PROF AD

Tuesday, October 8, 2024 11:36 AM

- Holistic process of growth and development of an individual towards achieving a

professional status.
- FIRST stage (point of entry: EDUCATION)
- A process of MATURATION — able to discern right from wrong and make decision.

Who is a PROFESSIONAL?
Sims, Price & Ervin (2000) CRITERION TO BE PROFESSIONAL — ABALACA
○ AUTONOMY —the “most important” characteristic. Includes self- determination,
self- decision, making self regulation, able to perform independent functions.
○ BODY OF KNOWLEDGE — utilizes the scientific method thru experiment
and research.
 Begins with a problem
 Hypothesis
 Data gathering
 Experiment
 Results
 Conclusions
○ ACADEMIC LEVEL OF ACHEIVEMENT — with a college degree

○ LONG TERM COMMITMENT — loyalty and Fidelity to the Profession; Prmose keeping
○ ASSOCIATION — a group of people with common goal
○ CODE OF ETHICS — source of guidance for ethical dilemmas
○ ALTRUISM — selflessness via service; to diiscipline oneself which is a mark
of a professional.
- ALL REQUIREMENTS MUST BE MET TO BE A PROFEESSIONAL.

Is the Nurse a Professional?

- AUTONOMY: Independent nursing actions with RA 1973 (Article 6) which states the SCOPE
OF PRACTICE.
○ Collaborative role in the healthcare team and independent practitioner.
- SCIENTIFIC: Use of NURSING PROCESS (ADPIE) which was established by Lydia Hall.
- College degree is required.
○ CHED — regulates the nursing curriculum and bale to close or open nursing
programs.
- LOYALTY: with the NIGHTINGALE PLEDGE for Oath Taking. LICENSE as a proof to the
Profession.
- ASSOCIATION: Philippine Nurses Association (PNA) established in 1922 founded by
Anastacia Giron Tupas.
- CODE OF ETHICS: BON Resolution #220 series of 2004
- ALTRUISM: Nursing care offered to pt which should be patient-ccentered.

NEGATIVE IMAGES OF NURSING PORTRAYED IN THE MEDIA.

- Which gives doubt on the nurse as a Professional.
○ HANDMAIDEN IMAGE:
 Seen as the “helper” of the physician; unable to function unless there is a
doctor’s order. Affects Autonomy crietria.
○ ANGEL OF MERCY
 Looked upon as sources of Miracles; affects being scientific. Miracles and
Science are 2 worlds apart.
○ NAUGHTY NURE
 Sexualized, bordering pornographic image.
○ COLECTIVE BARGAINING
 “hangyo” negtotiation between employer and employee. When employee
conditions are not met (wages, workoad, working conditions), a STRIKE may
happen (fighting for ourselves) — can be misinterpreted as SELFISHNESS.

TO IMPROVE IMAGE OF NURSING (EPAL)

- Educate the public that we are professionals, especially when u have a platform.
- Participate in pubic activities that show nursing as a profession. OCTOBER is the official
month of Nursing in the Philippines declared by Pres. Gloria Macapagal Arroyo.
- Advocate for laws that support the welfare of the nursing Profession.
Congress — LEGISLATIVE dept that creates laws.
○
○ Congressmen & Senators — vote to register an act.
- Lobby for laws that support nursing practice for better conditions.

LEVEL OF NURSING PROFESSIONALS:

- Theoritial Basis:
○ PATRICIA BENNER’S LEVEL OF SKILLS ACQUISITION (Novice to Expert)
 Claims that experience is the best teacher; higher level of exp = higher level of
professionalism.

NOVICE No professional experience yet; a “rule-bound” practitioner; NO INITIATIVE AND

INFLEXIBLE; Full supervision needed since nurse is probe to mistakes.
• “Tell me what to do and I’ll it”
SHADOWING — Following an expert or competent nurse.
Ex: Fresh grad, newly oriented nurse, neophyte nurse
ADVANCED 1st year at work; with marginally accceptable performance; a “Mediocre or
BEGINNER average” practitioner; with little experience and with LESS SUPERVISION.

COMPETENT 2 - 3 years at work; may start assuming positions. Ex: from staff nurse to head
nurse or staff manager; independent practitioner practices WITHOUT
SUPEPRVISION.
• “I can do things on my own now”

PROFICIENT With 3 - 5 years of experience; Holistic practitioner that “Considers all aspects
of care” delievers comprehensive approach. ABLE TO DISCERN AND PRIORITIZE
• “Sees the big picture”

EXPERT More than 5 years at work: Fluid practitioner FLEXIBLE AND INTUITIVE: With an
air of arrogance
• “I did it because it felt right”
Ex:
CHIEF NURSE — requires 5 years of experience a a Unit manager and a Masters
degree.
(Mentor: teach to share knowledge)

• TRANSFERS TO NEW DEPARTMENT OR UNIT WILL RETURN TO NOVICE STAGE.

ROUTE TO RN IN THE PH:

- 3 basic requirements:
1. Physically and Mentally fit / competent
2. BSN Degree — with a duration of 4 years and 8 semesters. Puurpose is to instill
preparation for a profession by learning.

○ Core values of Education:

 Love of God
 Love of Country
 Love of People
 Caring — foundation of Nursing

○ Head of Nursing Educ: DEAN

 RN
 MAN — with thesis; oriented in administration. Note: MSN is more oriented in
Research NOT qualified for Dean’s position.
 With 5 years of teaching experience in academe
 A member of PNA
 Good moral character — absence of conflict or interest.

○ Implementers of BSN Pprogram: FACULTY

 General Education — minor subjects that are not directly related
to the Profession; mandatory by law
 Professional Educ — major subjects
□ Faculty Qualifications;
⬥ RN
⬥ Master’s Degree (MAN, MSN, MPH, MBA, PhD in Philo)
⬥ At least 1 year of clinical experience
⬥ A member of PNA
⬥ Good moral character

3. License — a “Privilege” bestowed upon an individual granted by the state as

represented by the government (PRC)
 Purpose: TO PROTECT THE PUBLIC FROM MALPRACTICE
 Can be revoked when there are violations to the law.
 LIFETIME VALIDITY: Does not expire.
□ License needs to be renewed and updated every 3 years.
○ Proccurement of License:
 Citizen or Dual-Citizen
□ Pass the NLE; 75% with no lower grades under 60%
 Foreigner
□ Priority check: should have reciprocity based on the principle of “do ut
des” or MUTUAL GRANTING.
□ Can apply for 2 License:
⬥ TEMPORARY — given by BON; NO NLE NEEDED but with peific
amount of time to practice. Shoud be and RN in her/his own nation
before appication.
◊ Ex: medical missions, vounteer work, exchange programs.
⬥ PERMANENT —acquire for Filipino citizenship FIRST and pass the
NLE.
◊ 3 ways:
🞂 “JUS SOLI” — by place of birth
🞂 “JUS SAGUINI” — by blood: parents are
natural Filipinos
🞂 Naturalization — give up foreign passport to DFA
and be a resident for 10 consecutive years
in the PH.

 RA 9173 — Philippine Nursing Act of 2002

 RA 7164 — Previous nursing act (1991)

LEGISLATIVE TRACK:
- Must have at least 2 versions of the Bill before signed into law.
○ UPPER HOUSE (Senate)
 Authored by Sen. Juan Flavier, also a previous DOH secretary. Campaigns: HIV
progrram and Iodized salt.
○ LOWER HOUSE (House of Representative)
 Districts and Party Lists
 Authored by Rep. Carlos Padilla
○ Signed into law/ratification by Pres. Gloria Macapagal Arroyo

 BON Res No. 425 series of 2003 — implementing rules and regulations of RA 9173

RA 7164 RA 9173

• BON: 5 members, No chair • BON: 6 members with 1 chairperson

• BSN: College applicant must be part of upper 40% of • BSN: No requirement if high school
graduating high school class. graduate.
• NLE: Limited to 3 takes only. • NLE: No limit to NLE attempts, No
- Refresher course (1 sem) is required for 4th refresher course needed.
attempt.

- RA 9173 is more lenient since 2002 was the boom era of nursing due to increased
demand for nurses all over the world.

SALIENT FEATURES OF RA 9173

- 9 number of units in masters required to be a nurse manager. Not necessary to finish your
masters degree. This reflected in the clinical ladder.

CLINICAL LADDER
STAFF NURSE 9 Units of Master’s degree + 2 years of experience to upgrade to
Unit manager
UNIT MANAGER (HEAD Upgrade depends upon facility
NURSE)
SUPERVISOR Not present in all situations
CHIEF NURSE (NURRSE VII) MAN and 5 years olf experience in Managerial Experience

- 1 number of Accredited professional Nursing program (PNA). Membership is not mandatory

but compulsory for practice.

- 7 — members of BON (1 chair)

BOARD OF NURSING
- Aka the “ALTER EGO OF THE PRESIDENT” when it comes to nursing issues in the country
- Members are nominated by the PNA and appointed by the President of the PH
○ 1 term = 3 years
○ Term can be extended for up to 2 terms only
 Max: 6 years

POWERS OF BON:
1. EXECUTIVE — creates board exam
2. QUASI - LEGISLATIVE — Creates resolutions.
1. Eg: requirements for board exam
3. QUASI - JUDICIAL — Issue subpoenas (a summon from the court), hold trails, hold litigation
process.
○ 2 types of Subpoenas
 DUCES TECUM — to bring documentary evidence iin court
 AD TESTIFICANDUM — Called to be a witness and testify in court.
□ Priority: state the truth

- 3 years olf PRC ID Validity

IDENTIFICATION CARD CERTIFICATE OF REGISTRATION

- Card which is carried everywhere - A paper document for Safekeeping. Request for 2
copies
- With PRC LOGO and Sign of PRC - With seal of PRC
chairperson - With sign of BON Officials
- Non-transferable - Indicates NLE grade. Needed for job application

VALIDITY: 3 years during the bday of VALIDITY: No expiration

applicant

VIOLATIONS WHICH LEAD TO REVOCATION OF LICENSE:

1. Gross negligence and malpractice
2. FRAUD — Falsification of ID, signature (foregery), identity and educational attainment
(misinterpretation). Possible criminal charges may apply for Fraudulence.
3. ACTS OF MORAL TURPITUDE — should be guilty of criminal (murder, arson)
4. Practicing while under suspension.

RETURN OF REVOKED LICENSE:

1. 4 years has passed
2. Reason for revocation has been resolved
3. Note: NOT ALL licenses can be returned, it will depend on the reason for revocation.
○ Murder — reclusion perpetua or lifetime imprisonment.

ETHICS
- About moral philosophy, the study or norms, standards, rules and principles to help
determine right and wrong.
- A source of “guidance” rather than a solution.

MORALS VS ETHICS
○ MORALS
 Depends upon individual “specific beliefs”, culture or religion
○ ETHICS
 Depends upon “societal/general beliefs”

METAPARADIGM OF ETHICS
- METAETHICS — study of the origin of words or terms. Provides vocabularies and establish
definitions.
- NORMATIVE ETHICS — Establishment of ethical principles; what is normal, standard,
fuundamental should be followed.
- APPLIED ETHICS — application of the ethical principles into real life situation.

EX:
1. METAETHICS — what is right; fact
2. NORM — Veracity; truth telling
3. APPLIED — patient had Western Blot and results were positive — principles of Veeracity is
applied when the nurse tells the real diagnosis.

BRANCHES OF ETHICS (According to Application)

4. BIOETHICS — Applications of principles concerning issues about life
5. HEALTHCARE ETHICS — Application of principles concerning human healthcare.
6. NURSING ETHICS — application into nursing care
7. DESCRIPTIVE ETHICS — A bottom up approach wherein society defines what is ethical via
applications.
 "Most people in this society believe that it is wrong to steal,"

2 METHODS OF APPLYING ETHICAL PRINCIPLES:

TELEOLOGICAL METHOD DEONTOLOGICAL METHOD

- “TELOS” — results - The action/means itself will make the nurse

- The ends will justify the means. ethical regardless the results.
- Action is ethical based on the RESULTS - DUTY BOUND
regardless the means to achieve it. - The means will justify the ends.
- Proponent: ARISTOTLLE - Proponent: IMMANUEL KANT
- Idealism: - Idealism:
• Consequentialism • Kantianism
• Utilitarianism • Principalism
- Ex. Sacrificing ones to save the majority ○ Respect for Autonomy,
Beneficience, Non Maleficience and
Justice
- Ex: telling the truth no matter what the
consequences

NURSE APPLIES BOTH METHOD SINCE PATIENT CARE IS DYNAMIC.

ETHICAL PRINCIPLES:

 AUTONOMY
- Self determination; Self regulation
- Ability to decide on one’s own without coercion.
- Foundations: respect for Human Rights which universal.
○ Article 3 — Bill of Rights found iin Ph Constitution
○ Autonomy is subjected to:
 AGE
□ Age of maturity >18 years old
□ Age of minority <18 yo: with the right to decide
⬥ Legal basis: RA 6809 (EMANCIPATION LAW)
⬥ Minors can decide when they are emancipated.
⬥ Minors who are orphaned, pregnant, marriage.
□ Mental capacity
⬥ Diminished capacity — cannot decide for their own.
○ ADVANCED DIRECTIVES
 Preserves autonomy: instructions made in advance aboout healthcare and are
implemented once patient is unable to decide on his own. This is
recommended for all people, not only those who are terminally ill or dying,
includes:
□ LIVING WILL
□ DURABLE POWER OF ATTORNEY
⬥ A patient can appoint someone to decide on their behalf
□ DNR
⬥ Reversible, DNR order which expires within 24 hours; but can be
requested to have it permanent. Doctor discusses DNR order with
the pt.

○ INFORMED CONSENT
 Obtaining permission from a client by means of explanation about a certain
procedure.
 Applicable in all fields of nursing. Nurses CAN obtain informed consent.
 2 parts:
□ FULL DISCLOSURE:
⬥ Purpose
⬥ Methods
⬥ Benefits
⬥ Risks and Complications
⬥ Right to Refuse
○ CONSENT PROPER
 Asking for permission
□ CONSENT — permission from Adult
□ ASSENT — permission from Pediatric client/minor.
⬥ In acquiring CONSENT for a PEDIA pt, Consent is more important.
□ Ex:
⬥ MCN = a Vasectomy or a BTL for a married person, the couple
should BOTH sign the consent. If not married, whoever goes thru
the procedure should sign the consent.
⬥ PSYCH = for a VOLUNTARY ADMISSION, the Patient signs.
For INVOLUNTARY ADMISSION, the guardian signs the consent.
DAMA is only applicable for Voluntary Admissions.
⬥ RESEARCH = a participant can withdraw from the study even if they
have signed the informed consent. Priority action when a
participant withdraws is to RESPECT the right to refuse.
◊ ATTRITION — decreased amount of data due to the
withdrawal of the participant from the study.
⬥ CHN = COURTESY CALL during the entry phase is a form of
informed consent.

 VERACITY — principle of truth telling or Honesty.

○ Violation : Lying
 INTENTIONAL LYING — purposeful; despite knowing the truth
 INCOMPLETE INFORMATION — the truth should always be Whole
 LYING BY OMISSION — lying by NOT SAYING ANYTHING despite knowing the
truth.
○ In the case of family requests patient will not be informed, the nurse can participate.
Nurse can withdraw from patient-care if they cannot tolerate lying for the BENEFIT
of the Client.

 CONFIDENTIALITY —
○ The principle of honoring privacy
○ Confidentiality transects death.
○ Avoid talking about pt data in Public.

○ 2 types of PRIVACY:
 SOLITUDE — Right to be alone. In some case of invasion of privacy, apologize
first.
 DATA PRIVACY — right to”secrecy” of personal information to keep the
patient safe.
 BENEFICIENCE AND NON-MALIFICIENCE
○ “Twin-sisters” of Ethics.

○ Nurse instructs pt with COPD to stop smoking — NON MALI

○ Vacccines outweigh the risks by its benefits — BENE

RESTRAINTS — object given to the client prevent movement of a body part or entire body
EX: which can only be used upon a standing order of the physician.
○ The order expires in 24 hours.
BENEFICIENCE
 PHYSICAL — siderails (prevents ambulation). Complications: Impaired skin
NON- integrity.
□ Prevent this by releasing the restraint q2h for 30 mins per extremity.

 CHEMICAL — Sedatives and Major Tranquilizers. Complications: falls

□ Prevent by assisting hwn ambulating.
□ ANTICHOLINERGIC EFFECTS:
⬥ Blurred vision
⬥ Urinary retention
⬥ Constipation
⬥ Orthostatic hypotension
⬥ Photosensitivity
⬥ Amnesia — tempo
⬥ Dryness of mouth
⬥ Insomnia

 JUSTICE
○ Fairness and Equality
○ Fair distribution of burdens and opportunities which is usually tested when there is
scarcity or resources.
○ Violation: DISCRIMINATION (prejudice or a pre formed notion) or BIAS

 FIDELITY
○ Loyalty and keeping to one’s oath
○ Nurses oath — Nightingales Pledge.
 NO OATH TAKING, NO INITIAL REGISTRATION
○ Violation: CLIENT ABANDONMENT
○ EX:
 CLIENT ADVOCACY — speak and act on their behalf

 SOLIDARITY
○ “Solid” — being united; Principle of UNITY
○ Collaboration and Teamwork results to something good.

 TOTALITY
○ Principle of preserving human dignity by keeping the physical body pparts together.
○ Prioritize the good of the entire person including; Physical, Psychological, and
Spiritual factors
○ Also applies to elimination of a diseased body part to preserve the whole
(amputation)

 STTEWARDSHIP
○ Principle of caretaking (supervision or assistance); taking good care of God’s
creation.
○ Related to
 Beneficence
 Non-malificience
 Fidelity

ETHICAL DILEMMA
- A problem wherein ethical principles in conflict with each other; a univversal experience.
- Nurse is torn between 2 or more ethical principles or beliefs (intrapersonal conflict)
- No clear solution but requires a choice between 2 principles.
- Outcome is WIN-LOSE

• AUTONOMY VS BENEFICIENCE
○ Medical “PATERNALISM” — behaving like a parent; results to coercion in terms of
decision making for medical procedures.
 Pressuring the pt to choose the nurse’s preffered choice (violation of
autonomy)
• BENEFICIENCE VS NON MALEFICIENCE
○ EUTHANASIA — Mercy killing
 ACTIVE EUTHANASIA — deliberate ending of pts life. Patient is functional but
with terminal condition.
□ Ex: Assisted Suicide with high doses of sedatives (Dignitas in Switz)
 PASSIVE EUTHANASIA — dies in a natural death but not performing any life-
saving measures.
□ Ex. DNR, Removing pt from life-support machines.
 THERAPEUTIC ABORTION — for cases of Ectopic Pregnancy. (Teleological
Method)
• VERACITY VS CONFIDENTIALITY
○ HIV Diagnosis — right to keep the diagnosis confidential but sex partners should be
aware of the diagnosis. Follow the patient’s confidentiality because they are under
your care. If partner asks tell them to ask the pt themselves (lying by omission).
Violates veracity.

HIV Dx Test Western blot

HIV Screening ELISA (at least 2 tests)
MOT Sex and Body Fluids (NOT SALIVA)
AIDS DX CD4 (<200) with at least 2 opportunistic Infections

• JUSTICE VS BENEFICIENCE
○ Organ Donation (RA 7170) — scarcity or resources leads to unfair distribution organs.
 DONOR — either live or cadaver. Donation should not lead to the disability of
the live donor.
□ Most common donated: KIDNEY
□ Most common donated tissue: BLOOD
 RECIPIENT — either willed or non-willed (waiting list)
• VERACITY VS BENEFICIENCE
○ Placeboo effect in research — to maintain internal validity; giving a false medication
or telling lie to the patient to find a cure or an answer.

STEPS IN SOLVING ETHICAL DILEMMAS:

- Following Nursing Process
1. ASSESS the situation and gather data about the Dilemma
2. DIAGNOSIS — Identify the problem and establish the dilemma (which principles are
at conflict)
3. PLANNING — Perform values clarification (self awareness)
 Choose the value that you resonate with
 Cherish the value
 Act based on the cherished value
4. INTERVENTION — recommend action
5. EVALUATE if the action solves the Dilemma

OTHER RESOURCES TO SOLVE ETHICAL DILEMMA (Counselling)

1. Immediate supervisor
2. ETHICS COMMITTEE — Last resort, refer problems that aren’t complicated. Also involved
in research as the institutional review board by evaluating research proposals for Approval.

JURISPRUDENCE
• LAW — rule of the land as mandated by the state; policies or norms set to keep the peace
and order in a jurisdiction.
• JURISDICTION — a particular place where a law is implemented.

WHY DO NURSES STUDY LAW?

- IGNORANTIA LEGIS NEMINEM EXCUSAT
○ The ignorance of the law excuses no one; leniency ccan lead to violatons.
- To protect pt rights
- To protect self from injustice

Clarifications of Law

A. According to Source

DIVINE HUMAN

• From an omnipotent and omniscient being (all • Created by leggislators to keep peace
knowing, all powerful) and oorder.
• Mandate of the heavens • “statues” — pieces of legislation
• Supreme source of laws

B. According to Statues (ranked)

1. CONSTITUTIONAL LAW — “highest” form of law in the land. All other laws are based
on the constitutional stipulations (abortion and divorce are not supported by the Ph
Constitution). Changing the constitution will require 2/3 vote from the Senate and
President’s confirmation.
2. STATUTORY/ REGULATORY/ LEGISLATIVE — All “Republic Acts”
3. ADMINISTRATIVE — with local or exclusive clout; small coverage

C. According to Relationships and Governed/Applications

CIVIL LAW CRIMINAL LAW

- Involves PRIVATE relationships with another - PUBLIC relationship with the state
individual or group as represented by the
Governnement. (Involves the
society)

- Nurse -Patient, Nurse - Peer - People of the RPH vs Criminal

- Civil Code: RA 386 (public enemy)
- Revised Penal Code: RA 3715

TORT — Civil violation. Evidence required. CRIME — violation of the criminal

Preponderance of evidence — burden of proof; law. Evidence required. Proof beyong
greater weight of evidence is more likely than not reasonable doubt.
to have occurred. Ex:
- Murder : Death

• Both can be grounds for revocation but criminal violations has severe consequences.

CIVIL LAW VIOLATIONS

INTENTIONAL UNINTENTIONAL

- With “evil, malicious intent” - Without evil intent but results to

- “Dolo” — deceit harm
- With heavier consequences; may be a criminal - “Culpa” — fault
act

TYPE OF INTENTIONAL TORTS

1. ASSAULT
○ An actual threat that results to anxiety; either verbal or non-verbal.
 Cussing, body language, insulting gestures
2. BATTERY
○ Actual physical contact without consent resulting to harm.
 CPR on a DNR patient
 Blood transfusion on a Jehovas witness
3. FALSE IMPRISONMENT
○ Restraints and Isolation procedures results to harm.
 Restraints without order
4. ILLEGAL DETENTION
○ Unlawful, Non-discharging of a pt despite signing appropriate forms. (Promissory
note, DAMA)
○ Aviolation to the right of “Habeas corpus” (right to lawful admission and detention to
hospital)
5. SLANDER (ORAL DEFAMATION)
○ Malicious intent of destroying one’s reputation (what people think you are). Requires
witnesses to the act.
6. LIBEL (Published/written defamation)
○ Requires published evidence of calumny.
 Broadcast, interviews, posts
7. INVASION OF PRIVACY
8. FRAUD

TYPES OF UNINTTENTIONAL TORTS

NEGLIGENCE MALPRACTICE

- Carelessness - Professional violation.; breech in

professional duty

- Failure of a nurse to act in the same manner a - Overstepping beyond one’s job
prudent/careful nurse would do — resulting to resulting to injury, harm or death
damages/injury
- Can happen to anyone (Nursing aid — Unlicensed) - Exclusive to professionals
- Legal content: wrongful act or failure to act Legal content: the name of lawsuit

PREPONDERANCE OF EVIDENCE FOR CIVIL LIABILITY:

• DUTY — Under the scope of Practice
• DERELICTION OR BREECH OF DUTY — Neglectt, Failure to act, Breach of standards
• DAMAGE — Physical, emotional, mental, harm or death
• DIRECT CAUSATION OR PROXIMATION — Direct relationship of dereliction and damage.

EX: A nurse adm propofol (anes) instead of propanolol which results to comatose

Duty = rights of drug

administrations Dereliction =
failure to give the right drug
Damage = comatose condition
Direct causation = administration of Propofol results to
comatose Therefore, nurse is guilty of
MALPRACTICE.

Ex: A nurse administers Vit C instead of Vit D. No untoward effects happened.

:
Duty = rights of drug
administrations Dereliction =
failure to give the right drug
Damage = NONE
Direct causation = No damage but mistake has been made.
Therefore, nurse is NOT GUILTY but has to make an incident report within 24 hours from the period
of the event and submitted to the supervisor (private document). Do not put in the chart
that IR has been written. Do not place a copy of the IR in the chart. IR can be used
for research for quality improvement.

RESPONDEAT SUPERIOR — Superior is liable to the action of subordinate:

• CULBA IN ELIGIENDO — Fault in Delegation
• CULBA IN VIGILANDO — Fault in Supervision
Liability: “VICARIOUS LIABILITY” more than one person is liable for the breach of duty.
(Hospital & Supervisor)

RES IPSA LOQUITOR — “the thing speaks for itself” Evidence speaks for itself

FORCE MAJURE — natural occurrences that beyond one’s control.

BORROWED SERVANT DOCTRINE — employer is held liable for the acts of a temporary
employee

CRIMINAL LAW VIOLATIONS

- Crime: violation of the law of the land which destroys relationships with the state.

2 Basic Elements of Crime:

1. MENS RHEA — criminal intent; a dangerous mind
2. ACTUS REUS — the criminal act
- Both should bbe present for it to be considered a crime. You cannot sue for a criminal
intent alone.

3 DEGREES OF CRIME:

DEGREES MENS RHEA ACTUS REUS

Consummate Present & Fulfilled Successful and Executed Heaviest punishment

d given
Frustrated Present Executed but
Unsuucccessful
Attempted Present but unfulfilled Unsuccessful and stopped Least punishment

Ex:
- HOMICIDE — Murder without intention to kill
- PARRICIDE — murder of a Family member
- INFANTICIDE — Murder of an at-least 3 day old newborn
- ABORTION — murder of a fetus: worst form of killing since the victim is defenseless
- ARSON — intentional burning or property
- ROBBERY — stealing with force
- THEFT — stealing without force; lack of awareness
- BURGLARY — breaking into property; can be both theft and robbery
- STIMULATION OF BIRTH — Switching the Identity of infants
- RAPE —
○ Anti-Rape Law (RA 8353)
○ With 3 Elements:
 No consent
 Carnal knowledge (criminal intent)
 Penetration or Attempt to penetrate an orifice (actus reus)
□ STATUTORY RAPE — consensual rape with a minor
□ MARITAL RAPE — rape between couple. 3 attempts of refusal to engage.
□ GRAVE COERCION — Rape of a Male without penetration
□ INCESTOUS RAPE — worst form: rape by a family member.

CONSPIRACY OF A CRIME
1. PRINCIPAL — mastermind; with primary gain if crime is committed. Receives. Highest form
of punishment
2. ACCOMPLICE — partner in crime
3. ACCESSORY — Hides or destroy the body of crime

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY (JEMA)

1. JUSTIFYING CIRCUMSTANCES
○ To rationalize criminal act. Case will be dissolved.
○ Ex. Self defense, protection of the pt
2. EXEMPTING CIRCUMSTANCE
○ absence of criminal intent.
○ Ex. <9 years old — JUVENILE DELINQUENCY
○ <70 years old — DIMINISHED CAPACITY
3. MITIGATING CIRCUMSTANCE
○ Reduced amount of punishment.
○ Ex: 9 - 18 years old crimes due to obfuscation resulting from passion (crime of
passion)
4. AGGRAVATING CIRCUMSTANCES
○ Heightened amount of punishment.
○ Ex: crime perfomed at night since most victims are vulnerable
○ Crime performed during disaster / place of worship

PROCESS OF LITIGATION— holding a court trial

PLAINTIFF (Complainant) DEFENDANT (Accused)

• On the side of the prosecution • On the side of Defense

• File the “Lawsuit” • Named in the lawsuit and accused of a

Tort or Crime
• Tort case: Individual
• Crime: State

• With the burden of proof (evidence) since

they filed the case

STEPS OF LITIGATION:
1. Filing a Lawsuit:
○ Blotter
○ Police
○ Municipal trial court
2. Summons — civil
○ Warrant — crime
3. Pre-Trial: Lawyers represent the plaintiff and defendant. Case can be dismissed if plaintiff
settles with money in Civil. If it is a crime, Bail can be done.
4. Trial proper in court
5. Verdict — final decision of the judge or arbiter. No jury system in the Ph. Can file for an
appeal if conditions are appropriate.

LEADMA

• MANAGEMENT
○ A process of getting the cooperation of the group to achieve a common goal.
Required to have an organization.
○ Most popular theory: GENERAL ADMINISTRATIVE THEORY BY HENRY FAYOL

14 PRINCIPLES OF MANAGEMENT:
1. UNITY OF COMMAND
○ Once source of instruction.
2. UNITY OF DIRECTION
○ One common goal.
○ Reflected in the institutional mission and vision and goals.
3. SUBORDINATION
○ Being under a superior to work towards a common goal.
○ A form of Altruism.
4. ESPRIT DE CORPS
○ Teamwork
○ Pride in belonging in one’s group
5. INITIATIVE
○ Ability to start a task automatically
6. AUTHORITY
○ Right to command
7. ORDER
○ Proper chronology or sequence of tasks; Being Systematic.
○ Best basis = Nursing process.
8. DISCIPLINE
○ Self control
○ Ability to follow rules and abide by them
9. EQUITY
○ Fair treatment at work
○ No favoritism
10. REMUNERATION
○ Source of motivation for working in an organization
11. STABILITY OF TENURE
○ Non-existence of threat to one’s job status.
○ Job stability
○ No frequent dismissal and termination.
12. CENTRALIZATION/DECENTRALIZATION
○ Distribution of power and authority
 Centralized — power from Top (AUTOCRATIC)
 Decentralized — well distributed power
13. CHAIN OF COMMAND (Scale of Chain)
○ Functions; method of communication, distribution of authority, Delegations.
○ Reflected in Org chart
14. DIVISION OF LABOR
○ Delegation

FUNCTIONS OF A MANAGER:
 PLANNING
○ Output = Goal setting in the form of Plan
○ The brain of management
○ Most important step / function and the driving stimulus
 ORGANIZING
○ Output = Group of people to help in carrying out the plan.
○ The backbone of management
 DIRECTING
○ Delegation of tasks
○ The Heart of Management
 CONTROLLING
○ Ensuring that the activities being done are within Standards
○ The. Conscience or Superego of Management.

1. PLANNING
- Future oriented
- 2 types;
○ Strategic — LONG TERM
○ Operational — SHORT TERM
- Assess priorities thru SWOT ANALYSIS
- State statements that provide direction:
○ MISSION — (action) the reason “why” the org exists
○ VISION — (ambition) what the org sees itself in the future.
○ PHILOSOPHY — (beliefs and values) where decisions are based on.
○ GOALS — (general actions)
○ OBJECTIVES — (specific actions) should be SMART
 Specific
 Measurable
 Attainable
 Realistic
 Time-bound
○ POLICIES
○ RULES AND REGULATIONS

- BUDGETING — Aka “Fiscal Planning”

○ Not only about money
○ Purpose: proper allocation of funds
○ Duration: budgeting tasks 3 - 6 months
○ Total institutional budget elements:
 CAPITAL BUDGET:
 PERSONNEL BUDGET
 OPERATIONAL BUDGET
 UTILITY/CASH BUDGET
○ 2 types of Expenditures:
 Directs Costs — crucial to operate or offer services.
□ PPE, Meds, Salary, Benefits
 Indirect Costs — not directly related to org. Can still function without these
□ Fire extinguishers, CCCTV
○ Types of Budgeting:
 INCREMENTAL BUDGETING
□ Raising the budget allocation based on current inflation rate.
□ Easiest type of Budgeting
 ZERO BASED BUDGETING
□ Aka Sunset Budget
□ Manager needs to justify all budget allocations for the budget proposal.
□ Budget starts from zero instead of basing it from previous year.
 CEILING BUDGETING
□ Setting limits for each allocation
□ Budget should not go beyond maximum limit setting
 STANDARD BUDGETING
□ Fixed set
- Responsibilities of Manager during Budgeting
○ Budgeting is done ANNUALLY
○ Timeframe 3 - 6 months
○ Transparency
- When there is excess, inform the source.

2. ORGANIZING
○ Formation of group of people with the same goals to execute plan.
○ Choose a type of Org to build:
 2 types
FORMAL INFORMAL

With position, title, and job People do not have positions, they are
description assignments built by the together because they share the same
manager similarities

Communication thru a Chain of Communication thru Grapevine

Command.
Creation of Org Chart

○ Create an Org design:

 4 basic elements
□ DIVISION OF LABOR
□ CENTRALIZATION/ DECENTRALIZATION
□ SPAN OF CONTROL — pragmatic concern of the manager over the
subordinates.
⬥ Number of people under direction of manager
WIDE — > or 4
⬥
⬥ NARROW <4
□ ORG STRUCTURE
TALL FLAT
CENTRALIZED DECENTRALIZED
“Vertical” “Horizontal”
Narrow span of control Wide span of control
Difficult communication Faster communication

○ Establish and Identify org relationships

FORMAL INFORMAL

With classic command relationship Coordinating or consultative

- Superior - Subordinate pairing
Symbolized in “Solid” straight line Symbolized by a “Broken” line

○ Identify Org culture based on Philosophy of org

○ STAFFING
 Involved in Human Resource. Process of assigning competent and qualified
people to fill in job descriptions.
 Considerations:
□ Regulatory Requirements:
⬥ Supported by law.
⬥ Employee must work for 40 hours a week/ 8 hours a day for 5
days — 104 days in a year (excluding holidays)
⬥ According to RA 5901
□ BENCHMARKING — seeking the best practice and applying it into the org
to improve performance.
□ PATIENT CLASSIFICATION SYSTEM — classifying pts based on the amount
of nursing workload.
⬥ Patient acuity — measure of nsg workload generated for each pt
(high acuity = more work)
SELF CARE (Minimal) Capable of ADL’S. Ambulatory
Moderate Stable but with special tx procedure
Total Bedridden, lacks strength and mobility for ADL’S
Intensive Highest; constant danger of death. (ICU, PACU, ER, OR)

□ STAFF SUPPORT — number of personnel needed.

⬥ AM Shift: 45%
⬥ PM Shift: 37%
⬥ NOC: 18%
□ SKILL MIX — ratio of professionals to non-prof

○ Steps in Staffing:
 Determine number and type of personnel needed
 Recruitment — hiring
□ ADVERTISEMENT — more efficient thru word of mouth
□ APPLICATION — pass oof curriculum vitae with cover letter.
⬥ Includes contact #, 2 levels of educ attainment, NLE rating, Job
experience, character references.
□ Sorting of qualified Applicants
 Interview — wear corporate attire.
□ If u do not know the answer — DO NOT PRETEND. Apologize and admit
that you do not know and ask for another question.
□ Tell me about yourself — answer things not founf in the CV
□ Why should we hire you — contribute to the excellence of the company
□ Why this company — state mission, vision, goals of company
□ If you are given to ask Qs — DO NOT ASK ABOUT SALARY.
⬥ Expected amount of salary, give RANGE (minimum)
□ Upon entering, do not sit right away, wait to be seated.
□ After the interview, stand and offer to shake hands.
 Induct/Orient personnel
 Give Employment contract.

3. DIRECTING
○ Steps taken to ensure that tasks are being distributed properly
○ Elements of a good direction:
 CLEAR
 CONCISE
 CONSISTENT
 COMPLETE
○ ELEMENTS — COMMUNICATION
 Sender (ENCODER)
 Message
 Medium
 Receiver (DECODER)
 Feedback
○ Levels of Communication
 VERBAL
 PARAVERBAL
□ Tone
Sound
□
□ Speed
□ Vocabulary
 NON VERBAL
□ Body language
□ Actions
□ Gestures
□ More powerful than verbal
□ Communication is 93% nonverbal ; 7% verbal
○ Directions of Communications:
 VERTICAL — between superior and subordinate (formal command)
□ Upward — subordinate to superior
□ Downward — superior to subordinate
 HORIZONTAL — Between colleagues or peers (same level in position)
 DIAGONAL — talking with someone NOT part of the org
○ DELEGATION — division of labor
 AUTHORITY
 RESPONSIBILITY — accepting and completing task
 ACCOUNTABILITY — results/outcome
○ Common errors in Delegation:
 OVER-DELEGATION — results to burnout
 UNDER-DELEGATION — results to Redundancy
□ A redundant employee is a waste of org funds
 IMPROPER — results to negligence and malpractice
○ Prevention of Delegation Errors
 RIGHT:
□ Task
□ Person
□ Direction
□ Circumstances
□ Supervision
○ Things u CANNOT DELEGATE
 Admission and Discharge
□ Assessment
□ Health Teaching
 Med administration
 Highly invasive/ Sterile Procedures
 Unstable pt
 Documentation

○ MODALITIES/MODELS OF CARE
 Method of health care delivery: manner in which the staff and tasks available in
the unit will be divided.
□ TOTAL PT CARE / CASE METHOD
⬥ 1 RN = Patient/Group of Pt
⬥ Best modality (original) est by Florence Nightingale
⬥ Used in ICU / OR
□ FUNCTIONAL
⬥ Task based
⬥ 1 task for the whole shift
⬥ Used in emergencies / mass casualties
□ TEAM NSG
⬥ “partners in care”
⬥ 1 GROUP OF RN (atleast 4)
⬥ With Team leader; delegates tasks
⬥ Used in Tertiary hosps
□ PRIMARY
⬥ Autonomous/ Authoritative
⬥ 24 - hr based NCP; Care is assumed by “Reliever” after shift
⬥ Nurse decides hoe the pt will be taken care of (decentralized)
⬥ Used in hospice care / terminal conditions
□ CASE MGT
⬥ Collab mgt with HCP and support system
⬥ Nurse is called “Nurse manager”
⬥ No direct care given, only health teaching and directions.
⬥ Promotes continuity of care to the home
◊ IMCI

4. CONTROLLING
○ Mistakes are prevented by means of imposing norms and standards.
○ Priority: Est standards
 STANDARD —
Minimum requirement
□
□ Measured in numbers
□ Means of comparison
○ 3 types of Standards:
 STRUCTURE — eg shift, hours of work
 PROCESS — manual procedure
 OUTCOME — eg: survey
○ Methods of STAFF DEVELOPMENT:
IN SERVICE CONTINUING EDUC
Focused on skills Focused on career

Informal: incidental and Formal: planned

Unplanned

Responsibility of the Responsibility of the staff themselves

Agency/Hospital

CPD— Needed for renewal every 3 years (45

units in 3 years)

○ When should a Manager perform Controlling

 BEFORE THE TASK — feed forward control
 DURING — concurrent control
 AFTER — feedback control