Advanced or expanded nursing practice

Internal examination during labor and delivery; suturing of perineal lacerations and IVT
provided by ANSAP

a. Nursing specialty certification program

2 policy assurance
Adoption of Nursing Specialty Program
Creation of a NSCC

NSCC created by the BON

3 levels
1. Nurse Clinician I
2. Nurse Clinician II
3. Clinical Nurse Specialist

4 major nursing specialty groups

1. Community Health Nursing Specialty
2. Medical-Surgical Nursing Specialty
3. Mother and Child Health Nursing Specialty
4. Mental-Health and Nursing Specialty

The program is composed of

1. Didactic
2. Practicum
3. Witten exam

Requirements for the issuance of certifications:

1. TOR of BSN or MN degrees
2. Documents showing completion of the requirements for the level applied for
3. Recommendation of NSCC to BON

Specialty certification is valid for 5 years; renewable within 30 days before expiration

b. Internal Examination and Suturing of Perineal Wounds prepared by

ANSAP and MCNAP
Internal examination an examination of the females internal reproductive organs by
means of insertion of the examiners gloved fingers into the vaginal canal.
Suturing laceration the repair of the first and second degree laceration in the absence
of physician
Laceration - a wound caused by tissue tearing

Program:
1. Composed of 24-hr didactics/lecture and practicum
2. Open to all RN who have a minimum experience of at least 3 yrs at Labor/Delivery
Rooms or in community with a Lying in clinic

Parameters of evaluation
1. Written exam
2. 3 correctly performed IE
3. 3 supervised suturing of perineal lacerations

c. Intravenous Therapy (IVT) insertion of the needle/catheter into the vein as

prescribed
Program:
1. 24-hr didactics and practicum

Evaluation methods
1. Written exam: pre and post
2. Completion of cases
6 cases for initiating and maintaining peripheral IV infusion
6 cases for administering IV drugs
2 cases for administering blood and blood components
Ratings
1. Didactic 50%
2. Practicum 50 %
Scope of duties and responsibilities of IVTN
1. Interpret orders
2. Perform venipuncture except cut down
3. Prepare, monitor, additives, push
4. Administer blood, blood products as ordered
5. Recognize incompatibilities
6. Maintain, replace in accordance with the procedure
7. Establish flow rate of fluids and blood
8. Proficient technical ability in the use, care and evaluation
9. Documentation

The minimum qualifications of nurses in government service are as follows:

1. PHN (Nurse II and Nurse III) RN
2. Supervising PHN/Nurse Supervisor RN; Masters Degree in Nursing or Public
Health; at least 5 yrs of experience
3. Nurse Instructor II RN; MAN; 3 yrs as PHN; special training
4. Regional Training Nurse RN; Masters degree; 6 yrs of experience, 3 of which is
in training or nursing education
5. Regional Nurse Supervisor/Regional Public Health Nurse RN, Masters
degree in Public Health or MAN major in community health nursing administration and
supervision; 5 yrs as CHN, 2 yrs of which is in supervisory position
6. Nurse Program Supervisor - RN, Masters degree in Public Health or MAN major
in public healthnursing administration and supervision; 7 yrs as PHN
7. Chief Nurse RN; Masters degree in Public Health or MAN major in community
health nursing administration; 5 yrs of experience, 3 yrs of which is in supervisory or
assistant chief nurse position; leadership ability
8. Assistant Chief Nurse RN; Masters degree in Public Health or MAN major in
community healthnursing administration; 5 yrs of experience, 2 yrs of which is in
supervisory position; leadership ability
Standard Criteria of Nursing Personnel
1. Nursing Administrator MAN; 5 yrs in nursing supervisory
2. Assistant Nursing Administrator same with nursing administrator
3. Nurse Supervisor RN; 9 units in the graduate level; 3 yrs of experience as a head
nurse
4. Senior/Head Nurse RN; 2 yrs of experience as staff
5. Staff/Clinic/School Nurse be currently license to practice professional nursing

NURSING PRACTICE

4 Fundamental Nursing Responsibilities (ICN)

1. Promote health
2. Prevent illness
3. Restore health
4. Alleviate suffering

2 universal principles:
a. The need for nursing is universal
b. Respect for human right is inherent in nursing

Professional Regulatory Board of Nursing (PRBON)

Primary agency responsible for the regulation of the admission, registration and practice
of the nursing profession in the Philippines.
7-person board (1 chairperson and 6 members)
Appointed by the President of the Philippines from 2 recommendees from the PRC chosen
from 3 nominees by the PNA
Qualifications, requirements and duties (refer to RA 9173)

Philippine Nurses Association

biggest and earliest national nursing professional organization which was accredited by
the government on September 15, 1975
Initially called Filipino Nurses Association (FNA), formed in 1922

Standards of Safe Nursing Practice composed of the following professional

nursing organizations:
1. ANSAP
2. ADCPN
3. NLGN
4. PNA

Last week of October Nurses Week

 Certificate of Registration/Professional license issued to an examinee who
passes the exam, paid the prescribed fees for license and take his/her oath set by the PRC;
renewed after 3 years.

Competency Standards in Nursing Practice

Prepared by the Committee on Core Competency Standards Development for PRC-BON
and the CHED-TCNE
Aims to improve further the quality standards of nursing practice in the Philippines and to
ensure global competitive of Philippines RNs.
Core Competencies and Indicators
1. Safe and Quality Nursing Care
2. Management of Resources And Environment
3. Health Education
4. Legal Responsibility
5. Ethico-Moral Responsibility
6. Personal and Professional Development
7. Quality Improvement
8. Research
9. Record Management
10. Communication
11. Collaboration and Teamwork

CONTINUING EDUCATION IN NURSING

CONTINUING PROFESSIONAL EDUCATION (CPE)

1. To encourage nurses as an ethical and moral obligation to enhance their knowledge,

attitude and skills for competent and safe practice
2. 1988 nurses deciding to renew their PRC license were required to present
20 contact hours per year
3. PRC Resolution No. 99-624 dated Aug. 11, 1999 and PRC Resolution No. 507 S. 1997
were repealed and CPE were no longer required for licensure
4. PRC Resolution No. 2004-179 S. 2004 again implements the requirement. Registered
professionals are required a total of 60 units CPE credits units for 3 years. Any
excess credit shall not be carried over the next 3 year period except credit units earned for
doctoral and masters degree. This revises Resolution 99-624 which did not require CPE
units for renewal of licenses by professionals.

ETHICS

Some cases that have reached worldwide attention are:

1. Terri Schiavo'S stomach feeding tube was removed upon his husband's request to the
court as she was in persistent vegetative state
2. A couple who conceived a child in the hope that the baby would be a bone marrow donor
for his seven year old sister who is acutely ill for leukemia
 3. A couple convicted of manslaughter for the death of their 2 year-old son because they
failed to seek medical attention and the baby died of intestinal obstruction

Morality Behavior in accordance with the gen. ethical principles of health care; personally
held beliefs, opinions that guide our actions.

Principles of morality
1. The golden rule do not do unto others what you do not want to do unto you
2. Two-fold effect an act is foreseen to have both good and bad effects
That the action must be morally good
That the good effect most be willed and the bad effect merely allowed
That the good effect must not come from an evil action but from the action itself directly
That the good effect must be greater than the bad effect
3. Principle of totality - The whole is greater than any of its parts.
Ex. If an organ is diseased and endangering the whole, the organ may be removed
4. Epikia exception to the general rule
5. Ordinary means basic duty of a person in case of serious illness to take necessary
means to preserve life and health
6. Subsidiarity making the highest authority respect and protect the common good
7. One who acts under an agent is himself responsible
Ex: No one can force any person to answer a question if such will incriminate him/her
8. No one is obliged to betray himself - No one can force any person to answer a
question if such will incriminate him/her
9. The end does not justify the means
Ex: Giving sleeping tablets to someone who has chronic illness
10. Defects of nature may be corrected
Ex: Corrected by plastic surgery
11. If one is willing to cooperate in an act, no injustice is done
Ex: With patients consent
12. A little more or less does not change the substance of an act
Ex: Stealing
13. The greatest good for the greater number
Ex: Have more good effects for more people than a smaller group
14. No one is held to the impossible
Ex: Do not promise impossible things
15. The morality of cooperation
Ex: Formal cooperation is an evil act and never allowed
16. Principle relating to the origin and destruction of human life no person has
the right take someones life because it is inviolable
17. The Good Samaritan law (Love Article) if one does not act, you will be responsible
for moral negligence. Courage is doing exactly what one believes in.
18. Nurses have the right to appeal to conscience, refuse to participate in act for they
violate the right to freedom of thought, conscience and belief.
 Ethics rules, principles that guide nursing decisions or conduct in terms of the
rightness or wrongness of that decisions or actions. Serves the purpose of governing
conduct to ensure the protection of individuals rights.

Importance
Makes clear why one act is better than another
Keep an orderly social life by having agreement, understanding, principles or rules of
procedure
Moral conduct and ethical system must be intelligently appraised and criticized
BIOETHICS
Bioethics synonymous term with healthcare ethics and encompass not only questions
of equality of life, life-sustaining and a life-altering techniques
Principles that govern rights and proper conduct of a person regarding life, biology, & with
health professionals
Ethical Dilemma problem in decision making because there is no correct or wrong
choice. This may result in having to choose an action that violates ones principle or value
in order to promote another
Human acts voluntary, full knowledge, will to do it
Acts of man involuntary actions of man

Theories
Utilitarian or Telelogical the end justifies the means; "The right thing to do is the
good thing to do"; Comes from the Greek word telos or "goal or end"; If the act helps
people, then it is a good one, and if it harm people, then it is a bad one (Joseph Fletcher)
Deontological Comes from the Greek word deon which means duty; the ends DOES
NOT justify the means; the acts are the criterion for the determination of good and not
the consequence.
Intuitionism people inherently knows what is right and what is wrong

Principles of nursing ethics:

1. Autonomy - states that a person has unconditional worth and has the capacity to
determine his own destiny. It involves self determination and freedom to choose and
implement one's decision, free from deceit, duress, constraint or coercion.
Ex: Informed consent; allowing the patient to refuse treatment if he decides so
Consent
admission
blood transfusion
surgical consent
research consent
special consent like restraints, photographing the client, disposal of body parts during
surgery, organ donation or autopsy

Informed consent
Patients bill of rights
Considerate and respectful care
Relevant, current and understandable information
 Make decisions regarding his care plan
Have advance directive (living will)
Every consideration of his privacy
Confidentiality of communications and records
Review his records concerning his medical care
Be informed of business relationship among the hospital educational institution
Consent or decline to participate experimental research affecting his care
Reasonable continuity of care when appropriate and be informed of other care options
Be informed of hospital policies and practices
Illegal detention/false imprisonment (RA 9439)
Arbitrary detention
Restraints

Death and dying

right to informed refusal
care of the body
organ donation (RA 7170)
autopsy
assisted suicide
unauthorized patients discharge

Do Not Resuscitate/DNR (no code order) an order by the patients physician

instructing the w/holding of CPR if the patient goes into cardiac or respiratory arrest.

Duties of the nurse:

1. assure that everyone in the process understands the meaning of DNR
2. In case of conflict nurse will often act as mediator & help participants reach some shared
understanding.
3. ensure that the following information are documented
a. patients condition
b. prognosis
c. summary of decision making
d. parties involved in the decision making
e. future date to review the DNR order

2. Paternalism giving care like a good father/mother of a family

3. Non-maleficence do not harm; remove harm; prevent harm

- Medication rights
RA 6675 Generics Act 1988/Medication ; Orders, Drugs & Medication
RA 6425 Dangerous Drug Act 1972
RA 953 Narcotics Drug Law
RA 5921 Pharmacy Act
BON Res. No. 8 s. 1994 (Sec. 27 Art. V RA 7164)
RA 9502 - Cheaper Medicine Bill
4. Beneficence to do good; client advocate
 5. Justice allocation of goods & services & how or to whom they are distributed
a. equality everyone receives the same
b. need greater services go to those with greater needs
c. merit services go to more deserving (used as a criterion for transplant recipients).

6. Veracity telling the truth

a. Fraud deliberate deception intended to produce unlawful gain
b. Defamation character assassination verbal or written
c. Libel written
d. Slander verbal/oral
e. Medical record

7. Fidelity loyalty/faithfulness and keep promises

8. Confidentiality observing the seal of secrecy

a. Privileged communication
b. Invasion of privacy
c. Hearsay evidence
d. Dying declaration or ante mortem statement
e. Nurses as witness
When prohibition applies
Duration of the seal of secrecy

Nurses Code of Ethics

Four-fold responsibility of a nurse

BON Res. # 633 s. 1984 ICN Code of Ethics
1. Promotion of health
2. Prevention of illness
3. Alleviation of suffering
4. Restoration of health

Spiritual health holistic care

self-transcendence - going beyond self to help others reach self-actualization (5th
Declaration)
BON Res # 1995 s. 1989 PNA Code of Ethics was promulgated

CODE OF ETHICS
BON Res. # 220 s. 2004 Promulgation of the Code of Ethics for Registered Nurses
(amended code of ethics for nurses)

Preamble:
Sec. 1 Health is a fundamental right of the individual (4-fold responsibilities & if not
possible assistance towards a peaceful death
 Sec 2 Nurses have to gain knowledge & understanding of mans cultural, social, spiritual,
psychological, & ecological aspects of illness utilizing the therapeutic process.
Sec. 3 The desire for respect & confidence of clientele, colleagues, co-workers, & the
members of the community provide the incentive to attain & maintain the highest
possible degree of ethical conduct.

Article II - Registered Nurses and People (Service to Others)

1. Values, customs & spiritual beliefs held by the individual shall be represented
2. Individual freedom to make rational & unconstrained decision shall be respected.
3. Personal information acquired in the process of giving nursing care shall be in strict
confidence.

Article III Registered Nurse and Practice (Integrity and Objectivity)

1. Human life is inviolable
2. Quality & excellence in the care of the patients are the goals of nursing practice
3. Accurate documentation of actions & outcomes of delivered care is the hallmark of
nursing accountability
4. RNs are the advocate of the patients: they shall take appropriate steps to safeguard their
rights & privileges.
5. RNs are aware that their actions have professional, moral & legal dimensions. They
strive to perform their work in the best interest of all concerned.

Article IV Registered Nurses and Co-Workers (Solidarity and Teamwork)

1. The RN is in solidarity with other members of the health care team in working for the
patients best interest.
2. The RN maintains collegial & collaborative working relationship with colleagues & other
health care providers.

Article V RN, Society and Environment (Social and Civic Responsibility)

1. The preservation of life, respect for human rights & promotion of a healthy environment
shall be a commitment of a RN
2. The establishment of linkages w/ the public in promoting local, national & international
efforts to meet health & social needs of the people as a contributing member of society is
a noble concern of a RN

Article VI RN and the Profession (Professional Competence; Global

Competitiveness; Equality of all Professions)
1. Maintenance of loyalty to the nursing profession & preservation of its integrity are ideal
2. Compliance w/ the by-laws of the PNA, & other professional organizations of w/c the
RN is a member is a lofty duty
3. Commitment to continual learning and active participation in the development &
growth of the profession are commendable obligations
4. Contribution to the improvement of the socio-economic conditions & general welfare of
nurses through appropriate legislation is a practice & visionary mission.

CONTRACTS
Contracts
 meeting if the minds between two persons whereby one binds himself, with respect to
the other, to give something or to render some services (Art. 1305, CC)
Characteristics of contracts:
1. Obligatory - has force of law between parties
2. Autonomy - may establish agreement not contrary to law, morals good order, public
order, public policy
3. Mutuality - binding on both parties
4. Relativity - takes effect between parties, their assigns & heirs
Stages
1. Negotiation - from indicate interest to time contract in concluded
2. Perfection - birth; meeting of the mind on object and cause
3. Consummation death; performance of respective commitments

Kinds
1. Express - formal agreement whether written or verbal
2. Implied - presumed or inferred from acts
Duo ut des - i give that you give
Duo ut facias - i give, you do
Facio ut des - i do, you give
Facio ut facias - i do, you do
3. Formal - required to be in writing by some special laws
4. Informal - is not required to be in writing; intention is based on written document,
correspondence or oral/written agreement
5. Void or inexistent
object or purpose is contrary to law...
simulated or fictitious
object did not exist
object beyond commerce of man
performance of an impossible service
object cannot be determined with certainty
expressly prohibited or declared by law as void, invalid, ineffective
direct result of an illegal contract
6. voidable - can be annulled or voided
one party is incapable of giving consent
consent is vitiated by mistake, violence, intimidation, undue influence, fraud

Elements of validity
1. Consent
a. Legal age
b. Sound mind
c. Not under the influence of intoxicating drugs
d. Not suffering from mental disability

2. Object or subject matter

a. Not outside commerce of man including future things
b. Rights which are not intransmissible
 c. Future inheritance in cases expressly specified by law
d. All services which are not contrary to law
3. Cause - consideration, material, cause, reason, motive, price or impelling influence

Breach of contract (culpa contractual) - failure to perform an agreement whether

express or implied
1. Prevention of performance
2. Failure because of inconvenience or difficulty
3. Failure of cooperation
4. Abandonment of duty
5. Substitution of performance
6. Failure to use due care

Culpa aquilina (quasi delict) no contract but the nurse is still liable
Legal excuses
1. Discovery of material misrepresentation
2. Where performance is illegal
3. Illness or force majeure
4. Death of patient or nurse
5. Insufficient contract

WILLS
1. Succession
- mode of acquisition of rights, property & obligation transmitted thru will or by operation
of law upon the death of the testator
2. Decedent - person whose property is transmitted thru succession; testator
3. Estate - interest in hand or property to be transmitted
4. Testamentary capacity - capacity to comprehend the nature of transaction he is
engaging that time, recollect the property to be disposed; the persons who would have
claims to the property, comprehend the manner in which the instrument will distribute
the property
5. Wills - act whereby a person is permitted with the formalities prescribed by law to
control to a certain degree the disposition of his property to take effect upon his death

Who may make a will?

1. Married woman without the consent of the husband & without authority of the court
(separate property, share of the conjugal property or absolute community of property)
2. All persons who are not expressly prohibited by law (minors, mentally incapacitated;
mental capacity to be determined at the time of its execution
Forms/Kinds of Will
a. Notarial ( 3 or more credible witnesses, attestation clause, acknowledgement)
b. Holographic - written, dated and signed by the testator himself
c. Joint or Mutual will - not allowed as a matter of public policy
 Witnesses to wills
a. Legal age
b. Not blind, deaf or dumb
c. Able to read and write
d. Domiciled in the Philippines
e. Is not convicted of falsification of document or false testimony

Living will
Health care proxy form provided by hospitals
Forms part of hospital records
Designates health care representative - physical/mental incapacity
Includes to accept or refuse treatment, services, procedures, provide, withold or
withdraw life - sustaining devices; organ donation or acceptance
Doctor should be informed
Signed by patient and two other persons
It has the force of law

Advanced Directive/Durable power of attorney

document made by a competent individual to establish desired health care for the future or
give someone else the right to make health care decision if the individual becomes
incompetent
Made part of the medical record
Physician must be notified of its presence so that orders will be consistent with client'
wishes

CRIMINAL LIABILITY

Felonies

- act or omission punishable by law (RPC)

1. omission - inaction; failure to perform a (+) duty; there should be a law requiring to perform
the act
2. intent - purpose to use a particular means to effect a result ( deliberate intent - freedom and in
intelligence)
3. motive - moving power which impels one to act for a definite result

Stages of execution

1. Consummated when all the elements necessary for its execution and accomplishment are
present
2. Frustrated when the offender performs all the acts or execution which will produce the
felony as a consequence but which nevertheless produce it by the reason of causes independent
to the will of the perpetuator
3. Attempted when the offender commences the commission of the same directly by overt
acts and does not perform the acts which shall produce the felony.

conspiracy - two or more person agreed and committed the felony, a means by which another
person is held liable for the commission of a crime; each criminal is responsible for the acts of his
associates provided such act is a result of a common plan
proposal - a person who decided to commit a felony proposes its execution to another

Persons criminally liable

1. Principal
by direct participation
by inducement
by indispensable cooperation
2. Accomplice - accessory before the fact
3. Accessory - accessory after the fact
profiting themselves or assisting others to profit
concealing, destroying body of the crime, effects, instruments to prevent its discovery
harboring concealing, assisting the escape of the principal

Felonies according to degree of punishment

Grave offense, 1st offense - punishable of dismissal

1. Dishonesty
2. Gross neglect of duty
3. Grave misconduct
4. Notoriously undesirable
5. Conviction of a crime involving moral turpitude
6. Falsification of documents
7. Physical and mental incapacity due to vicious habits
8. Receiving for personal use of a fee and gift
9. Contracting loans or money from persons whom the office of the employee has business
relations
10. Soliciting or accepting directly or indirectly any gift, favor etc.
11. Disloyal to RP
12. Nepotism

Grave offense, 1st offense punishable with suspension without pay for six months
and 1 day to 1 yr; 2nd offense punishable with dismissal
1. Oppression
2. Disgraceful/immoral conduct
3. Incompetent/inefficient
4. Habitual absenteeism exceeds 2.5 days monthly allowable leave for at least in 3 months in a
semester or at least 3 consecutive months in a year
5. Habitual tardiness regardless of the number of minutes, 10 times a month for at least 2 months
in a semester or at least 2 consecutive months in a yr.
6. Refusal to perform duty
7. Gross insubordination
8. Financial interest in any transaction requiring the approval of his office
9. Engaging in the private practice of his profession unless authorized by law
10. Disclosing confidential information

Less grave offense, 1st offense punishable with suspension without pay for 1 month
and 1 day to 6 months; 2nd offense, punishable with dismissal
1. Simple neglect of duty
2. Simple misconduct
3. Gross discourtesy in the course of official duties
4. Gross violation of civil service law
5. Insubordination
6. Habitual drunkenness
7. Discrimination
8. Failure to file assets and liabilities

Light offense, 1st offense punishable with reprimand; 2nd offense punishable with
suspension without pay for 1 day to 30 days; 3rd offense punishable with dismissal
1. Discourtesy
2. Unauthorized solicitation from subordinates
3. Violation of office rules
4. Gambling
5. Refusal to render overtime
6. Disgraceful, immoral and dishonesty prior to entering the service
7. Borrowing money from subordinates
8. Lending money at usurious rates of interest
9. Willful failure to pay debts and taxes
10. Failure to process documents and complete action in documents

Circumstances affecting criminal liability

1. Justifying Circumstances - free from criminal and civil liability
J Self - defense
1. Unlawful aggression
2. Reasonable necessity of the
3. Means employed prevent/repel it
4. Lack of sufficient provocation
5. On the person defending himself
J Defense of relatives - up to 4th degree by consanguinity; that in the case of provocation was
given by the attacked, that the one making defense had no part therein
J Defense of a stranger - defending not induced by resentment, revenge or other evil motive
J Who acts in fulfillment of a duty or in a lawful exercise of a right or office
J Who acts in obedience to an order by a superior for some lawful purpose

2. Exempting Circumstances - no criminal liability only civil liability

1. Mistake of fact - (ignorantia facti excusat) must be committed in good faith or under an
honest belief

2. An insane or imbecile unless acted during lucid interval

3. Under 9 years of age

4. Over 9 under 15, unless acted with discernment

5. While performing a lawful act with due care causes an injury by mere accident without fault or
intention of doing it

6. Who acted under the compulsion of an irresistible force from a third person

7. Impulse of uncontrollable fear of an equal or greater injury

8. Insuperable or lawful cause

3. Mitigating Circumstances
1. Under 18 or over 70
2. No intention to commit so grave a wrong
3. Sufficient provocation or threat on the part of the offended party immediately preceded the act
4. Voluntary surrender
5. Deaf, dumb or blind or suffering from physical defect
6. Such illness that would diminish the exercise of his will power
7. Committed in the immediate vindication of a grave offense to the one committing the felony,
his/her spouse, ascendants, descendants, legitimate, natural or adopted brothers or sisters,
relative by affinity within the same degree
8. Acted upon an impulse so powerful as naturally to have produced an obfuscation

4. Aggravating Circumstances
1. Advantage of public position
2. In contempt or insult to public authorities
3. Abuse of confidence or obvious ungratefulness
4. Committed on occasion of epidemic, conflagration, shipwreck or other calamity or misfortune
5. In consideration of a price or reward or promise
6. Committed by means of fire, explosion, stranded of a vessel
7. With evident premeditation
8. Craft, fraud or disguise

5. Alternating (either mitigating or aggravating)

1. Relationship, intoxication, degree of education
2. Education is not mitigating in rape, forcible abduction, arson, treason, seduction, acts of
lasciviousness, heinous crimes
Criminal Negligence crime committed by means of fault (culpa)
Kinds:
1. Reckless imprudence doing or failing to do an act resulting to injuries or death due to an
inexcusable lack of precaution
2. Simple Imprudence lack of precaution; impending danger is not openly visible

Nurses and Crimes

1. Parricide killing of his father, mother or child or any of his ascendants, descendants
(legitimate or illegitimate) and spouse
2. Murder - with intent to kill
3. Homicide - without intent to kill; absence of proof on how the victim was killed
4. Infanticide - less than 3 days of age
5. Abortion - termination of pregnancy before fetus is viable (3-6 mos)

Under Philippine Law, Child Abuse refers to the maltreatment, whether habitual or not, of the
child, and such maltreatment includes any of the following:
a. Psychological and physical abuse, neglect, cruelty, sexual abuse and emotional maltreatment
b. Any act, by deeds or words, which debases, degrades, or demeans the intrinsic worth and dignity
of a child as a human being
c. Unreasonable deprivation of the child's basic needs for survival, such as food, shelter or
d. Failure to immediately give medical treatment to an injured child, resulting in serious
impairment of his growth and development or in his permanent incapacity or death

6. Sexual harassment - words, gestures actions which tend to annoy and verbally abuse another
person
7. Simulation of birth - crime against status by substitution of one child with another;
concealing or abandoning any legitimate child with intent to lose civil status
8. Misdemeanor - use to express every offense inferior to felony and punishable by indictment
or by particular prescribed proceedings
Example:
a. a person who practices nursing without certificate of registration
b. any person assuming or using title advertising as registered nurse without being conferred such
title
c. any person advertising any title to convey the impression that she is a nurse (e.g. using nurse's
uniform and cap)
9. Physical Injuries
Kinds:
1. Slight physical Injuries 1-9 days of incapacity/requires medical attention
2. Less serious physical injury 10 days or more
3. Serious physical injury more than 30 days

Torts - a legal wrong committed against a person or property independent of a contract which
renders the person who commits it liable for damages in a civil action

Examples
a. assault and battery
b. false imprisonment or illegal detention
c. Invasion of right of privacy and breach of confidentiality

J Assault attempt to touch or threat another person unjustifiably

J Battery willful touching of a person that may or may not cause harm;unconsented
touching of another person
J Defamation communication that is false and results in injury to the reputation of the patient
Libel by means of print, writing or pictures
Slander spoken words

J False Imprisonment of Illegal Detention

Unjustifiable detention of a person without a legal warrant within boundaries

J Invasion of Right to Privacy and breach of confidentiality

Right to privacy is the right to be left alone

Right to be free from unwarranted publicity

Exposure to public view

Divulge information from patients chart to improper sources or unauthorized person

Jurisprudence in Nursing Practice

Imprudence deficiency of action; lack of skill

 Negligence lack of foresight; deficiency of perception
Specific examples of negligence:
1. Failure to report observations to attending Physicians
2. Failure to exercise the degree of diligence which the circumstances of the particular case
demands
3. Mistaken Identity
4. Wrong medicine, wrong concentration, wrong route, wrong dose
5. Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the
patients

Malpractice failure to follow a reasonable professional standard of care, thereby resulting to

injury to a patient; professional negligence (Kozier, 2004)
Specific examples of malpractice:
1. Misdiagnosis of an illness, failure to diagnose or relay diagnosis
2. Birth Injuries
3. Surgical Complications
4. Prescription errors
5. Failure to provide treatment
6. Anesthesia related complications
7. Failure to follow advance directive
8. Failure of hospital or pharmacy to dispense the right medicine and dosage

Concept of Accountability
Accountability of the nurse to the patient, physician or to the public has a reference to the quality
of nursing care she renders
A contractual obligation which the nurse assumed exposes her to a certain degree of accountability;
the term accountability carries the idea of sanction or penalty.

Documentation recording/ charting

Purposes:
C Communication
A Assurance of quality
 R Research purposes
L Legal document
S Statistics source

SUBPOENA an order from court

Duces Tecum (papers) documents obj, materials, papers, chart
Ad Testificadum (person) witness

Dos & Donts of charting

Dos Donts
F Full, factual & accurate L language unacceptable
L Legible I Improper corrections
I Immediately after procedure S Spaces, skips
P Personal notes, not delegated A Avoid using too much abbreviations

addendum late entry

Doctrines in Nursing Practice

1. Bonus Pater Familias (good father of a family) employer is liable on his own negligence
Culpa In Eligiendo liable for being negligent in the selection of employees
Culpa In Vigilando liable for being negligent in the supervision of employees
2. Respondeat Superior (Let the master/superior answer) employer is responsible for the
action of the employee within the course of employment
3. Professional Negligence - Commission or omission of an act, pursuant to a duty
4. Res Ipsa Loquitor (the thing speaks for itself) Ex. Scalpel left behind after appendectomy
5. Force Majeure event which cannot be foreseen; an act of God; unexpected event. Ex. The
nurse and the patient trapped in the elevator because of an earthquake and the patient died
despite proper intervention.
6. Damnun Absque Injuria (although there was a physical damage, there is no legal injury)
Ex. Expert IVT nurse who carefully performed her duty hurt a patient because of the lighting that
strikes the room causing injury to the patient
7. Stare Decisis (stand by decisions) court should stand with its previous decision
8. Nolo Contendere (I will not defend it) plea of guilty
9. Malfeasance performance of some act which ought not to be done
10. Misfeasance improper performance
11. Nonfeasance omission of some act which ought to be performed
12. Captain of the Ship Doctrine
13. Doctrine of Corporate Liability
14. Doctors order rule
General rule - no telephone order
Whatever is not written is not an order
Exception Emergency!
After MD says order repeat instruction on phone
Have resident MD sign within 24 hrs! Administer meds.
When MD arrives have him counter sign his order
15. Nurse as witness rule
1. Ordinary witness one who can testify as to the conditions present in the issue or
surrounding the case
2. Expert witness testify on the issue by giving his opinion or advice from the facts presented

NURSING LAW OF 2002

SUMMARY
RA 9173 - An act providing for a more responsive nursing profession, repealing for the
purpose RA 7164 known as the Phil. Nursing Act of 1991 and for other purposes. This
act shall be known as the Phil. Nursing Act of 2002
ARTICLE I
TITLE
Section 1. Title - This act shall be known as the Phil. Nursing Act of 2002
Sec 2. Declaration of Policy
1. relevant nursing education,
2. humane working conditions,
3. better career prospect
 4. and a dignified existence of our nurses.
(BON Res. 425 s. 2003 IRR of RA 9173 state hereby guarantees the delivery of quality basic
health services thru an adequate nursing personnel system throughout the country.)
ARTICLE III
ORGANIZATION OF THE BOARD OF NURSING
Sec 3. Creation and Composition of the Board
A chairperson and six members, appointed by the President of the Republic of the
Philippines

Sec 4. Qualifications
1. Natural born citizen;
2. Member of good standing of the accredited professional organization for nurses;
3. RN, MAN, MA Education or other allied profession from university duly recognized by the
Government; provide that majority are MAN; Chairman is MAN holder;
4. 10 years continuous practice ; last 5 years in the Phil.
5. Not convicted of any offense involving moral turpitude
6. Membership to the board shall hold 3 areas namely, nursing education, nursing service and
community service
Sec 5.Requirement upon qualification
immediately resign from teaching from any school, college or university offering nursing
education, review program for the local nursing board or in any office or employment in the
government or in any government owned corporations
she/he shall not have pecuniary interest or administrative supervision over any institution
offering nursing education.
(IRR pecuniary interest refers to involvement of husband/wife, children, brothers/sisters,
and mother/father in any activity that will conflict w/ her/his position in the Board, particularly
money matters.)

Sec 6. Term of Office

1. 3 years; can be reappointed for another 3 years
2. any vacancy in the Board occurring shall be filled for the unexpired portion of the term only
(HOLD OVER DOCTRINE)
3. The incumbent chairperson & members shall continue to serve the remainder of their term
(RA 7164) until their replacements shall have been appointed (IRR)
4. Submit to the Pres. 2 nominees/ vacancy not later than 2 mos. Before the vacancy occurs w/
the request that the appointment be issued not later than 30 days before the scheduled board
exam (IRR)
5. the Board shall be under the supervision of PRC
Sec 7. Compensation of Board Members same as that of the PRC
Sec 8. Administrative Supervision of the Board, Custodian of its records, Secretariat
and Support Service - PRC
Sec 9. Powers and Duties of the Board
a. Police Powers
b. Quasi-legislative
c. Quasi-judicial
Sec 10. Annual Report - detailed account of its proceedings, accomplishments &
conditions affecting the nursing practice President
Sec 11. Removal or Suspension of Board Members
a. continued neglect of duty
b. commission or toleration of irregularities in the licensure examination
c. unprofessional, immoral or dishonorable conduct
ARTICLE IV
EXAMINATION AND REGISTRATION
Sec 12. Licensure Examination
Pass a written examination in accordance w/ RA 8981 PRC Modernization Act
Sec 13. Qualifications for Admission to the Licensure Examination:
1. Citizen of the Phil or subject of a country which permits Filipino nurses to practice within its
territorial limits
2. Good moral character
3. BSN degree holder from a college/university
Sec 14. Scope of examination shall be determined by the board taking into consideration
objectives of nursing curriculum, board areas of nursing & other related disciplines and
competencies.
Sec 15. Ratings
1. General weighted average of 75% with no grade lower than 60 % in any subject
2. An examiner who gets an average of 75% or higher but gets a rating of below 60% percent
in any subject Removal
Sec 16. Oath required prior to entering the practice of nursing
Sec 17. Certificate of registration shall be issued after the oath taking ceremony, which is
renewable every three years
Sec. 18. Fees for Examination & Registration - prescribed by the commission
Sec. 19. Automatic Registration of Nurses ipso facto registered
Sec 20. Registration by Reciprocity
A certificate of registration/professional license may be issued without examination to nurses
registered under the laws of a foreign country or state provided:
requirements for registration is substantially the same
laws of such state grants the same privileges to registered nurses of the Philippines
Sec 21. Practice through Special/Temporary Permit
1. Internationally known specialists/experts
2. On medical mission
3. Exchange professors
Sec 22. Non registration & non issuance of Certificate of Registration/Professional
License
1. convicted by final judgment of any crime involving moral turpitude
2. person guilty of immoral or dishonorable conduct
3. declared by court to be of unsound mind
Sec 23. Revocation/Suspension of Certificate of Registration/Prof. License &
Cancellation of Special/Temporary Permit
1. Persons convicted by final judgment of any criminal offense involving moral turpitude
2. Person guilty of immoral or dishonorable conduct
3. Any person declared by court to be of unsound mind
4. Unprofessional and unethical standard
5. Gross incompetence or serious ignorance
6. Malpractice or negligence in the practice of nursing
7. Uses fraud deceit, or false statements in obtaining certificate of registration/ professional
license or special/temporary permit
8. Violation of the Code of Ethics or conditions for the issuance of temporary/special permit
9. Practicing his/her profession during his/her suspension from such practice
10. PROVIDED however that such suspension of the cert. of registration/prof. license shall be for
a period not to exceed 4 years
Sec 24. Re-issuance of revoked Certificates and Replacement of lost Certificate
cause of revocation has disappeared/cured
or corrected subject to the rules of the Board
ARTICLE V
NURSING EDUCATION
Sec 25. Nursing Education Program
 shall provide sound general and professional foundation for the practice of nursing
learning experience shall adhere strictly to specific requirements by the CHED and standards
of the nursing practice.
Sec 26. Inactive nurses returning to practice (for 5 consecutive years) are required to
undergo 1 month didactic training and 3 months practicum in accredited hospitals.
Sec 27. Qualifications of the Faculty:
1. RN;
2. One year experience of clinical practice in a field of specialization;
3. Member of good standing of accredited professional nursing organization;
4. MAN, MA Education or other allied medical sciences conferred by a college or university
duly recognized by the government;
5. Dean - MAN and must have at least 5 years experience in nursing
ARTICLE VI
NURSING PRACTICE
Sec 28. Scope of Nursing Practice
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.
1. It includes but not limited to: nursing care during conception, labor, delivery, infancy,
childhood, toddler, pre-school, school age, adolescence, adulthood and old age.
2. As independent practitioners, nurses are primarily responsible for the promotion of health &
prevention of illness.
3. 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.
4. Provide nursing through the utilization of the nursing process. Nursing care includes but not
limited to:
a. traditional and innovative approaches
b. therapeutic use of self
c. executing health care techniques and procedures, essential primary health care, comfort
measures, & health teachings
d. administration of written prescriptions for treatment therapies, oral, parenteral medications,
e. internal examinations during labor in the absence of antenatal bleeding
f. delivery
g. in case of suturing of perineal laceration, special training shall be provided according to
protocol established
5. Establish linkages with community resources and coordination with the health team
6. Provide health education to include families and communities
 7. Teach, guide and supervise students in nursing education programs including administration
of services in varied settings such as hospitals, and clinics and undertake consultation
services; engage in such activities that require the utilization of knowledge and decision
making skills as registered nurses
8. Undertake nursing and health human resources development training, which shall include
but not limited to the development of advance nursing practice
Sec 29. Qualifications of Nursing Service Administrators
1. RN;
2. At least 2 yrs. experience in gen. nursing service administration;
3. BSN degree holder with at least 9 units in management and administration courses at the
graduate level;
4. Member of good standing of the accredited professional organization for nurses;
5. For chief nurse/ director of nursing service 5 yrs. experience in supervisory or managerial
position & MAN holder;
6. Chief Nurse (Primary Hospital) qualification same as supervisors; CN Public Health
Agencies -MPH
7. For military chief nurses MAN plus completion of the General Staff Course (GSC).
ARTICLE VII
HEALTH HUMAN RESORCE PRODUCTION, UTILIZATION AND DEVELOPMENT
Sec 30. Studies for Nursing manpower needs, production, utilization and development
The Board in coordination with APO & appropriated government and private agencies shall
initiate, undertake & conduct studies on health human resource production, utilization and
development.
Sec 31. Comprehensive Nursing Specialty Program
BON/ APO/ RSO/DOH
upgrade the level of skill and competence of specialty nurse clinicians
critical care/oncology/renal
beneficiaries to serve Phil. Hospital for 2 years
BON Res #14 s.1999 created NSCC oversee the administration of new program by
Specialty Cert. Board (Pres APO/ Academician/PRB)

Sec 32. Salary shall not be lower than grade 15 (RA 6758 Compensation & Classification
Act of 1989)
Sec 33. Funding of CNSP
PAGCOR/PCSO
DOH releases, accounts & audits and sets the criteria for the availment of the program
Sec 34. Incentives and benefits
 free hospital care for nurses and their dependents
scholarship grants & other non-cash benefits
maintain nurse-patient ratio as set by DOH
ARTICLE VIII
PENAL AND MISCELLENAOUS PROVISIONS
Sec 35. Prohibitions in the Practice of Nursing
(Penalty: fine of Php50,000.00 but not more than Php100,000.00 or imprisonment of not less
than 1 year but not more than 6 years or both)
Any person who practices nursing
1. without certificate of registration/ professional license; temporary permit
2. who uses as his/her own certificate of registration/ license/permit of another
3. who uses an invalid, suspended, revoked, expired, cancelled certificate, license or permit
4. who gives any false evidence to the Board in order to obtain a cert. of registration/ license/
or permit
5. who appends BSN/ RN or any similar appendages to his/her name without having been
conferred said degree or registration
6. who falsely advertises as registered/licensed nurse or uses any other means that tend to
convey the impression that he/she is a registered/licensed nurse
7. who as a registered/licensed nurse, abets or assists the illegal practice of a person who is
not lawfully qualified to practice nursing
Any person or the CEO of a juridical entity who undertakes in-service educational programs or
who conducts review classes for both local & foreign examination without permit/clearance
from the BON & PRC
Any person or employer of nurses who violates the minimum base pay of nurses and the
incentives & benefits that should be accorded as specified in RA 6758 Compensation and
classification Act of 1989
Any person or the CEO of a juridical entity violating any provision of this Act and its rules and
its rules and regulations