Professional Adjustment and Nursing Jurisprudence

Professional Adjustment and Nursing Jurisprudence JAY LAPAZ ANDRES, RN, BSN, MAN©, MAEd. ©

I.

PERS ERSONAL ONAL AND AND PRO PROF FESS ESSIONAL ONAL GROWT ROWTH H AN AND DEV DEVEL ELOP OPME MENT NT a. Histor Historica icall Persp Perspect ective ivess in Nurs Nursing ing The Philippine Nurses Association (PNA) established in 1922 was responsible in lobbying our government for the adoption of the recommendations made by the Internatio International nal Labor Organizatio Organization n in 1977 with regard the status status of the economic and soci social al welf welfar aree of our our nursi nursing ng pers person onnel nel.. The The Prof Profes essi sion onal al Regul Regulat atio ion n Commi Commiss ssio ion n of the the Phil Philip ippi pine ness duly duly recog recogni nize zess the the PNA PNA as the the lead leadin ing g Associ Associati ation on of nurses nurses in the country country.. In 1924, 1924, it publis published hed a standa standardi rdized zed curriculum for schools of nursing to adopt. The follow following ing were were the first first groups groups intere intereste sted d and regist registere ered d with with the Philippine Nurses’ Association (PNA), to wit: Academy of Nursing of the Philippines, Inc. (ANPHI) Association of Deans & Principals of Schools and Colleges of Nursing of the Philippines (ADPSCNP) Association of Nursing Administrators of the Philippines ( ANSAP) Association of Private Duty Nurse Practitioners of the Philippines (APDNPP) Critical Care Nurses’ Association of the Philippines (CCNAP) Catholic Nurses Guild of the Philippines (CGNP) Golden Age Nurses Association (GANA) Ministry of Health National League of Nurses (MHNLN) Occupational Health Nurses Association of the Philippines (OHNAP) Operating Room Nurses Association of the Philippines (ORNAP) Philippine Nurse Midwifery Society Philippine Nursing Students Association (PNSA) Philippine Orthopedic Nurses Society Psychiatric Nursing Specialists Foundation of the Philippines, Inc. (PNSI) Philippine School Nurses Association (PSNA) The following are the later members of the PNA: Association of Diabetes Nurse Educators of the Philippines (ADNEP) Graduate Nurses Christian Fellowship (GNCF) Integrated Nurses Association of the Philippines (IRNUP)  National League of Philippine Government Nurses (NLPGN) Maternal and Child Nurses Association of the Philippines (MCNAP) Military Nurses Association of the Philippines (MNAP) Phi Philipp lippin inee Oncol ncolog ogy y Nur Nurses Asso Associ ciat atiion (PONA) ONA) Philippine Orthopedic Nurses Society (PONS)

TIMELINE IN THE NURSING HISTORY:   

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In the early dawn of human history, diseases or illness were often related to superstitious beliefs and the treatment also often involved magical cures. The Sumerian Civilization is believed to have recorded in a clay-tablet 4,000 years ago some healing prescriptions but did not specify the illnesses. The The Code Code of Hamm Hammur urab abii trac tracea eabl blee to the the Baby Babylo loni nian an empi empire re in 1900 1900 BC documented regulations pertaining to sanitation and public health, the practice of  surgery, differentiation in the practice of human against veterinary medicine, a table of fees for operations and penalties for violation of the code. During these early days, nursing practice was vaguely described as those who render comfort and support to patient. In the Old Testament, it made mention of women as nurses who provided care for infants and children, the sick and dying The Greek and Roman empires related the care of the sick and those injured to the mythologies that they have created and believed that the gods and goddesses  possessed special healing powers. Hygeia, daughter of Greek god Asklepios, the chief healer, was revered to be the embodiment of the nurse.

Ancient India – Nursing functions were being carried out by male nurses provided they meet the four qualifications: 1. knowledge of the manner in which drugs should be prepared for administration 2. cleverness 3. devotedness to the patient 4. purity of mind and body •

Christian Benevolence- “love thy neighbor as thyself” had a significant impact on the development of Western Nursing. The principle of “Good Samaritan” is the basis of caring for most Christians Ch ristians that eventually • laid down some principles of nursing. During the time of the Roman Empire, rich matrons such as Fabiola used their wealth to •   provide houses of care and healing that served as the early hospitals for the poor, sick and the homeless. The Time of Crusades ( Holy mission or pilgrim to regain the Holy land by the Christians), • knights were trained to provide care for the wounded soldiers in the battle – this is perhaps the earliest recognition of men providing nursing care. Camillus De Lellis – considered the patron saint of nurses was the founder of the Nursing • Order of the Ministries who provided care to the sick and the poor. Florence Nigthangle born from a wealthy family chose to dedicate her life in providing • care for the sick and injured especially during the Crimean War. She also started a school to train nurses in 1860, which eventually sparked the development of Modern Nursing. •

NURSING AS A PROFESSION

Profession - “ an occupation or calling requiring advanced training and experience in some specific or specialized body of knowledge which provides service to society in that special field.” - It is a calli calling ng that that require requiress special special knowl knowledge edge,, skill skill and prepa preparat ration ion.. - “ a calling calling in whic which h its membe members rs profe profess ss to have have acquir acquired ed specia speciall knowled knowledge, ge, by training or by experience or by both, so that they may guide or advice or serve others in that special field.”

A profession is generally distinguished from other kinds of occupations/vocations by: 1. Requir Requireme ement nt of prolonged prolonged,, specia specializ lized ed traini training ng to acquire acquire a body body of knowledge knowledge  pertinent to the role to be performed usually entrusted to higher education. 2. An orient orientati ation on of the indivi individua duall toward toward service, service, either either to a commun community ity or to an organization. 3. The members must be united and identified through their membership and they must  be clearly separated from the laypeople or the ordinary congregations. 4. The society which it intends to serve has an indispensable need for such services and which others cannot provide and the society accepts it. 5. The techniques or skills applied are the product of scientifically proven and long experience. 6. Requirement to exercise discretion and judgment as to the time and manner of the  performance of the duty. 7. The presence of common values, cultures, and norms uniquely found among its members which are also being guided by its own code of ethics. 8. The ability to continue its research to expand constantly its body of knowledge.

Characteristics of a profession: 1. Autono Autonomy my – (indep (independe endence nce and self-go self-gover vernanc nance) e) the ability ability to chart chart or carve carve its own destiny independent from others. 2. Auth Author orit ity y – poss posses essi sion on of high highly ly adva advance nced d and and compe compete tent nt skil skills ls/m /mas aste tery ry of such such knowledge and skills not available to the general public. 3. Accountabili Accountability ty – responsib responsibilit ility/li y/liabilit ability y to own up up its action actions. s.

Nursing Nursing-- “is primar primaril ily y assist assisting ing the indivi individual dual (sick (sick or well) well) in the perfor performan mance ce of those those activities contributing to health, or its recovery (or to a peaceful death) that he would perform unai unaide ded d if he had had the the nece necess ssar ary y stre streng ngth th,, will will,, or know knowle ledg dge. e. It is like likewi wise se the the uniq unique ue contribution of nursing to help individual to be independent of such assistance as soon as  possible.” (Virginia Henderson, 1958; 1978)

 Nursing is putting “the patient in the best condition for nature to act.” This description/definition was given by Florence Nightangle, dubbed as the first nursing theorist. She made use of the environment (clean and healthy surrounding) in the recovery of an ill patient.   Nursing- is the diagnosis and treatment of human responses to actual and potential health  problems (ANA). The common focus of nursing is the need to provide humanistic and holistic care that includes the four areas related to health: he alth: 1. Health Promotion 2. Health Maintenance 3. Health Restoration 4. Care of the Dying •

RA 9173 or the Philippine Nursing Act of 2002 gives the meaning of nursing practice through the following: -alone or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting that includes: 1. nursing care during conception, labor, delivery, childhood, adulthood and old age 2., promotion of health and prevention prevention of illness. illness. 3. collaborati collaboration on with other health care providers for the curative, curative, preventive, preventive, and rehabilitat rehabilitative ive aspects of cares, restoration of health, alleviation of suffering and when recovery is not possible towards a peaceful death.

 Nursing Practice – covers the three areas of nursing, namely: nursing education, nursing service, and community health nursing (Rule 1 Sect. 3 (d) IRR RA 9173). Profes Professio sional nal Nurse Nurse – a person person whose whose name name and regist registrat ration ion/pr /profe ofessi ssiona onall licens licensee number number is entered in the Commission’s registry book and computerized database as legally authorized to  practice the nursing profession (Rule 1 Sect. 3 (e) IRR RA 9173). Practicing Professional Nurse- a person who is engaged in the practice of nursing profession or is  performing acts or activities, whether regularly or occasionally, including one who is employed in a government office or in a private firm, company or corporation whose duties require knowledge and application of the nursing profession (Rule 1 Sect. 3 (f) IRR RA 917 3). Foreign Professional Nurses – foreign nationals who, being licensed professional nurses in their  own countries, are authorized by existing laws to practice their profession either as holders of a certificate of registration and professional identification card or a special/temporary permit in the Philippines subject to some provisions of RA 9173 (Rule 1 Sect. 3 (g) IRR RA 9173).

 Nursing Specialty Program – a training and development program intended to develop/enhance the skills, skills, to which which a regis register tered ed nurse nurse devote devotess himsel himselff /herse /herself lf whether whether as a vocati vocation on or   profession to enable him/her to provide nursing service in specific areas in accordance with the ethics of the profession and applicable law.

THEORETICAL FOUNDATION OF NURSING APPLIED IN HEALTH CARE SITUATIONS

Purposes of Nursing Theories and Conceptual Frameworks ( Kozier et al.,45)

Provide direction and guidance for: a. structuri structuring ng professi professional onal nursing nursing practic practice, e, education education and and research research  b. Differenti Differentiating ating the the focus of nursing nursing from from other other professi professions. ons. Assist nurses to describe, explain and predict everyday experiences. Serves to guide assessment, intervention, and evaluation of nursing care Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation. Help to establish criteria to measure the quality of nursing care Help build a common nursing terminology to use in communicating with other health  professionals. Ideas are developed and works defined. Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions. Provide a general focus for curriculum design Guide curricular decision making Offer framework for generating knowledge and new ideas Assist in discovering knowledge gaps in the specific field of study Offer a systematic approach to identify questions for study, select variables, interpret findings, and validate nursing interventions

Concepts – are abstract ideas or mental images of phenomena or reality. reality. It can be concrete ideas that can be mentally pictured (eg. Cars, cellphones, house); or it can be abstract ideas (eg. Powerlessness, adaptation, nursing).

 Nursing theories addresses the following four major concepts: 1. Pers Person on or clie client nt 2. Environme nment 3. Heal Health th/i /ill llne ness ss 4. Nursing

Conceptual Framework  – group of related concepts. It can also be viewed as an umbrella under  which many theories can exist (Cresia & Parker 1991,p7). Conceptual Model - is a system of related concepts or a conceptual diagram.

Model- graphic illustration of relationships. Theory- is made up of concepts and propositions; however, a theory accounts for phenomena with much greater specificity.

GENERAL THEORIES IN NURSING Nightangle’s Nightangle’s Environmental Environmental theory – Florence Nightangle, “the mother of modern nursing” espoused her theory focusing on the environment. She linked health with five environmental factors:

(1) (2) (2) (3) (4) (5) (5)

pure pure or fresh fresh air  air  pure pure water  water  efficient efficient drainage drainage cleanl cleanline iness ss ligh lightt

Henderson’s Henderson’s Definition of Nursing- The definition of nursing given by Virginia Henderson in 1955 became a milestone milestone in the development of nursing as discipline discipline apart from medicine. medicine. The focus on her Nursing Concept is to help individuals and families gain independence in meeting the 14 fundamental needs; (1) Breathing Breathing normally normally (2) Eating Eating and drinking drinking adequatel adequately y (3) Eliminati Eliminating ng body wastes wastes (4) Moving and maintaini maintaining ng desirable desirable position position (5) Sleeping Sleeping and and resti resting ng (6) Selecting Selecting suitabl suitablee clothes clothes (7) Maintainin Maintaining g body temperature temperature within normal range by adjusting clothing clothing and modifying modifying the environment (8) Keeping Keeping the body clean and well-groome well-groomed d to protect protect the integument integument (9) Avoiding dangers in in the environment environment and avoiding injuring others (10)Communicating with others in expressing emotions, needs, fears, or opinions (11)Worshipping according to one’s faith (12) Working in such a way that one feels a sense of accomplishment (13) Playing or participating in various forms of recreation (14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities.

Rogers’s Science of Unitary Human Beings - Martha Rogers views the person as an irreducible whole, the whole being greater than the sum of its parts. Her Key concepts in describing the individual are energy fields, openness, pattern pattern and organization, and multidimensionality. multidimensionality. She described the Unitary Man as: (1) Irreducible, four-dimensional four-dimensional energy field field identified identified by pattern. pattern.

(2) (3) (4) (5)

Manifesting characteristics characteristics different from from the sum of the parts Interacts continuously continuously and creatively with with the environment Behaving Behaving as a totality totality Participat Participating ing creatively creatively in change change

Orem’s Self Care Deficit Theory  – Dorothy Orem developed the self-care deficit theory that includes self-care, self-care deficit and nursing system. She believed that the self-care of the individuals and the self-care of dependents are learned behaviors that individuals initiate and  perform on their own behalf to maintain life, health, and well-being. According to Rogers, there are three kinds of self-care requisites: (1) Universal requisites ( common to everybody like maintenance maintenance of air, water etc…) (2) Developmenta Developmentall requisit requisites es (3) Health Health deviation deviation requisite requisitess

Roy’s Adaptation Model –  Sister Callista Roy focuses on the individual as a biophysical adaptive system. Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an ongoing purposive response. Roy identified three classes of stimuli: (1) Focal Focal Stimul Stimulus: us: the intern internal al or extern external al stimul stimulus us most most immedi immediate ately ly confro confronti nting ng the  person and confronting the behavior. (2) Contextual Contextual stimuli: stimuli: all other internal internal or external external stimuli present present (3) Residual Stimuli: Stimuli: beliefs, attitudes, attitudes, or traits having an intermediate effect on the person’s  behavior but whose effects are not validated. King’s King’s Goal Goal Attainme Attainment nt The Theory ory –  Imogen Imogenee King King based based her theory theory from the concept conceptual ual framework of three dynamic interacting systems: (1) personal personal system concepts: concepts: perception, perception, self, body image, growth and development, development, space and time (2) Interpersonal system concepts: interaction, communication, communication, transaction, role, and stress. (3) Social system concepts: organization, authority, authority, power, status, and decision making. Neuman’s Health Care Systems Model –  Betty Neuman views the client as an open system consisting of a basic structure or central core of energy resources (physiologic, psychologic, sociocultural, developmental, and spiritual) surrounded by two concentric boundaries or rings referred referred to as lines of resistance resistance.. She identified identified individual’s individual’s response response to stress stress and the nursing interventions to be carried out on three preventive levels: (1) Primary Primary prevention prevention (2) Secondary Secondary prevention prevention (3) Tertiary Tertiary Prevention Prevention

Johnson’s Behavioral System Model - Dorothy Johnson defines a system as a whole that functions as a whole by virtue of the interdependence of its parts. A behavioral system is   patte patterne rned, d, repeti repetiti tive ve and purpos purposefu eful. l. Johnson Johnson’s ’s key concept conceptss descri describes bes the indivi individual dual as a  behavioral system composed of seven subsystems:

(1) attachment-affiliative subsystem provides survival and security. security. (2) Dependency subsystem promotes promotes helping behavior that that calls for a nurturing response. (3) Ingestive Ingestive system satisfies satisfies appetite. appetite. (4) Eliminati Eliminative ve subsystem subsystem excretes body wastes. (5) Sexual subsystem subsystem functions dually for procreation and gratification. gratification. (6) Achievement subsystem subsystem attempts to manipulate the environment. (7) Aggress Aggressive ive subsyste subsystem m protec protects ts and preser preserves ves the self self and societ society y within within the limits limits imposed by the society. Peplau’ Peplau’ss Psychody Psychodynam namic ic Nursing Nursing The Theoryory- Hild Hildeg egar ard d Pepl Peplau au intr introdu oduce ced d and and defi define ned d   psych psychody odynam namic ic nursin nursing g as underst understandi anding ng one’s one’s own behavior behavior to help help others others identif identify y felt felt difficulties and applying principles of human relations to problems arising during the experience. She also described the nurse-patient relationship in four phases:

(1) Orientati Orientation on – patient patient seeks help and the nurse assists assists patient patient to understand understand the problem and the extent of need for help. (2) (2) Iden Identi tifi ficat catio ion n - patie patient nt assu assume mess a postu posture re of depe depende ndenc nce, e, inte interd rdep epen ende dence nce,, and and independence in relation to the nurse (3) Exploitation - patient uses available available services on the basis of self interest and needs (4) Resolution Resolution - old needs needs and goals are put aside and new ones adopted. adopted. Leininger’s Transcultural Care Theory –  Madeleine Leininger established the transcultural nursing which she defined as a major area of nursing that focuses on comparative study and analysis of different cultures and subcultures in the world, with respect to their: (1) Caring Caring behav behavior  ior  (2) Nursin Nursing g care care (3) Health Health values values (4) (4) Beli Belief efss (5) (5) Patt Patter erns ns Watson’s Philosophy and Science of Caring – Jean Watson believes the practice of caring is central to nursing; it is a unifying focus for practice. According to her, there are two major  assumptions that underlie human care (carative factors): (1) care and love constitute the primal and universal psychic energy (2) care and love are requisite for our survival and the nourishment of the society FIELDS OF NURSING

The Fields of Nursing may be classified in general as follows: 1. Hospital Hospital Nursing Nursing or the Instituti Institutional onal Nursing Nursing 2. Publ Public ic Healt Health h Nur Nursi sing ng 3. Comm Communi unity ty Heal Health th Nur Nursi sing ng

4. 5. 6. 7. 8. 9.

School School Nursin Nursing g or Nursin Nursing g Educa Educatio tion n Occupational Occupational Health Health Nursing Nursing or Industrial Industrial Nursing Nursing Mili Milita tary ry Nurs Nursin ing g Clin Cliniic Nur Nursing sing Indepe Independen ndentt Nursin Nursing g Pract Practice ice Priv Privat atee Dut Duty y Nurs Nursin ing g

Institutional Nurses- those employed as staff nurses or nursing personnel in a hospital setting or  similar institutions. Public Health Nurse – is one who provides nursing care and counsel to persons and families, either to individual or groups in clinics, in their homes, in school, and at their place of work, and cooperates with others in health promotion. Community Health Nurse – a nurse whose work combines the element of nursing and public health practice and takes place outside the therapeutic institutions.

School Nurse –  a registered nurse employed to work in educational institutions to participate in health programmes for school-aged children. Responsibilities include monitoring growth and development, screening health problems and supporting those pupils with special needs.

Occupation Occupa tional al Health Health Nurse/ Nurse/ Industr Industrial ial Nurse Nurse – one one empl employ oyed ed in indus industr try y that that gives gives immediate care to ill or injured workers, follows up on the sick and the injured, and helps develop accident prevention and health programs for the workers.

Maternal and Child Health Nurse – one who cares for and safeguards the health of mothers and children. Nurse Educator – a nurse employed in the teaching or administrative staff of a school of  nursing or other educational institution for nurses. Pediatric Care Nurse – a registered nurse qualified in the nursing nu rsing care of the sick child. Private Duty Nurse – is a registered nurse who independently contracts with a patient; a private duty nurse is responsible for the total nursing care of the patient during the period she is with him. Nursing Administrator – is a professional nurse who is a member of the administrative staff of  a hospital, medical center, public health agency, or a similar institution and who, as a member of  the administrative staff, participates in formulating the policy and objectives of such.

Clinical Nurse Specialist – A professional nurse, who has had special training and experience in a particular clinical specialty, often holds a degree, and is prepared to give expert care to the acutely or chronically ill and to assist clients to maintain health.

ETHICO-MORAL RESPONSIBILITY

Ethi Ethics cs –    par partt of phil philos osop ophy hy that that deal dealss with with syst system emat atic ic appr approa oach ches es to ques questi tion onss of  morality. - a term for the study of how we make judgments regarding right and wrong. - a system system of of MORAL MORAL PRINC PRINCIP IPLES LES or or moral moral stand standard ardss governi governing ng conduc conduct. t.

Morals- human conduct in the application of ethics. Concerned with JUDGMENT PRINCIPLES of right and wrong in relation to human actions and character.

governing the NURSE’S NURSE’S BEHAVIOR, especially especially towards towards patients, patients, Nursing Ethics – the code governing 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 toward preventing or removing removing harm and promoting promoting good such as: (1) One ought to prevent prevent evil evil or harm harm (2) One ought to remove remove evil or harm (3) One ought to do or promote 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. In health care, justice seems to point to distributive justice that deals with the allocation of scarce resources. ARTICLE XIII of the 1987 Constitution  provides: The State shall adopt an integrated and comprehensive approach to health development and shall endeavor to make essential goods; health and social services available to all people at affordable cost. There shall be priority for the needs of the underprivileged, the sick, the elderly and the disabled, disabled, the women and the children. children. The State shall endeavor to provide provide free medical medical care care to pauper paupers, s, establ establish ish and mainta maintain in an effect effective ive food food and drug drug regula regulator tory y syste system, m, and undert undertake ake approp appropria riate te health health manpow manpower er and develop developmen mentt and resear research ch respon responsiv sivee to the country’s health needs and problems. It shall establish a special agency for disabled persons for  their rehabilitation.

Some methods of distributing goods and services in our society are as follows: (1) To each, each, an equal share (2) To each, each, accordin according g to need need (3) To each, each, according according to to effort effort (4) To each, accordin according g to contribution contribution (5) To each, each, according according to to merit merit (6) To each, accordin according g to ability ability to pay

care, it means the form of personal personal LIBERTY, LIBERTY, where the individu individual al is Autonomy - In health care, free to choose and implement ones’ own decisions, free from deceit, duress, constraint, or  coercion. Three Basic elements involved: (1) abili ability ty to decide decide (2) power to to act upon upon your decisions decisions (3) a respect for the individua individuall autonomy of others. 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 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: (1) the patient agrees to divulge such information information with written consent (2) the information is is material in a criminal case investigation (3) if public safety safety is jeopardized jeopardized (communicable (communicable disease) disease) (4) such information is relevant relevant to his care to be utilized utilized by other health team Priviliged Communication may be divided into two classes: (1) Absolute Absolute privileged privileged communicatio communication n – is one made in the interest 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. (2) Qualified privileged communication communication – is a slanderous statement uttered in good faith, 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.

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: a. that that the the acti action on must must be mora morally lly good good  b. that the the good effect effect must must be wille willed d and the bad bad effect effect merely merely allowed allowed

c. that the good good effect effect must not not come from from an evil action action but from from initial initial action action itself  itself  directly; and d. that the the good effect effect must be greater greater than than the the bad effect. 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 ONE IS HE HELD LD TO TH THE E IMPO IMPOSS SSIB IBLE LE – the the doct doctor orss and and nurs nurses es are are not 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. allowed. A nurse shall not participat participatee upon immoral operations 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. 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.

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: (1) disclo disclosur suree (2) underst understandi anding ng (3) volunt voluntari arines nesss (4) (4) comp compet eten ence ce (5) permis permissio sion n giving 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..)

The Patients Bill of Rights (Filipino)

1. The patient patient has the right right to considerate considerate and respectf respectful ul care, irrespect irrespective ive of socioeconomi socioeconomicc status 2. The The pati patien entt has has the the right right to obta obtain in from from his his physi physici cian an comp comple lete te curr current ent inform informat atio ion n 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 patient has the right right to receiv receivee from his physici physician an informat information ion necessa necessary ry to give info inform rmed ed conse consent nt prio priorr to the the star startt of any any proc procedu edure re and/o and/orr trea treatm tment ent.. Exce Except pt in emergencies, such information for informed consent should include but not necessarily limite limited d to the specif specific ic proced procedure ure and/or and/or treatm treatment ent,, the medica medically lly signif significa icant nt risks risks involv involved, ed, and the probab probable le durati duration on of incapa incapacit citati ation. on. Where Where medica medicall lly y signif significa icant nt alte altern rnat ativ ives es for for care care or trea treatm tment ent exis exist, t, or when when the the pati patien entt requ reques ests ts info inform rmat atio ion n 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 patient has the right to to refuse treatmen treatment/li t/lifegivi fegiving ng measures, measures, to the extent permitt permitted ed  by law, and to be informed of the medical consequences of his action. 5. The The pati patien entt has the righ rightt to ever every y cons consid ider erat atio ion n of his priv privac acy y conce concern rnin ing g his his own medical medical care program. Case discussion discussion,, consultati consultation, on, examination examination and treatment 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 patient has the right right to expect that that all communic communicati ation on and records records pertain pertaining ing to his care should be treated confidential. con fidential. 7. The The pati patien entt has has the the righ rightt to expect expect that withi within n its its capac capacit ity, y, a hosp hospit ital al must 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 patient has the right right to obtain obtain inform informati ation on as to any relatio relationsh nship ip of the hospit hospital al to other health care and educational institutions in so far as his care is concerned. The   patie patient nt has the right to obtain obtain informat information ion as to the existe existence nce of any professi professional onal relationship among individuals, by name, who are treating him. 9. The patien patientt has the right right to be advised advised if the hospital hospital propos proposes es to engage engage in or perform 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 bill regardless of  source of payment. 12. The patient has the the right to know what hospital rules and regulations regulations apply to his conduct as a patient.

The PATIENTS RESPONSIBILITIES towards his care in the hospital: 1. Providing information – It is a responsibility of the patient to provide the staff  with accurate and complete information, to the best of his knowledge, about the history of his illness, complaints. If the patient is unable to do so, then her  immediate family member may give such information. 2. Complying with instructions – the patient is responsible for complying with the treatment recommended by the attending physician p hysician or health team that is  primarily responsible for his care. 3. Informing the physician of refusal to treatment – A patient who refuses treatment or to be compliant with the treatment regimen must inform the  physician of his decision. 4. Paying the hospital charges –  upon admission, the patient understands that he or  she must pay the charges that he or she may incur in th course of her treatment. The exception is of course if the patient is admitted on charity hospitals giving everything for free. 5. Adherence to hospital rules and regulations –  the patient is also governed by the rules and regulation of the hospital which he or she is seeking medical help for  his/her condition. The patient or the immediate family member must read the

rules or must be informed about the policy of the hospital and must adhere to them. 6. Consideration and respect for others –  the patient must also show respect for  other patients admitted in the hospital.

NURSES’ BILL OF RIGHTS

(1) Nurses have the right right to practice practice in a manner that fulfills their obligation to to society and to those who receive nursing care. (2) Nurses have have the right to practice practice in environments environments that allow allow them to act in accordance with professional standards and legally au thorized scopes of practice. (3) Nurses have the right right to a work environment that supports and facilitates facilitates ethical  practice, in accordance with the code of Ethics for nurses and its interpretive statements. (4) Nurses have have the right to freely freely and openly advocate advocate for themselves themselves and their   patients, without fear or retribution (5) Nurses have the right right to a fair compensation for their work, consistent consistent with their  knowledge, experience, and professional responsibilities. (6) Nurses have the right right to a work environment that is safe for themselves and their   patients. (7) Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.

BASIC HUMAN RIGHTS ON RESEARCH SUBJECTS:

(1) Right to informe informed d consent consent (2) Right to refuse and/or withdrawal from participation (3) Right Right to priva privacy cy (4) Right to confident confidentialit iality y (5) Right to be be protected protected from harm harm

CODE OF ETHICS IN NURSING

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The fundamental responsibility of the nurse is fourfold: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is respect for life, dignity and the rights of man. It is unrestricted by consideration of nationality, race, creed, color, age sex,  politics, or social status.   Nurse Nursess render render health health servic services es to the indivi individual dual,, the family family and the commun community ity and coordinate their services with those of related groups.

The following Code for Nurses, adopted by the Council of National Representatives of the International Council of Nurses was also adopted by the Board of Nursing and became an integral part of the amended “Code of Nursing Ethics in the Philippines”: Nurses and People - The nurse’ nurse’ss primary primary responsibi responsibility lity is to to those those people people who who require require nursing nursing care. care. The nurse, in providing care, promotes an environment in which the values, customs and spiritual beliefs of the individual are respected. The nurse holds in confidence personal information and uses judgment in sharing this information. Nurses and Practice - The The nurse nurse carr carrie iess pers person onal al resp respons onsib ibil ilit ity y for for nurs nursin ing g prac practi tice ce and and for for main mainta tain inin ing g competence by continual learning. The nurse maintains the highest standards of nursing care possible within the reality of  a specific situation The nurse uses judgment in relation to individual competence when accepting and delegating responsibilities. The nurse nurse when when acting acting in a profes professio sional nal capacit capacity, y, should should at all times times mainta maintain in standards of personal conduct which reflect credit u pon the profession. Nurses and Society - The nurse nurse shares shares with other other citize citizens ns the responsi responsibil bilit ity y for initiat initiating ing and support supporting ing action to meet the health and social needs of the public. Nurses and the Profession - The nurse nurse plays plays the major major role role in determ determini ining ng and impleme implementi nting ng desirab desirable le standar standards ds of nursing practice and nursing education. The nurse is active in developing a core of professional knowledge. The nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing.

AMENDED CODE OF ETHICS FOR NURSES

Their conduct should be such that would bring credit to the profession. Just like any other    professional, nurses are looked upon with respect in the community. They should therefore endeavor to live a life that would uphold their self-respect. Especially when nurses are on duty, they should try to look neat and attractive. Female nurses are advised to use moderate make-up and have a neat hairstyle. They should wear uniforms that are not too short or tight fitting that would tend to restrict movements, nor expose unnecessarily

any part of the body while giving care to the patients. Clean uniforms and clean bodies tend to enhance the image of nurses. Use of anti-perspirant is advised most specially during hot summer  months. Male nurses are likewise advised to be clean, shaven, hair clipped close to the nape of the neck instead of flowing to the shoulders. The use of the uniform should be specified in the policy of the hospital/agency. It should be worn only when on duty. Dining in the public, shopping or going to the market while in uniform is discouraged. Nurses’ caps are worn only while on duty. These are either carried in bags or are left in their places of assignment. Jewelry, such as earrings, necklaces or bracelets are not allowed while on duty. However, wedding rings, school rings or school pins may be worn. Nurses are looked upon by nursing students as their role models. Therefore, especially while they are on duty, they should act in a manner that is worth emulating. Sincere and compassionate attitudes toward patients are caught by those around them. Soon their working environment  becomes permeated with good working wo rking relationships that are so vital in dealing with patients.

LEGAL RESPONSIBILITY

Legal Aspects in the Practice of Nursing -

The law has always governed the practice of modern nursing. This what makes the every erroneous nursing action liable to the law, either answerable to the Civil Law or the Criminal Law or both. The key word to remember in the legal responsibility of nurses is ACCOUNTABILITY. The professional nurse is expected to render reasonably competent nursing care to avoid getting entangled with the long arm of the law. Anything short of  such standard required that would cause harm or injury to the patient makes the nurse

responsible or liable to the law by way of negligence or even malpractice suit. The safe way to avoid such potential legal problems is amplified in the Philippine Nursing Act of  2002 (RA9173) – that is, for nurses to utilize the nursing process in the performance of  their function and observe the provision of RA 9173 which governs the practice of  nursing in the Philippines.

The The Phil Philip ippi pine ne Nurs Nursin ing g Act Act of 2002 2002 (RA (RA 9173 9173)) Arti Articl clee VIII VIII Sect Sectio ion n 35 enum enumer erat ates es the the   pro prohi hibi biti tions ons in the the prac practi tice ce of nursi nursing: ng: A fine fine of not not less less than than 50,00 50,000.0 0.00 0 nor nor more more than than 100,000.00 or imprisonment of not less than 1 year nor more than 6 years, or both, upon the discretion of the court, shall be imposed upo n: (a) any person person practicing practicing nursing nursing in the Philippi Philippines nes within within the meaning of RA 9173 9173 of 2002: (1) without certificate of registration/professional registration/professional license and professional identification identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of this Act; or  (2) who uses as his/her his/her own certificates of registration/ professional professional license and professional professional identification card or special/temporary permit of another; or  (3) who uses uses an invali invalid d certi certific ficate ate of regist registrat ration ion/pr /profe ofessi ssiona onall licens license, e, a suspen suspended ded or  revoke revoked d certi certific ficate ate of regist registrat ration ion/pr /profe ofessi ssional onal licens license, e, or an expire expired d or cancell cancelled ed special/temporary permit; or  (4) (4) who who give givess any any fals falsee evid eviden ence ce to the Boar Board d in orde orderr to obtai obtain n a cert certif ific icat atee of  registration/professional license, a professional identification card or special permit; or  (5) who falsely poses or advertises as a registered and licensed licensed nurse or uses uses any other means that tend to convey the impression that he/she is registered and licensed nurse; or  (6) who appends B.S.N./R.N. B.S.N./R.N. or any similar similar appendage to his/her name without without having been conferred said degree or registration; or  (7) who, as a registered registered and licensed nurse, nurse, abets or assists the illegal illegal practice practice of a person who is not lawfully qualified to practice nursing. (b) any person or the chief executive executive officer of a juridical juridical entity who undertakes undertakes in-servic in-servicee educational programs or who conducts review classes for local and foreign examination without permit/clearance from the board and the Commission; or  (c) any person person or employer employer of nurses who violate violate the minimum minimum base pay pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or  (d) any person or the chief executive executive officer of a juridical entity entity violating violating any provision provision of  this Act and its rules and regulations.

THE PHILIPPINE NURSING ACT OF 2002 OR RA 9173

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An Act providing for more responsive nursing profession, repealing for the purpose Republic Act 7164, otherwise known as the “Philippine Nursing Act of 1991” and for  other purposes.

(Note: The following presentation is the reproduction of RA 9173 with explanation on selected articles appearing in the italics) ARTICLE I TITLE

SECTION 1. Title – This This Act shall be known as the Philippine Nursing Act of 2002.”

ARTICLE II DECLARATION OF POLICY

SECTION 2. Declaration of Policy. – It is hereby declared the policy of the State to assume respons responsibi ibilit lity y for the protec protectio tion n and improv improveme ement nt of the nursin nursing g profes professio sion n by instit instituti uting ng measures that will result in relevant nursing education, humane working conditions, better career   prospects and a dignified existence for our o ur nurses. The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system throughout the country.

ARTICLE III ORGANIZATION OF THE BOARD OF NURSING

created a SECTION 3. Creation and composition of the Board - There shall be created a created Professional Regulatory Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They shall be appointed by the President of the Republic of the Philip Philippin pines es from from among among the two (2) recommen recommendees dees,, per vacancy vacancy,, of the accred accredite ited d  professional organization of nurses in the Philippines who possess the qualifications prescribed in Section 4 of this Act.  NOTE: The structure structure of the members of the Board Board of Nursing was augmented augmented from 5 members members under RA 7164 to 7 members in RA 9173. The chairperson shall have six members, shall cover  the three areas of nursing, namely: nursing education, nursing service, and community health nursing. nursing. The members members now are selected selected from two recommendees recommendees coming from the endorsement  of Accredi Accredited ted Professi Professiona onall Organi Organizat zation ion (Philip (Philippin pinee Nursin Nursing g Associa Associatio tion) n) which which also also pre selected their endorsement not later than three months prior to expected vacancy from three nominees per vacancy unlike under RA 7164 where the President appoints the members from 12 nominees. The 7 positions in the Board of Nursing does not ( mandatory) require that all    posit position ionss be filled filled up in order to function function ,if the majorit majorityy positi positions ons are occupied occupied then it  constitute the Board to function. SECTION 4. Qualifications of the Chairperson and the Members of the Board. – The Chairperson and the Members of the Board shall, at the time of their appointment, possess the following qualifications:

(a) Be a natural born citizen citizen and resident of the Philippi Philippines; nes;

 NOTE: Natural born Filipino citizen are those Filipino who, since birth did not make any  positive act to perfect their citizenship. (b) Be a member member of good good standi standing ng of the accredi accredited ted professi professiona onall organi organizat zation ion of  nurses;   NOTE: NOTE: The Accredi Accredited ted Profes Profession sional al Associa Associatio tion n (APO) (APO) recogn recognize izess the Phili Philippi ppine ne Nurses Nurses  Association (PNA) as mentioned in the Implementing Rules and Regulation of RA 9173. The other existing members of PNA mentioned in the preliminary chapter of this reviewer are deemed also accredited to satisfy this requirement.

( c ) Be a registered nurse and holder of a master’s degree in nursing, education or  other allied medical profession conferred by a college or university duly recognized by the government: Provided, That the majority of the Members of the Board shall be holders of a master’s degree in nursing: Provided, further, That the Chairperson shall be a holder of master’s degree in nursing.  NOTE: The new requirement for the members of the Board is a departure from the previous requirement requiring all members of the Board to be master’s degree holder in Nursing. RA 9173 provides that only the chairperson and a majority (not all the members) of the members must be master’s degree holder in nursing and the other members may be master’s degree holder in education or other allied health profession. (d) Have at least ten years (10) years of continuous continuous practice of the profession prior to appoint appointment ment:: Provid Provided, ed, howeve however, r, That That the last five five years years (5) of which which shall shall be in the Philippines; and  NOTE: This new provision which was silent in the previous law allows allows the member of the Board  Board  to qualify as a nominee even if she practiced nursing abroad, only that, the last five years before the appointment, that member must have practiced her nursing profession in the Philippines. Philippines .

(e) Not have been convicte convicted d of any offense offense involving involving moral turpitude turpitude;; Provided, That the membership to the Board shall represent the three areas of nursing, namely: nursing education, nursing service and community health nursing.  NOTE: Take note of the key word, convicted. An ongoing prosecution in a criminal case does not constitute a hindrance to being nominated as a member to the Board because the law speaks of conviction which means that a competent court had rendered already its final decision on the case. If such member was convicted in the past for crime involving moral torpidity, even if the  penalty was served, is a prohibition to be nominated in the Board.

SECTION 5. Requirements Upon Qualifications as Member of the Board of Nursing. – Any  person appointed as Chairperson or Member of the Board shall immediately resign from any teaching position in any school, college or university or institution offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations or in any office or  employment in the government or any of its subdivision, agency or instrumentality thereof, including including government-owned government-owned or controlled controlled – corporation corporationss or their subsidiari subsidiaries es as well as those employed in the private sector. He/she shall not have any pecuniary interest in or administrative superv supervisi ision on over over any insti institut tution ion offeri offering ng Bachel Bachelor or of Scienc Sciencee in Nursin Nursing g includ including ing review review classes.  NOTE: The qualification required by this Act means that they must be satisfied at the time of   Appointment  Appointment.. The President is the only person who can appoint appoint such member of the Board and   such appointment commences only after the President approves through her signature in the appointment paper. This further means that even if the nominee is not yet qualified during the recommendati recommendation on period, period, he/she shall have time to perfect perfect or satisfy satisfy all the requirements before the President signs her appointment. A member may continue to teach in a nursing institution and may only resign during the time that she is appointed.

SECTION SECTION 6. Term of Office. The Chairperson Chairperson and Members of the Board shall hold office office for a term of three three (3 years) and until their their successors shall have been appointed and qualified: Provided, That the Chairperson and Members of the Board may be reappointed for another term. Any vacancy in the Board occurring within the term of a member shall be filled for the unexpired portion of the term only. Each Member of the Board shall take the proper oath of office prior to the performance of his/her duties. The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under RA 7164 until their replacements have been appointed by the President and shall have been duly qualified.

 NOTE: The maximum number or years that a member member can stay as a member of the Board is six  years because from their original appointment of three years, they are still eligible to be reappointed for another three years. However, the Hold-over doctrine applies to this provisions because because it specifica specifically lly provides provides that a mem member ber shall continu continuee to hold office office until until their  their   successors shall have been appointed and qualified. SECTION 7. Compensation of Board Members. – The Chairperson and Members of the Board shall receive compensation and allowances received by the Chairperson and Members of  other professional regulatory boards.

SECTION 8. Administrative Supervision of the Board, Custodian of its Records, Secretariat and and Supp Suppor ortt Serv Servic ices es.. – The The Boar Board d shal shalll be under under the the admi admini nist stra rati tive ve super supervi visi sion on of the the Commission. All records of the Board, including applications for examinations, administrative and and othe otherr inve invest stig igat ativ ivee case casess cond conduct ucted ed by the the Boar Board d shal shalll be under under the the cust custod ody y of the the Commission. The Commission shall designate the Secretary of the Board and shall provide the the secretariat and other support services to implement the provisions of this Act. SECTION 9. Powers and Duties of the Board. – The Board shall supervise and regulate the  practice of the nursing profession and shall have the following powers, duties and functions: (a) Conduct the the licensure licensure examinatio examination n for nurse; (b) Issue, suspend or revoke certificates of registration for the practice of nursing; (c) Monitor Monitor and enforce enforce quality standards standards of nursing practice practice in the Philippines Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation; (d) Ensure Ensure quality quality nursing education education by examining examining the prescribed prescribed facilities facilities of universities universities or  colleges of nursing or departments of nursing education and those seeking permission to open nursing courses to ensure that standards of nursing education are properly complied with and maintained at all times. The authority to open and close colleges of nursing and/ and/or or nurs nursin ing g educa educati tion on prog progra rams ms shal shalll be vest vested ed on the the Comm Commis issi sion on of Highe Higher  r  Education upon written recommendation of the Board. (e) Conduct hearings hearings and investigati investigations ons to resolve conduct conduct and violations violations of this Act, or its rules and regulations and in connection therewith, issue subpoena ad testificandum and subpoena duces tecum to secure the appearance of respondents and witnesses and the  production of documents and punish with contempt persons obstructing, impeding and/or  otherwise interfering with the conduct of such proceedings, upon application with the courts; (f) (f) Prom Promul ulga gate te a Code Code of Ethi Ethics cs in coor coordi dina nati tion on and and cons consul ulta tati tion on with with the the accr accred edit ited ed  professional organization of nurses within one (1) year from the effectivity of this Act; (g) (g) Reco Recogni gnize ze nurs nursin ing g spec specia ialt lty y orga organi niza zati tions ons in coord coordin inat atio ion n with with the the accr accred edit ited ed  professional organization; and (h) Prescribe, adopt, issue and promulgate promulgate guidelines, regulations, regulations, measures and decisions decisions as may be necessary for the improvement of the nursing practice, advancement of the  profession and for the proper and full enforcement of this Act subject to the review and approval by the Commission.  NOTE: The adoption and regulation of a Code of Ethics and Code of Technical Standards for  the practice of nursing are new addition in the powers of the Board included in this law. The  Board also exercises quasi-judicial powers because they can issue subpoena duces tecum (court  ordering the person to bring documents with himself to appear before the court) and subpoena ad testificandum testificandum (court ordering the person to be present before the court). The Board can also  punish a person by way of contempt. This power is exercised only by competent courts but the law delegates delegates such powers to the Board of Nursing through through the legislation legislation of RA 9173.Under  this this Act, Act, the Board Board of nursing nursing now recogni recognizes zes special specialty ty organiz organizati ations ons with with the accredi accredited  ted   professional organizations.

SECTION 10. Annual Report. – The Board shall at the close of its calendar year submit an annual report to the President of the Philippines through the Commission giving a detailed account of its proceedings and the adoption of measures that will upgrade and improve the conditions affecting the practice of the nursing profession. SECTION 11. Removal or Suspension of Board Members. – The President may remove or  susp suspen end d any any memb member er of the the Boar Board d afte afterr havi having ng been been given given the the oppor opportu tuni nity ty to defe defend nd himself/herself in a proper administrative investigation, on the following grounds: (a) Continued Continued neglect neglect of duty or or incompetenc incompetence; e; (b) Commission or toleration of irregularities irregularities in the licensure examination; examination; and (c) Unprofessio Unprofessional, nal, immoral immoral or dishonorable dishonorable conduct.  NOTE: Only the President of the Philippines has the sole power to remove or suspend the members of the Board of Nursing. The members of the Board being Presidential appointees are the alter ego of the President, which means that they are under the whims and caprices of the appointing officer with respect to their stay in the office.

ARTICLE IV EXAMINATION AND REGISTRATION

SECTION 12. Licensure Examination. – All applicants for licensure to practice nursing shall  be required to pass a written examination, which shall be given by the Board in such places and dates as maybe designated by the Commission: Provided, that it shall be in accordance with Republic Act No. 8981, otherwise known as the “PRC Modernization Act of 2000.”  NOTE: Specific Specific dates as provided for in the previous previous law are no longer mentioned mentioned in the new law. It used to be not earlier than one month and not later than two months after the closing of  each semestral term. SECTION 13. Qualifications for Admission to the Licensure Examination. – In order to be admi admitt tted ed to the the exam examin inat atio ion n for for nurse nurses, s, an appl applic icant ant must must,, at the the time time of fili filing ng his/ his/her  her  application, establish to the satisfaction of the Board that: (a) He/she is a citizen citizen of the Philippines, Philippines, or a citizen citizen or subject of a country which which permits Filipino nurses to practice within its territorial limits on the same basis as the subject or  citizen of such country: Provided: That the requirements for the registration or licensing of nurses in said country are substantially the same as those prescribed in this Act;

(b) He/she is is good moral moral character; character; and and (c) He/she is a holder holder of a Bachelor’s Bachelor’s Degree Degree in Nursing from from a college or university university that that comp compli lies es with with the the stand standar ards ds of nursi nursing ng educa educati tion on duly duly reco recogn gniz ized ed by the the prop proper  er  government agency.  NOTE: Under the previous law, no examinee shall take the licensure exam below the age of 18.  It is no longer included in the new nursing law. SECTION 14. Scope of Examination. – The scope of the examination for the practice of  nurs nursin ing g in the the Phil Philip ippi pines nes shal shalll be dete determ rmin ined ed by the the Boar Board. d. The The Board Board shal shalll take take into into consideration the objectives of the nursing curriculum, the broad areas of nursing and other  related disciplines and competencies in determining the subject examinations.  NOTE: The scope of examination for nursing is determined by the Board of Nursing alone and  not in conjunction with the PNA or the PRC.

SECTION 15. Ratings. – In order to to pass the examination, an examinee must obtain obtain a general average of at least seventy-five percent (75%) with a rating of not below sixty percent (60%) in any subject. An examinee who obtains an average rating of seventy-five (75%) or higher but gets a rating below sixty-percent (60%) in any subject must take the examination again but only in the subject or subjects where he/she is rated below sixty percent (60%). In order to pass the succeeding examination, an examinee must obtain a rating of at least seventy-five percent (75%) in the subject or subjects repeated.   NOTE: specific number of times, which an examinee can take the licensure exam, is now abolished abolished under the new nursing nursing law. It also deleted the mandatory requirement requirement of attending attending a refresher course after failure to pass the nurse licensure examination in three takes. The removal  to take the examination is within two years after the last failed examination. The examinee who  failed may take only the subject which she failed if his/her average is 75 % but with a grade of  below 60% in any subject. The law however is silent about the prohibition of the examinee in taking the entire set of examination. In the interpretation of laws – if the law is silent on a matter, then it must be construed in favor to a side that is not onerous or burdensome to the  people. To retake the examination in a subject matter that the examinee failed the last time and  to target a rating of 75% in that subject area rather than 60% only if the person retakes the entire set, is onerous on the part of the examinee. This provision must be construed in favor of  the examinee. He/She must have the option to retake the entire examination with the original   passing rate of 75% average with no grade below 60% in any subject area or he/she may retake only that subject area where he/she failed failed the last time provided he/she obtained obtained an average of  75% or above

SECTION 17. Issuance of Certificate of Registration/Professional License and Professional Identification Card. – A certificate of registration/professional license as a nurse shall be issued to an applica applicant nt who passes the examin examinati ation on upon payment payment of the prescrib prescribed ed fees. fees. Every Every certificate of registration/professional license shall show the full name of the Commission and of  the Members of the Board, and the official seal of the Commission. A professional identification card, duly signed by the Chairperson of the Commission, bearing the date of registration, license number, and the date of issuance and expiration thereof shall likewise be issued to every registrant upon payment of the required fees. SECTION 18. Fees for Examination and Registration. – Applicants for licensure and for  registration shall pay the prescribed fees set by Commission. SECTION SECTION 19. Automatic Automatic Registration Registration of Nurses. Nurses. - All nurses nurses whose names appear at the roster of nurses shall be automatically or ipso facto registered as nurses under this Act upon its effectivity.   NOTE: Though the law provides for the automatic enrolment in the roster of nurses after   passing the licensure examination, the Code of Ethics formulated under this Act invites the nurse to become a member of the PNA. SECTION 20. Registration by Reciprocity. – A certificate of registration/professional license may be issued without examination to nurses registered under the laws of a foreign state or  country: country: Provided, Provided, That the requirements requirements for registrat registration ion or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided, further, That the laws of  such state or country grant the same privileges to registered nurse of the Philippines on the same  basis as the subjects or citizens of such foreign state o r country. SECTION 21. Practice Through Special/Temporary Permit- A special/temporary permit may  be issued by the Board to the following persons subject to the approval of the commission and upon payment of the prescribed fees: (a) Licensed Licensed nurses from foreign foreign countries/ countries/state statess whose service service are either for a fee or free if  they are internationally well-known specialists or outstanding experts in any branch or  specialty of nursing; (b) Licensed Licensed nurses from from foreign foreign countries/s countries/states tates on medical medical mission mission whose services services shall shall  be free in a particular hospital, center or clinic; and (c) Licensed Licensed nurses from foreign foreign countries/stat countries/states es employed by school/colleg school/colleges es of nursing nursing as exchange professors in a branch or specialty of nursing; Provided, however, That the special/temporary permit shall be effective only or the duration of  the project, medical mission or employment contract.

SECTION 22. Non-registration and Non-issuance of Certificates of Registration/Professional License or Temporary Permit. – No person convicted by final judgment of any criminal offense

involving moral turpitude or any person guilty of immoral or dishonorable conduct or any person declared by the court to be of unsound mind shall be registered and be issued a certificate of  registration/professional license or a special/temporary permit. The Board shall furnish the applicant a written statement setting forth the reasons for its actions, which shall be incorporated in the records of the Board SECTION 23. Revocation and Suspension of Certificate of Registration/Professional License and Cancellation of Special/Temporary Permit.- The Board shall have the power to revoke or  suspend the certificate of registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds: (a) (b) (c) (d) (e) (e)

For any of the the causes mentione mentioned d in the preceding preceding section; section; For unprofess unprofessional ional and unethica unethicall conduct; For gross gross incompetence incompetence or seriou seriouss ignorance; ignorance; For malpracti malpractice ce or negligence negligence in the practice of nursing; nursing; For For the the use use of frau fraud, d, dece deceit it,, or fals falsee stat statem emen ents ts in obta obtain inin ing g a cert certif ific icat atee of  registration/professional registration/professional license or a temporary/special permit; or  (f) For practicing practicing his/her his/her profession profession during during his/her suspension suspension from such such practice . Provided, however, That the suspension of the certificate of registration/professional license shall be for a period not to exceed four (4) years.  NOTE:  NOTE: Section Section 23 (f) is an addition addition in this new law. law. The suspended suspended nurse cannot cannot practice practice nursing profession while serving his/her suspension orders. Take note of the maximum period of   suspension, it cannot go beyond four years.

SECTION 24. Re-issuance of Revoked Certificates and Replacement of Lost Certificates.The Board may, after the expiration of a maximum of four (4 ) years from the date of revocation revocation of a cert certif ific icat ate, e, for for reas reason onss of equi equity ty and and just justic icee and and when when the the cause cause for for revoc revocat atio ion n has has disappeared or has been cured and corrected, upon proper application therefore and the payment of the required fees, issue another copy of the certificate of registration/professional license. A new certificat certificatee of registration/pr registration/profess ofessional ional license to replace replace the certificate certificate that has been lost, destroyed or mutilated may be issued, subject to the rules of the Board.

ARTICLE V  NURSING EDUCATION

SECTION 25. Nursing Education Program. – The nursing education program shall provide sound general and professional foundation the practice of nursing. The Learning experiences shall adhere strictly to specific requirements embodied in the  prescribed curriculum as promulgated by the Commission on Higher Education’s policies and standards of nursing education.

SECTION 26. Requirement for Inactive Nurses Nurses Returning to Practice. Practice. – Nurses who have not actively practiced the profession for five (5) years are required to undergo one month of didactic training and three months of practicum. The Board shall accredit hospitals to conduct the said training program.  NOTE: this is a new provision providing for the guidelines of inactive nurses who wish to return to practice their nursing career. Didactic training means a lecture program. SECTION 27. Qualifications of the Faculty. – A member of the faculty in a college of nursing teaching professional courses must: (a) (b) (c) (d)

Be a registered registered nurse nurse in the the Philippine Philippines; s; Have at least one (1) year of clinical practice in in a field of specialization; specialization; Be a member of good standing in the accredited professional organization of nurses; and Be a holder of a master’s master’s degree degree in nursing, education, education, or other allied medical medical and health sciences sciences conferred by a college college or university university duly recognized recognized by the Government Government of the Republic of the Philippines.

In addition to the aforementioned qualifications, the dean of a college must have a master’s degree in nursing. He/she must have at least five (5) years of experience in nursing.

 NOTE: The requirement for the clinical experience of a faculty was reduced from three years in the previous law to only one year in the new law. The requirement for the dean was increased from three years to five years in teaching and supervising a nursing education  program.

ARTICLE VI  NURSING PRACTICE

SECTION SECTION 28. Scope of Nursing. Nursing. A person shall shall be deemed to be practicing practicing nursing nursing within the meaning of this Act when he/she singly or in collaboration collaboration with another , initiates and performs nursing services to individuals, families and communities in any health care setti setting. ng. It includes includes but not limited limited to, nursing nursing care care during during concepti conception, on, labor, labor, delivery delivery,, infancy, infancy, childhood, toddler, pre-school, pre-school, school age, adolescence, adolescence, adulthood and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and  prevention of illness. As Members of the Health Team, nurses shall collaborate with other  health health care care provid providers ers for the curati curative, ve, preven preventiv tive, e, and rehabi rehabili litat tative ive aspect aspectss of care, care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a  peaceful death. It shall be the duty of the nurse to: (a) Provide nursing care through the utilization of the nursing process. process. Nursing care includes, includes,   but not limit limited ed to, tradit tradition ional al and innova innovativ tivee approach approaches, es, therap therapeut eutic ic use of self, self, executing executing health health care techniques and procedures, procedures, essential essential primary primary health care, comfort measures, measures, health health teachings, teachings, and administr administration ation of written written prescripti prescription on for treatment, treatment, therapies, therapies, oral, topical topical and parenteral parenteral medications, medications, internal internal examination examination during labor in the absence of bleeding bleeding and delivery. In case of suturing of perineal laceratio laceration, n, special training shall be provided according to protocol established; (b) Establish linkages with community resources resources and coordination with with the health team; (c) Provide health education to individuals, families families and communities; (d) (d) Teac Teach, h, guid guidee and super supervi vise se stud student entss in nurs nursin ing g educa educati tion on prog progra rams ms incl includi uding ng the the including including the administrat administration ion of nursing nursing services services in varied varied settings settings such as hospitals and clinic clinics; s; underta undertake ke consult consultati ation on servic services; es; engage engage in such such activi activitie tiess that that requir requiree the utilization of knowledge and decision-making skills of a registered nurse; and (e) Underta Undertake ke nursin nursing g and health health and health health human resour resource ce develop developmen mentt traini training ng and research, which shall include, but not limited to, the development of advance nursing  practice;

Provided: That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided further, That in the practice of  nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence   by continu continual al learni learning ng through through continu continuing ing profes professio sional nal educat education ion to be provid provided ed by the accredited accredited profession professional al organizatio organization n or any recognized recognized profession professional al organizati organization on or any recogni recognized zed profes professio sional nal nursin nursing g organi organizat zation ion:: Provid Provided, ed, finall finally, y, That That the progra program m and activity for the continuing professional education shall be submitted to and approved by the Board.  NOTE: The new law deleted already the special requirement of undergoing IV therapy trainin training g before before a nurse nurse can admini administe sterr IV medicat medication ions. s. Howeve However, r, the Nursing Nursing Servic Servicee  Administrator still requires formal training in this aspect. The new law also added the  special training for suturing the lacerated perineum being undertaken by the Association of   Nursing Service Administrators Administrators with the Maternal and Child Association Association of the Philippines Philippines ( MCNAP ).

SECTION 29. Qualifications of Nursing Service Administrators.- A person occupying supervisory or managerial positions requiring knowledge of nursing must: (a) Be a registered registered nurse nurse in the the Philippine Philippines; s; (b) Have at least two (2) years years experience in general nursing service administration; administration; (c) (c) Poss Posses esss a degr degree ee of Bache Bachelo lorr of Scie Scienc ncee in Nurs Nursin ing, g, with with at leas leastt nine nine (9) (9) unit unitss in management and administration courses at the graduate level; and (d) Be a member of good standing of the the accredited professional organization or nurses; nurses; Provided, That a person occupying the position of chief nurse or director of nursing service shall, in addition to the foregoing qualifications, possess: (1) At least five (5) years of experience in a supervisor supervisory y or managerial position position in nursing; and (2) A masters masters degree degree major in in nursing; nursing;

Provided, further, That for primary hospitals, the maximum academic qualifications and experiences for a chief nurse shall be as specified in subsections (a),(b), and (c) of this section: Provided, furthermore, That for chief nurses in the public health agencies, those who have a master’s degree in public health/community health nursing shall be given priority. Provided, even further, That for chief nurses in military hospitals, priority shall be given to those who have finished a master’s degree in nursing and the completion of the General Staff  Course (GSC): Provided, finally, That those occupying positions before the effectivity of this Act shall be given a period of five (5) years within which to qualify.

ARTICLE VII HEALTH HUMAN RESOURCE PRODUCTION, UTILIZATION AND DEVELOPMENT

SECTIO SECTION N 30. Studi Studies es for Nursin Nursing g Manpowe Manpowerr Needs, Needs, Product Production ion,, Utiliz Utilizati ation on and Development.- The Board, in coordination with the accredited professional organization and appropriat appropriatee government government or private private agencies agencies shall shall initiate, initiate, undertake and conduct studies on health human resource production, utilization and development. SECTION 31. Comprehensive Nursing Specialty Program.- Within ninety (90) days from the effectivity of this Act , the Board in coordination with the accredited professional organization, recogni recognized zed specia specialt lty y organi organizat zation ionss and the Departm Department ent of Health Health is hereby hereby mandat mandated ed to formulate and develop a comprehensive nursing specialty specialty program that would upgrade the the level of skill and competence of specialty nurse clinicians in the country, such as but not limited to the

areas of the critical care, oncology, renal and such other areas as may be determined by the Board. The beneficiaries of this program are obliged to serve in any Philippine hospital for a period of  at least two (2) years of continuous service. NOTE: The Board is mandated to formulate and develop a comprehensive nursing specialty  program that would upgrade the levels of skills and competency of specialty nurse clinicians in the country. This is a new provision of the Nursing law.

SECTION 32. Salary. – In order to enhance the general welfare, commitment to service and   profe professi ssiona onalis lism m of nurses nurses,, the minimum minimum base base pay of nurses nurses workin working g in the public public health health institutions shall not be lower than the salary grade 15 prescribed under Republic Act No. 6758, otherwise known as the “Compensation and Classification Act of 1989”. Provided , That for  nurses working in local government units, adjustments to their salaries shall be in accordance with Section 10 of the said law. SECTION 33. Funding for the Comprehensive Nursing Specialty Program. – The annual financial requirement needed to train at least ten percent (10%) of the nursing staff of the  participating government hospital shall be chargeable against the income of Philipine Charity Sweepstakes Office and the Philippine Amusement Gaming Corporation, which shall equally share in the costs and shall released released to the Department Department of Health subject to the accounting accounting and auditing procedures: Provided, That the Department of Health shall set the criteria of this  program.

SECTION 34. Incentives and Benefits.- The Board of Nursing, in coordination with the Department of Health and other concerned government agencies, association of hospitals and the accredited professional organization shall establish an incentive and benefit system in the form of free hospital care for nurses and their dependents, scholarship grants and other non-cash  benefits. The government and private hospitals are hereby mandated to maintain the standard nurse-patient ratio set by the Department of Health.

ARTICLE VIII PENAL AND MISCELLANEOUS PROVISIONS

SECTION 35. Prohibitions Prohibitions in the Practice of Nursing. Nursing. - A fine of not less than 50,000.00 nor  more than 100,000.00 or imprisonment of not less than 1 year nor more than 6 years, or both, upon the discretion of the court, shall be imposed upon:

(a) any person practi practicing cing nursing nursing in the Phili Philippines ppines within within the the meaning of RA 9173 of 2002: 1. withou withoutt certif certifica icate te of regist registrat ration ion/pr /profe ofessi ssional onal licens licensee and profes professio sional nal identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of  this Act; or  2. who uses as his/her his/her own own certificat certificates es of registra registration/ tion/ profess professional ional license license and profes professio sional nal identi identific ficati ation on card card or specia special/t l/tempo emporar rary y permit permit of  another; or  3. who uses an invali invalid d certif certificat icatee of registr registrati ation/ on/pro profes fessio sional nal license, license, a suspended suspended or revoked revoked certificat certificatee of registrat registration/pr ion/profess ofessional ional license, license, or  an expired or cancelled special/temporary permit; or  4. who who give givess any any fals alse evid eviden ence ce to the Boar Board d in orde orderr to obt obtain ain a cert certif ific icat atee of regi regist stra rati tion on/p /pro rofe fess ssio iona nall lice licens nse, e, a prof profes essi sion onal al identification card or special permit; or  5. who falsely falsely poses poses or advertises advertises as a registered registered and and licensed licensed nurse nurse or uses uses any any othe otherr mean meanss that that tend tend to conve convey y the the impr impres essi sion on that that he/s he/she he is registered and licensed nurse; or  6. who who appen appends ds B.S. B.S.N. N./R /R.N .N.. or any any simi simila larr appen appenda dage ge to his/he his/herr name name without having been conferred said degree or registration; or  7. who, who, as a regi regist ster ered ed and lice licens nsed ed nurse nurse,, abet abetss or assist assistss the the ille illega gall  practice of a person who is not lawfully qualified to practice nursing. (b.) any person or the chief executive officer of a juridical entity who undertakes in-service educational programs or who conducts review classes for local and foreign examination without permit/clearance from the board and the Commission; or  ( c ) any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as specified in Sections 32 and 34; or  ( d ) any person or the chief executive officer of a juridical entity violating any provision of  this Act and its rules and regulations.  NOTE: The new law also increased the penal provisions regarding violations of the Nursing  law. The fine was raised from the minimum 10,000 and maximum of 40,000 to a minimum of  50,000 and maximum of 100,000.00. ARTICLE IX FINAL PROVISIONS

SECTION 36. Enforcement of this Act. – It shall be the primary duty of the Commission and the Board to effectively implement this Act. Any duly law enforcement agencies and officers of  nation national, al, provin provincia cial, l, city city or munici municipal pal governm government entss shall shall,, upon the call call or reques requests ts of the Commission or the Board render assistance enforcing the provisions of this Act and to prosecute  persons violating the same.`

SECTION 37. Appointments. – The Chairperson of the Professional Regulation Commission shall immediately include in its program and issue such rules and regulations to implement the   pro provi visi sions ons of this this Act, Act, the the fundi funding ng of whic which h shal shalll be incl includ uded ed in the the Annua Annuall Gener General al Appropriations Act. SECTION 38. Rules and Regulations. – Within ninety (90) days after the effectivity of this Act, the Board of Commission, in coordination with the accredited professional organization, the Depart Departmen mentt of Healt Health, h, the Depart Departmen mentt of Budget Budget and Manage Managemen mentt and other other concer concerned ned govern governmen mentt agenci agencies, es, shall shall formul formulate ate such such rules rules and regula regulatio tions ns necessa necessary ry to carry carry out the  provisions of this Act. The implementing rules and regulations shall be published in the Official Gazette or in any newspaper of general circulation. SECTION 39. Separability Clause. – If any of this Act is declared unconstitutional, the remaining parts not affected thereby shall continue to be valid and operational. SECTIO SECTION N 40. Repeal Repealing ing Clause. Clause. – Republi Republicc Act No. 7164, 7164, otherw otherwise ise known as the “Philippi “Philippine ne Nursing Nursing Act of 1991” is hereby repealed. repealed. All other laws, decrees, decrees, orders, orders, circulars, circulars, issuances, rules and regulations and parts thereof which are inconsistent with this Act are hereby repealed, amended or modified accordingly. SECTION 41. Effectivity. – This Act shall take effect fifteen (15) days upon its publication in the official publication in the Official Gazette or in any two (2) newspapers of general circulation in the Philippines.

RELATED LAWS AFFECTING THE PRACTICE OF NURSING

Act # 1931 – Created for the ESTABLISHMENT OF NURSING SCHOOLS in the country under the Bureau of Education in 1909. Act # 1975 – An act that transferred the school of  NURSING UNDER THE BUREAU OF HEALTH. Act # 2468 – An act that authorized the GRANTING OF THE TITLES of graduate in nursing and midwifery from the school of nursing of Philippine General Hospital in 1915. Act # 2808 – This act provided for the earliest and TRUE NURSING LAW that served as the  basis of the practice of nurses in the Philippines in 1919 and a year after its passage, the first local licensure or board examination for nurses was held in 1920. The First Board Examiners were created under act # 2808 composed of three members then appointed by the Secretary Interior. The chairman was a doctor of medicine and the other two are registered nurses who must possess an experience in the nursing profession for at least five years and with a reputable character. RA # 649  – provided for the standardization standardization of nurses’ salaries both in institutions and in public health. RA # 465 – an act which STANDARDIZED THE FEES charged charged by the Examining Examining Boards for Examination and Registration . RA # 546 – An act that reorganized reorganized and placed all the BOARD OF EXAMINERS under the direct supervision of the President of the Philippines. RA # 877 – An Act also known as the “Philippine Nursing Law of 1953 ” approved on June 19, 1953. This Law was sponsored by Senator Geromina T. Pecson which enacted “ to regulate the practice of nursing in the Philippines and to set up provisions for the registration of nurses, for the establishment and maintenance of standards of nursing education and nursing practice”. RA # 1080 – This act approved on 1954 is also known as, An Act Declaring the Bar and Board Examinations as “ CIVIL SERVICE EXAMINATIONS ” which means that when a four year  degree course graduate had passed the board examinations or the Bar examinations for lawyers they automatically become first grade civil service eligible. RA # 997 – This Republic Act in 1954 ABOLISHED THE DIVISION OF NURSING and created created a decentraliz decentralized ed organizatio organization n with a chief Public Health Nurse consultant consultant in the office office of the Secretary of Health, and five consultant positions in nursing; namely, in Maternal and

Child Health, in Preventable Diseases, in Institutional Nursing, in Nursing Education, and in Hospital Standardization. RA # 4704 – This act in 1966 AMENDED THE PHILIPPINE NURSING LAW OF 1953 otherwise known as RA 877 and introduced some minor revisions of the said act due to some developments of the practice of nursing nu rsing in the country. RA # 6136 – In 1971, This Republic Act introduced other  MINOR REVISIONS IN THE NURSING LAW of 1966 thus amending RA 4704 of 1966. RA 7164 –  PHILIPPINE NURSING ACT OF 1991 was sponsored by Senator Heherson Alvarez and was approved and signed by President Corazon Aquino on November 21, 1991.

1977,, the the Phil Philip ippi pine ne Nurs Nurses es ILO conve conventi ntion on 149 149 and Recom Recomme menda ndatio tions ns 157 157 – In 1977 Association, formerly known as the Filipino Nurses Association established in 1922 lobbied our government government for the adoption of ILO 149 and Recommendations Recommendations 157 that were adopted in Geneva. It set the concerns of employment of nursing personnel and the CONDITIONS OF THE LIFE AND WORK OF NURSES and in 1978; the PNA passed The Declaration on the Economic and Social Welfare of Filipino Nurses. Proclamation No. 539  – The President of the Philippines declared on October 17, 1958 that the last week of October October (through this proclamation ) as the “NURSES WEEK ”

This decree decree formed formed the PROFESSIONAL Preside Presidentia ntiall Decree Decree No. 223 223 –  This REGULATION REGULATION COMMISSION COMMISSION on June 23, 1973. Among its power is the regulation of  different profession which used to be under the Civil Service Commission. RA 6511 – This Act Amended RA 465 in 1972, which STANDARDIZED the examination and REGISTRATION fees charged by the various Board Examiners. Letter of Instruc Letter Instruction tion No. 1000 1000   – this this requir required ed that that the member memberss of Accred Accredit ited ed Professional Organizations (eg. PNA) shall be given PRIORITY in the HIRING of employees in the government service and in the engagement of professional services. RA 1612 – Refers to the payment of PRIVILEGE TAX before any business or occupation can be lawfully begun or pursued. RA 7392 – This Act provided that only licensed midwives could practice and that nurses must pass first the MIDWIFERY EXAMINATION before they can practice midwifery

RA 2382  – PHILIPPINE MEDICAL ACT ; defines the practice of medicine in the Philippines. Section 10 of this Act provides: Act constituting the practice of medicine. A person shall be considered as engaged in the practice of medicine who shall for compensation, fee, salary, or reward in any form paid to him directly or through another or even without the same may physically examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental, physical condition or ailment nature, real or  imaginary, regardless of the remedy or treatment administered, prescribed or recommended. RA 5181 – An act that prescribes PERMANENT PERMANENT RESIDENCE RESIDENCE and reciprocity as qualif qualificat ication ionss for any examina examinati tion on or regist registrat ration ion for the practi practice ce of any profes professio sion n in the Philippines

decree ee allo allowi wing ng form former er Fili Filipi pino no (BALIKBAYANS ) Preside Presidentia ntiall Decree Decree 541 – a decr  professionals to practice their respective profession in the Philippines. enacted ed in 1972 1972 decl declar arin ing g that that sale sale,, RA 6425 6425 – “DAN “DANGE GERO ROUS US DRUG DRUG ACT” ACT” enact administration, delivery, distribution, and transportation of prohibited drugs are punishable by law. Act No. 3573 – This Act in 1929 declared that all COMMUNICABLE DISEASES shall be REPORTED to the nearest health station, and that any person may be inoculated, administered or injected with prophylactic preparations. RA 1082 – creation of RURAL HEALTH UNITS in the Philippines.

RA 4073 – liberalizes the LEPROSY LEPROSY TREATMENT. TREATMENT.   No person shall be confined in leprosarium unless such disease requires institutional treatment. Presidential Decree 996 – COMPULSORY IMMUNIZATION for all children below eight years old. RA 8981 – “ PRC MODERNIZATION ACT OF 2000” This Act gave the Professional Regulatory Commission its its regulatory powers and is is now an agency of its own. Presidential Presidential Decree Decree 825 – provided penalty for improper disposal of  GARBAGE and other  forms of unclealiness.

Presidential Decree 856 – CODE OF SANITATION,  provides for control of all factors in man’s environment that affect health including the quality of water, food, milk, control of  insect insects, s, animal animal carri carriers ers,, transm transmitt itters ers of diseas disease, e, sanita sanitary ry and recrea recreatio tion n facili faciliti ties, es, noise, noise, unpleasant odors and control of nuisance.

Presidential Presidential Decree 148 – “ WOMAN AND CHILD LABOR LAW” The employable age is 16 years and above and an d further provides for the privileges of working women.

RA 6365 – established a National Policy on Population and created the Commission on Population (POPCOM). PD 791 –  revised population Act. Empowered nurses and midwives to provide, dispense and administer acceptable METHODS OF CONTRACEPTION after having undergone training and having been granted authorization by POPCOM. PD 166 – Strengthened FAMILY PLANNING programs through participation of private organizations and individuals in the formulation and implementation of the program planning  policies. General General Order No. 18 – enjoins all citizens of the Philippines, universities, colleges, schools, government offices, mass media, voluntary and religious organizations of all creeds, business and industrial enterprises to promote the concept of family welfare, responsible parenthood and family planning. Letter of Instruction No. 47 – directs all schools of medicine, nursing, midwifery and allied medical medical profession professionss and social work to prepare, plan, and implement the INTEGRATION OF FAMILY PLANNING PLANNING in thei theirr curr curric icul ulaa and to requi require re from from thei theirr grad gradua uate tess suff suffic icie ient nt appropriate licensing examination.

requires all industrial industrial establishments establishments to provide provide Depar Departm tment ent of Labor Labor Order Order No. No. 7 –  requires FAMILY PLANNING SERVICES. PD 48 – limits paid MATERNITY LEAVE privileges to four children. PD 69 – limits the number of children to FOUR for TAX EXEMPTIONS purposes. PD 965 – requires that couples intending to get married must first undergo a family planning and responsible PARENTHOOD INSTRUCTION prior to the issuance of marriage license. RA 1054 – requires the owner, lessee or operator of any commercial, industrial or agricultural establ establish ishmen mentt to furnis furnish h free free EMERGENCY, medi medica cal, l, and dent dental al ASSISTANCE to his his employees and laborers. RA 4226 –  HOSPITAL LICENSURE ACT requires all hospital in the country to be licensed before it can offer to serve the community. The licensing agency is the Office For  Hospital and Medical Services, Department of Health.

RA 5901 – nurses working in agencies with 100-bed capacity and/or above and are working in area of one million population are supposed to WORK 40 HOURS A WEEK.

PD 442 – LABOR CODE OF THE PHILIPPINES  provides the right of the workers to selforganization and collective bargaining agreement. PD 603 –  CHILD AND YOUTH WELFARE CODE  protects and promotes the rights and welfare of children and youth.

PD 651 –  decrees the REGISTRATION OF BIRTH of a child within 30 days with the Civil Registrar. PD 1519 – MEDICARE –  MEDICARE BENEFITS TO ALL GOVERNMENT EMPLOYEES regardless of status of appointment. PD 626 – EMPLOYEE COMPENSATION AND STATE INSURANCE FUND RA 6675 – GENERICS ACT OF 1998 RA 6758 - standardized the salaries salaries of government employees which include the nursing  personnel. RA 7160 – LOCAL GOVERNMENT CODE OF 1991 devolution of powers from national to local government. RA 7305 – MAGNA CARTA FOR PUBLIC HEALTH WORKERS RA 7600 –  ROOMING-IN AND BREASTFEEDING ACT OF 1992  provides that babies  born in private and government hospitals should be roomed-in with their mothers to promote  breastfeeding and ensure safe and adequate ad equate nutrition to children. EO 51 – MILK CODE RA 7432 – SENIOR CITIZENS ACT does honor and justice to our people’s long tradition of  giving high regard to elderly. 20% discount in all public establishments such as restaurants,  pharmacies, public utility vehicles and hospitals. PRC Resolution No. 2004-17 Series of 2004 –  RE-IMPLEMENTED CONTINUING PROFESSIONAL PROFESSIONAL EDUCATION EDUCATION requ requir irin ing g sixt sixty y (60) (60) cred credit it unit unitss for for thre threee year yearss for  for   professionals with bachelor’s degree

NURSES AND CONTRACTS

Contract  – (Article 1305 New Civil Code) defines contract: A contract is a meeting of minds  between two persons whereby one binds himself, with respect to the other, to give something or  to render some service. •

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A contract, from the Latin word “contractus” and from the French word “contract,” is “ a  juridical convention manifested in legal form, by virtue of which, one or more persons ( or   parties) bind themselves in favor of another or others, or reciprocally, to the fulfillment of  a prestation to give, to do or not to do.” It is the agreement of two or more persons ( or parties ) for the purpose of creating, modifying, or extinguishing a juridical relation between them.

Characteristics of Contract (a) Freedom Freedom ( or liberty) liberty) to stipula stipulate te provided provided not contrary contrary to law, law, morals, morals, good customs, customs,  public order, or public policy (b) Obligatory Obligatory force force and compliance compliance in good faith (c) Perfectio Perfection n by mere mere consent consent as a rule rule (d) Both parties parties are are mutually mutually bound (e) Relatively ( Generally it is binding only between parties, their assigns, and heirs) heirs)

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The contracting parties may establish such stipulations, clauses, terms as they may deem convenient, provided they are not contrary to law, morals, good customs, public order, or   public policy. (1306 NCC)

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The contracts must bind both contracting parties; its validity or compliance cannot be left to the will of one of them.(1308 NCC)

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stipulates that contract takes effect only between the parties, their assigns and heirs.(1311  NCC)

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any third person who induces induces another to violate his contract contract shall be liable for damages to to the other contracting party.

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Contracts are perfected by mere consent and from that moment the parties are bound not only only to the the fulf fulfil illm lmen entt of what what has has been been expr expres essl sly y stip stipul ulat ated ed but but also also to all all the the consequences which, according to their nature, may be in keeping with faith, usage and the law. (1315 NCC)

ESSENTIAL REQUISITES OF A CONTRACT

There is no contract unless the following requisites concur: 1. CONSENT 2. OBJECT certain which is the subject matter of the contract 3. CAUSE of the obligation which is established •

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CONSENT is manifested by the meeting of the offer and the acceptance upon the thing and the cause which are to constitute the contract. Consent must be given freely and voluntarily Consent must be given by a capacitated person Consent must not be vitiated Under the 1987 Constitution, the age of majority is now fixed at 18 years old. This is now the legal age where a person can sign or give consent to contracts or any valid legal acts. Thus, by this provision of the constitution, there are no more emancipated minors who can give consent in the Philippines. Insane or demented persons, and deaf-mutes who do not know how to write cannot give consent. Contracts entered into during lucid intervals are valid Contracts agreed to in a state of o f drunkenness or during hypnotic spell are voidable A cont contra ract ct wher wheree cons consent ent is given given thro throug ugh h mist mistak ake, e, viol violen ence ce,, inti intimi midat datio ion, n, undue undue influence, or fraud is voidable. There is violence when in order to wrest consent, serious or irresistible force is employed. There is intimidation when one of the contracting parties is compelled by a reasonable and well grounded fear of an imminent and grave evil upon his person or property, or upon the  person or property of his spouse, descendants or ascendants, to give his consent. There is undue influence when a person takes improper advantage of his power over the will of another, depriving the latter of a reasonable freedom of choice. There is fraud when, through insidious words or machinations of one of the contracting  parties, the other is induced to enter into a contract which, without them, he would not have agreed to.

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OBJECT of cont contra ract ctss are are all all thin things gs whic which h are are not outsi outside de the the comm commer erce ce of men, men, including future things

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All rights which are not intransmissible may also be the object of contracts

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All services which are not contrary to law, morals, good customs, public order, or public  policy may likewise be the object of contract.

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Impossible things or services cannot be the object of contracts.

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The object of the contract con tract must be determinate as to its kind

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FORMS OF CONTRACT . (1356 NCC) Contracts shall be obligatory, in whatever form they may have been entered into, provided all the essential requisites for their validity are  present

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However, there are times when the law requires that a contract be in some form in order to  be valid or enforceable.

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The following are void or inexistent contracts:

1. When When the the cause cause,, objec objectt or purpos purposee of the contra contract ct is cont contra rary ry to law, law, morals morals,, good good customs, public order, or public policy 2. When the the contract contract is is absolutel absolutely y simulate simulated d or fictit fictitious ious 3. When When the cause cause or object object of the contrac contractt did not exist exist at the time time of the making making of the the contract 4. If the the object object of the contract contract is outside outside the the commerce commerce of men 5. If the contract contract contem contemplates plates or intends intends a performance performance of an impossi impossible ble service service 6. If the the intention intention of the contracti contracting ng parties parties cannot be ascertaine ascertained d 7. If the contract contract is expressly expressly prohibi prohibited ted by law or declared declared by laws as as invalid invalid or ineffective ineffective • •

Voidable contracts are valid contracts until annulled by a competent court The action to annul voidable contracts shall be brought within four years. This period  begins: In cases of intimidation, violence or undue influence, from the time the defect of  the consent ceases.

NURSES AND WILLS

SUCCESSION – is a mode of acquisition ac quisition by virtue of which property, rights, and obligations to the extent of the value of the inheritance, of a person are transmitted through his death to another  or others either by his will or by operation of law. (774 NCC)

DECEDENT – is the general term applied to the person whose property is transmitted through succession, whether or not he left a will. If he left a will, he is also called the testator.

 – a male decedent TESTATOR  – DEVISEE – is a person to whom a gift of real property (eg. Land, house) is given by virtue of a will LEGATEE –  is a person whom a gift of personal property (eg. Money, Jewelry) is given by virtue of a will

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The inheritance includes all property, rights and obligations which are not extinguished  by his death

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The rights to succession are transmitted from the moment of d eath of the decedent.

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An HEIR is a person called to succession either by b y the provision of a will or by operation of the law.

WIILL – is an act whereby a person p erson is permitted, with the formalities prescribed by law, to control to a certain degree the disposition of his estate, to take effect after his death.

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The making of a will is strictly personal act; it cannot be left in whole or in part to the discretion of a third person, or accomplished through the instrumentality of an agent or  attorney.

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All persons who are not expressly prohibited by law may make a will

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Persons of either sex under eighteen years of age cannot make a will

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In order to make a will it is essential that the testator be of sound mind at the time of its execution.

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To be of sound mind, it is not necessary that the testator be in full possession of all his reasoning faculties, or that his mind be wholly wh olly unbroken, unimpaired, or unshattered by disease, injury or other cause. It shall be sufficient if the testator was able at the time of making the will to know the nature of the estate to be disposed of, the proper objects of his bounty, and the character  of the testamentary act.

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The law presumes that every person is of sound mind

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Testamentary Capacity is the capacity to comprehend the nature of the transaction in which the testator is engaged at the time to recollect the property disposed of and the  persons who would naturally be supposed to have claims upon the testator and an d to comprehend the manner in which the instrument will distribute his property among the objects of his bounty.

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a married woman may make a will will without the consent of her husband, and without the authority of the court

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a married woman may dispose by will of all her separate property as well as her share of  the conjugal partnership or absolute community property.(802 NCC)

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Every Will must be in writing and executed in a language or dialect known to the testator(803 NCC)

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NOTARIAL WILL is a will that must be signed by the testator or if written by some

other person, it must be done in his presence and under und er his express direction •

A notarial will or an ordinary will must be subscribed and attested by three or more credible witnesses

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A notarial will must be acknowledged before a notary public

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If the testator be deaf, or a deaf-mute – he must personally read the will if he is able to do so; otherwise, he must designate two persons to read it and communicate to him in some  practicable manner its contents. If the testator is blind, the will must be read to him twice; once, by one of the subscribing witnesses and again, by the notary pub lic before whom the will is acknowledged.

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The requirement of the will must be in writing but it does not mean that the testator must himself perform the mechanical work of writing the will, except in the case of a holographic will, which must be entirely written, dated and signed by the hand of the testator himself.

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The requirement that the testator must sign the will is satisfied by the u se of his thumb mark, the sign of the cross, or the initials or portion of the name of the testator.

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Where the testator directs another person to sign h is name, it is essential that the person so directed write the testator’s name; it is not sufficient for the other to write his name only.

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HOLOGRAPHIC WILL is a will entirely written dated and signed by the testator 

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Any person of sound mind and of the age of eighteen years or more, and not blind, deaf  or dumb, and able to read and write, may be a witness to the execution of a will.

The following are disqualified from being witnesses to a will: (1) any person person not domiciled domiciled in the Philippines Philippines (2) Those who have been convicted convicted of falsification falsification of a document, perjury or false false testimony •

A will may be revoked by the testator at any time before his death. Any waiver or  restriction of this right is void

The following Will shall be disallowed in any of the following cases:

(1) If the formalities formalities required by law have not been complied with; (2) If the Testator was insane, or otherwise mentally mentally incapable of making a will, at the time of its execution (3) If it was executed by undue through force or under duress, or the influence of fear, or  threats; (4) If it was procured by undue and improper pressure and influence, on the the part of the  beneficiary or of some other person;

(5) If the signature signature of the testator was procured procured by fraud; (6) If the testator acted acted by mistake or did not intend that the instrument he signed should be his will at the time affixing his signature thereto.

The law provides for the following kinds of Will: (1) Ordinary Ordinary or Notari Notarial al Will Will (2) Hologr Holograph aphic ic will (3) (3) Mixed Mixed will will

NURSES AND CRIMINAL LAW

Criminal law – is that branch of law which defines crime and treats of their nature.

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Ignorance of the law excuses no one from compliance therewith

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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.

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The power to define and punish an act is within the powers of o f 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.

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Limitations in enacting Penal Laws

(1) General Generality ity (2) Territ Territori oriali ality ty (3) Irretrospe Irretrospectivi ctivity ty or prospectiv prospectivity ity

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Limitations in enacting Penal Laws

(1) it cannot enact enact an ex post facto facto law nor a bill of attainder  attainder  (2) it must be of general general applicatio application n (3) it cannot provide for a cruel, degrading or inhuman punishment punishment nor can it impose excessive fines.

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Theories of Criminal Law

(1) Classi Classical cal Theory Theory – 

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man is essenti essentially ally a moral moral creature creature with an an absolutely absolutely free free will to to choose between between good and evil and therefore more stress is placed upon the result of the felonious act

 b. Basic crimin criminal al liability liability is is human free free will will and the purpose purpose of penalty penalty is is retribution. c. Crime is is a juridical juridical entity entity and penalty penalty is is an evil and and a means of juridi juridical cal tutelage tutelage

(2) Positivist Theory – Man is subdued occasionally by strange and morbid 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.

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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.

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

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Voluntariness is an element of felony because if an act is committed or performed with deliberate intent then it implies that the act is v oluntary or freely committed.

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Felony is an act or omission punishable by the law

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A felony may be committed by means of DOLO (deceit) or CULPA (fault)

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The distinction of dolo and culpa: cu lpa: while both are voluntary, dolo is intentional, wh ereas culpa is not. Where there is intent there can be no negligence. In culpable felonies, intent is replaced by fault.

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Dolo (deceit) involves malice or deliberate intent; culpa (fault) results from negligence , imprudence, lack of foresight or lack of skill.

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Imprudence is deficiency in action

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 Negligence is deficiency of perception.

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 Negligent act must be voluntary- example ( an incidental dropping of pistol and fired and hit someone, there is no liability )

Elements of Dolo :

(1) (1) Free Freedom dom (2) Intell Intellige igence nce (3) (3) Inte Intent nt

Elements of Culpa:

(1) (1) Free Freedom dom (2) Intell Intellige igence nce (3) Negligence Negligence or imprudence imprudence

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Intelligence – is the moral capacity to determine what is right from what is wrong and to realize the consequences of one’s acts.

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Intent – is a mental state, the existence of o f which is shown by the overt acts of a person.

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A crime may be committed without criminal intent by means of culpa and offenses  punishable by special laws.

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Criminal liability shall be incurred by any person committing a felony although the wrongful act done be different from that which he intended. By any p erson performing an act which would be an offense against persons or property, were it not the inherent impossibility of its accomplishment or on account of the employment or inadequate or  ineffectual means.

STAGES OF FELONY

(1) Consummated – all elements necessary for execution and accomplishment are pesent. (2) Frustrated – the offender has performed all the acts of execution to produce the felony as a consequence but the crime does not result due to some cause independent of the will of the offender. (3) Attempted –  the offender begins the commission of the felony by direct overt acts but does not perform all the the acts of execution which should produce the felony as a consequence by reason of some cause or accident other than his own spontaneous desistance

SUBJECTIVE & OBJECTIVE PHASE OF FELONY : The subjective phase is that portion

of execution of the crime starting from the point p oint where he still has the control of his acts. If it reaches the point where he has no more control over his acts, the subjective phase has passed. If  the subjective phase is not yet passed, the felony would be mere attempt. If it has already passed  but the felony is not yet produced, as a rule it is frustrated.

Objective phase is the result of the acts ac ts of execution that is the accomplishment of crime. Consummated.

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY

(1) Justifying Circumstance – the acts of the actor are in accordance with the law , hence he incurs no criminal and civil liability ( no crime, no criminal). (2) Exempting Circumstance – those wherein there is an absence in the agent of the crime any of all the conditions that would make an act voluntary and hence, although there is no criminal liability, there is civil civil liability ( no criminal but there is crime ). (3) Mitigating Circumstances – those that have the effect of reducing the penalty due to the lesser perversity of the offender. (4) Aggravating Circumstance – those which increases the penalty. (5) Alternative Circumstance – either aggravating or mitigating depending on the facts of  the situation.

JUSTIFYING CIRCUMSTANCES:

(1) SelfSelf- defen defense se (2) Defense Defense of of Relat Relative ive (3) Defense Defense of of strange stranger  r  (4) State State of necessity necessity (5) Fulfillm Fulfillment ent of of duty duty (6) Obedience Obedience to superi superior or order  order 

EXEMPTING CIRCUMSTANCE

(1) Imbecilit Imbecility y and Insani Insanity ty (2) (2) Minor Minorit ity y (3) (3) Acci Accide dent nt (4) Compulsion Compulsion of Irresist Irresistible ible force force (5) Lawful Lawful causes causes (6) Instigatio Instigation n and entrapmen entrapmentt

MITIGATING CIRCUMSTANCES

(1) Passion Passion or obfuscatio obfuscation n (2) Voluntary Voluntary Surrender  Surrender  (3) Voluntary Voluntary plea plea of guilty guilty (4) Deaf, Deaf, and dumb, dumb, blind blind (5) Illness Illness that diminishes diminishes the exercise exercise of will power  power  (6) Lack of instructi instruction on (7) Incomplete Incomplete self-defens self-defensee (8) Offender Offender is below below 18 or over 70 years years old old (9) When the act is is committed in in the immediate vindication vindication of a grave offense

AGGRAVATING CIRCUMSTANCES

(1) Taking advantage advantage of officia officiall position position

(2) Crime is committed in contempt of or with with insult to public authorities (3) Crime committed with insult insult or disregard due to offended by age, sex or rank  (4) Crime Crime is committed committed in the dwelling of the offended offended (5) Abuse of confidence confidence or obvious obvious ungratefulness ungratefulness (6) Nightt Nighttim imee (7) (7) Band Band (8) Uninha Uninhabit bited ed place (9) Crime Crime committed committed during calamity calamity (10)

Recedivism

(11)

Habituality

(12) (12)

Crim Crimee com commi mitt tted ed in cons consid ider erat atio ion n of of pric price, e, prom promis isee or rewa reward rd..

(13) (13)

By means eans of fire, ire,ex expl plos osiion,p on,poi oisson and and stra strand ndiing of of a ves vesssel

(14)

Evident pr premeditation

(15)

Craft, fraud or disguise is employed

(16)

Advantage taken of superior strength

(17)

Means employed to weaken defense

(18)

Treachery

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Add Adds ig ignomi ominy to to th the na natura ural ef effects cts of of th the cr crime

(20)

Unlawful entry

ALTERNATIVE CIRCUMSTANCE

(1) degree of relati relationship onship (2) intoxi intoxicat cation ion

(3) illiteracy illiteracy or lack lack of education education

* CLASSIFICATION OF FELONIES

(1) (1) grav gravee (2) (2) less less grav gravee (3) light light feloni felonies es

PERSONS CRIMINALLY LIABLE FOR FELONIES

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When several persons take part in the commission of a crime it does not necessarily n ecessarily follow that their participation in it is equal. Some may ha ve a greater or more important in it than others. Consequently, their liability also varies according to the position they occupy in the commission of the felony, that is, whether they are principals, accomplices, or accessories

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This classification of offenders does not apply when there is c onspiracy to commit a crime because of the rule that the act of one is the act of all.

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A Juridical person cannot be punished pu nished like a natural person because they are only acting through their officers, generally, an officer of a corporation who commits a violation is the one criminally liable.

1. (Art. (Art. 16) The following following are criminall criminally y liable liable for grave and less grave felonies: felonies: a. principal b. acc accomplice ice c. acc accesso ssorie ries for light felonies: a. pri princi ncipals b. acco accomp mpli lice cess

2. The followi following ng are considered considered Principals Principals (Art. (Art. 17) : a. those those who take take a direct direct part part in the the executio execution n of the act; act;

*to be considered as a principal by direct participation, it is essential that the offender (a) participated in the criminal resolution as shown by his p rior or  simultaneous acts (b) carried out the plan and personally took part in its execution, and (c) performed acts tending directly to the same end. Accordingly, if he was not  present at the scene of the crime, he cannot be deemed to be a principal by direct  participation.

b. those those who direc directly tly force force or induce induce othe others rs to commit commit it; it;

* Principal by inducement  presupposes that the offender himself is determined to commit the felony; he must have persistently clung to his determination; he offers the strongest of temptations sufficient to induce the commission or exercises ascendancy to compel obedience and the inducement must be the determining cause for the commission of the crime. Where the inducer only made remarks or gave an order after the fatal blow had been struck, he cannot be punished as a principal by inducement.

c. those who who cooperate cooperate in the commission commission of the offense offense by by another another act without which it would not have been accomplished; * principal by indispensable cooperation must have concurred in the criminal resolution and cooperated by performing another act indispensable for the commission of the felony agreed upon. His co operation is similar to that of an accomplice but is of greater degree because of its indispensability to the accomplishment of the offender’s objective, while that of an accomplice is of a lesser  and minor importance.

3. Accomplices (Art. 18) - are those persons who, not being included in article 17, cooperate in the execution of the offense by previous or simultaneous acts * Under American law, accomplices are accessories before the fact * to be considered an accomplice, the offender must have known of the criminal design of the principal by direct participation and concurs therein. The acts of the accomplice should not produce the most serious effect on the victim, otherwise he will be a principal. The acts of o f an accomplice is similar to those of a principal by cooperation, but may be distinguished from the latter in that, although the acts of the accomplice are necessary for the commission of the crime, they are not indispensable. An example would be if a nurse agrees to prepare a 20 cc lethal drug to be used by the nurse’s friend on victim A and did inject a 10 cc killing k illing victim A but the other 10

cc was injected on another victim B to which the nurse does not know about, the nurse cannot be held criminally liable to the second victim B but an accomplice to victim A only. 3. Accessories (Art. 19) – are those who, having knowledge of the commission of the crime, and having participated therein, either as principals or accomplices, take part subsequent to its commission in any of the following manners: a. by profiting profiting themselve themselvess or assisting assisting the the offender to to profit by the effects effects of the the crme. * the acts of an accessory are always performed after after the commission of the crime by the principal and that the accessory had no participation therein in any form (accessory after the fact). An example is a daug hter who stole an earrings and the mother pawned them, the mother is guilty as an accessory.

 b. by concealing concealing or destroy destroying ing the body body of the crime, crime, or the the effects effects or instrum instruments ents thereof, in order to prevent its discovery.

* The prescribed acts of the accessory must have been intended to prevent discovery of the crime , hence mere silence does not make one an accessory. The body of the crime is equivalent to the corpus delicti. c. by harboring harboring , concealing, concealing, or or assisting assisting in in the escape of the principal principal of the crime, provided the accessory acts with abuse of his public functions. * this provision distinguishes distinguishes a person either as a public officer or a private private individual. They

may have different penalties.

NURSES AND CRIMES

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The professional practice of a nurse entails with it the legal responsibilities that he or she must know and understand in order to avoid liabilities in the discharge of he r functions.

The following are crimes that a nurse nu rse 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.

 – is the unlawful killing of a human being by another with intent to kill (DOLO is MURDER  – an element). HOMICIDE – is the killing of a human being by another without deliberate intent to k ill. 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.

than three days of age. INFANTICIDE - killing of a child less than 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. 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. 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 ch ild to lose its civil status.

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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. p rofession. 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, p ursuant 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

The elements of professional negligence are:

(1) existence of a duty on the part part of the person charged to use due care under circumstances

(2) failure failure to observe observe such such duty duty (3) such failure failure resulted resulted to injury injury or harm harm •

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The test for negligence: “ would a prudent man, in the position of the person to whom negligence is attributed, foresee harm to the person to whom negligence is attributed, foresee harm to the person injured as a reasonable consequence of the course about to be  pursued; if so, the law imposes a duty on the actor to refrain from that course or to take  precaution against its mischievous results, and the failure to do so constitutes negligence. Reasonable foresight of the harm and ignoring such foresight is constitutive fact in negligence. If such negligence is the proximate cause of the injury or harm, then the person causing such negligence is liable for damages under the law A failure of the nurse to apprise or report to the physician his/her observation like sudden increase in BP or sudden drop of vitals signs and such failure to report resulted to the death or injury to the patient, then the nurse is liable for negligence.

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Observance of the standard of care c are as prescribed by RA 9173 is the only for nurses to avoid negligence/malpractice suits in the practice of their profession in the the Philippines.

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Wrong medication or wrong drug given to another patient constitute negligence on the  part of the nurse

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MALPRACTICE - refers to a negligent act committed in the course of professional  performance. Any professional misconduct, unreasonable lack o f skill or fidelity in  professional or fiduciary duties ; evil practice; or illegal or immoral conduct; improper  discharge of professional duties, or failure to meet the standard of care of a professional which results in harm to another. - to go beyond the practice p ractice of nursing as prescribed by RA 9173, like for example, the nurse suturing in a surgical procedure without special training or the nurse  prescribing medicine or drugs, is malpractice. It means enc roaching on the  practice of other profession where the nurse is not supposed to perform as  prescribe by the law.

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 Negligence is malpractice Malpractice is determined if the nurse owed a duty to the client and did not carry out the duty, and the client was injured because be cause the nurse failed to perform the duty. If a nurse gives care that does meet appropriate standards, he or she may be held liable for negligence.

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 Negligence encompasses (includes) the concepts of foreseeability of harm to the person injured and of a duty of care toward that person. Article 20 of the New Civil Code of the Philippines provides that every person who, contrary to law, willfully or negligently causes damage to another shall indemnify the latter for the same. This means that negligent acts resulting to injuries must be indemnified in monetary terms. lack of ability, legal qualifications qualifications or fitness to to discharge the INCOMPETENCE - is the lack required duty. Incompetence is now included as a ground for revocation/suspension of  the certificate of registration as a nurse.

DOCTRINE OF RES IPSA LOQUITOR  – it literally means, “ let the thing speak for  itself”. This is a legal doctrine doctrine usually used in litigations litigations involving negligence or malpractice malpractice suits. If the plaintiff plaintiff (the one bringing an action in court) offers such evidence under this doctrine, then no other evidence is necessary. An example would be sponges left inside the abdomen of the patient after surgery – the fact that there is the sponge left is evidence by itself that can speak that negligence was indeed committed and the court may no longer ask  for other evidence to prove the occurrence of such such negligence. There are three conditions for  the application of this doctrine: (1) the accident must be of a kind kind which ordinarily does not occur in the absence of  someone’s negligence (2) the accident must be caused by an agency or instrumentality instrumentality within the exclusive control of the defendant ( one being sued in a civil case) (3) the accident must not have been due to any voluntary action or contribution contribution on the part of  the plaintiff ( injured party )

DOCTRINE OF RESPONDEAT SUPERIOR  – it means “let the master answer; let the  principal answer for the acts of his agent”. Respondent superior simply provides that where one acts through through the agency of another , then , in the contemplation of the law , he is himself acting so as to make him responsible responsible for the acts of his servant. This doctrine is is founded on the principle that he who expects to derive advantage from an act which is done  by another must answer for any injury which a third person may sustain from it. Masterservant or employer-employee relationship must exist for this doctrine to apply. DOCTRINE OF FORCE MAJEURE –  vis major, an act of God, irresistible force, one that is unforeseen, inevitable. Natural calamities like strong typhoons or floods that would deter the nurse to report for duty du ty in the hospital for her shift is an example of this doctrine. Even if the hospital needs her to report or some untoward incidents happ ened in the hospital, which would not happen if the nurse were there does not constitute any liability on the part of  the nurse because of this doctrine.

NURSE AS A WITNESS – Any information obtained in the course of caring for the patient  by the health team ( doctor, nurses, medtechs) or any matters communicated by the p atient to the nurse is considered privilege. The nurse nurse cannot testify in a civil case for any privilege privilege communication except when the patient allows such testimony or the patient himself offered such information first in a court hearing or whe n the health of the many will be jeopardized. This seal of secrecy will remain forever until removed by the patient. However, any  privileged communication may be divulged in a criminal proceeding even without the consent of the patient where such information was obtained. LIABILITY FOR FALSE TESTIMONY – any person who shall give false testimony in any criminal case, either against or in favor of the defendant, shall be liable to punishment as  provided by the law. The punishment, depending on the case, ranges from imprisonment to  paying fines and/or both. The nurse can commit this violation if he/she is negligent o n charting or erroneously altering her entry in the charts. •

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The hospital records, even if the patient was already discharged are part of public pu blic documents, which can be summoned in any court hearing should the need arises. Most of  the time, it is the record custodian of o f the institutions who is given the subpoena duces tecum or subpoena ad testificandum by the court. However, the nurses who made the entries in the chart, if clarification is needed may also be summoned to appear in a court hearing through the service of subpoena. A patient’s chart that is correctly and accurately accomplished is n ot only valuable as evidence in legal proceedings but also useful as guide in the proper treatment of the  patient.

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Doctor’s Orders – as mandated by law, nurses must execute such orders for the treatment of the patient, deviation or failure to perform this lawful duty can make the nurse criminally and civilly liable and her license may be revoked or suspended. The nurse must exercise certain degree of judgment in carrying out the doctor’s order. If in the assessment of the nurse that such order may cause some injury to the patient, then she is morally obligated to verify such orders before carrying them out. The verification must  be made to the person giving such order. The nurse must be assertive enough to protect the welfare of the patient (stewardship) and also to protect his/her professional career  from lawsuits arising from erroneous carrying out of doctor’s orders. Should the doctor  insist in carrying out a questionable order, the nurse must refer the matter to her  immediate superior and must properly document the actions taken.

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Telephone Orders  – the following guidelines may be observed in carrying out orders of  the physician given through telephone: a. the nurse must chart the date and exact time when the order was given b. the nurse must repeat and record the telephone order  c. the nurse must sign the order; begin with t.o. (telephone order) write the doctor’s name, and then signature the order  d. if another nurse witnessed the order, then her signature must also follow

e. if another physician or intern or resident is present in the station where such order  was given, then it is prudent that the phone call is given to that doctor so they can discuss the order properly and that doctor can c an sign the orders given in a telephone. f. The physician must sign the telephone order as soon as he is around or within 24 hours depending on the policy of the hospitals.

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Reporting Responsibilities – the nurse are required to report certain communicable diseases or criminal activities such as abuse, gunshot wound s, assaults, homicides, and suicides to the appropriate authorities. Incidental Report  – the nurse must write incidental report to protect themselves from sanctions. The matters that must be reported are those that deviate from the norms or  standard in the performance of their duties. This is also done so that proper remedy can  be reached in a given crisis or situation. The report must always be addressed to the immediate superior or proper authorities ( eg. DSWD,PNP,RITM etc…). Charting Done by students  – the clinical instructor or the nurse on duty must sign the charting done by the student as required by RA 9173. Those persons signing such charting attests that the charting made by the student are accurate and authentic and consequently takes or assumes the responsibility from that charting.

PROFESSIONAL PROFESSIONAL ADJUSTMENTS

( the concepts of professional adjustment are discussed in this reviewer according  to the format prepared by the Professional Regulation Commission as given by the  Board of Nursing.) * PROFESSIONAL ADJUSTMENT - means “ the preparation of a student nurse for the responsibilities of professional professional and social life, life, by the development of her capacities in a way that would make her fit to enter upon the practice of nursing.” “Being a nurse nurse means more than  just doing a good job; it means involving one’s self in the pressing health problems of the community; it means listening, understanding, communicating, and working with others whose life styles, beliefs, beliefs, morals, values and culture may differ from those of the nurse.” ( robles,183) * HOLD-OVER DOCTRINE – simply requires those who have been appointed to continue serving or holding their position even if their terms has already lapsed, until such time that their  successor or replacement shall have qualified and appointed. Under RA 9173, members of the

Board of Nursing are appointed by the President of the Philippines and confirmed by the Commission on Appointments. Members of the Board of Nu rsing may be appointed by: (1) Regular appointment . – The Philippine Nurses Association certifies for the Appointment to the Board of Nursing from the three (3) nominees per vacancy and the Board shall endorse two (2) nominees per vacancy to the President. (2) Ad interim Appointment – A board member is appointed appo inted in the meantime to fill in a vacancy or perform the duties of an office during the absence of o f the regular incumbent. There is no definite term of appointment.