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NURSING

JURISPRUDENCE
NURSING JURISPRUDENCE
 department of law which
comprise all legal rules and
principles affecting the practice
of nursing.

NURSING LEGISLATION
 the making of laws, or the body
of laws already affecting the
practice of nursing.
LAW
 a rule of civil conduct
prescribed by the supreme
power in a state commanding
what is right and prohibiting
what is wrong.
 Sum total of rules and
regulations by which society is
governed
TYPES OF LAW
 PRIVATE OR CIVIL LAW
body of law that deals with
relationship among private
individuals
 PUBLIC LAW
body of law for the welfare of
the general public; relationship
between individuals and the
government and government
agencies
COURT
 An agency in the government
wherein the administration of
justice is delegated.

LEGAL RIGHT
 a claim which can be enforced
by legal means against a
person whose duty is to
respect it.
COURT MECHANISM

LAWSUIT- proceeding in court


for a purpose.

Purpose:
Enforce a right
Redress a wrong
QUESTION
 If you think that a person has done
something seriously wrong to you, the
correct action to do get redress for the
injury received is to:
A. systematically plan on how to have a
vindication for the damage done
B. file a lawsuit against the person for
damage
C. hire someone to take revenge for you
D. nothing, just forget about it
PARTIES TO A CASE
 Complainant VS Defendant:
Civil case
 Plaintiff VS Accused: Criminal
case
 Witness- an individual held upon
to give necessary details either
for the accused or against the
accused
QUESTION

 The person who institutes legal


proceeding is called:

A. Plaintiff
B. Respondent
C. Defendant
D. Accused
QUESTION

 It is promulgated for the


common good by one who has
legitimate authority:
A. Jurisprudence
B. Dilemma
C. Law
D. Ethics
QUESTION

 A hospital filed a case of


damages against a nurse for
breach of contract. Who is the
nurse in the case?
A. complainant
B. accused
C. defendant
D. plaintiff
STATUTE OF LIMITATIONS

 Refers to the length of time


following the event during which
the plaintiff may file a suit.
 Example:
negligence- filed within 2-3
years from occurrence.
DUE PROCESS
 A fair and orderly process which aims
to protect and enforce a person’s
right.
FUNDAMENTAL REQUIREMENTS
OF DUE PROCESS:
1. Right to be informed
2. Right to remain silent
3. Right to competent counsel
4. No use of violence, threat, torture
5. Right to know the witness face to
face
PHASES OF DUE PROCESS

 PRE-TRIAL- eliminate matters


not in dispute, agree on issues
or settle procedural matters.

 TRIAL- facts are presented and


determined; law applied at the
end.
WRITTEN ORDERS OF
COURT
 WRIT- legal notes from court
 SUBPOENA- an order in court
 Duces tecum (papers) bring
documents, objects, materials, chart
to court
 Ad testificandum (person) testify as
witness at a specified time and place
 SUMMON- a writ commanding an
authorized person to notify a party to
appear in court to answer a complaint
made against him.
 WARRANT- a writing from a
competent authority in pursuance of
law, directing the doing of an act
addressed to a person competent to
do it

 Warrant of arrest- a court order to


arrest or detain a person
 Search warrant- a court order to
search for properties
QUESTION
 A process whereby the BON only
compel the personal attendance of a
witness to bring with him to the court
books, papers and the like to
elucidate the matters in issue:
A. Warrant
B. Subpoena
C. Subpoena duces tecum
D. Summons
LAWS THAT PROMOTE THE
WELFARE AND WELL-BElNG
OF NURSES
 P.D. 442- Labor Code
Defines among other things, hours of
work, contract and nurse staffing in
industrial clinics
 P.D. 807- Civil Service Law
Provide for the recruitment and
selection of employees in government
service; qualification standards;
personnel evaluation system; and
personnel discipline
 R.A. 7305- Magna Carta for Public
Health Workers
Has provisions on benefits, rights and
responsibilities of public health
workers
 R.A. 8344 “No Deposit Policy”
Prohibits hospitals and clinics from
demanding advance payments/cash
deposits before patients are admitted
or treated
LEGAL CONCEPTS AND
ISSUES IN NURSING
 LIABILITY: is an obligation or debt
that can be enforced by law
A person who is liable for malpractice
is usually required to pay for
damages.
 DAMAGES: refer to compensation in
money recoverable for a loss of
damage
PROFESSIONAL
NEGLIGENCE
 Negligence – failure to do
something which a reasonable
& prudent person should have
done.
 2 types:
1. Commission – wrong doing
2. Omission – total neglect of
care – didn’t do anything
ELEMENTS OF
NEGLIGENCE
 4D’S
Duty for nurse
Dereliction (breach of duty)
Damages as result
Direct result (injury, harm or
death)
OR…

An injury incurred within the


Breadth of duty of the nurse
where
Cause of injury is the failure to
perform the
Duty!
SPECIFIC EXAMPLES
 Burns resulting from hot water bags, heat
lamps, vaporizers, sitz bath
 Objects left inside the patient’s body;
sponges suction tips
 Falls of the elderly, confused, unconscious,
sedated patients
 Falls of children whose bed rails were not
pulled up and locked
 Mistaken identity- drug given to the wrong
patient
 Wrong medicine, wrong concentration,
wrong route, wrong dose
 Defects in the equipment
QUESTION
 Which of the following situations would
possibly cause a nurse to be sued due to
negligence?
A. Nurse gave a client wrong medication,
and an hour later, client complained of
dyspnea
B. While preparing a medication, the nurse
notices that instead of 1 tablet, she put two
tablets into the client’s medicine cup
C. As the nurse was about to administer
medication, the client questioned why the
medication is still given when in fact the
physician discontinued it.
D. Nurse administered 2 tablets of
analgesic instead of 1 tablet as prescribed.
Patient noticed the error and complained.
QUESTION
 Wilfred, 30 years old male, was brought to the
hospital due to injuries sustained from a
vehicular accident. While being transported to
the X-ray department, the straps accidentally
broke and the client fell to the floor hitting to
his head. In this situation, the nurse is:
A. not responsible because of the doctrine of
respondent superior
B. free from any negligence that caused harm
to pt.
C. liable along with the employer for the use of
a defective equipment that harms the client
D. totally responsible for the negligence
QUESTION
 Which of the following statements if made by
the nurse, would you consider him/her as a
prudent nurse?
A. careful giving of medication in a central
line
B. very cautiously asks supervision all the
time
C. follows the doctor’s order even when she
thinks it is wrong
D. questions wrong order of the doctor
QUESTION
 Which of the following actions by a
nurse would be considered
negligence?
A. Playing cards with an 8 y/o boy
with diabetes
B. Instructing a 6 y/o asthmatic to
blow on a pin wheel
C. Massaging the abdomen of a 5
y/o with Wilm’s tumor
D. Obtaining a blood test on a 6 day
old infant
QUESTION
 A nurse may be found negligent if:
1. a patient is injured
2. the nurse did not follow the
standard
3. failure to do the duty
4. the injury incurred by the pt. is
foreseeable
A. 1,2,3 C. 1,2,4
B. All of the above D. 2,3,4
QUESTION
 Monica shared with the interviewer
her most recent experiences about a
restless pediatric patient whom she
puts up the side rails of the bed to
prevent accidental falls. Which of the
following attributes is shown by
Monica?
A. Resourcefulness
B. Prudence
C. Honesty
D. Reliability
DOCTRINES OF
NEGLIGENCE
1. RES IPSA LOQUITOR
- “the things speak for itself”
- the injury is enough proof of
negligence
2. RESPONDEAT SUPERIOR
- Let the master answer for the acts
of the subordinate
- The liability is expanded to
include the master as well as the
employee
3. FORCE MAJEURE
- Irresistible force; unforeseen or
inevitable event
- No person shall be responsible for
those events which cannot be
foreseen
Ex. Flood, fire, earthquake

 INCOMPETENCE: lack of ability,


legal qualifications or fitness to
discharge the required duty
QUESTION
 One of the important conditions
that must be present in a negligent
act to be considered as force
majeure is:
A. The nurse is unable to predict the
possible occurrence of the action
hence, she cant prevent it
B. The injury is within the domain of
nursing practice
C. The patient did not voluntarily
participate in the action
D. The superior is also accountable for
the action
QUESTION
 When a staff nurse gives the wrong
medication to her patient, the head
nurse and supervisor are also
made responsible for the error.
This is based on what doctrine?
A. Respondent superior

B. Good Samaritan Act

C. Res ipsa loquitur

D. Force majeure
QUESTION
 When a nurse causes an injury
to the patient and the injury
caused becomes the proof of
the negligent act, the presence
of the injury is said to exemplify
the principle of:
A. Force majeure
B. Respondeat superior
C. Res ipsa loquitur
D. Holdover doctrine
MALPRACTICE
 Doing acts or conducts that are not
authorized or licensed or competent
or skilled to perform, resulting to
injuries or non-injurious
consequences
 Stepping beyond one’s authority
 Negligent act committed in the
course of professional performance
 RN exceeding the scope of nursing
practice & does an MD’s job.
ELEMENTS OF
MALPRACTICE

Duty of the nurse


Dereliction or breach of duty
Direct result (injury or harm)
Damages
Exceeds the limits of the
standards of care
Foreseability of harm
MEDICATIONS &
PRESCRIPTIONS
1. Only registered medical, dental and
veterinary practitioners are
authorized to prescribe drugs.
2. Prescription information (based on
R.A. 5921 of the Pharmacy Act)- all
prescriptions must contain the
following information:
 Name of MD, PTR, PRC#, location of
clinic/ hospital
 Name of patient, age, sex
 Information about drug – frequency
duration
 Generic & brand name in prescription
R.A. 6675- Generics Act of 1988
 All prescribed drug must be written in generic and
brand names or generic name but never the
brand name alone
 Purpose: for the pt. to choose what brand they
want

3. Know rights in giving meds


4. Proper identification of pt’s name
5. In cases of doubts and errors in medication,
refer to the physician.
6. Special training is required before a nurse
can administer IV injection.
BON Resolution No. 8 states that who
administers IV injection without training shall
be held liable whether causing or not an
injury or death to the patient)
7. Verbal or telephone order
General rule: as possible avoid T.O.
“whatever is not written is not an order”
Exception: During extreme emergency only!

What to do?
7. Nurse should read back such order to the
physician to make certain the order has
been correctly written.
8. Such order should be signed by the
physician within 24 hours.
9. The nurse should sign the physician’s
name per her own and note the time and
order was received.
QUESTION
 A telephone order is given for a client in
your ward. What is your most appropriate
action?
A. Copy the order on to the chart and sign
the physician’s name as close to his
original signature as possible
B. Repeat the order back to the physician,
copy onto the order sheet and indicate that
it is a telephone order
C. Write the order in the client’s chart and
have the head nurse co-sign it
D. Tell the physician that you can not take
the order but you will call the nurse
supervisor
QUESTION
 In an extreme situation and
when no other resident or intern
is available, should a nurse
receive telephone orders, the
order has to be correctly written
and signed by the physician
within:
A. 24 hours C. 48 hours
B. 36 hours D. 12 hours
INTENTIONAL WRONGS
 TORTS: A legal wrong,
committed against a person or
property

TYPES:
1. Unintentional- do not require
intent but do require the element
of harm.
Ex. Negligence and malpractice
2. Intentional- the act was done
on purpose or with intent; no
harm, injury or damage is
needed to be liable.

C.ASSAULT AND BATTERY


ASSAULT- an attempt or threat to
touch another person
unjustifiably; mental or
physical threat
Ex.- forcing a pt. to take his
medication or treatment
BATTERY- physical harm through
willful touching of person or clothing
without consent.
Ex. – giving of injection without pt’s
consent

2. FALSE IMPRISONMENT
- Unjustifiable detention of a person
without a legal warrant
- occurs when the person is not
allowed to leave a health care facility
when there is no legal justification to
detain the client.
- occurs when restraining devices
are used without an appropriate
clinical need.
3. INVASION OF PRIVACY
 Right to privacy is the right to be
left alone
 Right to be free from unwarranted
publicity
 Exposure to public view

 Divulge information from patient’s


chart to improper sources or
unauthorized person
 PRIVILEGED COMMUNICATION:
Statements uttered in good faith; not
permitted to be divulged in court of
justice
Exceptions: Confidential
information can be revealed!

Pt. consent, if there is


Inform HCT for precautionary
measures
Crimes, child abuse, BWS
Communicable disease- R.A.
3573 (Law on Notifiable
Diseases)
Ethics
4. DEFAMATION
 Character assassination
 There must be a third person who
hears or read the comment before it
can be considered defamation

TYPES:
 Slander-oral defamation

 Libel-written words
QUESTION
 The nurse writes the following
note in the client’s chart, “the
physician is incompetent
because he ordered the wrong
drug dosage.” This statement
may lead to a charge of:
A. Assault
B. Slander
C. Libel
D. Invasion of privacy
QUESTION

 Doing a nursing procedure


without the patient’s informed
consent may bring the health
professional to the court of law
for what violation?
A. Tort C. Negligence
B. Assault D. Battery
QUESTION
 Two janitors are having a heated
argument as to who shall dispose
the waste of a patient with typhoid
fever. The first one called the other
“lazybone” and “pain in the neck”
within the hearing of the rest of the
nurses. The case is:
A. Libel
B. Slander
C. Invasion of privacy
D. Negligence
QUESTION
 Allowing a person who is in no
way involved in the care of the
patient to read the patient’s
chart constitutes which of the
following violations:
A. Invasion of pt’s privacy
B. Breach of trust
C. Malpractice
D. Violation of pt’s dignity
QUESTION

 Which of the following persons


cannot have the access to the
patient record?
A. physical therapist
B. lawyer of the family
C. the patient
D. speech therapist
QUESTION

 It is unethical to tell one’s


friends and family members
data about the patient because
doing so is a violation of
patients’ rights to:
A. Informed consent
B. Confidentiality
C. Least restrictive environment
D. Civil liberty
QUESTION

 Should the accusation be


written in the newsletter of the
hospital, such liability is a/an:
A. Assault
B. Libel
C. Slander
D. Battery
QUESTION
 Confidentiality of patient’s identity
and condition is one of the nursing
responsibilities in the hospital.
Which of the following reasons can
information be given without patient
consent EXCEPT:
B. Patient is charged with a crime
C. Patient has a TB
D. Patient is a victim of child abuse
E. Patient with cancer
RESTRAINTS
 Restraints are protective devices
used to limit the physical activity of a
client or to immobilize a client or an
extremity.
TYPES:
 Physical restraints: restrict client’s
movement through the application of
a device
e.g. restraint jacket, straps,
 Chemical restraints: Medications
given to inhibit a specific behavior or
movement.
e.g. sedation, psychotrophic drug
RESTRAINTS SHOULD NOT
BE USED PRN!!!
R-equires physician’s order; consent
E-mergency, get MD’s order ASAP
S-hortest duration, least restrictive type
T-o protect pt. and others
R-enew order every 24 hours
A-ssess every 15 to 30 minutes and
document
I-ndividualized supervision
N-ever used as a punishment
T-otal documentation
S-eclusion as last step
ALTERNATIVES TO
RESTRAINTS
 Before restraints offer explanations, ask
someone to stay with the client, use clocks,
calendars, TV & radio (to decrease
disorientation) or any relaxation
techniques.
 Use LESS restrictive methods first.
RESTRAINTS should always be the last.
 Assign confuse and disoriented clients to
rooms near the nurse’s station.
 Maintain toileting routines & institute
exercise and ambulation schedules as the
client condition allows.
QUESTION
 The nurse noticed that restraining
patients is a common practice. Which of
the following should she remember?
A. Restraints are necessary so that the
nurse could do more work for patients
B. Use of restraints is an effective
intervention
C. Restraints require a physician’s
order
D. Refusal to be restrained is a ground
for terminating the nurse-patient
relationship
CRIMES & OTHER ACTS
 CRIME: An act committed or omitted
in violation of the law
Two elements:
 Criminal act
 Evil/criminal intent

 Criminal Actions
 Acts or offenses against public welfare
 Misdemeanor- offenses or acts less
than a felony
 Felony- a public offense committed with
deceit and fault
 Criminal negligence
 Reckless imprudence- person does an act
from which damage results immediately
 Simple imprudence- did not use
precaution and the damage was not
immediate

CLASSIFICATION
1. Manner of commission:
 Deceit (dolo) with criminal intent
 Fault (culpa) without; negligence
2. Stages of Execution
1. Consummated all elements
executed, with
successful result

2. Frustrated all elements


executed but no
successful result
3. Attempted not all elements
executed, no
successful result
3. Degree of penalty and fine
grave Capital above P6k
punishment or
>6yrs & 1 day
Less 1 month and 1 not > P 6 K
grave day to 6 years but not
<P200

Light 1 day to 30 fine not >


felony days P 200
4. Degree of participation
PRINCIPAL a. By direct participation- doer of
the act
Primary author
b. By inducement-directly force or
induce others
c. By cooperation- indispensable
ACCOMPLICE “cooperates before the fact”-
A person who absent at the time crime is
committed.
cooperates

ACCESSORY “cooperates after the fact”


Profits
Conceals/ destroys evidence
Assists in the escape of the
principal
QUESTION
 A crime can be committed with the
element of culpa if:
A. the person committed the crime
because of ignorance of the law
B. the person knows the action is a
crime and he chooses to do it
C. the person committed the crime
because he lacked the competency
to act correctly
D. all of these
QUESTION

 The nurse out of pity unhooked


the patient from a respirator.
The patient died after 15
minutes. This type of felony is:
A. Consummated
B. Frustrated
C. Attempted
D. Murder
QUESTION
 If the penalty is death, what is the
degree of the felony?
A. grave
B. less grave
C. light felony
D. none of the above
SITUATION
 Danaya is two-months pregnant. Her
parents do not know this. She
informed her friend Alena about the
problem. Alena then referred Danaya
to Pirena, an abortionist. Danaya
had an abortion.
 If those involved will be charge
legally, who is considered the
principal?
A. Pirena C. Alena
B. Dayana D. None of them
 If during the investigation, the pieces
of evidence were not found because
Gurna, the maid of Pirena burned it.
Gurna is considered as:
A. Accomplice
B. Accessory
C. Principal
D. Co-principal
QUESTION
 A nurse is liable as an accomplice
in an abortion if she;
A. Assist in the escape of the
offender
B. Refers the pregnant mother to
the abortionist
C. Conceals the evidence of the
crime
D. None of these
QUESTION

 A person uses the license of


another person to practice
nursing is liable for what?
A. negligence
B. malpractice
C. misdemeanor
D. invasion of privacy
QUESTION
 The receptionist of a clinic was
asked by police if a certain doctor
charged with murder was hiding in
the premises of the clinic. She lied
about it but unfortunately the doctor
was discovered inside the clinic.
She could be charged with:
B. Principal
C. Accessory
D. Accomplice
E. Assistant
Circumstances
affecting criminal
liability

J-E-M-A-A
JUSTIFYING
 SELF-DEFENSE
 Unlawful aggression
 Reasonable necessity
 Lack of sufficient provocation
 Fulfillment of Duty
 Obedience to an order from
superior
 Order must be lawful
 Superior acting within the
scope of practice
EXEMPTING
Insane/imbecile
Performance of a lawful act causes
injury by mere accident
Under 9 y/o
Under compulsion of uncontrollable
force
Under impulse of uncontrollable
fear
Failure to perform an act required
by law when prevented by some
lawful cause
MITIGATING
Under 18y/o or over 70 y/o
Under 18y/o or over 70 y/o
No intention to commit so grave a
wrong
Sufficient provocation/threat
preceding the act
Immediate vindication of a grave
offense
Voluntary surrender
Deaf & dumb/ with physical defect
Suffer from such illness that
diminishes willpower
AGGRAVATING
Treachery/taking advantage of
superior strength or position
Price, reward, promise
Use of fire, poison, explosion
Calamities
Craft, fraud or disguise employed
Evident Premeditation
Cruelty
ALTERNATIVE
 May increase/ decrease
criminal liability depending on
the nature and effects of the
crime
Relationship
Intoxication
Degree of instruction/
education
DRILLS

1. Under compulsion of
uncontrollable force
2. There is sufficient
provocation
3. Act is committed with abuse
of confidence
4. Fulfillment of a duty
5. Offender is over 70 years old
6. Voluntary surrender
7. Disguise in being employed
8. Defense of a stranger
9. Acts under the impulse of an
uncontrollable fear
10. Offender is insane
QUESTION

 Premeditating to commit a crime


is considered as:
A. justifying
B. mitigating
C. aggravating
D. exempting
QUESTION

 All of the following are


exempting circumstances
except:
A. Imbecile
B. 8 year old
C. performance of a lawful act
D. offender is deaf and dumb
QUESTION
 When a politician takes advantage
of his power in the performance of
unlawful actions, this is considered
as:
A. justifying circumstance
B. exempting circumstance
C. mitigating circumstance
D. aggravating circumstance
QUESTION

 When the defendant kills


someone accidentally:
A. justifying
B. exempting
C. aggravating
D. mitigating
CRIMES
CONCERNING
THE NURSE
MORAL TURPITUDE
 Are acts contrary to the accepted
and customary rule of right

1. Rape:
a.) Ordinary rape – forcible penetration of
sex organ to a sex organ
b.) Sexual assault – anything forcibly
inserted to any orifice.

 Intervention
Safety (emotional and physical)
Report the incidence
Referral (if the father is the rapist, refer to
DSWD)
ANTI- RAPE LAW (RA 8353)

R.A. 7877 – Anti-sexual Harassment Act


2. Any person who exercises authority
3. Asking sexual favors in exchange of
another favor
2.MURDER- killing of another with intent
3. HOMICIDE- unintentional killing of another
person

4. PARRICIDE
 Killing of a person to whom you have a
relationship
1. father
2. mother
3. brothers/sisters
4. ascendants
5. descendants
6. spouse
5. ABORTION- termination of product
of conception before the age of
viability.

6. INFANTICIDE
- the killing of an infant less than
three days or 72 hours.
7. ROBBERY
- Anyone who
gets the
personal
property of
another with the
use of
force,violence or
intimidation.

8. THEFT- -anyone who gets the


personal property of another without
the latter’s permission.
9. SIMULATION OF BIRTH
1. Pretend that a woman gave birth
2. Substitution or exchanging of babies
in the nursery
3. Intentionally putting wrong
information in the birth registration
form

P.D. 651 – Birth Registration Act - requires


any person (RN,OB, midwife) who shall
assist in giving birth to report within 30 days
without penalty any live birth at Local Civil
Registrar’s Office.
10. DISPENSING OF PROHIBITED
DRUGS
R.A. 6425 (1965) – Dangerous Drugs Act
A. Prohibited – chemicals or substances that
are totally and absolutely can’t be
consumed by human being.
Ex. Shabu, cocaine, cannabis

B. Regulated – can use this drug - with


appropriate prescription - MD with
appropriated license
Ex.- Valium, dormicum
PENALTY FOR VIOLATING
THE ACT

For licensed health care providers


Fines
Imprisonment
Automatic revocation of license
GUIDELINES TO PREVENT
CRIMINAL LIABILITY:

1. Be very familiar with the Philippine


Nursing law
2. Be familiar with the laws affecting
nursing practice
3. Know agency rules, regulations,
policies
4. Upgrade skills and competence
5. Develop good IPR with co-workers
6. Consult superior as needed
7. Verify vague/ erroneous orders
8. Always keep doctor updated
regarding patient
9. Ensure accurate recording and
reporting
10. Get informed consent
11. Do not delegate responsibilities to
others
TIPS FOR AVOIDING LEGAL
PITFALLS:

1. Patient Falls
 do proper
assessment
 appropriate
assistance
 use protective
measures
 document all
nursing
interventions
2. Medication errors
 observe the rights of drug administration
 Check dr’s order
 Understand the medication you will administer
 Consult drug handbook/ pharmacy
 Not exempt from liability for following wrong dr’s
order

3. Equipment injuries
 refuse to use a device you do not know how to
operate
 report adverse events to superiors
 monitor patient regularly
 bring questionable orders to the attention
of the doctor or superior
DRILLS

1. A student nurse is overheard


talking in the cafeteria about a
client and his suicidal
tendencies.
2. A nurse asks a client why he
chose Dr. Smith for her
physician when this doctor is
always rude to the staff.
3. A client is told he must pay the
remainder of his medical bill
before he can leave the facility.
4. A nurse told the client that she
will inject her with sedatives if
he does not cooperate.
5. A nurse forcibly opened the
mouth of a pedia patient and
gave his medication.
6. A nurse takes the wallet of the
patient while the latter is
sleeping.
7. A nurse takes the wallet of the
patient with the use of violence
and intimidation.
8. A nurse gives a potent
injection of morphine to a
patient causing his death.
9. A nurse poisons his client to
end his life.
10. A patient died because of
wrong medication given.
SEE
YOU
ALL
AGAIN
TOMORROW…