Professional Growth and

Development
Nina Anne Bernadette P. Paracad, RN, MSN
Medical Colleges of Northern Philippines
• Adjustment: An educational process referring to changes
in behavior towards better life, better relationships and
better contribution to society

• Profession: A calling by which members profess to have

special knowledge by training, by experience or both on
that they may guide or advice or serve other in that field.
 CRITERIA OF A PROFESSION

• Mastery of the Craft- the profession must possess the necessary skills and
attitude.
• Service orientation-Hall mark of the profession
• Autonomy-reasonable independent being (self-regulated)
• Accountability-the essence of profession
• Political Power- Adhere own sets of values
• Professional Organization- Must be a member of an accredited Organization
(e.g IMAP)
 EVOLUTION OF MIDWIFERY IN THE
Care of the sick in Primitive Times
PHILIPPINES
• Animism. Babaylan, catalonan,
• Superstitious and mystical beliefs: wind theory, natural Order and forces (mangkukulam or manggagaway)
Spanish Period
• Individual sin (Gaba or Bad Karrma), poot and Aswang
• Materia medica (MOrga. Governador-General in 1595-1596 noted used of wine as medicine: Lambanog and Tuba)
• Fore runner of Filipino Red Cross
American Period
• Separation of Producers, distributors, and consumers of health
• Exchange calue
• Iloilo Mission Hospitals School of Nursing (1906)
Contemporary
• Dr. Jose Fabella, first secretary of the department of health founded the first midwifery school in the 1922 as a
response to high infant mortality rate.
 Objectives of the First Midwifery Schools

• Train young women to replace hilots (traditional birth attendant)

• Train doctors and nurses for Rural assignments and
• Provide health service and education with emphasis on maternal and child
health (MCH)
 PROFESSION OF MIDWFERY

• Is the performance or offer to perform or render for a fee, salary,

or other reward or compensation of service recurring an
understanding of the principles and application of procedures
and techniques in the supervision of and care of women during
pregnancy, delivery and puerperium.
• Management of Normal Delivery
• Performance of Internal examination during Labor, except when patient
has antenatal bleeding.
• Health education of patient family and community, including nutrition
and family Planning
• Carrying out the written order of the physician with regards to ante-
natal, intra natal and post natal care of the normal pregnant women
• Giving Immunization
• Oral and parenteral dispensing of oxytocic after the delivery
of the placenta
• Suturing perineal laceration to control bleeding
• Giving intravenous fluid during obstetrical emergencies
provided they were trained for that purpose
• May inject vitamin K to new born
 Characteristic of Profession

• There is especial preparation and training

• With clearly defined permanent membership
• Acceptance of the service motive
 Determinants of Professional Practice

• Problems and needs by the people

• Policies and regulation
• Current socio-economic political and cultural
system
SPHERE OF MIDWIFERY PRACTICE IN THE
PHILIPPINES
Traditional Function of the Midwife (R.A No. 7392).
The Philippine Midwifery Act of 1992 provides the
midwife:
• Gives supervision care and advice to women during pregnancy, labor and
post-partum period.
• Conduct deliveries on her own responsibility
• Cares of the newborn including the detection of abnormalities and
counseling of parents or couple.
• Gives health Education
• Executive emergencies measures
• Procures medical supplies
 Expanded Function of the Midwifes

• Oral and parenteral dispensing of oxytocic drugs after

delivery of the placenta
• Suturing perineal lacerations to control bleeding
• Giving of intravenous fluids during obstetrical
emergencies
• Injecting of vitamin K. to the Newborn
PROFESSIONAL ORGANIZATION OF MIDWIVES

• Letter of Instruction 1980

Compulsory membership to professional association
accredited by the professional regulations commission
 INTEGRATED MIDWIVES ASSOCIATION OF THE
PHILIPPINES (IMAP)

• Brief History:
In the 1961 two organization were founded the Philippine Midwives association
of the Philippines or the PHIMIDAS with Atty. Angelina Fonce as first president and
the National Federation of Filipino Midwives or the NFFM with Mrs. Leoncia
Chuatoco as first president.

• In 1974, the two were integrated to become IMAP with Ms. Juana Reyes as its first
president. It is presently the only professional midwives association recognized by
the Philippine Regulatory Commission (PRC)
ETHICO-MORAL RESPONSIBILITY
Ethics – part of philosophy that deals with systematic
approaches to questions of morality.
• A term for the study of how we make judgments regarding
right and wrong.
•A system of MORAL PRINCIPLES or moral standards
governing conduct.

Morals- Human conduct in the application of ethics.

Concerned with JUDGMENT PRINCIPLES of right and
wrong in relation to human actions and character.
CODE OF ETHICS
• Fundamental responsibilities of midwife
• Render medical services regardless of the religious
belief , political belief or creed
 FREEDOM OF RELIGION
• No law shall be made respecting the establishment of a religion or to
prohibit the free exercise there of. The fee exercise and enjoyment of
religious profession and worship without discrimination shall forever be
allowed.
Two aspects of freedom of Religion
a. Freedom to Believe - Absolute
b. Freedom to Act – Relative (It must be in conformity to the law, morals,
customs and traditions)
• Render medical services on the ground medical neutrality –
don’t take the background of pt.
• Protect life and respect the dignity of man
The Patients Bill of Rights (Filipino)
1. The patient has the right to considerate and respectful care, irrespective of
socioeconomic status

2. The patient has the right to obtain from his physician complete current
information concerning his diagnosis, treatment and prognosis in terms the
patient can reasonably be expected and understand. When it is not medically
advisable to give such information to the patient, the information should be
made available to an appropriate person in his behalf. He has the right to know
by name and in person, the physician and nurse responsible in coordinating his
care.
3. The patient has the right to receive from his physician information necessary to
give informed consent prior to the start of any procedure and/or treatment.
Except in emergencies, such information for informed consent should include
but not necessarily limited to the specific procedure and/or treatment, the
medically significant risks involved, and the probable duration of
incapacitation. Where medically significant alternatives for care or treatment
exist, or when the patient requests information concerning medical
alternatives, the patient has the right to such information. The patient has also
the right to know the name of the person responsible for the procedures and/or
treatment.
4. The patient has the right to refuse treatment/lifegiving measures, to the
extent permitted by law, and to be informed of the medical consequences of
his action.
5. The patient has the right to every consideration of his privacy concerning his
own medical care program. Case discussion, consultation, examination and
treatment are confidential and should be conducted discreetly. Those not
directly involved in his care must have the permission of the patient to be
present.
6. The patient has the right to expect that all communication and records
pertaining to his care should be treated confidential.

7. The patient has the right to expect that within its capacity, a hospital must
make reasonable response to the request of patient for services. The hospital
must provide evaluation, service and/or referral as indicated by the urgency of
care. When medically permissible a patient may be transferred to another
facility only after he has received complete information concerning the needs
and the alternatives to such transfer. The institution to which the patient is to
be transferred must first have accepted the patient for transfer.
8. The patient has the right to obtain information as to any
relationship of the hospital to other health care and educational
institutions in so far as his care is concerned. The patient has the
right to obtain information as to the existence of any professional
relationship among individuals, by name, who are treating him.

9. The patient has the right to be advised if the hospital proposes to

engage in or perform human experimentation affecting his care or
treatment. The patient has the right to refuse or participate in such
research project.
10.The patient has the right to expect reasonable continuity of care;
he has the right to know in advance what appointment times the
physicians are available and where. The patient has the right to
expect that the hospital will provide a mechanism whereby his
physicians or a delegate of the physician of the patient’s continuing
health care requirements following discharge informs him.

11.The patient has the right to examine and receive an explanation of

his bill regardless of source of payment.
12. The patient has the right to know what hospital rules
and regulations apply to his conduct as a patient.
 The Stolen Berries
• Everyone likes a nice person and most of us try to be good in our own lives. Why is it,
then that there are so few people in the world who are good all the time? As hard as you
may try, there are always those rotten days of moments and weakness where it just
feels better to be bad. Whether that takes the form of driving too fast on the highway,
cheating on a test, or “liberating” a box of pens from the office, we’ve all done things we
can’t be proud of or justify. The key to becoming a truly good person is in accpeting the
bad parts of your own personality and admitting that you’re not perfect, not in trying to
act like a saint while the devil on your shoulder whispers in your ear. We all succumb to
temptation sometimes. But in the next scenario you might just get caught…
1. On a stroll through the countryside, you come across a field of delicious-
looking strawberries. Your stomach starts to rumble, and there’s no one else
around. Only a fence stands between you and a free lunch. How high is that
fence?
 2. You sneak into the garden and begin to help
yourself to the fruit. How many berries did you eat?
 3. Suddenly the farmer whose berries you’re stealing
appears out of nowhere and starts yelling at you. What do
you say in your own defense?
4. After all is said and done, how did the berries taste? And
looking back, how did you feel after your berry-stealing
adventure was over?
 Strawberries -seductively juicy and red - are
common symbol of sexual attraction and desire. The
way you envisioned this scenario helps us to
understand your attitude toward forbidden
romance and stolen love.
1. The height of the fence you imagined around the field is
a measure of your own level of self-control and resistance
to sexual temptation. The higher the fence, the greater
your own defenses. People who imagined a total enclosure
exercise admirable restraint. Those of you who said it was
only a string tied around some be at about knee height run
a higher than average risk of getting burned by the flames
of love
2. The number of berries you said you would steal is the
number of people you can believe yourself in love (or lust)
with at any given time. If you said you’d quit after eating
just one, you’re likely to be faithful in your own love life as
well (or at least a devoted serial monogamist). Those of
you who got onto double digits may need to think
seriously about applying the brakes to your libido. Nobody
can keep that pace up forever.
The excuses you made to the farmer represent the way you’d defend yourself
if you got caught having an affair. What was your excuse?

• “I’m so sorry. I promise I’ll never do it again” Sometimes a full confession

and a promise to behave is the best way to get yourself off the hook.
• “They looked so good, I just couldn’t help myself” Well actually you did help
yourself – to somebody else’s berries. But honesty is the best policy. After
all, it worked for George Washington, didn’t it? If you keep it up, maybe
someday you could be president too.
• “Hey those berries were great! Do you have if I have a couple more?”
Farmers have shotguns. Spouses have lawyers. Fortunately you still have a
chance to reconsider your choice of words.
4. The way you described the experience and the taste of the berries gives an
indication of how you imagine yourself feeling when looking back on a past
affair.
• “Actually, they didn’t taste good as they looked. The whole thing wasn’t
even worth the effort” All too true for most affairs. Chalk it up to experience
and put it behind you.
• “So sweet! So juicy and delicious! I’ve never tasted anything like it!” Uh, let’s
just say you’re addicted to love.
• “The berries were nothing special, but all in all it kind of fun” Statistically
speaking, you’re in the high-risk group for repeat offenders.
 Bill of Rights of Patients

1. Right to informed consent

2. Right to refuse and/or withdrawal from participation or
autonomy
3. Right to privacy
4. Right to confidentiality
5. Right to quality care
 1. Right to Informed Consent/ Contract
Conscious – all medical practice are not authorized ŝ consent
Unconscious – all medical practice are authorized as if consent is given to you

V – voluntary – Free act. Independent act. Rational

O – opportunity to ask questions, suggestions & make recommendations
T – treatment, surgery, procedure – specifically explained to the patient by MD

U – understood by patient
M – matured physically – age 18 yo & above
Mentally – with sound mind, same & not an imbecile.
Substitute or proxy consent – if pt is mentally or physically incapable of giving consent
1.Parent
2.Guardian
3.Adliter – (not a relative!) DSWD, MD
 • Informed Consent –The patient UNDERSTANDS the reason for the
proposed intervention, with its benefits and risks, and agrees to the
treatment by affixing his signature in the consent form. It generally contains
the following elements:
• disclosure
• understanding
• voluntariness
• competence
• permission giving
 In our present jurisdiction under the 1987 Constitution, the age of
majority is 18 years old. It means that only 18 years old and above can
sign for themselves in legal matters such as the signing of consent
(hospital admission, contracts, will etc..)
 2. Right to Make Decisions Or Autonomy

• - Right to Self Determination

• “A Person who is of a sound mind and of legal age shall
have the right to determine what is supposed to be done
to his body.”
 PERSONS TO MAKE DECISIONS IN CONSCIOUS
PATIENT
• parents
• grandparents
• paternal
• maternal
• eldest brother/sister
• relatives/guardians
• teachers
Q: How do you respect the dignity of patient?
A: By respecting the bill of rights of patient.
• Between the conflict of pt. and doctor, loyalty will
always be on the patient.
 3. Right to Privacy and Confidentiality

• Privacy of Communication
• “It shall be inviolable except upon the lawful order
of the court and when public safety, public health
requires it.”
• *Cannot be violated at all – SECRECY ACT LAW
• Q: Who owns the medical chart?
• A: Hospital
•
• Q: Who owns the communication in the medical chart?
• A: Doctor and Patient

• *Duty: Keeps in proper place (medical chart rack) with honesty,

confidentiality, and integrity
• Relative Privacy Absolute Privacy
• Doctor – Patient Midwife – Spouse
• Midwife – Patient Midwife – lawyer (case)
• Midwife – Priest (religion)
• Husband – wife = absolute privacy; order from court, no order to divulge/
reveal or right not to tell

• Q: What is Privacy?
• A: Privacy is any not related to health condition.

• Q: What is Confidentiality?
• A: Confidentiality is any related to health condition.

• Breach – Violation of right, e.g. breach of confidentiality

 4. Right to Quality Care
• Autonomy – “Freedom to CHOOSE”
• Beneficence – “Do only what’s GOOD”, respect, privacy
• Nonmaleficience – “Do NO harm”, e.g. side rails up
• Veracity – “Tell the TRUTH”
• Justice – “Be FAIR”
• Fidelity – “Keep your word”, keeping promises
“LOYALTY”
• MIDWIFERY ETHICS – the code governing the
NURSE’S BEHAVIOR, especially towards patients,
employing authority and to the profession.
 Beneficence
• any action that would BENEFIT others. The principle that imposes upon the
practitioner to seek the good for the patients under all circumstances.
Beneficence connotes positive action toward preventing or removing harm
and promoting good such as:
• One ought to prevent evil or harm
• One ought to remove evil or harm
• One ought to do or promote good.
 Nonmaleficence

• states the idea to REFRAIN from inflicting harm. “one

ought NOT to inflict evil or harm. The admonition of
nonmaleficence is stated in the negative manner while
the beneficence is in the positive.
 Justice
• The basic principle that deals with FAIRNESS, just deserts, and
entitlements in the distribution of goods and services.
• Some methods of distributing goods and services in our society
are as follows:
• To each, an equal share
• To each, according to need
• To each, according to effort
• To each, according to contribution
• To each, according to merit
• To each, according to ability to pay
 Autonomy
• In health care, it means the form of personal LIBERTY,
where the individual is free to choose and implement
ones’ own decisions, free from deceit, duress, constraint,
or coercion. Three Basic elements involved:

• ability to decide
• power to act upon your decisions
• a respect for the individual autonomy of others.
 Stewardship

• refers to the actions made for by the health

practitioner IN BEHALF of the patient and for the
greater benefit of the patient.
 Truth Telling/Veracity

• The patient must tell the truth in order that appropriate care can
be provided. The health practitioner needs to disclose FACTUAL
INFORMATION so that the patient can exercise personal
autonomy.
 Confidentiality

• is also known as PRIVILEGED COMMUNICATION which refers to

any information obtained by the nurse or the health team during
the course of caring for the patient. The information gathered
may only be disclosed under the following:
• the patient agrees to divulge such information with written consent
• the information is material in a criminal case investigation
• if public safety is jeopardized (communicable disease)
• such information is relevant to his care to be utilized by other health
team
Privileged Communication may be divided into two
classes:
• Absolute privileged communication – is one made in the interest
of the public service or the due administration of justice and is
practically limited to legislative and judicial proceedings and
other actions of the state.

• Qualified privileged communication – is a slanderous statement

uttered in good faith, and made on a proper occasion, from a
proper motive, based upon a probable cause and in honest belief
that such statement is true.
Reading You Like A Book
Some are very fussy about their books, refusing to read anything outside of a particular
genre or subject matter.
Others read indiscriminately, devouring volume after volume without pattern or
preference.
Many read only on occasion or when work or study demands it.
And then there are those who simply don’t read at all if they can avoid it.
But for those who do read, not just out of necessity, but for the sheer pleasure and
relaxation it affords, finding a good book is almost like making a new friend.
There’s a sense of simultaneous familiarity and discovery.
It’s as if a window has opened into a previously unimagined world, but one you
sensed was waiting for you all along.
Sometimes it’s almost as if the book has chosen you.
 Questions:

A book lies open in front of you.

What type of story does it contain?
You begin to read and soon find that you yourself are a
character in the story.
What kind of role do you play?
You read further and come to a section where the pages
have been damaged, making them nearly impossible to
read.

What part of the story is it?

You have just closed the cover after finishing
the book.
How was the ending?
 Answers:

While reading habits and preferences may vary widely from person to person,
we all share a common experience in which books and reading were an
inevitable part of life: our school years. In our culture, books and school are
inextricably linked, and the answers you gave in response to this scenario
likewise echo your own experiences during school.
The type of story you imagined reflects your general impression of your school
years.

Does your answer suggest you lived through a comedy, a mystery, or a

romance? Then again, who among us didn’t?

Or perhaps it was an erotic novel? Either you were a very precocious child or
you had an overactive imagination.

A Shakespearean tragedy? The fact that you survived all five acts has added
nobility to your character.
 The role you saw yourself in is the image you
have of yourself in your time as a student.

Were you the star of the tale? A sidekick? Comic

relief? Or no more than a bit player with only a
single line of dialogue on page 283? It may just be
that your character was being developed for the
sequel.
 The scene described in the damaged pages mirrors a
situation in which you were hurt during your youth.

Broken hearts can hurt as much as an act of violence,

and even seemingly minor traumas can take a lifetime to
heal. Although at first there might not seem to be any
immediate connection to your life, if you think back to
your past, it’s more than likely you’ll find some buried
painful memory associated with the scene.
 The ending of the story is an expression of your feelings of
closure (or a lack thereof) regarding your days spent at school.
Did you answer something like “And they rode off into the
sunset to live happily ever after”? A little clichéd, perhaps, but you
can’t argue with success.
Perhaps you envisioned a story in which your character dies in
the end? It’s likely you greeted your graduation as a chance to be
reborn into a new life.
Or was the ending a cliff-hanging “To be continued . . .”? In a
way, that’s the most accurate response you could give.
MORAL PRINCIPLES
• GOLDEN RULE – “ Do unto others what you would like others do
unto you”. It is a basic moral principle that if you want others to
respect you, you must also accord respect to them.
• THE TWO FOLD-EFFECT - facing a situation which would have
good and bad effects requires the following basis for arriving a
decision:
• that the action must be morally good
• that the good effect must be willed and the bad effect merely allowed
• that the good effect must not come from an evil action but from initial
action itself directly; and
• that the good effect must be greater than the bad effect.
• THE PRINCIPLE OF TOTALITY – states that the whole is always
greater than its parts. To save the patients’ life as a whole, it is
justified under this principle to surgically cut-off a disease body
part of the patient.
• EPIKIA – “exception to the general rule”. It is reasonable
presumption that the authority making the law will not wish to
bind a person in some particular case, even though the case is
covered by the letter of the law.
• If a mentally ill patient becomes berserk and the doctor could not be contacted, the
patient may be restrained by virtue of epikia.
• Another example of this is allowing a relative to see a seriously ill patient who
expresses the desire the relative although it is not yet visiting hours
• THE END DOES NOT JUSTIFY THE MEANS – giving a sleeping
tablet to a chronically ill person so he/she can de in peace is
morally wrong.
• THE GREATEST GOOD FOR THE GREATEST NUMBER – during
an epidemic, immunization against communicable diseases is
administered to the people. Although there may be some who
may have slight reactions to the vaccine, the greater majority of
the population shall be considered.
• NO ONE IS HELD TO THE IMPOSSIBLE – the doctors and nurses
are not guarantors of life. They cannot be held liable as long as
they have done everything that modern medicine can afford to
save a patient from dying.

• THE MORALITY OF COOPERATION – formal cooperation in an

evil act is never allowed. A nurse shall not participate upon
immoral operations such as abortion even if the doctor
commands it.
 PRINCIPLE RELATING TO THE ORIGIN AND
DESTRUCTION OF LIFE

• mercy killing or euthanasia is not allowed because it will lessen the incentive to
medical research. The state recognizes the sanctity of life. It shall protect the life
of the mother and the unborn since conception.

• Any direct attack on the life of a fetus for whatever cause is immoral. A fetus
shall be buried in consecrated grounds. If it is dead and came from dead mother,
it shall be buried with the mother.
 Privacy

• the right to be left alone or be apart from others. This right is guaranteed by most
civilized state laws and enshrined also in the patients’ bill of rights. The patient has
the right to every consideration of his privacy concerning his own medical care
program. Case discussion, consultation, examination and treatment are
confidential and should be conducted discreetly. Those not directly involved in his
care must have the permission of the patient to be present. This right also includes
privacy of one’s thoughts, opinions and physical presence and privacy of one’s
records.
 THE PHILIPPINE MIDWIFERY LAW

Section 1: “Philippine Midwifery Act of 1992”,

Section13: Qualification of Applicants for Examination

 Filipino Citizen
 Good Moral Character
 Graduate of midwifery in government recognized and duly accredited
institution

Fraud/Deceit – causing someone to believe what is not true

Neosoly – place of birth (Rule of Soil)
Sanguine – blood from parents (Rule of blood)
Naturalize – change of citizenship such American to Filipino
ORGANIZATION OF THE BOARD OF MIDWIFERY
RA6809 – age of majority is 18 yrs
 All licenses can be acquired at age of majority; such in movie watching rated
A, Parental Guidance (PG), General Patronage, R18.

RA 7392/2644 – Philippine Midwifery Law

Section 2: Composition of BOM

 1 Chair/chairperson
 4 members of the board

Note: 3 members shall be registered midwifes

1 Nurse-midwife
Appointment:
By the president of the Philippines from among the recommendees of the
Commissioner of the Professional Regulation Commission

Duties and Function

 Enforce provision of this act
 Administer oaths accordance to the provision of this act
 Issue, suspend or revoke certificate of registration
 Investigate violations of the act subpoena and subpoena duces tecum
 Conduct yearly Board examination
 Look into conditions affecting midwifery practice in the country, maintain
standards and ethics practice
Adopt an officials seat to authenticate it officials documents
Section 3: General Qualifications of BOM
 Natural Born Filipino Citizen & resident of the Philippines (Born in Philippines,
without taken action)
 Good Moral Character
 Thirty (30) years of age
 Not a member of the faculty whether full time or part time in a midwifery school &
to pecuniary benefit in such during his term (monetary interest) – (type of
disqualification)

Citizenship – right to political community

Nationality – not change at all
*Citizenship may change if person stayed for 10 years or marry a Filipina/Filipino
citizen to reduce stayed
years
*End of term, can teach again
*Resign from any employment, as qualified & appointed as BOM
Qualifications of
Chairperson
 Registered Obstetrician
 10 years of practice
before appointment
 Natural born Filipino
citizen
 Good Moral Character
 30 years of age
Qualifications of 3 Members of BOM
 Registered Midwife
 Degree holders preferably in the field
of health and social sciences (e.g.
psychology, medtech, pharmacist)
 10 years of midwifery practice, 5 years
of which is supervisory position
 30 years old
 Natural born Filipino citizen
Qualification of 1 Member of BOM
 Registered Nurse-Midwife
 10 years of experience & nurse-
midwife
 Natural Born Filipino Citizen
 Good Moral Character
 Steps in Appointment of BOM

IMAP
(Nominating Body)

PRC
(Recommending Body)

PRES.
(Appointing Body)

 Integrated midwives of the Philippine integrated association of Obstetrician

 PRC
 President of the Philippines
Section 5: Powers of BOM
1.Conduct the Midwifery Examination (Discretionary Power,
Examining Power) duty: preserve the integrity & honesty in
Board Exam
2.Issue, suspend/revoke certificates of Registration
(Discretionary Power)
PRC – release license, (as custodian of Record)
– Venue of Board Exam.
LICENSURE
Examination Requirements
Pass a written examination given by the
Board of midwifery.

Section 18: License Contains / Certificate of

Registration
1.full name of registrant
2.Serial number
3.official seal of commission
4.signature of Chairperson of Commission
5.Members of the Board
Section 7 R.A. 8981: Grounds for the Suspension / Removal of
BOM
 Neglect of Duty
 Gross incompetence/serious ignorance
 Unprofessional/Immoral or Dishonourable conduct

*Commision of Irregularities (revoked)

Tolerating Irregularities (releasing while arising of questions such
RETAKE!
Inhibit – not participate on that particular exam

3. To administer Oath (Ministerial Power)

Oath – first action after passing board exam
Section 16. All successful candidates are required to take the oath, to
BOM or Government authorized to administer.
The oath such as ambassador, consul, mayor, vice mayor. License
never is issued without the oath.

*Newborn place of birth when in airplane is where it was registered

*Midwife can attend the delivery while in place in DOCTRINE of
GOOD SAMARITAN
Article 3 Section 1. DUE PROCESS – Law that hears first before
it condemns (trial, hearing)

1.Monitor & enforce quality midwifery practice (Examining

Power, Dispensing Power)
2.Monitor & enforce quality midwifery education

CHED – closed midwifery school

BOM – agreed/ recommended, Memorandum of Agreement
(MOA)
1.Quasi-legislative powers – independent body, promulgating
rules & regulation within its jurisdiction
2.Quasi-Judiciary Powers – independent body, from regular
judges, for hearing revoked license
3.Executive Powers – under the office of the President poetically
appointed, supervision of the Board & Custodian of its
RECORDS
Section 8: Supervision of the Board and Custodian of its
Record

Office of the President


PRC (Custodian of all Records)

BOM
Section 4: Terms of Office of BOM-3 years chairman and members may
be reappointed for another term

APPOINTMENT OF BORD OF MIDWIFERY (BOM)

Regular Appointment – when the BOM is appointed to serve for a

period 3 years
Ad Interim Appointment – when a board member is appointed to fill
vacancy or to continue the unexpired period
of term of regular appointee
Hold Over – hold an office after his term of office has expired until his
successor is appointed

Note: Oath is Mandatory!

License – permission to practice the profession for life not unless revoked
or suspended
 Jurisdictional – applicable in the place where issued
Misdemeanor – practice without license or practice with expired licence
Misrepresentation – using of other license
Malpractice – go beyond scope

Ratings in the Board Exam

75% as general rating with no grade lower than 50%(old) 60%(new)
in one subject 120 days, the BOM shall report the rating of each candidate
to the PRC Commissioner.
Section 17: Report of the Results of the Examination
The Board shall, within 120 days after the examination, report the ratings
obtained by each candidate t the commissioner of PRC.

Q: When a midwife practice in another country making use of one’s license in

the Phil.?
A: Section 22: Reciprocity – Latin term, re-back, pro-forward

Du Ut Des - I give that you may also give

Reciprocal Duty – Give and take

Relationship between 2 persons/states International Agreement – TREATY

mostly in Middle East
 It can only be entered into the Pres. conquer 2/3 in senate not in congress
 An international agreement whereby one country would grant to true
citizens of the other country the privilege of being admitted to practice
ones profession
SPECIAL PERMITS
 Internationally recognized expert in the field of
midwifery
 Medical mission
 Exchange of professor program

Section 7: Ground for the Revocation/Suspension of

License
 Immoral & dishonourable conduct
 Conviction of a crime involving moral turpitude
MIDWIVES AND CRIMES
Criminal law – is that branch of law which defines crime and treats of
their nature.

 Ignorance of the law excuses no one from compliance therewith

 Laws take effect after 15 days from the publication in the official
gazette or any newspaper of national circulation. It serves as a
constructive notice to all persons so that no one is exempted from
complying with the law or to claim that he or she is ignorant from the
passage of that law.
 The power to define and punish an act is within the powers of the
Legislative Department (House of Congress) where the legislative
power is vested in the fundamental law and has the power to define
and punish an act or omissions as a crime. The Chief Executive has
also the prerogative.
 Theories of Criminal Law
1. Classical Theory
a. man is essentially a moral creature with an absolutely free will to choose between good and evil and
therefore more stress is placed upon the result of the felonious act
b. Basic criminal liability is human free will and the purpose of penalty is retribution.
c. Crime is a juridical entity and penalty is an evil and a means of juridical tutelage

2. Positivist Theory – Man is subdued occasionally by strange and morbid phenomenon which conditions him to do
wrong in spite of or contrary to his volition. The basis of criminal responsibility of the criminal is his dreadfulness or
dangerous state.

 The major source of our criminal law is Act # 3815 otherwise known as the Revised Penal Code of the Philippines

that took effect on January 1, 1932.

 Crime consists of internal and external acts. Internal acts are not punished in our jurisdiction.

 Voluntariness is an element of felony because if an act is committed or performed with deliberate intent then it

implies that the act is voluntary or freely committed.

 Felony is an act or omission punishable by the law

Moral Turpitude – an act of baseness, vileness or
depravity in social or private duties which man owes
to his fellow or to society in general, an act contrary
to the accepted customary rule of rights & duty b/w
men
– Any act that is CONTRARY to LAW, MORALS,
HONESTY, & JUSTICE
1. Adultery – disloyalty of wife to her husband having other man
Paramour – Man of A Married Woman (Kabit) Mistress – Girl of a married Man
(Kabit)
Cuncubinage – disloyalty of husband to his wife having other woman/ mistress

Crimes -act committed or omitted in violation of the law.

Felony -public offense for which a convicted person is liable to sentenced to death or to
be imprisoned in a penitentiary or prison
-committed with deceit and fault
-act is performed with deliberate intent,
-wrongful acts result from imprudence, negligence, lack of skill or foresight

Misdemeanor - criminal offense which does not in law amount to felony. Punishments
is usually a fine or imprisonment for a term of less than one year
The following are crimes that a midwife must be familiar with:
ASSAULT – An unlawful attempt or offer to beat or to do bodily injury to another.

BATTERY – The unlawful beating or touching of another person. The unlawful

beating or use of force upon a person without his consent.

MURDER – is the unlawful killing of a human being by another with intent to kill
(DOLO is an element).
hyle – soul
morfe – body

HOMICIDE – killing of a human being by another. It is committed without criminal

intent by any person who kills another, other than his father, mother, child or any
of his ascendants/descendants/his spouse. (Culpa-fault).
 death because of lack of knowledge, skill, competence and foresight.
ABORTION – Termination or expulsion of the product of conception
even before the age of viability. Abortion is a crime penalized in our
jurisdiction. A nurse who advises a woman on what drugs to take is
criminally liable.
Art. II Sec. 15 the Constitution of the Philippines
-Protects life of the unborn from conception
 Intentional Abortion (Art. 256) – willful killing of the fetus in the
uterus, or the violent expulsion of the fetus from womb resulting to its
death.
 Unintentional Abortion (Art. 257) – abortion by violence but
unintentional
 Abortion Practiced by the woman herself (Art. 256)
 Abortion Practiced by a physician or midwife and dispensing of
abortive (Art. 256)
INFANTICIDE - killing of a child less than three days of age.

PARRICIDE – is committed by one who kills his/her father, mother or

child whether legitimate or illegitimate, or any of his/her ascendants or
his/her espouse.

*means of blood relationship

Constitute parricide:
Spouse, legally adapted children, stepbrother
Murder homicide

Example:
Parricide – when mother throw the infant after birth in the taxi
ILLEGAL DETENTION – any private individual who shall detain another
or, in any other manner, deprive him of his liberty.

ARBITRARY DETENTION – any person in authority (public officer) who

shall detain another or, in any other manner, deprive him of his liberty.

SIMULATION OF BIRTH – any person who shall substitute one child for
another or who shall conceal or abandon any legitimate child with intent
to cause such child to lose its civil status.

ROBBERY/THEFT – crime against a person/property the taking of

personal property of a person from him (preserving the privacy of patient)

Robbery – committed with FORCE upon person or thing

SEXUAL HARASSMENT – is committed by a person who,
having authority, influence or moral ascendancy over
another in a work, training or education environment,
demands, requests or otherwise requires any sexual favor
from the other regardless of whether such demand, request
or requirement for submission is accepted.

Rape – mere touching of the labia by the male organ

CLASSES OF FELONY:
1. Consummated- all elements executed, with
successful result
2. Frustrated- all elements executed but no
successful result
3. Attempted- not all elements executed
ARSON/Conflagration (in cases of fire)
- the medical practitioner should

R-emove the patient

A-lert the fire alarm
C-onfine the fire
E-xtinguish the fire

- attempted arson
- consummated arson
- no frustrated arson
NEGLIGENCE - is often referred to as that “doing of a thing which a reasonably

prudent man would not have done and not doing a thing which a reasonably

prudent man would have done”. It also 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 do or would not do, and acting or the non-acting of

which is the proximate cause of injury to another person or his property

CRIMINAL NEGLIGENCE – is negligence of such character or
occurring under such circumstances, as to be punishable as a crime
by statute.

PROFESSIONAL NEGLIGENCE – breach of professional duty.

Negligence committed in the practice of a profession.
Negligence- Unintentional failure of an individual person to
perform an act or omission to do something that a reasonable
prudent person would do or not do

-Failure to observe the protection of one’s interest, the degree

of care, and vigilance of circumstances.
-Most common unintentional tort
ELEMENTS OF NEGLIGENCE LAWSUIT (B-R-O-D)
–OR-- ELEMENTS OF PROFESSIONAL
NEGLIGENCE
B- breach of duty was the cause of the 1. Existence of Duty
R- Real or actual proof injuries
2. Foreseeable Crisis
plaintiff’s injury 3. Breach of Standard of Care
O- owed specific nursing duty 4. Present of Injury
D- defendant breach the duty 5. Procimate Cause
TORTS – legal wrong, committed against a person or property,
independent of a contract which hinders the person who commit it liable
for damages in a civil action

a. Assault – imminent threat of harmful or offensive bodily contact

b. Battery – unconsented touching another person
c. False Imprisonment or Illegally detention – unjustifiable detention of
a person without a legal warrant (Doctrine is liberty of abode)
Liberty of Abode/ travel
“Liberty of abode/ travel shall not be impaired except upon
the lawful order of the court and when public safety, public
health requires it.”
> right where you wanted to go/ leave
d. Invasion of right to privacy and breach of confidentiality – the
right to privacy is the right to be left alone, the right to be freed from
unwarranted publicity and exposure to the public view is well as the
right to live one’s life without having anyone’s name, picture/ private
affairs made public against one’s will

e. Defamation – character assassination, be it written or spoken

• Slander – oral defamation of a person by speaking unprivileged or

false words by which his reputation is damaged
• Libel – defamation by written words
 f. Malpractice-illegal, corrupt, or careless professional behaviour.
-any professional misconduct which involves any conduct that exceeds the limits
of one’s professional standards means going beyond the context or scope of
allowed nursing practice resulting to injurious or non-injurious consequences.
- stepping beyond one’s authority

Example:
a. prescribing drugs
b. giving anesthesia
c. doing surgery
ELEMENTS OF MALPRACTICE (P-R-E)
P- professional SPECIFIC standards of care is required
R- required obedience
E- exceeds the limits of the standards of care
CLASSIFICATION OF CRIMINAL
LIABILITIES
Principal – -take direct part in the execution of the act, who directly
force or induce others to commit it, who cooperate in the
commission of the offense by another act without which it would
not have been accomplished.
1. direct participation
2. inducement (order, command, influence, convince,
persuade)
Accomplice (BEFORE THE FACT )– -who, not being principals,
cooperate in the execution of the offense by previous or simultaneous
act, must be shown that he had knowledge of the criminal intention of
the principal, demonstrated by previous or simultaneous acts that
contribute to the commission of the offense as ais thereto, whether
physical or moral.

1. Essential ,necessary, destroy materials material

Accessory –( AFTER THE FACT) - Having knowledge of
the commission of the crime, either as principals or
accomplices, take part subsequent to its commission by
profiting themselves or assisting the offender to profit
from the effects of the crime by concealing or destroying
the body of the crime, or the effects or instruments
thereof, in order to prevent its discovery or by harboring,
concealing or assisting in the escape of the principal of
the crime, provided the accessories act with abuse of
their public functions or are known to be habitually
guilty of some other crimes.
Q: Patient get out to get sunlight old woman introduce herself as a relative midwife let the woman go
inside the
room old woman get everything (theft)
A: Midwife: accomplice

Q: Midwife, Hospital – liable on what doctrine?

A: RESPONDEAT SUPERIOR (applied to employers)
(Let the master answer for the offense of their employees)

Q: The patient approaches the nurse and said that she is pregnant. The nurse said that she has a calling
card on the
table with a no. of midwife who can perform abortion. (may or may not get it). Abortion took place.
A: Midwife: principal by direct participation
Nurse: accomplice
Patient: principal by inducement
Mother: accessory
Doctor: accomplice
Circumstances that affect Criminal Liabilities
Exempting Circumstances
 No crime at all, exempted from criminal liability

1. Imbecile or insane person, unless he acted with lucid interval

2. The person is under 9 years of age
3. Over 9 years but under 15 years unless he/she acted with discernment (know the
own consequences)
4. When it is mere accident (force majoure)
5. When the person acted under the impulse of an uncontrolled fear
6. When the person acted under the compulsion of an irrestible force e.g. in school –
loco parenti (parental authority and custody transfer in teacher)

sunera – exerting circumstances, with freewill, unvoluntaryness to act, insanity

Mitigating Circumstances
 Lowering down by 7 years (Prison Mayor)

1. When the offender is under 18 years/ over 70 years of age

2. When there is voluntary surrender
3. When there is passion/ obfuscation
4. When there is sufficient provocation (alcohol)
5. When the person is deaf, mute, dumb, and blind
6. When there is no intention to commit so grave a wrong as the one
committed any kind of mental illness that will diminished will power
(bipolar)
Aggravating Circumstances
 Committed with plan, 1° higher

1. When one takes advantage of public position

2. When there is an abused of confidence
3. When the crime is committed inside the Church
4. When the crime is committed on the occasion of fire, shipwreck,
epidemic/ other calamity
5. When it is committed because of a price reward
6. When it is committed in times of natural calamities
7. When it is committed with evident premeditation
8. When it is committed with craft, fraud and disguise
* One’s you commit in confidence to your patient
Justifying Circumstances
 Without 1, not justified
ELEMENTS
1. When there is an unlawful aggression
2. When the person is under imminent danger
3. When there means employed in order to prevent or to repel the
aggression must be reasonable
4. Obedience to an order issued by superior for some lawful purpose
*no man apply self – defence
GUIDELINES TO PREVENT CRIMINAL LIABILITY:
1. Be very familiar with the Philippine Nursing law
2. Be familiar with the laws affecting nursing practice
3. Know agency rules, regulations, policies
4. Upgrade skills and competence
5. Develop good IPR with co-workers
6. Consult superior as needed
7. Verify vague/ erroneous orders
8. Always keep doctor updated regarding patient
9. Ensure accurate recording and reporting
10. Get informed consent
11. Do not delegate responsibilities to others
LEGAL CONSIDERATIONS IN CHARTING:
1. Don’t tamper with medical records- adding, rewriting and
destroying original record
2. Observe agency’s standards on documentation
• complete, concise, specific, use standard abbreviations
• telephone orders
TIPS FOR AVOIDING LEGAL PITFALLS
 1. Patient Falls
• do proper assessment
• appropriate assistance is given
• use protective measures
• document all nursing interventions
 2. Medication errors
• observe 7 R’s of drug administration
• Check dr’s order
• Understand the medication you will administer
• Consult drug handbook/ pharmacy
• Not exempt from liability for following doctors’ order
 3. Equipment injuries
• refuse to use a device not know how to operate
• report adverse events to superiors
• monitor patient regularly
• bring questionable orders to the attention of the doctor or
superior
• familiarize self with existing protocol
LEGAL RESPONSIBILITIES OF MIDWIFE
1. Contract – an agreement between two people which creates an obligation
recognized by the law

Elements of Valid Contract

 Consent must be freely given (voidable)
 Competent parties (void)
 Legal objects (void)
 Valid considerations (voidable)

Valid – no question
Voidable – valid until question: force, threat, intimidation
Void – with questions arise, < 18 as incompetent
Two kinds of Contract
1. According to Format
 Formal Contract – written down and it follows at all times the
legal document/ long bond paper, notarized
 Informal Contract – orally done/ written down but does not
follow the legal documents
2. According to Statement
 Expressed Contract – terminal conditions are written down
and the beginning and ending of the contract are also
expressed e.g. job description
 Implied Contract – it is actually based in the reaction and
behavior of contracts parties
2. WILL – an act whereby a person disposes of his property to take
effect after his death
Testator/ testatrix – a person who makes the will
Probate – to prove the validity of the will in court
Testament – an act whereby a person disposes of his personal
property to take effect after his death
Escheat – when his property is transferred in the name of Republic
of the Philippines
Two kinds of Will

1. Holographic Will – when the testator entirely writes

down the will. Date and signed of the testator should be
indicated in the will.

2. Notarial/ Nurcupative/ Authenticated Will – when

the testatorally makes the will and will ask someone to
write it down or him.
TWO KINDS OF SUCCESSION
1. Testate – when there is a will executed by the testator
2. Intestate – when there is no will executed by the testator
* The Midwife serves as a witness in making a will of your
patient.
* Ethical obligation – right to refuse in making patients will
* Durable Power Attorney – appointing someone if your not
capable to decide
* Disinherited by parents, relatives – only when attempt to
kill/ against their own life
Personal Property – movable property e.g. jewelries, given as
testament

Real Property – immovable property e.g. land, house, bldgs., given as

will
Will to the court (probate)
 Void from the start.
 Intestate
*Illegitimate siblings has < share of properties than legitimate siblings
*Adapted siblings has = properties to legitimate siblings
*spouse has ¼ of the properties
* ¼ free portion – for the taxes to be paid after getting the properties
*Prenuptial Agreement – agreement before marriage, which husband
property different from wife property vice versa/ have separate property
even they’re married
*Conjugal Agreement – husband’s properties is also wife’s properties/
vice versa
a. Criminal Action
 Complainant – person who file a case with a court against another, a
concise statement of the ultimate facts constituting cause of action.
 Respondent – the person against whom the case

b. Civil Action
 Plaintiff – person who file a case with PRC
 Defendant – the person against whom the case
Sub Poena ad testicandum/ Sub Poena – court summons is served directing a
witness to appear and give testimony on the date and time ordered

Sub poena duces tecum – served to a witness requiring him to bring records,
papers or charts

Testimony of facts – testifying only on what he knows based on facts

Tesstimony of opinion – may only be given by expert witness

Expert witness – one who is qualified to testify based on special knowledge, skill
and training

Perjury – false swearing under oath

Privileges against self – incrimination – right not to answer any
questions that will incriminate him/her
>mind/ imagination purely e.g. ejaculation to excrete sperm/semen
 not self – incrimination – mechanical e.g. pregnancy test, drug test,
urine test, DNA test, pubic hair, purgative/ laxative, blood sample

Hearsay evidence – repetition of what the witness heard others say

Ante mortem statement – dying declaration considered hearsay except

when made by a victim of a crime
You go to a Court:
 When rights are violated
 To correct a wrong and have it corrected
Remedies going to court:
 Quasi – Administration Body
Municipal
Regional
Board of Appeal
Supreme Court
A Desert Journey
 1. You are riding a camel in a desert. You really feel
tired and exhausted. What will you say to the camel
who has been with you all throughout your journey
in the desert?
2. You are really thirsty. Luckily, you saw an oasis. But
you are surprised to see that someone has arrived
before you. WHo is he/she? (A person you know).
3. Finally, your destination is already in sight.
How do you feel now?
 4. You have to leave the camel now since you
already reached your destination. Another person
will now ride to the camel. Who is he/she?
 Answers:

• The desert and camel theme symbolizes the journey

toward personal independence. Specifically, this
scenario reveals your feelings about parting with a
lover. Your answers show how you might react when
the time comes to go your separate ways.
• Meaning of your anwer to item #1: The words
you spoke to the camel reveal what you
might say to yourself when you realize love
has been lost.
• Meaning of your answer to item #2: The person
you encountered here could be someone who has
helped or comforted you in the past or one you
might turn to in times of need.
 • Meaning of your anwer to item #3: Your
feelings upon reaching the town are your true
feelings about finally getting over a lost love.
• Meaning of your answer to item #4: The new rider
is a person toward whom you feel a secret rivalry,
jealousy, or resentment