Professional Documents
Culture Documents
Jursiprudence
Ailyn B. Pineda
Lecturer
LEGAL CONCEPTS
AND ISSUES IN
NURSING
RESPONSIBILITY AND
ACCOUNTABILITY FOR THE
PRACTICE OF PROFESSIONAL
NURSING
Nurses employed in an agency,
institution or hospital are directly
responsible to their immediate
supervisors. Private duty nurses,
being independent practitioners, are
held to a standard of conduct that is
expected of reasonable prudent
nurse
WHAT IS LIABILITY?
Isan obligation or debt that can
be enforced by law. A person who
is liable for malpractice is usually
required to pay for damages.
Damages refer to compensation
in money recoverable for a loss of
damage.
PROFESSIONAL NEGLIGENCE
“NEGLIGENCE” refers to the
commission or omission of
an act, pursuant to a duty,
that a reasonably prudent
person in the same or similar
circumstance would or would
not to, and acting or the
non-acting of which is the
proximate cause of injury to
another person to his
ELEMENTS OF PROFESSIONAL
NEGLIGENCE
1. Existence of a duty on the part of
the person charged to use due
care under circumstances
2. Failure to meet the standard of
due care
3. The foreseeability of harm
resulting from failure to meet the
standard
4. The fact that the breach of this
standard resulted in an injury to
1. Errors due to family assistance
2. Administration of medicine
without a doctor’s prescription
THE DOCTRINE OF RES IPSA
LOQUITUR
“The thing speaks for itself”
When the harm that resulted
from negligence and the
responsibility for the harm are
clear that anyone would agree
on it, the term res ipsa
loquitur is used
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
CONDITIONS THAT ARE NECESSARY
FOR THE APPLICATION OF THE
DOCTRINE:
1. The accident must be a kind
which ordinarily does not occur in
the absence
of someone’s negligence
2. The accident must be caused by
an agency or instrumentality within
the exclusive control of the
defendant
3. The accident must not have been
due to any voluntary action or
MALPRACTICE
Impliesthe idea of improper
or unskillful care of a patient
by a nurse. It also denotes
stepping beyond one’s
authority with serious
consequences
EXAMPLES OF MALPRACTICE:
Misdiagnosis of an illness, failure to
diagnose or relay diagnosis
Birth Injuries
Surgical Complications
Prescription errors
Failure to provide treatment
Anesthesia related complications
Failure to follow advance directive
Failure of hospital or pharmacy to
dispense the right medicine, dosage
DOCTRINE OF FORCE MAJEURE
It is an irresistible or superior force, one
that cannot be foreseen or prevented;
a fortuitous event, and “act of God”. No
person shall be held liable for
nonperformance of what was expected
of him/her if the cause of the
nonperformance was a force majeure
(e.g. devastating typhoons,
earthquakes
and other calamities)
DOCTRINE OF
RESPONDEAT SUPERIOR
Means “let the superior answer; let
the principal answer for the acts of his
agent”
The doctrine is founded on the principle
that he who expects to derive
advantage from an act which is done by
another for him must answer for any
injury which a third person may sustain
from it. The doctrine rests upon the
proposition that, in doing the acts out of
EXAMPLES:
The hospital will be held liable, if, in
an effort to cut down on expenses it
decides to hire underboard nurses or
midwives in place of professional
nurses, and these persons prove to be
incompetent
The surgeon will be held responsible
in case a laparotomy pack is left in a
patient’s abdomen
INCOMPETENCE
Is the lack of ability, legal
qualifications or fitness to
discharge the required duty
Although a nurse is registered, if
in the performance of her duty
she manifests incompetency,
there is ground for revocation or
suspension of her certificate of
registration
LIABILITY OF NURSES FOR
THE WORK OF NURSING
AIDES
Nursing aides perform selected
nursing activities under the direct
supervision of nurses. They usually
given on-job-training by the Training
staff. Their responsibilities usually
pertains to the routine care of
chronically ill patients. They are
therefore responsible for their own
LIABILITY FOR THE WORK
OF NURSING STUDENTS
Under the Philippine
Nursing Act of 2002 R.A.
9173, nursing students do
not perform professional
nursing duties. They are to
be supervised by their
clinical instructors.
GUIDELINES TO AVOID
MISTAKES OF NURSING
STUDENTS
1. Nursing students should always be
Nursing students should always be
under the supervision of their clinical
instructors
2. They should be given assignments
that are at their level of training ,
experience, and competency
3. They should be advised to seek
guidance especially if they are
performing procedure for the first
time
5. Their performance should be
assessed frequently to determine
their strengths and weaknesses
6. Frequent conferences with the
students will reveal their
problems which they may want
to bring to the attention of their
instructors or vice-versa.
Discussion of these problems will
iron out doubts and possible
LEGAL DEFENSE IN
NEGLIGENCE
The most common defense in a
negligent action is when nurses
know and attain that standard of
care in giving service and that
they have documented the care
they give in a concise and
accurate manner
If the patient’s careless conduct
contributes to his own injury, the
patient cannot bring suit against
MEDICAL ORDERS, DRUGS,
AND MEDICATIONS
R.A. 6675 states that only validly registered
medical, dental, and veterinary practitioners,
whether in private institution/corporation or
in the government, are authorized to
prescribe drugs.
In accordance with R.A. 5921, or the
pharmacy Act as amended, all prescriptions
must contain the following information: name
of the prescriber, office address, professional
registration number, professional tax receipt
number, patient’s/client’s name, age, and
sex, and date of prescription. R.A. 6675
IV Therapy and Legal Implications
Philippine Nursing Act of 1991 Section
28
states that in the administration of
intravenous injection, special
training shall be required according
to protocol established
Board of Nursing Resolution No. 8
states that without such training
and who administers intravenous
injections to patients shall be held
liable either criminally under Sec 30
Art. VII of said law or
administratively under sec 21 Art III
SCOPE OF DUTIES AND
RESPONSIBLITIES IN IV THERAPY
1. Interpretation of the doctor’s orders for
IV therapy
2. Performance of venipuncture, insertion
of needles, cannulas except TPN and
cutdown
3. Preparation, administration, monitoring
and termination of intravenous solutions
such as additives, intravenous
medications, and intravenous push
4. Administration of blood/blood products
5. Recognition of solutions and medicine
incompatibilities
6. Maintenance and replacement of sites,
tubings, dressings, in accordance with
established procedures
7. Establishment of flow rates of solutions,
medicines, blood and blood
components
8. Utilization of thorough knowledge and
proficient technical ability in the
use/care, maintenance, and evaluation
9. Nursing management of total
parenteral nutrition, out-patient
intravenous care
10. Maintenance of established
infection control and aseptic
nursing interventions
11. Maintenance of appropriate
documentation, associated with
the preparation, administration
and termination of all forms of
intravenous therapy.
Telephone Orders
Doctors should limit telephone orders to
extreme emergency where there is no
alternative. The use of telephone in a non
emergency as a substitute for the physician
himself can lead to serious error and may
border on malpractice.
Nurse should read back such order to the
physician to make certain the order has been
correctly written.
Such order should be signed by the physician
within 24 hours
The nurse should sign the physician’s name
per her own and note the time and order was
received
CONSENT TO
MEDICAL AND
SURGICAL
PROCEDURE
Consent is defined as a “ free and
rational act that presupposes knowledge
of the thing to which consent is being
given by a person who is legally capable
to give consent”
Nature of consent- an authorization by
the patient or a person authorized by the
law to give the consent on the patient’s
behalf.
Informed Consent-A written consent
should be signed to show that the
procedure is the one consented to and
that the person understands the nature of
the procedure
The nurse’s responsibility in
witnessing the giving of
informed consent involves:
(1) witnessing the exchange b/w
the client and the physician (2)
witnessing the client affix his
signature (3) establishing that
the client really understood.
ESSENTIAL ELEMENTS OF
INFORMED CONSENT:
1. The diagnosis and explanation of the
condition
2. A fair explanation of the procedures to
be done and used and the
consequences
3. A description of alternative treatments
or procedures
4. A description of the benefits to be
expected
5. Material rights if any
WHO MUST
CONSENT?
Patient must consent in his own
behalf
If he is incompetent, or physically
unable, and is not in emergency
case, consent must be taken from
another who is authorized to give it
CONSENT
OF MINORS
Parents or someone standing in
their behalf, gives the consent to
medical or surgical treatment of a
minor. Parental consent is not
needed if the patient is married or
emancipated
CONSENT OF
MENTALY ILL
A mentally incompetent person
cannot legally consent to medical
or surgical treatment. The consent
must be taken from parents or
legal guardian
MENTAL COMPETENCY
All
patients are presumed to
be competent unless declared
incompetent by a court of law.
Supporting documentation of the
patient’s behaviors, speech,
decision making and physical and
mental status are very useful in
establishing his/her mental
EMERGENCY
SITUATION
No consent is necessary because
inaction at such time may cause
greater injury. If time is available
and an informed consent is
possible, it is best that this be
taken to protect all the parties
REFUSAL TO
CONSENT
A patient who is mentally and
legally competent has the right to
refuse the touching of his body or to
submit to a medical or surgical
procedure no matter how
necessary, nor how imminent the
danger to his life or health if he fails
CONSENT FOR
STERILIZATION
Sterilization is the termination of
the ability to produce offsprings.
The husband and the wife must
consent to the procedure if the
operation is primarily to accomplish
sterilization. If emergency cases like
ectopic pregnancy and abruptio
MEDICAL RECORDS
Was created as a means of
communication among health care
practitioners. Today medical records
serve two important functions: to
provide legal documentation, and
obtain third party payments (e.g.
Medicare) They are good evidence in
legal suits but are not admissible
evidence against the patient.
“ If information is not charted, it was
CHARTING DONE BY
NURSING
STUDENTS
LEGAL RISKS FOR
SAFETY EQUIPMENT
The nurse should exercise
reasonable care in selecting
equipment to be used in patients.
Generally, a nurse is not liable for a
non-observable and non-
discoverable defect in the
WHAT IS A CONTRACT?
Is
a meeting of minds between
two persons where they bind
themselves to give something or
to render some services.
Practically anything could be
subjected to a contract as long
as these are not contrary to law,
morals, good customs, public
Kinds of Contracts
Formal Contracts- refers to an
agreement b/w parties and is
required to be in writing. E.g.
marriage contracts
Informal Contracts- one in which
concluded as the result of a written
document where the law does not
require the same to be in writing.
Express Contracts- The one in
which the conditions and terms of
contract are given orally or in writing
by the parties concerned. E.g. PDN
Implied Contracts- one that is
concluded as a result of acts of
conduct of the parties to which the
law ascribes an objective intentions
to enter into a contract.
Void contracts- one that is
inexistent from the very beginning
and therefore may not be enforced.
Illegal contracts- one that is
expressly prohibited by law
Illegal Contracts
Those that are made in
protection of the law
Consent obtained by fraud
Those obtained under duress
Those obtained under undue
influence
Those obtained through material
misrepresentation
INTENTIONA
L WRONGS
A nurse may be held liable for
intentional wrongs
TORTS
A tort is 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. A person who has been
wronged seeks compensation for
the injury or wrong he has
suffered from the wrong doer.
EXAMPLES OF TORT:
ASSAULT AND BATTERY. Assault is a
unjustifiable attempt to touch another
person or even the threat of doing so
while Battery is the actual carrying out
of the threatened physical contact
DEFAMATION of character occurs where
a person discusses another individual
in terms that diminish reputation. Libel
is written defamation. Slander is oral
Defamation
FALSE IMPRISONMENT
J-E-M-A-A
Circumstances affecting Criminal
Liability
Justifying
Circumstances
SELF-DEFENSE
These are the defenses
in which the accused is
deemed to have acted
in accordance with the
law and therefore the
act is lawful. Since the
act is lawful, it follows
that there is no
criminal, no criminal
Justifying Circumstances
A person may not incur criminal liability under the following
circumstance:
There is no mens rea or criminal intent
The circumstances pertain to the act and not to the actor.
Hence all who participated in the act will be benefited. Thus if
the principal is acquitted there will be no accomplices and
accessories.
These apply only to intentional felonies, not to acts by
omissions or to culpable felonies or to violations of special laws
When he acts in defense of his rights
When he acts in defense of his relatives rights
When he acts in defense of a strangers rights and that the
person defending is not induced by revenge or evil motives.
When any person who, in order to avoid an injury does an act
which causes damage to another provided that an evil sought
to be avoided actually exists.
Circumstances affecting Criminal
Liability
ExemptingCircumstan
ces