Ethical Issues

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Concept of Ethics
The study of the rightness of conduct.
Deals with ones responsibilities (duties and
obligations).
Ethical persons put their beliefs into action.
Concept of Ethics
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The term morals is often mistakenly used
when ethics is intended.
Morality is behavior that usually reflects
personal or religious beliefs.
Ethics is rooted in the legal system.



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Relationship Between Legal and
Ethical Concepts
There is a connection between acts that are
legal and acts that are ethical.
The legal system judges action rather than
intention.
Ethical opinions reflect individual differences.
Laws change according to social and political
influences.
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Copyright 2004 by Delmar Learning, a
division of Thomson Learning, Inc.
Ethics in Health Care
Bioethics is the application of ethical
principles to health care.
Ethics affects every area of health care.
Ethics helps provide structure by raising
questions that ultimately lead to answers.
Factors Contributing to the Need
for Ethics in Health Care
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Technological advances
Changing fabric of our society
Increased consumer demand for health care
information
Decreasing allocation of federal funds for
health care


9-8
Examples of Ethical Issues
Newborns surviving at earlier gestational ages
with serious health problems
People living longer than ever before
Organ transplants and the use of bionic body
parts
Experimental research
9-9
Copyright 2004 by Delmar Learning, a
division of Thomson Learning, Inc.
Ethical Theories
Teleology
The value of a situation is determined by its
consequences.
Principle of utility states that an act must result in
the greatest good for the greatest number.
Good refers to positive benefit.


9-10
Copyright 2004 by Delmar Learning, a
division of Thomson Learning, Inc.
Ethical Theories
Deontology
The intrinsic significance of the act itself is the
criterion for determination of good.
Concept of categorical imperative states that
actions should be based on a principle that is
universal.
The person should never be treated as a means to
an end.
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Ethical Principles
Autonomy
The belief that every competent person has the
right to determine his or her own course of action.
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Copyright 2004 by Delmar Learning, a
division of Thomson Learning, Inc.
Autonomy
Examples of autonomous behavior that can
impair recovery or treatment:
Smoking
Refusing to take medication
Refusing to receive a blood transfusion

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Copyright 2004 by Delmar Learning, a
division of Thomson Learning, Inc.
Ethical Principles
Nonmaleficence
Duty to cause no harm to others
Physiological, psychological, social, spiritual
Helps guide decisions about treatment
approaches


Ethical Principles
Beneficence
Duty to promote good and to prevent harm
Providing benefit
Balancing benefits and harm
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Beneficence
Paternalism is a negative outcome of
beneficence.
Paternalism occurs when health care
providers decide what is best for clients.

Justice
Based on concept of fairness
Equality in treatment and allocation of
resources
Material Principle of Justice
Determines when there can be unequal
allocation of scare resources
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Veracity
Truthfulness, neither lying nor deceiving others.
Deception can take the form of intentional lying,
nondisclosure of information, or partial disclosure.

9-18
Copyright 2004 by Delmar Learning, a
division of Thomson Learning, Inc.

Fidelity

Faithfulness and keeping promises
Demonstrated by nurses in the role of client
advocate
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Values and Ethics
Values are individual rather than universal.
Individuals often fail to consider the impact of
values on decisions.
Nurses often care for clients whose value
systems conflict with theirs.
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Values Clarification
The process of analyzing ones own values to
better understand what is truly important
Three-step process of valuing:
Choosing
Prizing
Acting
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Ethical Codes
International Council of Nurses Code for
Nurses
American Nurses Association Code of Ethics
Canadian Nurses Association Code of Ethics
for Nursing
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Clients Rights
Clients have certain rights to
Make decisions regarding their care.
Be actively involved in the treatment process.
Be treated with dignity and respect.


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Clients Rights
Patient Bill of Rights
Established by the American Hospital Association.
Increases awareness of the need to treat clients in
an ethical manner.
Encourages health care providers to protect the
rights of clients.

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Ethical Dilemmas
Occur when there is a conflict between two or
more ethical principles.
The most beneficial decision depends on the
circumstances.
Ethical analysis is not an exact science.
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Ethical Dilemmas
Frequently Occurring Ethical Dilemmas
Informed Consent
Refusal of Treatment
Use of Scarce Resources
Cost-Containment Initiatives that Negatively Affect
Client Well-Being
Incompetent Health Care Providers
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Ethical Decision Making
Ethical Reasoning
Thinking through what one ought to do in an
orderly, systematic manner
Justification of actions based on principles

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Ethical Decision Making
Framework for Ethical Decision Making
Which theories are involved?
Which principles are involved?
Who will be affected?
What will be the consequences of the
alternatives?
What does the client desire?
9-28
Copyright 2004 by Delmar Learning, a
division of Thomson Learning, Inc.
Ethical Decision Making
Steps of Ethical Analysis
Gathering of relevant data to identify the problem
Consideration of all the people involved
Selection of a course of action
Evaluation of the resolution process
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Ethical Dilemmas
Euthanasia
Refusal of Treatment
Scarce Resources
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Euthanasia
Good or gentle death
Mercy killing (deliberate ending of life as a
humane action)

Euthanasia
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Active euthanasia is taking deliberate action
that will hasten the clients death.
Assisted suicide is a form of active euthanasia.
Passive euthanasia is the omission of an
action that would prolong dying.
Discontinuing the clients tube feedings is a form
of passive euthanasia.

9-32
Refusal of Treatment
The clients right to refuse treatment is based
on the principle of autonomy.
A clients right to refuse treatment and the
right to die challenge the values of some
health care providers.


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Scarce Resources
The availability of specialists and organs, is
contributing to a scarcity of resources.
The use of expensive services is influenced by
social and political forces.
Health care reform is needed to ensure
services to all.
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Ethics and Nursing
Professional nurses actions are both legal and
ethical.
Sound nursing practice involves making ethical
decisions.
Ethics affects nurses in every health care
setting.
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Ethics and Nursing
Ethics Committees
One approach for facilitating dialogue regarding
ethical dilemmas
Nurse as Client Advocate
Nurses are accountable for protecting the rights
and interests of the client.

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Ethical Decision-Making Model
Assessing the outcome of moral actions;
Were the actions ethical?
What were the consequences?
EVALUATION
Carrying out selected moral actions
IMPLEMENTATION
Consideration of priorities of claims;
Generation of alternatives for resolving the dilemma;
Consideration of the consequences of alternatives
PLANNING ANALYSIS AND DIAGNOSIS
Problem identification: Statement of the ethical dilemma
ASSESSMENT
Determination of claims and parties
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Legal Responsibility
Legal responsibility refers to the ways in which
a nurse is expected to follow the rules and
regulations prescribed for nursing practice.
Licensure ~ insuring basic competence in
nursing practice.
Responsibility of the nurse
The main responsibilities of a nurse are to provide
care based on nursing diagnosis, prioritizing the
needs; planning, implementing and evaluating the
nursing care.
provides care to the patient based on needs, respect,
dignity and right without considering race,
nationality, caste, creed, colour or socio economic
status.

LAW (Etymology : lex)

A set of rules established by a governing power to guide
actions, regulate conduct of the people and impose
sanctions for violation or non-compliance thereof.
Obligatory upon the people because it commands the
people to do right and prohibits them to do wrong.
a rule of civil prescribed by the supreme power in a
state, commanding what is right and prohibiting what is
wrong. It is a rule prescribed by the sovereign power.


Branches of Law
Divine Law : promulgated by our Creator.
Human Law
* General / Public Law : includes international
law and religious law
* Individual or private law : consists of civil
law, mercantile and procedural law.
Jurisprudence
Etymology : juris (oral legal tradition and to
functional applications of Law, to and in
particular sets of facts ans circumstances);
prudentia (one who behaves prudently or
wisely because he has knowledge of the
possible consequences of a particular action).
Jurisprudence
Denotes or pertains to the judicial precedent
or the course or established decisions of the
Supreme Court.

Major Groups of Law
Criminal laws
Regulate public conduct and set out duties owed
to society
Civil laws
Regulate relations between individuals or groups
of individuals
Criminal Laws
Legal action brought by the government
against a defendant (person charged with
committing a crime)
have penalties
Imprisonment, fines, probation (placed under
supervision)
Divided into felonies and misdemeanors
Kinds of Criminal laws
Duties to society
Cases brought by gov.
Types
Felony
Misdemeanor
Difference in criminal offenses
FELONY
Penalty is a term of more than one year in prison
o Murder, robbery, rape, possession with intent to
distribute

MISDEMEANOR
Penalty is a prison term of one year or less
Simple assault, minor theft, possession

beyond a reasonable doubt
the standard of proof required in most
criminal cases within an adversarial system
Means that if a jury (or a judge in a bench
trial) has ANY reasonable doubts about the
defendants guilt then it MUST vote not to
convict

preponderance of evidence
standard of proof that must be met by a
plaintiff if he or she is to win a civil action
The jury (or judge) needs only to decide if it is
more likely than not that the plaintiffs
complaint is true.



Criminal
Criminal
Parking Violation
Criminal
Civil Laws
Civil action
Lawsuit that can be brought by a plaintiff (person)
who feels wronged or injured by another person
Courts may award the injured person money for
the loss or order the one who committed the
wrong to make amends in
some other way
Civil Laws
Regulate many everyday situations
Marriage
Divorce
Contracts
Real estate
Insurance
Negligence

Kinds of Civil Laws
Regulates relations b/w
individuals or groups
Brought by people for injury
by another person
Civil
Warranty Law
LEGAL ASPECTS OF
NURSING
General Divisions of Law
Natural Law an integral part of nature because it
is immutable and inherent in the nature of man or
every element or part of the universe.
Positive Law a precept made and imposed by
someone in authority.
* divisions
- divine law
- human law
Applicable laws and jurisprudence in
nursing practice
Constitutional Law is that branch of the science
of laws which treats of the nature of
constitutions, their adoptions and
amendments, their construction and
interpretation and of the validity of legal
enactments as tested by the criterion of their
conformity to the law of the land.
Kinds of Constitution
Cumulative or evolved constitution is one that
originates in customs, common law principles,
decisions or courts, etc.

Conventional constitution is an enacted
constitution because it is deliberately passed by
a representative body or a ruler.

Written constitution is one where the
provisions are embodied in one
document or sets of documents while an
unwritten constitution is one where most
of the provisions are not in a single
document but scattered in various
sources such as customs and traditions,
statutory enactments of a fundamental
character, judicial decisions and certain
common law principles.
Kinds of Constitution
Rigid constitution is one that can be
amended only by a formal and usually
difficult process, whereas a flexible
constitution is one that can be changed
by ordinary legislation.

Kinds of Constitution
Criminal Law
the branch of law which defines crimes, treats of
their nature and provides for their punishment.
- Aptly described as the instrument of criminal
policy for it is in criminal law that are found
- it covers offenses resulting to injuries or death of
the patients.
Prosecution of a criminal offense resulting
to injuries
Nature
Location
Size, shape and
incursion
Color
Number, and
Other appearances
Re: Death of a patient..
Natural
Suicide
Homicide / murder / parricide
Accident
undetermined
Useful pieces of evidences for the
criminal offenses
Body
Objects on or with the body
Injuries sustained
Tissues and body fluids
Other medical evidence or findings
R.A. 3815 otherwise known as
Revised Penal Code (RPC) which
was approved on December 8, 1930
which defines crimes, treats of their
nature and provides for their
punishment.
3. Civil Law - the branch of Law that pertains to the
organization of the family and the regulation of
property. It has been defined as the mass of
precepts which determine and regulate the
relations of assistance, authority and obedience
among the members of a family, and those which
exist among members of a society for the
protection of private interests.
R.A. 386, popularly known as the New Civil Code
(NCC) or the Civil Code of the Philippines took
effect on August 30, 1950 and covers the
following aspects of human life; persons and
family relations, property rights and ownership,
the modes of acquiring ownership, obligations
and contracts and special contracts.

One important amendment to this code is EO
209, the Family Code, amending its provisions on
marriage and family relations.

is that branch of Law that governs and regulates
the relationship of employers and
employees. Broadly called labor
legislation , it consists of statutes,
regulations and jurisprudence governing the
relations between capital and labor, by
providing for certain employment standards
and legal framework for negotiating,
adjusting and administering those standards
and other incidents of employment.
Labor Law
Labor Law
Labor Standards Law that which sets out the minimum
terms, conditions and benefits of employment must
provide or comply with and to which employees are
entitled as a matter of right.
Labor Relations Law defines the status, rights and
duties and the institutional mechanisms, that govern the
individual and collective interactions of employers,
employees or their representatives.
Labor Code
Promulgated as P.D. No 442 on May 1 1974
and took effect on November 1, 1974 except
portions on Book IV whose effectivity was
deferred to January 1, 1976 by P.D. No. 608.
Administrative Law
is that branch of law which deals with the activities or
functions of executive or administrative agencies
such as the departments, bureaus, boards or
commission or all other offices under the
administrative supervision of the office of the
President, which are created and vested by Law
with qusi-judicial, quasi-legislative and executive
powers.
Administrative Law
Executive Order No. 292 is the principal law in
the study of administrative laws in the
Philippines and was promulgated by then
President Corazon Aquino dated July 25, 1987,
otherwise known as the Administrative Code
of 1987, which incorporated in a single
document the major structural, functional and
procedural guidelines of governance.
Administrative Law (cont)
Professional Regulation Commission (PRC)
Three main functions
Executive
Quasi-judicial
Quasi-legislative
Functions of the PRC
To investigate and decide cases against erring
examinees and professionals;
To formulate and promulgate policies and
guidelines on administrative investigation and
professional regulations.
To implement the laws, regulatory policies and
standards; and
To maintain and promote professional and
occupational standards and ethics.
Civil Service Law
is that branch of law which deals with the civil
service in all branches, subdivisions,
instrumentalities and agencies of the
government including government-owned or
controlled corporations with an original
charter.
Civil Service Law (cont)
Primary purpose is to establish and
maintain a merit system in the selection of
public officers and employees without
regard to sex, color, social status or political
affiliation.
General purpose is to ensure and promote
the constitutional mandate regarding
appointments, particularly according to the
merit and progressive system of personnel
administration to ensure the maintenance
of an honest, efficient, progressive and
courteous civil service in the Philippines.

Civil Service Commission
P.D. No. 110 dated January 26, 1973, created the
Civil Service Commission (CSC), replacing the CSC
established under R.A. no 2260.
repealed by PD No. 807 otherwise known as the
Civil Service Decree of the Philippines, which was
superceded by Subtitle A, Title I, Book V of E.O. No
292, the Administrative Code of 1987, E.O. No 292,
which codified the major structural, functional and
procedural principles of governance, is the basic
legal document in the study of civil service law.
Case
is that body of the prevailing jurisprudence or
decisions of the Supreme Court interpreting the
laws or the Constitution or applying them to
certain sets of facts or actual cases and
controversies.
TORT
TORT
A 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 tort in common law is defined as
a civil wrong that involves a breach
of civil duty owed to someone
else. This is in exception to
contractual duty.

A tort is similar to crime but crimes
involve breach of duties toward the
society in general.
The aggrieved party who has been
injured due to a tort may bring a
lawsuit.

Tortfeasor--One who commits a tort
A person who suffers a tortuous act is
entitled to receive damages, usually
monetary compensation, from the person
or people responsible or liable for those
injuries.
Tort law defines what a legal injury is
and therefore, a person may be held
for an injury that was caused.

Legal injuries are not limited to
physical injuries. They may also
include emotional, economic, or
reputational injuries as well as
violations of privacy, liability.

For defective consumer products,
copyright infringement and
environmental pollution among many
others.

In the law world, the most
prominent tort liability is
negligence.

If the injured party can prove that the
person believed to have caused the injury
acted negligently.

That is without taking a reasonable care
to avoid injuring others- tort law will
allow compensation.


negligence torts
intentional torts
standard torts

Negligence torts: The standard action in tort is negligence. The
tort of negligence provides a cause of action leading to damages,
to belief, in each case designed to protect legal rights, including
those of personal safety, property and in some cases, intangible
economic interests.
CATEGORIES OF TORTS

Intentional torts: include those torts
arising from the occupation or use of
land. The torts of nuisance, trespass, etc
come under this category. Intentional
torts also include false imprisonment.
The tort of illegally arresting or
detaining someone and defamation,
broadcasting false information
damaging the plaintiffs reputation.

Statutory torts: Statutory torts are like
any other, expect for the fact that these
have been enacted by the legislature and
not by courts.

Examples include consumer protection
laws, labor laws governing safety and
health of workers, etc.

The burden to prove a tort vests with the
plaintiff. It is his duty to prove the
defendants negligent tort or intentional
tort.

The plaintiff owns a duty of care. A duty
of care is a relationship which exists
between a plaintiff and the defendant.

There must be a breach of that duty
and the plaintiff suffered damages as
a result of that breach.
The defendant has to take proper care
not to damage or cause injury to the
property, emotion, reputation and to the
person himself. And lastly, the damage
must be significant and not remote.

Nuisance
Legally, the term nuisance is used in
three ways, to describe an activity or
condition that is harmful or annoying to
others.

Defamation
Defamation is tarnishing the reputation of
someone.
two types.
Slander
Libel
Slander
is oral defamation of a person by speaking
unprivileged or false words by which his
reputation is damaged.
---- spoken defamation

Libel
is defamation by written words, cartoons
or such representations that cause a
person to be avoided, ridiculed, or held in
contempt or to tend to injure him in his
work.
printed or broadcast defamation


Assault and Battery.
Assault is the imminent threat of a
harmful or offensive bodily contact.

Battery is an intentional, unconsented
touching of another person.


False Imprisonment or Illegal
Detention

It means that the unjustifiable detention of a person
without legal warrant within boundaries fixed by the
defendant by an act or violation of duty intended to
result in such confinement.

LAWS RELEVANT TO
NURSING PRACTICE
PD 48 four (4) children with paid
maternity leave privilege
PD 69 four (4) children for personal tax
exemption
PD 79 Revised the Population Act; Defines
the objectives, duties and functions of
POPCOM
PD 223 Creation of Professional Regulation
Commission (PRC) in 1973
PD 442 New Labor code
PD 491 Nutrition program
PD 541 Former Filipino professionals allowed to
practice their respective professions in the
Philippines
PD 568 Role of Public health midwives expanded
under the RHCDS; Restructuring of the
Philippine Health Care)
DeliverySystem:
Deployment of midwives to improve rural
situation
1 PH Mid = 5,000 pop.
1 PH Nurse = 10,000 pop
1 RH Physician = 20,000 pop
PD 603 Child and Youth Welfare Code
PD 628 Employee Compensation & State
Insurance Fund
PD 651 Birth registration following delivery (all
health workers shall identify and encourage the
registration of all birthswithin 30 days following
delivery)
PD 825 Anti- improper garbage disposal (provides
penalty for improper disposal of garbage)
PD 851 13th month pay
PD 856 Code of Sanitation provides for the
control of all factors in mans environment that
affect health including thequality of water, food,
milk, control of insects, animal carriers,
transmitters of diseases, sanitary and recreation
facilities, noise,pollution, unpleasant odors and
control of nuisance.
PD 965 Family Planning and responsible
parenthood instructions prior to issuance of
marriage license
PD 996 September 16, 1976 Compulsory
immunization for all children below eight (8)
years old against six (6)immunizable diseases
PD 1063 Muslim Holidays
PD 1204 Amends PD # 79B.


ADMINISTRATIVE ORDERS

A.O. No. 114 s. 1991 Revised/updated the
roles and functions of the Municipal Health
Officers, Public Health Nurses and Rural
Health Midwives
Dept. Circular Order No. 75 Reinstitution of
Tetanus Toxoid among Pregnant Women
Min. Circ. No. 2 s. 1986 Includes AIDS as a
notifiable disease
EXECUTIVE ORDERS
EO 51 Milk Code
EO 85 Integration of Public Health and
Hospital Services
EO 119 Reorganization of Department of
Health
EO 180 Guidelines on the right to organize of
government employees

EO 203 List of regular holidays & special days
EO 209 Family Code of the Philippines (amended
by RA 6609)
EO 226 - Command Responsibility
EO 503 Provides for the Rule and Regulation
Implementing the Transfer of Personnel Assets,
Liabilities and Records of National Government
HOUSE BILLS
HB # 16 Two-Child Policy
HB # 3773 Responsible Parenthood and Population
Movement Act
PRESIDENTIAL PROCLAMATIONS /
PRONOUNCEMENTS

Proc. # 4 Philippine Measles Elimination Campaign
Declaring the period of September 16 October
14, 1998 as theLigtas Tigdas Month
Proc. # 6 April 3, 1986 United Nations - Universal
Goal on Child Immunization by 1990
Proc. # 46 September 16, 1992 Reaffirming the
commitment of the Philippines to the Universal
Child and MotherImmunization Goal of the World
Health Assembly


Proc. # 118 Professional regulation Week June
16-22
Proc. # 539 - Nurse week every last week of
October
Proc. # 1275 - Midwifery week every third week of
October
Proc. # 147 March 3, 1993 Declares April 21 and
May 19, 1993 and every 3rd Wednesday of
January and February and thereafter for 2 years
as National Immunization Days
Proc. # 773 March 28, 1996 Every 3rd Wednesday
of April and May as the Knock-out Polio Day
Proc. # 1064 August 27, 1997 Enjoining all sectors
of society to participate in the Acute Flaccid
Paralysis (AFP)surveillance component of polio
eradication campaign
Proc. # 1066 Declaring a National Neonatal
Tetanus Elimination Campaign starting 1997
LETTERS OF INSTRUCTIONS
LOI # 149 October 19, 1979 - Adoption of Primary Health
Care; Legal basis of primary health care
LOI #1000 Members of accredited professional
organizations given preference in hiring or attendance
to seminars
ILO convention #149- Improvement of life and work
conditions of nursing personnel (ILO Recommendation
# 157)
REPUBLIC ACTS
RA 491 - Nutrition Law (July month)
RA 611 MediCare an employee becomes
automatically a member; Public office is a public
trust
RA. 1054 Free emergency medical & dental attendance
to employees/laborers of any commercial; industrial
or agricultural establishments

RA. 1080 Civil Service eligibility for all degrees
with licensure examinations
RA. 1082 Creation of 1st Rural Health Act in
1953 - The employment of more physicians,
dentists, nurses, midwives and sanitary
inspectors who will live in the rural areas where
they are assigned to help raise the health
condition of the barrio people and thus help
abate the still high incidence of preventable
diseases in the country. It created the first 81
Rural HealthUnits.
RA. 1136 Tuberculosis Law (August Month)
RA. 1612 Privilege Tax / Professional Tax
RA. 1891 Strengthening Health and Dental
services in the rural areas and providing funds
thereto; amended RA 1082
RA. 2382 Philippine Medical Act
RA. 3573 Reporting communicable Disease (all
communicable diseases should be reported to
the nearest health stationand that any person
maybe inoculated, administered or injected)
RA. 4073 Liberalized the treatment of Leprosy
- Except where the patient requires
institutional treatment, no persons afflicted
with leprosy shall be confined in a
leprosarium. The shall be treated in a
government skin clinic, rural health unit or by
a duly licensed physician (February as
Leprosy Month).

RA. 4226 Hospital licensure
RA. 5181 Permanent residence & reciprocity
qualifications for examinations/ registration
RA. 5901 Working hours & compensation in
agencies with 100 bed capacity
RA. 6365 Established a National Policy on
Population and Created the Commission of
Population
.
RA. 6425 Dangerous Drug Act the sale,
administration, delivery, distribution and
transportation of prohibited drugs is punished
by law.
RA. 6675 Generics Act of 1988 this
promotes, requires and ensures the
production of an adequate supply,
distribution, use an acceptance of drugs and
medicines identified by their generic names
RA. 6713 Code of Conduct and Ethical Standards
for Public Officials and Employees. This Code
upholds a time-honored principle that public
office is a public trust. It the policy of the state to
promote high standards of ethics in public office
of public officials and employees shall at all times
be accountable to the people and shall discharge
their duties with utmost responsibility, integrity,
competence and loyalty, act with patriotism and
justice, lead model lives and modest living and
uphold public interest over personal interest.
RA. 6715 Senior Citizen Center for every
Barangay
RA. 6725 Prohibition on discrimination vs.
women
RA. 6727 Wage Rationalization
RA. 6758 Salary Standardization of
Government employees that includes nurses
RA. 6972 Day Care Center in every Barangay
RA. 7160 Local Government/Autonomy Code
(the devolution of powers, functions and
responsibility to the local government units)
RA. 7170 Legacy of donation of all or part of a
human body after death
RA. 7192 Women in development & Nation
Building
RA. 7277 Magna Carta for Disabled persons
RA. 7305 Magna Carta for Public Health workers
this Act aims to promote and improve the
socio-economic well-being of health workers,
their living and working conditions and terms of
employment; to developed their skills and
capabilities in order that they will be more
responsive and better equipped to deliver health
project and programs; and to encourage those
with proper qualifications and excellent abilities
to join and remain in government service.

RA. 7432 Senior Citizen Benefits & Privileges
RA. 7600 Rooming In and Breast feeding Act of
1992
RA. 7610 Anti-Child Abuse Law (Special Protection
of Children against Child abuse, Exploitation &
Discrimination)
RA. 7641 New Retirement Law of employees in the
Private Sector
RA. 7719 National Blood Service Act of 1994
RA. 7846 Requires compulsory immunization
against Hepatitis B among infants and below 8
years old
RA. 7875 National Health Insurance Act of
1995
RA. 7876 Senior Citizen Center for Every
Barangay
RA. 7877 Anti- sexual harassment Act of
199538. RA. 7883 Barangay Health workers
Benefits & Incentives Act of 1992

39. RA. 8042 Migrant workers & Overseas
Filipinos Act of 1992
40. RA. 8172 Asin Law / Iodize Salt Law
41. RA. 8187 Maternity Leave Act of 1995
42. RA. 8282 Social Security Law of 1997
(amended RA 1101)
43. RA. 8291 Government Service
Insurance System Act of 1997 (amended
PD 1146)
44. RA. 8344 Hospitals/ doctors to treat
emergency cases referred for treatment
45. RA. 8353 Anti-Rape Law
46. RA. 8423 Traditional and Alternative
Medicine Act of 1997 (Gamot na Mabisa
sa Abot Kayang Halaga)
RA. 8424 Personal Tax Exemptions
RA. 8479 Clean Air Act
RA. 8504 Philippine AIDS Prevention and Control
Act of 1998
RA. 8972 Nationwide Iodination Law
RA. 8976 Food Fortification Act
RA. 8981 PRC Modernization Act of 2000
RA. 9173 The Nursing Act of 2002
RA. 9211 No Smoking Act
RA. 9257 Expanded Senior Citizen Act of 2003
RA. 9262 - Domestic Violence Act
BOARD OF NURSING RESOLUTIONS
BON # 557 Series 1988 Code of Ethics
BON # 100 Series 1993 Implementing Rules &
Regulations of RA 7392
BON # 633 Series 1964 ICN Code of ethics
BON # 1955 Series 1989 PNA Code of Ethics
BON # 08 Series 1994 Special Training on
intravenous injections for the R.N.
BON # 20 Series 1994 Implementing
Rules & Regulations of RA 7164
BON # 110 Series 1994 Guide to Evaluate
Compliance with Standards for Safe
Nursing Practice
SALIENT ASPECTS IN THE 1987 CONSITUTION OF THE
PHILIPPINES
Article II Declaration of Principles & State
Policies
Sector 11 Human Dignity and right
12 Sanctity of family, equal protection of the
life of the mother and the unborn from
conception
13 Role of the youth in nation building
15 Right to health
16 Right to a balanced & healthy ecology
Article III Bill of Rights
Section 1 Equal protection of laws & the due
Process of Law
3 Privacy of Communication and Correspondence
8 Formation of unions, associations or societies
12 To remain silent & have counsel when under
investigation
14 The accused person is presumed innocent until
the contrary is proved
Article IV Citizenship
Sector 3 Philippine citizenship may be lost or
re-acquired in the manner provide by law.
Article XIII Social Justice &
Human RightsSector
3 Right of all workers to self- organization,
collective bargaining and negotiations and
peaceful concerted activities.
11 Priority for the needs of the under-
privileged, sick, elderly, disabled, woman and
children.
13 Special agency for disabled persons
14 Protection of working women
Article XV The Family
Sector 1 Filipino family as the foundation of the
nation
2 Marriage, as an inviolable social institution,
is the foundation of the family
4 The family has the duty to care for its elderly
members
LEGAL BASES OF NURSING
EDUCATORS, NURSING
REGULATION AND NURSING
PRACTICE
Nursing Education and nursing practice are
constantly interacting while in the process of
rapid change to adopt to the existing demands
and condition of the health care delivery system.
They are complimenting each other.
The success of nursing practice rest upon a
sound educational foundation of the nurse.
The goal of nursing education is to prepare the
nursing student for nursing practice.

Goal of nursing practice is to provide quality
nursing service and improve nursing care.
This is when nursing regulation comes into play.
Everyone has a right to nursing education as a
constitutionally guaranteed right.
Art. XIV, Sec. 1 of the 1987
Constitution
To protect and promote the right of all citizen
to quality education at all level and to take all
appropriate steps to make such education
accessible to all.
R.A. No. 9173 Nursing Law
Aims to provide a sound general and professional
foundation for the practice of nursing through quality
nursing education.
The first policy encourages nursing schools and colleges
to implement some standards for admission, qualifying
exams for 3
rd
year level promotion and quality part
indices for the continuance of nursing student in their
respective nursing degree programs to ensure the
quality of their nursing graduates.
The 2
nd
policy total quality education can only be achieved
when the government makes it accessible to all who are fit and
prepared for it.
Uplift standard of nursing education for this country to produce
quality nursing graduates and ultimately globally competitive
Filipino Nurses.
Not to discriminate against student where spirits are willing but
in intellectual, they are wanting.
Every Filipino has the right to education however; every Filipino
has the responsibility to know his limitation and to change the
course for which he is suited.
R.A. No, 9173 Nursing Law
A. NURSING EDUCATION
R.A. 7164
Required a certification by the school that the
applicant belong to the upper 40% of the
graduating class, as a general requirement to the
nursing degree course.

R.A. 9173

> deletion of said admission requirement
> one high school performance is not an accurate
basis for college admission and students mental
competence and psychological preparedness for
college education.
> More nursing students because more
graduating students will be eligible to enroll in
nursing degree program and more nursing
schools will be opened and offer the degree of
BSN.
R.A. 7722 CHED
Provide standard or minimum
requirement for the operation and
regulation of educational
institution offering tertiary courses
such as BSN.

NURSING EDUCATION
(Cont)
CHED Memo Circular No. 30, s. 2001
Updated policies and standards for
nursing education.
New policy directing the CHED to
regulate the establishment and
operation of review center.
Duly authorized government agency that
approves the opening and regulates the
operation of nursing schools all over the
country.
Created through R.A. 7722, May 18, 1994
CHED Policy on Nursing schools and
colleges
Nurses are needed in every part of the world,
with the tremendous global demand, nursing
schools and colleges are sprouting everywhere
like mushrooms.
Authority to open and close nursing schools /
colleges

CMO No. 30
The authorization to open a nursing school shall
be based upon:
1. written recommendation of BON, PRC and
NSA (National Student Affiliation), DOH
2. approval of CHED
The power of BON as to authorization of opening
or closing nursing schools is recommendatory
pursuant to COM No. 30 and RA 9173.
ADMINISTRATION AND FACULTY
Fulltime Dean and Faculty
Qualification of Dean
Perform vital role and function in nursing school, required to work
fulltime because she is in charge to administer and manage the
nursing school, faculty and staff, the nursing student and degree
program.
Filipino Citizen
Currently registered nurse in the Philippines
Holder of Masters Degree in Nursing
5 years of competent teaching and supervisory experience in
college or institute of nursing.
Member of good standing (ADPCN) and accredited national
nursing organization (PNA)
Qualification and Rank of Faculty
Members
A Filipino Citizen
Currently RN in the Philippines
Holder of Masters degree
At least 3 years of Clinical experience
Member of good standing accredited national
nursing organization.
NURSING REGULATION
Professional Regulatory Board of Nursing
* created under new nursing law (RA 9173)
* Primary agency responsible for the regulation
of the admission, registration and practice of
nursing profession in the Philippines.

Composition of BON

* one Chairperson
* Six Members
* Appointed by the President of
the Philippines
Qualification of Chairperson and
Members of BON
Representative of 3 areas of nursing
(education, service and community health
nursing)
Natural born citizen and resident of the
Philippines.
Member of good standing accredited
professional organization of nurses.
Registered nurses and holder of Masters
Degree
10 years of continuous practice of the
profession prior to appointment
No conviction of any offense involving sound
turpitude.

Powers, Duties and Responsibilities of
the BON
Conduct licensure examination for nurses (R.A.
8981)
Prepare adopt and issue the syllabi or tables of specification
of the subject for examination in consultation with the
academe.
Determine and prepare the questions for the licensure
examinations which shall strictly be within the scope of
syllabi or table of specification of the subject for
examination.

To score and rate the examination papers with
the name and signature of the board
members concerned appearing thereon and
sublit the result in all subjects duly signed by
the members of the board to the commission
within 10 days from the last day of
examination unless extended by the
commission for justifiable cause and subject
to the approval of the commission.
Conduct licensure examination for
nurses (R.A. 8981)-Cont
Determine the appropriate passing general
average rating in an examination if not
provided for in the law regulatory thru
profession.
Negligence
Definition
It refers to the commission or omission of an
act, pursuant to a duty, that a reasonably
prudent person in the same or similar
circumstances would or would not do, and
acting or the non-acting of which is the
proximate cause of injury to another person or
his property.




Civil Code, Article 19
One shall act with justice, give every man his
due, observe honesty and good faith.


Civil Code, Article 20
Those who, in the performance of their
obligations through negligence cause any
injury to another, are liable for damages.


Common Acts of Negligence
Burns
Objects left inside the patients body
Falls of elderly
Falls of children
Failure to observe and take appropriate action
as needed


Specific Examples
Failure to report observations to attending
physicians
Failure to exercise the degree of diligence
which the circumstances of the particular case
demands
Mistaken identity
Wrong medicine, wrong concentration, wrong
route, wrong dose



Conditions for Res ipsa loquitor
That the injury was of such nature that it
would normally occur unless there was a
negligent act on the part of someone
That the injury was caused by an agency
within control of the defendant
That the plaintiff himself did not engage in any
manner that would tend to bring about the
injury

Malpractice
Definition
Implies the idea of improper or unskillful care
of a patient by a nurse
Denotes stepping beyond ones authority with
serious consequences
Is a term for negligence or carelessness of
professional personnel
Refers to a negligent act committed in the
course of professional performance (1962)


MEDICAL ORDERS,
DRUGS, and medications.
RA 6675
Only validly registered medical,
dental and veterinary
practitioners, whether in private
institution, corporation or in the
government, are authorized to
prescribed drugs.
RA 5921 (PHARMACY ACT)
All prescriptions must contain the following
information:
Name of the prescriber
Office address
professional registration number
Professional tax receipt number
Patients/clients name, age , sex
Date of prescription.

RA 6675
Requires that the drug be written in their
generic names.

Only when these orders are legal writing and bear
the doctors signature thus the nurse have the
legal right to follow them
The nurse must not execute an order if she is
reasonably certain it will result in harm to the
patient.
INTRAVENOUS THERAPY AND
LEGAL IMPLICATIONS
Philippine nursing act of 1991 section 28
in the administration of intravenous injections,
special training shall be required according to
protocol established.
Basis of nurses legal right to give IV injection.
Board of nursing resolution no. 8 states that any
registered nurse without such training and who
administers IV injections to patients should be
held liable, either criminally or administratively or
both.
TELEPHONE ORDERS
Only in an extreme emergency and when no
other resident or intern is available should a
nurse receive telephone orders.
The nurse should read back such order to the
physician to make certain the order has been
correctly written.
Such order should be sign by the physician on
his next visit within 24 hours.
MEDICAL RECORDS
Supplies rich material for medical and nursing
research
Serves as a legal protection for the hospital,
doctor, and nurse by reflecting the disease or
condition of the patient and his management.
if it was not charted, it was not observed or
done.
CONT.
Nurses are expected to record fully, accurately,
legibly and promptly their observations from
admission to the time of the patients
discharge.
Nurses are legally and ethically bound to
protect the patients chart from unauthorized
person.
CHARTING DONE BY STUDENT
NURSES
When a nurse or clinical instructor counter
signs the charting of the nursing student,
he/she has personal knowledge of information
and that such is accurate and authentic.
Anyone who countersigns without verification
commits herself to possible legal risks.
Liabilities of nurses for the work
of nursing aides
Nurses should not delegate their functions to nursing
aides since the Philippine nursing act specifies the
scope of nursing practice of professional nurses.
Nurses are enjoined to supervise their subordinates
and see to it that they perform only those which they
been taught to do and those which they are capable
of doing.


Nursing aids are responsible for their
actions.
Nurses should not delegate their
functions to nursing aides.
Nursing aides perform selected nursing
activities under the direct supervision
of nurses.
LIABILITY FOR THE WORK OF
NURSING STUDENTS
RA 9173 nursing students do not perform
professional nursing duties.
Nursing students should be under supervision
of their clinical instructors.
In order that the errors committed by nursing
students will be avoided or minimized, the
following measures should be taken:
Nursing students should always be under
supervision of their clinical instructors.

They should be given assignments that are their
level of training experience and competency.
They should be advised to seek guidance if they
are performing a procedure for the first time.
They should be oriented to the policies where
they are assigned.
Their performance should be assessed
frequently to determine their strength and
weaknesses.

CRIMES
Crime defined
It is an act committed or omitted in violation
of the law. It is composed of two elements: (1)
criminal act and (2) evil/criminal intent


Conspiracy to commit a crime
A conspiracy to commit a crime exists when
two or more persons agree to commit a felony
and decide to do it.

Criminal Liability
nurse may incur criminal liability or subject
herself to criminal prosecution either by
committing a felony or by performing an act
which would be an offense against person or
property.

Ignorance of the law is not an excuse
for failure to comply therewith.
Violators of the criminal law cannot
escape punishment on the ground of
ignorance of the law

Circumstances affecting criminal
liability
Justifying circumstances
Exempting circumstances
- an imbecile or insane person, unless the
latter has acted during a lucid interval.
-below 9 years old
-over 9 years of age and under fifteen
unless he/she acted with discernment



- causes an injury which is merely an
accident without fault or intention or
causing it
-acts under the compulsion of an
irresistible force
-acts under the impulse of an
uncontrollable fear of an equal or greater
injury


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

Aggravating circumstances
Are those attending the commission of
crime and which increase the criminal
liability of the offender or make his guilt or
more severe.
Some of the ff circumstances:
When the offender takes advantages of his
public position.
When the crime is commited in place of
worship
When the act is committed with evident
premeditation or after an unlawful entry.

Alternative circumstances
-are those which must be taken into
consideration as aggravating or mitigating
according to the nature and effects of the
crime and other conditions attending in
commission.

Should be taken consideration when the
offended party is the spouse, ascendant or
descendant, legitimate, natural or adopted
or relatives.

Points in order to avoid criminal
liability:
1. Be very familiar with the Philippine nursing
law.
2. Beware of laws that affecting nursing practice
3. At the start of employment, get a copy of your
job description, the agencys rules, regulations
and policies.
4. Upgrade you skills and competence

5. Accept only such responsibility that is
within the scope of your employment and
your job description.
6. Do not delegate your responsibilities to
others.
7. Determine whether your subordinates are
competent in the work you are assigning
them.
8. Develop good interpersonal relationships
with your co-workers, whether they be
your supervisors, peers or subordinates.

9. Consult your superior for problems that
maybe too big for you to handle.
10. Verify orders that are not clear to you or
those that seem to be erroneous.
11. The doctors should be informed about the
patients conditions
12. Keep in mind the values and necessity of
keeping accurate and adequate records
13. Patients are entitled to an informed
consent.

Examples liabilities of Nursing:
Liability for injury to patient
Liability for sponge left in the patients
abdomen
Liability for a safety pin left in patients
abdomen
Liability for defective equipment
Liability for death for patient who jump
from window of his room


Liability for negligence of surgical nurse
Liability for rapture of surgical wound.
Liability for burns for suffered by patient
Liability for burns from hot water bags
Liability for negligence of nurse employees
Liability fro death of infant resulting from
injection of digitalis
Liability of nurse performing administrative
work


Principals
Are those who take a direct part in the
execution of the act; who directly force or
induce others to commit; or who cooperate in
the commission of the offense by another act
without which it would not have been
accomplished.

Accomplices
Are those persons who, not being principals,
cooperate in the execution in the offense by
previous or simultaneous act.

Accessories
Are those who, having knowledge of the
commission of the crime, either as principals
or accomplices, take part in the subsequent to
its commission by profiting themselves or
assisting the offender to profit from the
effects of the crime.

Criminal Actions
Deal with acts or offenses against public
welfare.

Misdemeanor
Is a general name for a criminal offense
which does not in law amount to felony.

Felony
Is a public offense for which a convicted
person is liable to be sentenced to death
or to be imprisoned in a penitentiary or
prison.
Is committed with deceit and fault.

Criminal negligence
Reckless imprudence when a person does an
act or fails to do it voluntarily but without
malice, from which material damage results
immediately.
Simple imprudence means that the person or
nurse did not use precaution and damage was
not immediate or the impending danger was
not evident or manifest.

Examples of negligence
harmful objects left near the patient with suicidal ideation
not following Five R (Rights) and causing harm to the
patient by giving wrong medicine
causing thermal, chemical, physical injuries to the patient
fall of patient, under sedation, after operation recovering
from anesthesia, semiconscious state, and person suffering
from dizziness
failure to observe and take appropriate action
failure to inform to the team members about untoward
effect observed in patient
absconding of patient
loss/damage of patients property
foreign object left in patients body during the surgery due to
wrong counting
delay in obtaining help for patient
Criminal intent
Is the state of mind of a person at the time
the criminal act is committed.
Two elements of deliberate intent:
freedom and intelligence

Lawsuits
Actions brought to the court or tribunal.
Any action, complaint, charge, case or legal proceeding
brought before the court of law, tribunal or quasi-
judicial body, in which the party commencing the case
seeks a legal remedy.
It is initiated by any person who is called the plaintiff in
civil action or the complainant in other lawsuits,
against another who is called the defendant in civil
actions or the respondent in administrative case or the
accused in criminal case.
Lawsuits (cont)
Three (3) basic lawsuits are civil, criminal and
administrative.
The parties in a lawsuit:
a. Civil actions, the plaintiff against the
defendant.
b. Criminal Actions , the people against the
accused.
c. Administrative cases, the complainant
against respondent.
Liability
An obligation or duty which is owed by one
person to another to refrain from some course
or conduct injurious to the latter or to
perform some act or to do something for the
benefit of the latter and for breach of which
the law gives the remedy to the latter as
damages, restitution, specific performance,
and / or injunction.
Liability (cont)
Simply the legal responsibility for acts or
failure to act according to standards, protocols
or policies of the hospital, resulting in another
persons injury or death.
It means legal accountability or obligation to
pay money, do or refrain to do something, and
/ or serve penalty as adjudged by the court or
administrative body.
Legal Doctrine
A framework, set of rules, procedural steps, or
test, often established through precedent in
the common law through which judgments
can be determined in a given legal case or
lawsuit.
Generally accepted principle of law which is
being used or applied in the resolution of
cases, be it administrative, civil or criminal.
Kinds of Civil Liability
Actual or compensatory damages pertain to losses
that are actually sustained by the plaintiff. These are
such compensation or damages for an injury and
will put the injured party in the position in which he
was before he was injured.
Moral Damages are awarded by reason of physical
suffering, mental anguish, fright, serious anxiety,
besmirched, reputation, wounded feelings, moral
shock, social humiliation and similar injury.
Nominal damages are awarded for vindication
or recognition of a legal right.
Temperate or moderate damages are those
damages which are more than nominal but
less than compensatory damages which may
be recovered when the court finds that some
pecuniary loss has been suffered but its
amount cannot, from the nature of the case,
be proved with certainty.
Liquidated damages are those damages
agreed upon by the parties to a contract, to be
paid in case of breach thereof.
Exemplary or corrective damages are those
imposed by way of example or correction for
the public good, in addition to the moral,
temperate, liquidated or compensatory
damages.
Lawsuits in Nursing Practice
Felony - RPC
Offense - special law
Infraction - ordinance
Criminal Negligence, mala in se and
mala prohibita
Criminal Negligence committed by means of
faulty (culpa); deceit (dolo) (mala in se) and
those which are punished by special law (mala
prohibita).
Kinds of criminal negligence
Reckless imprudence doing or failing to do
an act resulting to injuries or death due to an
inexcusable lack of precaution.
Simple imprudence - mere lack of precaution
in a situation where threatened harm is not
immediate or the impending danger is not
openly visible or manifest.
Culpa Contractual (breach of Contract) when
a nurse is contractually obligated to perform a
particular health service or intervention to a
patient and he/she causes death or injuries to
the latter.
Culpa aquiliana a tortous liability which arises
from the breach of a professional duty to any
person fixed by the laws and such breach
constitutes violation of a private legal right,
not created by any contract.
NEGLIGENCE AND MALPRACTICE

Malpractice is professional negligence
when the conduct fails to meet the legal
standard of care and someone is damaged as
a result. any unreasonable lack of skill in
professional duties or illegal or immoral
conduct that result in injury or
death to the client/consumer.

Negligence is described as lack of proper care and
attention; carelessness
i) the failure to do something that a nurse guided by those
considerations that ordinarily regulate the conduct of
nursing would do.
ii) doing something that a prudent and reasonable nurse
would not do.
iii) the failure to expertise ordinary care under
circumstances.
iv) conduct that a reasonably prudent nurse should realize
that not to get involved in an unreasonable risk of
invading a patients interest.
v) failure to do an act that is necessary for the protection
or assistance of a patient.
ELEMENTS OF A LAWSUIT
DUTY - A nurse-client relationship exists and
judges the action compared to others in like
circumstances
BREACH OF DUTY - Failure to perform to the
standard
CAUSATION - Connection between action and
injury
DAMAGES - Actual loss which occurred
LEGAL AND ETHICAL IMPLICATIONS IN
VARIOUS NURSING SITUATIONS
Legal Implications in Admission and Discharge
Examination of Female Patient
Legal Responsibility of Nurse while Administering
Medication
Nursing Records and its Legal Implications
Practice by the Nurses Which may be Considered
Unethical
Admission and Discharge of Medico-Legal
Cases (MLC)
After receiving the patient in A&E, immediately inform the physician.
All the OPD records, admission cards, and other records of patient
should be kept under lock and key.
No records of patient should be shown to anyone else than the
physician looking after the patient.
All the belongings of the patient should be kept under safe custory.
If relatives or police want to take the belongings of patient, the prior
permission of physician is important. Description of the belonging
should be written. Relationship with the patient, signature and thumb
impression should be obtained from the person collecting the
belongings.
Body discharge of the patient should not be thrown until confirmed by
the physician.
Accurate recording of body discharge, its quantity, colour and
consistency should be maintained.
Admission and Discharge of Medico-Legal Cases
(MLC)
Dont destroy/discard any evidence without discussing
with physician.
Take consent of relative or patient (if patient is conscious)
for any kind of procedure/treatment.
Allow the relative to be with the patient on request of
patient.
Avoid answering enquiries to an insurance agent.
The condition of patient should be reported verbally only.
It is not obligatory on the part of nurse to provide
information to the police officer, to the press reporter or
any agent of the public. In case of any difficulty s/he may
inform the immediate higher authority.

Admission and Discharge of Medico-Legal Cases
(MLC)
On Discharge

If patient is transferred from one ward to another, or to
any other hospital, it should be clearly entered and
signed.
No records should be handed over to police. If required,
physician attending the patient should give in writing to
Nurse.
Name and address of the relative should be written clearly
before allowing the patient to leave the hospital.
Discharge notes should be kept under lock and key, until
handed over to the department concerned.
Admission and Discharge of Medico-Legal
Cases (MLC)
In Case of Death of Patient

If death occurs in the hospital, Physician on duty must inform the CMO
and withhold the body for post mortem examination according to
hospital policy.
Nurse must get written instruction from the medical officer for
handing over the body to mortuary/relative/police officer with:
complete name and signature
complete address of the person from mortuary/relative/police officer
identification number
signature of witness
List of all articles of patient should be made in triplicate while handing
over the body.
Maintain the privacy of the dead body while attending last offices or
care of the dead.
All the articles should be disposed off, after making list and with
approval of medical officer.
Discharging a Patient with Mental
Illness

As a nurse you must remember that:
Voluntarily admitted patient may ask for discharge
and psychiatrist/medical officer on
duty will make discharge slip.
Check the signature of the patient and
relatives/witness.
Note the address of patient on discharge.
L AMA(Left Against Medical Advice or
AOR D/C)
If the patient is in a critical condition, as a Nurse, your
responsibility is to:

1) explain about the critical condition of the patient
to relatives,
2) inform the medical officer, and get it written from
the medical officer that patient can go on LAMA,
3) signature of relative should be taken in which s/he writes
that s/he is taking full responsibility of taking away the
patient, that the Doctors and nurses have explained the
critical condition, and the risk of taking away the patient,
4) if it is a hospital policy, the life support system should not be
withdrawn,
5) all the records should be kept under lock and key.
Absconding

If the patient runs away from the ward/hospital, it becomes a
major responsibility of a nurse. To avoid this problem you
must remember the following:
Check the number of patients admitted, with the actual
number of patients present in the ward while handing over,
and taking over, during change of shifts.
Inform immediately the CMO, if any patient is reported
absconded, in writing and get is signed. Record of absconded
patient should be kept under lock and key.
Examination of Female Patient
When the female patient is being examined by male Dr., nurse
must ensure that she should:
maintain total privacy during the physical examination.
be present during the physical examination of the female
patient.
expose the patient as little as possible.
protect the right of the patient if she refuses to be examined
by a male doctor.
discourage repeated examination of breast, abdomen and
perineal part of patient.
Legal Responsibility of Nurse while
Administering Medication
5R must be kept in mind while giving medication to the
patient, that is right medicine, to right patient, in right
dose, through right route, and at right time.
No verbal instructions from physician should be carried on
for giving medicine.
There are limited number of days for administering
antibiotics.
Strict monitoring of medicine, especially ones which may
change the blood chemistry (Heparin, Digoxin).
Measuring of liquid medicines at eye level.
Error cause in medication, by a nurse should be reported
immediately,
Ensure that all the medicine containers are labeled clearly.
Nursing Records and its Legal Implications
On admission of patient to the hospital, various
records are maintained. Some of them are:
Nurses Notes/Doctors notes
T.P.R. records
Poisonous and essential drugs records
Admission and Discharge records.
Discharge records should be kept under the lock
and key, until they are handed over to the medical
record section.
MUST maintain security of medical records at ALL
times.
Practice by the Nurses Which may be
Considered Unethical
prescribing medicines
doing decaputation of still birth baby
conducting obstructed labour, which may cause threat to
the life of the mother or the baby
delivery when the presentation is placenta previa
getting registration done by false means
dishonest use of certificates (may be for higher
education)
taking bribes
conduct of derogatory to nursing profession. Theft,
cheating, immoral act, habitual use of drugs.

LEGAL TERMS DEFINED
A TORT is a civil wrong made against a property.
Torts may be classified as unintentional or
intentional. An example of an unintentional tort is
NEGLIGENCE or MALPRACTICE. Intentional torts are
willful acts that violate anothers rights (assault,
battery, defamation, and invasion of privacy).
LEGAL DEFINITIONS (contd)
NEGLIGENCE: Conduct that falls below a
standard of care.
MALPRACTICE: Results when nursing care is
below that required for safe nursing practice.
LEGAL DEFINITIONS (contd)
No intent is needed for negligence to occur. It
is established by law for the protection of
others against reasonable risk of harm. It is
characterized chiefly by inadvertence,
thoughtlessness, carelessness, or inattention.
NEGLIGENCE & MALPRACTICE
If a nurse performs a procedure for which they
have not been trained and do it carefully, but
still harm the patient, a claim of negligence or
malpractice could be made.
NEGLIGENCE & MALPRACTICE
(contd)
If nurses give care that does not meet
appropriate standards, they may be held
negligent. Because these actions are
performed by a professional, the negligence of
the nurse is termed malpractice.
NEGLIGENCE & MALPRACTICE
RISKS
IV therapy errors resulting in infiltration of
phlebitis
Burns from improperly monitored heat
therapy
Falls resulting in injury
Failure to use aseptic technique
Errors in sponge, instrument, or needle counts
in surgical cases
NEGLIGENCE & MALPRACTICE
Nurses must perform all procedures correctly.
They must also use professional judgment as
they carry out MD orders as well as
independent nursing therapies for which they
have authority.
NEGLIGENCE & MALPRACTICE
(contd)
The following actions must take place for Nursing
Negligence to occur:
Nurse owed a duty to patient
Nurse did not carry out duty
Patient was injured
Patients injuries were result of the nurses failure to
carry out the duty
STUDENT NURSE ROLE
Student nurses must also practice nursing in a
reasonably safe manner. They should never be
assigned to tasks for which they are
unprepared & should be carefully supervised
by instructors/staff as they learn new
procedures.
STUDENT ROLE
Student nurses are expected to perform as
professional nurses would in providing safe
patient care.
Student nurses must be accountable for
informing staff of their current safe level of
practice.
STAYING LEGAL
Nurses can reduce their chances of being named in
lawsuits by following standards of care, giving
competent health care, & developing an empathetic
rapport with patients. In addition, careful, complete,
& objective documentation serves as evidence of the
standard of nursing care provided.
Jurisprudence on Fault & Negligence
at fault the nurses action is contrary to
what should have been done to the patient.
negligent when there is failure in
observing the necessary protection of
interests and wellness of the patient the
degree of care, precaution and vigilance which
circumstances demand, whereby such patient
suffers an injury or even death.
Jurisprudence on Negligence test
Prevention is the best defense in Law.
Negligence may be criminal or not criminal.
It is criminal when it results to a acrime; not
criminal when it is either contractual or quasi-
delictual.
General Divisions of Law
Natural Law an integral part of nature
because it is immutable and inherent in the
nature of man or every element or part of
the universe.
Positive Law a precept made and imposed
by someone in authority.
* divisions
- divine law
- human law
Applicable laws and jurisprudence in
nursing practice
1. Constitutional Law is that branch of the
science of laws which treats of the nature of
constitutions, their adoptions and
amendments, their construction and
interpretation and of the validity of legal
enactments as tested by the criterion of
their conformity to the law of the land.
Kinds of Constitution
Cumulative or evolved constitution is one
that originates in customs, common law
principles, decisions or courts, etc.
Conventional constitution is an enacted
constitution because it is deliberately
passed by a representative body or a ruler.

Written constitution is one where the
provisions are embodied in one
document or sets of documents while an
unwritten constitution is one where most
of the provisions are not in a single
document but scattered in various
sources such as customs and traditions,
statutory enactments of a fundamental
character, judicial decisions and certain
common law principles.
Kinds of Constitution (cont)
Rigid constitution is one that can be amended
only by a formal and usually difficult process,
whereas a flexible constitution is one that can
be changed by ordinary legislation.

Kinds of Constitution (cont)
2. Criminal Law the branch of law which
defines crimes, treats of their nature and
provides for their punishment.
- Aptly described as the instrument of
criminal policy for it is in criminal law that
are found
- it covers offenses resulting to injuries or
death of the patients.
Prosecution of a criminal offense
resulting to injuries
Nature
Location
Size, shape and
incursion
Color
Number, and
Other appearances
Re: Death of a patient..
Natural
Suicide
Homicide / murder / parricide
Accident
undetermined
Useful pieces of evidences for the
criminal offenses
Body
Objects on or with the body
Injuries sustained
Tissues and body fluids
Other medical evidence or findings
R.A. 3815 otherwise known as
Revised Penal Code (RPC) which
was approved on December 8, 1930
which defines crimes, treats of their
nature and provides for their
punishment.
3. Civil Law - the branch of Law that pertains
to the organization of the family and the
regulation of property. It has been defined
as the mass of precepts which determine
and regulate the relations of assistance,
authority and obedience among the
members of a family, and those which exist
among members of a society for the
protection of private interests.
R.A. 386, popularly known as the New Civil Code
(NCC) or the Civil Code of the Philippines took
effect on August 30, 1950 and covers the
following aspects of human life; persons and
family relations, property rights and ownership,
the modes of acquiring ownership, obligations
and contracts and special contracts.

One important amendment to this code is EO
209, the Family Code, amending its provisions
on marriage and family relations.

4. Labor Law is that branch of Law that governs
and regulates the relationship of employers
and employees. Broadly called labor
legislation , it consists of statutes,
regulations and jurisprudence governing the
relations between capital and labor, by
providing for certain employment standards
and legal framework for negotiating,
adjusting and administering those standards
and other incidents of employment.
Labor Law (CONT)
Labor Standards Law that which sets out the
minimum terms, conditions and benefits of
employment must provide or comply with and to
which employees are entitled as a matter of right.
Labor Relations Law defines the status, rights and
duties and the institutional mechanisms, that govern
the individual and collective interactions of
employers, employees or their representatives.
Labor Code
Promulgated as P.D. No 442 on May 1 1974
and took effect on November 1, 1974 except
portions on Book IV whose effectivity was
deferred to January 1, 1976 by P.D. No. 608.
5. Administrative Law is that branch of law
which deals with the activities or functions
of executive or administrative agencies such
as the departments, bureaus, boards or
commission or all other offices under the
administrative supervision of the office of
the President, which are created and vested
by Law with qusi-judicial, quasi-legislative
and executive powers.
Administrative Law (cont)
Executive Order No. 292 is the principal law in
the study of administrative laws in the
Philippines and was promulgated by then
President Corazon Aquino dated July 25, 1987,
otherwise known as the Administrative Code
of 1987, which incorporated in a single
document the major structural, functional and
procedural guidelines of governance.
Administrative Law (cont)
Professional Regulation Commission (PRC)
Three main functions
Executive
Quasi-judicial
Quasi-legislative
Functions of the PRC
To investigate and decide cases against erring
examinees and professionals;
To formulate and promulgate policies and
guidelines on administrative investigation and
professional regulations.
To implement the laws, regulatory policies and
standards; and
To maintain and promote professional and
occupational standards and ethics.
6. Civil Service Law is that branch of law which
deals with the civil service in all branches,
subdivisions, instrumentalities and agencies
of the government including government-
owned or controlled corporations with an
original charter.
Civil Service Law (cont)
Primary purpose is to establish and maintain a
merit system in the selection of public officers
and employees without regard to sex, color,
social status or political affiliation.
General purpose is to ensure and promote the
constitutional mandate regarding appointments,
particularly according to the merit and
progressive system of personnel administration
to ensure the maintenance of an honest,
efficient, progressive and courteous civil service
in the Philippines.

Civil Service Commission
P.D. No. 110 dated January 26, 1973, created the
Civil Service Commission (CSC), replacing the CSC
established under R.A. no 2260.
repealed by PD No. 807 otherwise known as the Civil
Service Decree of the Philippines, which was
superceded by Subtitle A, Title I, Book V of E.O. No
292, the Administrative Code of 1987, E.O. No 292,
which codified the major structural, functional and
procedural principles of governance, is the basic legal
document in the study of civil service law.
7. Case is that body of the prevailing
jurisprudence or decisions of the Supreme
Court interpreting the laws or the
Constitution or applying them to certain sets
of facts or actual cases and controversies.
Lawsuits
Actions brought to the court or tribunal.
Any action, complaint, charge, case or legal
proceeding brought before the court of law, tribunal
or quasi-judicial body, in which the party
commencing the case seeks a legal remedy.
It is initiated by any person who is called the plaintiff
in civil action or the complainant in other lawsuits,
against another who is called the defendant in civil
actions or the respondent in administrative case or
the accused in criminal case.
Lawsuits (cont)
Three (3) basic lawsuits are civil, criminal and
administrative.
The parties in a lawsuit:
a. Civil actions, the plaintiff against the
defendant.
b. Criminal Actions , the people against the
accused.
c. Administrative cases, the complainant
against respondent.
Liability
An obligation or duty which is owed by one
person to another to refrain from some course
or conduct injurious to the latter or to
perform some act or to do something for the
benefit of the latter and for breach of which
the law gives the remedy to the latter as
damages, restitution, specific performance,
and / or injunction.
Liability (cont)
Simply the legal responsibility for acts or
failure to act according to standards, protocols
or policies of the hospital, resulting in another
persons injury or death.
It means legal accountability or obligation to
pay money, do or refrain to do something, and
/ or serve penalty as adjudged by the court or
administrative body.
Legal Doctrine
A framework, set of rules, procedural steps, or
test, often established through precedent in
the common law through which judgments
can be determined in a given legal case or
lawsuit.
Generally accepted principle of law which is
being used or applied in the resolution of
cases, be it administrative, civil or criminal.
Kinds of Civil Liability
Actual or compensatory damages pertain to losses
that are actually sustained by the plaintiff. These are
such compensation or damages for an injury and
will put the injured party in the position in which he
was before he was injured.
Moral Damages are awarded by reason of physical
suffering, mental anguish, fright, serious anxiety,
besmirched, reputation, wounded feelings, moral
shock, social humiliation and similar injury.
Nominal damages are awarded for vindication
or recognition of a legal right.
Temperate or moderate damages are those
damages which are more than nominal but
less than compensatory damages which may
be recovered when the court finds that some
pecuniary loss has been suffered but its
amount cannot, from the nature of the case,
be proved with certainty.
Liquidated damages are those damages
agreed upon by the parties to a contract, to be
paid in case of breach thereof.
Exemplary or corrective damages are those
imposed by way of example or correction for
the public good, in addition to the moral,
temperate, liquidated or compensatory
damages.
Lawsuits in Nursing Practice
Felony - RPC
Offense - special law
Infraction - ordinance
Criminal Negligence, mala in se and
mala prohibita
Criminal Negligence committed by means of
faulty (culpa); deceit (dolo) (mala in se) and
those which are punished by special law (mala
prohibita).
Kinds of criminal negligence
Reckless imprudence doing or failing to do
an act resulting to injuries or death due to an
inexcusable lack of precaution.
Simple imprudence - mere lack of precaution
in a situation where threatened harm is not
immediate or the impending danger is not
openly visible or manifest.
Culpa Contractual (breach of Contract) when
a nurse is contractually obligated to perform a
particular health service or intervention to a
patient and he/she causes death or injuries to
the latter.
Culpa aquiliana a tortous liability which arises
from the breach of a professional duty to any
person fixed by the laws and such breach
constitutes violation of a private legal right,
not created by any contract.
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