NLM, LAW & ETHICS

LEADERSHIP AND MANAGEMENT

LEADERSHIP & MANAGEMENT STYLES

• Autocratic - Decisions are made with little or no staff input.
The manager doesn’t delegate responsibility.
• Laissez-faire — Little direction, structure, or support is
provided by the manager. The manager abdicates
responsibility and decision making when possible. Staff
development isn’t facilitated.
• Democratic — Staff members are encouraged to participate
in decision making when possible. Most decisions are made
by the group. Staff development is encouraged.
Responsibilities are carefully delegated and feedback is
given to staff members to encourage professional growth.
• Participative — Problems are identified by the manager and
presented to the staff with possible solutions. Staff
members are encouraged to provide input but the manager
makes the decision. Negotiation is key. The manager
encourages staff advancement.
• Situational - uses a combination of styles based on the
current circumstances and events. Situational styles are
assumed according to the needs of the group and the tasks
to be achieved.
• Bureaucratic - The leader or manager believes that
individuals are motivated by external forces. The
leader/manager relies on organizational policies and
procedures for decision making.

FUNCTIONS OF MANAGEMENT
• Planning - Determining objectives and identifying methods
that lead to achievement of objectives
• Organizing - Using resources (human and material) to
achieve predetermined outcomes
• Staffing
• Directing - Guiding and motivating others to meet expected
outcomes
• Controlling - Using performance standards as criteria for
measuring success and taking corrective action
TYPES OF POWER
• Reward: Ability to provide incentives
• Coercive: Ability to punish
• Referent: Based on attraction
• Expert: Based on having an expert knowledge base and
skill level
• Legitimate: Based on a position in society
• Personal: Derived from a high degree of self-confidence
• Informational: When one person provides explanations
why another should behave in a certain way

DELEGATION and ASSIGNMENT

• Delegation involves entrusting a task to another staff
member.
• Delegation is a process of transferring performance of a
selected nursing task in a situation to an individual who is
competent to perform that specific task.
• Only the task, not the ultimate accountability, may be
delegated to another.
• Guidelines for successful delegation:
o recognize that delegation is necessary for effective
management
o delegate whenever possible
o delegate tasks only if they’re within the scope of
practice and skill of the person assigned the tasks
o delegate tasks according to priority (client care must
always come first)
o delegate clearly and concisely and include a time
frame for completing the task
o provide support and positive feedback when possible.
• 5 rights of delegation:
o TASK
o CIRCUMSTANCES
o PERSON
o DIRECTION/COMMUNICATION
o SUPERVISION/EVALUATION
• Assignment is transferring performance of client care
activities to specific staff members.
• Guidelines for client care assignments:
 o Always ensure client safety.
o Be aware of individual variations in work abilities.
o Determine which tasks can be delegated and to whom.
o Match the task to the delegatee based on the nurse
practice act and appropriate position descriptions.
o Provide directions that are clear, concise, accurate,
and complete.
o Validate the delegatee’s understanding of the
directions.
o Communicate a feeling of confidence to the
delegatee, and provide feedback promptly after the
task is performed.
o Maintain continuity of care as much as possible when
assigning client care.

LPN/LVN and NURSING ASSISTANT

• Generally, noninvasive interventions, such as skin care,
range-of-motion exercises, ambulation, grooming, and
hygiene measures, can be assigned to a nursing assistant.
• Generally, a licensed practical nurse (LPN) or licensed
vocational nurse (LVN) can perform not only the tasks that
a nursing assistant can perform, but also certain invasive
tasks, such as dressing changes, suctioning, urinary
catheterization, and medication administration (oral,
subcutaneous, and intramuscular), according to the
education and job description of the LPN or LVN.
• A registered nurse can perform the tasks that an LPN or
LVN can perform and is responsible for assessment and
planning care, initiating teaching, and administering
medications intravenously.

QUALITY IMPROVEMENT
• focuses on processes or systems that significantly contribute
to client safety and effective client care outcomes
• Quality improvement processes or systems may be named
quality assurance, continuous quality management, or
continuous quality improvement
• Peer review is a process in which nurses employed in an
organization evaluate the quality of nursing care delivered
to the client.

CONFLICT
 • Types of conflict:
o Intrapersonal: Occurs within a person
o Interpersonal: Occurs between and among clients,
nurses, or other staff members
o Organizational: Occurs when an employee confronts
the policies and procedures of the organization
• Modes of conflict resolution
1) Avoidance - do not pursue their own needs, goals, or
concerns, and they do not assist others to pursue theirs
2) Accommodation - Accommodators neglect their own
needs, goals, or concerns (unassertive) while trying to
satisfy those of others. Accommodators obey and
serve others and often feel resentment and
disappointment because they “get nothing in return.”
3) Competition - Competitors pursue their own needs
and goals at the expense of others.
4) Compromise - Compromisers are assertive and
cooperative. Compromisers work creatively and
openly to find the solution that most fully satisfies all
important goals and concerns to be achieved.

DISCHARGE PLANNING
• Discharge planning begins when the client is admitted to the
hospital or health care facility.
• All caregivers need to be involved in discharge planning,
and referrals to other health care professionals or agencies
may be needed. A physician’s prescription may be needed
for the referral, and the referral needs to be approved by the
client’s health care insurer.
• Discharge teaching:
o How to administer prescribed medications
o Side effects of medications that need to be reported to
the physician
o Prescribed dietary and activity measures
o Complications of the medical condition that need to
be reported to the physician
o How to perform prescribed treatments
o How to use special equipment prescribed for the
client
o Schedule for home care services that are planned
o How to access available community resources
 o When to obtain follow-up care

DISASTERS AND EMERGENCY RESPONSE PLAN

• A disaster is any human-made or natural event that causes
destruction and devastation that cannot be alleviated
without assistance.
• Internal disasters - occur within a health care agency (e.g.,
health care agency fire, structural collapse, radiation spill)
• External disasters - occur outside the health care agency
(e.g., mass transit accident that could send hundreds of
victims to emergency departments)
• An emergency response plan is a formal plan of action for
coordinating the response of the health care agency staff in
the event of a disaster in the health care agency or
surrounding community.
• Phases of disaster management:
1) Mitigation
o Actions or measures that can prevent the
occurrence of a disaster or reduce the damaging
effects of a disaster
o Determination of the community hazard and
community risks (actual and potential threats)
before a disaster occurs
2) Preparedness
o Plans for rescue, evacuation, and caring for
disaster victims
o Plans for training disaster personnel and
gathering resources, equipment, and other
materials needed for dealing with the disaster
o Collection of anticipatory provisions and
creation of a location for providing food, water,
clothing, shelter, other supplies, and needed
medicine
o Practice of community emergency response
plans (mock disaster drills)
3) Response
o Putting disaster planning services into action and
the actions taken to save lives and prevent further
damage
o Primary concerns include safety, physical health,
and mental health of victims and members of the
disaster response team
 4) Recovery
o Actions taken to return to a normal situation after
the disaster
o Preventing debilitating effects and restoring
personal, economic, and environmental health
and stability to the community

LAW AND ETHICS

INFORMED CONSENT
• Your client’s right to be adequately informed about a
proposed treatment or procedure
• Responsibility for obtaining informed consent rests with the
person who will perform the treatment or procedure
(usually the physician)
• The client should be told that he has a right to refuse the
treatment or procedure without having other care or support
withdrawn and that he can withdraw consent after giving it.
• Witnessing informed consent:
o The client voluntarily consented.
o The client’s signature is authentic.
o The client appears to be competent to give consent.
• Grounds for challenging a client’s right to refuse treatment:
o The client is incompetent.
o Compelling reasons exist to overrule client’s wishes
such as:
▪ refusal endangers the life of another
▪ parent’s decision to withhold treatment threatens a
child’s life
▪ client makes statements indicating that he wants to
live
▪ when public interest outweighs the client’s right.

ADVANCE DIRECTIVE
• legal document provides information about the client’s
wishes for medical decisions in the event that the client
becomes incapacitated
• includes a living will and a durable power of attorney for
health care
• A living will specifies a client’s wishes about medical care,
 including treatment options, in the event that he becomes
incompetent or no longer able to express his wishes.
• A durable power of attorney for health care designates a
person (proxy) to make medical decisions for a client if he
becomes incompetent.

REPUBLIC ACTS
• RA 9173 - "Philippine Nursing Act of 2002"
o Qualifications for Admission to the Licensure
Examination
▪ 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
▪ good moral character
▪ 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
o Practice Through Special/Temporary Permit
▪ Licensed nurses from foreign countries/states
whose service are either for a fee or free if they
are internationally well-known specialists or
outstanding experts in any branch or specialty of
nursing
▪ Licensed nurses from foreign countries/states on
medical mission whose services shall be free in a
particular hospital, center or clinic
▪ Licensed nurses from foreign countries/states
employed by schools/colleges of nursing as
exchange professors in a branch or specialty of
nursing
o Non-registration and Non-issuance of Certificates of
Registration/Professional License or
Special/Temporary Permit
▪ convicted by final judgment of any criminal
offense involving moral turpitude
▪ any person guilty of immoral or dishonorable
conduct
▪ declared by the court to be of unsound mind
o Revocation and suspension of Certificate of
Registration/Professional License and Cancellation of
Special/Temporary Permit
 ▪ Reasons for non-registration/non-issuance
▪ unprofessional and unethical conduct
▪ gross incompetence or serious ignorance
▪ malpractice or negligence in the practice of
nursing
▪ use of fraud, deceit, or false statements in
obtaining a certificate of registration/professional
license or a temporary/special permit
▪ 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
▪ practicing his/her profession during his/her
suspension from such practice
o Suspension à not to exceed four (4) years
o Salary - minimum base pay of nurses working in the
public health institutions shall not be lower than salary
grade 15 prescribes under Republic Act No. 6758,
otherwise known as the "Compensation and
Classification Act of 1989"

• RA 10354 - “The Responsible Parenthood and

Reproductive Health Act of 2012”
o Access to Family Planning
▪ All accredited public health facilities shall provide
a full range of modern family planning methods,
which shall also include medical consultations,
supplies and necessary and reasonable procedures
for poor and marginalized couples having
infertility issues who desire to have children
▪ No person shall be denied information and access
to family planning services, whether natural or
artificial: Provided, That minors will not be
allowed access to modern methods of family
planning without written consent from their
parents or guardian/s except when the minor is
already a parent or has had a miscarriage.
o The Philippine National Drug Formulary System
and Family Planning Supplies
▪ include hormonal contraceptives, intrauterine
devices, injectables and other safe, legal, non-
abortifacient and effective family planning
 products and supplies
o PhilHealth Benefits for Serious .and Life-
Threatening Reproductive Health Conditions
▪ All serious and life-threatening reproductive
health conditions such as HIV and AIDS, breast
and reproductive tract cancers, and obstetric
complications, and menopausal and post-
menopausal-related conditions shall be given the
maximum benefits, including the provision of
Anti-Retroviral Medicines (ARVs), as provided
in the guidelines set by the Philippine Health
Insurance Corporation (PHIC)
o Age- and Development-Appropriate Reproductive
Health Education
▪ provide age- and development-appropriate
reproductive health education to adolescents
which shall be taught by adequately trained
teachers informal and nonformal educational
system and integrated in relevant subjects
o Sexual and Reproductive Health Programs for
Persons with Disabilities (PWDs)
o Prohibited Acts:
▪ Knowingly withhold information or restrict the
dissemination thereof, and/or intentionally
provide incorrect information regarding programs
and services on reproductive health including the
right to informed choice and access to a full
range of legal, medically-safe, non-abortifacient
and effective family planning methods
▪ Refuse to perform legal and medically-safe
reproductive health procedures on any person of
legal age on the ground of lack of consent or
authorization of the following persons in the
following instances:
- Spousal consent in case of married persons:
Provided, That in case of disagreement, the
decision of the one undergoing the procedure
shall prevail
- Parental consent or that of the person exercising
parental authority in the case of abused minors,
where the parent or the person exercising
parental authority is the respondent, accused or
convicted perpetrator as certified by the proper
 prosecutorial office of the court. In the case of
minors, the written consent of parents or legal
guardian or, in their absence, persons
exercising parental authority or next-of-kin
shall be required only in elective surgical
procedures and in no case shall consent be
required in emergency or serious cases
▪ Refuse to extend quality health care services and
information on account of the person’s marital
status, gender, age, religious convictions,
personal circumstances, or nature of work
• RA 9262 "Anti-Violence Against Women and Their
Children Act of 2004"
o "Battered Woman Syndrome" refers to a
scientifically defined pattern of psychological and
behavioral symptoms found in women living in
battering relationships as a result of cumulative abuse.
o Acts of Violence Against Women and Their Children
▪ physical harm
▪ Threatening to cause the woman or her child
physical harm
▪ Attempting to cause the woman or her child
physical harm
▪ Placing the woman or her child in fear of
imminent physical harm
▪ Threatening to deprive or actually depriving the
woman or her child of custody to her/his family
▪ Depriving or threatening to deprive the woman or
her children of financial support legally due her
or her family, or deliberately providing the
woman's children insufficient financial support
▪ Depriving or threatening to deprive the woman or
her child of a legal right
▪ Preventing the woman in engaging in any
legitimate profession, occupation, business or
activity or controlling the victim's own mon4ey
or properties, or solely controlling the conjugal or
common money, or properties
▪ Causing or attempting to cause the woman or her
child to engage in any sexual activity which does
not constitute rape, by force or threat of force,
physical harm, or through intimidation directed
against the woman or her child or her/his
 immediate family
▪ Stalking or following the woman or her child in
public or private places
▪ Peering in the window or lingering outside the
residence of the woman or her child
▪ Entering or remaining in the dwelling or on the
property of the woman or her child against
her/his will
▪ Destroying the property and personal belongings
or inflicting harm to animals or pets of the
woman or her child
▪ Engaging in any form of harassment or violence
▪ Causing mental or emotional anguish, public
ridicule or humiliation to the woman or her child,
including, but not limited to, repeated verbal and
emotional abuse, and denial of financial support
or custody of minor children of access to the
woman's child/children
o Violence against women and their children shall be
considered a public offense which may be prosecuted
upon the filing of a complaint by any citizen having
personal knowledge of the circumstances involving the
commission of the crime
o Healthcare Provider Response to Abuse
▪ properly document any of the victim's physical,
emotional or psychological injuries
▪ properly record any of victim's suspicions,
observations and circumstances of the examination
or visit
▪ automatically provide the victim free of charge a
medical certificate concerning the examination or
visit
▪ safeguard the records and make them available to the
victim upon request at actual cost
▪ provide the victim immediate and adequate notice of
rights and remedies provided under this Act, and
services available to them

• RA 9502 "Universally Accessible Cheaper and Quality

Medicines Act of 2008"
o List of Drugs and Medicines that are Subject to
Price Regulation
▪ All drugs and medicines indicated for treatment of
 chronic illnesses and life threatening conditions,
such as, but not limited to, endocrine disorders,
e.g., diabetes mellitus; gastrointestinal disorders,
e.g., peptic ulcer; urologic disorders, e.g., benign
prostatic hyperplasia (BPH); cardiovascular
diseases, e.g., hypertension; pulmonary diseases,
e.g., pulmonary tuberculosis (PTB), asthma;
auto-immune diseases, e.g., systemic lupus
erythematosus (SLE); skin diseases, e.g.,
psoriasis; neuro-psychiatric disorders; other
infectious diseases, e.g., human
immunodeficiency virus-acquired immune
deficiency syndrome (HIV-AIDS); and other
conditions such as organ transplants and
neoplasm
▪ Drugs and medicines indicated for prevention of
diseases, e.g., vaccines, immunoglobulin, anti-
sera
▪ Drugs and medicines indicated for prevention of
pregnancy, e.g., oral contraceptives
▪ Anesthetic agents
▪ Intravenous fluids

• RA 6675 Generics Act of 1988

o "Generic Name or Generic Terminology" is the
identification of drugs and medicines by their
scientifically and internationally recognize active
ingredients or by their official generic name as
determined by the Bureau of Food and Drugs of the
Department of Health
o "Generic Drugs" are drugs not covered by patent
protection and which are labeled solely by their
international non-proprietary or generic name
o "Brand Name" is the proprietary name given by the
manufacturer to distinguish its product from those of
competitors
o Who Shall Use Generic Terminology
▪ All government health agencies and their
personnel as well as other government agencies
▪ All medical, dental and veterinary practitioners,
including private practitioners, shall write
prescriptions using the generic name. The brand
name may be included if so desired
 ▪ Any organization or company involved in the
manufacture, importation, repacking, marketing
and/or distribution of drugs and medicines shall
indicate prominently the generic name of the
product. In the case of brand name products, the
generic name shall appear prominently and
immediately above the brand name in all product
labels as well as in advertising and other
promotional materials
▪ Drug outlets, including drugstores, hospital and
non-hospital pharmacies and non-traditional
outlets such as supermarkets and stores, shall
inform any buyer about any and all other drug
products having the same generic name, together
with their corresponding prices so that the buyer
may adequately exercise, his option

• RA 5921 “Pharmacy Law”

o Sale of medicine, pharmaceuticals, drugs and
devices
▪ No medicine, pharmaceutical, or drug, except for
those which are non-prescription or over-the-
counter, of whatever nature and kind or device
shall be compounded, dispensed, sold or resold,
or otherwise be made available to the consuming
public except through a prescription drugstore or
hospital pharmacy, duly established in
accordance with the provisions of this Act. Non-
prescription or over-the-counter drugs may be
sold in their original packages, bottles, containers
or in small quantities, not in their original
containers to the consuming public through
supermarkets, convenience stores and other retail
establishments.

• RA 9165 "Comprehensive Dangerous Drugs Act of

2002"
o Unnecessary Prescription of Dangerous Drugs
▪ prescribe any dangerous drug to any person whose
physical or physiological condition does not
require the use or in the dosage prescribed
therein, particularly those who are involved in the
care of persons with severe pain
 ▪ imprisonment ranging from twelve (12) years and
one (1) day to twenty (20) years and a fine
ranging from One hundred thousand pesos
(P100,000.00) to Five hundred thousand pesos
(P500,000.00) and the additional penalty of the
revocation of his/her license to practice shall be
imposed upon the practitioner
o Unlawful Prescription of Dangerous Drugs
▪ make or issue a prescription or any other writing
purporting to be a prescription for any dangerous
drug
▪ penalty of life imprisonment to death and a fine
ranging from Five hundred thousand pesos
(P500,000.00) to Ten million pesos
(P10,000,000.00)
o Authorized Drug Testing
▪ Applicants for driver's license
▪ Applicants for firearm's license and for permit to
carry firearms outside of residence
▪ Students of secondary and tertiary schools
▪ Officers and employees of public and private
offices – random drug testing
▪ Officers and members of the military, police and
other law enforcement agencies – annual drug
test
▪ All persons charged before the prosecutor's office
with a criminal offense having an imposable
penalty of imprisonment of not less than six (6)
years and one (1) day shall have to undergo a
mandatory drug test
▪ All candidates for public office whether appointed
or elected both in the national or local
government shall undergo a mandatory drug test

• RA 7170 "Organ Donation Act of 1991"

o Person Who May Execute A Legacy
▪ Any individual, at least eighteen (18) years of age
and of sound mind, may give by way of legacy, to
take effect after his death, all or part of his body
o Person Who May Execute a Donation
▪ Spouse
▪ Son or daughter of legal age
▪ Either parent
 ▪ Brother or sister of legal age
▪ Guardian over the person of the decedent at the
time of his death
o Persons Who May Become Legatees or Donees
▪ Any hospital, physician or surgeon - For medical
or dental education, research, advancement of
medical or dental science, therapy or
transplantation
▪ Any accredited medical or dental school, college
or university - For education, research,
advancement of medical or dental science, or
therapy
▪ Any organ bank storage facility - For medical or
dental education, research, therapy, or
transplantation
▪ Any specified individual - For therapy or
transplantation needed by him
o Manner of Executing a Legacy
▪ By will à effective upon the death of the testator
without waiting for probate of the will. If the will
is not probated, or if it is declared invalid for
testamentary purposes, the legacy, to the extent
that it was executed in good faith, is nevertheless
valid and effective.
▪ Other document à may be a card or any paper
designed to be carried on a person, must be
signed by the testator in the presence of two
witnesses who must sign the document in his
presence. Delivery of the document of legacy
during the testator's lifetime is not necessary to
make the legacy valid.
▪ To a specified legatee or without specifying a
legatee à absence of legatee at time of death,
attending MD may accept legacy as legatee
▪ MD to carry out donation may be designated or
not à no designation, any MD authorize
o Amendment or Revocation of Legacy or Donation
▪ If the will, card or other document, or an executed
copy thereof, has been delivered to a specific
legatee or donee, the testator or donor may
amend or revoke the legacy or donation either by:
- execution and delivery to the legatee or donee
 of a signed statement to that effect
- oral statement to that effect made in the
presence of two other persons and
communicated to the legatee or done
- statement to that effect during a terminal illness
or injury addressed to an attending physician
and communicated to the legatee or done
- signed card or document to that effect found on
the person or effects of the testator or donor
▪ Any will, card or other document, or an executed
copy thereof, which has not been delivered to the
legatee or donee may be revoked by the testator
or donor or by destruction, cancellation or
mutilation of the document and all executed
copies thereof

• RA 10152 “Mandatory Infants and Children Health

Immunization Act of 2011”
o Repealed PD 996
o Coverage
▪ Tuberculosis
▪ Diphtheria, tetanus and pertussis
▪ Poliomyelitis
▪ Measles
▪ Mumps
▪ Rubella or German measles
▪ Hepatitis-B
▪ H. Influenza type B (HIB)
▪ Such other types as may be determined by the
Secretary of Health in a department circular
o The mandatory basic immunization shall be given for
free at any government hospital or health center to
infants and children up to five (5) years of age
o Hep B vaccine administration for infants born outside
the healthcare facilities à give within 24 hours from
birth but not later than 7 days
Compiled by: Theresa May P. Pimentel, RN Page 2