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PROFESSIONAL ADJUSTMENT, LEADERSHIP & MANAGEMENT AND RESEARCH

A. Patient’s Bill of Rights

1. The patient has the right to considerate & respectful care, irrespective of socio-
economic status.
2. The patient has the right to obtain from his physician complete current information
concerning his diagnosis, treatment and prognosis in terms the patient can reasonably
be expected to 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 or in person, the medical team responsible in
coordinating his care.
3. The patient has the right to receive from his physician information necessary to give
informed consent prior to start of any procedure and or treatment. Except in
emergencies, such information for informed consent should include but not necessarily
limited to the specific procedure and or treatment, the medically significant risks
involved, and the probable duration of incapacitation. Where medically significant
alternatives for care or treatment exist, or when the patient requests information
concerning medical alternatives, the patient has the right for such information. The
patient has also the right to know the name of the person responsible for the procedure
and/or treatment.
4. The patient has the right to refuse treatment / life-giving measures, to the extent
permitted by law and to be informed of the medical consequence of his action.
5. 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.
6. The patient has the right to expect that all communication and records pertaining to his
care should be treated as confidential.
7. The patient has the right that within its capacity, a hospital 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 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 has the right to obtain information as to any relationship of the hospital to
other health care and to other health care and educational institutions in so far as his
care is concerned. The patient has the right to obtain as to the existence of any
professional relationship among individuals, by names that are treating him.
9. The patient has the right to be advised if the hospital proposes to engage on or perform
human experimentation affecting his care or treatment. The patient has the right to
refuse or participate in such research projects.
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 he is
informed by his physician or a delegate of the physician of the patient’s continuing
health care requirements following discharge.

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11. The patient has the right to examine and receive an explanation of his bill regardless of
source of payment.
12. The patient has the right to know what hospital rules and regulations apply to his
conduct as a patient.

B. Nursing as a Profession

Nursing is a profession. A profession possesses the following primary characteristics:

 Education, requires an extended education of its members, as we;; as basic liberal
foundation.
 Theory has a theoretical body of knowledge leading to defined skills, abilities and
norms.
 Service
 Autonomy
 Code of ethics
 Caring

C. Organization of the Board of Nursing

 The Board is composed of a chairperson and six (6) members

 That the membership to the Board shall represent the three (3) areas of nursing,
namely: nursing education, nursing service and community health nursing.
 The Chairperson and Members of the Board shall possess the following
qualifications:
 Be a natural born citizen and resident of the Philippines
 Be a member of good standing of the accredited professional organization of
nurses.
 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 holder of a master’s degree in nursing.
 Have at least ten (10) years of continuous practice of the profession prior to
appointment: Provided, however, that the last five (5) years of which shall
be in the Philippines; and
 Not have been considered of any offense involving moral turpitude.
 The Board shall supervise and regulate the practice of the nursing profession and
shall have the following powers, duties and functions: CIMECPRP
 Conduct the licensure examination for nurses
 Issue, suspend or revoke certificates of registration for the practice of
nursing;
 Monitor and enforce quality standards of nursing practice in the Philippines
 Ensure quality nursing education
 Conduct hearings and investigations to resolve complaints against nurse
practitioners
 Promulgate a Code of Ethics
 Recognize nursing specialty organizations in coordination with the
accredited professional organization

 Prescribe, adopt issue and promulgate guidelines, regulations, measures and

decisions as may be necessary for the improvements of the nursing practice.
 The president may remove or suspend any member of the Board after having been
given the opportunity to defend himself/herself in a proper administrative
investigation, on the following grounds:
 Continued neglect of duty or incompetence
 Commission or toleration of irregularities in the licensure examination; and
 Unprofessional immoral or dishonorable conduct

D. Licensure Examination

 In order to be admitted to the examination for nurses, an applicant must, at the

time of filing his/her application, establish to the satisfaction of the Board that:
 He/she is a citizen of the Philippines, or a citizen or subject of a country
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 is prescribed in this
Act;
 He/she is of good moral character, and
 He/she is a holder of a Bachelor’s Degree in Nursing from a college or
university that complies with the standards of nursing education duly
recognized by the proper government agency.
 In order to pass the examination, an examinee must 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 percent (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.
 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:
 Licensed nurses from foreign countries/states whose service are either for a
fee or free. If they are internationally well-known specialist or outstanding
experts in any branch or specialty of nursing;
 Licensed nurse from foreign countries/states on medical mission whose
services shall be free in a particular hospital, center or clinic, and
 Licensed nurses from foreign countries/states employed by schools/colleges
of nursing as exchange professor in a branch or specialty of nursing.
 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:
 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
 For unprofessional and unethical conduct;

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 For gross incompetence or serious ignorance;

 For malpractice or negligence in the practice of nursing;
 For the use of fraud, deceit, or false statements in obtaining a certificate of
registration/professional license or a temporary/special permit;
 For violation of this Act, the rules and regulations, Code of Ethics for nurses
and technical standards for nursing practice, policies of the Board and the
Commission, or the conditions and limitations for the issuance of the
temporarily/special permit; or for practicing his/her profession during
his/her suspension from such practice;

E. Nursing Education and Practice

 A member of the faculty in a college of nursing teaching professional courses must:

 Be a registered nurse in the Philippines;
 Have at least one (1) year of clinical practice in a field of specialization;
 Be a member of good standing in the accredited professional organization of
nurses; and
 Be a holder of a master’s degree in nursing, education, or other allied
medical and health sciences conferred by a college or university duly
recognized by the 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.
 A person occupying supervisory or managerial positions requiring knowledge of
nursing must:
 Be a registered nurse in the Philippines;
 Have at least two (2) years experience in general nursing service
administration;
 Possess a degree of Bachelors of Science in Nursing with at least nine (9)
units in management and administration courses at a graduate level; and
 Be a member of good standing of the accredited professional organization of
nurses;
 Provided, that a person occupying the position of chief nurse or director of
nursing service shall in addition to the foregoing qualifications, possess:
 At least five (5) years of experience in a supervisory or managerial
position in nursing; and
 A master’s degree major in nursing

F. Laws Affecting Nursing Profession

PD 442 Labor Code

PD 651 Birth registration following delivery (all health
workers shall identify and encourage the
registration of all births within 30 days
following delivery)
PD 825 Anti-improper garbage disposal
PD 856 Code of Sanitation
PD 996 Compulsory immunization for all children
below eight (8) years old against six (6)
immunizable disease

EO 51 Milk Code
R.A. 1136 Tuberculosis Law
R.A. 3573 Reporting communicable disease
R.A. 4073 Liberalized the treatment of Leprosy
R.A. 6425 Dangerous Drug Act – the sale, a dministration,
delivery, distribution and transportation of
prohibited drugs is punished by law
R.A. 6675 Generic Act of 1988 – this promotes, requires
and ensures the production of an adequate
supply, distribution, use an acceptance of
drugs and medicines identified by their
generic names
R.A. 7160 Local Government Code
R.A. 7171 Organ Donation Law
R.A. 7277 Magna Carta for Disabled person
R.A. 7305 Magna Carta for Public Health workers
R.A. 9257 Expanded Senior Citizen Act of 2003
R.A. 7600 Rooming-In and Breast feeding act
R.A. 7610 Anti-Child Abuse Law
R.A. 8172 Asin Law / Iodize Salt Law
R.A. 8423 Traditional and Alternative Medicine Act
R.A. 8504 Philippine AIDS Prevention and Control Act
R.A. 8976 Food Fortification Act
R.A. 9173 The Nursing Act of 2002

G. Inform Consent

 Requisites for Validity of Informed Consent

 Written permission is best and legally accepted.
 To ensure that the client understand the nature of the treatment including
the potential complications and disfigurement (explained by attending
medical doctor)
 Signature is obtained with the client’s complete understanding of what to
occur.
 Adult sign their own operative permit
 Obtained before sedation
 For minors, parents or someone standing in their behalf gives the consent.
Note: for a married emancipated minor parental consent is not needed
anymore, spouse is accepted.
 For mentally ill and unconscious patient, consent must be taken from the
parents or legal guardian
 If the patient is unable to write, an “X” is accepted if there is a witness to his
mark.
 Secure without pressure and threat
 A witness is desirable – nurse, physician or authorized persons
 When an emergency situation exists, no consent is necessary because
inaction at such time may cause greater injury (permission via telephone /
cellphone is accepted but must be signed within 24 hrs.)

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H. Living Will

 It is a legal declaration of a person’s intentions upon death

 The nurse should note the soundness of the patient’s mind and that there was free
from fraud or undue influence and that the patient was above 18 years or of age
 The patient should write that the will was signed by the testator, that the witnesses
were all present at the same time and signed the will in the presence of the testator
 Advance Directive
 Signed request to be allowed to die when life can be supported only
mechanically or by heroic measures
 Includes the decision to accept or refuse any treatment, service or
procedure used to diagnose or treat his/her physical or mental condition
and decisions to provide
 Health Care Proxy
The patient designates a health care representative, usually a member of the family,
a friend or a family physician to make decisions for him/her when he/she is unable,
due to physical or mental incapacity, accept or refuse treatment, service or
procedure used to diagnose or treat his/her physical or mental condition and
decisions to provide, withhold or withdraw life sustaining measures

I. Negligence

 “NEGLIGENCE” refers to the commission or omission of an act, pursuant to a duty,

that a reasonably prudent person in the same or similar circumstance would or
would not, and acting or the non-acting of which is the proximate cause of injury to
another person to his property.
 Elements of Negligence:
 Existence of a duty on the part of the person charged
 Failure to meet the standard of due care
 Harm resulting from failure to meet the standard
 Specific examples of Negligence:
 Failure to report observations to attending Physicians
 Failure to exercise the degree of diligence which the circumstances of the
particular case demands
 Mistaken identity
 Wrong medicine, wrong concentration, wrong route, wrong dose
 Defects in the equipment such as stretchers and wheelchairs may lead to
falls thus injuring the patients
 Errors due to family assistance
 Doctrine of Negligence
1. RES IPSA LOQUITOR
“the things speaks for itself” – the injury is enough proof of negligence
2. RESPONDEAT SUPERIOR
Let the master answer for the acts of the subordinate.
The liability is expanded to include the master as well as the employee
3. FORCE MAJEURE
Irresistible force: unforeseen or inevitable event
No person shall be responsible for those events which cannot be foreseen,
e.g., flood, fire, earthquake

J. Malpractice

 Doing acts or conducts that are not authorized or licensed or competent or skilled to
perform, resulting to injuries or non-injurious consequences
 Stepping beyond one’s authority
 RN exceeding the scope of nursing practice and does an MD’s job

K. Torts

 Assault is a unjustifiable attempt to touch another person or even the threat of

doing so
 Battery is the actual carrying out of the threatened physical contact
 Defamation of character occurs where a person discusses another individual in
terms that diminish reputation.
 Libel is written defamation
 Slander is oral defamation
 False Imprisonment it is making someone wrongfully feel that he or she cannot leave
the place.

L. Restraints

 Restraints are protective devices used to limit the physical activity of a client or to
immobilize a client or an extremity.
R-equires physician’s order; consent
E-mergency, get physician’s order ASAP
S-hortest duration, least restrictive type
T-o protect patient and others
R-enew order every 24 hours
A-ssess every 15 to 30 minutes and document
I-ndividualized supervision
N-ever used as a punishment
T-otal documentation
S-eclusion as last step

M. Crimes

 Conspiracy to commit a crime:

 Principals – are those who take a direct part in the execution of the , who’s
directly force or induce others to commit it; or who cooperate in the
commission of the offense by another act without which it would not have
been accomplished.
 Accomplices – are those who, not being principals, cooperate in the
execution of the offense by previous and simultaneous act.
 Accessories – are those who, having the knowledge of the commission of
the crime. Assisting the offender to profit from the crime either by disposing
the body, concealing or assisting in escape of the principal of the crime.

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 Degree of the acts of execution

 Consummated – when all the elements necessary for its execution and
accomplishment are present.
 Frustrated – when the offender performs all the acts or execution which will
produce the felony as a consequence but which nevertheless, do not
produce it by reason of causes independent of the will of the perpetrator
 Attempted – when the offender commences the commission of the same
directly by overt acts, and does not perform the acts which shall produce the
felony.

LEADERSHIP AND MANAGEMENT

A. Leadership Style

RESEARCH

A. Types of Research

 Basic /Pure Research, it is done for the intellectual pleasure of learning to search for
the knowledge for its own sake and eventually filter down the result into real life
situation.
 Applied Research, seeks for practical application of theoretical or abstract
knowledge. The truth is adapted to every situation.
 Action Research, the process involves the study of certain problem and from that
experience, decisions, actions and conclusion are drawn.
 Correlational Research, involves the systematic investigation of relationship
between or among variables.
 Experimental, an objective, systematic, highly controlled investigation for the
 purpose of predicting and controlling phenomena in nursing practice.
 Non Experimental, the researcher collects data without introducing any treatment
or making any changes.
 Quasi – Experimental, is like experimental research because it actively introduces
some form of treatment or manipulation of an independent variable.
 Quantitative Research, a formal, objective, systematic process in which numerical
data are used to obtain information about the world.
 Qualitative Research, systematic, interactive, subjective approach used to describe
life experiences and give them meaning
 Phenomenological Research, begin with accumulation of evidence when little topic
is known or when studying new topic it involves gathering of fresh perspective.
 Grounded Theory Research, the primary purpose of grounded theory research is to
develop a theory. The concepts and theories discovered through this research
approach are derived directly from the data.
 Ethnographic Research, a tool for studying cultures
 Narrative Research, focus on the story as the object of inquiry, to determine how
individuals make sense of events in their lives.

B. Differences Between Conceptual and Theoretical Model

Conceptual Model or Paradigm Theoretical Model or Framework

It is a pre-theoretical basis from which It proposes a framework derived from

substantive theories may be derived theories

It is highly abstract It is less abstract

Concept are related and Concepts are narrowly bounded,

multidimensional specific and explicitly interrelated
It provides a perspective for science It is postulates relationships. It is
descriptive, explanatory or predictive
It is derived from systematic It is constructed from available
observation and intuition theories and findings of empirical
research.
It is developed through the process of It is develop through the process of
intuition induction and deduction
It must be evaluated through logical It permits empirical tests.
grounds and cannot be empirically
tested

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C. Variables

 Independent Variables (CAUSE), these are factors that are being manipulated by the
researcher and the focus of the inquiry.
 Dependent Variable (EFFECT), this is the factor or variable that is affected or
influenced by the independent variable.
 Intervening Variable (MEDIATOR), this is a factor or variable that exists between the
independent and the dependent variable.
 Moderator Variable, this is a variable that affects the strength or direction of the
relationship between

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