ETIIICS

EMILIO AGUINALDO COLLEGE $c1lOol of nur:sing & Midwifery

N -105

PROFESSIONAL ADJUSTJ\IENT

Comes from the Greek word Ethos means moml duty

"It studies how people nlJke judgment in regJrd to right or wrong

-It is about making choices that arc best for the individual or society at certain times and p>lfticular situation, Jnd then e\ Jlll.llln); such and outcomes

MORALITY Derived from the Greek word Momlis which means socbl consensus about mora! conduct for human bClII.!;S :Jnd society [t is a specific way of behavior of accomplishing ethical pmctices [I is the right or wrong, good or evil, proper or improper, cruel or benevolent acts

Professional Ethics . is a branch or moral sciencc conccrned with the obligations that a member of the profession owes to the public

Health care Ethics- is the division of ethics that relates to human health Bio-ethics- is a specific domain of ethics that focuscs on moml issues in the field of health care

ETlIICAL PRINCIPLES & APPROACHES

A. TELELOGICAL APPROACH

-.L. Comes from the Greek word telos or "goal or end" � "Thc right thing to do is the good thing to do" "'. Also termed as the utilitarianism where the good resides in the promotion of happincss or the greJtcsl net

increase of pleasure over pain ...j If the act helps people, then 11 is a good one, and ifit hum people, then 1I:l b:ld one (Joseph Fletcher)

GUIDELINES FOR MAKING ETHICAL DECISIONS: I. Consideration for people as hum:ln beings 2. Consider:ltion of consequenccs 3. ProporlionJtc good to come from the choices 4. Propriety of aClu:ll needs over idea! or potential needs 5. A desire to enlarge choices and reduce ehJnee 6. A eourJgeous JeceptJnec of the consequences oflhc decision

S. DEONTOLOG1CAL APPROACH

� Comes from the Greek word deon which means duty � "It is only through dutiful actions t hat people have montl worth. Even when individuals do not \\allt to fu lfill

their duty, they ne required to do so" (Immanuel Kant)

C. VIRTUE ETHICS APPROACH

.... Comes from the Creek word arete ..L Focuses all the traits and virtues of a good person such as courage, temperance, wisdom and justice

D. DIVINE COMMAND ETHICS

-.j.. Based on the theory that there is a supreme or divine being that sets dOl\ II the rulcs to IlrO\'idc guid�ncc to moral decisions.

NURSING ETHICS

.j... Is the examination of all ethical and bio-ethical issues from the prospective of nursing theory and nursing ethics

( Johnston) -i- Is the field of nursing that focused on the needs and experiences Gf practicing nurses, the e)."(lloration of its

meaning and that of ethical practice in terms of the perception oflhese nurses (Vercoe)

UNIVERSAL PRINCIPLES OF BIOMEDICAL F.TIlIeS

AUTONOMY Comes from the Greek word Autos meaning self and Monos me'H1illg governance, It involves self .. detel'lnin:u ion and freedom to choose and implement one's decision, frec from dc(cit, durcss, constraint 01' (oelTion,

VERAClTY The truth, accuracy or pCfcision of something The truthfulness or honesty of a person

Beneficence It promotes doing acts of kindness and mercy that directly benetlt the p:'lticnt.

PATIENT'S BILL OF RIGHTS The right to considerate and respectful care The right to relevant, current and understandable information concerning diagnOSiS, treatment prognosis, specific procedures, treatment, risks involved, medically reasonable alternative benefits needed to maj,e informed consent The right to make decisions regarding his plan of care; in case of refusal he is entitled to other lIPIII'Opri.\te care and service or be transferred to another hospital The right to have ad\'ance directive( such as a living will) concerning trealment or desigllaling:1 surrog<lte decision maker The right to every considerntion of his privacy such as in case discussion, COll5ull:1Iioll :11111 trelLtlllellt The right 10 confidentiality of communications and records

-i- The right to review his records concerning his medical care and have Ihese e)."pJained to him except when restricted by law

... The right to be informed of business relationship among the hospital, educational institution, health care providers that may influence the patient's treatment and care

.... The right to consent or decline to participate in experimental rese:Lrdl :lffcClill:': his Glre '* The right to reasonable continuity of care when apl)ropriate and be informcd of other care options \\ hen

hospital care is no longer appropriate -i- The right to be informed of hospital pOlicies that relate to patient (lire

NONMAlEFICENCE

Principle of "DONO HARM"

JUSTICE The right to be treated justly, fairly and equally

Article XIII of the Phili!JPine Constitution

Guarantees that the state shall adopt an integrated and comprehensive approach to health de\eloplllent and shall endeavor to make essential goods, health and social services available to all people at affordable cosIo There

shall be priority for the needs of the underprivileged, the sick the elderly .Hld thc disabled, the women and the children.

The st:'lte shall endeavor to provide free medical care to paupers, estalJlish :lnd maintain :'In effl.'ctjve food :lnd drug regulatory system, and undertake appropriate health manpower development and rcse:u'ch responsive to

the country'S health needs and problems. It shall establish a special agency for disabled persons for their rehabilitation.

ETIIICS COI\IMITTEES IN THE HOSPITALS AND THE I�OLE OF l\IEDICAL ETIIIClSTS

Composed of philosophers, doctors, nurses,lawyers, clergy or social workers. They discuss sensitive issues such.as when to withdraw or withhold treatment for an adult and the treatment of a severely handicapped newborn.

Some Cases that have reached worldwide .attention are:

Terri Schiavo'S stom.ach feeding tube w.as removed upon his husband's request to the court as she "as in ,I

persistent vegeu, Ove state for 15 years A couple who conceived ar child in the hope that the baby would be a bone marro" donor for ii'S seven year old sister who is acutely ill for leukemia A couple convicted of manslaughter for the death of their 2 Y, year-old son iJee:lUse they failed to seek medical attention and the baby died of intestinal obstruction

RESPONSIBILITIES OF THE NURSE TO THE PATIENT'S Th� primary responsibility of the nurse is to give the patient the best of care regardless of the race, creed, colo!", nationality or status The nurse should be f:l.miliar with the patient's bill of rights and observe its pro\isions Nurses should not accept tips or expensive gifts th:1I may induce them to give more care to f:l\ored patienb :lnd neglect those who cannot give When engaged in an agency, the nurse should complete the length of time stipul:lled in the contnlct Nurses should commit themsel\'e.� to the welfare of those entrusted to their care. They should be loyal to their own sworn duty.

CO]'\"FIDENTIALlTY OF INFORMA nON may only be revealed when:

The patient himself/herself permits such revelation as in the case of claim for ilospitalization, insurance benefits, among others

The case is medico-legal such as attempted suicide, gunshot \\ounds which h:l\'e to be reported to the 101';,1 police or NBI or constabulary The p:l.tient is ill of communicable disease and public safety may be jeopardized Gh·en to IIlelnbers of the health team if information is relevant to hi� c:,,·("

PATIENT'S RESPONSIBILITIES Pro\iding information Complying with Instructions Informing the physician of refusal to treatment Paying Hospital charges Following hospital rules and regulations Showing respect and considerations

BILL Of" RIGHTS FOR REGISTERED NURSES Nurses have the right to practice in a manner that fulfills their obligation� to societ) and to those who re�ei\<.' nursing care Nurses have the right to practice in environments that allow them to act ill :lceordance with jlrofe��ional standards and legally authorized scopes of practice Nurses have the right to.a work environment that supports and facilitates ethical practice, in accordance wilh the code of ethics for nurses and its interpretive sl:Uements Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retributioll J'liurses have the right to fair compensation forlheir work consistent with their knowledge, e:l.]lericn�e, and professional responsibilities Nurses have the right to a work environment that is safe for themselves and their patients Nurses have the right to negotiate the conditions of their employment, either as individuals or colll'�ti\'el�, in �Il practice settings

J{ESI'ONSIBILITIES OFTHE NURSE TO THE PIIVSICIAN

It shlill be the duty of the nurse to:

Pro\-ide nursing care through utiliz:oItion of the nursing process. Nursing care includes, but not limiled 10, tr2ditional and innovative approaches, theupeutic use of self, executing heliith care techniques and Ilrocedures. comfort measures, health teachings, and administration of written prescription for treatment, thcnlllies, oral, fOplcal and parenteral medications, internal eX:'lInination during labor in the absence of antenat:ll blecdinl: ;lIul delivery. In c:lse of suturing of perineal [accration, s[lccial traininl: shall be provided :Iccordinl: to protocol established.

RESPONSIBILITIES OF NURSES TO TIIEIR COLLEAGUES

RESPONSIBILITIES OF NURSES TO THEMSELVES

MORAL PRINCIPLF,S I.The Golden Rule 2.Thc 1\\0 fold Efreci

a. Thallhe aclion muSI be morally good b. Thal lhe good effect most be willed and the bad effecl merely attuned c. Th:l.llhe good effect musl not come from an evil aclion but from the .action ilself directl) d. Thllt the good mu�ct be greater th:oln the bad effeci

3. The principle oftot:ollily 4. Epikia "Excepllon to the General Rule" S. One who :oIcts through an :oIgent Is himself responsible 6. No one is obliged to betr.ay himself/herself 7. The end does not justify the means 8. Defects of nature may be corrected 9. If one is willing to cooperate in the act, no injuslice is done 10 him/her 10. A linle more or less does oot change the substance of an 2=1 II. The gre:uest good for the greatest number 12. No one is held to the Impossible 13. The morality of cooperation 14. Principle relating 10 the origin .and deSlruction ofJife

TilE GOOD SA:\1ARITAN LAW This law provides immunily frolll civil liability when :1 p('rson pro\·ide, a�'d\t:"LCC ill :111 CLL1l'I·):"'LI"�

CODE OF GOOn CQVERNANCF, Promulgated by the PRC on July 23, 2003 Stales th:tl the hallmark of all professionals is their willingness to accept a sct of Ilrofl'ssion:11 anLi ethical principles which they will follow in the conduct of Iheir daily lives. This code is adopted by the professional regulation commission and the 42 professional n'gulatof) boards 10 co\'er.an environmenl of good governance in "hieh al\ Filipino profcssionals shall perform their duties.

GENERAL I'RINCIPLES 1. Service To Others 2. Integrity and Objectivity 3. Professional Competence 4. Solidarity 2nd Teamwork S. Social and Civic responsibility 6. Global Competitiveness 7. Equality of all professions

NUI�SING COnE OF ETHICS

J{egistered Nurse and People Ethical Principles

I) Values, customs and spIritual beliefs shall be respectcd

2) )ndhitlual freedom to make decisions 3) )'erson:!.! information liIequired must be in eonfideuee

GUIDELINES TO BE OBSERVED: 2) Individuality 2nd tot2lity of patients b) Respect e) Uphold the right of individuals tI) Take into consideration culturc and values

-in the event of connkt, welfare and safety take precedence

Registered Nurse and Puctlce Ethical Principles

1) lIumliin life is inviolable: 2) QU2lity and excellence: in the Clire of patients 3) Accurate documtntation- nursing 2ccountability

GUIDELINES TO BE OBSERVED: a) Know the definition and scope of nursing practice b) Be aware of dUlies and rtSI)on�ibilities c) Acquire and develol' competence in KSA (knowledge, skills and :Lttitutlc) d) Optimum st2ndard ofsafc nursing practkc c) Be 1lI0ully and legally responsible

f) Patieilt's records consldere:d confidential 4) Registered Nurses 2re 2ware: that their 2ctions haH professional, cthiul, 1II0rai and legal dimensions GUIDELINES TO BE OBSERVED:

a) DUlies in conformity with law b) Not allo\\ to be used in 2d\ertisements that demean the image of the profession c) Decline: any gifl, fnor, or hospit21ily from the: p21ient d) Nol demand and receive any conlmission, fee or emoluments for recommendations made e) Avoid any abuse of relationship

Registered Nurses and the Profession Ethical Principles

I) Mainlain loyalty 2) Compliance with by.la" s of accredited professioual organil3tions 3) Commitmenl to continual le:arning 4) Contribute to the improvement of the: socio-economic conditions and welfare of uur�es

GUID[L1�'ES TO BE OBSERVED: 2) De: 2 member of accredited professional organiz:ttions (PNA)

b) Strictly adhue: to nursing standards c) Strl\'e to se:cure equitable: working conditions through appropriate legislations and other means d) Assert for the implementation of labor and work standards

TilE PHILIPPINE NURSING LAW R.A. 9173

BOARD OF NURSING

COMPOSITION: A chairperson and six members APPOINTMENT: by the president of the Republic of the Philippines QUALIFICATIONS:

1. Natural born citizen and resident of the Philippines 2. Member of good standing In an accredited Professional Organization in the Philippine� 3. It.N. and holder of Master's degree in nursing, education or olhcr allied medical profcs�ion 4. At least ten years of coutlnuou:. practice, last five years in the Philippines 5. NOI convicted of any offense (moral Turpitude)

BO� SHALL REPRESENT 3 AREAS OF NURSING Community Health Nursing ;\ursing Eduution ;..lursing Service

TER;\I OF OHICE: I. Appoinled for Ihree years, eligible for reappointment. l\iuimullI of rna terms ollly 2. Appointment to "auncy shall be for the: unexpired portion of the term

3. Proper oath of office

CHAIRMAN: Carmencita!\1. Abaqnin j\'IEMBERS: Leonila A. Faire

Betty F. Merritt Perla G. Po

Marco Antonio C. SIO Tomas Amelia B. Rosales Yolanda C. Arugay

POWERS, FUNCTIONS & DUTIES I. Conduct licensure exam for nurses 2. Issue, suspend or revoke certificates of registration for the practice of nnrsing 3. Monitor and enforce quality standards of nursing practice 4. Ensure quality nursing education 5. Conduct hearings and in�stigations 10 resolve complaints against nursc pnlcliliollcrs 6. Promulgate a code of ethics 7. Recogllize nursing specialty organizations 8. Prescribe, adopt, issue and promulgate guidelines, rcgulations, mcasures and decisions a� lIl:tyb!' ncnss:tr)

REMOVAL OR SUSPENSION OF A MEMBER: I . Incompetence or continuous neglect o f duty 2. Commission! tolerance or irregularities in the board exam 3. Unprofessional, immoral, dishonorable conduct

REQUIREMENTS UPON QUALIFICATION: I. Immediately resign from any teaching position In any institution offcring BSN andlor revic\\ prognun 2. Immcdiately rcsign from any government or prh'ate employment 3. Not have pecuniary interest in, or admInistrative supervision in any institution offering BSN or re\ie\\ classes

EXAMINATION AND REGISTRATION

QUALIFICATIONS FOR ADMISSION TO THE LICENSURE EXAM: J. Citizen of the Philippines or by r�ciprocity 2. Holder of BSN Degree from a school duly recognized

RATINGS: General Average of at least 75";" with a rating of not below 60% in any suhject If above 75% but with a subject below 60%, must repeat that subject with a ratine above 75%

OATil TAKING-priority action of bO:lnl passer ISSUANCE OF CERTIFICATE OF REGISTRATION! PROFESSIONAL LICENSE

A. Bearing- full name of the registrant - serial number - signature of tile chairperson and membcrs of Ihe board - official seal of the commission and the board

B. I'RC CARD- bears: -date of registration; license number and date of issuance and expiration date RENEWAL-third year on binh month

REGISTRATION BY RECIPROCITY; CONDITIONS BEFORE NURSES flEGISTERED IN A FOREIGN COUNTI{Y CAN I'RACTICE IN TilE PHILIPPINES

I. The requirements for registration in their country arc �ubslantial1y thc sallie in our country 2. Undcr their laws, Filipino nurses are granted the same privilegcs and on the samc basis as their citiJ;cns

SPECIAL AND TEMPORARY PERMI T T O PRACTICE FOR LICENSED FOREIGN NURSES I. Medical Mission 2. Outstanding expert/lecturer 3. Professor on cxchange employment

GROUNDS FOR REVOCATION AND SUSPENSION OF PROFESSIONAL LICENSE 1. Conviction by final judgment of any criminal offense involving moral turpitude, immoral or dishononlble

conduct, having unsound mind

2. Unprofusional or Unethical Conduct 3. Gross Incompetence or serious ignorance ·t i\lalpractice or negligence 5. Use of fraud, deceit of false statements in obtaining II certificate of registration 6. Violation of RA 9173, Code of ethics for nurses 7. !'racticing profession during suspension

REQUIIU:i\lEr"TS FOR RE-ISSUA!\CE OF REVOKED CERTlIICATE OR RU'LACEI'IEI'< I 01' LOSS CERTlJ.'ICATE

I. E:qllralion of a maximum of four years from date 0{ revocation 2. Cause of re\'ocation has disappeared or has been corrected 3. Request is 10 replace lost, destro)etl or mutilated cerlificat .... / licellse �. Proper applic.:Uion 5. Payment of required fees

SCOPE OF NURSING PRACTICE I. Provide nursing care; covering the different stages of life (frolll concelltion to old age) 2. Promotion of health 3. !'reHntion of Illness 4. Initiate and perform nursing services In any health care setting 5. Collaborate with other health care providers for the preventive, curative, and rehabilitativc aspects of care

DUTIES OF NURSES I. Do utilize nursing pr(\(css in providing nursing care 2. Undertake nursing lind heliith human resource development training and research 3. Teach, gUide, supervise nursing students �. Interrelationship or linkage .... ith community resources and health care ttam 5. Educale Individual, family and community 6. Strict or duty- bound adherence to tbe code of elhics

./ Brief llistory: Act iII'o. 2493 of 1915- first law that has 10 do \\llh Ihe nursing ilractice Act 2808 of 1919- first true nursing la\\; created the bo:trd of u.aminers 1920- first board exam for nurses R.A. 877 (June 19, 1953)· Phil. Nursing law established; need for registration iJefore nur�e C:1I1 pf;lctice

R.A. 7164- students who will enroll to the school of nursinc should beiong to the upper 40·Y .. of gr. HI. Cla�s in thcir high school

o P.O No. 223 (June 23,1973)- PRe was crcatl'tl I'RC Resolution No. 200�-17 Series of 2004- re-implemcnted conlin uin� I'rotl'\�it)n:11 ElIul'al iUIi rl'Iluirill� (>0 cretlit units for 3 years for professionals with bachelor'S degree.

DEFINITlO:'ll OF' LAW

UIW is defined as "The sum total of rules and regul:lfions by which society i� governed. It is man 111:l(le :Iud regulates social conduct in a formal and binding way.

What is the scope of practice in the Philippines? A Person is deemed to be practicing Nursing:

I. When he/she singly or in collaboration with another; initiates aud ilerfoflus lIursing SCf\il'l'� 10 indi.idu:lb, families and conlinunilil'S In any health care sellin!:

2. When he/she provide nursing care during conception, labor, delh'ery, infanc)', childhood, toddler, J1rl'-�choul, school age, adolescence, adulthood and old age.

3. When, as independent practitioner, the nurse is primarily responsible for the promotion of health and pre\'ention of illness �. "hen as a member of the health team, the nurse collaborates with olher he",lth c:ll'e Ilro.ill(,1'5 for the cur:ltiH', Ilre\ enthe and rehll.bllitll.tive aspects of care, restoration of health, alle\iation of �ufrering, and" hen I'eco"cf) is nOI possible towards a peaceful death.

DUTIES OFTIIE NURSE Article IV Sec. 28: It shall be the duty of the Nurse to:

I. Provide nursing care through the utilization of the Nursing Process. Nursing care includes but not limited to, traditional and innovative approaches, therapeutic usc of sclf, c):ecuting health care tcchniqucs :lIld proccdur�s, essential primary health care, comfort measures, health teachings, and administration of II riltell prescriptiun for tre:ltment, ther:lpies, oral, topic:l1 and parenteral medications, internal eumination during labor in the absence of antenatal bleeding and delivery. In case of suturing of pereneal l:lceratioll, special training shall bc provided :lccording to protocol established.

2. Establish Linkages with community resources and coordination "ith the health te:llll 3. Provide health education to individuals, families and communities 4. Teach, guide and supervise students in nursing education programs including the administration of nUl'sing scn'icc� in varied settings such as hospitals and clinics; undcrtake consultation services; ellg:lge in such actili[ics th:lt I·C(luil"c t hc utilization of knowledge and decision-making skills of a registered nurse

5, Undertake nnrsing and health human resource deve[opmclJ{ training lind research, which shall include, bul nOI limited to, the development of advanced nursing practice

I LA WS AFFECTING NURSES AND NURSING What are the sources of law?

STATUTORY LA \V- is composed of enacted law (enacted by congress) and l'egnl:1tol1' 1:111 (1'IIIe� ;ulIl regulations estllblished by government lIgencies to carry out thcir duties assigned in st:uutory law) Regul:lIory [all' is also called liS administrative law COMMON LA w� derives from common usage, custom and judicial decisions Of court rulings. Previous judici;11 decisions or rulings in court cases are used to establish precedents for intel"prel:ltions of both statutory aud common law

LAWS THAT PROJ\'1OTE THE WELFARE AND WELL�BElNG OF NURSES LABOR CODE (PO 442) defines among other things, hours of wol'k, contract ( including termination of contract) and nurse staffing in industrial clinics CIVIL SERVICE LAW ( PO 807)- provide for the recruitment and selection of employees in government service; qualification standards; personnel evaluation system; and personnel discipline). Also provides that flO employee orthe Civil service can be suspended except for cause as provided for by law :lnd after due process

EXECUTIVE ORDER No. 180- uphold the exercise of the right to organize of gOI'Crnment employees. Thb b in accordance with the 1987 constitution that stlltes; "the right of people .. to form Ul1ions, associalion�, or societic� for purposes not contrary to law shall not be abridged". MAGNA CARTA OF PUBLIC ilEAL Ttl WORKERS ( RA 7305)- has provisions on bcnelils (Iimll1ci;ll and non financial), rights and responsibilities of public health workrrs. Public health workers include e\ er) body IIho works in governmellt health institutions such as hospitals and laboratories.

SALARY STANDARDIZATION LAW (RA 6758)- provides for the standardiLation of salaries of Ihose I,orl;.ing in government. One of tbe benchmark positions is Nurse I which is assigned salary grade Ill. (RA ')173 upgr:ulcs the entry salary of nurses In government to grade 15) RA 7041 (An Act Requiring Regular Publication of Existing Vacant 1'05itiolis in Government Offires). the intention of this law is for government offices to be transparent in their recruitment pr:l.ctiCl's. By puhlishing presence of vacant positions, applicants arc less likely to be subjected to unethical "ractices in gOlefnmenl practices

ANTI- SEXUAL HARASSMENT ACT (RA 7877)- protects employees against sexual harassment. Sexual harassment is committed by :lIly person who exercises authority, influence or moral ascendancy onr another .. by demanding, requesting or requiring sexual favor regardless of,.helher or not .. Is accepted b) the object of sexual solicitation

LAWS T1IAT SPELL OUT TilE RESPONSIBILITIES OF EMPLOYEES (INCLUDING NURSES)

CODE OF CONDUCT AND ETHICAL STANDARDS FOR PUBLIC OffiCIALS ANI) E:\I['LOYEES ( RA 67[3) Provides that public officials and employees shall at all times be accountable to the people and shallllisch;lrgc thcir duties with utmost responsibility, integrity, competence, and loyalty, act" ith patriotism and j liSt icc, lC<ld modest lives and uphold public Interest over personal interest.

CIVIL SERVICE RULES ANI) REGULATIONS (PO 807)

Promote morale and hi�hest degree of responsibility, integrity, loyalty, effidency, and professionalism. Public office is a public tr..; This illw spells out , L� ,,' ,.uuh of disciplinary action. Som" of these :!l'C; di.,hoILC�ly, nc::lc,·t I)f Ilul)', 1)1)J1rl'��wLl, misconduct, disgraceful and immoral conduct, being 1I0torioll�ly undesirable, discourtc�y in the coune of omci:!t duties, inefficiency and incompetence in the perfornmnce of official duties, COIL viet ion of a cri l1Ie involving moz"LI turpitude, falsification of documents, frequent unauthorized :Lbsences or tardiness, gambling, iusubordin:!lion, nepotism and refusal to pu't"orm official duty or render OVertime service

RA 8344 (AN ACT PENALIZING THE R!·"�I 'SAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TRl. T AND SUPPORT IN EMERGENCY CASES)

In emergency cases, it is unltwful io. ;.HHiy (including the IIl1tSe) in a hospital or medical clinic to request, solicit, demand or accept any deposLt or any other form of :ldvance payment as a pre requbite for confinement or medical treatment of a patient or 10 refuse to administer medical treatment and support as dictated by good practice of medicine.

LEGAL CONC£PTS AND ISSUES IN NUF.sING RESPONSIBILITY AND ACCOUNTABiliTY FOR TilE P�ACTICE OF PROFESSIONAL NURSING

Nurses employed in an agency, in'.titution or hospital are directly responsible 10 their immediate supervisors. Private duty nurses, bctng indep' ndent practitioners, are held to a standard of conduct that is expected of rensonable prudent nurse

WHAT IS LIABILITY'! Is an obligation or debt that .an be enforced by law. A person who is liable for malpractice is usually required to pay for damages. Damages refer to compensation ill money reco�'erab!e for a loss of damage.

PROFESSIONAL NEGLIGENC� "NEGLIGENCE" refe.s to the commission or omission of an act, I)UrSuant to a duty, that a reasoll:lbly prudent person in the same or similar circumstance would or would not to, and acting or the nOll-acting of which is the proximate cause ofbjury to another person to his property,

ELEMENTS OF PROFESSIONAL NEGLIGENCE J. Existence of a duty on the part of the person charged to usc due care IIl1der circli mstances 2. Failure to meet the standard of dlle care 3. The foreseeability of harm resulting from failure to meet the standard 4. The fact that tbe breach of this standard resulted in an inj ury to the plaintiff 5, Errors due to . ,ili!y assistance 6. Administratwn of medicine without a doctor's prescription

TilE DOCTRINE OF RES IPSA LOQUITUR "The thing speaks for itsclr' \Vhen the harm that resulted from neg[j�enl'e and the re�l)onsibility for the twrm are cleunhat anyone would agree on it, the term res ipsa loquitur is lIsed

SI'ECIFIC EXAMPLES OF NEGLIGENCE I. Failure to report observations to attending Physicians 2. FaiJ�re to exercise the degree of diligence which the circumstances of the pm'ticular case dcnwnds 3. M�[aken Identity 4. Wrong mcdicine, wrong concentration, wrong route, wrong dose S. Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients

CONDITIONS THAT ARE NECESSARY FOR THE APPLICATIO;-.l OF TIIE DOCTRINE:

I. T�e accident must be a kind which ordinarily docs not occur in the absence ofsomeone's negligence

2. 1he accident must be caused by an agency or instrumentality within the exclusive control of the dcfend:mt 3. The accident must not have been due to any voluntary action or contribution on the part of the plaintiff (injured party)

MALPRACTICE Implies the idell of improper or unskillful care of a patient hy a uurse, It also denotes stellping beyolHl one's authority with serious consequences

EXAMPL£S OF MALPRACTICE; Misdiagnosis of an illness, failure to diagnose or relay diagnosis

Birth Injuries Surgical Complications Prescription errors Failure to provide treatment Anesthesia related eompllcations Failure to follow advance direeth'e Failure of hospital or phannlley to dispense the right medicine. dosage

DOCTRINE OF FORCE MAJEURE It is an irresistible or superior force, one that cannot be foreseen or prc\'entetl: ;1 forluilou) cvcnl. ;1I1t1 "act of God". No person shall be held liable for nonperformance of what "as cxpected of him/her if thc c;w)e of till' nonperformance \\as a force majeure (e.g. deva:.tating t) I)hoons, earthquakes

alld other calamities)

DOCTRINE OF RESPONDEAT SUPERIOR Means "Iellhe superior �nswer; lellhe principal anmer for the acts of his agenl"' The doctrine is founded on Ihe principle that he who expects 10 derhe advantage from an act "hich is done h} anolher for him must answer for any injury which 3 third person may sustain from it. The doctrine rests "11011 the proposition thai, In dOing the acts out of which the accident arose. the sen'ant was reprnclltillg thc 111;lstcr at the time

EXAI\IPLES: The hospital will be held liable, if, In an effort to cut down Oil npenses it decides to hire underboard nurses or mid", ives in place of profhsional nurses, and these persons pro\'e to be incompelenl The surgeon will be held responsible in case a laparotomy pack is lefl in a patient's abdomen

Ii\CO;\lPETENCE Is the lack of ability, legal qualifications or filness to discharge the required dut)' Although a nurse is registered, if in the performance of her duty she manifests incompetenc)', there i� ground for revocation or suspension of her certificate of registration

LIABILITY OF NURSES FOR TilE WORK OF NURSING AIDES Nursing aides perform selected nursing activities under the direct sUllervhion of IIlIr)e$. The) u�u;III�' gi\ en 011-job-Iraining by Ihe Training 5taff. Their re-sponsibitities usually pertains 10 the routine C:If(:: of chronicaJl� ill patients. They are therefore responsible for their on n 3clions.

LIABILITY FOR THE WORK OF �URSING STUDE:"1TS Under the Philippine NurSing Act of 2002 R.A. 9173, nunill� students do 1I0t perform pmfe�\ion;11 II uf\illJ,: duties. They are to be super .. lsed by their clinical instructors.

GUIDELINES TO AVOID MISTAKES OF NURSING STUDENTS I. Nursing students should always be under the supervision of their dinkal inMrllcton 2. They should be given assignments that are at their le\'el of training , experience, and competency 3. They should be ad\iscd to seek guidance especially if they arc performing procedure for the first time 4. They should be oriented to the policies of the nursing unit where Ihey are assigned S. 5. Their performance should be assessed frequently to determine their strenglhs and \\uknesses 6. 6. Frequent conferences with the students \\iII re\'eallheir problems ",hich they may "ant to bring to the

attenlion of Iheir instructors or vlce-\'ersa. Discussion of these problems wlll iron out tloubu and possible solntions may be provided.

LEGAL DEFENSE IN NEGLIGENCE The most comlllon defense in a negligent action is when nurses know and attain that M:uldard of care in giving service and thal lhey have documented the care they give in a concise and accur;ltc m;ulllcr If the patient's careless conduct contributes to his 0"'11 injury, the patient cannot bring suit :Igainst the lIune.

'IEI)ICAL ORDERS, DRUGS. AND i'\IEDICATIONS R.A. 6675 states that only validly registered medical, denIal, and \ eterinary Jlr!lctitiuuen, \\ JII�ther in privale Inslilutlon/corpulliltion or in Ihe goyernmellt, arc authorized to prescribe drugs. In accordance with R.A. 5921, or the pharmacy Act as amended, all prescriptions mll)t cOlllain the follo'l ing information:: name of Ihe pre�criber, office address, Ilrofenional registratioll nu mber, profe)sional tax receipt

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number, patient'slclient's name, age, and sex, and date of prescription. R.A. 6675 requires that the drugs be written in their generic names.

IV Therapy and Legal Implications Philippine Nursing Act of 1991 Section 28 - states that in the administration of intravenous injection, specia!

training shall be required according to protocol established Board of Nursing Resolution No.8

st:ltcS that without such training and who administers intravenous injections to patients sh:lll be held liable either criminally under Sec 30 Art. VII of snid law or administratively under sec 21 Art 111 or both (whether c:lUsing or not lin injury 01' death to the patient)

SCOPE OF DUTIES AND RESPONSIBLITIES IN IV THERAPY I. Interpretation of the doctor's orders for IV therapy 2. Performance of venipuncture, insertion of needles, cannulas cxcept TPN and cutdown 3. Preparation, administration, monitoring and termination of imra\'enous solutions such liS additives, intravenous

medications, and intraven.ous push 4. Administration of bloodlblood products as ord('red by the physicians

5. Recognition nf soltltions and m('dicine incompatibilities 6. Maintenance and replacement of sites, tUbings, dressings, in accord:mce with estllblished procedures 7. Establishment of flow rates of solutions, medicines, blood and blood components 8. Utilization of thorough knowledge :l!Ld prbficient techniclli :lbili!y in Ihe use/ca I'e, maintell:ll!cc, :Inc! cV:llualiol! of intravenous equipment 9. Nursing management of total parenteral nutrition, out-patient intravenous care 10. Maintcnance of established infection control and aseptic nursing inten'entions 11. Maintenance of appropriate documentation, associated with the prcparation, administration :lnd termination of all forms of intravenous therapy.

Telephone Orders Doctors should limit telephon(' ord('rs to extreme emergency wherc there is no alternative. The use of tcl('phonc in a non emergcncy as a substitute for the physician himself can lead 10 serious crror and mlly border on malpractice. Nurse should read back such order to the physician to mal,e certain the order has been correctly IHilien. Such order should be signed by the physician within 24 hours The nurse should sign the physician's name per her own lind note Ih(' timc and order was r('ceivct!

CONSENT TO MEDICAL AND SURGICAL PROCEDURE Consent is defined as a U fre(' and rational act that presupposes knowledge of the thing to which cons('nl is being given by a person who is legally capable to give consent" Nature of consent- an authorization by the patient or a p('rson authorized by th(' law to give the consent on the patient's behalf. Informed Consent-A written consent should be signed to show thaI the procedure is the one consentcd 10 and that the person understands the natul'e ofthe pl'ocedurc

The nurse's responsibility in witnessing the giving of informcd conscnt involves: (1) witneSSing the exchange b/w the client and the physiclan (2) witnessing the client lIfflx his sign:ltul'e (3) cstablishing that the client really understood.

ESSENTIAL ELEMENTS OF INFORMED CONSENT: I. The diagnOSiS and explanation of the condition 2. A fair explanation of the procedures to be done and used and the consequences 3. A description of alternative treatments or procedures 4. A description of tile benefits to be exp('cted 5. Malerial rights if any 6. The prognOSiS, the recommendcd care, procedure is refused

WHO MUST CONSENT? Patient mnst consent in his own behalf If he is incompetent, or physically uuable, and is not in emcrgency case, conscnt must be taken from :Ulothcr II'ho is authorized to give it in his own behalf. CONSENT OF MINORS Parents or someone standing in their behalf, gives the consent to medical or surgical treatment of a minor. P:ll'cntal consent is not needed ir the patient is married or emancipated

CONSENT OF MENTALY ILL A mentally incompetent person cannot legally consent to medical or surgical treatment. Thc consent must be t:I"CIi t"nun pareuts or legal guardian _

MENTAL COMPETENCY All pll.tients 3re presumed to

be competent unless declared incompetent by a court of la". Supporting documentatiun uf Ihe p:lticnt'� bchavior" speech, decision making and physical :md mental status are very useful ill est:Ji.llishinJ: his/her ment:Ll comlJrt�ncy

El\lERGENCY SITUATIO:-i 1\0 consent is necessary because inaction at such time may cause greater injury. If time is avail:lbJe :1I1l1;\1I informctl consent is possible, it is best that this be taken to protect all the parties concerned.

REFUSAL TO CONSENT A patient who is mentally and legally competent has the right to refuse the touching of his body or to submit to a medical or surgical procedure no matter h�' necessary, nor how imminent the danger to his life or health if he fails to submit to treatment.

CONSENT FOR STERILIZATION Sterilization is the termination of the ability to produce offsprings. The husband aJHi the wife must consell! to the procedure if the operation is primarily to accomplish sterilization. If emergency cases like ectopic pregnancy and abruptio placentae, consent from patient is sufficient.

MEDICAL RECORDS Was created as a means of communication among health care practitiollers. Today medical records sene t\\ 0 important functions: to provide legal documentation, and obtain third party payments (e.g. Medic:lre) Thcy :Ire good e\'ldence in legal suits but are 1I0t admissible evideuce against the patielil. .. If information is not charted, it was not done or observed"

CHARTING DONE BY NURSING STUDENTS

LEGAL RISKS FOR SAFETY EQUIPMENT The nurse should exercise reasonable care in selecting equipment to be used in patients. Generally, :l nurse is not liable for a non-observable and non-discoverable defect in the equipment.

WIIAT IS A CONTRACT"! Is a meeting of minds between two persons where they bind themselves to give something or 10 render some services. Practically anything could be subjected to a contract as long as these arc not contr:lr)" to 1:111, moral" good customs, !lublic order :"Ind public policy.

Kinds of Contracts Formal Contracts- refers to an agreement blw parties and is required to be in " riting. E.g. marriaJ;e contract .. Informal Contracts- one In which concluded as the result of a written document where the law docs not fccluire the same to be in writing. Express Contracts- The one ill which Ihe conditions and terms of contract :Ire given orally or in \\'\"itilll; by Ihe parties concerned. E.g. PDN under the doctrine of " facio ut des" means I do that you may give.

Implied Contraets- one that Is concluded as a result of acts of conduct of the parties to \\hich the 1:1\\ ascriLll's :111 objective intentions to enter into a contract. Void contracts- one thai is inexistent from the very beginning and therefore rn:ly not be enforced. Illegal contracts- Olle that is expressly prohibited by law

Illegal Contracts Those thai are made In protection of the law Consent obtained by fraud Those obtained under duress Those obtained under undue influence Those obtained through matuial misrepresentation

INTENTIONAL WRONGS A nurse llIay be held liable for inlentional wrongs

TORTS A tort Is a legal wrong, committed against a penon or prOperty illdepl'ndent of a contract \\ hich rl'lIders thc penon who commits it liable for damages in a civil action. A person \\ho has been wronged seeks compensation for the Injury or wrong he has suffered from lhe '" ronl: doer.

EX.\ '1 PLES OF TORT: ASSAULT A'\D SA TIERY. Assauilis a unjustifiable atlelupt to touch another Ilenon or l'\cn Ihl' Ihrc.u 01 doing so while Ballery is lhe actual carrying out of the threatened ph}sical contact DEFAMATION of character occurs where a person discusses :mother intllvldu:11 in terms that dil1liui�h reputatiOII. Libel is written defamation. Slander is oral Defamation

FALSE 1:\IPRISONMENT Is the Infringement of upon an Indh'idual's freedom of mo\emcnt. It is making someone \\ rongfull, feel t1l3! he or she cannot IU\'e tbe place. The unjustifiable detentibn of a person "'ithout a legal warr:mt within boundaries fixed by the defendant by an act or \'Iotation of duty intended to result in such confinement.

USE OF' RESTRAINTS Restnlints should be used with caution and discretion. Ali patients shoulti have the right to Independence and freedom of mO\iClmnt. Restr3ints require a physician's order. If a patient or his legal guardillll refuses to be restrained, this should be documented in the patient's medical record.

INVASIO:\, OF' RICIITTO PRIVACY ANO BREACH OF CONFIDEiliTIALITY The rigbt to privacy is the rigbt to be left alone, the rlCht to be free from unwarranted publicity and exposure to public view as well as the right to li\'e one's life without h3ving anyone'S 113111e, picture or prh"ate aff:lirs 1I13dl: public against one's will. Nurses may become liable for invasioll of right to privacy if they diVUlge Inform:ltlon from

a Ilatlent's chart to improper source) or unauthorized persons

DEFAMATION Occurs when a person discusses another individual In terms that diminish reputalion. SLANDER- is oral defamation of a person by speaking unprh-lleged or false words by ",hicb hl� rCI)lll3tioil b damaged LI BEL- is defamation by wrillen words, cartoons or such repres('ntatiOIiS lhat cause a person to bc a\olti('d. ridiculed or held in contempt or tend to injure him In his ",ork

CRI\IES, MISDEMEANORS, AND F£LOi'IES CRIME Is denned as an act conlmitted or omitted In \ lolation of the law. Criminal offenseJ. al·e cOlllpos('d of 1"0 elements: (I) Criminal Act (2) Evil/criminal intent In criminal action, tbe state seeks tbe punishment of the wrongdoers

Conspiracy to commit a crime Prindpal�- are those who take a direct part in the execution of the aCI, who directly force or induce 01 hen to commit it; or wbo cooperate in the commission of the offense by another act \\ithout which it \\ould not ha\e been accomplished. Accomplkf's- are those wbo, not being prindpali, cooperate in the execution of the offense by pre\'ious and simultaneous act. Accl'�snril's· are those ",ho, having the knowledge of the commissioll of the crime. Assisting the offtnder 10 pront from the crime either by disposing the body, concealing or assisting in escalle of the IJrinci]Jat of th(' crime.

Criminal Actions Dtil with acts or offenses against publie nelfare. l\lisdemeanor- a general name for criminal offense \\ hkh docs not in I:m amount to frlon). Felony- a public offense for nbich a cOllvicted person is liable 10 be senl(,llced to death or be imprisoned in a penittntiary or prison. I! is committed with deceit and bult.

Criminal Negligence Reckless Imprydencl'- ",hell a person docs an act or falls to do involuntary without malice, from \\hlch dam3gt results Immediately. Simplt I mprudtnce- means that the penon or nurse did not use precaution :lllti [11\: d':l.Inagc ,us nOI immedLlIc or tbe impending danger \las not evident or manifest

Criminal Intent Is the stale of mind ofa person at the time the criminal act is committed, that is, he/she Imows that an act is lawful and still decided to do it anyway. Deliberate intent includes t""o other elements without which there can ue no crime. These arc freedom and intelligence. ,Vhen a person ltccused of the crime offers evidence showing insanity, necessity, compulsion, accidelH, or infancy the court will decide if he did not commit a criminal offense and \\1II declare the person lIot guilty.

Classes of Felonies Felonies arc classified according to degree of the acts of execution

};o Consummated- when all the clemcnts uccessary for its execution and accompJi�lInll'nt :Irc "rcsenl. )- Frustrated- when Ihe offeuder performs all the acts or execution which 1\ ill produce the fclony as a conse(tuence

but which nevertheless, do not produce it by reason of causes independent of the " ill of the Jlerpetrator. ;;. Attempled- when the offender commences the commission of the same directly b) overt :lets, and doe� not

perform the ltcts which shall produce the felony. o Consummated felonies as well as attempted and frustrated are all punishable by lal\.

Felonies according to degree of punishment Grave Felonies- are those to \\hich the law attaches Ihe capital punishment or pcnalties which in an) of thcil' periods arc afnietive. (ImJlrisonment rangiug from 6 )TS and I day with fine IWI excccdin� 1'6,000) Lc.�s Gra'c Fclonies_ arc those which the law punishes with penaltics which in their maximum periud <Ire correctional (imprisonment ranging from I month and I day to 6 yrs or fiue 1I0t eJ.:ceeding (,,000 but not below 200) Light Felonics- are those infractions of law for the commission of which the penalty of "arrestQ m/:/lor"

(imprisonment for I day to 30 days or a fine not exceeding 200 or both of which arc imposed)

Circumstances affecting Criminal Liability Juslif\.ing Circumstanccs- a person may not incur criminal liahility under the following circumSlance:

)- When he acts in defense of his rights )- When he acts in defense of his relatives rights j.. 'Vhen he aCls in defense of a strangers rights and Ihat the person defending is not induced by re' engc or C\"iJ

motives. :;.. 'Vhen any person who, in order to avoid an injury docs an ;lei which causes damage to another provided Ihat :1II

evil sought to be avoided actually exists. )- When he acts In the fulfillment of a duty or In lawful exercise ofa right or office.

Exempline: Circnm�tance�- There arc certain circumstances under which the Jaw exempts a penon from criminal liability

)- An imbecile or ;1II insane penon, unless the Jatter has acted during :1 lucid intcn':II ,. A person under nine years of age j.. A person over nine years of age and under fifteen unless he acted with discernment. ,. A person while performing a lawful act with due care causes an injury \\hich is merely an accident. ).0 Any person who acts under the compulSion of an irresistible force > An)' person who acts under the impulse of uncontrollable fear or an el111al 01" J.:l"c:l(cr injury )- Any person who fails to perform an act required by law, "hell pre\ellted by some 13\\flll or in�upenllJle (;lII�l·.

EXEMPTING CIRCUMSTANCES Are those which do not constitute justification or excuse of the offense in question, but which, in fairness and mercy, may be considered as extenuating or redUCing Ihe degree of moral culpability.

J. Circumstances which are otherwise justifying or exempling were il not for the fact that all requisites ucces!>:!!") to justify the act or to exempt the offender from criminal liability in the respective cases are not attcndant

2. When the offender has no intentlon to commit so grave a \, rong as the one committed 3. When the offender is under eighteen years of age or over 70 years old 4. When sufficient provocation or threat on the part of the offended party immediately precedes the act 5. When the act is committed in the immediate ... ·indication ofa grave of reuse to the one committing the felony,

his/her spouse, ascendants, descendants, legitimate, natural or adopted brothers, or relative by affinit�· "ithin the same degree

6. 'Vhen a person aelS upon an impulse so powerful as naturally to have produced an obfuscation 7. When Ihe offender voluntarily surrenders himself to a person in authority or confesses before the court llrior to

the presentation of the evidence for the prosecution 8. When the defender is deaf and dumb, blind or otherwise suffcring from physical defect

AGGRAVATING CIRCUMSTANCES Are those attending the commission of a crime and which increase the crimin:,[ liabilit) of the offender or make his guilt more severe.

I . When the offender takes advantage o f his public position 2. When fhe crime is ("ommitted in contempt of or with insult to public authorities 3. \Vhen the act is commilted ""ith insult or disregard of the respect of the offended I):,rl), on account of his ranI;.,

age, sex

�. When the aCI is committed ""ilh abuse or confidence or ob\'ious ungralefulness 5. when a crime is committed in II plllce of worship . 6. When the crime Ii commilled on the oCCll;sion ofll confl.agration, shipwrcck, carthljuake, ellidcmic or other (lIl:IInily or misfortune 7. "'hen the crime is commitled in consideration of a price, re,\ard or promise 8. \Vhen the crime Is committed by means of inundation, fire, polson, explosion, standings of a "esse! or intentional damage 9. When the act Is committed with evident premeditation or after unlawful entry 10. When craft, fraud, or disgUIse I� employed

when the wrong dOlle In Ihe commission of the ("rime is delibenllely aUJ.:menled by cau�inJ.: othcr wronJ:s not necessary for its commission

ALTERNATIVE CIRCUMSTANCES Are Ihose wbich must be taken Into consideration as aggra,:uing or mitig:lIing according to the n:lture and effeCIS oftbe crime and other conditions attending ils commission. TheSl' arc Ihe rel:llioilShill, inlo.\ic:llion anti degree of instruction and education of the offender

LACK OF EDUCATION IS NOT ;\lIT1GATING IN: I. Rape 2. Forcible abduclion 3. Arson 4. Treason 5, In crlmts against chastity like seduction and acts of lasciviousness 6. Those acts committed In a mercitess or heinous manner

MORAL TURPITUDE- h an act of baseness, vileness or depr;l\·it) in socilll or prinlle dulieS which a nlln o""es 10 his fellow man or 10 society in genenti, :1.11 aCI cOlltra1)' to the accepted lind cuslomary rule of righl and duty between men �tURDER- ls Ihe unlawful killingofa human being "ith intent to kill. It ls a "cry serious crime. ]\urses should keep in mind that death resulting from a criminal abortion is murder. Euthanasia is also considen'd murder'.

1I0MICII)E- is the killing of a human being in anolhrr, It may be committed \\ itholJl criminal intent, by an� person whom kills another, other than his father, mother, or child or any of his :Lscendants or dc�cendanls, or his spouse, without any of the circumstances attendant the crime of murder enumerated abo\ \: being present. ABORTION-Is illegal accortling to the rcvised [lena! code. The p:llienl should :lssurne resllonsibiJiI� for her abortion. She should be made to sign a statement relieving Ihe hOSi1itai anti its personncl from li:lhilily

Il"I'FANTICIDE- IS TilE KILLING OF A CHILD LESS TIIAN TIIREE DA YS OF AGE. The mother oflhe child " ho commits this crime sball suffer penalty of imprisonment ranginJ.: from 1\\'0 years !lIld four mont h� and 1 day to 6 years PARRICIDE- Is a crime committed by one who kills her/his falher, mother or child whelher legilimate or ilIej;:ltlmate, or any of his/her IIscendants or dtscendants or his/her siiouse. ROBBERY- is a crime against a person or property

CO�TROLLED SUBSTANCES R.A. 6425 kno""n as the Dangerous Drug Act of 1972 co\'ers the administration and regulation of the manufacture, distribution, dispensing of controlled druj;:S. Persons authorized 10 prescribe or disptnse these drugs are required to registc,' aut! h:l\e a spccial Hcen�l' for this purpose

POINTS TO OBSERVE I�' ORDER TO AVOID CRIMINAL LIABILITY I . B e \l'1')' famiJi:r.r wJth the Philippine Nursing Law 2. Bewllfe of la\\s tbat affect nursing pr:r.clice 3. Al lhe Slart of employment, get a copy of your job description, the agency's rules, re{:ulations and policies

4. Upgrade your skills and competence 5. Accept only such responsibility tbat is witbin the scope of your employment and your job description 6. 6. Do not delegate your respon�ibi1ity to others 7. 7. Determine whether your subordinates are competent In the work are assigning them 8. 8. Develop good interpersonal rel:uionships with your co-workers, \\ hether they be your supcrvisor�, peers, or·

subordinates 9. 9. Con�ult your sUllcrlors for Ilrllblcms Ih:!1 Ill:!y he ton hi� fvr )'011 II) h;lJlllle 10. 10. Verify orders Ihal arc not clear to you or those th:lI seem 10 be erroneou�

I I . The doctors should be informed about the patient's condition 12. Keep in mind the value and necessity of keeping accurate and adequate records 13. Patients are entitled to an Informed consent

WILLS Il ls 2 1eg21 declu2tlon Of2 person's intentions upon death. It is c211ed testamentary dpcument beuuse il takes effecl affer the dealh of its maker DECEDENT- a person whose propeny Is transmitted through succession whether or not he left a w ill. If he left a wiJl he is ulled a TESTATOR. lfa woman TESTATRIX 1I0LOGRAPIIIC WILL- 11 wlll thllt is written lind Signed by the testator

IIEI R is a person called to succession either by the pro\ision of a will or by operation of Ill"

There should be a witness who knows Ihe handwriting and signature of the testator elillicitly ded:\rClI that the will and the signature are in the handwriting of the testator ORAL WILL is also called as NUCUPATIVE WILL or NUNCLPATION it is during Ihe last illness, th:1I it is done in the place in which a he dies, thaI he asked one or more witness 10 the will, that fhe will be put ill II I·itin� \Iilhin 2 gh'en number of days, that it be for probate within a specified lime

NURSE'S OBLIGATION IN THE EX�CUTION OF A WILL The nurse should note the soundness of Ihe patient's mind and Ihat there was fr·cc from fraud or undul' influence and that the patient was above 18 yens or of aile . The patil'nt should write that the will was Signed by the trstator, th�t the wilnesse� wcre nil present ;\1 the sallie lime and signed the will I the presence of the testator

LIVING WILL Is an indh'idual's signed requeslto be allowed to die when life can be supported only mechanicall) or b) hcrok measures. It also Includes the decision to accept or refuse 2n) t,·eatment, scrvice or procedure uscd to diagnose or Ire;.l! his/her physical or mental condition and decisions to prOl>ide

\I>V \NCE DIRECTIVE & II EAL Til CARE PROXY The patient designates 2 health care representative, usu211y a member of the family, a friend or a famil� Ilhysiciall to make dccisions for him/her when he/she Is unable, due to physical or mental incllpacity, llCCCjlt or refuse trenl menl, sCI'"lce or procedure used to di2gnose or treat his/her physical or mental condition and decisions to provide, l\ ilhhold or withdral\ life sustaining measures

WIIAT SIIOULO A NURSE R£MEMBERABOUT WILLS·! A nurse especially those t2king care of well-lo-do patients should remember that the main requisite for making a

will is testamentary capacity or sanity. The person who makes a will should at least be 18 yellrs old and is Ilot prohibited by law. The will is written and should be \\ itllessed by three crediblc II itnesses, unless it is holographic "ill. A Holographic will is one that is entirely written, dated and Signed by hand. There i� no leg:!1 reason for the nurse to rt'fuse 10 witncss the prep:ualion of a will.

WIIAT IS AN INCIDENT REPORT II is an administrative rellort that is required of nurses if there are violations of standanl� and policic� II hether or not injury occurs. Through incident repons, hospital administration can monitor quality of patient Cllre and institule some measures to prevent slmllu incidents in the future.

co_\nION LEGAL TERMS THAT A :\URSE SHOULD KNOW: Affidavit· is a "ritten slatement made under oath before a notary puhlic or orhl'r Ilerson duly authorized Contempt of Co un- is the \\illful disobediencf: to, or open disresjlect for, Ihe rules of courl Derendant- the person being accused of a "rongdoing; the thererore needs to defend thl'mseh es

Day in court- the right of a person to appear in court and be heard concerning his compliant/dcfense

Due process- is fair and orderly process which aims to protect and enforce a person's rights False Testimony- is punishable both criminal and civil law Hearsay Evidence- is evidence that is derived from something the witncss heard from others Inquest- is the legal inquiry into the cause or manner of a death Perjury- is thc willful telling of a lie under oath Plaintiff- the person who files the lawsui! and is seeking for a perceived wrongdoing

Prima facie Evidence- evidence, which if unexplained or ullcontradicted would establish Ihc fact alleged Privilegcd Communicalion- statements uttered in good failh. These are not permilled to be divulged in court justice. Statute of Llmltations- define the length of time followiug the event during which the pl:iintiff may file till' lawsuit Subpoena- is an order Ilrt requires a person to attend at )1 spccific time and place to testify as witness

Subpoena Duccs Tecum- is a subpoena that requires a witness to bring required p:qJCrsl dOell!llents lind the like which may be in his possession Summons- is a writ commanding an authorized person to notify a p:lrty 10 :lppe:\I· in eourl to answel· a tallJ]ll:lin! made agaInst them Warrant- is writing from a competent authority in pursuance of law, directing the doin):: or all :lct, and addressed to a person competent to do it

Prepared by: Ms. Jennilyn A. MusIIgi, RN, MAN

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