use of anti-perspirant is advised most specially during hot summer months. Male nurses are likewise advised to be clean, shaven, hair clipped close to the nape of the neck instead of flowing to the shoulders. The use of the uniform should be specified in the policy of the hospital/agency. It should be worn only when on duty. Dining in the public, shopping or going to the market while in uniform is discouraged. Nurses caps are worn only while on duty. These are either carried in bags or are left in their places of assignment. Jewelry, such as earrings, necklaces or bracelets are not allowed while on duty. However, wedding rings, school rings or school pins may be worn. Nurses are looked upon by nursing students as their role models. Therefore, especially while they are on duty, they should act in a manner that is worth emulating. Sincere and compassionate attitudes toward patients are caught by those around them. Soon their working environment becomes permeated with good working relationships that are so vital in dealing with patients.

LEGAL RESPONSIBILITY

Legal Aspects in the Practice of Nursing The law has always governed the practice of modern nursing. This what makes the every erroneous nursing action liable to the law, either answerable to the Civil Law or the Criminal Law or both. The key word to remember in the legal responsibility of nurses is ACCOUNTABILITY. The professional nurse is expected to render reasonably competent nursing care to avoid getting entangled with the long arm of the law. Anything short of such standard required that would cause harm or injury to the patient makes the nurse

responsible or liable to the law by way of negligence or even malpractice suit. The safe way to avoid such potential legal problems is amplified in the Philippine Nursing Act of 2002 (RA9173) that is, for nurses to utilize the nursing process in the performance of their function and observe the provision of RA 9173 which governs the practice of nursing in the Philippines.

The Philippine Nursing Act of 2002 (RA 9173) Article VIII Section 35 enumerates the prohibitions in the practice of nursing: A fine of not less than 50,000.00 nor more than 100,000.00 or imprisonment of not less than 1 year nor more than 6 years, or both, upon the discretion of the court, shall be imposed upon: (a) any person practicing nursing in the Philippines within the meaning of RA 9173 of 2002: (1) without certificate of registration/professional license and professional identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of this Act; or (2) who uses as his/her own certificates of registration/ professional license and professional identification card or special/temporary permit of another; or (3) who uses an invalid certificate of registration/professional license, a suspended or revoked certificate of registration/professional license, or an expired or cancelled special/temporary permit; or (4) who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a professional identification card or special permit; or (5) who falsely poses or advertises as a registered and licensed nurse or uses any other means that tend to convey the impression that he/she is registered and licensed nurse; or (6) who appends B.S.N./R.N. or any similar appendage to his/her name without having been conferred said degree or registration; or (7) who, as a registered and licensed nurse, abets or assists the illegal practice of a person who is not lawfully qualified to practice nursing. (b) any person or the chief executive officer of a juridical entity who undertakes in-service educational programs or who conducts review classes for local and foreign examination without permit/clearance from the board and the Commission; or (c) any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or (d) any person or the chief executive officer of a juridical entity violating any provision of this Act and its rules and regulations.

THE PHILIPPINE NURSING ACT OF 2002 OR RA 9173 An Act providing for more responsive nursing profession, repealing for the purpose Republic Act 7164, otherwise known as the Philippine Nursing Act of 1991 and for other purposes.

(Note: The following presentation is the reproduction of RA 9173 with explanation on selected articles appearing in the italics) ARTICLE I TITLE

SECTION 1. Title This Act shall be known as the Philippine Nursing Act of 2002. ARTICLE II DECLARATION OF POLICY SECTION 2. Declaration of Policy. It is hereby declared the policy of the State to assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses. The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system throughout the country. ARTICLE III ORGANIZATION OF THE BOARD OF NURSING SECTION 3. Creation and composition of the Board - There shall be created a created a Professional Regulatory Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They shall be appointed by the President of the Republic of the Philippines from among the two (2) recommendees, per vacancy, of the accredited professional organization of nurses in the Philippines who possess the qualifications prescribed in Section 4 of this Act. NOTE: The structure of the members of the Board of Nursing was augmented from 5 members under RA 7164 to 7 members in RA 9173. The chairperson shall have six members, shall cover the three areas of nursing, namely: nursing education, nursing service, and community health nursing. The members now are selected from two recommendees coming from the endorsement of Accredited Professional Organization (Philippine Nursing Association) which also preselected their endorsement not later than three months prior to expected vacancy from three nominees per vacancy unlike under RA 7164 where the President appoints the members from 12 nominees. The 7 positions in the Board of Nursing does not ( mandatory) require that all positions be filled up in order to function ,if the majority positions are occupied then it constitute the Board to function. SECTION 4. Qualifications of the Chairperson and the Members of the Board. The Chairperson and the Members of the Board shall, at the time of their appointment, possess the following qualifications: (a) Be a natural born citizen and resident of the Philippines;

NOTE: Natural born Filipino citizen are those Filipino who, since birth did not make any positive act to perfect their citizenship. (b) Be a member of good standing of the accredited professional organization of nurses; NOTE: The Accredited Professional Association (APO) recognizes the Philippine Nurses Association (PNA) as mentioned in the Implementing Rules and Regulation of RA 9173. The other existing members of PNA mentioned in the preliminary chapter of this reviewer are deemed also accredited to satisfy this requirement. ( c ) Be a registered nurse and holder of a masters degree in nursing, education or other allied medical profession conferred by a college or university duly recognized by the government: Provided, That the majority of the Members of the Board shall be holders of a masters degree in nursing: Provided, further, That the Chairperson shall be a holder of masters degree in nursing. NOTE: The new requirement for the members of the Board is a departure from the previous requirement requiring all members of the Board to be masters degree holder in Nursing. RA 9173 provides that only the chairperson and a majority (not all the members) of the members must be masters degree holder in nursing and the other members may be masters degree holder in education or other allied health profession. (d) Have at least ten years (10) years of continuous practice of the profession prior to appointment: Provided, however, That the last five years (5) of which shall be in the Philippines; and NOTE: This new provision which was silent in the previous law allows the member of the Board to qualify as a nominee even if she practiced nursing abroad, only that, the last five years before the appointment, that member must have practiced her nursing profession in the Philippines. (e) Not have been convicted of any offense involving moral turpitude; Provided, That the membership to the Board shall represent the three areas of nursing, namely: nursing education, nursing service and community health nursing. NOTE: Take note of the key word, convicted. An ongoing prosecution in a criminal case does not constitute a hindrance to being nominated as a member to the Board because the law speaks of conviction which means that a competent court had rendered already its final decision on the case. If such member was convicted in the past for crime involving moral torpidity, even if the penalty was served, is a prohibition to be nominated in the Board.

SECTION 5. Requirements Upon Qualifications as Member of the Board of Nursing. Any person appointed as Chairperson or Member of the Board shall immediately resign from any teaching position in any school, college or university or institution offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations or in any office or employment in the government or any of its subdivision, agency or instrumentality thereof, including government-owned or controlled corporations or their subsidiaries as well as those employed in the private sector. He/she shall not have any pecuniary interest in or administrative supervision over any institution offering Bachelor of Science in Nursing including review classes. NOTE: The qualification required by this Act means that they must be satisfied at the time of Appointment. The President is the only person who can appoint such member of the Board and such appointment commences only after the President approves through her signature in the appointment paper. This further means that even if the nominee is not yet qualified during the recommendation period, he/she shall have time to perfect or satisfy all the requirements before the President signs her appointment. A member may continue to teach in a nursing institution and may only resign during the time that she is appointed. SECTION 6. Term of Office. The Chairperson and Members of the Board shall hold office for a term of three (3 years) and until their successors shall have been appointed and qualified: Provided, That the Chairperson and Members of the Board may be reappointed for another term. Any vacancy in the Board occurring within the term of a member shall be filled for the unexpired portion of the term only. Each Member of the Board shall take the proper oath of office prior to the performance of his/her duties. The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under RA 7164 until their replacements have been appointed by the President and shall have been duly qualified. NOTE: The maximum number or years that a member can stay as a member of the Board is six years because from their original appointment of three years, they are still eligible to be reappointed for another three years. However, the Hold-over doctrine applies to this provisions because it specifically provides that a member shall continue to hold office until their successors shall have been appointed and qualified. SECTION 7. Compensation of Board Members. The Chairperson and Members of the Board shall receive compensation and allowances received by the Chairperson and Members of other professional regulatory boards.

SECTION 8. Administrative Supervision of the Board, Custodian of its Records, Secretariat and Support Services. The Board shall be under the administrative supervision of the Commission. All records of the Board, including applications for examinations, administrative and other investigative cases conducted by the Board shall be under the custody of the Commission. The Commission shall designate the Secretary of the Board and shall provide the secretariat and other support services to implement the provisions of this Act. SECTION 9. Powers and Duties of the Board. The Board shall supervise and regulate the practice of the nursing profession and shall have the following powers, duties and functions: (a) Conduct the licensure examination for nurse; (b) Issue, suspend or revoke certificates of registration for the practice of nursing; (c) Monitor and enforce quality standards of nursing practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation; (d) Ensure quality nursing education by examining the prescribed facilities of universities or colleges of nursing or departments of nursing education and those seeking permission to open nursing courses to ensure that standards of nursing education are properly complied with and maintained at all times. The authority to open and close colleges of nursing and/or nursing education programs shall be vested on the Commission of Higher Education upon written recommendation of the Board. (e) Conduct hearings and investigations to resolve conduct and violations of this Act, or its rules and regulations and in connection therewith, issue subpoena ad testificandum and subpoena duces tecum to secure the appearance of respondents and witnesses and the production of documents and punish with contempt persons obstructing, impeding and/or otherwise interfering with the conduct of such proceedings, upon application with the courts; (f) Promulgate a Code of Ethics in coordination and consultation with the accredited professional organization of nurses within one (1) year from the effectivity of this Act; (g) Recognize nursing specialty organizations in coordination with the accredited professional organization; and (h) Prescribe, adopt, issue and promulgate guidelines, regulations, measures and decisions as may be necessary for the improvement of the nursing practice, advancement of the profession and for the proper and full enforcement of this Act subject to the review and approval by the Commission. NOTE: The adoption and regulation of a Code of Ethics and Code of Technical Standards for the practice of nursing are new addition in the powers of the Board included in this law. The Board also exercises quasi-judicial powers because they can issue subpoena duces tecum (court ordering the person to bring documents with himself to appear before the court) and subpoena ad testificandum (court ordering the person to be present before the court). The Board can also punish a person by way of contempt. This power is exercised only by competent courts but the law delegates such powers to the Board of Nursing through the legislation of RA 9173.Under this Act, the Board of nursing now recognizes specialty organizations with the accredited professional organizations.

SECTION 10. Annual Report. The Board shall at the close of its calendar year submit an annual report to the President of the Philippines through the Commission giving a detailed account of its proceedings and the adoption of measures that will upgrade and improve the conditions affecting the practice of the nursing profession. SECTION 11. Removal or Suspension of Board Members. The President may remove or suspend any member of the Board after having been given the opportunity to defend himself/herself in a proper administrative investigation, on the following grounds: (a) Continued neglect of duty or incompetence; (b) Commission or toleration of irregularities in the licensure examination; and (c) Unprofessional, immoral or dishonorable conduct. NOTE: Only the President of the Philippines has the sole power to remove or suspend the members of the Board of Nursing. The members of the Board being Presidential appointees are the alter ego of the President, which means that they are under the whims and caprices of the appointing officer with respect to their stay in the office.

ARTICLE IV EXAMINATION AND REGISTRATION

SECTION 12. Licensure Examination. All applicants for licensure to practice nursing shall be required to pass a written examination, which shall be given by the Board in such places and dates as maybe designated by the Commission: Provided, that it shall be in accordance with Republic Act No. 8981, otherwise known as the PRC Modernization Act of 2000. NOTE: Specific dates as provided for in the previous law are no longer mentioned in the new law. It used to be not earlier than one month and not later than two months after the closing of each semestral term. SECTION 13. Qualifications for Admission to the Licensure Examination. In order to be admitted to the examination for nurses, an applicant must, at the time of filing his/her application, establish to the satisfaction of the Board that: (a) He/she is a citizen of the Philippines, or a citizen or subject of a country which permits Filipino nurses to practice within its territorial limits on the same basis as the subject or citizen of such country: Provided: That the requirements for the registration or licensing of nurses in said country are substantially the same as those prescribed in this Act;

(b) He/she is good moral character; and (c) He/she is a holder of a Bachelors Degree in Nursing from a college or university that complies with the standards of nursing education duly recognized by the proper government agency. NOTE: Under the previous law, no examinee shall take the licensure exam below the age of 18. It is no longer included in the new nursing law. SECTION 14. Scope of Examination. The scope of the examination for the practice of nursing in the Philippines shall be determined by the Board. The Board shall take into consideration the objectives of the nursing curriculum, the broad areas of nursing and other related disciplines and competencies in determining the subject examinations. NOTE: The scope of examination for nursing is determined by the Board of Nursing alone and not in conjunction with the PNA or the PRC.

SECTION 15. Ratings. In order to pass the examination, an examinee must obtain a general average of at least seventy-five percent (75%) with a rating of not below sixty percent (60%) in any subject. An examinee who obtains an average rating of seventy-five (75%) or higher but gets a rating below sixty-percent (60%) in any subject must take the examination again but only in the subject or subjects where he/she is rated below sixty percent (60%). In order to pass the succeeding examination, an examinee must obtain a rating of at least seventy-five percent (75%) in the subject or subjects repeated. NOTE: specific number of times, which an examinee can take the licensure exam, is now abolished under the new nursing law. It also deleted the mandatory requirement of attending a refresher course after failure to pass the nurse licensure examination in three takes. The removal to take the examination is within two years after the last failed examination. The examinee who failed may take only the subject which she failed if his/her average is 75 % but with a grade of below 60% in any subject. The law however is silent about the prohibition of the examinee in taking the entire set of examination. In the interpretation of laws if the law is silent on a matter, then it must be construed in favor to a side that is not onerous or burdensome to the people. To retake the examination in a subject matter that the examinee failed the last time and to target a rating of 75% in that subject area rather than 60% only if the person retakes the entire set, is onerous on the part of the examinee. This provision must be construed in favor of the examinee. He/She must have the option to retake the entire examination with the original passing rate of 75% average with no grade below 60% in any subject area or he/she may retake only that subject area where he/she failed the last time provided he/she obtained an average of 75% or above

SECTION 17. Issuance of Certificate of Registration/Professional License and Professional Identification Card. A certificate of registration/professional license as a nurse shall be issued to an applicant who passes the examination upon payment of the prescribed fees. Every certificate of registration/professional license shall show the full name of the Commission and of the Members of the Board, and the official seal of the Commission. A professional identification card, duly signed by the Chairperson of the Commission, bearing the date of registration, license number, and the date of issuance and expiration thereof shall likewise be issued to every registrant upon payment of the required fees. SECTION 18. Fees for Examination and Registration. Applicants for licensure and for registration shall pay the prescribed fees set by Commission. SECTION 19. Automatic Registration of Nurses. - All nurses whose names appear at the roster of nurses shall be automatically or ipso facto registered as nurses under this Act upon its effectivity. NOTE: Though the law provides for the automatic enrolment in the roster of nurses after passing the licensure examination, the Code of Ethics formulated under this Act invites the nurse to become a member of the PNA. SECTION 20. Registration by Reciprocity. A certificate of registration/professional license may be issued without examination to nurses registered under the laws of a foreign state or country: Provided, That the requirements for registration or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided, further, That the laws of such state or country grant the same privileges to registered nurse of the Philippines on the same basis as the subjects or citizens of such foreign state or country. SECTION 21. Practice Through Special/Temporary Permit- A special/temporary permit may be issued by the Board to the following persons subject to the approval of the commission and upon payment of the prescribed fees: (a) Licensed nurses from foreign countries/states whose service are either for a fee or free if they are internationally well-known specialists or outstanding experts in any branch or specialty of nursing; (b) Licensed nurses from foreign countries/states on medical mission whose services shall be free in a particular hospital, center or clinic; and (c) Licensed nurses from foreign countries/states employed by school/colleges of nursing as exchange professors in a branch or specialty of nursing; Provided, however, That the special/temporary permit shall be effective only or the duration of the project, medical mission or employment contract. SECTION 22. Non-registration and Non-issuance of Certificates of Registration/Professional License or Temporary Permit. No person convicted by final judgment of any criminal offense

involving moral turpitude or any person guilty of immoral or dishonorable conduct or any person declared by the court to be of unsound mind shall be registered and be issued a certificate of registration/professional license or a special/temporary permit. The Board shall furnish the applicant a written statement setting forth the reasons for its actions, which shall be incorporated in the records of the Board SECTION 23. Revocation and Suspension of Certificate of Registration/Professional License and Cancellation of Special/Temporary Permit.- The Board shall have the power to revoke or suspend the certificate of registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds: (a) (b) (c) (d) (e) For any of the causes mentioned in the preceding section; For unprofessional and unethical conduct; For gross incompetence or serious ignorance; For malpractice or negligence in the practice of nursing; For the use of fraud, deceit, or false statements in obtaining a certificate of registration/professional license or a temporary/special permit; or (f) For practicing his/her profession during his/her suspension from such practice . Provided, however, That the suspension of the certificate of registration/professional license shall be for a period not to exceed four (4) years. NOTE: Section 23 (f) is an addition in this new law. The suspended nurse cannot practice nursing profession while serving his/her suspension orders. Take note of the maximum period of suspension, it cannot go beyond four years. SECTION 24. Re-issuance of Revoked Certificates and Replacement of Lost Certificates.The Board may, after the expiration of a maximum of four (4 ) years from the date of revocation of a certificate, for reasons of equity and justice and when the cause for revocation has disappeared or has been cured and corrected, upon proper application therefore and the payment of the required fees, issue another copy of the certificate of registration/professional license. A new certificate of registration/professional license to replace the certificate that has been lost, destroyed or mutilated may be issued, subject to the rules of the Board.

ARTICLE V NURSING EDUCATION

SECTION 25. Nursing Education Program. The nursing education program shall provide sound general and professional foundation the practice of nursing. The Learning experiences shall adhere strictly to specific requirements embodied in the prescribed curriculum as promulgated by the Commission on Higher Educations policies and standards of nursing education. SECTION 26. Requirement for Inactive Nurses Returning to Practice. Nurses who have not actively practiced the profession for five (5) years are required to undergo one month of didactic training and three months of practicum. The Board shall accredit hospitals to conduct the said training program. NOTE: this is a new provision providing for the guidelines of inactive nurses who wish to return to practice their nursing career. Didactic training means a lecture program. SECTION 27. Qualifications of the Faculty. A member of the faculty in a college of nursing teaching professional courses must: (a) (b) (c) (d) Be a registered nurse in the Philippines; Have at least one (1) year of clinical practice in a field of specialization; Be a member of good standing in the accredited professional organization of nurses; and Be a holder of a masters degree in nursing, education, or other allied medical and health sciences conferred by a college or university duly recognized by the Government of the Republic of the Philippines.

In addition to the aforementioned qualifications, the dean of a college must have a masters degree in nursing. He/she must have at least five (5) years of experience in nursing. NOTE: The requirement for the clinical experience of a faculty was reduced from three years in the previous law to only one year in the new law. The requirement for the dean was increased from three years to five years in teaching and supervising a nursing education program.

ARTICLE VI NURSING PRACTICE

SECTION 28. Scope of Nursing. A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another , initiates and performs nursing services to individuals, families and communities in any health care setting. It includes but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, pre-school, school age, adolescence, adulthood and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. As Members of the Health Team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. 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 care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labor in the absence of bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established; (b) Establish linkages with community resources and coordination with the health team; (c) Provide health education to individuals, families and communities; (d) Teach, guide and supervise students in nursing education programs including the including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and (e) Undertake nursing and health and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice; Provided: That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided further, That in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional organization or any recognized professional nursing organization: Provided, finally, That the program and activity for the continuing professional education shall be submitted to and approved by the Board. NOTE: The new law deleted already the special requirement of undergoing IV therapy training before a nurse can administer IV medications. However, the Nursing Service Administrator still requires formal training in this aspect. The new law also added the special training for suturing the lacerated perineum being undertaken by the Association of Nursing Service Administrators with the Maternal and Child Association of the Philippines ( MCNAP ).

SECTION 29. Qualifications of Nursing Service Administrators.- A person occupying supervisory or managerial positions requiring knowledge of nursing must: (a) Be a registered nurse in the Philippines; (b) Have at least two (2) years experience in general nursing service administration; (c) Possess a degree of Bachelor of Science in Nursing, with at least nine (9) units in management and administration courses at the graduate level; and (d) Be a member of good standing of the accredited professional organization or nurses; Provided, That a person occupying the position of chief nurse or director of nursing service shall, in addition to the foregoing qualifications, possess: (1) At least five (5) years of experience in a supervisory or managerial position in nursing; and (2) A masters degree major in nursing; Provided, further, That for primary hospitals, the maximum academic qualifications and experiences for a chief nurse shall be as specified in subsections (a),(b), and (c) of this section: Provided, furthermore, That for chief nurses in the public health agencies, those who have a masters degree in public health/community health nursing shall be given priority. Provided, even further, That for chief nurses in military hospitals, priority shall be given to those who have finished a masters degree in nursing and the completion of the General Staff Course (GSC): Provided, finally, That those occupying positions before the effectivity of this Act shall be given a period of five (5) years within which to qualify.

ARTICLE VII HEALTH HUMAN RESOURCE PRODUCTION, UTILIZATION AND DEVELOPMENT SECTION 30. Studies for Nursing Manpower Needs, Production, Utilization and Development.- The Board, in coordination with the accredited professional organization and appropriate government or private agencies shall initiate, undertake and conduct studies on health human resource production, utilization and development. SECTION 31. Comprehensive Nursing Specialty Program.- Within ninety (90) days from the effectivity of this Act , the Board in coordination with the accredited professional organization, recognized specialty organizations and the Department of Health is hereby mandated to formulate and develop a comprehensive nursing specialty program that would upgrade the level of skill and competence of specialty nurse clinicians in the country, such as but not limited to the

areas of the critical care, oncology, renal and such other areas as may be determined by the Board. The beneficiaries of this program are obliged to serve in any Philippine hospital for a period of at least two (2) years of continuous service. NOTE: The Board is mandated to formulate and develop a comprehensive nursing specialty program that would upgrade the levels of skills and competency of specialty nurse clinicians in the country. This is a new provision of the Nursing law. SECTION 32. Salary. In order to enhance the general welfare, commitment to service and professionalism of nurses, the minimum base pay of nurses working in the public health institutions shall not be lower than the salary grade 15 prescribed under Republic Act No. 6758, otherwise known as the Compensation and Classification Act of 1989. Provided , That for nurses working in local government units, adjustments to their salaries shall be in accordance with Section 10 of the said law. SECTION 33. Funding for the Comprehensive Nursing Specialty Program. The annual financial requirement needed to train at least ten percent (10%) of the nursing staff of the participating government hospital shall be chargeable against the income of Philipine Charity Sweepstakes Office and the Philippine Amusement Gaming Corporation, which shall equally share in the costs and shall released to the Department of Health subject to the accounting and auditing procedures: Provided, That the Department of Health shall set the criteria of this program. SECTION 34. Incentives and Benefits.- The Board of Nursing, in coordination with the Department of Health and other concerned government agencies, association of hospitals and the accredited professional organization shall establish an incentive and benefit system in the form of free hospital care for nurses and their dependents, scholarship grants and other non-cash benefits. The government and private hospitals are hereby mandated to maintain the standard nurse-patient ratio set by the Department of Health. ARTICLE VIII PENAL AND MISCELLANEOUS PROVISIONS

SECTION 35. Prohibitions in the Practice of Nursing. - A fine of not less than 50,000.00 nor more than 100,000.00 or imprisonment of not less than 1 year nor more than 6 years, or both, upon the discretion of the court, shall be imposed upon:

(a) any person practicing nursing in the Philippines within the meaning of RA 9173 of 2002: 1. without certificate of registration/professional license and professional identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of this Act; or 2. who uses as his/her own certificates of registration/ professional license and professional identification card or special/temporary permit of another; or 3. who uses an invalid certificate of registration/professional license, a suspended or revoked certificate of registration/professional license, or an expired or cancelled special/temporary permit; or 4. who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a professional identification card or special permit; or 5. who falsely poses or advertises as a registered and licensed nurse or uses any other means that tend to convey the impression that he/she is registered and licensed nurse; or 6. who appends B.S.N./R.N. or any similar appendage to his/her name without having been conferred said degree or registration; or 7. who, as a registered and licensed nurse, abets or assists the illegal practice of a person who is not lawfully qualified to practice nursing. (b.) any person or the chief executive officer of a juridical entity who undertakes in-service educational programs or who conducts review classes for local and foreign examination without permit/clearance from the board and the Commission; or ( c ) any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or ( d ) any person or the chief executive officer of a juridical entity violating any provision of this Act and its rules and regulations. NOTE: The new law also increased the penal provisions regarding violations of the Nursing law. The fine was raised from the minimum 10,000 and maximum of 40,000 to a minimum of 50,000 and maximum of 100,000.00. ARTICLE IX FINAL PROVISIONS SECTION 36. Enforcement of this Act. It shall be the primary duty of the Commission and the Board to effectively implement this Act. Any duly law enforcement agencies and officers of national, provincial, city or municipal governments shall, upon the call or requests of the Commission or the Board render assistance enforcing the provisions of this Act and to prosecute persons violating the same.`

SECTION 37. Appointments. The Chairperson of the Professional Regulation Commission shall immediately include in its program and issue such rules and regulations to implement the provisions of this Act, the funding of which shall be included in the Annual General Appropriations Act. SECTION 38. Rules and Regulations. Within ninety (90) days after the effectivity of this Act, the Board of Commission, in coordination with the accredited professional organization, the Department of Health, the Department of Budget and Management and other concerned government agencies, shall formulate such rules and regulations necessary to carry out the provisions of this Act. The implementing rules and regulations shall be published in the Official Gazette or in any newspaper of general circulation. SECTION 39. Separability Clause. If any of this Act is declared unconstitutional, the remaining parts not affected thereby shall continue to be valid and operational. SECTION 40. Repealing Clause. Republic Act No. 7164, otherwise known as the Philippine Nursing Act of 1991 is hereby repealed. All other laws, decrees, orders, circulars, issuances, rules and regulations and parts thereof which are inconsistent with this Act are hereby repealed, amended or modified accordingly. SECTION 41. Effectivity. This Act shall take effect fifteen (15) days upon its publication in the official publication in the Official Gazette or in any two (2) newspapers of general circulation in the Philippines.

RELATED LAWS AFFECTING THE PRACTICE OF NURSING Act # 1931 Created for the ESTABLISHMENT OF NURSING SCHOOLS in the country under the Bureau of Education in 1909. Act # 1975 An act that transferred the school of NURSING UNDER THE BUREAU OF HEALTH. Act # 2468 An act that authorized the GRANTING OF THE TITLES of graduate in nursing and midwifery from the school of nursing of Philippine General Hospital in 1915. Act # 2808 This act provided for the earliest and TRUE NURSING LAW that served as the basis of the practice of nurses in the Philippines in 1919 and a year after its passage, the first local licensure or board examination for nurses was held in 1920. The First Board Examiners were created under act # 2808 composed of three members then appointed by the Secretary Interior. The chairman was a doctor of medicine and the other two are registered nurses who must possess an experience in the nursing profession for at least five years and with a reputable character. RA # 649 provided for the standardization of nurses salaries both in institutions and in public health. RA # 465 an act which STANDARDIZED THE FEES charged by the Examining Boards for Examination and Registration. RA # 546 An act that reorganized and placed all the BOARD OF EXAMINERS under the direct supervision of the President of the Philippines. RA # 877 An Act also known as the Philippine Nursing Law of 1953 approved on June 19, 1953. This Law was sponsored by Senator Geromina T. Pecson which enacted to regulate the practice of nursing in the Philippines and to set up provisions for the registration of nurses, for the establishment and maintenance of standards of nursing education and nursing practice. RA # 1080 This act approved on 1954 is also known as, An Act Declaring the Bar and Board Examinations as CIVIL SERVICE EXAMINATIONS which means that when a four year degree course graduate had passed the board examinations or the Bar examinations for lawyers they automatically become first grade civil service eligible. RA # 997 This Republic Act in 1954 ABOLISHED THE DIVISION OF NURSING and created a decentralized organization with a chief Public Health Nurse consultant in the office of the Secretary of Health, and five consultant positions in nursing; namely, in Maternal and

Child Health, in Preventable Diseases, in Institutional Nursing, in Nursing Education, and in Hospital Standardization. RA # 4704 This act in 1966 AMENDED THE PHILIPPINE NURSING LAW OF 1953 otherwise known as RA 877 and introduced some minor revisions of the said act due to some developments of the practice of nursing in the country. RA # 6136 In 1971, This Republic Act introduced other MINOR REVISIONS IN THE NURSING LAW of 1966 thus amending RA 4704 of 1966. RA 7164 PHILIPPINE NURSING ACT OF 1991 was sponsored by Senator Heherson Alvarez and was approved and signed by President Corazon Aquino on November 21, 1991. ILO convention 149 and Recommendations 157 In 1977, the Philippine Nurses Association, formerly known as the Filipino Nurses Association established in 1922 lobbied our government for the adoption of ILO 149 and Recommendations 157 that were adopted in Geneva. It set the concerns of employment of nursing personnel and the CONDITIONS OF THE LIFE AND WORK OF NURSES and in 1978; the PNA passed The Declaration on the Economic and Social Welfare of Filipino Nurses. Proclamation No. 539 The President of the Philippines declared on October 17, 1958 that the last week of October (through this proclamation ) as the NURSES WEEK Presidential Decree No. 223 This decree formed the PROFESSIONAL REGULATION COMMISSION on June 23, 1973. Among its power is the regulation of different profession which used to be under the Civil Service Commission. RA 6511 This Act Amended RA 465 in 1972, which STANDARDIZED the examination and REGISTRATION fees charged by the various Board Examiners. Letter of Instruction No. 1000 this required that the members of Accredited Professional Organizations (eg. PNA) shall be given PRIORITY in the HIRING of employees in the government service and in the engagement of professional services. RA 1612 Refers to the payment of PRIVILEGE TAX before any business or occupation can be lawfully begun or pursued. RA 7392 This Act provided that only licensed midwives could practice and that nurses must pass first the MIDWIFERY EXAMINATION before they can practice midwifery

RA 2382 PHILIPPINE MEDICAL ACT ; defines the practice of medicine in the Philippines. Section 10 of this Act provides: Act constituting the practice of medicine. A person shall be considered as engaged in the practice of medicine who shall for compensation, fee, salary, or reward in any form paid to him directly or through another or even without the same may physically examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental, physical condition or ailment nature, real or imaginary, regardless of the remedy or treatment administered, prescribed or recommended. RA 5181 An act that prescribes PERMANENT RESIDENCE and reciprocity as qualifications for any examination or registration for the practice of any profession in the Philippines Presidential Decree 541 a decree allowing former Filipino (BALIKBAYANS) professionals to practice their respective profession in the Philippines. RA 6425 DANGEROUS DRUG ACT enacted in 1972 declaring that sale, administration, delivery, distribution, and transportation of prohibited drugs are punishable by law. Act No. 3573 This Act in 1929 declared that all COMMUNICABLE DISEASES shall be REPORTED to the nearest health station, and that any person may be inoculated, administered or injected with prophylactic preparations. RA 1082 creation of RURAL HEALTH UNITS in the Philippines. RA 4073 liberalizes the LEPROSY TREATMENT. No person shall be confined in leprosarium unless such disease requires institutional treatment. Presidential Decree 996 COMPULSORY IMMUNIZATION for all children below eight years old. RA 8981 PRC MODERNIZATION ACT OF 2000 This Act gave the Professional Regulatory Commission its regulatory powers and is now an agency of its own. Presidential Decree 825 provided penalty for improper disposal of GARBAGE and other forms of unclealiness. Presidential Decree 856 CODE OF SANITATION, provides for control of all factors in mans environment that affect health including the quality of water, food, milk, control of insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, unpleasant odors and control of nuisance.

Presidential Decree 148 WOMAN AND CHILD LABOR LAW The employable age is 16 years and above and further provides for the privileges of working women. RA 6365 established a National Policy on Population and created the Commission on Population (POPCOM). PD 791 revised population Act. Empowered nurses and midwives to provide, dispense and administer acceptable METHODS OF CONTRACEPTION after having undergone training and having been granted authorization by POPCOM. PD 166 Strengthened FAMILY PLANNING programs through participation of private organizations and individuals in the formulation and implementation of the program planning policies. General Order No. 18 enjoins all citizens of the Philippines, universities, colleges, schools, government offices, mass media, voluntary and religious organizations of all creeds, business and industrial enterprises to promote the concept of family welfare, responsible parenthood and family planning. Letter of Instruction No. 47 directs all schools of medicine, nursing, midwifery and allied medical professions and social work to prepare, plan, and implement the INTEGRATION OF FAMILY PLANNING in their curricula and to require from their graduates sufficient appropriate licensing examination. Department of Labor Order No. 7 requires all industrial establishments to provide FAMILY PLANNING SERVICES. PD 48 limits paid MATERNITY LEAVE privileges to four children. PD 69 limits the number of children to FOUR for TAX EXEMPTIONS purposes. PD 965 requires that couples intending to get married must first undergo a family planning and responsible PARENTHOOD INSTRUCTION prior to the issuance of marriage license. RA 1054 requires the owner, lessee or operator of any commercial, industrial or agricultural establishment to furnish free EMERGENCY, medical, and dental ASSISTANCE to his employees and laborers. RA 4226 HOSPITAL LICENSURE ACT requires all hospital in the country to be licensed before it can offer to serve the community. The licensing agency is the Office For Hospital and Medical Services, Department of Health.

RA 5901 nurses working in agencies with 100-bed capacity and/or above and are working in area of one million population are supposed to WORK 40 HOURS A WEEK. PD 442 LABOR CODE OF THE PHILIPPINES provides the right of the workers to selforganization and collective bargaining agreement. PD 603 CHILD AND YOUTH WELFARE CODE protects and promotes the rights and welfare of children and youth. PD 651 decrees the REGISTRATION OF BIRTH of a child within 30 days with the Civil Registrar. PD 1519 MEDICARE BENEFITS TO ALL GOVERNMENT EMPLOYEES regardless of status of appointment. PD 626 EMPLOYEE COMPENSATION AND STATE INSURANCE FUND RA 6675 GENERICS ACT OF 1998 RA 6758 - standardized the salaries of government employees which include the nursing personnel. RA 7160 LOCAL GOVERNMENT CODE OF 1991devolution of powers from national to local government. RA 7305 MAGNA CARTA FOR PUBLIC HEALTH WORKERS RA 7600 ROOMING-IN AND BREASTFEEDING ACT OF 1992 provides that babies born in private and government hospitals should be roomed-in with their mothers to promote breastfeeding and ensure safe and adequate nutrition to children. EO 51 MILK CODE RA 7432 SENIOR CITIZENS ACT does honor and justice to our peoples long tradition of giving high regard to elderly. 20% discount in all public establishments such as restaurants, pharmacies, public utility vehicles and hospitals. PRC Resolution No. 2004-17 Series of 2004 RE-IMPLEMENTED CONTINUING PROFESSIONAL EDUCATION requiring sixty (60) credit units for three years for professionals with bachelors degree

NURSES AND CONTRACTS

Contract (Article 1305 New Civil Code) defines contract: A contract is a meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to render some service. A contract, from the Latin word contractus and from the French word contract, is a juridical convention manifested in legal form, by virtue of which, one or more persons ( or parties) bind themselves in favor of another or others, or reciprocally, to the fulfillment of a prestation to give, to do or not to do. It is the agreement of two or more persons ( or parties ) for the purpose of creating, modifying, or extinguishing a juridical relation between them.

Characteristics of Contract (a) Freedom ( or liberty) to stipulate provided not contrary to law, morals, good customs, public order, or public policy (b) Obligatory force and compliance in good faith (c) Perfection by mere consent as a rule (d) Both parties are mutually bound (e) Relatively ( Generally it is binding only between parties, their assigns, and heirs) The contracting parties may establish such stipulations, clauses, terms as they may deem convenient, provided they are not contrary to law, morals, good customs, public order, or public policy. (1306 NCC) The contracts must bind both contracting parties; its validity or compliance cannot be left to the will of one of them.(1308 NCC) stipulates that contract takes effect only between the parties, their assigns and heirs.(1311 NCC) any third person who induces another to violate his contract shall be liable for damages to the other contracting party. Contracts are perfected by mere consent and from that moment the parties are bound not only to the fulfillment of what has been expressly stipulated but also to all the consequences which, according to their nature, may be in keeping with faith, usage and the law. (1315 NCC)

ESSENTIAL REQUISITES OF A CONTRACT There is no contract unless the following requisites concur: 1. CONSENT 2. OBJECT certain which is the subject matter of the contract 3. CAUSE of the obligation which is established CONSENT is manifested by the meeting of the offer and the acceptance upon the thing and the cause which are to constitute the contract. Consent must be given freely and voluntarily Consent must be given by a capacitated person Consent must not be vitiated Under the 1987 Constitution, the age of majority is now fixed at 18 years old. This is now the legal age where a person can sign or give consent to contracts or any valid legal acts. Thus, by this provision of the constitution, there are no more emancipated minors who can give consent in the Philippines. Insane or demented persons, and deaf-mutes who do not know how to write cannot give consent. Contracts entered into during lucid intervals are valid Contracts agreed to in a state of drunkenness or during hypnotic spell are voidable A contract where consent is given through mistake, violence, intimidation, undue influence, or fraud is voidable. There is violence when in order to wrest consent, serious or irresistible force is employed. There is intimidation when one of the contracting parties is compelled by a reasonable and well grounded fear of an imminent and grave evil upon his person or property, or upon the person or property of his spouse, descendants or ascendants, to give his consent. There is undue influence when a person takes improper advantage of his power over the will of another, depriving the latter of a reasonable freedom of choice. There is fraud when, through insidious words or machinations of one of the contracting parties, the other is induced to enter into a contract which, without them, he would not have agreed to. OBJECT of contracts are all things which are not outside the commerce of men, including future things All rights which are not intransmissible may also be the object of contracts All services which are not contrary to law, morals, good customs, public order, or public policy may likewise be the object of contract. Impossible things or services cannot be the object of contracts. The object of the contract must be determinate as to its kind

FORMS OF CONTRACT. (1356 NCC) Contracts shall be obligatory, in whatever form they may have been entered into, provided all the essential requisites for their validity are present However, there are times when the law requires that a contract be in some form in order to be valid or enforceable. The following are void or inexistent contracts:

1. When the cause, object or purpose of the contract is contrary to law, morals, good customs, public order, or public policy 2. When the contract is absolutely simulated or fictitious 3. When the cause or object of the contract did not exist at the time of the making of the contract 4. If the object of the contract is outside the commerce of men 5. If the contract contemplates or intends a performance of an impossible service 6. If the intention of the contracting parties cannot be ascertained 7. If the contract is expressly prohibited by law or declared by laws as invalid or ineffective Voidable contracts are valid contracts until annulled by a competent court The action to annul voidable contracts shall be brought within four years. This period begins: In cases of intimidation, violence or undue influence, from the time the defect of the consent ceases.

NURSES AND WILLS

SUCCESSION is a mode of acquisition by virtue of which property, rights, and obligations to the extent of the value of the inheritance, of a person are transmitted through his death to another or others either by his will or by operation of law. (774 NCC) DECEDENT is the general term applied to the person whose property is transmitted through succession, whether or not he left a will. If he left a will, he is also called the testator. TESTATOR a male decedent DEVISEE is a person to whom a gift of real property (eg. Land, house) is given by virtue of a will LEGATEE is a person whom a gift of personal property (eg. Money, Jewelry) is given by virtue of a will The inheritance includes all property, rights and obligations which are not extinguished by his death The rights to succession are transmitted from the moment of death of the decedent. An HEIR is a person called to succession either by the provision of a will or by operation of the law.

WIILL is an act whereby a person is permitted, with the formalities prescribed by law, to control to a certain degree the disposition of his estate, to take effect after his death. The making of a will is strictly personal act; it cannot be left in whole or in part to the discretion of a third person, or accomplished through the instrumentality of an agent or attorney. All persons who are not expressly prohibited by law may make a will Persons of either sex under eighteen years of age cannot make a will

In order to make a will it is essential that the testator be of sound mind at the time of its execution.

To be of sound mind, it is not necessary that the testator be in full possession of all his reasoning faculties, or that his mind be wholly unbroken, unimpaired, or unshattered by disease, injury or other cause. It shall be sufficient if the testator was able at the time of making the will to know the nature of the estate to be disposed of, the proper objects of his bounty, and the character of the testamentary act.

The law presumes that every person is of sound mind Testamentary Capacity is the capacity to comprehend the nature of the transaction in which the testator is engaged at the time to recollect the property disposed of and the persons who would naturally be supposed to have claims upon the testator and to comprehend the manner in which the instrument will distribute his property among the objects of his bounty.

a married woman may make a will without the consent of her husband, and without the authority of the court

a married woman may dispose by will of all her separate property as well as her share of the conjugal partnership or absolute community property.(802 NCC)

Every Will must be in writing and executed in a language or dialect known to the testator(803 NCC)

NOTARIAL WILL is a will that must be signed by the testator or if written by some other person, it must be done in his presence and under his express direction

A notarial will or an ordinary will must be subscribed and attested by three or more credible witnesses

A notarial will must be acknowledged before a notary public If the testator be deaf, or a deaf-mute he must personally read the will if he is able to do so; otherwise, he must designate two persons to read it and communicate to him in some practicable manner its contents. If the testator is blind, the will must be read to him twice; once, by one of the subscribing witnesses and again, by the notary public before whom the will is acknowledged.

The requirement of the will must be in writing but it does not mean that the testator must himself perform the mechanical work of writing the will, except in the case of a holographic will, which must be entirely written, dated and signed by the hand of the testator himself.

The requirement that the testator must sign the will is satisfied by the use of his thumb mark, the sign of the cross, or the initials or portion of the name of the testator.

Where the testator directs another person to sign his name, it is essential that the person so directed write the testators name; it is not sufficient for the other to write his name only.

HOLOGRAPHIC WILL is a will entirely written dated and signed by the testator Any person of sound mind and of the age of eighteen years or more, and not blind, deaf or dumb, and able to read and write, may be a witness to the execution of a will.

The following are disqualified from being witnesses to a will: (1) any person not domiciled in the Philippines (2) Those who have been convicted of falsification of a document, perjury or false testimony A will may be revoked by the testator at any time before his death. Any waiver or restriction of this right is void

The following Will shall be disallowed in any of the following cases:

(1) If the formalities required by law have not been complied with; (2) If the Testator was insane, or otherwise mentally incapable of making a will, at the time of its execution (3) If it was executed by undue through force or under duress, or the influence of fear, or threats; (4) If it was procured by undue and improper pressure and influence, on the part of the beneficiary or of some other person;

(5) If the signature of the testator was procured by fraud; (6) If the testator acted by mistake or did not intend that the instrument he signed should be his will at the time affixing his signature thereto.

The law provides for the following kinds of Will: (1) Ordinary or Notarial Will (2) Holographic will (3) Mixed will

NURSES AND CRIMINAL LAW Criminal law is that branch of law which defines crime and treats of their nature.

Ignorance of the law excuses no one from compliance therewith

Laws take effect after 15 days from the publication in the official gazette or any newspaper of national circulation. It serves as a constructive notice to all persons so that no one is exempted from complying with the law or to claim that he or she is ignorant from the passage of that law.

The power to define and punish an act is within the powers of the Legislative Department (House of Congress) where the legislative power is vested in the fundamental law and has the power to define and punish an act or omissions as a crime. The Chief Executive has also the prerogative.

Limitations in enacting Penal Laws

(1) Generality (2) Territoriality (3) Irretrospectivity or prospectivity

Limitations in enacting Penal Laws

(1) it cannot enact an ex post facto law nor a bill of attainder (2) it must be of general application (3) it cannot provide for a cruel, degrading or inhuman punishment nor can it impose excessive fines.

Theories of Criminal Law

(1) Classical Theory

a.

man is essentially a moral creature with an absolutely free will to choose between good and evil and therefore more stress is placed upon the result of the felonious act

b. Basic criminal liability is human free will and the purpose of penalty is retribution. c. Crime is a juridical entity and penalty is an evil and a means of juridical tutelage

(2) Positivist Theory Man is subdued occasionally by strange and morbid phenomenon which conditions him to do wrong in spite of or contrary to his volition. The basis of criminal responsibility of the criminal is his dreadfulness or dangerous state.

The major source of our criminal law is Act # 3815 otherwise known as the Revised Penal Code of the Philippines that took effect on January 1, 1932.

Crime consists of internal and external acts. Internal acts are not punished in our jurisdiction.

Voluntariness is an element of felony because if an act is committed or performed with deliberate intent then it implies that the act is voluntary or freely committed.

Felony is an act or omission punishable by the law A felony may be committed by means of DOLO (deceit) or CULPA (fault) The distinction of dolo and culpa: while both are voluntary, dolo is intentional, whereas culpa is not. Where there is intent there can be no negligence. In culpable felonies, intent is replaced by fault.

Dolo (deceit) involves malice or deliberate intent; culpa (fault) results from negligence , imprudence, lack of foresight or lack of skill.

Imprudence is deficiency in action Negligence is deficiency of perception. Negligent act must be voluntary- example ( an incidental dropping of pistol and fired and hit someone, there is no liability )

Elements of Dolo: (1) Freedom (2) Intelligence (3) Intent

Elements of Culpa:

(1) Freedom (2) Intelligence (3) Negligence or imprudence

Intelligence is the moral capacity to determine what is right from what is wrong and to realize the consequences of ones acts.

Intent is a mental state, the existence of which is shown by the overt acts of a person. A crime may be committed without criminal intent by means of culpa and offenses punishable by special laws.

Criminal liability shall be incurred by any person committing a felony although the wrongful act done be different from that which he intended. By any person performing an act which would be an offense against persons or property, were it not the inherent impossibility of its accomplishment or on account of the employment or inadequate or ineffectual means.

STAGES OF FELONY (1) Consummated all elements necessary for execution and accomplishment are pesent. (2) Frustrated the offender has performed all the acts of execution to produce the felony as a consequence but the crime does not result due to some cause independent of the will of the offender. (3) Attempted the offender begins the commission of the felony by direct overt acts but does not perform all the acts of execution which should produce the felony as a consequence by reason of some cause or accident other than his own spontaneous desistance

SUBJECTIVE & OBJECTIVE PHASE OF FELONY: The subjective phase is that portion of execution of the crime starting from the point where he still has the control of his acts. If it reaches the point where he has no more control over his acts, the subjective phase has passed. If the subjective phase is not yet passed, the felony would be mere attempt. If it has already passed but the felony is not yet produced, as a rule it is frustrated.

Objective phase is the result of the acts of execution that is the accomplishment of crime. Consummated.

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY (1) Justifying Circumstance the acts of the actor are in accordance with the law , hence he incurs no criminal and civil liability ( no crime, no criminal). (2) Exempting Circumstance those wherein there is an absence in the agent of the crime any of all the conditions that would make an act voluntary and hence, although there is no criminal liability, there is civil liability ( no criminal but there is crime ). (3) Mitigating Circumstances those that have the effect of reducing the penalty due to the lesser perversity of the offender. (4) Aggravating Circumstance those which increases the penalty. (5) Alternative Circumstance either aggravating or mitigating depending on the facts of the situation.

JUSTIFYING CIRCUMSTANCES: (1) Self- defense (2) Defense of Relative (3) Defense of stranger (4) State of necessity (5) Fulfillment of duty (6) Obedience to superior order

EXEMPTING CIRCUMSTANCE (1) Imbecility and Insanity (2) Minority (3) Accident (4) Compulsion of Irresistible force (5) Lawful causes (6) Instigation and entrapment

MITIGATING CIRCUMSTANCES (1) Passion or obfuscation (2) Voluntary Surrender (3) Voluntary plea of guilty (4) Deaf, and dumb, blind (5) Illness that diminishes the exercise of will power (6) Lack of instruction (7) Incomplete self-defense (8) Offender is below 18 or over 70 years old (9) When the act is committed in the immediate vindication of a grave offense

AGGRAVATING CIRCUMSTANCES (1) Taking advantage of official position

(2) Crime is committed in contempt of or with insult to public authorities (3) Crime committed with insult or disregard due to offended by age, sex or rank (4) Crime is committed in the dwelling of the offended (5) Abuse of confidence or obvious ungratefulness (6) Nighttime (7) Band (8) Uninhabited place (9) Crime committed during calamity (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) Recedivism Habituality Crime committed in consideration of price, promise or reward. By means of fire,explosion,poison and stranding of a vessel Evident premeditation Craft, fraud or disguise is employed Advantage taken of superior strength Means employed to weaken defense Treachery Adds ignominy to the natural effects of the crime Unlawful entry

ALTERNATIVE CIRCUMSTANCE (1) degree of relationship (2) intoxication

(3) illiteracy or lack of education

* CLASSIFICATION OF FELONIES (1) grave (2) less grave (3) light felonies

PERSONS CRIMINALLY LIABLE FOR FELONIES


When several persons take part in the commission of a crime it does not necessarily follow that their participation in it is equal. Some may have a greater or more important in it than others. Consequently, their liability also varies according to the position they occupy in the commission of the felony, that is, whether they are principals, accomplices, or accessories

This classification of offenders does not apply when there is conspiracy to commit a crime because of the rule that the act of one is the act of all.

A Juridical person cannot be punished like a natural person because they are only acting through their officers, generally, an officer of a corporation who commits a violation is the one criminally liable.

1. (Art. 16) The following are criminally liable for grave and less grave felonies: a. principal b. accomplice c. accessories for light felonies: a. principals b. accomplices

2. The following are considered Principals (Art. 17) : a. those who take a direct part in the execution of the act; *to be considered as a principal by direct participation, it is essential that the offender (a) participated in the criminal resolution as shown by his prior or simultaneous acts (b) carried out the plan and personally took part in its execution, and (c) performed acts tending directly to the same end. Accordingly, if he was not present at the scene of the crime, he cannot be deemed to be a principal by direct participation.

b. those who directly force or induce others to commit it; * Principal by inducement presupposes that the offender himself is determined to commit the felony; he must have persistently clung to his determination; he offers the strongest of temptations sufficient to induce the commission or exercises ascendancy to compel obedience and the inducement must be the determining cause for the commission of the crime. Where the inducer only made remarks or gave an order after the fatal blow had been struck, he cannot be punished as a principal by inducement.

c. those who cooperate in the commission of the offense by another act without which it would not have been accomplished; * principal by indispensable cooperation must have concurred in the criminal resolution and cooperated by performing another act indispensable for the commission of the felony agreed upon. His cooperation is similar to that of an accomplice but is of greater degree because of its indispensability to the accomplishment of the offenders objective, while that of an accomplice is of a lesser and minor importance.

3. Accomplices (Art. 18) - are those persons who, not being included in article 17, cooperate in the execution of the offense by previous or simultaneous acts * Under American law, accomplices are accessories before the fact * to be considered an accomplice, the offender must have known of the criminal design of the principal by direct participation and concurs therein. The acts of the accomplice should not produce the most serious effect on the victim, otherwise he will be a principal. The acts of an accomplice is similar to those of a principal by cooperation, but may be distinguished from the latter in that, although the acts of the accomplice are necessary for the commission of the crime, they are not indispensable. An example would be if a nurse agrees to prepare a 20 cc lethal drug to be used by the nurses friend on victim A and did inject a 10 cc killing victim A but the other 10

cc was injected on another victim B to which the nurse does not know about, the nurse cannot be held criminally liable to the second victim B but an accomplice to victim A only. 3. Accessories (Art. 19) are those who, having knowledge of the commission of the crime, and having participated therein, either as principals or accomplices, take part subsequent to its commission in any of the following manners: a. by profiting themselves or assisting the offender to profit by the effects of the crme. * the acts of an accessory are always performed after the commission of the crime by the principal and that the accessory had no participation therein in any form (accessory after the fact). An example is a daughter who stole an earrings and the mother pawned them, the mother is guilty as an accessory. b. by concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery. * The prescribed acts of the accessory must have been intended to prevent discovery of the crime , hence mere silence does not make one an accessory. The body of the crime is equivalent to the corpus delicti. c. by harboring , concealing, or assisting in the escape of the principal of the crime, provided the accessory acts with abuse of his public functions. * this provision distinguishes a person either as a public officer or a private individual. They may have different penalties.

NURSES AND CRIMES The professional practice of a nurse entails with it the legal responsibilities that he or she must know and understand in order to avoid liabilities in the discharge of her functions.

The following are crimes that a nurse must be familiar with: ASSAULT An unlawful attempt or offer to beat or to do bodily injury to another. BATTERY The unlawful beating or touching of another person. The unlawful beating or use of force upon a person without his consent.

MURDER is the unlawful killing of a human being by another with intent to kill (DOLO is an element). HOMICIDE is the killing of a human being by another without deliberate intent to kill. ABORTION Termination or expulsion of the product of conception even before the age of viability. Abortion is a crime penalized in our jurisdiction. A nurse who advises a woman on what drugs to take is criminally liable. INFANTICIDE - killing of a child less than three days of age. PARRICIDE is committed by one who kills his/her father, mother or child whether legitimate or illegitimate, or any of his/her ascendants or his/her espouse. SEXUAL HARASSMENT is committed by a person who, having authority, influence or moral ascendancy over another in a work, training or education environment, demands, requests or otherwise requires any sexual favor from the other regardless of whether such demand, request or requirement for submission is accepted. ILLEGAL DETENTION any private individual who shall detain another or, in any other manner, deprive him of his liberty. ARBITRARY DETENTION any person in authority (public officer) who shall detain another or, in any other manner, deprive him of his liberty. SIMULATION OF BIRTH any person who shall substitute one child for another or who shall conceal or abandon any legitimate child with intent to cause such child to lose its civil status.

CRIMINAL NEGLIGENCE is negligence of such character or occurring under such circumstances, as to be punishable as a crime by statute. PROFESSIONAL NEGLIGENCE breach of professional duty. Negligence committed in the practice of a profession. NEGLIGENCE - is often referred to as that doing of a thing which a reasonably prudent man would not have done and not doing a thing which a reasonably prudent man would have done. It also refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would do or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property The elements of professional negligence are:

(1) existence of a duty on the part of the person charged to use due care under circumstances

(2) failure to observe such duty (3) such failure resulted to injury or harm The test for negligence: would a prudent man, in the position of the person to whom negligence is attributed, foresee harm to the person to whom negligence is attributed, foresee harm to the person injured as a reasonable consequence of the course about to be pursued; if so, the law imposes a duty on the actor to refrain from that course or to take precaution against its mischievous results, and the failure to do so constitutes negligence. Reasonable foresight of the harm and ignoring such foresight is constitutive fact in negligence. If such negligence is the proximate cause of the injury or harm, then the person causing such negligence is liable for damages under the law A failure of the nurse to apprise or report to the physician his/her observation like sudden increase in BP or sudden drop of vitals signs and such failure to report resulted to the death or injury to the patient, then the nurse is liable for negligence. Observance of the standard of care as prescribed by RA 9173 is the only for nurses to avoid negligence/malpractice suits in the practice of their profession in the Philippines. Wrong medication or wrong drug given to another patient constitute negligence on the part of the nurse

MALPRACTICE - refers to a negligent act committed in the course of professional performance. Any professional misconduct, unreasonable lack of skill or fidelity in professional or fiduciary duties; evil practice; or illegal or immoral conduct; improper discharge of professional duties, or failure to meet the standard of care of a professional which results in harm to another. - to go beyond the practice of nursing as prescribed by RA 9173, like for example, the nurse suturing in a surgical procedure without special training or the nurse prescribing medicine or drugs, is malpractice. It means encroaching on the practice of other profession where the nurse is not supposed to perform as prescribe by the law. Negligence is malpractice Malpractice is determined if the nurse owed a duty to the client and did not carry out the duty, and the client was injured because the nurse failed to perform the duty. If a nurse gives care that does meet appropriate standards, he or she may be held liable for negligence.

Negligence encompasses (includes) the concepts of foreseeability of harm to the person injured and of a duty of care toward that person. Article 20 of the New Civil Code of the Philippines provides that every person who, contrary to law, willfully or negligently causes damage to another shall indemnify the latter for the same. This means that negligent acts resulting to injuries must be indemnified in monetary terms. INCOMPETENCE- is the lack of ability, legal qualifications or fitness to discharge the required duty. Incompetence is now included as a ground for revocation/suspension of the certificate of registration as a nurse.

DOCTRINE OF RES IPSA LOQUITOR it literally means, let the thing speak for itself. This is a legal doctrine usually used in litigations involving negligence or malpractice suits. If the plaintiff (the one bringing an action in court) offers such evidence under this doctrine, then no other evidence is necessary. An example would be sponges left inside the abdomen of the patient after surgery the fact that there is the sponge left is evidence by itself that can speak that negligence was indeed committed and the court may no longer ask for other evidence to prove the occurrence of such negligence. There are three conditions for the application of this doctrine: (1) the accident must be of a kind which ordinarily does not occur in the absence of someones negligence (2) the accident must be caused by an agency or instrumentality within the exclusive control of the defendant ( one being sued in a civil case) (3) the accident must not have been due to any voluntary action or contribution on the part of the plaintiff ( injured party )

DOCTRINE OF RESPONDEAT SUPERIOR it means let the master answer; let the principal answer for the acts of his agent. Respondent superior simply provides that where one acts through the agency of another , then , in the contemplation of the law , he is himself acting so as to make him responsible for the acts of his servant. This doctrine is founded on the principle that he who expects to derive advantage from an act which is done by another must answer for any injury which a third person may sustain from it. Masterservant or employer-employee relationship must exist for this doctrine to apply. DOCTRINE OF FORCE MAJEURE vis major, an act of God, irresistible force, one that is unforeseen, inevitable. Natural calamities like strong typhoons or floods that would deter the nurse to report for duty in the hospital for her shift is an example of this doctrine. Even if the hospital needs her to report or some untoward incidents happened in the hospital, which would not happen if the nurse were there does not constitute any liability on the part of the nurse because of this doctrine.

NURSE AS A WITNESS Any information obtained in the course of caring for the patient by the health team ( doctor, nurses, medtechs) or any matters communicated by the patient to the nurse is considered privilege. The nurse cannot testify in a civil case for any privilege communication except when the patient allows such testimony or the patient himself offered such information first in a court hearing or when the health of the many will be jeopardized. This seal of secrecy will remain forever until removed by the patient. However, any privileged communication may be divulged in a criminal proceeding even without the consent of the patient where such information was obtained. LIABILITY FOR FALSE TESTIMONY any person who shall give false testimony in any criminal case, either against or in favor of the defendant, shall be liable to punishment as provided by the law. The punishment, depending on the case, ranges from imprisonment to paying fines and/or both. The nurse can commit this violation if he/she is negligent on charting or erroneously altering her entry in the charts. The hospital records, even if the patient was already discharged are part of public documents, which can be summoned in any court hearing should the need arises. Most of the time, it is the record custodian of the institutions who is given the subpoena duces tecum or subpoena ad testificandum by the court. However, the nurses who made the entries in the chart, if clarification is needed may also be summoned to appear in a court hearing through the service of subpoena. A patients chart that is correctly and accurately accomplished is not only valuable as evidence in legal proceedings but also useful as guide in the proper treatment of the patient. Doctors Orders as mandated by law, nurses must execute such orders for the treatment of the patient, deviation or failure to perform this lawful duty can make the nurse criminally and civilly liable and her license may be revoked or suspended. The nurse must exercise certain degree of judgment in carrying out the doctors order. If in the assessment of the nurse that such order may cause some injury to the patient, then she is morally obligated to verify such orders before carrying them out. The verification must be made to the person giving such order. The nurse must be assertive enough to protect the welfare of the patient (stewardship) and also to protect his/her professional career from lawsuits arising from erroneous carrying out of doctors orders. Should the doctor insist in carrying out a questionable order, the nurse must refer the matter to her immediate superior and must properly document the actions taken. Telephone Orders the following guidelines may be observed in carrying out orders of the physician given through telephone: a. the nurse must chart the date and exact time when the order was given b. the nurse must repeat and record the telephone order c. the nurse must sign the order; begin with t.o. (telephone order) write the doctors name, and then signature the order d. if another nurse witnessed the order, then her signature must also follow

e. if another physician or intern or resident is present in the station where such order was given, then it is prudent that the phone call is given to that doctor so they can discuss the order properly and that doctor can sign the orders given in a telephone. f. The physician must sign the telephone order as soon as he is around or within 24 hours depending on the policy of the hospitals. Reporting Responsibilities the nurse are required to report certain communicable diseases or criminal activities such as abuse, gunshot wounds, assaults, homicides, and suicides to the appropriate authorities. Incidental Report the nurse must write incidental report to protect themselves from sanctions. The matters that must be reported are those that deviate from the norms or standard in the performance of their duties. This is also done so that proper remedy can be reached in a given crisis or situation. The report must always be addressed to the immediate superior or proper authorities ( eg. DSWD,PNP,RITM etc). Charting Done by students the clinical instructor or the nurse on duty must sign the charting done by the student as required by RA 9173. Those persons signing such charting attests that the charting made by the student are accurate and authentic and consequently takes or assumes the responsibility from that charting.

PROFESSIONAL ADJUSTMENTS ( the concepts of professional adjustment are discussed in this reviewer according to the format prepared by the Professional Regulation Commission as given by the Board of Nursing.)
* PROFESSIONAL ADJUSTMENT - means the preparation of a student nurse for the responsibilities of professional and social life, by the development of her capacities in a way that would make her fit to enter upon the practice of nursing. Being a nurse means more than just doing a good job; it means involving ones self in the pressing health problems of the community; it means listening, understanding, communicating, and working with others whose life styles, beliefs, morals, values and culture may differ from those of the nurse. ( robles,183) * HOLD-OVER DOCTRINE simply requires those who have been appointed to continue serving or holding their position even if their terms has already lapsed, until such time that their successor or replacement shall have qualified and appointed. Under RA 9173, members of the

Board of Nursing are appointed by the President of the Philippines and confirmed by the Commission on Appointments. Members of the Board of Nursing may be appointed by: (1) Regular appointment. The Philippine Nurses Association certifies for the Appointment to the Board of Nursing from the three (3) nominees per vacancy and the Board shall endorse two (2) nominees per vacancy to the President. (2) Ad interim Appointment A board member is appointed in the meantime to fill in a vacancy or perform the duties of an office during the absence of the regular incumbent. There is no definite term of appointment.