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PROFESSION

An occupation or calling requiring advance training Experience in some specific or specialized body of knowledge Provides service to society in that special field The term profession is honoric and should be carried with pride and honor

NURSING

An occupation requiring a unique body of knowledge and skills and which serves society

PROFESSIONAL NURSE

Completed a basic nursing education program Licensed in his/her country or state to practice professional nursing

NURSING PRACTICE

Primary responsibility promotion of health and prevention of illness Collaborate with other health care providers

o Curativeo Preventiveo Rehabilitative aspects of careo Restoration of healtho Alleviation of sufferingo Towards a peaceful death

Provide nursing care through the utilization of the nursing processo Therapeutic use of selfo Executing health care techniques and procedureso Essential primary health care o Comfort measureso Health teachings

o Administration of written prescription for treatmento Therapieso Oralo Topicalo Parenteral medicationso Internal examination during labour in the absence of antenatal bleeding and deliveryo Suturing of perineal laceration

Establish linkages with community resources Coordination with the health team Provide health education to individuals, families and communities Teach, guide and supervise students in nursing education programs The nurse is required to maintain competence by continual learning through continuing professional education

QUALIFICATIONS AND ABILITIES OF A PROFESSIONAL NURSE

Professional Preparationo Have a license to practiceo Bachelor of science degree in nursingo Be physically and mentally fit

Personal Qualities and Professional Proficiencieso Interest and willingness to work and learno Warm personality and concern for peopleo Resourcefulness and creativity, well balanced emotional conditiono Capacity and ability to work cooperatively with otherso Skill in decision making

DEFINITION OF LICENSE

A legal document given by the government that permits a person to offer to the public his or her skills and knowledge in a particular jurisdiction

CONTRACT

Meeting of minds between two persons whereby one binds himself, with respect to other, to give something or to render some service A promise or a set of promise which the law recognizes as a duty and when that duty is not performed the law provides a remedy

NURSING ETHICS

Ethics came from the Greek word ETHOS moral duty Standard to examine and understand moral life Guides of human conduct provided by ethical systems How people make judgement in regard to right or wrong Critical reflection about morality and rational analysis about it JOHNSTON- examination of all ethical and bio-ethical issues from the prospective of nursing theory and nursing ethics VERCOE - the fields of nursing ethics be focused on the needs and experiences of practicing nurses, the exploration of its meaning and that

of ethical practice in terms of the perception of these nurses

Morals

Specific ways of behaviour or of accomplishing ethical principles Greek work MORALIS Social consensus about moral conduct for human beings and society Morality is what you believe is right and good

Health Care ethics

Division of ethics that relates to human health Realm of human values, morals, customs, personal beliefs and faith

Bioethics

Specific domain of ethics that focuses on moral issues in the field of health care Result of life and death dilemmas faced by health care practitioners Systematic study of human behaviour in the field of life science and health care in the light of moral values and principles

TELEOLOGICAL APPROACH

Greek word TELOS or goal or end The right thing to do is the good thing to do Act utilitarianism- good resides in the promotion of happiness or the greatest net increase of pleasure over pain If the act helps people, then it is a good act If the act hurts people then it is a bad act

FLETCHER’S GUIDELINES FOR MAKING ETHICAL DECISIONS

1. Consideration for people as human beings2. Consideration of consequences3. Proportionate good to come from the choices4. Propriety of actual needs over ideal or potential needs5. A desire to enlarge choices and reduce chance6. A courageous acceptance of the consequence of the decision

DEONTOLOGICAL APPROACH OR DUTY ORIENTED THEORY

Basic rightness or wrongness of an act depends on the intrinsic nature rather than upon the situation or its consequences Greek word DEON meaning DUTY Immanuel Kant- rational human being with freedom and social worth A person is morally good and admirable if his actions are done from a sense of duty and reason

W.D ROSS- PRIMA FACIE DUTIES- WHAT ONE SHOULD DO WHEN OTHER RELEVANT FACTORS IN A SITUATION ARE NOT CONSIDERED

Duties of fidelity- telling the truth, keeping promises Duties of reparation- righting the wrong we have done to others Duties of gratitude- recognizing the service others have done for us Duties of justice- preventing distribution of pleasure or happiness that is not in keeping with the merit of people involved Duties of beneficence-helping to better the condition of other beings Duties of self improvement- bearing ourselves with respect to virtue or intelligence Duties of nonmaleficence- avoiding or preventing injury to others

VIRTUE ETHICS APPROACH

ARETIC, Greek word ARETE, heart of the person performing the act Traits and virtues of a good person, courage, temperance, wisdom, and justice

DIVINE COMMAND ETHICS

Supreme or divine that sets down rules to provide guidance to moral decisions

UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS

To determine right or wrong in regard to value issues Autonomy-

o Greek word AUTOS meaning self and nomos meaning governanceo Self determinationo Freedom to choose and implement one’s decisiono Informed consento Allowing the patient to refuse treatment if he decides soo The person making the decision must be deemed competent, intellectual capacity, legal age

Veracityo Health care providers are bound to tell the truth

Beneficenceo Promotes the doing acts of kindness and mercy that directly benefit the patient

PATIENT’s BILL OF RIGHTSo Considerate and respectful careo Relevant, current and understandable informationo Make decisions regarding his care plano Have advance directive (living will)o Every consideration of his privacyo Confidentiality of communications and recordso Review his records concerning his medical careo Be informed of business relationship among the hospital educational institutiono Consent or decline to participate experimental research affecting his careo Reasonable continuity of care when appropriate and be informed of other care optionso Be informed of hospital polices and practices

NONMALEFICENCE- o To do no harmo Not assisting in or performing abortiono Not to assist people to commit suicideo Be involved in mercy killing

JUSTICEo The right to demand to be treated justly, fairly and equally

NURSES’ BILL OF RIGHTSo Registered nurses promote and restore healtho Prevent illnesso Protect the people entrusted to their careo Alleviate suffering o Provide services that maintain respect for human dignity

LVING WILLS OR ADVANCE DIRECTIVEo Accept or refuse any treatment, service or procedure used to diagnose or treat physical or mental conditiono Decision to provide or withhold life-sustaining measureso This living will is signed by the patiento Witnessed by two other persons who is not designated as the person’s health care representativeo Directive has force of law

MORAL PRINCIPLESo The golden rule

Do unto others what you would like others do unto youo The two fold effect

May have bad and good effect Must be morally good Good effect must be willed and the bad effect merely allowed Good effect must not come from an evil action Good effect must be greater than the bad effect

o The Principle of Totality The whole is greater than any of its parts

o Epikia

Exception to the general ruleo One who acts through an agent is himself responsible

Ex. Nurse recommends patient to another clinic for abortion but does not want to performo No one is obliged to betray himself/herself

No one can force any person to answer a question if such will incriminate him/hero The end does not justify the means

Giving sleeping tablets to someone who has chronic illnesso Defects of nature may be corrected

Corrected by plastic surgeryo If one is willing to cooperate in the act, no injustice is done to him/her

With patient’s consento A little more or less does not change the substance of an act

Stealingo The greatest good for the greatest number

Have more good effects for more people than a smaller groupo No one is held to the impossible

Do not promise impossible thingso The morality of cooperation

Formal cooperation is an evil act and never allowedo Principle relating to the origin and destruction of life

Thou shall not kill

GOOD SAMARITAN LAW

A nurse who renders first aid or treatment at the scene of an emergency and who does so within the standard of care, acting in good faith, is relieved of the consequences

CODE OF GOOD GOVERNANCE

Service to otherso Commitment to a life of sacrifice and genuine selflessness in carrying out their professional duties

Integrity and Objectivityo Perform their responsibilities with the highest sense of integrity

Professional Competenceo Knowledge, technical skills, attitudes and experience

Solidarity and teamworko Maintain and support one professional organization

Social and Civic Responsibilityo Shall always carry out their professional duties with due consideration of the broader interest of the public

Global Competitivenesso Shall remain open to challenges of a more dynamic and interconnected world

Equality of All professionso Shall treat their colleagues with respect and strive to be fair in their dealings with one another

AMENDED CODE OF ETHICS FOR NURSES

Section 3 Republic Act No. 877 known as the Philippine Nursing Law and Section 6 of P.D No. 223 the amended Code of Ethics of Nurses Article I

o Preamble- health is a fundamental right of every individual Article II

o Values, customs and spiritual beliefs held by individual shall be representedo Consider the individuality and totality of patients when they administer care

Article IIIo Human life is inviolableo Quality and excellence in the care of patients are the goals of the nursing practiceo Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability

Article IVo The registered nurse is in solidarity with other members of the healthcare team in working for the patient’s best interest

Article Vo Preservation of life, respect for human rights and promotion of healthy environmento Promotion in local, national, and international efforts to meet health and social needs of the people

Article VIo Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal

Article VII

o The certification of registration of the registered nurse shall either be revoked or suspended for violation of any provisions of this code.

DEFINITION AND MEANING OF LAW

The sum total of rules and regulations by which society is governed Man mad regulates social conduct in a formal and binding way Rule of conduct pronounced by controlling authority and which may be enforced

o Authority or right to declare that the rule existso Rule is pronounced or expressedo Source can be definedo A right to enforce the same must be provided

Controlling authority in our system is the government Fundaments law of the government is the constitution Principal sources of pronouncements

o Constitutiono Statutes or legislationso Executive brancho Case decision/judicial opinionso Presidential decreeso Letters of instructions

RESONSIBILITY AND ACCOUNTABILITY FOR THE PRACTICE OF PROFESSIONAL NURSING

Professional Negligenceo Commission or omission of an act, pursuant to a duty

Existence of a duty on the part of the person charged to use due care under circumstances Failure to meet the standard of due care The foresee ability of harm resulting from failure to meet the standard The fact that the breach of this standard resulted in an injury to the plaintiff

Article 19 of the civil codeo One shall act with justice, give every man his due, observe honest and good faith

Article 20

o Those who in the performance of their obligations through negligence causes any injury to another, are liable for damages Common acts of negligence

o Burns resulting from hot water bags, heat lamps, vaporizers, sitz batho Objects left inside the patient’s body; sponges suction tips, loose dentures lodged in the patient’s tracheao Falls of the elderly; confused, unconscious, sedated patients o Falls of children whose bed rails were not pulled up and lockedo Failure to observe and take appropriate actiono Failure to report observations to attending physicianso Failure to exercise the degree of diligence which the circumstances of the particular case demandso Mistaken identity- drug given to the wrong patiento Wrong medicine, wrong concentration, wrong route, wrong doseo Defects in the equipment o Errors due to family assistanceo Administration of medicine without a doctors prescritption

THE DOCTRINE OF RES IPSA LOQUITUR

Injury was of such nature that it would not normally occur unless there was negligent act Injury was caused by an agency within control of the defendant Plaintiff himself did not engage in any manner that would tend to bring about the injury

MALPRACTICE

The idea of improper or unskilful care of a patient by a nurse Stepping beyond one’s authority with serious consequences Carelessness of professional personnel LESNIK- negligent act committed in the course of professional performance

DOCTRINE OF FORCE MAJEURE

Irresistible force; unforeseen or inevitable No person shall be responsible for those events which cannot be foreseen Floods fire, earthquakes

DOCTRINE OF RESPONDEAT SUPERIOR

Let the master answer for the acts of the subordinate The liability is expanded to include the master as well as the employee

INCOMPETENCE

Lack of ability, legal qualifications or fitness to discharge the required duty

CONSENT TO MEDICAL AND SURGICAL PROCEDURES

Consento Free and rational act that presupposes knowledge of teh thing to which consent is being given by a person who is legally capable to

give consento Signed by the patient or authorized representative/legal guardiano An authorization by a patient or a person authorized by law to give the consent on the patient’s behalfo Nurse secures the consent of the patient upon admission

Informed Consento Established principle law that every human being of adult years and sound mind has the right to determine what shall be done with

his own bodyo May choose whether to be treated or not

Proof of Consento A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature

of the procedure

TORTS

A legal wrong, committed against a person or property Assault and Battery

o Imminent threat of harmful or offensive bodily contacto Unjustifiable to tough another person or to threaten to do so

Batteryo An intentional, unconsented touching of another person

False Imprisonment of Illegal Detention

o Unjustifiable detention of a person without a legal warrant within boundaries Invasion of Right to Privacy and breach of confidentiality

o Right to privacy is the right to be left aloneo Right to be free from unwarranted publicity o Exposure to public viewo Divulge information from patient’s chart to improper sources or unauthorized person

Defamationo Character assassinationo Slander-oral defamationo Libel-written wordso There must be a third person who hears or read the comment before it can be considered defamation

CRIMES, MISDEMEANORS, AND FELONIES

CRIME An act committed or omitted in violation of the law Two elements

o Criminal acto Evil/criminal intent

Conspiracy to commit a crimeo Two or more persons agree to commit a felony

Principals- who take a direct plan/part Accomplices- cooperate in the execution Accessories- having knowledge of the commission of the crime

Criminal Actionso Acts or offenses against public welfare

Criminal negligenceo Reckless imprudence- person does an act or fails to do it voluntarily but without maliceo Simple imprudence- did not use precaution and the damage was not immediate or the impending danger was not evident or

manifest Criminal Intent

o States of mind of a person at the time the criminal act is committed that he/she knows that an act is not lawful and still decide to do it anyway

WILLS

A legal declaration of a person’s intentions upon death Testamentary document takes effect after the death of its maker Decedent- person whose property is transmitted through the succession whether or not he left a will If he left a will he is called a testator Woman is testatrix Heir- called to succession either by the provision of a will or by operation of law A person who dies leaving a will is said t have died testate One who dies without will is said to have died intestate Validation of the will in a court is known as probate A will which is written, dated and signed by the testator is called holographic will An oral will is called nuncupative will or nuncupation- made during the person’s last illness, that it be done in the place in which he died,

one or more witnesses to the will Testator must have the expressed intention of making a will Must be right of age Under 18 cannot make a will Required to have sound mind Think clearly ability at the time of its execution

NURSES OBLIGATIONS IN THE EXECUTION OF A WILL

The nurse should note the soundness of the patient’s mind There was freedom from fraud or undue influence Make a notation on the patient’s chart of the apparent mental and physical condition of the patient at the time of making the will