Professional Documents
Culture Documents
Palmr 1
Palmr 1
Nursing Research
Phenomenon.
• everyday phenomenon that affects the nurse (eg. bacteria, drugs, physician)
• Systematic
o conduct research in a step by step process or procedure
• Empirical
o objective data should be observable/measurable or readily collected using your senses
• Controlled/ manipulated
o Methods/tool of controlling is research design
• Critical investigation/fact finding investigation
o In order to answer the data is by using facts.
o Looking for human beings who can give us facts
• Descriptive
o observe, describe and record
o gain richer familiarity regarding the phenomena
o 100% known to RN
• Exploratory
o Explore to those areas that are unknown
o Observe more
o 50%-50% (50%known to nurses and 50% unknown to the nurses
• Experimental
o Active intervention, active manipulation
o Want to find out cause & effect
o Done something before observing results
• Developmental
o To improve the system of care for the your patient.
o Florence Nightingale
• Birthplace – Italy
• Training Ground – Germany
• Greatest Contribution – environmental Theory, training RNs in Crimean War
• School – Saint Thomas School of Nursing
Develop and improve existing system
Conducting research is for the benefit the pt or patient care/pt focus
Ethics of a Researcher
• S – Scientific Objective – conductive research for a good purpose or object for your pt
• C – Cooperation and Consent. Do not conduct data/experiment w/o a consent (legally the
patient owns the chart. However the hospital owns the chart)
• I – Integrity – worked hard on the research
• E – Equitable – acknowledging works or contribution of others
• N – Nobility – protect the rights of your subjects
o Right not to be harmed
▪ (physical, mental, moral harm) usually done during experimental research
▪ Physical Harm/ Negligence - undeliberate physical harm
• Commission – done outside the standard practice of nursing (eg. urinary catheter placed on
the nose of the pt)
• Omission – from the very start, you did not do something about it.
▪ Moral Harm
• Assault – mental fear/threat without physical harm
• Battery – physically you harm the pt
▪ Restraint is never an independent nursing order
• physical restraint – eg. Jacket
• chemical restraint – eg. use of psychotropic drug
▪ Moral harm
• Slander – oral defamation
• Libel – published or placed in the newspaper
o Right to self-determination
o Right to privacy
▪ Anonymity – identity of subject may not be disclosed. Privacy of the Informant (pt) eg.
conduct a study on HIV pt. but the pt wants his name to be written in the newspaper as Mr. X,
Mr. Y or Mr. W
▪ Confidentiality – information acquired must be disclosed. Privacy of the information eg.
conduct a study on HIV pt. but the pt wants the nurse should only know
• T – Truthfulness – put only the data you have collected
• I – Importance – importance to the nursing profession
• F – Factual – facts or data
• I – Ideal (follow the 11 steps of research)
• C – Courage
Research:
LEADERSHIP
Nursing Leadership
• style or process whereby a person is called by a nurse leader were influence of group of
people called his followers for the purpose of attaining only one goal/objective.
Leadership styles
• Authocratic/Authoritarian/dictatorial/”hard” leader
o unilateral style of leadership. Only the leader here performs the decision making without
getting the inputs from his members.
o One sided style of leadership Behavior :
A – apathy – insensitive to others
B – Boisterous speech
C – consistency
D – Dominating
E – Exploitative behavior
o not a good style of leadership but only best style during emergency or intensive crisis
• Permissive, ultra-liberal, laissez faire, free-rein
o Loose style of nursing leadership.
o Giving excess freedom or liberality towards your subordinates if to lenient in your
subordinates, there will be ↓ control and power = ↑ negligence
• Democratic/participative
o best style of leadership. Mutual style of nursing leadership
• A – Authority
o basis of the leader to delegate tasks, responsibilities, jobs to be performed by his
subordinates
o 2 types of authority
▪ Centralized – top to bottom for proper management
▪ Decentralized – Bottom, to manage directly
• B – Behavioral
o S – specialized body of knowledge and skills to do safe care
o P – patient centered
o A – accountability – liable for the results of your actions
o C – confidentiality – nurse-patient relationship
▪ Exceptions to confidentiality of the contract :
• P – patient consent, if there is
• I – inform/report to healthcare team for purpose of precautionary measures
• C – Communicable disease
o RA 3573 Law on Notifiable Disease
o 24 – Polio/ Measle
o 1 Week – SAD/ HIV/Tetanus Neonaturom
• C – Crimes
o Child Abuse à 48 hours, Baranggay, NGO
• E – ethics
• C – Communication skill
o transfer of information with understanding
o Communication barriers/communication backlog – eg. Dialect differences, noise, deaf, high
level of anxiety, hallucinating
• D – Decision making skills
o Steps
▪ identify the problem
▪ identify person affected
▪ gather options/alternative
• brainstorming
• delphitechnique – gathering solutions outside the group (eg. specialized nurse)
▪ choose and implement
▪ Evaluation
• E – Ethics
o Principles
o Principle of Autonomy
▪ independent judgment or decision making
▪ in all situation the pt himself is the one who should decide for his own care
▪ Consent
• respect the decision of the pt
• explain the risk to the patient/SO
• waiver - a legal doc when the pt refuse for treatment.
o Principle of Veracity
▪ telling the truth to the patient
▪ #1 the patient has the right to know from the PHYSICIAN (not the nurse)
o Principle of Double Effects
▪ if the pt is made to choose between 2 equal danger and he only needs to choose one, choose
the one that will produce one good effect and less evil effect.
o Principle of Beneficence
▪ doing good to the patient (eg. providing therapeutic communication, providing privacy)
o Principle of Non-Maleficence
▪ do no harm
▪ 3 types of Harm
• Physical – negligence by commission
• Mental – assault and battery
• Moral – slander and libel
o Principle of Justice
▪ Prioritize the needs of the patient.
▪ To be able to provide nursing care to the patient, provide the nursing process.
▪ Nursing Process characteristics :
• A – acceptable universally
• B - based patients assessment needs
• C – client focused
• D – dynamics – base on the ever changing needs of the pt
• E – equitable care
• F – familiarity/rapport to the patient
• G – goal directed towards solving the assess needs of the patient (SMART)
o Principle of Respect/Inviolability of life
▪ Suicide and abortion is violation of this principle
• F – Face/solve Conflicts
o any clash of ideas resulting to crisis
o Methods of resolving conflict
▪ avoidance – by paying attention
▪ smoothing – appealing to ones conscience and kindness
▪ unilateral action – use of forced fear or threat
▪ negotiation – best method in resolving conflict. The head nurse should offer negotiation
between conflicting parties.
NURSING MANAGEMENT
NURSING MANAGEMENT
▪ choosing the right person and giving them the appropriate task for the purpose of achieving
their goal/objective in achieving total care
▪ Elements
o choosing the appropriate person (TAO)
o choosing the appropriate team
o choosing the appropriate training
o choosing the appropriate tools
▪ the be a good manager, there should be a good interpersonal relationship between the leader
and follower
▪ Planning stage
o looking ahead of time.
o Formulating future goals/objective
o Types of plan
▪ Standard/Operational Plan (NCP)
• plans for everyday or ordinary activities
▪ Strategic/Contingency Plan
• plan used during sudden or acute crisis
▪ Long-range/future Plan
• plans which you can’t evaluated immediately.
• Usually last months or yrs.
• Used for chronic pt which requires longer period of care.
o Stages of Planning Process
▪ Mission – present reason when established your organization
▪ Vision - statement of your future purpose of your future organization
▪ Philosophy – set of values and beliefs of your organization
▪ Goal – general statement of your purpose
▪ Objectives – more specific statement of your purpose
▪ Policies – set of rules and regulations in your organization
▪ Procedures
• Budgeting – proper allocation of your resources
o 3 types
▪ Personnel
• Compensation for salaries of workers
▪ Operational
• everyday use of equipment and facilities (gloves, water, electricity)
▪ Capital
• long term use equipment (MRI, CT Scan, hospital beds, hospital buildings)
▪ Organizing
o 4 stages
▪ Organize your team RN Subordinates
• Duties of the RN
• Only assessment can perform the nurse
• Only the nurse can perform HT
• Only the nurse should explain the procedure to the patient
• Preparation, administration, treatment of drugs to the patient
• The nurse can only perform evaluation
• The nurse can only do judgment
▪ Delegate Task
• They can only delegate to subordinates the Routinary task (standard, unchanging procedure)
eg. monitoring of I&O, bathing, ambulating, toileting, shampooing, transporting, feeding,
clothing, wiping
• Stable patient - predictable outcome (eg. postmortem care with direct supervision of the
nurse only)
• Supervision – need guidance
▪ Staff Schedule/ Staffing
• Schedules (How many hours)
o Traditional – 8hrs a day/40hrs/wk
o Ten hour shift/4 days a week
o Baylor plan – it consist of two shifting nurses
▪ traditional – mon-fri 8hrs
▪ 2nd shift – 12hr shift during weekends
o Part-time work – fewer working hours per day and may choose the day or work. Less than
8hrs job
o On – call – during shortage of nurses/staff but increase in the number of patients.
▪ Methods of Nursing care Delivery
• Different Methods
o Primary – 24hrs a day
▪ Primary nurse is the only nurse who is responsible to make a care plan of the patient from
the moment of admission till the moment of discharge. (eg. private duty nurse or special
nurse)
o Functional Method
▪ DOH format/government hospitals
▪ Assign nurse :
• Duty/task
• One nurse, one task
• Highly recommended during a period of shortage of nurses and budget
▪ poorest method of delivery because communication is hindered
o Case Method/Case Nursing
▪ provide total care within your shift. Used in ICU department
▪ C – Case Method
▪ T – total care to the patient
▪ O – one is to one ratio
▪ Directing/Delegation stage
o a job or a task is done or performed by another perform for you
o What you cannot delegate:
▪ you cannot delegate total control of the procedure
▪ you can’t delegate discipline of subordinates or staff members.
▪ Confidential task
▪ Technical task
▪ Medical task performing surgical procedure is done by the doc not the nurse
▪ Coordination/Collaboration
o the nurse needs to collaborate to other members of the health care team.
o Multi-interdisciplinary approach – to be able to provide holistic approach to the patient.
o Types of Collaboration
▪ Interpersonal/Intradepartmental
• One patient, one unit.
• Collaboration between one nurse to another healthcare team in one unit/department
• Eg. MI patient - nurse, dietary, specialized in cardio
▪ Interdepartmental
• 4 units in one hospital.
• Coordination of the patients care between 2-more units/departments but still under one same
hospital or institution
• Eg. patient due for appendectomy is transferred to the OR
▪ Inter Agency/Institutional
• Coordination of patient’s care between 2 or more hospitals/health care institution for the
benefit of the patient
• Eg. lying – in due for C/S and was transferred to a hospital
▪ Evaluation/Controlling
o stage wherein you determine whether or not your plans for your patient is met or achieved
o Methods of evaluating staff performance
▪ Checklist
• it is being evaluated higher than you. (eg. nurse manager/supervisor or head nurse)
▪ Nursing rounds
• it is being evaluated higher than you. (eg. Nurse manager/supervisor or head nurse)
• Psychiatric ward is not done by nursing rounds
▪ Peer review
• same rank or level is being evaluated you
• poor method
▪ Performance appraisal
• the patient evaluates you
• best method in evaluation
Professional
▪ A calling in which its members profess to have acquired special values, knowledge, training
or by experience so that they may guide others in that special field.
Nursing is a profession
Characteristics by profession
All are independent nursing actions
• Promotive, preventive, curative and rehab care in all health care service
• health education
• utilizes nursing process
• link of patients in different health care services
• collaboration of patient’s care for continuity of patient care
• train nursing students
• supervision of subordinates
• accurate recording and reporting
• execution of valid doctor’s order (the only one that is dependent nursing action)
• Perennial Suturing after training
• Perform IE if antenatal bleeding is absent and before full delivery
A doctor’s order is valid when giving medication is when it is put into writing and signed by
the physician. Whatever is not put into writing is considered not ordered by the physician.
• During emergency, national calamity, national epidemic there is no doctor around the life or
the patient is in possible danger, then you can give drugs alone provided you know the
drugs for the patient.
1. Institutional Nursing
• Once a Public nurse in the community, you are focus on the preventive and promotive of
health because this is the mandate of Primary Health Care Law.
• 1st PHC
o Date : 1978
o Place : Alma Ata
o Country : Russia
o Local version of F. Marcos after 1yr of Alma Ata
o Conference: Letter of Instruction 949 that mandates that all public workers to have a duty
of promotive and preventive care for the patient.
• Promotion of Public Health
o PD 8976 – Micronutrient Supplement Act
• Vit. A, iron supplements, iodine
o PD 825 (Environmental sanitation law of the Phils.)
• It is cleanliness of the environment. Outside the institution (eg. proper disposal of excreta,
proper drainage system)
o PD 856 (sanitation code of the Phils.)
• Involves proper sanitation of an institution that engage in food and water supply. Inside the
institution. (eg. canteen, mineral water store, public market, Sex shop : ADONIS, PEGASUS,
CHICOS) not applicable to private sex practitioners.
• Prevention of Disease
o PD 996 (EPI law)
• Compulsory Immunization of children below 9 y/o
• Psychological and social adjustments because you will be taking care of numerous clients
o RA 7160 (local government code)
• decentralization or devolution of care. The DOH together with DILG and local government
units (brgy, provincial) together with community participation they made a local health board
which is the MAYOR.
• Purpose of local health board : it makes quality health care available, accessible and
proximal for all
• Participation is maintained with all members of the community, health care team and
family
4. Clinical Instructor
o Qualifications :
▪ A – accredited nursing Org
▪ M – MAN in nursing or other health courses
▪ O – One yr clinical experience
▪ R – R.N.
• Declared by Pres. Garcia law declaring the last week Oct as the official nurses week.
• UPCN – 1st
• Schools originated in the Phil.
o Iloilo Mission hospital
o PGH
o St. Luke’s
o Mary Johnston Hospital
o St. Paul Hospital
o San Juan de Dios
• V – voluntariness
• O – Opportunities to ask questionbe explained to pt
• T – treatment explained to the patient
• U – understood by pt
• M – matured both physically and mentally
• 18 y/o – above
• Mentally capacitated (absence of insanity and imbecility)
• If below 18 y/o and mentally incapacitated a proxy consent : in chronological order
o Parents
o Guardian
o physician (if parents and guardian are dead)
• Guardian Ad Litem – social worker or Surgeon
• Act whereby a person is permitted by the law to have control in the manner of disposing/
giving his estate but will take effect at the time of his death
• Testate Succession – son or daughter will inherit the last will of the parents
• Intestate Succession – without last will and testament
• 2 types of Last Will and Testament
o Property
▪ Notarial/ Ordinary Will
• Check LOC
• Check proper location of the signature – end part of all the pages at the side
• Nurses can be a witness
▪ Holographic Will
• During emergency cases
• No witness involved call a persdon who knows and familiar with the handwritten of the
testator
• Entire last will and testament is hand written dated and signed by the testator
o Life Body
▪ Advance Directives
• Respectful death
• Direction/ instruction of the patient in advance
• DNR, donate organ, cremation
• only registered medical, dental and veterinary practitioners are authorized to prescribe drugs
• 3 information
o name of the AMD, address of his clinic/hosp and PTRC license #
o name of the pt, age, sex
o drug name, frequency, duration of the drug
• RA 6675 Generic Act
o all prescribe drug must be written in generic and brand name or generic name but never the
brand name alone)
o Purpose : for the pt to choose what brand name they want
• Remember the 10 R’s of medication
• Right patient name by checking the pt wrist tag
• Verbal or telephone – only done during emergency
• doubts or error – in case there is doubt in medication, refer to the physician
• IV drugs – in proper training
Professional Negligence
Negligence
• failure to do something which are reasonable and prudent nurse should have done
something under a particular situation. (eg. failure to raise side rales when the pt is
unconscious)
• 3 elements of negligence
o duty on part of the nurse
o failure to do said duty
o injury, harm, death – most important negligence
Malpractice
• committed by any person who exercises authority. (eg. teacher to student, head nurse to staff
nurse).
• That person who is in authority is asking for a sexual favor in an exchange of another favor.
Types of Rape
• Ordinary rape
o a forcible penetration of an organ for copulation to another organ for copulation. (eg.
women are only the victim)
• sexual assault
o anything that is forcible inserted to a body orifice with sexual malice.
o Also form of rape (eg. hand or an object is being inserted in the anal. Committed in both
female or male)
o Intervention :
▪ S – safety (emotional or physical safety)
▪ R – report (↓ 18 – report to brgy.)
▪ R – referral (if father is the rapist, refer to DSWD)
Abortion
• is the expulsion or termination of a product of conception before the stage of viability. (3-
6month/12-24weeks)
Infanticide
Parricide
• killing another person to whom you have a relationship (mother, father, husband)
Homicide
• unintentionally killing another person without any relationship (eg. negligence in giving
meds)
Murder
• committed by any person who shall substitute one child to another child or alter his
identities for the purpose of losing his civil status. (eg. the midwife failed to report the birth
of the baby, giving wrong information of the gender of the baby)
PD 651 (Birth registration act)
• law any person who assist in giving birth to report within 30 days to the Local Civil
Registration Office
Supervisor/Manager H
Community
Military Hosp
• B – BSN RN
• A – Accredited Org
• N – 9 units
• T – 2 yrs
Chief/Director
RN + MAN +
5 yrs supervisor
experience
(N.B. if primary
hosp)
Add only
master’s in
PHN or
CHN
MAN +
GSC
(Gen.
Staffing
Course)
o Examinees
▪ CGM (Good Moral Character)
▪ Proofs of Valid Holder of Filipino Citizenship
▪ Proofs of valid holder of a BSN Degree only from schools whose curriculum is approved by
the CHED
▪ 3 docs sub to PRC
▪ RLE certificate
▪ TOR with Scanned picture
▪ List of cases
▪ Examination fee is P900
▪ Last day Is :