FUNDAMENTALS OF NURSING PRACTICE

2nd Semester, Academic Year 2019 – 2020

Ethico-Moral and Legal Considerations

in the Practice of Nursing

SECOND PART OF LECTURE

LO19: Familiarize oneself with the Philippine Nursing Law and other legal, regulatory
and institutional requirements for safe nursing practice

OVERVIEW OF PROFESSIONAL NURSING PRACTICE

Benner’s 5 Stages of Proficiency

 Stage 1. Novice. A novice is a nursing student or any nurse entering a clinical

setting where that person has no experience. Because of this, novices have no
experience; their ability is extremely limited, inflexible, and governed by
structured rules and protocols.

 Stage 2. Advanced Beginner. The advance beginner can demonstrate

marginally accepted performance. The beginner has had experience with enough
real situations to be aware of the meaningful aspects of a situation.

 Stage 3. Competent. Competence develops when the nurse consciously and

deliberately plans nursing care and coordinates multiple complex care demands.
The nurse at this stage demonstrates organizational ability but lacks the speed
and flexibility of the proficient nurse. The competent nurse knows how to
prioritize care requirements for an individual or groups of client.

 Stage 4. Proficient. The proficient nurse perceives a situation as a whole rather

than just its individual aspects. This holistic understanding improves the decision
making of the proficient nurse. The proficient nurse uses maxims as guides but
applies them only after acquiring a deep understanding of the situation.

 Stage 5. Expert. The expert performer no longer relies on rules, guidelines, or

maxims to connect an understanding of the situation to an appropriate action.
The expert nurse may be inclined to say that a certain action was taken because
“it felt right”. Her performance is fluid, flexible, and highly proficient.

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Scope of Nursing Practice based on Republic Act 9173

SEC. 28. Scope of Nursing. A person shall be deemed to be practicing within

the meaning of this Act when he/she singly or in collaboration with another, initiates and
performs using 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, pre-school, school age, 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 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, comfort measures, health teachings, and administration
of written presentation of 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 the hospitals, clinics;
undertake consultation services; engage in such activities that require the utilization
of knowledge and decision-making skills of a registered nurse; and

(e) Undertake nursing and health human resource development, training 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 continual learning through continuing
professional education to be provided by the accredited professional nursing
organization: Provided finally, That the program and activity for the continuing
professional education shall be submitted to and approved by the Board.

The Code of Ethics for Nurses

Ethical codes are systematic guides for developing ethical behavior. They
answer normative questions of what beliefs and values should be morally accepted.
The Code of Good Governance states that the hallmark of all professionals is
their willingness to accept a set of professional and ethical principles which they will
follow in the conduct of their daily lives. The acceptance of these principles requires the
maintenance of a standard of conduct higher than what is required by the law.
The general principles of the Code of Good Governance include the following:

1. Service to others. This implies a commitment to a life of sacrifice and

genuine selflessness in carrying out their professional duties even at the
expense of a personal gain.

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 2. Integrity and Objectivity. Professionals should perform their responsibilities
with the highest sense of integrity and imbued with nationalism and spiritual
values, maintain objectivity, be free of conflicts of interest, refrain from
engaging in any activity that would prejudice their abilities to ethically carry
out their duties.
3. Professional Competence. A certain level of competence is necessary,
undertaking only those professional services that they can deliver.
4. Solidarity and Teamwork. Each professional shall maintain and support one
professional organization for all its members, promoting a deep spirit of
solidarity and teamwork.
5. Social and Civic Responsibility. Professionals shall always carry out their
professional duties with due consideration of the broader interest of the
public, serve them with professional concern consistent with their
responsibilities to society and as Filipinos, contribute to the attainment of the
country’s national objectives.
6. Global Competitiveness. Professionals shall remain open to the challenge
of a more dynamic and interconnected world, rise up to global standards and
maintain levels or professional practices fully with the global practices.
7. Equality of All Professions. All professionals shall treat their colleagues with
respect and strive to be fair in their dealings with one another.

Nurses’ Bill of Rights

Right is a privilege or fundamental power to which an individual is entitled
unless it is revoked by law or given up voluntarily.
Registered nurses promote and restore health, prevent illness, and protect the
people entrusted to their care. They work to alleviate the suffering experienced by
individuals, families, groups, and communities. To maximize the contributions nurses
make to society, it is necessary to protect the dignity and autonomy of nurses in the
workplace. To that end, the following rights must be afforded:

1. Nurses have the right to practice in a manner that fulfills their obligations to
society and to those receiving nursing care.
2. Nurses have the right to practice in environments that allow them to act in
accordance with professional standards and legally scopes of practice.
3. Nurses have the right to a work environment that support and facilitate ethical
practice, in accordance with the Code of Ethics for Nurses and its interpretive
statements.
4. Nurses have the right to freely and openly advocate for themselves and their
patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with their
knowledge, experience, and professional responsibilities.
6. Nurses have the 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 in all practice.

Patient’s Bill of Rights

A Patient’s Bill of Rights is a statement of the rights to which patients are entitled
as recipients of medical care. Typically, a statement articulates the positive rights which
doctors and hospitals ought to provide patients, thereby providing information, offering
fair treatment, and granting them autonomy over medical decisions.
The following rights of a Filipino patient shall be respected by all those involved
in his care:
1. Right to appropriate medical care and humane treatment
2. Right to informed consent
3. Right to privacy and confidentiality
4. Right to information

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 5. Right to choose health care provider and facility
6. Right to self determination
7. Right to religious belief
8. Right to medical records
9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence and to receive visitors
12. Right to express grievances
13. Right to be informed of his rights and obligations as a patient

Philippine Professional Nursing Roadmap

Nursing Roadmap
The Board of Nursing has mandated itself to pursue the challenge in the
nursing profession. Amidst allcontroversies, the new set of board has maintained its
course toward unifying the profession and pavingits way to excellence and competitive
nursing in the year 2030.As such, the Nursing Profession would need to progress in the
public governance pathway from “Compliant” to “Proficient” status.
With the nursing profession’s vision of becoming the lead in promoting Philippine
Nursing in the Asia Pacific Region by 2030, five strategic themes and four perspectives
set the framework of the Balance Scorecard (BSC) that will determine the outcome
measures that will have to be achieved. The crafting of the Nursing Roadmap is a
continuing work in progress participated in by three (3) clusters of organizations,
namely: the Philippine Nurses Association (PNA) as the accredited professional
organization, the nursing specialty organizations and nursing interest groups. The
nursing profession’s charter statement, i.e., mission, vision and values, shall be the
banner, we, Filipino nurses shall hold together.

VISION: By 2030, the Philippines shall be the lead in promoting Professional

Nursing in the Asia PacificRegion.

MISSION: We, the Filipino Nurses are committed to provide society with
professional Nursing servicethrough innovations in education and training
research and management that will improve the well-beingand quality of life.

CORE VALUES: Love of God, Caring, Love of People, Love of Country

STRATEGIC OBJECTIVES/THEMES:
a. Dynamic Leadership.Develop dynamic leaders and provide opportunities for
innovative management in education, training and research
b. Service Excellence.Ensure adherence to professional ethical and legal
standards for the health and safety of thepublic
c. Operational Excellence.Practice good governance to sustain participative
efforts among nurses and nursingorganizations
d. Strategic Partnerships. Maintain linkages with domestic and international
stakeholders.
e. Social Responsibility. Sustain growth and productivity that will improve the
quality of life of nurses, the Filipinos and thepeople of the world

BALANCED PERSPECTIVES:
a. Learning and growth
b. Internal processes
c. Customer perspective
d. Financial perspective

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Continuing Professional Development
Section 2 of Article 1, of the Republic Act (R.A) 9173, otherwise known as the
“Philippine Nursing Act of 2002” provides for the policy of the State to regulate and
professionalize the practice of the profession by instituting measures that will result in
relevant nursing education, humane working conditions, better career prospects, and a
dignified existence of nurses.
Nurses are hereby expected to expand their knowledge and improve their
technical competencies to meet healthcare needs and demands of better delivery of
safe nursing care. Thus, there is a need for nurses to continually update themselves in
order to meet these challenges.

LO27: Determine importance of maintaining a harmonious and collegial relationship

among members of the health team for effective, efficient and safe client care

PRINCIPLES OF COLLABORATION AND TEAMWORK; LEADERSHIP AND

MANAGEMENT

Legal Aspects of Nursing Practice

Legal responsibilities of nurses begin together with their professional
obligations. They are given the license when they are qualified under the law to practice
their profession. The Philippine Nursing Act is the best guide the nurse can utilize as it
defines the scope of nursing practice.
Nurses need not be afraid of laws. These should be understood so that their
scope and limitations may be defined and identified. When these are clarified,
performance of daily tasks is assumed with more confidence and safety.
The practice of nursing is always paralleled with responsibility and
accountability for the quality performance of their duties. Nurses employed in an
agency, institution, or hospitals are directly responsible to their immediate supervisors.
Private duty nurses are held to a standard of conduct that is expected of reasonably
prudent nurses.

 Assault. Any intentional threat to bring about harmful or offensive contact. No

actual contact is necessary
 Battery. Any intentional touching without consent. The contact can be harmful to
the client and cause an injury, or it can be merely offensive to the client’s
personal dignity.
 False Imprisonment.This may occur in situations with unjustified restraining of a
person without legal warrant such as the use of unnecessary restraints or solitary
confinement.
 Defamation of character. Publication of false statements that result in damage
to a person’s reputation. Libel refers to a written statement or photograph that is
false or damaging. Slander is the term given to malicious verbal statements that
are false or injurious.
 Negligence. The term negligence refers to the commission of an act, that a
reasonably prudent person would not have done or an omission of a duty that a
prudent person would have fulfilled, resulting in injury or harm to another person.
 Malpractice. Malpractice implies the idea of improper or unskillful care of a
patient by a nurse. It is a type of negligence wherein the nurse fails to meet the
standards of care.
 Incompetence. The lack of ability, legal qualifications of fitness to discharge the
legal required duty.
 Doctrine of Force Majeur. This term means an irresistible force, or that is
inevitable or unforeseen. Examples may include assault, in which a nurse

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 induces threat or attempt to do bodily harm; and battery, which involves physical
contact without the person’s consent.
 Doctrine of Respondeat Superior. Under this doctrine, the liability is expanded
to include the master as well as the employee and not a shift of liability from the
subordinate to the master.

Consent
A signed consent form is required for all routine treatment, hazardous
procedures, and research involving clients. When admitted to a hospital, a client signs a
general consent form. The client and his representative signs a separate special
consent or treatment form before starting a procedure. Informed consent is an
agreement by a client to accept a course of treatment or procedure after provided
complete information, including the benefits and risks of treatment, alternatives to the
treatment, and prognosis if left untreated. Generally, it is the physician and nurses in
advance practice who obtains the consent. Nurses on the other hand, must need to
communicate this with the client by ensuring that the client understands, acts as witness
to the client’s signature, and obtains the permission prior to the start of the procedure.
The following are general guidelines when providing an informed consent:
1. The purpose of the procedure
2. What the client can expect to feel or experience
3. The intended benefits of the treatment
4. Possible risks or negative outcomes of the treatment
5. Advantages and disadvantages of possible alternatives

Those who can consent to medical treatment include the following:

1. Adults – any competent individual 18 years of age or older; grandparents can
sign in for a minor grandchild if it is an emergency and the parents are not
around. Exclusions for adult include those who are unconscious or have been
under the influence of harmful drugs; and those that have mental illness or
mental capacity of a child.
2. Minors if: a. he or she is a parent of the child or any child in his or her legal
custody
b. emancipated minor
c. legally appointed by court

Abandonment and Assignment Issues

Short staffing occurs when there is shortage in nursing or there is inadequate
staffing. The implication in practice shows that there is a greater likelihood of making an
error related to client care. Nurses are sometimes required to float from the area in
which they normally practice to other nursing units. Nurses who float need to inform the
supervisor of any lack of experience in caring for the type of clients on the nursing unit.
They also need to request and receive orientation to the unit.Delegationis a process of
transferring performance of a selected nursing task in a situation to an individual who is
competent to perform that specific task. Even though a task may be delegated to
someone, the nurse who delegates maintains accountability for the task. Generally,
noninvasive interventions such as skin care, range-of-motion exercises, ambulation,
grooming, and hygiene measures can be assigned to a nursing assistant. Licensed
vocational nurses can perform certain invasive tasks. However, the task of assessment
and planning care, initiating teaching, and administering medication intravenously
remains to be the task of the nurse.

Risk Management
Risk management is a system of ensuring appropriate nursing care that attempts
to identify potential hazards and eliminate them before harm occurs. Incident report or
occurrence report is used as a means of identifying the risk situation and improving
client care. It provides a database for further investigation in an attempt to determine
deviations from standards of care. The report is confidential and separate from the

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medical record. Therefore, never document in the client’s medical record that an
occurrence report was completed.
Prepared by:
2nd Part, NCM 0103 Instructors
2nd Semester, Academic Year 2019-2020

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