Community

Health
Nursing
ETHICO-LEGAL ISSUES
• TRAVELLING AT NIGHT
• HAZARD PAY/ACCIDENT
• LIMITATION OF PRACTICE
• HARASSMENT/SAFETY
• MALPRACTICE
 Republic Act No. 7305
MAGNA CARTA FOR PUBLIC HEALTH WORKERS
AIM:
• TO PROMOTE AND IMPROVE THE SOCIAL
AND ECONOMIC WELL-BEING OF HEALTH
WORKERS, THEIR LIVING AND WORKING
CONDITIONS AND TERMS OF EMPLOYMENTS
• TO DEVELOP THEIR SKILLS AND CAPABILITIES
IN ORDER THAT THEY WILL BE MORE RESPONSIVE
AND BETTER EQUIPPED TO DELIVER HEALTH
PROJECTS AND PROGRAMS
AIM:
• TO ENCOURAGE THOSE WITH PROPER
QUALIFICATIONS AND EXCELLENT ABILITIES
TO JOIN AND REMAIN IN GOVERNMENT
SERVICE
SEC. 9. Discrimination Prohibited. - A public worker shall not
be discriminated against with regard to gender, civil status, civil
status, creed, religious or political beliefs and ethnic groupings in
the exercise of his/her profession.

SEC. 10. No Understaffing/Overloading of Health Staff. - There

shall be no understaffing or overloading of public health workers.
The ratio of health staff to patient load shall be such as to
reasonably effect a sustained delivery of quality health care at all
times without overworking the public health worker and over
extending his/her duty and service. Health students and
apprentices shall be allowed only for purposes of training and
education.
SEC. 13. Duties and Obligations. - The public health workers
shall:
(a) discharge his/her duty humanely with conscience and
dignity;
(b) perform his/her duty with utmost respect for life; and race,
gender, religion, nationality, party policies, social standing
or capacity to pay.
SEC. 15. Normal Hours of Work. - The normal hrs. of work of any public
health worker shall not exceed eight (8) hours a day or forty (40) hours a
week.

"On Call" status shall not be considered as hours worked but shall entitled
the public health worker to an "On Call" pay equivalent to fifty percent
(50%) of his/her regular wage.

"On Call" status refers to a condition when public health workers are called
upon to respond to urgent or immediate need for health/medical assistance
or relief work during emergencies such that he/she cannot devote the time
for his/her own use.
SEC. 17. Work During Rest Day. -
(a) Where a public health worker is made to work on his/her
schedule rest day, he/she shall be paid an additional
compensation in accordance with existing laws

SEC. 18. Night-Shift Differential. -

 10% of his/her regular wage for each hour of work performed
during the night-shifts

 Every health worker required to work on the period covered

after his/her regular schedule shall be entitled to his/her regular
wage plus the regular overtime rate and an additional amount of ten
percent (10%) of such overtime rate for each hour of work
performed between ten (10) o’clock in the evening to six (6) o’clock
in the morning.
OTHER BENEFITS
• Hazard Allowance:
*25% of the monthly basic salarysalary
grade 19 and below
*5%salary grade 20 and above
• Subsistence Allowance
3 meals, travel allowance (rural health MD)
• Longevity Pay
5% of the monthly basic pay shall be paid to a
health worker for every five (5) years of
continuous, efficient and meritorious services
OTHER BENEFITS
• Laundry Allowance
 Php 125.00 (reviewed and increased accordingly)
• Remote Assignment Allowance
incentive bonus=50% of basic pay +
reimbursement of transpo + priority for
promotion
• Housing
free quarters or quarters allowance
OTHER BENEFITS
• Medical Examination
 free
• Compensation of Injuries
• Leave Benefits
 VL, SL, ML
PATIENT’S BILL OF RIGHTS
• Right to Appropriate Medical Care and
Humane Treatment
- The patient has the right to
appropriate health and medical care of
good quality. In the course of such care, his
human dignity, convictions, integrity,
individual needs and culture shall be
respected
PATIENT’S BILL OF RIGHTS
• 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 of all proposed procedures.
PATIENT’S BILL OF RIGHTS
• Right to Privacy and Confidentiality
- The privacy of the patients must be
assured at all stages of his treatment
PATIENT’S BILL OF RIGHTS
• Right to Information
- the patient or his/her legal guardian
has a right to be informed of the result of
the evaluation of the nature and extent of
hisher disease
PATIENT’S BILL OF RIGHTS
• Right to Choose a Healthcare Provider
and Facility
- The patient is free to choose the
health care provider to serve him as well as
the facility.
PATIENT’S BILL OF RIGHTS
• Right to Self-determination
- The patient has the right to avail
himself/herself of any recommended
diagnostic and treatment procedures.
PATIENT’S BILL OF RIGHTS
• Refusal of treatment
a. The Patient is of legal age and is mentally competent
b. The Patient is informed of the medical
consequences
of his/her refusal;
c. The Patient releases those involved in his care from
any obligation relative to the consequences of
his/her decision; and
d. The Patient's refusal will not jeopardize public
health and safety.
PATIENT’S BILL OF RIGHTS
• Right to Religious Belief
- The patient has the right to refuse
medical treatment or procedures which
may be contrary to his religious beliefs
PATIENT’S BILL OF RIGHTS
• Right to Medical Records
- The patient is entitled to a summary
of his medical history and condition.
PATIENT’S BILL OF RIGHTS
• Right to Leave
- The patient has the right to leave a
hospital or any other health care
institution regardless of his physical
condition
* No patient shall be detained against
his/her will.
PATIENT’S BILL OF RIGHTS
• 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.
DECLARATION OF HELSINKI
PATIENT’S BILL OF RIGHTS
• 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
• Right to Express Grievances
- The patient 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
PATIENT’S BILL OF RIGHTS
• Right to be Informed of his Rights and
Obligations as a Patient
- RIGHTS & OBLIGATIONS must
benplaced in an area that is readily visible
to patients
PATIENT’S OBLIGATIONS
• Know rights (responsibly and reasonably)
• Provide accurate and complete information
• Report unexpected health changes
• Understand purpose and cost of treatment
PATIENT’S OBLIGATIONS
• Accept consequences of own informed consent
• Settle financial obligations
• Relation to others
• Exhaust grievance mechanism
Community
Health
Nursing
FAMILY CODE OF THE PHILIPPINES
• EO NO. 209
• Governs marriages
• Legal separations
• Rights and obligations between spouses
• Property relations between husband and wife
• The family
• Paternity and filiation
• Adoption
• Parental authority
Marriage
• Essential requisites:
- legal capacityMale and Female
- consent freely given
VOID MARRIAGES
- Incest
- b/n blood relatives up to 4th civil degree
- b/n step-parents and step-children
- b/n parents-in-law and children-in-law
- b/n adopting parent and adopted child
- b/n surviving spouse of the adopting parent
and the adopted child
- b/n adopted children of the same adopter
- b/n parties where one, with the intention to marry the
other , killed that other person’s spouse, or his or her
own spouse
Legal Separation
• Repeated physical violence or grossly abusive
conduct
• Moral pressure to compel the petitioner to
change religious or political affiliation
• Attempt of respondent to corrupt or induce
the petitioner to engage in prostitution
• Final judgment sentencing the respondent to
imprisonment of more than 6 years
Legal Separation
• Drug addiction or habitual alcoholism of the
respondent
• Lesbianism or homosexuality of the
respondent
• Contracting by the respondent of a
subsequent bigamous marriage (pH or
abroad)
• Sexual infidelity or perversion
Legal Separation
• Attempt by the respondent against the life of
the petitioner
• Abandonment of petitioner by respondent
without justifiable cause for more than one
year
Rights and Obligations between
Husband and Wife
The husband and wife are obliged to live
together, observe mutual love, respect and
fidelity, and render mutual help and support.
Property Relations between
Husband and Wife
3 Principal Types

a. Absolute Community of Property

- fusion of all properties
- divided equally when marriage is dissolved
b. Conjugal Partnership of Gains
- allows the spouses to keep the ownership of
assets that they bring to the marriage and
those they may acquire during the marriage
- creates common fund out of income from
properties
- when marriage is dissolved50/50
c. Separation of Property
- a matrimonial regime under which the interest

of the spouses are completely independent of

each other, there being a separation not only of
assets, but also of liabilities.
- “what’s mine is mine”
The Family
Art. 149. The family, being the foundation of the
nation, is a basic social institution which public
policy cherishes and protects. Consequently, family
relations are governed by law and no custom,
practice or agreement destructive of the family shall
be recognized or given effect.
Paternity and Filiation
Legitimate Children Illegitimate Children

Conceived or born during valid Conceived and born outside a

valid marriage or inside a void
marriage of the parents. marriage.
Paternity and Filiation
Art. 177. Children conceived and born outside
of wedlock parents who, at the time of
conception of the former, were not disqualified
by any impediment to marry each other, or
were so disqualified only because either or
both of them were below 18, may be
legitimated.
Paternity and Filiation
Illegitimate children
- shall use the surname of the mother unless
father expressly recognizes filiation
- under the parental authority of the mother
Paternity and Filiation
CASE STUDY

1.Gerardo Concepcion, the petitioner, and Ma. Theresa Almonte, private respondent, were married
in December 1989, and begotten a child named Jose Gerardo in December 1990.

2.The husband filed on December 1991, a petition to have his marriage annulled on the ground of
bigamy since the wife married a certain Mario Gopiao sometime in December 1980, whom
according to the husband was still alive and living in Loyola Heights, QC. 3.

3.Trial court ruled that the son was an illegitimate child and the custody was awarded to the wife
while Gerardo was granted visitation rights. Theresa argued that there was nothing in the law
granting “visitation rights in favor of the putative father of an illegitimate child”.

4.She further wanted to have the surname of the son changed from “Concepcion to Almonte”, her
maiden name, since an illegitimate child should use his mother’s surname. After the requested
oral argument, trial court reversed its ruling and held the son to be not the son of Gerardo but of
Mario. Hence, the child was a legitimate child of Theresa and Mario.
Adoption
Adoption
Adoption
Adoption
Parental Authority
• Art. 213
- in case of separation of parents=
PARENTAL AUTHORITY parent
designated by court

* No child under 7 y/o shall be

separated from the mother,
unless court finds compelling
reasons to order otherwise
Parental Authority
• SUSPENSION OF PARENTAL AUTHORITY
(1.) Treats the child with excessive cruelty
(2.) Gives the child corrupting orders, counsel
or example
(3.) Compels the child to beg
(4.) Subjects the child or allows him to be
subjected to acts of lasciviousness
Community
Health
Nursing
EXPANDED SENIOR
CITIZEN’S ACT OF 2010
• RA 9994
PRIVILEGES OF SENIOR CITIZENS
• 20% discount and VAT exemption on the ff:
 Medicines (with prescription)
 PF of APs (private, OPD, home health care)
 Medical, dental and diagnostic tests
Medical supplies and equipments
Domestic air and sea travel fares
Public land transportation fares
Hotels
Restaurants
Recreation centers
Places of leisure (cinema, museum, park, theatre, etc.)
Funeral and burial services for deceased senior citizens
5% Discount on power and water bills
*accounts are registered in their name
*does not consume 100kWh of electricity/mo.
*does not consume >30 cubic meters of water/mo.
SOLO PARENTS’ WELFARE ACT OF 2000
• RA NO. 8972
- Provides for benefits and privileges to solo parents
and their children.

- Aims to develop a comprehensive package of social

development and welfare services for solo parents
and their children to be carried out by DSWD, as the
lead agency, various govt. agencies including NSO and
other related NGOs.
 SOLO PARENT
- A person who has been left with the
child’s responsibility or care under
any of the ff. circumstances:

• A woman who gives birth as a result of rape

• Due to the death of spouse
• Spouse is detained or is serving sentence for a
criminal conviction for atleast 1 year
• Physical and/or mental incapacity of spouse
• Legal separation from spouse for atleast 1 year
*declaration of nullity or annulment of marriage
• Unmarried mother/father who
has preferred to keep and rear
her/his child/children
• Any other person who solely
provides parental care and
support to a child
• Any family member who assumes
the responsibility of head of
family
Conditions for the termination of
privilege

-Change in the status or

circumstances of the parent
CRITERIA FOR SUPPORT
• Any solo parent whose income falls below the
poverty threshold
• Agencies:
• Health Services- DOH
• Educational Services- CHED, TESDA
• Housing- NHA
• Parental leave-employer, DOLE
Apply for Solo Parent ID (CSWD)

Assessment of Social Worker (30days)

Release of Solo Parent ID

(may avail of benefits)
PARENTAL LEAVE
- Leave enabling solo parent to
perform parental duties and
responsibilities where physical
presence is required.
MORTALITY
-death

MORBIDITY
-refers to having
a disease
WORLDWIDE MORTALITY
MORTALITY-PHILIPPINES
MORTALITY-CORDILLERA
1. Diseases of the Circulatory System
2. Diseases of the Respiratory System
3. Neoplasms
4. Injury, poisoning and certain other consequences of
external causes
5. Diseases of the Genitourinary System
6. Endocrine, Nutritional and Metabolic Diseases
7. Certain infectious and parasitic diseases
8. Diseases of the Digestive System
9. Mental and Behavioral Disorders
10. Diseases of the Nervous System
WORLDWIDE MORBIDITY
1. Ischemic heart disease, or coronary artery disease
2. Stroke
3. Lower respiratory infections.
4. Chronic obstructive pulmonary disease.
5. Trachea, bronchus, and lung cancers
6. Diabetes Mellitus
7. Alzheimer’s disease and other forms of dementia
8. Dehydration due to diarrheal diseases
9. Tuberculosis
10. Cirrhosis
MORBIDITY-PHILIPPINES
1. Acute Respiratory Infection
2. Acute Lower Respiratory Tract Infection and Pneumonia
3. Bronchitis/Bronchiolitis
4. Hypertension
5. Acute Watery Diarrhea
6. Influenza
7. Urinary Tract Infection
8. TB Respiratory
9. Injuries
10.Acute Febrile Illnesses
MORBIDITY-CORDILLERA
1. Diseases of the Respiratory System
2. Diseases of the Circulatory System
3. Injury, poisoning and other consequences of external
causes
4. Diseases of the Digestive System
5. Certain Infectious and Parasitic Diseases
6. Diseases of the Genitourinary System
7. Diseases of the Skin and Subcutaneous Tissue
8. Diseases of the Musculoskeletal System and Connective
Tissue
9. Endocrine, Nutritional and Metabolic Diseases
10.Diseases of the Ear and Mastoid Process
 DALY
(Disability-Adjusted Life Year)
- Measure of overall disease burden expressed as the
number of years lost due to ill-health, disability or
early death
FORMULA:

DALY = YLL + YLD

WHERE:
YLL = YEARS OF LIFE LOST
YLD = YEARS LOST DUE TO DISABILITY
 DALY
(Disability-Adjusted Life Year)
A. YLL = N x L
N = number of deaths
L = standard life expectancy at age of death in years

A. YLD = I x DW x L
I = number of incident cases
DW = disability weight
L = average duration of the case until remission or
death (years)
 DALY
(Disability-Adjusted Life Year)

DISABILITY WEIGHT
- weight factor that reflects the severity
of the disease on a scale from 0 (perfect
health) to 1 (equivalent to death)
CASE

a woman with a standard life expectancy of 82.5 years

and dying at age 50 would suffer 32.5 YLL. If she
additionally turned blind at aged 45, this would add 5
years spent in a disability state with a weight factor of 0.33
(?????), resulting in 0.33 x 5 = 1.65 YLD. In total, this
would amount to 34.15 DALYs.
 QALY
(Quality-Adjusted Life Year)
- A generic measure of disease burden, including both the
quality and the quantity of life lived

- Measure of the state of health of a person or group in

which the benefits, in terms of length of life, are adjusted
to reflect the quality of life.
COMPUTATIONS
1. If an individual has perfect health for a period of 1 year, they will
be said to have 1 QALY.
ie. 1 Year of Life x 1 Utility Value = 1 QALY

2. If an individual lives in perfect health but only for half a year, that
individual will have 0.5 QALY.
ie. 0.5 Years of Life x 1 Utility Value = 0.5 QALY

3. If an inidividual lives for 1 year in a situation with 0.5 utility (half

of perfect health) that individual will have 0.5 QALY
ie. 1 Year of Life x 0.5 Utility Value = 0.5 QALY
LIFE-EXPECTANCY
(PHILIPPINES)
MALE:
66.2
FEMALE:
72.6
TOTAL: 69.3
WORLDWIDE LIFE EXPECTANCY
WORLD BANK (2016)

MALE: 70 YEARS OLD

FEMALE: 74 YEARS OLD

AVERAGE LIFE EXPECTANCY:

72 YEARS OLD
References:
https://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/

https://www.nice.org.uk/glossary?letter=q

https://www.eufic.org/en/understanding-science/article/meas
uring-burden-of-disease-the-concept-of-qalys-and-dalys