RELEVANT ETHICO-LEGAL GUIDELINES

IN CONDUCTING HEALTH ASSESSMENT

 Objectives:

Identify ethico-legal considerations when providing safe, quality, and

professional nursing care.

Understand how to Protect client rights based on “ Patient’s Bill of Rights

and Obligations”

Implement policies related to informed consent in conducting health

assessment

 RELEVANT ETHICO-LEGAL GUIDELINES

IN CONDUCTING HEALTH ASSESSMENT

❖ Nursing Practice is governed by many legal concepts. It is important

for nurses to know the basic legal concept, because nurses are
accountable for their professional judgments and actions.
❖ Accountability is an essential concepts of professional nursing
practice and the law.
❖ Knowledge of laws that regulate and affect nursing practice is
needed for two reasons:
1. To ensure that the nurse’s decisions and actions are consistent with current
legal principles.
2. To protect the nurse from liability.

 General Legal Concepts:

Law can be defined as “the sum total of

rules and regulations by which a society
is governed. As such, law is created by
people and exists to regulate all persons”
Guido, 2014,p.2)
 Functions of Law in Nursing

The law serves a number of functions in Nursing:

❑ It provides a framework for establishing which nursing
actions is the care of clients are legal.
❑ It differentiates the nurse’s responsibilities from those of
other health professionals.
❑ It helps establish the boundaries of independent nursing
action.
❑ It assists in maintaining a standard of nursing practice by
making nurses accountable under the law.

 Selected Categories of Laws Affecting Nurses

Category Examples
Constitutional Right for due process
- A constitution creates legal rights and Rights for equal protection
responsibilities and is the foundation for a
system of justice.
Criminal (Public) Homicide, manslaughter
- Public law – refers to the body of law Theft
that deals with relationships between Arson
individuals and the government and Active Euthanasia
governmental agencies Sexual assault
- Criminal Law- deal with actions against Illegal possession of illegal of controlled
the safety and welfare of the public. drugs.

 Selected Categories of Laws Affecting Nurses

Category Examples
Contract (Private /Civil)
- Is a body of law that deals with
relationship among private individuals.
- It can be categorized into a variety of
legal specialties such as contract law or
tort law.
➢ Contract law – involves the enforcement Nurse and client
of agreements among private Nurse and employer
individuals or the payment of Nurse and insurance
compensation for failure to fulfill Client and agency
agreements
Professional negligence/malpractice
➢ Tort law – defines and enforces duties
Libel and slander
and rights among private individuals Invasion of privacy
that are not based on contractual Assault and battery
agreements. False imprisonment
Abandonment

 Nurses as Witnesses

➢ A nurse may be called to testify in a legal action.

➢ It is advisable that any nurse who is asked to testify in such a situations seek the advice of
an attorney before providing testimony.
➢ In most cares, the attorney of the nurse’s employer provide support and counsel during the
legal case.
➢ A nurse may also be ask to provide testimony as an expert witness.

 Ethics
is a system of moral principles or moral standards
governing conduct.
It is a particular system of principles and rules
concerning duty.
It is also called Moral Philosophy
It furnishes the norm by which relations among men are
regulated.

 NURSING ETHICS

✓ is a system of principles governing the conduct of nurses: it

deals with the relationship of a nurse to the patient, patient’s
family, her associates and fellow nurses, and the society at
large.
✓ reinforces the nurses’ ideals and motives in order to
maximize effectively their services.

 ETHICO-MORAL PRINCIPLES

AUTONOMY
BENEFICENCE
NONMALEFICENCE
VERACITY
CONFIDENTIALITY
JUSTICE
FIDELITY

 ETHICO-MORAL PRINCIPLES

Principle of Autonomy : “FREEDOM TO CHOOSE”

AUTONOMY
is having the freedom to make choices about issues that affect one’s life. It is the right to choose
what will happen to one’s own person. It is also the right to determine personal care given and by
whom.

3 Basic elements:
1. the ability to decide.
2. The power to act upon your decision
3. Respect for the individual autonomy of others
- the provision of a general respect for personal autonomy for both practitioner and patient alike.

NURSES SHOULD SUPPORT CLIENT’S INDEPENDENCE TO MAKE DECISIONS AND TAKE

ACTION THEMSELVES.

 ETHICO-MORAL PRINCIPLES
Principle of Beneficence: “DO ONLY WHAT’S GOOD”

BENEFICENCE
is a principle that requires nurses to act in ways that benefit clients.

3 components to the principle of good:

a. One ought to do or promote good.
b. One must prevent evil or harm in all instances and always advocate for what is in the client’s
best interest.
c. The nurse must not prevent, but also must remove, evil or harm.

NURSES HAVE THE RESPONSIBILITY TO HELP OTHERS BY DOING WHAT IS BEST FOR THEM.

 ETHICO-MORAL PRINCIPLES

Principle of nonmaleficence – “DO NO HARM!”

Nonmaleficence requires nurses to act in such a way as to avoid causing harm

to clients.
The principle seeks to do no harm in situations requiring nursing actions.
This principle also addresses the need to avoid harm regardless of reasons for
negative actions.

“NURSES SHOULD ACT WITH EMPATHY WITHOUT BAD FAITH OR ILL WILL, NOR MAKE
FALSE ACCUSATIONS.”

 ETHICO-MORAL PRINCIPLES

Principle of Veracity – “TELL THE TRUTH”

IS SIMPLY THE PRACTICE OF TELLING THE TRUTH.

Veracity engenders respect, open communication, trust and
shared responsibility.

NURSES SHOULD DOCUMENT TRUTHFULLY AND ACCURATELY

 ETHICO-MORAL PRINCIPLES

Principle of Confidentiality
“KEEP PRIVATE”

Confidentiality states that it is the nurse’s responsibility to

safeguard the client’s right to privacy by judiciously
protecting information of a confidential nature.

NURSES SHOULD SAFEGUARD THE CLIENT’S PRIVACY.

 ETHICO-MORAL PRINCIPLES

Principle of Justice – “ BE FAIR”

Justice is fair, equitable and appropriate treatment according to what is

due or owed to persons, with the understanding that giving to some
will deny receipt to others who might otherwise have received those
things.

NURSES SHOULD MAKE USE OF AVAILABLE RESOURCES FAIRLY AND

REASONABLY

 ETHICO-MORAL PRINCIPLES

Principle of Fidelity
“KEEP YOUR WORD / PROMISE”
Fidelity is often related to the concept of faithfulness and the
practice of keeping promises.

NURSES SHOULD ATTEND TO THE DETAILS OF WHAT THEY SAY THEY DO

 Good Samaritan Act

• The Good Samaritan Act is a law that was passed in 1959

• A GOOD SAMARITAN refers to someone who renders aid in
an emergency to an injured person on a voluntary basis
• This law protects nurses(or any other trained professional)
who gives emergency care from liability for civil damages

 Good Samaritan Act

• ✓ A nurse, therefore, who renders first aid or treatment

at the scene of an emergency and who does so within
the standard of care, acting in good faith, is relieved of
the consequences of the act.

 Good Samaritan Act

✓ The nurse should never make a promise of a cure

✓ You should be certain that a patient understands the instructions
you give them(from the physician)
✓ When you hand them written instructions, make sure they can
read(draw or read the instructions)
✓ The importance of doing everything possible to avoid a medical
malpractice suit cannot be overemphasized
✓ Medical assistants are vital in providing patient education to
supplement the physician’s orders
✓ With a friendly, interpersonal relationship(rapport), the patient is
much less likely to feel angry about anything associated with the
care received.

 73: P hilippine Nurs ing

RA 91
Act of 2002
TWO FOLD POLICY FOR THE
NURSING PROFESSION:
TWO FOLD POLICY FOR THE
NURSING PROFESSION:

A. State policy
B. State guarantee

 TWO FOLD POLICY FOR THE

NURSING PROFESSION:

A. State policy
o Government’s responsibility to protect and improve the nursing
profession through the institution of measures for the attainment and
improvement of the nursing profession through the ff measures:
1. relevant nursing education
2. humane working conditions
3. better career prospects
4. dignified existence of the Filipino nurse

 TWO FOLD POLICY FOR THE NURSING

PROFESSION:

B. State guarantee

Government’s commitment to deliver quality health care

service by providing adequate nursing personnel
through the country

 REGULATION OF THE NURSING

PROFESSION:

RA 2808: “An Act Regulating the Practice of nursing profession

in the Philippines” March 01, 1919

RA 7164: Philippine Nursing Act of 1991, approved by Pres.

Corazon C. Aquino

RA 9173: Philippine Nursing Act of 2002, approved October 21,

2002 by Pres. Gloria M. Arroyo

 Regulation of Nursing Practice

➢ Protection of the public is the legal purpose for defining the

scope of nursing practice, licensing requirements, and
standards of care.

Philippine Nursing Act of 2002 (RA 9173)

Licensure Exam
➢ Is a legal permit that a government agency grants
to induvial to engage in the practice of a
profession and to use a particular title.

 Standards of Nursing Care

❑The legal guidelines for minimally safe and adequate

nursing practice

❑Written policies and procedures of an employing

institution defines the standards of care for nurses
at that institution

 Impaired Nurse

➢ The term impaired nurse –refers to a nurse’s inability to

perform essential job functions because of chemical
dependency on drugs or alcohol or mental illness.
➢ Nurses administer medications for all purpose (relieve pain,
prevent infection, decrease anxiety and depression.

 Unprofessional Conduct

✓ According to most nurse practice acts, unprofessional conduct is

considered one of the grounds for action against a nurse’s license
✓ Includes incompetence or gross negligence for practicing without a
license, falsification of client records, and illegal obtaining, using, or
possessing controlled substances.
✓ Having personal relationship with the client, especially a vulnerable
client, may be considered unprofessional conduct because the
Code of Ethics for Nurses states that nurses are responsible for
maintaining their professional boundaries. (ANA, 2010).

 Documentation

✓The client’s medical record is a legal document that can

be produce in the court as evidence. Often, the chart is
used to remind a witness of events surrounding a lawsuit
goes to trial.
✓The effectiveness of a witness testimony can depend on
the accuracy of the nurse’s documentation of nursing care.

 Incident Report

✓ An incident report (also called as unusual occurrence report) is

an agency record of an accident or unusual occurrence.
✓ Incident report are used to make all facts available to agency
personnel to contribute too statistical data about the accident or
incident, and to help health personnel prevent future incidents or
accidents

 Incident Report

Completing an incident report:

✓ Identify the client by name, initial, and hospital or identification number
✓ Give the date, time, and place of the incident
✓ Describe the facts of the incident. Avoid any conclusion or blame. Describe the
incident as you saw it even if your impression differ from those of others.
✓ Incorporate the client’s account of the incident. State the client’s comments by
using direct quotes.
✓ Identify all witnesses to the incident
✓ Identify any equipment by number and by any medication by name and dosage.

 Reporting Crimes, Torts, and Unsafe

Practices

➢Nurses may need to report nursing colleagues or other

health professionals for practices that endanger the health
and safety of clients.
➢For instance: alcohol and drug use, theft from client or
agency, and unsafe nursing practice should be reported.

 Reporting Crimes, Torts, and Unsafe

Practices
➢ Guidelines:
1. Write a clear description of the situation you believe you should report.
2. Make sure that your statements are factual and complete.
3. Make sure that you are credible
4. Obtain support at least one trustworthy person before filling the report.
5. Report the matter starting at the lowest possible level in the agency hierarchy.
6. Assume responsibility from reporting the individual by being open about it. Sign your name at the
letter.
7. See the problem through once you have reported it.

 Patient’s Bill of Rights

A PATIENT’S BILL OF RIGHTS is a document that

provides patients with information on how they can
reasonably expect to be treated during the course of their
hospital stay. These documents are, in almost all cases, NOT
legally-binding. They simply provide goals and expectations
for patient treatment.

 Patient’s Bill of Rights

1. RIGHT TO APPROPRIATE MEDICAL CARE AND HUMANE

TREATMENT.
 - Every person has a right to health and medical care corresponding to his
state of health, without any discrimination and within the limits of the
resources, manpower and competence available for health and medical care
at the relevant time.

2. RIGHT TO INFORMED CONSENT

-  The patient has a right to a clear, truthful and  substantial  explanation,  in 
a  manner  and  language  understandable  to  the patient.

 INFORMED CONSENT

Informed consent is a patient's agreement

to allow something to happen, such as
surgery based on a full disclosure of risks,
benefits alternatives and consequences of
refusal (Black, 1999)

 Patient’s Bill of Rights

✓ Written consent
✓ For procedures such as surgery, diagnostic tests,
experimental procedures, treatment of minors,
✓ It is defined as the permission granted voluntarily by a
person of sound mind, after the procedure and all risks
have been explained in terms the person can understand.

 Patient’s Bill of Rights

¨ Emergency Consent is presumed when patient unable to provide

¨ Informed consent is a process that people go thru, not just a

paper.
¨ Nurses role is to make sure client understands everything and that
the person that signs is the person who needs to be signing! The
nurse can’t go in and explain the procedure again, otherwise the
nurse could be in trouble.

 Patient’s Bill of Rights

The  client  will not  be subjected  to any procedure without his

written informed consent, except in the following cases:

a)  IN EMERGENCY CASES, when the patient is at imminent risk of

physical injury, decline Of  death if treatment is withheld or
postponed. In such cases, the physician can  perform  any
diagnostic  or treatment  procedure  as good practice of medicine
dictates without such consent;

b)  when the health of the population is dependent on the adoption

of a mass health program to control epidemic;





 Patient’s Bill of Rights

c)  when the law makes it compulsory for everyone to submit a

procedure;

d)  When the client  is either a minor, or legally incompetent, in

which case. a third-party consent is required;




 Patient’s Bill of Rights

INFORMED CONSENT shall be obtained from a patient concerned if

he is of legal age and of sound mind. In case the patient is
incapable of giving consent and a third party   consent is required,
the following persons, in the 
order of priority stated hereunder, may give consent. 
1.spouse
2.son or daughter of legal age
3.either parent
4.brother and sister of legal age
5. guardian   
 
If a patient is a minor, consent shall be obtained from his parents of legal guardian.

 COMPONENTS OF INFORMED CONSENT

1.You must have the capacity (or ability) to make the decision.
2.The medical provider must disclose information on the treatment, test,
or procedure in question, including the expected benefits and risks, and
the likelihood (or probability) that the benefits and risks will occur.
3.You must comprehend the relevant information.
4.You must voluntarily grant consent, without coercion

*The consent form should be signed and dated both by the doctor and
the patient.

 Patient’s Bill of Rights

3. RIGHT TO PRIVACY AND CONFIDENTIALITY.

-  The privacy of the clients must be assured at all stages of his
treatment. The client has the right  to be free from unwarranted
public exposure, EXCEPT in the  following cases:

a) when his mental or physical condition is in controversy and the

appropriate court, in its discretion, order him to submit to a
physical or mental examination by a physician;
b) when the public health and safety so demand; and
c) when the client waives this right in writing.

 Patient’s Bill of Rights

4. RIGHT TO INFORMATION.
 -  In the course  of his/her  treatment  and  hospital care, the client or
his/her legal guardian has a right to be informed of the result of the
evaluation  of the nature and extent of his/her disease,  any other additional 
or further  contemplated    medical  treatment on surgical procedure or
procedures

5.THE RIGHT TO CHOOSE HEALTH CARE PROVIDER AND FACILITY.

 -  The client is free to choose the health care provider to serve  him as
well as the facility except when he is under the care of a service facility or
when public health and safety so demands or when the patient expressly
waives this right in writing.

 Patient’s Bill of Rights

6. RIGHT TO SELF-DETERMINATION.
 - The patient has the right to avail himself/herself of any
recommended diagnostic and treatment procedures.

7. RIGHT TO RELIGIOUS BELIEF.

 - The patient has the right to refuse medical treatment or
procedures which may be contrary to his religious beliefs,
subject to the limitations described in the preceding subsection.

 Patient’s Bill of Rights

8. RIGHT TO MEDICAL RECORDS.

 - The client is entitled to a summary of his medical history and
condition. He has the right to view the contents  of his medical
records, psychiatric notes and other incriminatory information
obtained about third parties, with the attending physician explaining
contents thereof.
9.RIGHT TO LEAVE.
 - The client has the right  to leave hospital or any other health care
institution regardless of his physical   condition.
*No patient shall be  detained against his/her will in any health care institution on the  sole 
basis  of  his failure to  fully  settle  his  financial  obligations.

 Patient’s Bill of Rights

10.RIGHT TO REFUSE PARTICIPATION IN MEDICAL RESEARCH.

- The patient has the  right to be advised if the  health care provider  plans to 
involve him in medical research, including but not limited  to  human 
experimentation which may be performed only with the written informed
consent of the patient.

11. RIGHT TO CORRESPONDENCE AND TO RECEIVE VISITORS.

- The patient has the  right to  communicate  with  relatives and other  persons 
and to receive visitors subject to reasonable limits prescribed by the rules and
regulations of the health care institution.

 Patient’s Bill of Rights

12. RIGHT TO EXPRESS GRIEVANCES.

 - The client has the  right to  express complaints and grievances about the care and 
services received  without fear of discrimination or reprisal and to know about the
disposition of such complaints. Such a system shall afford all parties concerned with the
opportunity to settle amicably all grievances.

13.RIGHT TO BE INFORMED OF HIS RIGHTS & OBLIGATIONS AS A

CLIENT.
 - Every person has the right to be  informed of his rights & obligations as a client. The DOH,
shall launch and sustain a nationwide  information & education  campaign  to  make  known 
to  people  their rights  as patients, as declared  in this Act  such  rights  & obligations  of
patients  shall  be posted in a bulletin board conspicuously  placed in a health care
institution.

 Patient’s Bill of Rights

What claims are included in the PATIENT’S BILL OF RIGHTS?

While specific wording varies from hospital to hospital, most
BILLS OF RIGHTS include the following focus areas:

❖High-quality hospital care

❖A clean and safe treatment environment
❖Involvement in care
❖Protection of patients’ privacy
❖Help with patients’ billing and insurance claims
❖Preparing for the end of patients’ hospital visits

 Patient’s Bill of Rights

What if medical professionals fail to honor patient rights?

If medical professionals fail to provide STANDARD OF

CARE (i.e. appropriate treatment) or do not obtain a
patient’s INFORMED CONSENT (or the informed permission of a
parent/guardian) before taking a specific course of action, this
is negligent behavior. If their negligence harms a patient, it
constitutes medical malpractice, and they can be subject to
lawsuits.

 Malpractice & Negligence

malpractice: “professional negligence”

It is defined as the failure of a professional to use the degree

of skill and learning commonly expected in that individuals
profession.

Example: nurse performing minor surgery without training.

 Negligence:
It is defined as the failure to give care that is normally
expected of a person in a particular position, resulting in
injury to another person.

Example: falls, using defective equipment, infections as a

result of nonsterile instruments or equipment, burns
caused by improper use of heat or radiation treatments

 PRI VAC Y A C T O F 2 012

DATA
(republic a ct 1 017 3 )



 DATA PRIVACY ACT OF 2012
(Republic Act 10173)

“An act protecting individual personal information in

information and communications systems in the
Government and the private sector, creating for this
purpose a National Privacy Commission, and for
other purposes”



 DATA PRIVACY ACT OF 2012
(Republic Act 10173)

SCOPE
This act applies to the processing of all types of personal
SEC. 4. Scope. –

information and to any natural and juridical person involved in personal

Information processing including those personal Information controllers
and processors who, although not found or established in the Philippines,
use of equipment that are located in the Philippines, or those who maintain
an office, branch or agency in the Philippines …



 DATA PRIVACY ACT OF 2012
(Republic Act 10173)

KEY ROLES IN THE DATA PRIVACY ACT



 DATA PRIVACY ACT OF 2012
(Republic Act 10173)
Data Subjects
refers to an individual whose, sensitive personal, or privileged information is processed
personal
Personal Information Controller (PIC)
controls the processing of personal data, or instructs another to process personal data
on its behalf.
Personal Information Processor (PIP)
organization or individual whom a personal information controller may outsource or
instruct the processing of personal data pertaining to a data subject
Data Protection Officer (DPO)
responsible for the overall management of compliance to dpa
National Privacy Commission
independent body mandated to administer and implement the dpa of 2012, and to
monitor and ensure compliance of the country with international standards set for
personal data protection

 DATA PRIVACY ACT OF 2012

(Republic Act 10173)

What are the main

principles that govern the
approach for the Data
Privacy Act?


 DATA PRIVACY ACT OF 2012
(Republic Act 10173)
Principle of Transparency

A data subject must be aware of the nature, purpose, and

extent of the processing of his or her personal data,
including the risks and safeguards involved, the identity of
personal information controller, his or her rights as a data subject,
and how these can be exercised. Any information and
communication relating to the processing of personal data should
be easy to access and understand, using clear and plain language.



 DATA PRIVACY ACT OF 2012
(Republic Act 10173)

Principle of Legitimate Purpose

The processing of information shall be compatible

with a declared and specified purpose, which
must not be contrary to law, morals, or public policy.



 DATA PRIVACY ACT OF 2012
(Republic Act 10173)

Principle of Proportionality
The processing of information shall be adequate, relevant,
suitable, necessary, and not excessive in relation to a
declared and specified purpose. Personal data shall be
processed only if the purpose of the processing could not
reasonably be fulfilled by other means.



 DATA PRIVACY ACT OF 2012
(Republic Act 10173)

What are the

classification of
Personal Data?


 Personal Information

Refers to any information whether recorded in

a material form or not, from which the
identity of an individual is apparent or
can be reasonably and directly ascertained
by the entity holding the information, or
when put together with other information
would directly and certainly identify an
individual
 Sensitive Personal Information

Refers to personal information about an individual’s:

❑ race, ethnic origin, marital status, age, color, religious, philosophical or political
affiliations, health, education, genetics, sexual life, any proceeding for any
offense committed or alleged to have been committed, the disposal of such
proceedings, the sentence of any court in such proceedings;

Also includes information issued by government agencies peculiar to an individual

which includes, but not limited to:
❑ social security numbers, previous or current health records, licenses or its
denials, suspension or revocation, and tax returns
SENSITIVE PERSONAL INFORMATION
All processing of sensitive and personal information is Prohibited except in
certain circumstances.
¢ Consent of the data subject;
¢ Pursuant to law that does not require consent;
¢ Necessity to protect life and health of a person;
¢ Necessity for medical treatment;
¢ Necessity to protect the lawful rights of data subjects in court
proceedings, legal proceedings, or regulation.

PENALTIES
❑Ranging from P100,000 to P5,000,000
❑Imprisonment of 1 year up to 6 years
❖Unauthorized processing of personal information and sensitive personal information
❖Accessing personal information and sensitive personal information due to negligence.
❖Improper disposal of personal information and sensitive personal information
❖Processing of personal information and sensitive personal information for unauthorized purposes
❖Unauthorized access or intentional breach.
❖Concealment of security breaches involving sensitive personal information.
❖Malicious disclosure.
❖Unauthorized disclosure

 Health Insurance Portability And

Accountability Act(HIPAA)

• One of the most recent developments in PATIENT

CONFIDENTIALITY has been addressed through
HIPAA(1996)

• Every medical office needs to provide a notice of privacy

practices to every patient(signed and in the patient’s
chart)

 Health Insurance Portability And

Accountability Act(HIPAA)
• This has the following SIX COMPONENTS:
✓ How a patient’s protected information is used and disclosed
✓ The provider's duties to protect the patient privacy
✓ Written notice of the provider’s practices to ensure each patient’s privacy
✓ The term of the provider’s notice
✓ The patient’s individual right concerning protected health information
✓ How to contact the office to obtain further information or to file a complaint

If in doubt when releasing patient information; check with the HIPAA

officer (medical records)