The Law and Nursing Practice

NCM 100 Part II

Laws affecting Nursing Practice

On Nursing

On Family, Women, and Children

On Environment On labor and work settings

RA 7160

Local Government Code

Transfers the responsibility for delivery of basic services and facilities of the national government to local government units All communicable diseases should be reported

RA 3572

Communicable Disease Act of the Philippines

RA 4073
RA 3720 RA 6675

Leprosy Act of the Philippines

Food, Drugs, and Cosmetics Act Generics Act of 1998

Treatment of leprosy in local level

Creation of BFAD Promote, require, and ensure the production, supply, distribution, use, and acceptance of drugs and medicines identified by their generic names. Created the Philippine Institute of Traditional and Alternative Medicine

RA 8423

The Philippine Alternative Medicine Act

RA 9165

Comprehensive Dangerous Drugs Act of 2002

Magna Carta for Public Health Workers Forty Hours Law

Sale, administration, delivery, distribution, and transportation of prohibited drugs are punishable by law
Benefits and privileges of health workers working in the government Requires that nurses working in a 100bed and above hospital or in an area of one million population should work forty hours a week

RA 7305 RA 5901

RA 1054
RA 7875

Occupational Health Act

National Health Insurance Act

Free emergency medical and dental services to employees

Creation of PhilHealth

RA 8344
RA 7392

Medical Emergency Response Act of the Philippines

Midwifery Law

Mandatory treatment of emergency cases referred to hospitals

Nurses may be licensed as midwives by submitting 20 delivery cases and pass the examination

RA 8749 PD 825 PD 856 PD 996 PD 1204

Clean Air Act of 1999 Garbage Disposal Code Code of Sanitation EPI Code Family Planning Code

An act regulating the use of incinerators and plant-based fume systems Provides penalty for improper disposal of garbage and other forms of uncleanliness Control of all factors in mans environment that affects health Compulsory immunization of children below eight years old against CD Participation of other government agencies in the formulation and implementation of policies in family planning Prohibition of advertisement on milk formulas for babies under two years of age Basic services to be delivered at the barangay.

EO 51 LOI 949

Milk Code of the Philippines Primary Health Care Delivery

LOI 1000
LOI 47

CPE programs
Responsible Parenthood Education

Members of APO are priorities in hiring of employees

Directs all schools of medicine, nursing, midwifery, and allied medical services and social work to integrate family planning in their curricula

RA 1000 RA 7600

Civil Service Act of the Philippines

Eligibility of board and bar passers to civil service

Rooming in and Breastfeeding Provides that babies born in private and government hospitals should be roomedAct of 1992 in with their mothers

BON Resolution No. 110

BON Resolution No. 220 BON Resolution 459 series of 2002 Proclamation No. 539 PD 651

Safe Nursing Practice evaluation standards

Code of Ethics for Filipino Nurses Maternal and Child Nursing Standards of Practice

Standardization of evaluation tools for nurses

Promulgation of COE

RN-RM registrations

Nurses week celebration Birth Registry Code

Last week of October as the official nurses week Requires registration of birth within 30 days after delivery

Professional roles and accountabilities

Act of commission something was done

incorrectly and unreasonable. Act of omission something that should be done was not done. Professional negligence when a person committed negligence while practicing his profession. Prudence refers to habitual carefulness to avoid errors and following the most polite and profitable course of action.

Professional roles and accountabilities

Liability the quality or state of being responsible to

account for ones obligation and actions and to make financial restitution for wrongful acts. Accountability ones liability to answer for his act or conduct. Responsibility refers to the obligation to answer for an act done and to repair any injury it may have cause. Sanction punishment for violation of accepted norms of social conduct.

Legal roles and responsibilities

Nursing functions:

Independent Function nursing actions initiated by the nurse herself Dependent Function concerned with carrying out legal orders of the physician in relation to the medical plan of care Interdependent Function involves carrying out activities that have been decided upon in consultation or collaboration with other members of the health team

Legal roles and responsibilities

Code of Good Governance for the Professions (EO 220)

Service to others Integrity and objectivity Professional competence Solidarity and teamwork Social and civic responsibility Global competitiveness Equality of all professions

Professional roles and accountabilities

Contractual relationships the relationship of nurse

and the patient which depends on the settings of a particular workplace. Independent Nurse Practitioner Contractual relationship with the client is independent. Nurse employed by a hospital The nurse represents and acts for the hospital and therefore must functions within the policies of the agency.

Contractual relationships
Contracts a meeting of the minds between two

parties wherein one binds himself with respect to the other, to give something or to render some service. It is also an obligation whereby an agreement is entered into upon sufficient consideration to do or not to do a particular thing. A valid contract consist all the following elements: Consent Object or subject matter of the contract Cause of contract

Contractual relationships
Express contract The agreement is formal and mentioned either verbally or in writing Implied contract Concluded or inferred agreements from the overt acts or conduct of the parties, which the law presumed or ascribed as the manifestation of intention of parties to enter into contract

Breach of contract violation or non-performance of an

expressed or implied agreement without ground or just cause.

Note: A contract is considered annulled if one of the parties is

incapable of giving consent to contract or when the consent is initiated by mistake, violence, intimidation, undue influence, or fraud.

PROFESSIONAL NURSE
1.Function within the scope of education and job description 2.Follow procedure and policies of the employing agency Take appropriate steps to obtain complete nursing histories Observe and monitor the client adequately. Communicate and record significant changes in clients condition to the physician Carry out physicians orders promptly and correctly, provided that the orders are not ambiguous or considered dangerous for the client Check any order that the client questions Identify clients before initiating any interventions or nursing actions Perform procedures appropriately Protect clients from falls and preventable injuries Document all nursing assessment and interventions accurately and promptly Ask for assistance and supervision in situation for which they feel inadequately prepared. 1.Build and maintain a good rapport with clients

STUDENT NURSE
1. They are responsible for their own actions and liable for their own acts of negligence committed during the course of clinical experiences 2. The student in her late teen and mentally competent is treated by the law as an adult and as such is not free form potential liability 3. They are not usually considered as employees of the agencies in which they receive clinical experience since this nursing service program contract with agencies to provide clinical experience for students 4. In the negligence involving nursing students, the hospital or agency and the educational institution will be held potentially liable for negligent actions by the students 5. Students in clinical situations must be assigned activity within their capabilities and be given reasonable guidance and supervision. Failure to provide reasonable supervision and or assignment of a client to a student who is not prepared and competent can be a basis for liability 6. Nursing students need to comply with the policies of the agency in which they obtain their clinical experience 7. Nursing students need to comply with the policies and definitions of responsibility supplied by the school of nursing

Common liabilities
Crime an act

committed in violation of law and punishable by a fine and/or imprisonment. An act does not have to be intended to be classified as a crime.

Classifications: Felony a crime of serious in nature, such as murder, punishable by a term in prison. Misdemeanor an offense of a less serious in nature and is usually punishable by a fine or short term jail sentence or both.

Common liabilities
Tort a civil wrong committed against a

person or a persons property and can be an act of commission or omission.

Tort
Intentional torts: Fraud the false presentation of some facts with the intention that it will b acted upon by another person. Invasion of privacy direct wrong of personal in nature. The effect of revealed information may injure the feelings of the person. Defamation may be a false communication or truth that results to damage the reputation of a person. May be classified as libel (any printed material) or slander (spoken). Assault described as an attempt or threat to touch another person unjustifiably. Battery the willful touching of a person or his part that may or may not cause harm. False imprisonment unjustifiable detention that deprives a person of personal liberty for any lengths of time.
Note: The client has the right to insist of leaving the hospital premises

though it may be detrimental to his health. Detention should only be imposed to protect the public or protect the individual from possible harm.

Tort
Unintentional tort: Negligence the commission or omission of an act, pursuant of duty that a reasonably prudent person in the same or similar circumstance would or would not do. It is also act acting or non-acting of which is the proximate cause of injury to another person or his property. Malpractice improper or unskillful care of a patient by a nurse. It also denotes stepping beyond ones authority with serious consequence.

Example forms of negligence: Failure to report observation to attending physician Failure to exercise the degree of diligence which the circumstances of the particular case demands Mistaken identity Medication errors Defects in equipments that may cause falls or harm to the patient Errors due to family assistance

Common legal concerns

Confidentiality any information that the

patient communicates to the nurse should not be disclosed. Consent to treatment assumes that all adult individuals are legally capable of consenting to treatment. Right to refuse treatment as a basic human right, the nurse must respect the refusal of a treatment from a patients point of view.

Points to observe to avoid criminal liability: Be very familiar with the Philippine Nursing Law Be aware of the laws that affects the nursing practice Obtain a copy of job description and agencys rules and regulations Upgrade skills and competence Accept responsibilities that are within the scope of job description Do not delegate responsibilities to others Determine the competence of the subordinates

Ethico-moral and legal aspects

Code Registered Nurses and People

Code of Ethics for Registered Nurses (BON Resolution 220 of 2004)

Ethical principles Individuality must be respected Confidentiality of information Guidelines Consider the difference of the individual Respect the rights of the person

Registered Nurses and Practice

Maintain quality delivery of care

Know the definition and scope of nursing practice through the laws Be legally responsible to any actions

Code of Ethics for Registered Nurses

Registered Nurses and Co Respect co-nurses workers Build rapport to the other health team members Registered Nurses and Society Build linkages and Environment Promote health
Registered Nurses and the Maintain loyal to the Profession profession Contribute to the improvement Conform with the culture Act in a civil manner

Active community participation Support organizations

Universal doctrines
Res ipsa loquitur
The thing speaks for itself The accident itself affords reasonable evidence The event which caused the damage would not have occurred without some fault of the person sought to be held responsible

Respondent superior
The servant represents the master Applies only when the relation of the master and servant is show to exist Does not apply where the injury occurs while the servant is acting outside the legitimate to scope of his authority

Force majeure
Act of God Irresistible or superior force A fact or accident which human prudence can neither foresee nor prevent No persons shall be responsible for these events which could not be foreseen, or though foreseen, were inevitable

Universal doctrines
Good Samaritan Act protects health care

providers who provide assistance at the scene of an emergency against claims of malpractice, provided this is not willful wrong doing or gross departure from every standard of care. Note: The nurse may also be held liable as an individual in case of inappropriate behavior.

Common ethical principles

Ethics the study of morality and

philosophical reflection on its norms and practices. It also addresses the question what should I do in this situation?
Nursing ethics moral principles governing

the nurses behavior towards her patients, colleagues, society, and the profession.

Common ethical principles

Informed consent process by which after the health providers

informed the possible outcomes, alternatives, and risks of a treatment, the patient is given the opportunity to autonomously choose a course of action. Non-compliance unwillingness of the patient to participate in health care activities. Beneficence nurses are expected to do the beneficial good for the patient. Non-maleficence to do no harm or intentional harm for the patient Veracity the practice of telling the truth Confidentiality non-disclosure of private or secret information with which one is entrusted. Justice relates to fair, equitable, and appropriate treatment in light of what is due or owed to persons Fidelity related to the concept of faithfulness and keeping of promises.

Death and nursing practice

Advance health care directive a living will which states the

health care preferences, including the types of special treatments that the patient may or may not want at the end of life, desire for diagnostic tests, surgery, cardiopulmonary resuscitation, or organ donation.
Will an act whereby a person (decedent or testator) is

permitted with the formalities of prescribed by law, to control to certain degree the disposition of his estate to take effect after his death. Persons who can make a will include: All persons who are not expressly prohibited by law At least 18 years of age Persons of sound mind at the time of execution of the will

Kinds of Will
Notarial Holographic Nuncupative

Subscribed or Entirely written, Oral will signed by the dated, and signed Direction of the testator or by some by the testator testator prior to his other person in the himself. death presence of the It is not subject to testator. any specific form Expressed direction and need not be and attested by the witnessed but needs testator and a to be authenticated witness by authorities.

Elements of a valid notarial will:

It must be in writing It must be executed in language known to the testator It must be subscribed by the testators presence and by his

express direction to provide testamentary capacity. (The capacity to comprehend the nature of the transaction in which the testator is engaged.) It must be attested and subscribed by three or more credible witnesses in the presence of the testator and of one another It must be signed on the left margin, on each and every page thereof except the last, by the testator as well as the instrumental witnesses All its pages must be numbered correlatively in letters place on the upper part of the page It must contain an attestation clause. (The witnesses certify that the instrument has been executed before them) It must be acknowledge before a notary public by the testator and the witnesses.

Death and nursing practice

DNR stands for do not resuscitate, also called

compassionate care which means the health providers will not perform cardiopulmonary resuscitation in case of the situation permits it.

Advantage

Disadvantage

Client may decide Good prognosis Clients ability to cope The benefits outweighs burden

Will not provide benefit due to terminal debilitating disease The quality of life is not acceptable Will just prolong suffering The deterioration caused by CPR would be unacceptable to them

Death and nursing practice

Euthanasia the practice may indicate

liability on the part of the health providers. Usually involves withdrawal of life sustaining measures, especially nutrition and hydration.

End!