PROFESSIONAL ADJUSTMENT

• Every nurse must bring credit to the profession but

Questions Frequently Asked it cannot discredit other professions, do not overlap
1. Liability of a nurse functions; do not dictate other professions on what
• Duty- obligation to do e.g., telling a surgeon to scrub again, you
o Comes from a right, if there is not duty, there is should only ASK
no right vice versa • Assert the profession but NEVER discredit or
• Breach- failure to perform the duty dictate other professions
• Proximate injury- occurs because if breach 3. Accountability
o Proximate- kadikit • Keyword- liability
o Injury- invasion of a right • Hallmark of profession
o This is the first thing you should look at to • Attached to the standards which is attached to the
determine if a nurse is liable or not profession
o If there is no injury, do not answer that the • Negligence- violating of the standards of your OWN
nurse is liable profession e.g., failing to raise the siderails
Universal rule of Human Rights o Look at the nature of duty—is the duty a duty
You have the absolute right to love anybody but you do not of a normal prudent person or a professional?
have the right for you to be loved back by the person you love
• Malpractice- violation of the standards of OTHER
→ If they love you back, it’s basic privilege
professions e.g., administering the wrong
medication
Sources of Rights/ Obligations
o This is not expected from a normal prudent
→ The sources of obligations are rights
person, should be of a professional
→ Law- the highest source of rights
• Rules and regulations ruled implemented by a Breach of Duty
supreme being
→ Failure to perform the duty
→ Contract- COC
→ Omission- act not done that should have been done
• Consent (consent is only used in the Philippines)
• (-) action
o Age of majority in the Philippines is >18 years
→ Commission- action done that should not have been
old
done
Additional Law (American Common Law)
• (+) action
→ Assent- emancipation consent, the moment the support
is cut because the person is already able to sustain
themselves Misdemeanors
• Can occur even when a person is less than the legal → Nonfeasance- duty, action not performed
age → Misfeasance- duty, action but is erroneous
• Use- to create legal relations→ gives person the • Deltoid injection of iron but z-track is not done
ability to consent
→ Malfeasance- duty should not be done/ absolutely
• Not applicable in the Philippines
→ Legal prohibited, but is performed
• Selling of illegal drugs
In the boards
→ If emancipation is placed in the situation, do not question Proximate Injury
if it is applicable or not, nilagay na eh → Should have a cause and injury
o Object- ano ang nasayo na ibibigay mo sa • There should not be an intervening cause
kabilang party (something that can break the chain of causation)
o Consideration- kung ano ang matatanggap mo → Proximate cause→ intervening cause→ proximate
mula sa kabilang party injury
▪ If object and consideration don’t meet, → An intervening cause can remove liability
there will be no contract → E.g., tinaga→ hospital→ nosocomial infection→ died→
o The law and contract are not in contrary to one liable yung nanaga
another → E.g., tinaga→ hospital, signed a HAMA form→
▪ If the contract is not in contrary to the law, infection→ died→ liable, (+) intervening cause dahil
the contract must prevail sa katigasan ng ulo nung patient
▪ If the contract is in contrary to the law, then → Is your error the reason for the injury of the person?
the law must prevail → Proximate injury- dapat yung pagkakamali connected
→ Delict- crime doon sa cause, if not then liability
• All delicts are laws, but all laws are not delicts
→ Quasi-contract Entities
→ Quasi-delict/ tort → Preliminary investigation- does not give verdict—guilty
or not
Type of Duty • Done to screen cases that should proceed to court
→ Normal prudent person • Complainant- nagsasampa ng kaso
• You do not need authority, autonomy, and • Respondent- sinasampahan ng kaso
accountability → Criminal case- if (+) cause
• Standard is of an average person • Plaintiff- nagsasampa, “the people of the
→ Duty of a professional Philippines”
• (+) Authority, autonomy and accountability • Accused- defendant
→ Administrative case
Criteria • Complainant vs. respondent
1. Authority- mastery of knowledge and skills not common • Privileges can be removed
to the general public → Civil
• Ang tambay ba ay marunong nito? • Complainant vs. defendant
2. Autonomy- professional governance
• Violation of a penal law
• All professions have standards
o What to do and what not to do (general) Admin
• Standards of nursing practice
→ Life
o Safeguard the practice of the nurse or the
→ Liberty
profession itself
→ Property
→ Profession/ privilege
→ Proof- substantial evidence, relevant proof needed to
support a conclusion
→ Filed to the BON→ PRC→ Office of the President→
court of appeals→ supreme court (appealing process
→ 80% filed against female and male nurses are gross
immorality practices—adultery, concubinage, bigany
Civil
→ Life
→ Liberty
→ Property
→ Privilege/ practice of profession.
→ Proof- preponderance of evidence, paramihan/
pabigatan lang ng evidence—who among the parties
have weightier rights
→ Filed at the court
Criminal
→ Life
→ Liberty- imprisoned
→ Property
→ Profession- but not necessarily removed, there are
penalties that allows practice of calling, if there are no
accessory penalties that suspend the license
→ A criminally liable person is also civilly liable
→ Since it is a heavy verdict, proof should be of beyond
reasonable doubt, walang pag-aalinlangan
→ Filed at the court
The practice of profession affects the public; therefore, it has
to be regulated by the state→ privilege
→ Hospital
Additional notes
→ Ostensible agency- parang may authority pero wala
naman talaga
• A person is not an employee but it LOOKS LIKE they
are an employee
3. Captain of the ship
→ Liability is only at the person who is in command and in
control
→ Not used in the Philippines because you are diluting the
act of the person who committed the act
→ A common law doctrine
→ Still answer for the purpose of the boards haha
4. Force majeure
→ Act of God
→ Unforeseeable or foreseeable but inevitable
→ Element of voluntariness is removed, therefore,
→ Element of voluntariness is removed, therefore,
removes liability from anyone because the event is not
controlled by anyone
Nurse Practice Act (Philippine Nursing Act)
→ NPA is used because there are different standards of
nursing practice per state, but this is not used in the
Philippines

Doctrines of Negligence and Malpractice

1. Res ipsa loquitur
→ Res- thing
→ Ipsa- itself
→ Loquitor- to shout or speak
→ The evidence or the thing speak for itself
→ First true nursing law- act 2808
→ Only used when the nature of injury is one of common
• (+) own regulatory board
knowledge
• Act 2493→ no own regulatory board
Elements of Res Ipsa Loquitur • Three seats
o Chair- medical doctor
→ The negligent act should be the SOLE cause of the
o Members- 2 RNs
injury
→ RA 877- Sen. Geronima T. Pecson is the writer
→ The plaintiff should’ve not contributed anything to the
injury • First female senator of the Republic of the
Philippines
→ The respondent must be the author/ doer of the
negligent act • Chair person is now a nurse, BON are already all
nurses
→ The injury must be of common knowledge, no technical
knowledge involved (does not need an expert to • Repealing/ replace law of act 2808
validate it) → RA 6136, RA 4707- amendatory laws
• They modify preexisting laws not remove it
2. Respondeat superior • They increased the membership of the BON from
→ Let the master answer three to five
→ Management- command responsibility, concept of • If hypodermic medications are given there should
direct command and control be a supervising doctor
• There is supervision and control at the time the act → RA 7164
was performed • Medications can now be administered without the
→ Two entities are liable supervision of a physician
• Vicariously liable- liable because of another’s • Author- Sen Heherson Alvarez
action, those who have direct supervision and • No more age requirement that a nurse should only
control work until 65 years old maximum
• Personally liable- the actor, liable for your own • Before doing IV therapy, (+) training
actions → RA 9173
→ There is no shift of liability • IV therapy training is already removed, but
→ Shared liability of the actor and the person who has companies may require this to benefit their
direct control and supervision over the actor business
Admin- only one is liable, only the actor • 7 seats-- 1 chairperson, 6 members
Civil- two are liable • Author- Juan Flavier
Criminal- two are also liable, but mostly personal in character • Approved by Gloria Macapagal- Arroyo
• Approved in October 21, 2002
A janitor has unintentionally killed a combative psych patient, → SB 2720 (HB 6411 congress; 16th)
who is most liable? • A huge equalizer for nurses, standardizes the
→ Janitor
salary of public and private nurses
→ Nurse
• Author of HB 6411- Imelda Samaco Paquis
→ Physician
• SB 2720 authors
 o Nancy Binay Vetoed by the late
o Teofisto Gringona III President Benigno
o Antonio Trillanes IV Aquino III
Steps of the Appointment of the Board
1. Nomination- the APO will nominate
• Accredited professional organization→ PNA
(Philippines Nurses’ Association)
• Submitted to the Commission→ PRC
• Three per vacancy
2. Recommendation- PRC will recommend to the Office of
the President
• Two per vacancy
• Recommendation may or may not be followed
3. Issuance of appointment
• Commission will issue this
• Oath of office is also included here
4. Acceptance of appointment
• For a nurse to become a BON, they have to remove
any interest to any institution offering nursing
subjects, courses, and review upon appointment
• Conflict of interest
• The President can appoint a person to be a
member even if they are not recommended
5. Oath of office
• Done in front of any person who is authorized to
administer an oath
• President, PRC, consulars
6. Assumption of office
• Already discharged the functions of the office
Types of Appointment
→ Regular
• Went through the nomination, recommendation,
and appointment
• Term- one term and eligible for reappointment for
another term
o Maximum of two terms
• Each term consists of three years, maximum six
years
→ Ad interim
• Filling up in the unexpired portion of the term
→ Hold over
• At the pleasure of the appointing authority
o The President is the appointing authority
• You cannot leave office until a new successor have
been appointed
• Hold over of the status quo (maintain the current
member)
Term vs. Tenure
→ Term- entitlement to hold office
• Duration is always based by the law
• E.g., Erap was elected President and should last for
6 years
→ Tenure- actual holding of office
• Duration depends on facts
• E.g., Erap only help 3 years of office
Qualifications
→ RNMAN
→ Should be a natural born Filipino
• You are not required to perform any positive act to
perfect your citizenship→ if (+) action→ naturalized
• Jus sanguinis→ by blood (applied in the
Philippines)
• Jus soli→ if you are born there, you are citizen there
→ Residency- should reside within the country for at least
five years
• 10-5 rule
• 10 years of continuous practice, the last five years
should be here in the Philippines
→ Should be a good standing member of the PNA (APO)
• Should not have any unpaid monthly dues, not a
delinquent
→ The nature of the PNA membership is only an invitation
→ The seven seats are not required to filled up so long as it
represents the three areas of nursing—SEC (service,
education, and community health)
→ But in the SB 2720, they added nursing leadership
and governance
→ Should be a holder of a masters
• Chair- masters in nursing
• Members- masters in nursing, education, and any
allied medical profession, but majority should be
holders of master’s degree in nursing
• 5 out of the seven BON should have a Master’s
Degree in Nursing (1 chairman, 4 members)
→ Should not be convicted of any moral turpitude offense
• You do not need a law to tell if an action is bad—it
is inherently bad or vile
• Requirements and eligibilities are continuing in
character, if a member is convicted after
appointment, they cannot continue office
Functions of the Board of Nursing
1. Executive
• EO 609- 200 million funds to
cater those who want to
retake the exam or review
again in 2006
• Created by GMA to support the 2006 retakers
• Recommend (BON)
• Approve (CHED)
• PRC is the custodian of records
Conduct of NLE, joint function or sole function of BON?
→ It’s a joint function of PRC and BON
Creation of NLE questions?
→ Sole function on BON
2. Quasi-legislative
• Mimics the actin of the legislative
• They try to enact laws that is only effective to the
practice/ for the persons concerned
• BON Res. No. 426 Series of 2003—implementing
rules and regulations of the new nursing law (IRR)
• PRC Res. No. 2019-1146, Series of 2019
o If no year is mentioned, answer the most
updated, 15 CPD/ 3 years
• If the reference is 2017, answer 45 CPD units in
three years
• Moratorium up until December 21, 2022- effectivity
of a law is suspended
• Affidavit of undertaking- complete the 15 CPD units
in the next renewal→ If you fail to secure, you can
no longer renew your license for that year
o Should be notarized
3. Quasi-judicial
• Subpoena vs. summons
o Difference is the parties involved
o Subpoena- witnesses
o Summon- respondent
• The best evidence that you are an active nurse-
certificate of registration
o This is considered primary because of the
signature of the BON
o Secondary evidence if the license, for
portability
• Inactive- not practicing for five consecutive years
Code of Ethics
→ BON Res. No. 220 s. of 2004
→ Basis of the adoption of the code of ethics for
nurses→ code of good governance
→ Mandate that code of good governance should be
adopted is from the PRC
→ The law that dictates good governance→ RA 8981
(PRC modernization act)
 Suspension Revocation ASEAN, in the
→ Removal of privilege to → Removal/ cancellation Philippines there
practice the profession from the roster or is only PQF 8 (to
but the license is still nurses because make nurses
effective privilege, COR competitive even
→ Serve the suspension→ (revocation), and in other ASEAN
suspension will be lifted license (cancellation) countries)
by operation of law→ are revoked • Without CPD, a
privilege will be returned → Reissuance→ write a nurse will be able
→ Suspension is no more letter of intent to renew their
than 4 years addressed to the BON license
→ The excess years will be (because they give and • Nurses in the first
void remove the COR) cycle of renewal is
Past board question → After four years + you still exempted
One dean has been have to prove that the Earned units 60 units/ 3 15 units/ 3 years
suspended, he chose to cause of revocation is years
taught in a nursing school already cured (this is the Implementation Not Moratorium-
and his reason was “its not reason why the COR is implemented suspended application
a practice of profession”, revoked), prove the by the PRC • Therefore, PRC
is this valid? moral fitness will only require
→ No, because practice → an affidavit of
of profession is the undertaking
use of knowledge Inactive Nurses
related to the → Not practicing for five continuous years
profession → Removal in the roster of active nurses
→ Privileges are
→ Practicum- skills-based, pracTHREEcum
suspended, he
cannot practice • Three months
→ Didactic- lecture, one month
Gag order- you cannot talk about the issue outside court
Special Temporary Permit vs. Alien Employment Permit
→ Tagapangulo- PRC commissioner, because they are
the custodian of records, makes the record authentic → STP
• Rules- MEP
Position Masters Years of Experience • Medical missions- should be free, applicable
BON • Chair- masters in 10-5 rule whether there are emergencies or not
nursing • 10 years of • Experts- can charge fees but can also be free
• Member- masters continuous • Professors, students (exchange)
in nursing, allied practice the last • In the 2720, additional→ to give international
health, and five years here in medical aid to the Phill pines, only during natural
education the Philippines calamities
CI/ faculty Masters in nursing 1-year clinical → AEP- rules of reciprocity (do ut des- I give what you may
practice
give)
Dean Masters in nursing 5 years
• Strict, issued by DOLE because they are guided by
Chief • General hospital- 5 years of managerial
nurse/ masters in and administrative Filipino first policy (dapat wala munang pinoy na
Nursing nursing experience kayang gumawa ng trabaho na ‘yan)
director • Public health • No need to get this when going to America
institutions-
masters of public Board Rating
health → General average of 75%, with no grades lower than
• Military hospitals- 60%
masters in
→ If one NP is <60%, retake the removal exam within 2
nursing and has
years and get 75%
finished general
staff course (32-
36 units training) Advanced Practice Nursing
Supervisor No need for masters → Nurses are allowed to perform episiorrhaphy is (+)
Chief • Only need 9 units in the graduate training from MCNAP (maternal and child nurses
nurse, level (postgraduate) studies— association of the Philippines) under the supervision of
primary managerial and administrative ANSAP (Association of Nursing Service Administrators
hospital 2 years of general nursing service of the Philippines)
administration • Episiotomy are only performed by physicians
→ Nurses can perform IE, not allowed if (+) bleeding
• Florence Nightingale is the only chief
nurse without masters degree with • Written in the scope of nursing practice
less than five years’ experience
Staff nurse BSN and an RN RA 6758 Compensation and Classification Act of 1989
Joint resolution no. 4 decreased SG15 to SG10, is this valid?
Continuing Continuing NO, because only a law can amend a law
Professional Professional → Joint resolution is now a law; therefore, it cannot
Education Development downgrade the salary grade of nurses
Source Made by the RA 10912 Continuing
PRC Professional Crimes
• PRC Res. Development act of → Three types
No. 179 s. 2016 • Felony
of 2004 • From the ASEAN • Offense
integration
• Infraction
• To create a
correct PQF
ranking (personal Felony Offense Infractions
qualification Act is Punishable by Violation of
framework) punishable by special penal law ordinances—
• There are 12 the revised • Enacted curfew hours
PQFs in the penal code— purposely to
 combination of curb a specific → Tort- a wrongful act which is not a crime
the codified action e.g., RA • Civil in character
crimes/ 9173 has
compiled/ provisions that
Crimes and Nurses
collective can be
violated→ (+)
→ Look for: crime, criminal, liability
penalty • Crime- freedom, intelligence, and intent
• (-) crime, (-) criminal, (-) liability
Crimes vs. Tort
Situations Crime Criminal Liability Examples
J- justifying • Self-defense
• You only exercised you • Defense of property
right
E- exempting • Insane- (+) lucid intervals
• Imbecile- incurable in character
M- mitigating • Previous good character
• Remorse or good conduct
following arrest
• Voluntary compensation of victims
• Full admission of facts and guilt
• Minors
A- aggravating • Crimes done during disasters or at
night
• Crimes done to a vulnerable
person
• Abuse of power
A- alternating • Intoxication
• Verdict can increase or decreased
depending on the situation
• Relationship to the plaintiff

→ Cunnilingus- tongue to the vagina

Types of Crimes → Felatio- penis to the mouth
1. Crimes against persons
• Homicide- killed a person with an intent to kill Types of Rape
Reckless imprudence resulting to homicide→ not intentional → Simple- no other qualifying circumstances
but has killed a person → Qualified- (+) qualifying circumstances
• Murder- homicide + qualifying circumstances • Has higher penalty
o Treachery- betrayal • Pregnancy after rape
o Evident premeditation- pinagplanuhan maigi • Mental disorder
o Use of motor vehicle- para makatakas e.g., • Incurable STD
riding in tandem • Homicide
• Parricide- homicide + relationship → Statutory- rape created by the law itself
o Descendants • Kahit na gusto nung bata, rape pa rin kasi a minor
o Spouse cannot give consent according to the law
o Children- be it legitimate or illegitimate (but an • Statutory rape- <16 years old
adopted child only have a relationship to the → Marital- kahit na asawa mo pa, consent is still needed
adoptee)
o Ascendants Crimes Against Properties
• Infanticide- homicide + age of the victim (<3 days Robbery Theft Estafa
old) Definition Take the personal (+) duty to return an
o If the child is exactly 72 hours, this is not property of object, if the owner
another demands that you bring it
infanticide because the law states it should be (+) Intent to gain back and you have not
LESS THAN 72 hours given it→
• Rape- under crimes against persons misappropriation (trinato
o Unconsented sexual intercourse mong sa’yo ang isang
bagay na hindi naman
o RA 8353 expands anti-rape law, made it sayo)
genderless
• Misappropriation of
Modes of a certain part of
Papasok Papasukan property
Committing Rape
Rape by carnal Penis Vagina • Under the criminal
knowledge • Length- 6-8 law
• Different from inches Force
coitus (lengthens • Directed to a
• Walang narape when (+) thing
ang gustong foreplay or Intimidation
marape excitement) • Directed
• The vagina will • Resting- 3-4 towards a
not lengthen, inches person
insertion of the • No bodily
penis will harm done
cause vaginal but may
laceration cause mental
• Not full affectation/
penetration fear
Penis • Mouth Violence
• Anus • Directed
Object • Vagina towards a
Rape by sexual • Tongue is • Anus person
assault considered as • (+) Physical
an object harm
(cunnilingus)
• Finger
 Past board question:
A patient was prescribed a sedative, an orderly took the
client’s bag. Is this theft or robber? Theft, since the patient is
sedated and the orderly did not give the sedation to the
patient
Crimes Against Honor
Libel Slander Slander by Deed
Acts of defamation, they only differ in their form
Written Oral Act (overt)—can
be seen
observed
Electronics are Slapping a person
used→ electronic/ in public,
cyber libel person’s face is
considered their
honor or identity
(+) Intent to shame
others in public
Torts
→ Intentional tort- (+) intent to cause a wrongful act
against another
→ Unintentional tort- (-) intent
Unintentional Tort
→ Look at the standards that are not complied
→ Malpractice- professional standards, (+) professional
knowledge
→ Negligence- normal prudent person, does not need
technical/ professional knowledge
Intentional Tort
1. Battery- unconsented touching that has produced actual
harm
• May include not touching so long as it created harm
• (+) Intent to cause harm
2. Assault- threatening bodily harm but has not performed
the act
3. Breach of confidentiality- a right not to disclose
• Breach- invasion
• Only in exceptional circumstances are we allowed
to breach confidentiality- 4 Ps
o Permission of the patient/ waiver
▪ If a stranger wants to read the patient’s
chart, he should get permission from the
patient and the hospital
▪ If the patient wants to open the chart- they
can read it subjected to hospital policy
Who owns the chart? Hospital or facility
Who owns the information in the chart? The patient
Difference of Chart and Medical Records
→ Chart- colloquial term for a patient who is still receiving
service from the hospital or facility—still admitted
→ Medical records- once the patient is discharged, placed
in the medical records section
Medical Records
→ Types- traditional/ non-medico-legal and medico-legal
→ Non-medico-legal- (-) court litigation
• Disposal- 10 years from the moment that the record
is filed with the medical record section, from the
discharge of the patient
• After 10 years, it will be disposed of by the
institution→ sent to the RMAO (records
management archival office)—central agency for
the disposal or records→ bureau of archives, a unit
in the RMAO
→ Medico-legal- (+) court litigation
• Disposal- 10 years after the end of the litigation→
RMAO
• Strictly confidential and after the disposal it can be
converted to a public purpose but only for limited
purposes—conduct of research and the like
Incident Reports
→ Brief statement of facts
→ What is the primary reason for the execution of the
incident report? National patient safety program,
before for risk management purpose
• If these two presents choose for risk management
purpose
→ Not placed in the patient’s chart, you cannot place in
the patient’s chart that there is an IR created→ can be
taken in as evidence against the hospital, once this is
open for discussion confidentiality will be waived
→ It should be placed in the 201 files of the employee
involved—clinical record of every employee, in a locked
cabinet
→ How does the incident report protect the hospital?
or Every patient safety issue must be considered a sentinel
event. Immediate investigation will be done and IR is
the evidence of immediate investigation
a • P- public safety is jeopardized, RA 11332
(Mandatory Reporting of Notifiable Diseases and
Health Events of Public Health Concern Act)
o Name of the person can be disclosed for
limited persons only
• P- provider of care, members directly involved in
the care of the patient
• P- proceedings, a subpoena may be issued by the
court (subpoena duces tecum)
o What type of proceedings to avail confidential
records? Criminal cases. In civil cases, it is
hard to obtain charts
4. Breach of privacy- right to be apart from others/ left alone
A nurse has given Depo-Provera to ta patient that has not
consented. What is this?
→ Battery, if not in the choices→ intentional tort→ tort→
malpractice (any unprofessional conduct)
Bioethics
1. Autonomy
→ General rule- a patient must
always be autonomous but if
the patient is incompetent
then somebody has to
decide for them
→ Sequence of gaining
consent if the patient is
incapable
→ Autonomy ends when paternalism begins
2. Paternalism
→ Effective ONLY if the patient is incompetent and in
cases of emergency
Which of the following ethical principle is manifested when
you appear to be a role model?
a. Autonomy
b. Paternalism
c. Stewardship
d. Role Fidelity- upholding oath
What principle is violated when you donate your body organ?
Stewardship, you do not own your body God owns it
Principle of Totality contradicts Stewardship
→ Totality- removal of a body part in order to save the
person e.g., mastectomy or removal of a diabetic foot
→ The whole is different from the sum of its parts
3. Veracity
→ Truth-telling
→ Pre-requisite of autonomy, a patient has to be well-
informed before they can decide
4. Benevolent deception
→ Not telling/ concealing the truth for the benefit of a
person
→ Done only if the patient is incompetent to handle the
truth
5. Justice
→ Act to prioritize
→ Triaging, distribution of resources, equity should be
practiced
→ Used for organ donations, who shall the organ be given
to?
 • The usability of the certain organ will determine the Types
recipient e.g., a patient with SLE is lower in priority → Full- give everything—medications at right intervals,
than a patient with syphilis because SLE would CPR
damage the kidneys → Slow- give medications but not correct interval
• Kanino mas may gamit ‘yung organ? • Theatrical, because you are not there to prolong
• Utilitarianism will be used the life of the patient but to remove the guilt of the
family members
When there is only one pacemaker and there are many → No- no heroic interventions will be done
patients needing it, the principle to be used is: • DNR (do not resuscitate)
a. autonomy o Continue ordinary measures—pain
b. justice
medications, face mask oxygen (anything
c. respect
greater than face mask is not used), foods,
d. beneficence
fluids
When the nurse triage patients to render care accordingly, o Stop extraordinary measures- CPR, surgical
you are using this particular principle procedures
a. respect/ if this is changed to justice, still choose justice • DNI (do not intubate)
(distributive justice) • DNT (do not treat)
b. allocation of resources
c. beneficence Type of Patients for DNR
d. autonomy
→ PVS (persistent vegetative state)- even if life support is
What ethical principle should be used when you are removed, can still live
administering an IM injection? Priority for any parenteral → Clinically dead- dependent on the life-support, once
medications is to avoid any injury to the nerves and blood removed will expire
vessels, nonmaleficence is the answer • A living will may be written
→ If no non-maleficence in the choices, choose • Spouse or children may decide to remove life
beneficence support
• Who pulls the plug? The significant other, the
Distribution of vaccines in certain areas is considered what?
doctor is only there to witness and to declare death
Beneficence, you did something to promote good—the act of
distribution
of the patient
• All medical practitioners do not pull the plug
Beneficence Non-maleficence because we are advocates of palliative care
Doing something, Not doing something,
“to do” maintenance of the status 3. Euthanasia
quo Active Passive
Doing → Prevent Mercy killing
good complications/ harm (+) action to mercy Not practiced in the (-) action
Positively stated Negatively stated—avoid, kill the person Philippines
do not, refrain • Assisted constitutive of murder
Proactive Inactive suicide- a • Oregon is the first
request must country in the US
be made to allow
Three Important Research Principles
• Only the euthanasia
→ Nuremberg code- birth of informed consent
eligible patients
• In Germany, political and civil rights are suspended. are those for
Kahit walang consent pwede sila kunin for research hospice care,
• Dictates that every research subject must give their <6 months to
informed consent live
• The right to consent carries with it the right to
withdraw, no exceptions Who should give potassium chloride during death sentence
• The research subject can withdraw anytime, but execution per lethal injection?
the research subject will be liable for damages → Medical Doctor- Hippocratic oath All the three
since there are breaching contract → Registered Nurse- nightingale pledge should
→ Registered Medtech- also have their own oath
→ Belmont report- summation of all research ethics promote/
→ Trained Health Worker
• (+) Assurance of privacy and confidentiality advocate
• Research vs. subject- when there is a threat to the palliative care
subjects, the research subject will be the because they
paramount consideration have sworn
→ Helsinki declaration- classify whether the research is oaths
therapeutic or nontherapeutic
• Clinical trial- therapeutic research
• If the research is therapeutic, it should undergo
review of the regulated ethics committee/ IRB
(institutional review board), it has to be approved
first, if (x) approval it cannot move forward

Common Nursing Issues

1. Telephone order
• The RN signs the telephone order, the physician
countersigns the TO within 24 hours (second
answer) or per hospital policy (because there is
flexibility per policy, number 1 answer)
• Third answer is ASAP (not priority
because this is not specific)
2. Hospital codes
• Primarily used to prevent panic