ETHICAL AND LEGAL FOUNDATIONS OF PATIENT
EDUCATION
Why do you think ethical and legal foundations of
health education are very important?
● There are scenarios in the clinical area that can
result to a lot of danger, or may result to
aggravated patient condition especially if it is not
properly explained to the patient and family, same
is true to the nursing student who will go on
clinical duty
● Patient education, student nurses education
generally falls to the staff nurse / CI
● The role of the nurse in this education process is
essential in providing safe, high quality as
mandated in the standards and scope of nursing
practice
● Consumers are aware of and demand recognition
of their constitutional rights regarding freedom of
choice and self determination
Nursing Law - Republic Act (RA) No. 9173
● Also called as Philippine Nursing Act of 2002
● The bill seeks to institute reforms to further
protect and develop the nursing profession
● It delineates the scope of work of Registered
Filipino nurse
● Established linkages with community resources
and requires the updating of professional
knowledge in the nursing field, patient care, level
of nursing practice, and development of nursing
education
● This is an recognition of the vital role of nurses in
the delivery of quality services not only in the
country but also over the world
R.A 4704 - Creation of Board of Nursing
● An act to amend certain sections of R.A 877
● Name and composition of the Board
● Qualifications of Board members
● Term of office
● Compensation of the Board Members
● Clinical and public health nursing
● Qualifications of faculty members
● General entrance requirements to schools,
colleges, and universities of nursing
● Scope of practice of nursing
● Holding of examination
● Qualifications of applicants
● Scrope of examination
● Ratings in the examination
● Report of results of examination
● Fees for examination and registration
Department of Health (DOH)
● 1944
● E.O No. 94
● Principal Health Agency
● Ensures access to basic public health services by
all Filipinos
● Provision of quality health care
● Regulation of all health services and products
Board of Nursing (BON)
● Under the PRC (Professional Regulation
Commission)
● Regulates the practice of nursing in the
Philippines
Primary Purpose of BON
1. To provide regulatory standards in the practice
of Nursing by implementing the Nurse Practice
Act and by lobbying to Congress any proposed
amendment to any laws with direct relationship to
the practice of nursing
2. To ensure public safety by administering the
Philippine Nursing Licensure Exam (PNLE) to
graduates of nursing schools prior to practice of
Registered Nursing in the Philippines
3. To maintain high standards of nursing
education by auditing the performance of
Philippine Nursing Schools
Commission on Higher Education (CHED)
● 1997
● R.A No. 8292
● To establish a complete, adequate and integrated
system of higher education
CHED MANDATE
● Promote relevant and quality higher education
● Ensure that quality higher education is accessible
to all who seek it particularly those who may not
be able to afford it;
● Guarantee and protect academic freedom for
continuing intellectual growth, advancement of
learning and research, development of
responsible and effective leadership, education
of high level professionals, and enrichment of
historical and cultural heritages; and
● Commit to moral ascendancy that eradicates
corrupt practices, institutionalized transparency
and accountability, and encourages participatory
governance in the Commission and the sub-
sector
JCAHO 3. Comprehension
● Means Joint Commission on Accreditation of 4. Voluntariness
Healthcare Organizations ● Important in patient education
● It is the oldest and largest standard-setting ● Related to medical treatment.
accrediting body in health care
● JCAHO evaluates and accredits more than CONFIDENTIALITY
19,000 health care organizations ● Personal information entrusted and protected as
● They are the leader in developing the highest privileged information via social contract,
standards for quality and safety in delivery of healthcare standard/code, or legal covenant
healthcare
● The Joint Commision was created to set NONMALEFICENCE
standards in health care ● “Do no harm”
● Standards help guide organizations to administer ● The ethics of legal determination involving
care ● Negligence, and malpractice
● JCAHO is the only organization with the capability ● Negligence is the doing or undoing of an act
and experience to evaluate healthcare across the pursuant to a duty that a reasonable person in the
continuum of care same circumstances would or would not do
● Malpractice refers to a limited class of negligent
JCAHO accredits other facilities, such as; activities that fall within the scope of performance
● Ambulatory care by those pursuing a particular profession
● Mental health institutions involving highly skilled and technical services
● Long-term care centers ● Duty is a standard of behavior or a behavioral
● Home health care agencies expectation relevant to one’s personal or
● Laboratory services professional status in life.
● Office based surgery
● General, children’s , rehabilitation and specialty
NEGLIGENCE MALPRACTICE
hospitals
● Critical access hospitals ● Does not Intentional
● JCAHO Accreditation Benefits involvement
● Patient safety is improved intent;
● Advertising that the institution is accredited may
bring in more patients ● Improper and A type of negligence
● By showing that the institution is committed to wrongful conduct called “professional
quality health care, liability insurance premiums by anyone arising negligence
may decrease from any activity
● Insurance reimbursement are large if accredited
● Conduct which
falls below the
Ethical Principles to Patient Education standard
- AUTONOMY established by the
- Greek words “auto” *(self), “nomos” (law) law for
- Right to self determination
- Allows an individual to decide on his own ● The protection of
others against
VERACITY unreasonable risk
● “Truth telling” of harm
● Helps patient to use autonomy
● Nurse must always tell the truth;
● Patient is entitled to the truth Most Common Causes of Malpractice
● Failure to follow standards of care
4 ELEMENTS MAKING UP THE NOTION OF ● Failure to use equipment in responsible manner
INFORMED CONSENT ● Failure to communicate
1. Competence ● Failure to assess and monitor
2. Disclosure of Information ● Failure to act as patient advocate
 ● Failure to delegate tasks properly ● Failure = renders other staff potentially liable,
also renders the facility liable and in jeopardy of
BENEFICENCE losing its HC accreditation
● “Doing good” for the benefit of others
● Legalized through properly carrying out tasks Economic Factors of Patient Education: Justice and
● Effort to save lives and relieve human suffering is Duty Revisited
a duty to do what is right within responsible limits Challenge for HCPs:
● Efficient & cost-effective patient education
JUSTICE ● Legal responsibility of all nurses
● Equal distribution of goods and services ● Little preparation on pre-licensure level
● Fairness
● Equality Financial Terminology
● Equitable treatment ● Direct Costs
○ Those that are tangible and predictable
Application of Ethical and Legal Principles - Fixed costs
1. Autonomy - Stable and ongoing
2. Veracity - Variable costs
3. Confidentiality - Those related to fluctuations in
4. Non Malfeasance volume, program attendance,
- Negligence occupancy rates
- Malpractice ● Indirect Costs
- Duty ○ Those that may be fixed but not
5. Beneficence necessarily directly related to a particular
6. Justice activity, such as expenses of heating,
lighting, housekeeping, maintenance
ACCOUNTABILITY ● Cost Savings, Benefit, and Recovery
● Accepting responsibilities and consequences for ○ Money realized through decreased use
one’s own actions of costly services, shortened LOS, or
fewer implications resulting from
FIDELITY preventive services or patient education
● Being true to one’s professional promise ● Cost Benefit
○ Occurs when the institution realizes an
DOCUMENTATION economic gain resulting from the
● Required by JCAHO educational program such as a drop in
● Required by Third-party Reimbursement readmission rates
○ Insurance companies ● Cost Recovery
○ Medicare and medicaid programs ○ Occurs when revenues generated are
○ Private pay equal to or greater than expenditures
● Required by Respondeat Superior
○ Employer may be held liable for for the Program Planning and Implementation
negligence or other unlawful acts of the 1. Revenue Generation
employee during the performance of his - Profit realized when fees for an
or her job-related responsibilities educational program exceed the
● Initial assessment, progress notes, nursing care aggregate costs of program preparation
plans, stag notes, and discharge planning forms and delivery
● Can provide information about the learning needs 2. Relationship of Costs and Outcomes
of patients a. Cost-effectiveness Analysis
● Documentation by other members of the - Refers to determining the
healthcare team, can yield valuable insights with economic value of an
respect to the needs of the learner educational offering by making a
● Vehicle of communication that provides critical comparison between 2 or more
information to other health professionals programs based on reliable
measures of positive changes in
the behaviors of participants as
 well as evidence of maintenance
of these behaviors when a real
monetary value cannot be
assigned to the achievement of
program outcomes
b. Cost-Benefit Analysis
- Relationship ratio between
actual program costs and actual
program benefits as measured in
monetary terms to determine if
revenue generation was realized

The Ethics of Education in Classroom and Clinical

Practice
Criteria
1. Risk of harm to the student (patient) or to the
student-teacher (patient-teacher) relationship
2. Presence of coercion of exploitation
3. Potential benefit to the student or to the student-
teacher relationship
4. Balance of interest and teacher’s interest
5. Presence of professional ideals

Legality of Patient Education and Information

● The patient’s right to adequate information
regarding his or her physical condition,
medications, risks and access to information
regarding alternative treatments
● Joint commission on Accreditation of Healthcare
Organizations
● State Regulations
● Federal Regulations

State of Evidence
● Legal and ethical issues
● Documentation of Practice
● New Technologies
● Health Related Outcomes
● Economic Implications