Professional adjustment/ Bioethics NURSING JURISPRUDENCE- department of law which comprise all legal rules and principles affecting

the practice of nursing. NURSING LEGISLATION- the making of laws, or the body of laws already enacted affecting the practice of nursing. LAW- a rule of civil conduct prescribed by the supreme power in a state commanding what is right and prohibiting what is wrong. LEGAL RIGHT- a claim which can be enforced by legal means against a person whose duty is to respect it. COURT MECHANISM: LAWSUIT- proceeding in court for a purpose. Purpose: 1. to enforce a right 2. to redress a wrong Civil case- Complainant/ defendant Criminal case- Plaintiff/ accused STATUTE OF LIMITATIONS- the length of time following the event during which the plaintiff may file a lawsuit. Example: negligence- filed within 2-3 years from occurrence. DUE PROCESS- is fair and orderly process which aims to protect and enforce a persons right. Fundamental requirements of Due Process: 1. right to be informed 2. right to remain silent 3. right to have competent counsel 4. no use of violence, threat, torture TRIAL- facts are presented and determined; law is applied at the end SUMMONS- is a writ commanding an authorized person to notify a party to appear in court to answer a complaint made against him. SUBPOENA- is an order that requires a person to attent at a specific time and place to testify as a witness. SUBPOENA DUCES TECUM- is a subpoena that requires a witness to bring documents/ papers in his possession. WITNESS- person giving necessary details. Nurses as witness: Could not divulge PRIVILEGED COMMUNICATION in a civil case- means that the nurse is incompetent to testify on the communications made to him by the patient, all the advice given and all information gathered by observation. Duration of seal of secrecy except: 1. criminal case 2. with patients consent 3. patient sued doctor for damages Testimonies of fact- factual information - no opinion unless an expert witness. Perjury- is the willful telling of a lie under oath. Hearsay evidence- rumors not admissible in evidence Dying declaration- considered hearsay unless the dying person is a victim of a crime. NURSES AND CRIMINAL LIABILTY

FELONIES- acts or omissions punishable by law. Elements: 1. deceit (dolo)- deliberate intent 2. fault (culpa)- results from imprudence, negligence, lack of foresight Stages of crimes: 1. Consummated 2. frustrated 3. attempted Degree of crimes: 1. Grave- capital punishment, or penalty of above 6 yrs and one day, or fine of more than 6 thousand pesos. 2. Less grave- penalty of 1 month and 1 day- 6 yrs, or fine 0f not more than 6k but not less than 200 pesos. 3. Light- penalty of 1day to 30 days, or fine of not more than 200 pesos. Classification of persons criminally liable: 1. Principal a. by direct participation b. by inducement c. by indispensable cooperation 2. 3. Accomplice- accessory before the fact Accessory- accessory after the fact a. profiting themselves or assisting others to profit b. concealing/ destroying the evidence of the crime c. harboring or assisting the escape of the principal

Circumstances affecting criminal liability: 1. Justifying circumstance- not criminally liable a. lawful self-defense elements: 1. unlawful aggression 2. reasonable necessity of the means employed by the offender 3. lack of sufficient provocation 2. b. obedience to an lawful order of superior Exempting circumstance- exempted from criminal liability a. imbecile/ insane, except lucid interval b. person below 9 years old c. person above 9 and below 15 unless acted with discernment d. performance of a lawful act Mitigating circumstance- reduces penalty a. below 18 y/o or over 70 y/o b. does not meet all requisite circumstances c. offender is deaf, dumb, blind or with physical defect d. voluntary surrender e. illness diminishing exercise of the will power Aggravating circumstance- increases liability a. take advantage of public position b. committed with abuse of confidence c. on occasion of earthquake, epidemic, calamity d. for price or reward e. fire, poison, explosion f. evident premeditation g. craft, fraud or disguise h. treachery Alternative circumstances-

3.

4.

5.

a. b. c.

relationship intoxication degree of instruction/ education

Types of contracts: 1. Implied- terms are inferred from the actions of the parties 2. Expressed- verbal/ written, terms are specified Breach of Contract: failure without legal excuse to perform any promise which forms the whole or part of the contract. Will- an act whereby a person is permitted with formalities of law to control to a certain degree the disposition of a state to take effect after his death. Decedent- person whose property is transmitted through succession Testator- a decedent who left a will Two kinds of wills: 1. Notarial 2. Holographic Nurses obligation in the execution of a will: 1. Note the soundness of cliets mind 2. that the will is signed by the testator 3. that the witnesses shall be present at the time and sign in the p-rese4nce of the testator. Gifts Mortis Causa- disposing of gifts by a person in anticipation of death/ belief in approaching death. - limited to personal properties - acceptance by the recipient - gifts are revocable and subject to the claims of creditors without proof of intent of defrauding them.

Crimes concerning nurses: 1. Parricide 2. homicide 3. murder 4. infanticide 5. abortion 6. illegal detention/ false imprisonment 7. simulation of birth 8. misdemeanor 9. robbery 10. theft 11. assault 12. battery 13. invasion of privacy 14. defamation- slander - libel Guidelines to prevent criminal liability: 1. be familiar with Phil Nursing Law 2. be familiar with laws affecting the nursing practice 3. know agency rules, regulations, policies 4. upgrade skills and competence 5. develop good IPR 6. consult superior as needed 7. verify vague/ erroneous orders 8. always keep doctor updated regarding patient 9. ensure accurate recording and reporting 10. informed consent Legal considerations in charting: 1. dont tamper with medical records 2. observe agencys standards on documentation - complete, concise, specific, use standard abbreviations - telephone orders Tips for avoiding legal pitfalls: 1. Patient falls - do proper assessment - appropriate assistance is given - use protective measures - document all nursing interventions 2. Medication error - observe 7 Rs of drug administration - check drs order - consult drug handbook/ pharmacy - not exempt from liability for following drs order Equipment injuries - refuse to use a device not knopw how to operate - report adverse events to superiors - monitor patient regularly

NEGLIGENCE AND MALPRACTICE NEGLIGENCE- Doing of that thing which a reasonably prudent person would not have done; or the failure to do that thing which a reasonably prudent person would have done in like or similar circumstances. * 3 ESSENTIAL CONDITIONS FOR ACTIONABLE NEGLIGENCE: 1. Existence of a duty on the part of the person charged to protect the complaining party from the injury received. 2. Failure to perform that duty. 3. Injury resulting from such failure. Burden of Proof: complaining or injured party

3.

Nurses and Contracts/ Wills Contract- agreement between atleast two parties which create an obligation recognized by law. There must be acceptance of the obligation. Elements of a valid contract: 1. given freely 2. competent parties 3. lawful object 4. valid consideration

* DOCTRINES UNDER NEGLIGENCE: 1. Doctrine of Res ipsa Loquitur - the thing speaks for itself Three Conditions: A) Accident must be of a kind which ordinarily does not occur in the absence of someones negligence; B) The accident must be caused by an agency or instrumentality within the exclusive control of defendant; C) Not have been due to any voluntary action or contribution on the part of injured party. Examples of Cases: - Negligence resulting to injury to a delirious patient Maki vs Murray Hospital

2.

Liability for sponge left in the patients abdomen Ales vs Ryan Doctrine of Respondeat Superior Let the principal answer for the acts of his agent Application: Failure of servant to use such care necessary in the course of employment. - not applied if acting outside the legitimate scope of his authority. Examples of Cases: - Liability for burns due to hot water bag Aderhold vs Bishop - Liability for death of infant due to overdose of Digitalis Nortow vs Argonaut Ins. Company

3.

Effect of Force Majeur- Act of God; Irresistible or superior force - Neither foresee or prevent; fortuitous event Not answerable unless: A) Expressly specified by the law. B) Declared by stipulation. C) Nature of obligation requires assumption of -

risk. * THE NURSE AND THE DOCTORS ORDERS - it is expected that nurses exercise reasonable judgment/ sound discretion in carrying out doctors orders. - if life of patient is endangered, liable for criminal negligence or reckless imprudence Somera Case II.

b. Appointment to vacancy shall be for the unexpired portion of the term c. proper oath of office Powers, functions and duties: a. conduct licensure exam for nurses b. issue, suspend or revoke certificates of registration for the practice of nursing c. monitor and enforce quality standards of nursing practice d. ensure quality nursing education e. conduct hearings and investigations to resolve complaints against nurse practitioners f. promulgate a code of ethics g. recognize nursing specialty organizations h. prescribe, adopt, issue and promulgate guidelines, regulations, measures and decisions as maybe necessary Grounds for Removal or suspension of a member: a. continued neglect of duty or incompetence b. commission or tolerance of irregularities in the licensure examination c. unprofessional, immoral and dishonorable conduct Requirements upon qualification: a. Immediately resign from any teaching position in any institution offering BSN and/or review program; b. Immediately resign from any govt or private employment; c. Not have pecuniary interest in, or administrative supervision in any istitution offering BSN or review classes.

EXAMINATION AND REGISTRATION Qualification for admission to the licensure exam: a. Citizen of the Philippines or by reciprocity; b. Good Moral Character; Suspended by PRC Resolution No. 2004-192 Reasons: 1. Proliferation of enterprising professionals victimizing examinees from the provinces; 2. Reports that pre-signed certificates of GMC are also allegedly being sold outside; 3. Additional expenses c. Holder of BSN Degree from a school duly recognized Ratings a. General average of atleast 75% with a rating of not below 60% in any subject; b. If above 75% but with a subject below 60%, must repeat that subject with a rating above 75% Oath taking Issuance of Certificate of Reg/Prof License a. Bearing full name of the registrant; - serial number; - signature of the Chairperson and members of the Board; - official seal of the Commission and the Board b. PRC CARD bears :- Date of Registration; - License Number; - Date of Issuance and Expiration Date

MALPRACTICE- Any professional misconduct, or any unreasonable lack of skill or fidelity in the performance of professional or fiduciary duties: - Objectionable practice/ Contrary to established rules; Example: Nurse giving out prescription of drugs

PHILIPPINE NURSING ACT ( RA 9173) I. BOARD OF NURSING - composed of a chairperson and six members - appointment: - appointed by president of the republic of the phils. qualification: a. natural born citizen and resident of the phils b. member of good standing c. be a registered nurse and holder of masters degree in nursing, education or other allied medical profession d. ten years of continuous practice, last five years in the phils e. no conviction of any offense involving moral turpitude Term of office: a. Appointed for 3 years/ reappointment for two years or two terms only -

Renewal- Third year on birth month

REGISTRATION BY RECIPROCITY: Conditions before nurses registered in a foreign country can practice in the phils: 1. the requirements for registration in their country are substantially the same in our country; 2. Under their laws, Filipino nurses are granted the same privileges and on the same basis as their citizens. SPECIAL OR TEMPORARY PERMIT TO PRACTICE FOR LICENSED FOREIGN NURSES: 1. well-known specialists or outstanding expert 2. on a medical mission 3. employed as exchange professors permit valid for the duration of the project, mission or employment contract. GROUNDS FOR REVOCATION AND SUSPENSION OF PROFESSIONAL LICENSE: 1. Conviction by final judgment of any criminal offense involving moral turpitude, immoral or dishonorable conduct, having unsound mind 2. Unprofessional or unethical conduct 3. Gross incompetence or serious ignorance 4. Malpractice or negligence 5. Use of fraud, deceit or false statements in obtaining a cert of registration 6. Violation of RA 9173, Code of Ethics for nurses BR 220 7. Practicing profession during suspension REQUIREMENTS FOR RE-ISSUANCE OF REVOKED CERTIFICATE OR REPLACEMENT OF LOSS CERTIFICATE: 1. Expiration of a maximum of four years from date of revocation 2. Cause of revocation has disappeared or has been corrected 3. Request is to replace lost, destroyed or mutilated cert/ license 4. Proper application 5. Payment of required fees III. NURSING EDUCATION - Inactive nurses for a period of Five (5) Consecutive years can return to practice after one month didactic training and three months of practicum. The Board shall accredit hospitals to conduct said training.

- DUTIES OF NURSES: 1. Provide nursing care 2. Establish linkages with community resources 3. Provide health education 4. Teach, guide and supervise students in nursing programs 5. Undertake research and training, professional continuing education 6. Observe Code of Ethics -QUALIFICATIONS OF NURSING ADMINISTRATORS 1. Supervisory or Managerial positions - Qualifications: a. registered nurse in the Philippines b. atleast two years experience in nursing administration c. with atleast nine units in management and administration d. member of good standing of accredited professional org of nurses 2. if the position is for chief nurse or director: a. Same with supervisors; b. atleast five years of experience in a supervisory or managerial position c. a masters degree major in nursing 3. Chief nurse for primary hospital: a. two years experience in general nursing service administration b. nine units management and administration course 4. Chief nurse in public health agencies: a. masters degree in public health/ CHN be given priority 5. Chief nurse in military hospitals: a. masters degree in nursing and completion of the General Staff Course V. Comprehensive Nursing Specialty Program - Beneficiaries are 1. Issued a Certificate of Completion 2. Must serve in any Phil. Hospital for atleast two years of continuous service

- FACULTY OF NURSING - Qualifications: a. registered nurse b. atleast one year clinical experience c. member of good standing d. holder of masters degree in nursing, education or other allied medical and health sciences - DEANS Qualifications: a a. Same with faculty; b. Atleast five years of experience in teaching and supervising a nursing education program IV. NURSING PRACTICE

Incentives and benefits: - limited to non-cash benefits such as: - free hospital care for nurses and their dependents; scholarship grants and others VI. Penal and Miscellaneous Provisions Prohibitions in the practice: Any person practicing nursing 1. without a Cert of registration/ prof license and PRC Card 2. uses an invalid certificate; 3. uses a suspended or revoked Certificate or expired or cancelled permit 4. gives false evidence to the Board 5. falsely poses or advertises or conveys the impression that he is a registered nurse 6. who appends BSN, RN without authority 7. who as aregistered nurse, assists illegal practice of a non-qualified person Penalties:

- SCOPE OF NURSING PRACTICE: 1. singly or in collaboration with another, initiates and performs nursing services to individuals,families and communities 2. provide nursing care from delivery up to old age 3. as independent practitioner, primarily responsible for the promotion of health and prevention of illness 4. collaborates with other members of health team

a fine of not less than P50000. Nor more than P100,000. Or imprisonment of not less than 1 year nor more than six years, or both, upon the discretion of the court.

LAWS AFFECTING NURSING PRACTICE I. LAWS AFFECTING HEALTH/ STATUS RA 6675- GENERIC DRUG ACT OF 1988 Generic name- identification of drugs with scientifically and internationally recognized active ingredients. Brand name- propriety name given by manufacturer Essential drug list- list of drugs prepared by DOH on the basis of health conditions in the Phils as well as internationally accepted criteria. Relevant provisions: - All government and private agencies and their personnel shall use the generic terminologies for drug quality in all instances. - The label of all drugs and medicines shall have the following: name, country of manufacture, date of manufacture and expiration - Prescription should include generic and trade name of the drug, quantity, doctors signature, license number and PTR number RA 953 NARCOTIC DRUG ACT - registration and imposition of license on all persons who deal in narcotic drugs and the control of the legal traffic in narcotic drugs. - Narcotics- drugs which produces insensibility, stupor, melancholy or dullness of mind, habit forming - Prohibited drugs- drugs with opium, coca leaf, heroine, morphine,LSD - Regulated drugs- self-inducing sedatives, secobarbitals, hypnotic drugs RA 6425- provision of S2- code of selected doctors who can prescribe narcotic drugs PD 603- CHILD AND YOUTH WELFARE CODE - highlights the role of the nurse which include immediate registration of births, childs enjoyment of highest standard of health, uphold childs freedom of expression, childs inherent right to life, access to basic health services. PD 996- provided for compulsory basic immunization for infants and children below 8 years old PD 949- Primary health care RA 3573- an act providing for the prevention and suppression of dangerous communicable diseases II. LAWS THAT PROMOTE THE WELFARE AND WELL BEING OF NURSES RA 7305- Magna Carta of Public Health Workers - has provisions on the benefits, rights and responsibilities of public health workers PD 442 Labor Code of the Philippines PD 807- Civil Service Law- provides for recruitement and selection of employees in govt service RA 7877- Anti- Sexual Harassment Act III. LAWS THAT PROVIDE THE RESPONSIBILITY OF THE EMPLOYEES RA 6713- Code of conduct and Ethical Standards for Public Officials and Employees - public officials and employees shall at all times be accountable to the people and shall discharge

their duties with utmost responsibility, integrity, competence and uphold public interest RA 8344- An act penalizing the refusal of Hospitals and medical Clinics to administer appropriate initial treatment and support in emergency cases RA 7160- Local Government Code - general features include decentralization and local autonomy - the Local chief executive have the power over budgets for health, implementation of programs and appointment of personnel. PROFESSIONAL ADJUSTMENT growth of the individual and development of his capacities- physical, mental, emotional, social and spiritual. Characteristics of a profession: a. Altruism- work for the good of society b. Autonomy- self- determination c. Authority- based on knowledge d. Accountability- answerable for their conduct and responsible for their practice. e. Code of Ethics- relevance to social values f. Distinct identity NURSING ETHICS ETHICS- study of the norm of human acts as guided by human reason. Theories: 1. EGOISM- self-interest of the doer determines goodness of the act. 2. UTILITARIANISM- consequentialism Ethical if: - minimizes pain and suffering - maximizes pleasure - seeks happiness of the majority 3. DEONTOLOGISM- legalistic view - what is legal is not necessarily ethical 4. RELATIVISM/ SUBJECTIVISM- standard of right or wrong is relative to people, to time and to place. 5. SITUATIONALISM- love theory 6. NATURAL LAW THEORY- work of creator - if acts preserves life, it is good; if rejects life, it is bad.

Principles: 1. BENEFICENCE- means to do good and not to do harm. 2. NON- MALEFICENCE- one ought not to inflict evil or harm. 3. AUTONOMY- means self-determination 4. JUSTICE- refers to the obligation to be fair to other people. 5. VERACITY- refers to telling the truth or not intentionally deceiving or misleading patients 6. STEWARDSHIP- not harm our body because it is Gods not ours. PATIENTS BILL OF RIGHTS 1. Right to considerate and respectful care - nurse avoids discriminating acts that tends to bring the appearance of favoritism - tender loving care attitude 2. Right to information about diagnosis, treatment and prognosis 3. Right to informed consent - refers to the capacity of the patient to accept or refuse treatment options offered by the health care provider. Elements:

a. voluntariness b. information c. capacity 4. Right to refuse treatment - waiver signed 5. Right to Privacy 6. Right to confidentiality - all records and communications held in confidence - when to divulge information: a. patient placed in serious danger b. public welfare c. legal proceeding 7. Right to services and to transfer - referrals 8. Right to know relationship with other health care and educational institutions 9. Right not to be subjects of research or experimentation 10. Right to expect reasonable continuity of care - follow up consultations 11. Right to examine and receive an explanation of his bill 12. Right to know what hospital rules and regulations apply to his conduct as a patient NURSING CODE OF ETHICS - BR # 220 Four basic ethical principles: a. Fundamental responsibility of the nurse is four fold b. Nurse renders service regardless of race, creed, nationality or political belief. c. Nurse protects life and respects the dignity of man. d. Nurse works in collaboration with members of the health team. BIOETHICS- is the study of human conduct in the area of the life sciences and health care using moral values and principles. Examples: abortion, euthanasia, contraception, art. Insemination etc.

4) CONTRACEPTION- is any act done befor, during, or after the act of intercourse that purposely frustrates begetting of new life. Types: 1) Direct- deliberately intended a) Artificial - Mechanical = condom,diaphragm,cervical cup, IUD - Chemical = cervical sponge, vaginal suppository, vaginal jelly - Surgical = tubal ligation, vasectomy b) Natural 2) Indirect Argument that support contraception: - Womans autonomy or right - Situationalism ( Love Theory) - Utilitarianism (Sexual pleasure or happiness) - Population Time Bomb 5) ABORTION- Termination of pregnancy, which begins at the moment of conception, when the sperm fertilizes the egg, and ends at the birth of the child.

ETHICAL DILEMMAS

1) ARTIFICIAL INSEMINATION- is a procedure or

process whereby the fertilization of an egg is the result of the sperm being introduced into the female reproductive system other than the natural, that is, other than the sexual act or intercourse. Types: 1) Artificial Insemination by the Husband (AIH) or Homologous Type 2) Artificial Insemination by a Donor(AID) or Heterologous Type 2) IN VITRO FERTILIZATION- Laboratory procedure whereby one or a few eggs are surgically taken from a womans ovary, fertilized with sperm in a petri dish, and transferred to and implanted in the womans uterus, hoping for a normal pregnancy to happen. 3) HUMAN CLONING- Refers to the production of one or more living human beings that are genetically identical to an original human being. Types: 1) Embryo Cloning- Artificial Twinning 2) Adult DNA Cloning 3) Therapeutic Cloning ( Somatic Cell Nuclear Transfer)

Types: 1) Spontaneous Abortion- miscarriage, kind that occurs without medical or some other kind of intervention. - Complete- all content in uterus expelled - Incomplete- part or entire placent is retained - Missed abortion- fetus is retained in the uterus for a period of time after its death. 2) Direct, induced or procured Abortionelective or therapeutic abortion - Early Uterine Evacuation or Vacuum aspiration- suctioning - Dilatation and Evacuation, Dilatation and Curettage (D & C) - Prostaglandin and Saline injection- through amniotic sac - Hysterectomy 3) Indirect Abortion- necessary result of another medical procedure. Right of the mother versus Right of the unborn/ fetus Principle of Double Effect- refers to an act that causes two immediate effects: one,good,the other bad. - Conditions: 1) The act must either be good or at least indifferent. 2) The intention is to achieve the good effect. 3) The expected good effect must be equal to or greater than the harmful effect that is expected.

4) The good effect must follow from the action,or at least,must happen as immediately as the bad effect. 6) EUTHANASIA- MERCY KILLING, is the intentional taking of the life of an ailing person, for any of the following reasons: Incurability of illness, Unbearable intensity of physical or emotional pain, unbearable financial burden arising from the illness. Types: 1) By Reason of the manner of attaining death A) Active or Direct Euthanasia- the active taking of steps by the physician or the caregiver to end the life of the patient. B) Passive or Indirect Euthanasia- the intentional omission or nonadministration of medical treatmentto cause or hasten the death of the patient. 2) By reason of patients consent A) Voluntary Euthanasia- the patient consciously and directly requests the health care provider to take the steps to put an end to the patients life. B) Involuntary Euthanasia- the act of seeking the death of the patient is without the patients consent or knowledge. Argument favoring Euthanasia: - compassion for the patient and shortening the period of suffering of the patient Argument disapproving Euthanasia: - it is intrinsically wrong since it rejects life.

1.

INSTRUCTIVE DIRECTIVE- specifies life- sustaining treatment to be withheld or withdrawn. Ex: living will

2. PROXY OR DURABLE POWER OF ATTORNEYassigns a surrogate if becomes unconscious or mentally incompetent LEADERSHIP AND MANAGEMENT Leadership: is a learned behavior involving influence and role modeling that inspires people to achieve personal and group goals.

Attributes of a good leader: Self awareness Self confidence Advocacy Accountability Different leadership styles: Autocratic -leaders exert total control over members -focus is on productivity Democratic -leader shares control with group members Laisez-faire -leader relinguishes control to group members. -there is total freedom in a hihgly permissive atmosphere. Multi critic -leader utilizes varying styles depending on the situation. Management -process of coordinating and supervising personnel and resources to accomplish organizational goals. Attributes of an effective manager: Vision to plan for the future of the organization Increased trust Sound communication Increased decision making ability Organizational skills Neutral(ability to balance) Nursing management functions: -Planning -organizing staffing directing controlling PLANNING: -forecasting of events, and based on which decisions are made, goals are set and prioritized and policies and standards are developed. Different types of planning: 1. long range or strategic planning -extends from 3-5 years into the future 2. short range or operational planning -deals with day to day maintenance activities. Purposes of Planning: D-irects the organization I-mproves efficiency R-esources are maximized E-fective for controlling C-ost effective measures are identified T-otal enhancement of communication and coordination

7. PHYSICIAN ASSISTED SUICIDE- the patient

requests from the physician to provide the means to end his life.

8. HUMAN TRANSPLANTATION- surgiccal procedure

whereby an organ or tissue is transferred from one part of the body to another or from one organism to another organism. TYPES: 1. Autotransplantation- donor and recipient are one and the same Ex: skin and bones 2. Heterologous- donor and recipient are two different individuals. a. animal to human b. human to human cadaver donor living donor Ethical considerations: 1. Principle of totality Body mutilation is ethical for the sake of saving the whole body or of preserving life. ADVANCE CARE DIRECTIVE- makes known in writing the wishes or preferences of the patient when no longer able to speak for himself. TYPES:

Phases of Planning: 1. determining objectives 2. collecting data 3. developing a plan of action 4. evaluating the plan BUDGETING: -planning and controlling resources that affect the organization -involves examining resources, anticipating costs and predicting gains and shortfalls. Purposes of Allocation of Budget: 1. promotes proper allocation of resources 2. promotes smooth and efficient organizational operation 3. serves as a tool for modification and changes in the organization 4. ensures availability or resources for the organizations achievement of goals 5. enables the management to control the organization by allocating resources. Two commonly used approaches to budgeting: 1. Incremental Budgeting -budget is developed annually based on the previous years expenditure 2. Zero-based Budgeting -each year the budget begins at zero. Processes involved in Budgeting: 1. planning 2. preparation 3. modification and approval 4. monitoring ORGANIZING: -structuring the agency to accomplish the tasks necessary to meet the agency goals. Different Functions of the Nurse in Organizing: -establishing objectives -establishing the structure to carry out plans -determining the most appropriate type of patient care delivery -grouping activities to meet unit goals -working with in the structure of the organization -understanding and using power and authority MISSION: -describes and reflects an organizations core value. VISION: -provides an image of the desired future. PHILOSOPHY: -is a statement of belief that influences nursing practice Different types of organizing client care 1. Case Nursing -oldest approach -a nurse is responsible for all the care required for a particular patient -usually used in critical care units 2. Functional Nursing task-oriented a nurse performs specific tasks and procedures according to schedule 3. Team Nursing -based on group approach -staff members work as a team 4. Primary Nursing -involves comprehensive care of patients -the primary nurse has a 24-hour responsibility for the assigned patients. STAFFING: -refers to the required number and mix of nursing personnel in a nursing unit with in a 4 hour period. Main purpose of Staffing:

-to provide safe, quality care. Determinants of Staffing: Number of personnel Mix of personnel Number of patients Type of patient care delivery system Classification of patients Types of Staffing: 1. centralized staffing: -assignment of personnel is made by the nurse manager at the organizational level. 2. decentralized staffing -allocation of nursing personnel at the unit level. DIRECTING: -Is the issuance of assignment, orders and instructions that permit the worker to understand what is expected of him or her and guidance and overseeing of the worker so that he or she can contribute effectively and efficiently to the attainment of organizational goals. POWER-the ability to impose the will of one person or group to bring about certain behaviors in other persons or groups. AUTHORITY-is the legitimate right to give commands. Different forms of Power: NURSING RESEARCH Nursing Research-scientific process that validate and refines existing knowledge and generate new knowledge that directly influence nursing practice. -includes the study of all aspects, components, activities and phenomena relating to health and of interest to nurses. Importance of Research In Nursing: So that we could: describe, explain, predict and control Purpose: 1. to generate new knowledge 2. to develop new gadgets, techniques 3. to evaluate a program or technique 4. to validate theories TYPES: 1. According to motive or purpose a. basic- for knowledge sake b. applied- practical, knowledge generated 2. According to methodology a. descriptive- exploration and description of a phenomena in real life situations - may use survey method - common methods used are questionnaire, interview, observation b. Correlation- examines linear relations between 2 or more variables - determines the type ( + or - ) and degree of relationship c. Quasi- experimental- examines cause and effect - done in partially controlled situations - Quasi experiment may or may not have control groups and random assignment may or may not be made. d. experimental- examines cause and effect

- done in highly controlled conditions - independent variable is manipulated True experiment has three features: 1. subjects are randomly assigned 2. experimental variable is manipulated 3. with at least 2 groups-experimental and control. e. historical- study conducted regarding the past. Limitations in Nursing research: 1. Ethico- legal considerations 2. Measurement problem a. face validity- doing pretests by giving questionnaire b. contrast validity- done by giving the tool to group of experts Differences between the two Basic Types of Research: 1. Qualitative- collection of narrative data - undertaken to describe natural phenomena without controlling or manipulating variables examples: historical research,researches regarding beliefs and practices, experiences 2. Qualitative- collection of numerical data - statistical analysis, control research conditions - examples: experimental studies, extent of knowledge, effectiveness Steps in the Research Process: 1. Identify the problem 2. Conduct literature review 3. Identify theoretical/conceptual framework 4. Formulate hypothesis 5. Operationalize variables 6. Select research design 7. Ascertain and select sample 8. Conduct a pilot study 9. Collect data 10. Analyze data 11. Interpret results 12. Disseminate information Research Problem: Is a situation in need of description or quantification, solution, imrovement or alteration.You can evaluate these problems by using the following criteria: 1. Significance of the problem 2. Researchability of the problem 3. Feasibility 4. Interest to the researcher Sources of problem: 1. experience 2. review of rel literature 3. issues and popular concern 4. replication studies 5. intellectual curiosity

2.

Secondary data- involve someone who is not directly the source of information Ex: opinions, write ups

Data collected based on time orientation: 1. retrospective- certain events in the present is linked to a particular phenomenon in the past. 2. Cross-sectional- involves different age groups 3. Longitudinal- one group is studied for a longer period of time Framework: Is an abstract logical structure of meaning that guides the development of the study and enables the researcher to link the findings to nursing body of knowledge. A conceptual framework deals with abstractions that are put together because of their relevance to a common theme. Unlike a theoretical framework, it does not have a deductive system or propositions that assert a relationship between the concepts. Hypothesis: -is a statement of the anticipated or expected relationship between the independent and dependent variables. Types: 1. Null hypothesis- states no relationship between variables 2. Research hypothesis- gives the predicted relationship Complexity of Hypothesis: 1. Simple- one independent and one dependent variable 2. Complex or Multivariate- 2 or more independent or dependent variable Variable -Is any quality of a person, institution or situation that varies or takes on different values. Independent vs dependent variables: An independent variable is the presumed cause while the dependent variable is the presumed effect. The variability in the dependent variable is presumed to be due to the variability in the independent variable. Extraneous vs intervening Extraneous variables are other factors that affects the measurement of the IV or DV Example: knowledge, attitude Intervening variables are any factor that are not directly observable in research situation but which maybe affecting the behavior of the subject.

Purposes of a literature review: 1. Search for research ideas/topics 2. Be oriented on what is known 3. Establish the conceptual context of our study 4. Assess the feasibility of the study that we are planning 5. Be informed on research approach Sources of data: 1. Primary data- provided directly by the subjects under study, the most unbiased raw material Example: letters, diaries, speeches, interview

Examples: 1. Problems and coping strategies of COPD Patient. IV- COPD, DV- Degree of seriousness, IV- problems and coping strategies 2. Difficulties of nursing students in doing nursing research: A basis for research enhancement IV- nsng research, DV- difficulties, EV- a basis for research enhancement 3. Transcultural care rendered by staff nurses to hypertensive patients. IV- transcultural care, DV-level of care Operational Definition: Is a specification of the operations that researcher must perform to collect the required information. Examples of data collection methods: -physiological/biological measures

-observational methods-use of checklists and rating scales -interviews -use of questionnaires -psychological measures -content analysis -diaries Difference between validity and reliability: The validity of research tool is the extent to which the instrument actually reflects the construct or variable being examined. External- applicability and generality of findings Internal- truth value of findings Reliability is concerned with how consistently the measurement technique measures the concept of interest. Different levels of measurement in research: NOMINAL is used when data can be organized into categories of a defined property but the categories can not be compared. ORDINAL is used when data can be assigned to categories of an attribute that can be ranked. INTERVAL have equal numerical distances between intervals in the scale; there is no absolute zero point. RATIO is the highest form of measure; similar to interval except that it has an absolute zero point. Difference between non-probability and probability sampling: In non-probability sampling, not every element of the population has an opportunity to be included. Examples: accidental/convenience, quota, purposive and network/snowballing. In probability sampling, every member of the population has a probability of being included in the sample. Examples: simple random sampling, stratified random sampling, cluster sampling and systematic sampling. Data Summary and Analysis: Frequency tabulations Measure of central tendency-mean, median, mode Difference between internal and external validity: Internal Validity: is the extent to which the results of the study can actually be attributed to the action of the independent variable, and not something else. External Validity: is the degree to which the findings of the study are generalizable to the target population. Ethical issues and considerations in research: Autonomy: The researcher should get the research participants/respondents informed consent. Informed consent implies that: 1. the participant received adequate information about the research project 2. the participant understood what he/she is expected to do and the implications of his/her participation 3. he/she participated voluntarily. 2. Right to privacy: The researcher should ensure the anonymity of the research participants and the confidentiality of the data/information collected from them. 3. Anonymity: Protection of participants in a study that even the researcher can not link them with the information they provided. 4. Confidentiality:

Protection of the participants that their identities will not be linked to the information they provided and will never publicly divulged. 5. Beneficence Implies the benefits of the research to the research subject/participants. This should be adequately explained to the participants. 6. Nonmaleficence -means avoidance of harm or reduction of risks to the research subject. The researcher should weigh the risks and the benefits of the study. The benefits should be far greater than the risks. 7. Social Justice Includes these issues: 1. right to be represented in the sample 2. right of equal access to knowledge 3. right not to be discriminated against This ethical value is prominent in experimental studies, particularly those studies that have great promise to do good (e.g. drug that may cure a disease) to the participants. Elements of an ethical research: 1. protecting subjects rights 2. balancing the benefits and risks in a study 3. obtaining informed consent 4. obtaining institutional approval for research NUREMBERG CODE- guide researchers to conduct human experimentation informed consent DECLARATION OF HELSINSKI- experiment should not be done in violation of human rights. ## -------------------## dcgallman

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