Nursing Notes: RA 9173 (Philippine Nursing Act of 2002


Republic of the Philippines HOUSE OF REPRESENTATIVES Quezon City FOURTEENTH CONGRESS Second Regular Session

House Resolution -, 724 Introduced by Gabriela Women's Party Representatives lIZA LARGOZA-MAZA and LUZVIMINDA C. ILAGAN RESOLUTION DIRECTING THE HOUSE OF REPRESENTATIVES COMMITTEE ON APPROPRIATIONS, AND THE COMMITTEES ON OVERSIGHT AND HEALTH, TO CONDUCT AN INQUIRY, IN AID OF LEGISLATION, INTO THE FAILURE OF THE NATIONAL GOVERNMENT TO IMPLEMENT THE UPGRADING OF SALARY lEVel OF GOVERNMENT NURSES SINCE THE EFFECTIVITY OF REPUBLIC ACT NO. 9173, OTHERWISE KNOWN AS THE PHILIPPINE NURSING LAW OF 2002, AND FOR CONGRESS TO INCLUDE THE CORRESPONDING BUDGET NEEDED FOR ITS IMPLEMENTATION IN THE ANNUAL GENERAL APPROPRIATIONS WHEREAS, the State, recognizing labor as a primary social economic force, has the obligation to protect the rights and welfare of Filipino workers as mandated by the Philippine Constitution in Section 18, Article 2; WHEREAS, the State has the obligation to protect and promote the right to health of the people as mandated by the Constitution in Section 15, Article 2; WHEREAS, the State must protect and improve the practice of nursing profession in the country to encourage the best of Filipino nurses to serve our nation, rather than promoting the exodus of nurses abroad; WHEREAS, the present basic pay of government nurses at Salary Grode 10, equivalent to P10,000.00 monthly is inadequate to cope with the rising cost of living in the country. Accord ing to the National Wages and Productivity Commission (NWPCl, the living wage for a family of six in the National Capital Region already reached P894 as of June 2008. This means that the monthly living wage for a family of six must be at least P26,820.00; WHEREAS, in search of better income opportunities, an estimoted 13,000 nurses leove the country every year to work abroad either as nurses, caregivers or domestic helpers consequently intensifying the lack of nurses for our health centers and hospitals; WHEREAS, Republic Act No. 9173 or the Philippine Nursing Act of 2002 was passed in October 2002 with the aim af strengthening the nursing profession and encouraging nurses to stoy ond work in the country. Tawards this end, RA 91 73 provided for an increase in basic so lary of nurses from solory grade 10 which is now equivalent to P12,026, to not lower than solory grade 15, which is now pegged at P16,093.00; WHEREAS, the increase can somehow, lessen the gop between the basic salory and the family living wage, as well as cushion the impact of increasing prices of basic commodities on our nurses and their familYi WHEREAS, the approximately 21,000 nurses working in public hospitals, government agencies and health centers nationwide have long been waiting for the implementation of the said low;

WHEREAS, the Philippine Nurses Association reported that despite the enactment of RA 9173 in October 2002, the
corresponding increase in basic pay of government nurses as mandated by the aforementioned law has not yet been granted to them due to lack of corresponding budget appropriations; WHEREAS, the continuous inaction by the government to raise the basic pay of nurses as mandatedin RA 91 73 is anapporent vioIation of the afarementioned Iawand our consti tution; WHEREAS, Congress must look into this matter the soonest possible time and include in the General Appropriations the corresponding budget needed for the implementation of the said law, including the unreleased amount since RA 9173's effectivity in 2002; NOW TH EREFOR E, BE IT RESOLVED that the House of Rep resentotives Committee on Appropriations, and the Committees on Oversight and Health, conduct an inquiry into the failure of the Notional Government to implement the upgrading of salary grade leve) of government nurses since the effectivity of Republic Act No. 9173 otherwise known as the Philippine Nursing Law of 2002; BE IT RESOlYEO FURTHER that Congress include in the Annual General Appropriations the corresponding budget needed for the implementation of the aforesaid low. Adopted,

The Patient's Bill of Rights
What is the Patient's Bill of Rights?
Here you will find a summary of the Consumer Bill of Rights and Responsibilities that was adopted by the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. It is also known as the Patient's Bill of Rights. The Patient's Bill of Rights was created with the intent to reach 3 major goals: 1. to help patients feel more confident in the U.S. health care system; the Bill of Rights:    3. assures that the health care system is fair and it works to meet patients' needs gives patients a way to address any problems they may have encourages patients to take an active role in staying or getting healthy

2. to stress the importance of a strong relationship between patients and their health care providers to stress the key role patients play in staying healthy by laying out rights and responsibilities for all patients and health care providers

This Bill of Rights also applies to the insurance plans offered to federal employees. Many other health insurance plans and facilities have also adopted these values. Even Medicare and Medicaid stand by many of them.

The 8 key areas of the Patient's Bill of Rights
Information disclosure You have the right to accurate and easily-understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don't understand something, help should be given so you can make informed health care decisions. Choice of providers and plans You have the right to choose health care providers who can give you high-quality health care when you need it. Access to emergency services If you have severe pain, an injury, or sudden illness that makes you believe that your health is in serious danger, you have the right to be screened and stabilized using emergency services. You should be able

to use these services whenever and wherever you need them, without needing to wait for authorization and without any financial penalty. Participation in treatment decisions You have the right to know your treatment options and take part in decisions about your care. Parents, guardians, family members, or others that you select can represent you if you cannot make your own decisions. Respect and non-discrimination You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you. Confidentiality of health information You have the right to talk privately with health care providers and to have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it is not correct, relevant, or complete. Complaints and appeals You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.

Other bills of rights
This bill of rights focuses on hospitals and insurance plans, but there are many others with different focuses. There are special kinds, like the mental health bill of rights, hospice patient's bill of rights, and bills of rights for patients in certain states. Insurance plans sometimes have lists of rights for subscribers. Many of these lists of rights tell you where to go or whom to talk with if you have a problem with your care. The American Hospital Association has a list of rights along with patient responsibilities that can help a person be a more active partner in his or her health care

Respect Your Rights · To be treated with respect and courtesy · To receive safe, considerate, ethical and cost effective medical care · To have your individual cultural, spiritual and psychological needs respected · To have your privacy and personal dignity maintained · To expect that information regarding your care will be treated as confidential Your Responsibilities · To respect hospital personnel · To respect care givers’ effort to provide care for other patients · To respect hospital property · To be considerate of other patients and to see that your visitors do the same Treatment Your Rights

· To receive treatment regardless of race, religion or any other discrimination prohibited by law. · To receive emergency treatment regardless of ability to pay · To expect reasonable continuity of care and to be informed of available and realistic care options when hospital care is no longer appropriate · To have your needs for pain management addressed and treated · To be free from the use of restraints and/or seclusion unless clinically necessary. Your Responsibilities · To follow your caregivers’ instructions and help them in their efforts to return you to health. · To inform your caregiver if you think there may be problems in following their instructions · To participate in decision making about your medical care · To recognize the impact of lifestyle on your personal health Information Your Rights · To understand your diagnosis and treatment, as well as the possible outcomes, risks and benefits of your care. · To have information regarding your medical treatment explained to your family member or other appropriate individual when you are unable to participate in decisions about your care. · To be advised of hospital policies, procedures, rules and regulations that may affect your care. · To understand that your caregiver may both be teachers and students · To know the names/ titles of your caregiver. · To see your medical records (in accordance with hospital policy and/or the law) · To review your bill and to have any questions or concerns you have adequately addressed. Your Rights · To provide the hospital with accurate and complete information about your medical history

· To ask your doctors for more information if you d not understand your illness or treatment · To provide the hospital with necessary payment and/or insurance information Involvement Your Rights · To be involved in decisions concerning your care · To have your family members and/or others from participating in decisions about your care · To discuss any treatment planned for you · To give your informed consent or informed refusal for treatment · To leave the hospital or request a transfer (in accordance with hospital policy and/or the law) Your Responsibilities · To abide by hospital rules and regulations · To keep your appointments · To pay your bills on time · To inform the hospital management if you believe your rights have been violated

Below is a complete listing of all NANDA nursing diagnoses through the 12th conference (1996). Activity/Rest Circulation Ego Integrity Elimination Food/Fluid Hygiene Neurosensory Pain/Discomfort

Respiration Safety Sexuality Social Interaction Teaching/Learning Activity/Rest Activity intolerance (specify level) Activity intolerance, for Disuse syndrome, risk for Diversional activity deficit Fatigue Sleep pattern disturbance Circulation Adative capacity: intracranial, decreased Cardiac output, decreased Dysreflexia Tissue perfusion, altered (specify): cerebral, cardiopulmonary, renal, pastrointestinal, peripheral Ego Integrity Adjustment, impaired Anxiety (mild, moderate, severe, panic) Body image disturbance Coping, defensive Coping, individual, ineffective Decisional conflict Denial, ineffective Energy field disturbance Fear Grieving, anticipatory Grieving, dysfunctional Hopelessness Personal identity disurbance Post-trauma response (specify stage) Powerlessness Rape-trauma syndrome (specify) Rape-trauma syndrome: compound reaction Rape-trauma syndrome: silent reaction Relocaction stress syndrome Self-esteem, chronic low Self-esteem disturbance Self-esteem, situational low Spiritual distress (distress of the human spirit) Spiritual well being, enhanced, potential for
Elimination Bowel incontinence Constipation Constipation, colonic Constipation, perceived Diarrhea Incontinence, functional Incontinence, reflex Incontinence, stress Incontinence, total Incontinence, urge Urinary elimination, altered Urinary retention, (acute/chronic) Food/Fluid Breastfeeding, effective Breastfeeding, ineffective Breastfeeding, interrupted Fluid volume deficit (active loss) Fluid volume deficit (regulatory failure) Fluid volume deficit, risk for Fluid volume excess Infant feeding pattern, ineffective Nutrition: altered, less than body requirements Nutrition: altered, more than body requirements Nutrition: altered, risk for more than body requirements Oral mucous membrane, altered Swallowing, impaired Hygiene Self-care deficit (specify level): feeding, bathing/hygiene, dressing/ grooming, toileting Neurosensory Confusion, aacute Confusion, chronic Infant behavior, disorganized

Infant behavior, disorganized, risk for Infant behavior, organized, potential for enhanced Memory, impaired Peripheral neurovascular dysfunction, risk for Sensory perception alterations (specify): visual, auditory, kinesthetic, gustatory, tactile, olfactory Thought processes, altered Unilateral neglect Pain/Discomfort Pain Pain, acute Pain, chronic Respiration Airway clearance, ineffective Aspiration, risk for Breathing pattern, ineffective Gas exchange, impaired Spontaneous ventilation, inability to sustain Ventilatory weaning response, dysfunctional (DVWR) Safety Body tempurature, altered, risk for Environmental interpretation syndrome, impaired Health maintenance, altered Home maintenance management, impaired Hyperthermia Hypothermia Infection, risk for Injury, risk for Perioperative positioning injury, risk for Physical mobility, impaired Poisoning, risk for Protection, altered Self-mutilation, risk for Skin integrity, impaired Skin integrity, impaired, risk for Suffocation, risk for

Sexuality(component of ego integrity and social interaction) Sexual dysfunction Sexuality patterns, altered Social Interaction Caregiver role strain Caregiver role strain, risk for Communication, impaired verbal Community coping, enhanced, potential for Community coping, ineffective Family coping, ineffective Family coping, potential for growth Family processes, altered: alcoholism (substance abuse) Family processes, altered Loneliness, risk for Parental role conflict Parent/infant/child attachment, altered, risk for Parenting, altered Parenting, altered, risk for Role performance, altered Socical interaction, impaired Social isolation Teaching/Learning Growth and development, altered Health-seeking behaviors (specify) Knowledge deficit (learning need) (specify) Noncompliance (compliance, altered) (specify) Therapeutic regimen: community, ineffective management Therapeutic regimen: families, ineffective management Therapeutic regimen: individual, effective management Therapeutic regimen: individual, ineffective

Thermoregulation, ineffective Tissue integrity, impaired Trauma, risk for Violence, (actual)/risk for: directed at self/others Hypothermia


If our body temperature falls much below 35°C, the control centre in the brain stops working. The result is that we can no longer control our body temperature: the metabolic rate falls and the body temperature gets lower and lower. Eventually we go into a coma. This is called hypothermia, and if no action is taken the person will die.


1. Low body core temperature. 2. Persistent shivering.
3. Blue lips and/or fingernails.

4. Speech slowed and slurred. 5. Memory lapses. 6. Unconsciousness. •

1. Move victim to warm environment.
2. Remove wet clothing.

3. Rewarm victim with blankets or body-to-body contact in a sleeping bag. 4. If victim is conscious, give warm (not hot) fluids.
5. Keep victim warm and quiet. diuretic.

6. Do not give victim any alcohol, which is a blood-thinning agent, or caffeine, which is a 7. Contact medical professionals as soon as possible, if required.

• •

Hyperthermia is also an alternative remedy that has been used for hundreds of years in treating infectious and non-infectious diseases. This treatment has been shown effective in treating syphilis and, in addition to chemotherapy and radiation, some forms of cancer. The treatment itself involves gradually raising the temperature of the blood to over 104 degrees (F) for a short period of time. This can be done one of two ways: 1. Immersion of the patient in a hot bath for a period of about an hour or so. 2. Removing the blood from the body through a catheter, heating it, and re-inserting it back into the patient. This method is called extracorporeal hyperthermia. This second method is employed in the medical field as a valid treatment for some cancers and syphilis. The complications of this procedure are high, and therefore, it still remains a last resort, and rare method. The rationale behind the procedure is this; By raising the body temperature and artificially creating a fever, pathogens and cancer cells that are sensitive to higher temperatures will be

killed off. Also, the body's immune system, due to the fever, is stimulated, and the amount of interferon and white blood cells increase, further killing pathogens. •

urse Practice Acts (NPAs) are laws in each state that are instrumental in defining the scope of nursing practice. NPAs protect public health, safety, and welfare. This protection includes shielding the public from unqualified and unsafe nurses. In each state, statutory law directs entry into nursing practice, defines the scope of practice, and establishes disciplinary procedures. State boards of nursing oversee this statutory law. They have the responsibility and authority to protect the public by determining who is competent to practice nursing. NPAs are the most important pieces of legislation related to nursing practice. Common Law is derived from principles or social mores rather than from rules and regulations. It consists of broad, interpretive principles based on reason, traditional justice and common sense. Together, the NPAs and Common Law define nursing practice. It is a nurse's responsibility to be informed on both the NPA and Common Law for the state(s) in which they are licensed and practice. Listed below are links to the state boards of nursing for the United States. Each website has information on that particular state's NPA. Also listed is a link to the National Council of State Boards of Nursing, which maintains an online database of NPAs. National Council of State Boards of Nursing: The NCBSN maintains a database which contains available NPAs from 49 states, the District of Columbia, and four U.S. territories (Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands). Maryland's NPA is not available, per state restrictions. National Council of State Boards of Nursing
Republic Act No. 9173 October 21, 2002 AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION, REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE KNOWN AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR OTHER PURPOSES. ARTICLE VI Nursing Practice Section 28. Scope of Nursing. - A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. A members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of 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. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established; (b) establish linkages with community resources and coordination with the health team; (c) Provide health education to individuals, families and communities; (d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and


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